Dr. Frank Spinelli: Cruise Control
COMMENTARY: Imagine for a moment that you’re a doctor — a gay doctor with a practice that predominantly treats gay men. Now guess how many text and phone calls you might receive during any given weekend involving questions that have to do with recreational drugs, penile discharge, or the risk of contracting HIV from unprotected sexual encounters. Now take that number and multiply it by 10 if that weekend should occur around Gay Pride, Folsom Street Fair, Gay Days at Disney, or any one of the Atlantis cruises. Welcome to my world.
At this point, you might be thinking, What did you expect when you decided to treat gay men? I knew what I was signing up for. The life of a gay party boy is not foreign to me. I’ve been to Folsom, Gay Days at Disney, and several Atlantis cruises. But even I struggle to understand the brain of a gay man, especially of those who make the regular 3 a.m. Sunday calls to me seeking advice, reassurance, or quick pharmaceutical relief.
Over the years I have monitored and treated gay men with curiosity. I’ve concluded that some of the most telling insights into the gay mind come from watching my own (presumably) heterosexual nephews. At age 15 and 16, they don’t always listen to their parents, they’re eager to push the limits set by their teachers, and when confronted about their risk-taking behavior, they invariably roll their eyes to show their disinterest in having a rational conversation. That’s because teenagers, like gay men, are a conundrum, baffling to scientists and doctors.
I’m not alone. My colleagues in Manhattan and Los Angeles give similar reports about their patients. We scratch our heads and wonder why the rates for syphilis are at an all-time high among men who have sex with men. And with all the media attention paid to HIV prevention and risk modification, the majority of new HIV cases in the United States are among gay men.
ecstasy pills, nearly three grams of methamphetamine, a small quantity
of ketamine, and about $51,000 in cash. While waiting for the suspect in
his cabin, two more passengers stopped by seeking drugs, according to
When I read the article online and spoke to passengers upon their
return, I felt angry. In a time when gay men and women want to be taken
seriously so that we can serve openly in the military and have the legal
right to marry, isn’t counterproductive to read about the drug busts
and overdoses on a floating circuit party? Or maybe we just want it
all — the rights we deserve and the option to choose which, if any, fit
into our particular circumstances and plans.
The normal reward system in the brain serves a vital evolutionary
purpose. As this center matures it helps us deal with the terrifying
realities that face us in the modern world. This world also includes
access to illegal drugs and risky sex. If these signals continue to
trigger the reward system, they may lead to anxiety, depression and
addiction. On the other hand, the cognitive control network is the part
of the brain that acts like our moral conscience. In teenagers, the
reward-system network matures rapidly due to the rush of hormones. These
hormones do not speed up the cognitive control network. In fact,
cognitive control matures slowly. So then why doesn’t an adult gay man
have the cognitive control to chaperon their risk-taking behavior? One
explanation is that most gay men do not feel the same pressures of
responsibility as most heterosexual men. Gay men who enjoy circuit
events are more likely to be single. If they are in a relationship, the
couple often negotiates rules that include three-ways or sexual
encounters outside their relationship. More often these men do not have
children. This freedom supports exploratory behavior to indulge in sex
and drugs. For most teenagers, gaining control of the reward-system
center comes with maturity, especially as their cognitive center
develops. Unfortunately for some gay men, the strong impulses of the
reward-system center often outweigh the associated risks that face the
average partygoing male.
If 5,400 people, mostly gay men, go on an Atlantis cruise, what
percentage will succumb to the impulses of the reward system by using
recreational drugs, drinking alcohol, and engaging in unsafe sex? Now
take that number and multiply it by 10. Despite the arrest, Atlantis
announced that it will repeat the trip in 2012. I hope it’s over a
weekend when I’m not on call.