A Vicious Cycle: Stimulant Drugs and Compulsive Sex
For centuries, cocaine has been known for its aphrodisiac properties. During the late 19th and 20th centuries, cocaine gained notoriety for its ability to induce what was then known as “sexual “frenzy” and “uncontrollable lust.” More recently, methamphetamine also has become known for potent aphrodisiac properties as described over the past two decades or so by users seeking treatment for stimulant dependence.
A strong connection between drug use and sex appears to be more common and more powerful for methamphetamine than it is for cocaine. Similar to cocaine but even more dramatically, methamphetamine has been said to enhance sex drive, lower inhibitions, delay orgasm, and improve sexual performance. Moreover, these effects are considerably longer lasting with methamphetamine than with cocaine due to its longer half-life and duration of action. In addition, methamphetamine is less likely than cocaine to impair sexual performance, making it especially appealing to individuals seeking prolonged, highly erotic, and uninhibited sexual experiences.
Similar to cocaine but even more dramatically, methamphetamine has been said to enhance sex drive, lower inhibitions, delay orgasm, and improve sexual performance.-Arnold M. Washton
The link between methamphetamine use and sex has generated heightened public health concerns about the contribution of drug-related high-risk sexual behaviors to the spread of sexually transmitted diseases such as HIV and hepatitis C. Regardless of the user’s sexual orientation or gender, methamphetamine-induced hypersexuality is often associated with unsafe or high-risk sexual behaviors.
Under the influence of methamphetamine, individuals are less likely to use condoms, more likely to have sexual encounters with strangers whose health status is unknown, and more likely to engage in vigorous unprotected vaginal and/or anal intercourse with multiple sex partners. Recent studies indicate that among gay and bisexual men (i.e., men who have sex with men) methamphetamine use is associated with higher rates of HIV positivity, unprotected anal receptive sex, intravenous use and needle sharing, and engaging in unprotected sex with a partner who is HIV positive. In addition, methamphetamine users who are HIV positive appear to be less likely to comply with antiretroviral therapy and, not surprisingly, to sustain higher viral loads.
A Look at the Research
A study I conducted some years ago surveyed cocaine-related sexual behavior in cocaine users enrolled in an outpatient treatment program in New York City (see Washton & Zweben, 2009). We found that upwards of 50 percent of male patients reported their cocaine use was associated with increased sex drive, fantasies, and sexual acting-out behaviors. By contrast, fewer than 20 percent of female patients reported these effects.
A more recent study in California by Dr. Richard Rawson and colleagues at UCLA (see Washton & Zweben, 2009) found that among outpatients in treatment for stimulant dependence, methamphetamine users reported significantly stronger associations than did cocaine users between their drug use and various sexual behaviors. Whereas 60 to 70 percent of methamphetamine users reported drug-induced increases in sex drive, fantasies, pleasure, performance, obsession, and unusual or risky sexual behaviors, 40 to 50 percent of cocaine users reported these effects. Moreover, for methamphetamine users the powerful association between drug use and sex was as strong for women as it was for men whereas for cocaine users (similar to the earlier New York study) the association between drug use and sex was not nearly as strong for women as it was for men.
It is important to mention that a substantial number of stimulant users find that neither cocaine nor methamphetamine enhances their sexuality…-Arnold M. Washton
It is important to mention that a substantial number of stimulant users (the likely majority) find that neither cocaine nor methamphetamine enhances their sexuality or that these drugs have only negative effects (i.e., reduced sex drive and/or performance). It remains unknown as to why some users experience strong aphrodisiac effects from these stimulant drugs while others do not, why methamphetamine is a stronger aphrodisiac than cocaine for both sexes, or why cocaine has less effect on sexuality in women than in men.
Implications for Treating Stimulant Addiction
Assessment: The strong link between stimulant drug use and sex, the potential consequences of this phenomenon to individual and public health, and its role in perpetuating relapse all point to the importance of addressing this issue routinely in all individuals who seek treatment for stimulant abuse. The first clinical step is to assess whether a client’s stimulant drug use is linked with sex at all, and if so, to determine more specifically the nature and extent of this linkage. This assessment is best performed as part of a clinical intake interview to ensure that this linkage, when present, is taken into account in the initial treatment plan. An assessment questionnaire I developed for this purpose is in my book Cocaine and Methamphetamine Addiction: Treatment, Recovery, and Relapse Prevention (WW Norton, 2009).
Treatment Considerations: Breaking the connection between stimulant use and compulsive sex requires abstinence from drug use and in many cases temporary abstinence from sex. A “cooling off” period (e.g., 30 days) can help to diminish the power of the drug-sex connection and facilitate the process of identifying sexual relapse triggers such as those mentioned above. The long-term goal, of course, is not sexual abstinence but developing a satisfying sex life that does not involve using drugs.
When stimulant drug use and sex are strongly linked with one another, attempts to stay off the drugs are less likely to be successful if the client continues to engage in sexual behaviors previously associated with the drug use. These sexual behaviors are powerful triggers for drug urges and relapse. Similarly, returning to drug use will inevitably trigger sexual urges and a return to compulsive sexual behaviors. This phenomenon in which drug use leads to sex and sex leads to drug use has been termed “reciprocal relapse.”
This phenomenon in which drug use leads to sex and sex leads to drug use has been termed “reciprocal relapse.”-Arnold M. Washton
When a strong connection has been established between drugs and sex, stopping the drug use does not automatically stop recurring thoughts and fantasies about previous drug-related sexual experiences. Whereas these fantasies do tend to fade over time as drug abstinence continues, they are likely to be rekindled in full force by any return to stimulant use. For clients who reject the idea of a sexual “cooling off” period, especially those who have been engaging in high-risk sexual behaviors (e.g., unprotected intercourse with strangers), a harm reduction approach can be a useful option. For example, clients can be asked to stop engaging in high-risk sexual behaviors and switch instead to masturbation (even daily masturbation, if needed) as a way to relieve sexual tension, reduce the likelihood of returning to drug use, and eliminate exposure to the potential harm associated with high-risk behaviors.
Here are 8 tips that can help to break the sex-drug connection:
- Refrain from all sexual activity for at least an initial “cooling off” period (e.g., 30 days) to let the intensity and frequency of your sexual thoughts, feelings, and fantasies diminish.
- Identify sexual triggers associated with your drug use and develop an action plan to anticipate, avoid, or respond safely to these triggers.
- Develop a list of alternative activities that you can turn to when confronted with temptations and urges to act out sexually.
- Develop a social support system of empathetic people you can talk to about your struggle.
- Dispute and discuss your unrealistic thoughts about being unable to engage in erotic and exotic sexual experiences without getting high.
- Be proactively open and honest with your therapist and/or group about any thoughts and desires to act out sexually.
- Recognize that it is normal and expectable for you to be concerned that sex without drugs might be boring and unsatisfying. Learning how to enjoy sex again without using drugs is a process that may take some time. It will not happen overnight.
- Recognize that if you have little or no sex drive after stopping your drug use, this too shall pass. Most people find that it takes at least several weeks for their sex drive to return to normal.
The reference material for this article can be found in: Washton AM, Zweben ZE, Cocaine and Methamphetamine Addiction: Treatment, Recovery, and Relapse Prevention. (WW Norton, 2009).
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