When my partners and I opened ProMD Health, an aesthetic medicine clinic in City Center, I anticipated my “glow up” would include less wrinkles, more volume, and smoother, healthier skin. What I did not expect was to lose 37 lbs. in just five months. Offering injectables such as botox, sculptra, and filler, along with IV therapy, body contouring, and various spa treatments — I was eager to try all of our treatments except one: Semaglutide. I too was one who believed the things I heard, from upset stomach to hollowness in the face. It wasn’t until I was left without a choice that I embarked on the journey. 

What is semaglutide?

Semaglutide, a GLP-1 known as the brand name Ozempic, has become a global phenomenon that can help individuals lose up to 10 pounds a month with consistent diet and exercise. It works by sending signals to our hypothalamus (the part of the brain that controls hunger and sex drive) to be satiated with less food, regulating our cravings and urges. The drug is currently being studied for addiction therapy as patients with existing substance abuse have also noticed a reduction in their inclinations. 

Why I joined the celebrity craze

In January 2023, I had learned from my primary physician that I was pre-diabetic, with a BMI of 30, and had alarming triglyceride, cholesterol, and blood pressure levels. At only 33 years old, I felt defeated. On one end, I was a young entrepreneur celebrating the opening of a new business, where on the other, we were discussing medication to help me lower my blood pressure and analyzing my diet (which consisted mostly of nachos, red wine, and chocolate ice cream.) The stress of life was consuming me, where each time I craved something unhealthy — I rationalized that it was deserved for all the many things I was doing.

My mental and physical health was in a bad place, where the more I’d work out — the hungrier I would get, where ice cream was my reward for stepping on the treadmill. Due to my inability to regulate my cravings and intake, I decided to finally start semaglutide, as a change was needed to happen or illness diagnosis would follow. 

The journey

The first week was horrendous. I was puking endlessly. I had completely ignored our provider’s advice, continuing to eat what I normally did which semaglutide rejected. I realized then that me eating in the way I did was not only based on hunger, it was emotional. Food was my boyfriend, my comfort, and gift to myself. The puking was like a self-induced hazing process, because after that — I no longer craved foods that were not compatible with the drug. Essentially — fatty foods, highly processed meals, and foods high in sugar will leave you sick. 

The nausea and sickness went away after a week (probably would have never come had I made the diet change on day one) and I started to have to force myself to eat as the hunger signals I relied on were no longer there. After eating half of what I would normally consume, I would feel satiated and full. 

As my body got used to the drug, we would go up in dose — where I started to have to force myself to eat. The well balanced diet of protein, vegetables, and carbs gave me the nutrients needed to sustain my day of meetings and post-work gym sessions. 

In just one month, my clothes are slipping off and my face had became noticeably slimmer. I started receiving levels of attention I hadn’t since my early 20s, and my confidence and belief in myself skyrocketed. 

Getting to my goal weight month four, we decided to lower the dosage and taper off while incorporating more whole foods in my diet to supplement my workouts. With the weight off, my current focus is muscle growth. 

With social media misinforming viewers on a daily basis — I have put together a list of myths, do’s, and don’ts from my experience.

Myths:

– Ozempic Face: The drug does not make your face cave in. When folks lose a lot of weight in a short period of time (with or without GLP-1), they will experience volume loss. One of the few aesthetic benefits of being overweight is fullness in the face, where our wrinkles and signs of aging are less noticeable. Eating too much sugar and having a high fat intake can also cause acne — so it is a double edged sword. Our providers usually recommend slowly increasing the dosage where treatments such as mid-face filler can address new concerns around visible aging. 

– You will need to be on it forever. 

– Your GI will be ruined. 

Do’s:

– Take a probiotic daily.

– Drink a lot of water to help with your digestion and to flush your system. 

– Take an anti-nausea prescription, nauzene, or fresh ginger in the first two weeks.

– Make sure you are eating a well-balanced diet of protein, carbs, and vegetables. Even if you have to force yourself to eat it — without the nutrients, you will have no energy for the gym and could experience hair loss or malnutrition symptoms.

– Eat fruit: Although the cravings will decrease, if a sweet tooth has its requests — eat fresh fruit. It is somehow way more refreshing and satisfying while on semaglutide and will aid in digestion. 

Don’ts: 

– Get semaglutide from an inexpensive online retailer — the price you pay will match the dosage and quality of product.

– Eat foods high in sugar. You will pay for it. 

– Eat oily foods. 

– Binge drink.

– Be inconsistent.

– Stop abruptly. It takes time but worth the journey! 

“Ladies and Gentlemen, please stand for the Pledge of Allegiance.” I clearly remember this call from a pulpit decades ago because it seemed so odd to hear such a thing in church. Rev. D. James Kennedy, a ballroom dancing instructor in the 1950s who became senior pastor of Coral Ridge Ministries in Fort Lauderdale, Fla., grandly announced: “The Pledge of Allegiance to the Bible!”  

Down from the rafters, hanging on wires above the pulpit descended a huge Bible seemingly ablaze. Accompanied by old time miracle-riffs on an organ, Kennedy’s congregants stood with hand over heart to recite a chilling pledge of allegiance to The Word: “I pledge allegiance to the Bible….”.  I went to Coral Ridge to see for myself how Kennedy preached about “the infamous men of Sodom who have moved into our churches.” I was one of those men.  In the 1980s, when visiting my hometown Dallas, I attended what is still considered the largest LGBTQ church in the world, the Cathedral of Hope. I had helped this church raise money for a chapel to be designed by gay architect Philip Johnson (1906-2005). I had not experienced Christian Nationalists warning about the “men of Sodom moving into our churches” until I saw that giant hanging Bible in Fort Lauderdale.

A pledge of allegiance to a flying Bible seems quaint compared to today’s Christian Nationalist movement, now a pillar of the new Trump presidency, which evangelical leaders liken to a “Red Sea moment in America.” One leader recently compared Donald Trump to Moses parting the Red Sea allowing his people safe passage into a new Promised Land. Amanda Tyler, the lead organizer of  the Christians Against Christian Nationalism Campaign of the Baptist Joint Committee for Religious Liberty in Washington, D.C., warns in her new book the U.S. is now at “a high tide of Christian Nationalism.”  

Tyler, a devout Baptist from Austin, is direct about the threat Christian Nationalism poses to religious freedom in the U.S. “Christian Nationalism is a political ideology that seeks to fuse American and religious identities….into one set of political beliefs…..It is pernicious and insidious,”  she explains in her book, “How to End Christian Nationalism.” Besides being written by a Christian from Texas who asks hard questions, what makes this “how to” book such a good read is Tyler’s rejection of the despondency of the moment. She has no time for that. “We all have a role to play in ending Christian Nationalism,” she explains, by organizing in our communities, churches and with our legislative allies nationwide. This, she emphasizes, includes all who are impacted by Christian nationalism in unequal ways including “people of color, people who are not Christian, LGBTQIA+ people and people who belong to more than one of those identity groups.”

Tyler lays it out: Christian Nationalism exists in a multiverse beyond the old-school haters we once knew and loved. How can one forget “God Hates Fags” Rev. Fred Phelps of the Westboro Baptist Church? When my friend the conservative Republican Sen. Alan Simpson of Wyoming said he favored same-sex marriage, Phelps called him a “Senile Old Fag Lover” (2003). Today, Tyler writes, Christian Nationalists have smoothed those rough edges “using Christianity as a prop to achieving power” in their drive toward an authoritarian theocracy. She explains with cool precision how they evolved into a “well-funded and highly organized political” movement that “points not to Jesus of Nazareth but to the nation….as the object of allegiance.”

A Texan to her Baptist core, Tyler draws from her unique experience working at “ground zero of the culture wars,” the Texas Legislature. Following a proposal to post the Ten Commandments in every classroom in the Texas public school system (which passed in Louisiana) came legislation to replace licensed counselors in the public schools with religious chaplains.  Using her “how to” logic she tells the story of Texas State Rep. James Talarico (D-Austin), a committed Christian and seminarian, who successfully opposed the school chaplain bill. Talarico told Tyler that his years as a public school teacher and his Christian faith meant he couldn’t stay silent “in the face of the Christian Nationalist agenda.” Tyler asks, “What would happen if a broad-based coalition of people of faith joined state Rep. James Talarico in saying we don’t want religious instruction happening in our public schools?” Tyler puts this to readers as a basis for action to be carried from the lawmaking trenches of Austin to Washington itself.  Tyler’s how-to book rises beyond anger, despondency and “hopium” into concrete ideas for organizing and action among believers and non-believers alike. 

Maybe Amanda Tyler’s campaign will take root in states like Oklahoma where the Superintendent of Schools issued a request for vendors to supply 55,000 Bibles (for $59.99 each) that sounded a lot like Donald Trump’s “God Bless the USA” Bible printed in China for $3. The Bibles were to be used for classroom instruction in history, supporters claimed. After a storm of derision, the superintendent’s request was revoked without explanation. 

Charles Francis is president of the Mattachine Society of Washington, D.C., and author of “Archive Activism: Memoir of a ‘Uniquely Nasty’ Journey.”

As the opioid epidemic continues to dominate national news, another urgent crisis is wreaking havoc in communities throughout the United States. Methamphetamine addiction is on the rise, and it’s hitting communities hard, especially the LGBTQ+ community.

November 30 is National Methamphetamine Awareness Day, a poignant time to raise the alarm about the devastating impact of this drug and the reasons behind its growing prevalence within the LGBTQ+ community.

Based on 2020 and 2021 data compiled by the Substance Abuse and Mental Health Services Administration (SAMHSA), sexual minorities (gay, lesbian, or bisexual) adults were at least twice as likely to use stimulants in the past year as their heterosexual counterparts. Gay men were over four times more likely than straight men to have used meth in the past year.

As a mental health counselor and coordinator of the LGBTQ+ program at River Oaks Treatment Center in South Florida, I know firsthand how devastating meth addiction in this marginalized demographic can be. The National Institute on Drug Abuse notes that sexual minorities tend to enter treatment with more severe substance use disorders than those who identify as heterosexual, and I often find this to be the case in our patient population as well. Our LGBTQ+ patients face numerous challenges that may lead to substance use as a means of coping, such as discrimination, stigma, and trauma. 

Our LGBTQ+ patients talk often about feeling their needs and experiences are invalidated by those around them. Constantly feeling unsafe or unable to live as one’s true self at a young age can have a lasting impact on a person’s mental health and is a risk factor for problematic substance use as a tool to manage shame and emotional pain. 

Another complicating factor is that for many queer people, there are few safe spaces, and one of the first ones they encounter is gay bars, where drinking and/or substance use is the norm. Meth is popular in gay nightclubs and parties because it causes euphoria, increases libido, and raises energy, enabling people to party for many hours before crashing. But while use of the drug often begins voluntarily, it quickly becomes compulsive and very difficult to quit. 

The brain quickly learns to link certain people, places, and activities with drug use, triggering uncontrollable cravings. Meth use is ubiquitous in the social circles or “chosen families” of some sexual and gender minorities, making avoiding the drug uniquely difficult. Quitting meth may require them cutting ties and breaking contact with people they’ve come to love and care about deeply.

Our LGBTQ+ patients sometimes express fear they won’t be able to experience sex and other activities in the same way once they quit using meth. Indeed, it can take some time for someone’s brain and body to return to normalcy after quitting. Methamphetamine has a profound effect on dopamine activity, a brain chemical associated with motivation and the urge to repeat pleasurable activities. Over time, this effect can limit someone’s ability to experience pleasure from healthy activities. 

The effects of chronic meth use and withdrawal also complicate the early treatment and recovery process. Intense paranoia — a common long-term effect of meth use — makes it very difficult to trust people, a crucial facet of treatment that is necessary for building relationships with counselors, mentors, and peers. 

Distrust of clinicians and treatment programs is often heightened among LGBTQ+ patients, who often face even more stigma when entering treatment programs and have a distrust of institutions like law enforcement, which they may associate with addiction treatment. To further this point, some of our patients have had bad experiences in the past and worry about treatment being safe for them. Many of our LGBTQ+ patients also have complicated relationships with their families who might otherwise form the foundation of their support network in recovery.

These obstacles highlight the importance of specialized LGBTQ+ addiction treatment programs, in which patients are surrounded by peers who can relate to their experiences. It’s crucial that treatment centers don’t just claim to be accepting of sexual and gender minorities but do the necessary work to make these patients feel safe and welcome, protecting them from harassment and mistreatment from both staff and other patients.

These programs also must work to address common issues that co-occur with addiction among LGBTQ+ patients, such as trauma, emotional turmoil, and interpersonal conflicts. For example, utilizing effective, evidence-based therapeutic approaches, such as dialectical behavior therapy (DBT). 

DBT is among the techniques we use in our programs. Originally developed to treat borderline personality disorder (BPD), DBT has been expanded to treat many mental health disorders that involve emotional dysregulation, which is something we often see among our patients in early recovery from meth addiction. 

The approach functions to enhance one’s capabilities to regulate emotions, practice mindfulness, improve interpersonal effectiveness, and strengthen distress tolerance before practicing these skills and encouraging patients to apply them in their daily lives. DBT also works to improve a patient’s motivation to track and reduce their dysfunctional behaviors.

On a nationwide level, it will take significant work to disentangle the grip of methamphetamine on the LGBTQ+ community. With the pervasiveness of illicitly manufactured fentanyl — a synthetic opioid that causes overdose in very small doses — in the drug supply, the need for action has never been more immediate.

A large part of this work involves changing the perception of society toward methamphetamine addiction and especially queer people who struggle with this disease. Rather than viewing it as a moral failure, we need to see it for what it truly is: A public health crisis. Much like at the start of the HIV/AIDS epidemic, the disease of addiction is heavily stigmatized and too often, we place blame on those who are impacted rather than taking effective action to curb the crisis. 

In addition to culturally competent addiction treatment, we desperately need more sober, safe spaces for the LGBTQ+ community. Upon exiting treatment, many find themselves on uncertain ground and in desperate need of sober friendships and networks that support their recovery. Substance-free community centers provide a useful model that can be implemented on a larger scale.

While these are trying times, I sincerely believe we can make a profound difference by confronting this issue with compassion and understanding. It will take a multi-faceted approach that involves the cooperation of treatment centers, queer people in recovery, allies, and the broader LGBTQ+ community.

Karah Moody, LMHC, CPP, MCAP, is a counselor and LGBTQ2+ Coordinator at River Oaks Treatment Center, an American Addiction Centers facility.