Sex on the “high” seas

Drinking, drugs and unsafe sex: The risk-taking behavior of the gay party male.

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 ten if that weekend should occur around Gay Pride, Folsom, Gay 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 guess I knew what I was subscribing to.  The life of a gay party boy is not foreign to me. I’ve been to Folsom, Gay Disney and several Atlantis Cruises. But even I struggle to understand the brain of a gay man, especially of those who make the regular 3am Sunday morning 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 seemingly heterosexual nephews. At fifteen and sixteen years old, 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 scientists and doctors for centuries.

I’m not alone. My colleagues in Manhattan and in 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. As doctors, we do our best. I counsel my patients accordingly about drugs and sexually transmitted diseases, including HIV. Although I feel confident in my abilities, I still picture my nephews’ eyes rolling into the back of their heads when I try to instill some sense of caution in my patients before a circuit event. I don’t judge, or at least that is what I tell myself. But I suppose I do. I stopped going out years ago when it became a never ending merry go round of witnessing overdoses and retreating STDs. I tell myself I’m getting older. When I was younger, I didn’t listen either, but the age of the modern day party boy is well beyond the age of when any of us should be referring to each other as “boy.” I’ve read that the average age of an Atlantis Cruise ship passenger is 41.

The trouble with gay men is that, like teenagers, they fall prey to the rush of hormones that drive the reward-system network. Essentially, this is the spot in the brain that reacts to desire or a bump of crystal. The body responds to this reward-system network by releasing the neurotransmitters dopamine and norepinephrine. Cocaine raises dopamine levels 400 percent higher than normal. In comparison, methamphetamine triggers a 1,500 percent increase in dopamine. Although dopamine affects many parts of the brain and body, the effect is most important on two brain sites: the nucleus accumbens, and the ventral tegmentum. These two brain sites are connected by a bundle of cells called the mesolimbic pathway, or the brain-reward center. This is the area of the brain that is most powerfully associated with pleasure and addiction. Stimulating this pathway makes a person want to repeat this behavior in order to feel the reward it brings. Unfortunately, that reward is never truly like the first time – no matter how much sex you have or how many bumps you take.

Of course the obvious culprit is that we are fueled by our desires, whether these are sexual or drug-fueled escapes, especially when these desires have been liberated after years of confusion and confinement. Who wouldn’t want to go on a sex, drug and alcohol binge while drifting through the Caribbean on a gay cruise where there are no judgmental eyes watching your every move?

On February 6th, the Royal Caribbean ship “Allure of the Seas” set sail from Port Everglades, Florida. Billed as the largest gay cruise ever, Atlantis hosted more than 5,400 passengers. “Where does it go?” I asked one patient as he reviewed a list of prescriptions he would need for his upcoming trip: Cialis, Xanax and Ambien.

“Who cares,” he said. “I’m never getting off the boat.” Several days later the text messages started to arrive, “This trip is a disaster. Guys are overdosing left and right. The authorities bordered the ship and arrested a drug dealer. They have dogs and they’re making surprise room searches.”

Agents who searched the suspect’s cabin reported finding more than 140 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 agents.

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 counter productive 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 chaperone 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 explorative 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 party-going 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 ten.  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.



  1. Posted February 23, 2011 at 3:30 pm | Permalink

    Great post. I think because you are in NYC, a microcosm for adventure seekers, as in any large city, you are going to have a higher population of risk taking gay adults.

    There are still plenty of us homebodys, quite and shy types in the background.

    I kind of feel that what you describe, although true, is a stereotype.

    I do agree the large percentage of Gay adults who engage in risk taking behavior is overwhelming and I can’t imaging being in your position being constantly bombarded.

    I have no clue about the bareback business… can only see it as some type of symptom of mental illness…

    There are so many factors involved that you have mentioned, the lack of responsibility as well as in general an excess of money to spend on partying.

    I think, at least I hope, the vast majority of us need only one or two big scares to learn a lesson and, providing we don’t have an addictive personality, and are able to remember the hangovers, the racing heartbeat and panic feelings of the drugs instead of whatever good feelings we may have temporarily had, and will not want to repeat that. At least that is how I feel. If something becomes unpleasant, I generally stop…

    As a Dr. with a Gay practice in Manhattan, of course you are literally ground zero for this type of behavior. Hopefully for everyone on that cruise ship, there are at least one of us who have never been on one of the cruise ships and find that this type of “party boy” lifestyle hinders success in other areas of life.

    Personally, I find dealing with stress to be a bit uncomfortable to intentionally bring it upon myself…

    I see nothing wrong with telling your patients to grow up and or get therapy, if needed.

  2. spinellimd
    Posted February 23, 2011 at 8:09 pm | Permalink

    @ Phillip. Thank you for taking the time to write. Like you, others think that men who party on gay cruises or at circuit events are a stereotype that represents a small minority of gay men. But how do you explain over 5,400 passengers on a gay cruise? What do think most of them did on that cruise? Play shuffleboard. How do you explain the thousands of gay men who are about to make there way to Miami next week for Winter Party, followed by Black Party in March. Not to mention all the party goers who attended one of the many President’s Day festivities. I think you’re living in a microcosm of gay men who don’t party. Unfortunately, your denial is shielding you from a very dangerous statistic that we don’t like to discuss because it’s our dirty gay secret. We need to stop saying that party going gay men make up a small minority when in fact it’s a larger group than you can possibly imagine.

  3. Posted February 24, 2011 at 11:29 am | Permalink

    Well, I certainly didn’t mean to sweep it under the rug. I know it is a problem, but don’t straight people party and use drugs too?

    And, of the people on the cruise, some of them had to be people who went there intentionally to party and possibly do not behave in the same fashion back home when they are not on vacation.

    I know that this is part of the “Gay lifestyle” and I would be included in those statistics had the been taken an specific points in my life.

    Of course I know it is a HUGE problem though. I don’t understand such risk taking behavior in anyone. I know several heterosexual people are quite addictive and permissions too.

    I certainly don’t deny that it is a problem.

    You might say that most college students are also of this bend if you were to be in Florida during spring break. I just don’t think it is the norm, although of course it is a problem.

  4. Posted February 24, 2011 at 11:32 am | Permalink

    I mean “addictive and promiscuous”… it’s early.

  5. Posted February 24, 2011 at 11:36 am | Permalink

    And, perhaps this behavior is part of natural selection and nature making certain that persons who repeatedly engage in stupid and risky behavior aren’t able to pass on their genes…

  6. Posted February 24, 2011 at 11:38 am | Permalink

    …and I have also wondered about that idea for the homosexual in general.. perhaps we are supposed to be the “end of the line” for a reason.

  7. CrosbyStreet
    Posted February 24, 2011 at 3:35 pm | Permalink

    Thanks for this post.

    My partner and I, in our mid-30s & early 40s, have been on two Atlantis cruises in the Mediterranean and are booked to go on a third this summer. We’re not into drugs (unless you count white wine and martinis!) and didn’t see much of them around. Still there definitely is a sense that party drugs are around if you need them.

    We got to go to Vatican City with a gay tour guide and heard his fresh insights into gay life in Rome and the Vatican. We went to Alexandria and toured the pyramids with hundreds of gay men. At the leisurely luxe dinners onboard, we were able to meet other young gay couples like us. There really aren’t too many places for us to meet other gay couples.

    Most importantly, perhaps, is that Atlantis cruise passengers from rural places who have never been around this many gay men get the chance to feel that there are plenty of us around. They get the chance to feel completely welcome and safe while seeing a sunny new part of the world.

    Still, I need to say I’m very embarrassed by the recent publicity from the world’s largest gay cruise. I’ve raved about Atlantis cruises in the past. Many co-workers and friends forwarded me links to articles about the arrest on the ship.

    I think Atlantis does a poor job managing the passenger experience and is lax in monitoring for illegal activity. I hope they work with the cruise companies they charter to step it up.

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