Two Behaviors: One Addiction?
Although the intersection of stimulant abuse and sexual behavior is extremely under-researched, in recent years it has become increasingly apparent that there are many individuals who abuse or are addicted to stimulants who consistently fuse their drug use with sexual activity. It is also clear that when a stimulant drug addict consistently fuses drugs with sex, the sexual fantasy/behavior can both reinforce the intensity and frequency of chronic or binge drug abuse and act as a significant contributor to post-treatment relapse. One recent study (focused on HIV+ gay men and methamphetamine use) strongly supports this idea, finding the leading factor for crystal meth use for these individuals was sexual enhancement, including lowered inhibitions and prolonged duration of sexual encounters.1 The study concluded that with some addicts it is virtually impossible to separate their sexual behavior from their drug abuse. While this study is limited in scope and focused on a specific population, it is not unreasonable to assume that as further, broader studies are conducted these findings will translate across the board. After all, the plethora of research on stimulant abuse shows remarkably consistent results, particularly in terms of how it affects patterns of decision-making, overall functioning, and social isolation – regardless of cultural background or the specific stimulant abused.
Many addiction specialists, particularly those clinicians trained to assess sexual concerns, report seeing a significant subgroup of clients who abuse cocaine, meth, and other party drugs (Ketamine, GHB, MDMA, etc.) solely in combination with sexual activity. Male clients with this issue will often also abuse Viagra, Cialis, and similar drugs in order to maintain an erection for many hours or even days at a time. Some also become hooked on benzodiazepines and/or “cold medicines,” taken in order to simply get some sleep when the “action” is ended. Over time, stimulant drug abuse and sexual activity can become so tightly paired for these individuals that engaging in one inevitably leads to the other. In other words, getting high on stimulants AND finding/seeking/having sex become a single, paired addiction with interrelated, co-existing, complementary factors. In treatment these concerns must be addressed in concert as a single issue, rather than making the incorrect assumption that “getting the client sober” will resolve the sexual acting out. To achieve lasting sobriety, these complex, integrated behavior patterns need to be dealt with simultaneously in an integrated manner. Simply put, if you don’t treat both, the client may not heal from either!
Who Are These Clients?
In some respects, we are dealing with a seemingly new (or at least previously unrecognized) category of addict. Many of these men appear to have various forms of early trauma and attachment challenges over which this mix of drugs and sex gives them a sense of emotional control. One typical male addict of this type is the married, straight professional who has the time and resources to buy large amounts of cocaine and rent a hotel room, disappearing for a night or weekend into drug use paired with prostitutes, sensual massage, or sex with anonymous partners met online. Just as typical is the gay man who abuses crystal meth while losing himself for several days in sex clubs, bathhouses, or at home having sex with strangers who want to PNP (party and play) – men often found online or via “friend finder” smartphone apps like Grindr. We also see bisexuals and men of both sexual orientations who isolate with cocaine or meth while compulsively masturbating to online porn, sometimes for days at a time. Of course, the “two behaviors but one addiction” scenario varies from individual to individual, but the fusion of drug addiction and problematic sexual behavior is always there. If this addict engages in one behavior, he or she will also, without fail, engage in the other.
Many of these individuals present with a history of chronic stimulant drug relapse. Some have already tried to get clean from cocaine, meth, and other party drugs only to have failed miserably – directly or indirectly related to their search for a sexual high. While these addicts may for a time stop using stimulants, they still want and seek-out the thrilling, super-intense, days-on-end sex they used to have when high. When they return (now sober) to the places and people that offered those mind-blowing sexual experiences they end up using once again. And before the addict knows it, he or she is off and running. I cannot emphasize strongly enough the difficulty these addicts have in trying to achieve long-term drug sobriety! Remember, the most difficult substances to get and stay sober from are cocaine and crystal meth, and when the allure (and neurobiology) of sexual intensity is added to the use of those substances – triggering it, intertwined with it – the challenge of long-term drug recovery is magnified exponentially.
How Can We Treat this Population?
Until very recently, there was no drug and alcohol or sexual disorders rehabilitation facility that comprehensively treated drug abuse fused with problem sexual behavior. Thus, an individual with this “dual issue” would enter a well-regarded drug addiction treatment setting to deal with a cocaine or meth problem, only to have his or her concurrent sexual behavior minimized (due to client and staff discomfort with the subject) and/or written off as “something to deal with in your 9th step, since it only happens when you’re using.” So these clients – individuals with an extensive history of abusing drugs and sex simultaneously – have ended up being treated for only half their problem. Their shame and secrets regarding past sexual behaviors were left unaddressed, as was education regarding how they might handle SEX IN SOBRIETY. Many of these addicts left substance abuse treatment without even realizing there was a whole other set of issues that needed to be dealt with.
To address the needs of this population, the newly opened Stimulant and Sexual Disorders Program (SSDP) at Promises Malibu has developed and implemented the first drug treatment program in the US that concurrently addresses the unique issues of men who fuse stimulants and sexual behavior. In addition to traditional cognitive behavioral and 12-step type approaches typical to most good substance abuse programs, the SSDP integrates much needed medical and neurobiological components specifically designed to help clients deal with the urges and cravings that so often lead to stimulant/sex addiction relapse. To that end, the program has a dedicated focus on urge reduction, aided by state of the art computer-based cognitive training modules (or “brain training”) designed to improve short-term memory loss (a frequent problem for stimulant abusers), which helps to reduce impulsivity and response to cravings. Furthermore, the issue of how these clients can approach healthy sexuality is deeply embedded into the curriculum as a part of the relapse prevention focus. In essence, the SSDP provides a more integrated, holistic view of the addict’s mind and body – particularly in relationship to past and present sexual choices – than currently exists in any other inpatient treatment facility.
Hope for the Previously Hopeless
As mentioned earlier, clients who regularly fuse stimulant drug abuse with sexual behavior often present with a history of chronic relapse. Many have expended significant financial and other resources trying to achieve and maintain sobriety, only to relapse when the unrecognized, untreated, sexual half of their behavioral problem rears its ugly head. Some of these individuals have likely lost hope of ever achieving lasting sobriety. Only by recognizing and fully treating the fusion of their behaviors as one addiction can clinicians construct and implement treatment regimens that entirely (rather than partially) meet the needs of these heretofore “hopeless” addicts. Treating drug use and sexual acting out simultaneously is the best way to help these clients gain insight into the full nature of their addiction patterns, reduce shame, identify succinct relapse triggers, and develop a relapse prevention plan for the entire spectrum of their problem. When treated in this holistic way, these individuals are offered the best available opportunity to both develop and maintain a drug-free life.
1Terry L. Gatewood, “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, Cal State University, Los Angeles in June 2009.