Abstract
Drawing on 24 interviews conducted with gay, bisexual, queer and other men who have sex with men (GBM) living in Toronto, Canada, we examined how they are making sense of the relationship between their mental health and substance use. We draw from the literature on the biopolitics of substance use to document how GBM self-regulate and use alcohol and other drugs (AODC) as technologies of the self. Despite cultural understandings of substance use as integral to GBM communities and subjectivity, GBM can be ambivalent about their AODC. Participants discussed taking substances positively as a therapeutic mental health aid and negatively as being corrosive to their mental wellbeing. A fine line was communicated between substance use being self-productive or self-destructive. Some discussed having made ‘problematic’ or ‘unhealthy’ drug-taking decisions, while others presented themselves as self-controlled, responsible neoliberal actors doing ‘what a normal gay man would do’. This ambivalence is related to the polarizing binary community and scientific discourses on substances (i.e. addiction/healthy use, irrational/rational, uncontrolled/controlled). Our findings add to the critical drug literature by demonstrating how reifying and/or dismantling the coherency of such substance use binaries can serve as a biopolitical site for some GBM to construct their identities and demonstrate healthy, ‘responsible’ subjectivity.
Highlights
Determining what constitutes ‘problematic’ alcohol and other drug consumption (AODC) can be a contentious affair
In Toronto, Canada, HIV activists recently engaged in heated debates on crystal methamphetamine use among gay, bisexual, queer and other men who have sex with men (GBM)
Some argued that the uptake of crystal methamphetamine is dangerous and requires a firm prevention approach, while others averred that healthier patterns of methamphetamine use are possible and that the denial of this reality perpetuates stigma which harms GBM (Valelly et al, 2019)
Summary
Determining what constitutes ‘problematic’ alcohol and other drug consumption (AODC) can be a contentious affair. While the topic of crystal methamphetamine has elicited heightened emotional responses globally (Bryant et al, 2018), the polemical nature of these debates is indicative of a greater problematic within the GBM health sector: how to effectively address some of the noted health concerns related to AODC while avoiding a reification of stigmatizing belief systems Exploring this tension, from the point of view of GBM managing mental distress in their everyday lives, is the aim of the following analysis. In the public health and biomedical literatures, AODC is often considered to be a factor exacerbating health disparities among GBM, and notably correlated to worse mental health This scholarship posits that GBM report higher levels of AODC, substance use disorders and worse mental health outcomes (i.e. anxiety, depression, suicidality) than their heterosexual counterparts (Brennan et al, 2010; Kelly et al, 2015; Lachowsky et al, 2017). HIV stigma is thought to increase substance taking, leading to poorer HIV treatment adherence and worse mental health outcomes among GBM living with HIV (Edelman et al, 2016)
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