When Sex and Stimulants are Fused: Two Behaviors, One Addiction

The intersection of stimulant addictions and sexual behavior is drastically under-researched, as are most areas of addictive disorders in relationship to sex. It is nonetheless increasingly apparent to many addiction treatment professionals, particularly clinicians trained to assess for sexual concerns, that there is a significant subgroup of drug addicts who regularly abuse stimulants like cocaine and methamphetamine (and sometimes party drugs like Ketamine, GHB, MDMA, etc.) almost solely in conjunction with their sexual behavior. Many of the male addicts who present with concurrent patterns of “stimulant abuse and sexual behavior” may also abuse Viagra, Cialis, or similar drugs in order to maintain an erection for hours, even days at a time. Some present with related addictions to benzodiazepines (Valium, Ativan, Xanax, Klonopin, etc.) and/or over-the-counter cold medicines, taken to offer the addict a few hours of sleep in the midst of a stimulant run. Over time, stimulant drug abuse and sexual activity can become so tightly paired that engaging in one inevitably leads to the other. For these addicts, getting high and finding, seeking, and having sex becomes a single, paired, interrelated, co-existing, and complementary addiction. 

When stimulant drug abuse is consistently fused with the hunt for and experience of intensely arousing sex, these paired behavioral patterns become mutually reinforcing. Over time, even simple fantasies and urges regarding past sexual acts or situations become a psychological trigger to drug use and relapse. It seems unconscionable to this author that addiction specialists are not universally trained to consistently and routinely identify and address these co-existing concerns in treatment as a single issue, rather than simply and erroneously believing that getting a client “sober” (off drugs) will make the sexual issues go away or become a non-issue. To achieve lasting chemical sobriety, individuals who repeatedly demonstrate complex behavioral patterns—sex, gaming, eating, self-abuse, etc.—that have become entwined over time with stimulant and other substance abuse need integrated assessment and treatment methods. These clients need to disclose and address potential shame related to past sexual activity engaged in when they were high, while relapse prevention plans need to succinctly anticipate, discuss, and predict their sexual urges, fantasies, and behaviors and address them for what they are—a prominent trigger to drug relapse. As stated above, if you don’t treat both, the client may not heal from either.

Current Research  

A recent study, focused on men who struggle with methamphetamine abuse, strongly supports the idea that stimulant abuse and sexual activity can become so fused that drugs and sex are no longer separate addictions (Gatewood, 2009). Instead, the two behaviors combine, morphing into a single addiction to “stimulants and sex,” where both the drugs and the sex, abused in concert, form the addict’s “drug of choice.” The study indicates that for these men the leading reason for crystal meth use is sexual enhancement, as methamphetamine both lowers their sexual inhibitions and prolongs the potential duration of their sexual encounters. The study draws the conclusion that with some addicts it can be “virtually impossible” to separate sexual behavior from drug abuse. While this particular study is limited in scope, as it focuses on a specific stimulant drug (methamphetamine) and a particular population (gay men), it is not unreasonable to extrapolate these findings to other stimulant addicts. After all, the plethora of research on stimulant abuse shows remarkably consistent results, particularly in terms of how it affects overall patterns of decision-making, daily functioning, and social isolation—regardless of cultural background or the specific drug being abused (Cunha, Bechara, de Andrade, & Nicastri, 2011).

Though other research into stimulant drug addiction typically has had a broader focus than the direct connection between stimulant abuse and sexual behavior, a few studies have touched directly on the issue. For instance, one study looking at both male and female HIV-negative methamphetamine users found in part that for women, drug use and high risk sexual behaviors were significantly interrelated, with meth use directly linked to increasing instances of unprotected sex and STDs—despite the fact that women typically said they used meth as a way “to escape,” “to feel more attractive,” and/or “to lose weight” rather than as a sexual enhancement. For men, the stimulant-sex connection was much more direct, with males often citing “a desire to boost sexual pleasure” as a primary reason for using drugs (Cheng, Garfein, Semple, Strathdee, Zians, & Patterson, 2009). Again, the study was limited in scope and not focused on the potential fusion of stimulant abuse and sexual activity, but it is clear from the findings that stimulant drugs and sexual behavior are inextricably linked far more often than is realized. 

Yet another study, this one examining the effects of methamphetamine use on the transmission of STDs, found that meth use increased the likelihood of numerous high-risk sexual behaviors (Cheng, Garfein, Semple, Strathdee, Zians, & Patterson, 2010). Even “casual” meth users, if there exists such a thing, showed an increased tendency to engage in anonymous and/or casual sex, have multiple sex partners, contract an STD within the preceding sixty days, engage in unprotected sex, and participate in “sex marathons” while high. Binge stimulant drug use in particular was strongly associated with unprotected sex, casual and/or anonymous sex, and marathon sex. Cheng et al. concluded: “The combination of unprotected sex with the increased duration of (and the potentially greater number of partners during) sex marathons suggests that binge users may experience a higher risk of acquiring an [STD]” (2010). That conclusion is unsurprising. What is notable here is that once again there is documented evidence of a direct link between stimulant abuse and the desire to engage in concurrent sexual activity.

Who Develops a Stimulant/Sex Issue?  

In some respects we appear to be dealing with an entirely new, or at least previously unrecognized, category of “dual” addict. Like other addicts, though intellectually intact, these individuals often have various forms of unresolved early trauma and attachment challenges. They appear to use intensity-based, often risky sexual behaviors combined with drugs in an attempt to temporarily escape underlying emotional challenges, such as loneliness, anger, and fear, and/or to deal with past trauma. The goal for the addict is to achieve a sense of emotional control over seemingly overwhelming feelings and experiences. In other words, these individuals attempt to deal with anxiety, depression, low self-esteem, past abuse, neglect, and external life stressors by dissociating with their drug of choice—in this case the fusion of drugs and sex. These are the same reasons alcoholics drink, compulsive gamblers place bets, and those with eating disorders consume a quart of Ben and Jerry’s in a single sitting. The only real difference here is the dual, fused nature of the addict’s preferred drug.

One typical male addict with a stimulant-sex issue is the married, heterosexual professional who has the time and resources to buy large amounts of cocaine and disappear for a night or weekend at home or in a hotel into drug use paired with prostitutes, porn, or anonymous sex with partners met online and through smartphone hookup apps. Also typical is the gay man who abuses crystal meth while having sex for extended periods in sexual environments like bathhouses or at home with strangers—met online and on apps like Grindr—who want to PnP (“Party and Play”). Bisexuals and men of both sexual orientations can isolate for days at a time with cocaine and/or meth while compulsively masturbating to online porn, seeing transgender prostitutes, or having sex with multiple partners. 

Female stimulant addicts will engage in many of the same behaviors, but often with more of a connection and/or relationship focus. For instance, women may use cocaine or meth in conjunction with sexual or “romantic” webcam chat and mutual masturbation, rather than simply viewing and masturbating to porn. Or they may be in a “romantic relationship” with their drug dealer or pimp. The addiction scenario varies from person to person, but regardless of sexual orientation, gender, or life history, for these addicts the fusion of drug addiction and problematic sexual activity is always there. If the addict engages in one behavior, he or she will also, without fail, engage in the other. 

Doubling Down  

The “dual addiction” of stimulants and sex is often double-trouble in terms of risks and potential consequences. For starters, these addicts struggle desperately to achieve long-term chemical sobriety. Many of these individuals present in treatment with a history of chronic relapse. They have tried over and over to get clean from cocaine, meth, and other party drugs, only to fail miserably—directly or indirectly related to their continued search for a sexual high. While these well-intentioned addicts may stop using stimulants for a time, they still want and seek the thrilling, super-intense, days-on-end sex enjoyed when using—not understanding that without the drugs this kind of sexual high is simply not possible. When they return, now sober, to the people and places that offered those mind-blowing sexual encounters they inevitably pick up drugs, and before they know it they are once again awash in the stimulant-sex tsunami. I cannot emphasize strongly enough the difficulty these individuals have maintaining chemical sobriety. Of course, this is hardly surprising as cocaine and methamphetamine are two of the most difficult substances to get sober from. When these substances are used in combination with the neurochemical charge of sexual intensity, the challenges of long-term recovery increase exponentially. 

There are other long-term dangers for this addict, mostly stemming from the fact that stimulant addicts, as well as sex addicts, when high, exhibit poor judgment and regrettable decision making, especially around sex. While disinhibited by stimulant drugs, safe sex loses priority, especially among individuals accustomed to marathon sessions with multiple partners. This propensity for unsafe sex while abusing stimulants greatly increases the addict’s risk for unwanted pregnancy, and also for contracting and/or transmitting HIV, hepatitis, and other STDs. Even worse, addicts in long-term relationships can easily infect unsuspecting partners; in particular those individuals who think their spouse’s problems are solely drug-related.

Treating the Stimulant-Sex Issue  

Prior to this year, there was no drug and alcohol or sexual disorders treatment center with a program dedicated to addressing stimulant abuse fused with sexual behavior. Thus, individuals with this dual issue typically entered treatment for cocaine or methamphetamine abuse, only to have their concurrent sexual activity either minimized—due to staff and client discomfort with and/or ignorance of the subject—or written off as something that needn’t be examined or addressed because “it only happens when using.” What many drug programs fail to recognize is the fact that the sexual behavior only happens when the person is using is far less important than the fact that the sexual behavior always happens when using, and, further, the client always uses when he or she is being sexual in certain settings. Thus, these addicts—individuals with an extensive history of abusing stimulants and sex simultaneously—have ended up being treated for only half their problem. Their shame and secrets about past sexual behaviors have not been addressed in a safe setting, separate from other drug addicts who don’t share these issues, nor have they been educated as to how they might be able to engage in post-treatment sober sex while managing the co-related trigger to use. As such, many addicts with the stimulant-sex issue have exited perfectly good substance abuse treatment programs not having done a detailed sexual inventory or any work anticipating sex as a primary relapse trigger. 

To address the very specific needs of this population, the newly opened Stimulants and Sexual Disorders Program (SSDP) at Promises Treatment Centers in Malibu, CA, has implemented the first drug treatment program designed to simultaneously address the treatment needs of addicted individuals whose stimulant abuse and sexual acting out are fused. In addition to traditional drug treatment approaches such as cognitive behavioral therapy, group therapy, and Twelve Step involvement, the SSDP integrates much needed neurobiological and medical components specifically aimed at controlling the urges and cravings that so often lead to stimulant-sex relapse—especially during the critical early stages of recovery. Most notably, the program incorporates cognitive restructuring techniques or “brain training,” which is a treatment commonly utilized to aid those with brain injury, dementia, and similar concerns. Brain training has also proven effective in improving short-term memory loss—a problem that contributes directly to impulsivity and indirectly to the formation and maintenance of stimulant addiction.

Addressing healthy sexuality is also a necessity when treating addicts with a stimulant/sex issue because, to them, “sober sex” is often a mystery. They simply have no idea (or no appealing idea) how to engage in sexual activity without also using drugs. As such, treatment of these addicts must include a significant relapse prevention focus centered on how to approach sexual activity as sober individuals. When appropriate, this segment of treatment should include spouses and partners, who, like the addict, need education on which sexual activities are and are not acceptable, along with advice on how to deal with their newly sober partner and how to protect themselves if relapse occurs.

Hope for the Hopeless  

As mentioned above, individuals who have fused their stimulant abuse with sexual behavior often present with a lengthy history of relapse. Many have expended significant financial and other resources in an attempt to find and maintain sobriety, only to fail, oftentimes repeatedly, when the unrecognized, untreated, sexual half of their addiction pops up. Sometimes these individuals have lost hope of ever finding long-term sobriety, health, and a happy life. Many arrive in treatment yet again, seeking at best a respite from their drug use, a period of safety during which they can recharge their batteries before returning to the world and reengaging with their problematic behaviors. This revolving door is the antithesis of true recovery.

Only by recognizing and fully addressing the fusion of these individuals’ stimulant abuse and sexual behaviors can clinicians construct and implement treatment regimens that entirely rather than partially meet the needs of these heretofore hopeless addicts. Treating stimulant abuse and concurrent sexual behaviors simultaneously is the best shot we have to help these individuals gain the necessary insight into the full nature of their addictive patterns, reduce their guilt and shame, identify and combat triggers for relapse, support their spouses, and (re-)engage in patterns of sober, healthy intimacy and sexuality. Treating individuals with fused stimulant-sex behaviors in this holistic way, by deeply examining and anticipating the entire spectrum of their problem, provides these addicts their best opportunity to develop and maintain engaged, productive, drug-free lives. 

References  

Gatewood, T. (2009). Attitudes and motivating factors for methamphetamine use among HIV+ men who have sex with men. (Thesis presented to the Faculty of the School of Social Work). California State University, Los Angeles. 

Cunha, P. J., Bechara, A., de Andrade, A. G., & Nicastri, S. (2011). Decision-making deficits linked to real-life social dysfunction in crack cocaine-dependent individuals. American Journal of Addiction, 20(1): 78-86.

Cheng, W. S., Garfein, R., Semple, S., Strathdee, S., Zians, J., & Patterson, T. (2009). Differences in sexual risk behaviors among male and female HIV-seronegative heterosexual methamphetamine users. American Journal of Drug and Alcohol Abuse, 35(5): 295-300.

Cheng, W. S., Garfein, R., Semple, S., Strathdee, S., Zians, J., & Patterson, T. (2010). Binge use and sex and drug use among HIV(-) heterosexual methamphetamine users in San Diego. Substance Use and Misuse, 45(1-2): 116-133.