There is a thin line that separates drug and alcohol use from abuse. Most young people take risks, and a lot of us will experiment with many things as we move through life. But when drugs become an escape that we rely upon, it can be dangerous or hazardous to your health. Feeling like you need help relaxing or even escaping is not unusual or wrong. Similarly, it's not right for anybody else to categorize or judge you based on what you put into your body. But it is good to think about what may be too much for you, particularly now that your body is dealing with HIV.

"

Almost everybody I know gets fucked up but a lot of them have control and have things going on in their life, and those are the ones who know when to stop, but the people who go to the point where they can't remember shit, or aren't aware of their actions...it has a lot to do with being depressed or having no control over your life, it's something beyond what people think. There is a big connection between drug use and AIDS but you also have to look at why people use drugs. -An outreach worker at the Center for Young Women's Development

"

"

I have never had a moral or ethical dilemma about drug use, it was simply a matter of health. I have always been an advocate of personal liberties and believe that individuals have the right to behave however they choose, whether that means deciding to take drugs at a circuit party, eat fatty foods, or smoke two or three packs of cigarettes a day. -Alex

"

Wherever you are with your own substance use, it is not something to ignore. Whether you drink on weekends with friends, use substances like speed or cocaine regularly or are recovering, it is important to look at why and how pot, beer, crystal, ecstasy, heroine, etc. may be part your life right now. Hopefully this might also help you approach the fear and/or anxiety that you may be trying to avoid by using these substances.

Once you tested positive, you may have felt bombarded by the list of things you would have to look at, things you had to think about changing or getting better at. Take this book, for instance. In a few short chapters we have told you to eat better, see a doctor, talk about your feelings more, cut back on stress, and start thinking more about your choices. Even if this is possible for you, it might not be easy. In addressing substance use and abuse, this book does not look to condemn you or give you orders. We do want to bring up the issue, and we want you to think about it and ask yourself some basic, but difficult, questions.

"

By the time I was 18 I had succeeded at becoming that which I had despised and put down a damned drunken Indian. Growing up among alcoholics, I saw a lot of stuff I said I would not do. It was hard not to drink. I felt like another person (and I was) when I drank. I felt FREE...I didn't have to deal with reality. -Darrell

"

Well, what are you looking to escape from? Why? Are there other ways to do this? How can you make plans to get through a problem that may be bothering you, rather than to steer around it?

And remember: we all have had experiences that we regret. The people around you may want to help you get over any issues you have with drugs and alcohol, but they may not know how to help you get rid of the regret and shame that go along with them. The world is full of mixed messages about substance use. One advertisement may make drinking look cool, while another may show an angry violent person, and attribute that behavior to alcohol. The only person who can make the decision to stay healthy around drugs and alcohol is you. And the only way to do this is to value yourself enough to stick it out when things get rough, and by facing the hard stuff at just the point when you may least want to.

To start this off, we should clarify that there is a lot we do not know about the possible interactions between HIV meds and recreational drugs. The issue has been discussed at length but there have not been official studies or experiments done to prove most of the logical assumptions and conclusions that can be made. These are some reasons why we don't know very much: most large pharmaceutical companies feel that giving advice on the issue may open them up to lawsuit; a supply of recreational drugs in their pure forms that could be used in a study are nearly impossible to get; and there are a number of ethical concerns involved. Conducting scientific tests on humans can be difficult to do without infringing on their rights as individuals.

Your liver is responsible for rounding up any chemicals you decide to put in your body and, shall we say, moving em on out. It is the organ responsible for cleansing your system of pollutants, food additives, and the toxins created by drug use. Because most street drugs are not pure, but cut with filler substances, like baking soda, they can be particularly hard to process.

When experts refer to the way recreational drugs react with HIV meds, they refer to something called your liver's metabolic pathway, meaning the path through which your liver can effectively process and remove foreign substances in your body. Anyway, many of the commonly used HIV meds either slow down or alter that pathway. It's already working overtime, processing the meds; when you add another chemical to the mix, it has to work back-to-back shifts with no rest, which can mean sheer exhaustion, failure, and clearly, an inability to fight off any illness that may come through the door.

The legal forms of body-and-mind-altering substances, such as caffeine, nicotine, and alcohol, either speed up or slow down some of your body's functions, and can also interact with the way HIV meds are processed by your body.

There are several ways to maintain a healthy liver. Many do not involve complicated medication schedules, including:

• Drinking drinking drinking water: at least 8 glasses a day to flush the toxins away (adding lemon to your first glass of water in the morning is also a very helpful way to start it functioning healthily through the day).
• Aerobic Exercise: the kind that gets your heart going. 30-45 minutes at a time, at least three-four times a week.
• Herbs:

  - Dandelion-cleans and strengthens the liver.
  - Licorice-reduces inflammation of the liver.
  - Golden Seal-decongests the liver. (Should only be taken in small doses.)
  - Milk Thistle-helps cleanse the toxins from the liver.
  

  Visit your local herb store or consult an herbalist as to how to best use the above.

In the same way that HIV affects each person differently, drugs will react differently in different people's bodies. It is likely that you may take longer to recover from using pot, alcohol, or other substances, now that your immune system may be weaker. A profound change has taken place in your body, and respecting that means paying extra attention to what you eat, drink, smoke, and ingest.

Also, if you're using you may not notice symptoms that are HIV related because they could be similar to the effects of your drug use or even hepatitis or TB. These may include being tired or having a fever, weight loss, or diarrhea.

Other ailments that may occur more frequently in an HIV+ drug user can be abscesses, blood infection, pneumonia, and bacterial infections.

Obviously, you don't have to tell your doctor anything. But he or she is likely to suspect that something's up, and will want to know how exactly the substances you use are affecting things like your health and/or medication schedule. Hopefully, if you are seeing a doctor, your health is their main concern. They should not make you feel judged. In order for them to provide you with the best care, it can't hurt to let them know.

When mixed with the anti-HIV drug Norvir, amphetamines and ecstasy have been shown to increase from 3 to 22 times in the blood stream. Meaning, you may take 1 dose but it may affect you like 2 or 5 doses. When mixing recreational drugs with any and all medications, it is smart to start with a very low dose of the recreational drug (as little as 1/4 of one dose), allowing time to pass before you increase the dose. The effects of methadone, on the other hand, decrease when it is put into a bloodstream that is already altered by HIV meds. So, if you may be used to a set dose of methadone, when you mix that with HIV meds, you may still not feel like you have had enough.

Hepatitis C is a form of hepatitis that can be passed from person to person during the exchange of blood. It is caused by a virus called HCV and can become chronic. Like other forms of hepatitis, Hep C attacks the liver and can be particularly dangerous to someone with an already weakened immune system. (See www.hepcfoundation.org for more information.)

Also called K, Vitamin K, and Kit-kat, Special K is short for ketamine, the name of a very strong anesthetic. It was first used by veterinarians to sedate large animals like horses and cows. It can be found in the form of a liquid, powder, or pill, and has seen a rise in popularity in the club scene over the last five years. K is said to cause hallucinations and can also put you in a semi-catatonic state if you take too much (often referred to as a K-hole). As with other drugs, it should be taken with lots of water, but because it may possibly slow down the kidney's processing of the water, you should not drink too much at once! And definitely avoid alcohol.

GHB, otherwise known as liquid X or liquid E, has effects that are actually quite different than those of ecstasy. It is either sold in liquid form or as a powder to be mixed and dissolved in water. It was sold as a sleeping aid throughout the 80's and is now seen frequently at raves and public parties. If the right amount is taken, it can heighten your senses similar to the way ecstasy does, but in a lighter, milder way. When mixed with other substances, particularly with alcohol, or when taken in too large a quantity, it may make you feel very out of it. Even worse, you may experience breathing failure and you may run the risk of seizures, coma, or death.

While marijuana is known for its ability to reduce pain and nausea among people in the advanced stages of AIDS, there have been other findings that hint at the ways repeated use may damage your immune system. Studies have shown that marijuana impairs the ability of T-cells in the lungs' immune defense system to fight off some infections. Men and women are affected differently by marijuana. It may also impair women's menstrual cycles and lower men's sperm counts. However, people who practice harm reduction (a method that aims to meet a person where they are and help them find realistic ways to be safer), advocate for the use of marijuana in small quantities, as opposed to heavier, or harder drugs.

Alcohol, like coffee and sugar, can seriously dehydrate you, meaning that your body will be using more water to process the alcohol than you are putting in. Although you may technically be pouring liquid in through your mouth, your body will end up parched if you don't continue to drink water. And, if your immune system is not in the best shape possible, drinking alcohol often or a lot at a time can be really hard on your body. Some of the other short-term affects are: you may get violent, your face turns red, you get sick to your stomach (vomiting), bad breath, poor coordination (when you can't walk or drive straight), and possibly alcohol poisoning. The long-term affects of heavy alcohol consumption are long-term blacking out, cirrhosis (deterioration) of the liver, and brain damage.

Again, here are no hard facts about the effects of these drugs on your body if you are HIV-positive. The thing to keep in mind, however, is that when you are high, you won't be taking care of your body in the basic ways that are necessary. You may forget to eat, sleep, take your meds or vitamins, and if you are shooting up, your skin will be extra prone to infections. It is generally a bad idea to speedball or mix speed/cocaine with opiates (like heroin) as it gives your body very mixed messages. The stress your body will go through as it tries to speed up and slow down can be exhausting. The more you use any hard drug, the harder you crash or come down. Not only does this typically involve exhaustion, but it can make you feel like you have a cold, and can also sometimes cause severe depression.

"

I donated blood for my high school and I thought I was doing something for a good cause. [Testing positive] came as a complete surprise. My drug usage had slowed down. I was at a period in my life where I'd finally decided to start concentrating on school. I had been a dealer, I'd thrown away a perfectly good education at a college prep high school and I was now going to public school in my home town of Alameda. I felt like I had gone to hell and back. Little did I know I was just entering the depths of it. The only times I used needles, I shared them and I hadn't really realized it, I was so out of it. I presume it was the needles because it happened about three months before [I tested positive] and that's a little bit too much of a coincidence. My substance abuse kind of cushioned the reality. It was the only way for me to really deal with it and hide the fact that I was positive. I've always been an addict. I'm manic depressive. There's a history of substance abuse in my family. I'm the only one who's come in and come out of it. I attended the National AIDS Update Conference in San Francisco and heard something that actually put fear in my heart for the first time since I was positive. And that was the way I was gonna go out of this world if I didn't shape up. I went to this workshop on substance use and I saw the exact effect that the drugs I was putting in my body were going to have on me. Horrible disgusting ways to go out of this world [such as] your stomach acids eating their way through the lining of your stomach, flowing out through the rest of your body...And I'm sitting there looking at this and I was like, this isn't how I wanna do it. I went to a youth agency in the city where I was affiliated, Bay Area Young Positives, and I told them I wanted help. I dropped out of college and gave up a year of my life to learn a new way of living. And I'd been in denial for a really long time. I think that's the reason a lot of people use. They don't go through the five steps of finding out, and accepting the reality of a potentially fatal disease, of actually accepting it. I think there's denial, anger, bargaining, depression, and finally acceptance. I went through all of those, I think I was in anger the longest. After I saw all the help others gave me and I started to talk to other people with programs and I realized I would get a lot out of helping other people. I found out that I had a knack for it. I have 16 months clean. My roommate drinks beers every night. But I set boundaries...I told him straight up that my recovery is more important to me than he is. Recovery gives me my vitality and my life back. That's what makes me able to smile and actually have a lust for life...It gave me happiness, something I didn't have before. It's really sad that it took HIV to open my world up and make me realize what made me happy, but I'm confident that this isn't gonna take me out. So [death] isn't really what I'm trippin about, I'm trippin about how I'm gonna take care of myself... - Chris