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By Dr. David Fawcett

Like other addictions, paired substance/sex addiction creates consequences that are far beyond the imagination of users when they first experiment with these behaviors. People are initially pulled into these behaviors by the powerful and immediate psychological rewards they provide, along with the numbing and distraction from uncomfortable emotions. Unfortunately, things can quickly begin to fall apart, affecting the individual’s physical, psychological, interpersonal, and spiritual life. Physical and psychological impacts will be covered in this post. Interpersonal and spiritual impacts will be covered in next week’s post.

Physical Consequences

There are abundant physical consequences of paired drug use and sexual behavior, but those most on the minds of users are sexually transmitted infections (STIs). These range from the more dangerous STIs such as HIV to largely treatable STIs such as gonorrhea and syphilis.

Thankfully, HIV is much more manageable now than it was in the early years of the HIV epidemic thanks to antiretroviral medications and drugs such as PrEP (pre-exposure prophylaxis). These advances have been among the more remarkable achievements of medicine and have greatly reduced the mortality from HIV. Hepatitis B and Hepatitis C remain threats to drug users, too, particularly intravenous drug users, but even these viral infections are better managed today. There is a vaccine for hepatitis B, and there are effective medications to treat hepatitis C.

Other STIs have also been unwelcome companions of drug addicts for many years, and, unfortunately, some, such as syphilis, occur with greater frequency today than ever before. Most can be readily treated with antibiotics, although it is worrisome that new strains of drug-resistant gonorrhea and syphilis are emerging. These new strains are challenging the ability of doctors to manage these infections.

There are other dangerous physical consequences of paired drug use and sexual behavior. Liver and kidney damage are a constant concern, and amphetamine users must be alert to cardiac complications. These include pulmonary hypertension, cardiac infarcts (heart attacks), and stroke.[1]

Other drugs that are commonly used by those who pair drugs and sex also have notably dangerous properties. One such example is GHB/GBL (gamma hydroxybutyrate), which can easily cause respiratory failure when taken in large quantities.[2] GHB/GBL are close cousins of Rohypnol, the so-called date rape drug, and their use in drug and sexual contexts has resulted in an increase in sexual assault.

Finally, the dangers of alcohol, benzodiazepines (anti-anxiety medications), and opioids are well-known. Opioids create an intense and uncomfortable withdrawal, although such withdrawal is typically not life-threatening. Alcohol, on the other hand, can create potentially fatal withdrawal symptoms. Benzodiazepines also create a dangerous withdrawal, with psychological and physical symptoms including seizures. Detoxification from alcohol and benzodiazepines is very dangerous and should always be medically supervised.

Psychological Consequences

All addictions impact the amygdala, a very old part of our brain that regulates emotions. The amygdala is the reward center of the brain. It gives us bursts of “feel good” neurotransmitters when we behave in ways that help us sustain ourselves as individuals and as a species. These behaviors include cooperating, eating good food, loving and being loved, and most of all, having an orgasm.

Addiction commandeers this part of the brain, and there is no more powerful way to do this than paired drug use and sexual behavior.

As addictive processes take hold in this part of the brain, neural pathways connecting it with the frontal cortex (the thinking/reasoning part of the brain) grow thin.[3] The frontal cortex is responsible for controlling our behavior, predicting bad outcomes, resisting impulsive choices, and other essential executive functions. As a result of the diminishing role played by the frontal cortex, addictive processes gradually gather strength in the brain.

As stated in last week’s post, paired drug use and sexual behavior is an intensity addiction. As such, paired substance/sex use increases levels of incoming stimulation far above that found from any source in nature, thereby creating a new baseline for stimulation that must be reached in order to experience pleasure from any activity. Basically, the brain tries to maintain homeostasis.

One of the ways the brain compensates for heightened levels of stimulating input due to addiction is by shedding dopamine receptors. This effectively allows the brain to self-regulate by “turning down the volume” created by the heightened stimulation of substance/sex addiction. This creates the phenomenon of tolerance – a phenomenon that is universal among addictions but particularly profound with sex addiction and the use of certain types of drugs.

When someone enters recovery and ceases addictive behaviors, thereby reducing input and intensity, the brain is still accustomed to high levels of stimulation. This results in a period of anhedonia (the inability to experience pleasure) in the early months of recovery. This can also result in significant mood changes, notably hopelessness and depression. This has unfortunately caused many people who paired drug use and sexual behavior to think that, for them, recovery is simply not possible. This is not true, but it can seem logical to someone who is experiencing anhedonia.

Another psychological impact of paired substance/sex addiction, particularly with amphetamines, is a dramatic increase in psychotic episodes, especially paranoia. It is common for stimulant users, especially those who have used too much methamphetamine, to scan air vents for microphones and cameras and to sincerely believe that there are vast law enforcement efforts dedicated to following their every move. The psychotic features caused by meth can be quite profound and, in a small fraction of meth users, will persist even into recovery.

Perhaps the most profound psychological consequences of paired drug use and sexual behavior is the sense of hopelessness that begins to overwhelm the user. This is due not only to changes in the brain and the inability to experience pleasure but also to the sense of defeat that comes with trying to control addictive behavior. It is at this point that many people become open to discovering the relief of treatment and 12-step recovery.


[1] Paratz, E. D., Cunningham, N. J., & Macisaac, A. I. (2016). The Cardiac Complications of Methamphetamines. Heart, Lung and Circulation25(4), 325–332. doi: 10.1016/j.hlc.2015.10.019.

[2] Darke, S., Peacock, A., Duflou, J., Farrell, M., & Lappin, J. (2020). Characteristics and circumstances of death related to gamma hydroxybutyrate (GHB). Clinical Toxicology, 1–6. doi: 10.1080/15563650.2020.1726378.

[3] Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nature reviews. Neuroscience12(11), 652–669.