Article Data

  • Views 368
  • Dowloads 150

Original Research

Open Access

Substance-specific readiness to change among sexual and gender minority men who use crystal methamphetamine

  • Kiffer G. Card1,2,*,
  • Madison McGuire3
  • Jordan Bond-Gorr4
  • Tribesty Nguyen5
  • Gordon A. Wells2
  • Karyn Fulcher2
  • Graham Berlin6
  • Nathan J. Lachowsky2

1Faculty of Health Sciences, Simon Fraser University, Burnaby BC V5A 1S6, Canada

2School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada

3Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada

4Gay Men’s Sexual Health Alliance, Toronto, ON M4Y 2W5, Canada

5Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada

6Department of Psychology, Ryerson University, Toronto, ON M5B 1Y2, Canada

DOI: 10.22514/jomh.2022.005 Vol.18,Issue 12,December 2022 pp.3-11

Submitted: 01 June 2022 Accepted: 01 November 2022

Published: 30 December 2022

*Corresponding Author(s): Kiffer G. Card E-mail:


A patient-oriented approach to addressing high levels of polysubstance use among sexual and gender minority men (SGM) who use crystal methamphetamine (CM) requires an understanding of which drugs they would like to change their use of. We examined readiness to change for 24 separate substances. Participants were SGM, aged 18+, living with Canada, who used CM in the past six months that were recruited through advertisements on socio-sexual networking applications. Frequency of use and readiness to change were descriptively analyzed and associations between frequency of use and readiness to change were assessed. Only slightly more than half (53.1%) of CM-using SGM were ready now, soon, or in the future to change substance use. Participants were most ready to change their tobacco, methamphetamine, and barbiturate use. Greater frequency of use was associated with greater readiness to change for all drugs in which daily or almost daily use was common. SGM participants reported high levels of comfort being asked about their substance use from primary care, mental health, and queer-identified health professionals. Interventions addressing multiple and specific substances are needed in health care settings serving SGM who use CM. Screening, brief interventions, and referral to treatment (SBIRT) in these settings may help identify those ready to address their substance use. Harm reduction interventions should offer supports for those not wanting to change their substance use—which includes most SGM for most of the drugs they use.


Substance use; Sexual minorities; Frequency of use; Problem recognition; Readiness; Crystal methamphetamine

Cite and Share

Kiffer G. Card,Madison McGuire,Jordan Bond-Gorr,Tribesty Nguyen,Gordon A. Wells,Karyn Fulcher,Graham Berlin,Nathan J. Lachowsky. Substance-specific readiness to change among sexual and gender minority men who use crystal methamphetamine. Journal of Men's Health. 2022. 18(12);3-11.


[1] Demant D, Hides L, Kavanagh DJ, White KM, Winstock AR, Ferris J. Differences in substance use between sexual orientations in a multi-country sample: findings from the Global Drug Survey 2015. Journal of Public Health. 2017; 39: 532–541.

[2] Ross M, Mattison A, Franklin Jr D. Club drugs and sex on drugs are associated with different motivations for gay circuit party attendance in men. Substance Use & Misuse. 2003; 38: 1173–1183.

[3] Souleymanov R, Brennan DJ, Logie C, Allman D, Craig SL, Halkitis PN. Pleasure and HIV biomedical discourse: the structuring of sexual and drug-related risks for gay and bisexual men who Party-n-Play. International Journal of Drug Policy. 2019; 74: 181–190.

[4] Marshall BDL, Werb D. Health outcomes associated with metham-phetamine use among young people: a systematic review. Addict Abingdon. 2010; 105: 991–1002.

[5] Grov C, Westmoreland D, Morrison C, Carrico AW, Nash D. The crisis we are not talking about: one-in-three annual HIV seroconversions among sexual and gender minorities were persistent methamphetamine users. Journal of Acquired Immune Deficiency Syndromes. 2020; 85: 272–279.

[6] Rajasingham R, Mimiaga MJ, White JM, Pinkston MM, Baden RP, Mitty JA. A systematic review of behavioral and treatment outcome studies among HIV-infected men who have sex with men who abuse crystal methamphetamine. AIDS Patient Care and STDs. 2012; 26: 36–52.

[7] Card KG, Armstrong HL, Carter A, Cui Z, Wang L, Zhu J, et al. A latent class analysis of substance use and culture among gay, bisexual, and other men who have sex with men. Culture, Health & Sexuality. 2018; 20: 1424–1439.

[8] Card KG, Armstrong HL, Carter A, Cui Z, Wang L, Zhu J, et al. Assessing the longitudinal stability of latent classes of substance use among gay, bisexual, and other men who have sex with men. Drug and Alcohol Dependence. 2018; 188: 348–355.

[9] Card KG, Fournier AB, Sorge JT, Morgan J, Grace D, Ham D, et al. Substance use patterns and awareness of biomedical HIV prevention strategies among sexual and gender minority men in Canada. AIDS Care. 2020; 32: 1506–1514.

[10] Cheng B, Sang JM, Cui Z, Bacani N, Armstrong HL, Zhu J, et al. Factors associated with cessation or reduction of methamphetamine use among gay, bisexual, and other men who have sex with men (gbMSM) in vancouver Canada. Substance Use and Misuse. 2020; 55: 1692–1701.

[11] John WS, Zhu H, Mannelli P, Schwartz RP, Subramaniam GA, Wu L. Prevalence, patterns, and correlates of multiple substance use disorders among adult primary care patients. Drug and Alcohol Dependence. 2018; 187: 79–87.

[12] Bovasso G, Cacciola J. The Long-Term Outcomes Of Drug Use By Methadone Maintenance Patients. The Journal of Behavioral Health Services and Research. 2003; 30: 290–303.

[13] A. Demaria Jr., Robert Sterling, St P. The effect of stimulant and sedative use on treatment outcome of patients admitted to methadone maintenance treatment. American Journal on Addictions. 2000; 9: 145–153.

[14] John D, Kwiatkowski CF, Booth RE. Differences among out-of-treatment drug injectors who use stimulants only, opiates only or both: implications for treatment entry. Drug and Alcohol Dependence. 2001; 64: 165–172.

[15] Medina KL, Shear PK. Anxiety, depression, and behavioral symptoms of executive dysfunction in ecstasy users: contributions of polydrug use. Drug and Alcohol Dependence. 2007; 87: 303–311.

[16] Wang L, Min JE, Krebs E, Evans E, Huang D, Liu L, et al. Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users. International Journal of Drug Policy. 2017; 49: 32–40.

[17] Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Substance Abuse and Mental Health Services Administration (US). 2005.

[18] Rounsaville B, Petry NM, Carroll KM. Single versus multiple drug focus in substance abuse clinical trials research. Drug and Alcohol Dependence. 2003; 70: 117–125.

[19] Abiola T, Udofia O, Sheikh TL, Sanni K. Assessing change readiness and treatment eagerness among psychoactive substance users in Northern Nigeria. Journal of Substance Abuse Treatment. 2015; 58: 72–77.

[20] Myers B, van der Westhuizen C, Naledi T, Stein DJ, Sorsdahl K. Readiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending South African emergency departments. BMC Psychiatry. 2016; 16: 35.

[21] Sloas LB, Caudy MS, Taxman FS. Is treatment readiness associated with substance use treatment engagement? An exploratory study. Journal of Drug Education. 2017; 47: 51–67.

[22] Becan JE, Knight DK, Crawley RD, Joe GW, Flynn PM. Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change. Journal of Substance Abuse Treatment. 2015; 50: 38–49.

[23] DiClemente CC, Schlundt D, Gemmell L. Readiness and stages of change in addiction treatment. American Journal on Addictions. 2004; 13: 103–119.

[24] Nwakeze PC, Magura S, Rosenblum A. Drug problem recognition, desire for help, and treatment readiness in a soup kitchen population. Substance Use and Misuse. 2002; 37: 291–312.

[25] Saltman DC, Newman CE, Mao L, Kippax SC, Kidd MR. Experiences in managing problematic crystal methamphetamine use and associated depression in gay men and HIV positive men: in-depth interviews with general practitioners in Sydney, Australia. BMC Family Practice. 2008; 9: 45.

[26] Rosen CS. Is the sequencing of change processes by stage consistent across health problems? A meta-analysis. Health Psychology. 2000; 19: 593–604.

[27] Sutton S. Back to the drawing board? A review of applications of the transtheoretical model to substance use. Addiction. 2001; 96: 175–186.

[28] Krebs P, Norcross JC, Nicholson JM, Prochaska JO. Stages of change and psychotherapy outcomes: a review and meta-analysis. Journal of Clinical Psychology. 2018; 74: 1964–1979.

[29] Migneault JP, Adams TB, Read JP. Application of the Transtheoretical Model to substance abuse: historical development and future directions. Drug and Alcohol Review. 2005; 24: 437–448.

[30] CCSA. Informing responses to harms related to methamphetamine use with lessons from public health crises. Canadian Centre on Substance Use and Addiction. Canada: Canadian Centre on Substance Use and Addiction. 2020.

[31] Papamihali K, Collins D, Karamouzian M, Purssell R, Graham B, Buxton J. Crystal methamphetamine use in British Columbia, Canada: a cross-sectional study of people who access harm reduction services. PLoS ONE. 2021; 16: e0252090.

[32] Treloar C, Hopwood M, Drysdale K, Lea T, Holt M, Dowsett GW, et al. Stigma as understood by key informants: a social ecological approach to gay and bisexual men’s use of crystal methamphetamine for sex. International Journal of Drug Policy. 2021; 94: 103229.

[33] Knight R. Investments in implementation science are needed to address the harms associated with the sexualized use of substances among gay, bisexual and other men who have sex with men. Journal of the International AIDS Society. 2018; 21: e25141.

[34] Fulcher K, Berlin G, Taylor K, Wells A, Nguyen T, Hull M, et al. Understanding the service needs and preferences of men who have sex with men who use crystal methamphetamine in British Columbia, Canada: a qualitative study. International Journal of Mental Health and Addiction. 2022. (online ahead of print)

[35] Sex Now Survey. Community-Based Res Cent. 2022. Available at: (Accessed: 31 May 2022).

[36] McGuire M, Card KG, Lachowsky NJ. The Crystal Methamphetamine Project: Understanding the need for culturally-safe supports and services addressing crystal methamphetamine use among gay, bi, and queer men (both cis and trans). Community-Based Research Centre. 2020.

[37] RStudio Team. RStudio: integrated development for R. Boston, MA: RStudio, Inc. 2019.

[38] Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005; 19: S67–S72.

[39] Cochran SD, Grella CE, Mays VM. Do substance use norms and perceived drug availability mediate sexual orientation differences in patterns of substance use? Results from the California Quality of Life Survey II. Journal of Studies on Alcohol and Drugs. 2012; 73: 675–685.

[40] Caulkins JP, Reuter P, Coulson C. Basing drug scheduling decisions on scientific ranking of harmfulness: false promise from false premises. Addiction. 2011; 106: 1886–1890.

[41] Dubljević V. Toward an improved multi-criteria drug harm assessment process and evidence-based drug policies. Frontiers in Pharmacology. 2018; 9: 898.

[42] van Amsterdam J, Opperhuizen A, Koeter M, van den Brink W. Ranking the harm of alcohol, tobacco and illicit drugs for the individual and the population. European Addiction Research. 2010; 16: 202–207.

[43] O’Gorman A, Schatz E. Civil society involvement in harm reduction drug policy: reflections on the past, expectations for the future. Harm Reduction Journal. 2021; 18: 17.

[44] Duvall JL, Oser CB, Leukefeld CG. Readiness to change as a predictor of drug-related behaviors in a sample of rural felony probationers. The American Journal of Drug and Alcohol Abuse. 2008; 34: 741–748.

[45] Knight R, Karamouzian M, Carson A, Edward J, Carrieri P, Shoveller J, et al. Interventions to address substance use and sexual risk among gay, bisexual and other men who have sex with men who use methamphetamine: a systematic review. Drug and Alcohol Dependence. 2019; 194: 410–429.

[46] Lau N, Sales P, Averill S, Murphy F, Sato SO, Murphy S. A safer alternative: cannabis substitution as harm reduction. Drug and Alcohol Review. 2015; 34: 654–659.

[47] Schütz C. High dose stimulant substitution for the treatment of cocaine and crystal meth use disorders. Journal of Addiction Research & Therapy. 2015; 6: e131.

[48] Appropriate Use of Drug Testing in Clinical Addiction Medicine. Journal of Addiction Medicine. 2017; 11: 1–56.

[49] Iguchi MY, Belding MA, Morral AR, Lamb RJ, Husband SD. Reinforcing operants other than abstinence in drug abuse treatment: an effective alternative for reducing drug use. Journal of Consulting and Clinical Psychology. 1997; 65: 421–428.

[50] Incze MA. Reassessing the role of routine urine drug screening in opioid use disorder treatment. JAMA Internal Medicine. 2021; 181: 1282–1283.

[51] Babor TF, Del Boca F, Bray JW. Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice. Addiction. 2017; 112: 110–117.

[52] Barbosa C, Cowell A, Dowd W, Landwehr J, Aldridge A, Bray J. The cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States. Addiction. 2017; 112: 73–81.

[53] Dentato MP, Ortiz R, Orwat J, Kelly BL, Gates TG, Propper E. Peer-based education and use of the SBIRT model in unique settings with transgender young adults. Journal of Social Work Practice in the Addictions. 2019; 19: 139–157.

[54] McNeely J, Kumar PC, Rieckmann T, Sedlander E, Farkas S, Chollak C, et al. Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff. Addiction Science and Clinical Practice. 2018; 13: 8.

[55] Ellenberg L. SBIRT with LGBT patients: identifying and addressing unhealthy substance use in primary care settings . 2015. Available at: (Accessed: 15 October 2020).

[56] King DB, O’Rourke N, DeLongis A. Social media recruitment and online data collection: a beginner’s guide and best practices for accessing low-prevalence and hard-to-reach populations. Canadian Psychology/Psychologie Canadienne. 2014; 55: 240–249.

[57] Salway TJ, Morgan J, Ferlatte O, Hawkins B, Lachowsky NJ, Gilbert M. A systematic review of characteristics of nonprobability community venue samples of sexual minority individuals and associated methods for assessing selection bias. LGBT Health. 2019; 6: 205–215.

[58] Tomkins A, George R, Kliner M. Sexualised drug taking among men who have sex with men: a systematic review. Perspectives in Public Health. 2019; 139: 23–33.

[59] Edmundson C, Heinsbroek E, Glass R, Hope V, Mohammed H, White M, et al. Sexualised drug use in the United Kingdom (UK): a review of the literature. International Journal of Drug Policy. 2018; 55: 131–148.

[60] Brennan DJ, Card KG, Collict D, Jollimore J, Lachowsky NJ. How might social distancing impact gay, bisexual, queer, trans and two-spirit men in Canada? AIDS and Behavior. 2020; 24: 2480–2482.

[61] Halkitis PN, Wolitski RJ, Millett GA. A holistic approach to addressing HIV infection disparities in gay, bisexual, and other men who have sex with men. The American Psychologist. 2013; 68: 261–273.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Directory of Open Access Journals (DOAJ) DOAJ is a unique and extensive index of diverse open access journals from around the world, driven by a growing community, committed to ensuring quality content is freely available online for everyone.

SCImago The SCImago Journal & Country Rank is a publicly available portal that includes the journals and country scientific indicators developed from the information contained in the Scopus® database (Elsevier B.V.)

Publication Forum - JUFO (Federation of Finnish Learned Societies) Publication Forum is a classification of publication channels created by the Finnish scientific community to support the quality assessment of academic research.

Scopus CiteScore 0.7 (2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Norwegian Register for Scientific Journals, Series and Publishers Search for publication channels (journals, series and publishers) in the Norwegian Register for Scientific Journals, Series and Publishers to see if they are considered as scientific. (

Submission Turnaround Time