Joe Ruggiero is known for starting a cutting-edge adult program at The Addiction Institute of Mount Sinai Hospital in New York City that focuses on the lives of gay men and their use of methamphetamine. The groups he created include men in various stages of substance use on the continuum of change and those working toward abstinence. I have always wanted to know more about Joe’s work, as I imagined he would have a trove of important insights around working with this difficult group of patients. I decided to interview Joe for this issue of Psychoanalytic Inquiry, and I am so pleased I did. He does not disappoint. In our discussion, Joe helps us identify unique themes that emerge in working with this population. Joe also helps us to identify how contemporary psychoanalysis invites clinicians and their patients to be curious and interested in the “function” that crystal meth provides its user, and how enhanced self-reflection can create useful conversations that help patients reduce risk and find their way, if they choose, to significant change.