“You don’t typically overdose and die on meth. You decay.” – Sam Quinones

Crystal meth (aka Tina, or T) addiction is a unique challenge that requires prompt, active and creative intervention strategies. There are four main reasons for this.

Crystal meth is exceptionally toxic to the brain.

Traditionally, crystal meth was made from ephedrine, an active ingredient in over-the-counter nasal decongestants. Then governments cracked down and strictly controlled access to ephedrine. Now meth is “counterfeit” and mass-produced very cheaply, using dangerous chemicals to create a compound with a similar high. Phenyl-2-propanone (P2P) is the main ingredient in all crystal meth on the street today. P2P is made from toxic commercial chemicals such as cyanide, lye, mercury, and sulfuric acid, which are also used in racing fuel and perfume.

Crystal meth addiction is unusually crippling

It is not uncommon for users to suffer severe mental health consequences, including extreme paranoia and psychosis. This makes intervention very challenging, as family members and people trying to help become part of a conspiracy in the mind of the user.

Crystal meth is readily available.

Since 2010, meth production has evolved from small, homegrown operations into “super labs” that produce hundreds of tons of P2P meth, driving prices down 90%.

Crystal meth users commonly use many other drugs.

Adderall has an effect similar to meth and is used to complement the drug. Users of crystal meth commonly use downers such as pot, high doses of benzodiazepines, GHB (aka G) to combat anxiety, and sleeping pills such as Ambien. These cocktails of uppers and downers can be a lethal mix.

Crystal Meth Effects

The damaging effects of crystal meth have greatly increased in recent years. People that we work with decline rapidly and show signs of acute distress, including losing their jobs, isolation, and paranoia. Consequences that would have taken years to develop when consuming the old crystal meth are now seen just months after initial consumption.

A deep sense of mistrust is common among crystal meth users. They believe that everyone is plotting against them whether it’s doctors, therapists, partners, parents or friends. They often claim that they are being stalked or tracked by government agencies. They are on guard and refuse any plea to seek help. If they do reach out for help their families are relieved, but with the very next hit of the drug the lucid moment disappears and they fall back into paranoia.

Crystal meth often separates users from possible support. They flood their social media pages with incoherent rants, which leave friends and family wary of contacting them. In almost all cases that we see, the relationship with the individual’s cell phone is a barometer for how bad the abuse has become. Users don’t trust their own phones, often switching numbers or phone carriers in order to avoid being traced by imaginary people. Unidentifiable sounds are attributed to government agencies, like the NSA or the FBI, that would never be investigating a single user. As psychosis seeps deeper into their lives, crystal meth seems to calm the voices in their heads. It allows them to “communicate” with whoever is out to get them. Of course, this attempt to combat the paranoia leads to increased substance use and the cycle is reinforced.

Crystal meth is currently popular in the LGBTQ community. It is a very sexually enhancing drug. Sex and crystal meth have become inextricably connected. One can’t be had without seeking the other. The high prevalence of crystal meth in the LGBTQ community makes the drug easy to obtain.

Below are 3 case studies of clients of Suntra. I present them because they illustrate common situations that we encounter. The names have been changed.

3 Crystal Meth Case Studies in the LGBTQ community


Kal was a handsome guy who made a living as personal trainer to the rich and famous. As he entered his mid-thirties his career was stagnating and his body was sore. He had to wake up at 4:30 to meet a 5:00 AM client, but Kal was focused on attending all the hottest events. Once he began using meth, Kal felt like he had found the answer. He had unlimited energy. He could be up early and work hard with clients while staying up late and attending parties. Crystal meth allowed him to do it all.

Kal began to create distance between himself and his loved ones, limiting his interactions with them or avoiding them altogether. This led to the dissolution of many relationships. As he continued to use he gained new friends that were users or dealers themselves, a reflection of his new lifestyle.

Kal sought out sexual partners that he could use with, often staying up for days in hotel rooms with a rotating cast of people. Kal was living two lives, training celebrities by day and hanging out with dangerous characters by night.

When it was suggested that he attend treatment Kal was adamant that he wanted to continue to use “a little bit longer.” Sadly, he passed away in his apartment. Although using crystal meth didn’t cause his death, his addiction put him in a situation that proved fatal.


I hired Kent as a receptionist during the early stages of his recovery journey. Kent had a bright smile and a warm personality. He exuded a positive energy that attracted everyone to him, employees and customers alike.

Knowing that I was sober, Kent looked to me for advice. About two years into his employment, he began to miss work consistently. He wouldn’t call in sick, we just wouldn’t hear from him for a few days. When he did show up, his eyes were dull and surrounded by dark circles. He had an uncharacteristic short temper and was distracted. He acted like he was doing me a favor by coming to work.

Kent used Grindr, a hook-up app that is commonly used by gay men to meet, to have them bring crystal meth to his apartment. Drug use is widespread on Grindr. Finding hook-ups that want to “PNP.” Party and play is easy.

To keep up with the men on Grindr, Kent used steroids to build a more attractive body. I watched as Kent aged right before my eyes with steroids bulking him up and lack of sleep aging his face.

As his employer I offered Kent many chances for recovery. I would have been happy to send him to rehab or bring him with me to 12-step meetings. Kent passed away while on a bender, overdosing on crystal meth and GHB.

Kent will always haunt me. To this day, I wish that I had done more. Did I enable him? Could I have said something different? Should I have offered to send him to a different treatment facility? I will never know. I wish that I had moved fast and more aggressively. As his employer I wish I had called his parents and let them know he was in trouble.


In New York’s gay community, Andy’s story is a common one. A man in his mid-to-late-thirties going through a second youth phase. Often men like Andy are just out of a significant long-term relationship. They start going to parties, dating younger men, and using drugs like crystal meth with new sexual partners. They begin abandoning their responsibilities and start to underperform at work, or miss work so frequently that they get fired. Being mid-career, they are often discharged with a severance package that gives them months of money to burn before they have a hard landing. Without the routine that work gave them their substance use increases, and their downward spiral accelerates.

Andy consumed many different drugs including marijuana, GHB, steroids, Xanax and crystal meth. After a year of consistent use he began to show signs of psychosis and paranoia, missing work numerous times.

We tried to convince Andy to enter treatment many times but he was impossible to engage with. His psychosis was so intense that he would not interact with anyone who tried to help him. Andy thought we were all part of a conspiracy against him, which he could only “figure out” when he was high. He believed crystal meth was helping him to ward off the entities that were plotting against him.

Many of us went to Andy’s apartment to check on him. We also started to call the police for wellness checks to ensure his safety. On one of those checks EMS found that he had overdosed. Thankfully the paramedics arrived just in time and were able to revive him. Had we not called for the wellness check he would not have survived. Andy was stabilized in a locked psychiatric ward. After 10 days he was mentally well enough to recognize that he needed a longer treatment program.

Andy stayed in a nine-month residential program. He was able to get the help he needed.

Crystal meth interventions – what works?

Users of crystal meth are rarely willing or in a clear enough mental state to accept help. In the past we were able to wait until after someone had gone on a bender, then intervene during the awful hangovers that followed. Intervening seemed most effective in the window after last use, a time when they were feeling sick and were more receptive to treatment.

Now we are often racing to attempt to save someone from irreversible or even catastrophic outcomes. We do not have the luxury of waiting for the best moment to intervene. To prevent a descent into a critical mental state, we must intervene early and aggressively.

Intervention when someone is experiencing a psychotic episode can be dangerous for the people who are offering help. It may take several people and many attempts to persuade the user to accept treatment. If they’ve become too ill to agree, they may need to be hospitalized against their will as they are a danger to themselves and to others around them. In a psychiatric facility, they can be stabilized before they are admitted into a drug rehabilitation center.

Our intervention needs to be immediate, well-planned, and properly executed. This includes:

A 30-day inpatient treatment program is only the beginning of recovery from crystal meth addiction. If, after just 30 days of treatment, the person returns to the same home, social circle, or emotional environment after they’re released, we can almost guarantee that they will relapse.

  • Strong and consistent family involvement
  • Careful consideration of the safety of everyone involved.
  • A one step at a time approach, aiming to first stabilize the individual of concern.
  • Continuing education and support for the family, who must understand the long-term nature of recovery.
  • Professional support for the long-term recovery plan.

Plans need to be in place for a long-term, supervised recovery program. A successful treatment program should include 2-3 months of inpatient treatment, sober living in a safe environment for 2-3 more months, and frequent attendance at support groups.

We are grateful to Sam Quinones, whose article October 18, 2021, in The Atlantic titled ‘I Don’t Know That I Would Even Call It Meth Anymore’ helped us understand current developments in the use of crystal meth.


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