Why I Ask About Drug Use in Your First Session: A Message for Gay Men

Whether or not you use drugs regularly, occasionally, or only in certain social or sexual contexts, I ask every client about substance use in the very first session. For many gay men, this question can feel loaded. Some worry I’m judging their choices, making assumptions, or trying to steer the conversation somewhere uncomfortable. But the reason I ask is simple: it’s clinically important.

In our community, drugs can show up in lots of different ways - at parties, during sex, to ease social anxiety, to feel more confident, or to switch off from stress. None of this automatically means there’s a “problem.” But substances can have real effects on mood, sleep, anxiety, motivation, libido, and emotional regulation. If you’re coming to therapy because you’re feeling flat, overwhelmed, disconnected, or anxious, understanding your relationship with drugs helps me understand the full picture.

This isn’t about blame. It’s about clarity.

If certain symptoms are being amplified or perpetuated by substance use, that gives us a lever we can pull together. It might explain why you’re stuck in a cycle you can’t quite break. It might highlight patterns that make your mental health harder to manage. And sometimes, simply talking openly about drug use, without shame, without judgement, is the first time someone feels genuinely understood.

My role isn’t to police your decisions. It’s to understand them, so I can support you in a way that’s honest, grounded, and helpful.