By Dr. David Fawcett

Countless individuals pair substance use and sexual behavior as a cross, co-occurring, or paired addiction. Often, this pairing involves a stimulant drug like cocaine or methamphetamine, though alcohol and a wide variety of other drugs, including erection-enhancers like Viagra, Levitra, and Cialis, are also used in conjunction with sex.

There are countless ways in which this pairing occurs, any of which can create a mutually reinforcing pattern. Based on my extensive clinical experience working with substance abusers, sex addicts, and substance/sex addicts, I have identified the following variations.

  • Substances Used for Sexual Disinhibition: Some people use the disinhibiting and confidence-building properties of alcohol and other drugs to overcome fears about their sexual desires and behaviors, or to overcome feelings of low self-worth in sexual settings.
    • Example: Jason’s unrealistically low self-esteem leaves him feeling unwanted and unattractive. So, when he goes out at night trying to meet someone, he drinks heavily, knowing that he is only able to approach a woman about hooking up when he is drunk. Sadly, he often gets so drunk that women who might otherwise be interested choose to ignore him. And those who are willing to go home with him typically leave disappointed because he is too drunk to perform sexually.
  • Substances Used to Numb Sexual Shame: Some people use the dissociative (numbing) properties of alcohol and other drugs to reduce the shame, anxiety, stress, guilt, and depression they feel about their sexual orientation, gender identity, sexual arousal template, or sexual behaviors.
    • Example: Eric reluctantly admits that he is attracted to both men and women, but mostly to men. Because of his family’s conservative religion and his personal beliefs about what it means to be gay (weak and effeminate), he struggles painfully with his bisexual/gay orientation. He finds that the only way he can overcome this shame and act on his arousal template is to drink or get high first. He uses after sex, too, to numb the shame he feels about what he just did.
  • Cycling Substance Use and Sexual Behavior: This is a pattern where substance use and sexual behavior alternate over a period of time – anywhere from a few days to several months. Often, people engage in one behavior in an attempt to control the other.
    • Example: Elise alternates with compulsive sexual behavior and heavy drinking. When she is being sexual, she chats online every night with dozens of men (and sometimes a few women), typically engaging in ‘dirty talk’ and mutual masturbation. Usually, after several weeks of this behavior, she feels ashamed, as if there is something inherently wrong with her that causes her to behave in this way. So she turns off the computer and numbs herself with marijuana and food. Those behaviors continue until she feels shame about them, at which point she sobers up and goes back to webcamming.
  • Ritualized Substance Use and Sexual Behavior: This is a ritualized cycle of addictive use, where the addict devotes a great deal of time and energy to planning for substance/sex behaviors – clearing his or her schedule, lining up a supply of drugs and sex partners, creating time for ‘recovery’ after a binge, etc.
    • Example: Alexander has a high paying, high-stress job during the week, and he substance/sex binges on the weekends. Usually, preparation for his binges begins on Wednesday when he starts cruising online sites for prostitutes and calls his cocaine dealer to set up a buy. On Thursday, he reserves a hotel room for the weekend, sets up ‘dates’ with several prostitutes, and stops by his dealer’s apartment to pick up the cocaine. When work ends on Friday, he has a few beers with colleagues and then heads to the hotel to party. He says he enjoys the ritualized anticipation of his weekends as much (and maybe more) than the actual events.
  • Paired Substance Use and Sexual Behavior: This is a pattern of substance use paired with sexual behavior. Often, though not always, the substance is a stimulant. Typically, if the user is engaging in one behavior, he or she is also engaging in the other. But it is still possible to have sex without substances, and to use substances without also pursuing sex.
    • Example: Mark is married and says he is attracted to his wife and they have a decent sex life together, even though they don’t have sex as frequently as they once did. He says he also likes porn, and he uses it to ‘fill the gaps’ in his sex life with his wife. Often, after she goes to bed and falls asleep, he does a few lines of cocaine and masturbates to porn, nearly always staying online for much longer than he intended. Then, when he finally shuts it down, he can’t sleep without the assistance of benzodiazepines.
  • Fused Substance Use and Sexual Behavior: This is the longer-term result of paired drug use and sexual activity, to the point where the two behaviors have fused. Substance use and sexual behavior become dependent on one another. For these individuals, there is no longer a separation between substance use and sexual activity.
    • Example: Andrew started pairing alcohol and either cocaine or meth with sexual behaviors in college, finding it easier to pick up women after a few drinks, and that sex was more enjoyable (and he was able to perform better) with stimulant drugs in his system. Now in his 30s, he can’t remember the last time he had sex without also being a little bit drunk and extremely amped up on either cocaine or meth. He also says that he only drinks and uses when he’s being sexual, and he’s only sexual when he’s drinking and using. For Andrew, substance use and sex have become a single, fused behavior.
  • Chemsex: This term originally referred to gay men pairing or fusing stimulants (usually meth) and sexual behavior, though other populations have begun to use this language. With chemsex, stimulant drugs are used for multiple purposes – to disinhibit, to overcome sexual shame, and to increase both sexual arousal and physical pleasure.
    • Example: Hector struggles with being gay, and also with being into kink. But he finds that when he can stop worrying and just let go, his BDSM encounters with other men can be incredibly hot. So a year ago he started getting high as a way to free himself mentally during sex. Now, after a year of this, he automatically smokes or shoots meth as part of his sexual behavior. Often, his meth/sex runs last for several days, only ending when he is dehydrated, exhausted, and paranoid from the drugs.

After many years spent working with individuals who engage in substance/sex behaviors – regardless of their substance of choice, sexual behavior of choice, and addictive pattern – I can tell you that nearly all of these individuals have two stages of recovery and healing. In the first stage, they attempt to address only half of their addiction, usually the substance abuse half. Inevitably, they relapse thanks to the unacknowledged and untreated half of their problem. In the second stage of recovery and healing, they recognize that their addiction is larger than they thought, and they need to address all aspects of their addictive behavior simultaneously if they hope to establish and maintain sobriety.

Stage One

  • Addressing Only Substance Abuse: This is a common mistake for substance/sex addicts. They assume that if they address their substance abuse issues, their sexual issues will go away on their own. These addicts undervalue or ignore the fact that their substance use and sexual behaviors are tied together. Then, when they go out seeking the sexual intensity they’re used to, they inexorably relapse with substances.
  • Addressing Only Sex Addiction: This is a less common mistake for substance/sex addicts, though it does occasionally occur. An addict assumes that if he or she can get sober from sex, porn, and similar behaviors, his or her desire to use and abuse addictive substances will abate and he or she will then be able to drink and use like a normal, non-addicted person. Eventually, however, they learn that any time they drink or use, the hunt for sex soon follows.

Stage Two

  • Addressing the Entire Addiction: Individuals who’ve addressed only half of a substance/sex addiction are incredibly susceptible to relapse, even when they are zealous about maintaining sobriety in the acknowledged half of their addiction. It is only when they uncover and address both halves of their addiction that they are able to establish and maintain a sober life. Dealing with only one half of an addiction is not enough.

The simple, sad reality is that cross, co-occurring, and paired substance/sex addictions are double trouble when it comes to relapse. Cues, triggers, and reactions for both behaviors can complicate the process of healing and recovery. Worse still, substance use and sexual activity can, over time, become very tightly paired, often to the point where they become a single, fused behavior. The deeper into that process the addict is, the less likely it is that getting sober from half the problem will have even a small positive impact.

Unfortunately, the link between substance use and sexual behavior is woefully under-researched. There is very little study of the ways in which substances and sex pair and the impact that such a pairing might have. But it is clear from both existing data and a great deal of anecdotal evidence that a lot of individuals – men and women, gay and straight, young and older – are indeed engaging in substance/sex behaviors to the point of addiction.

As stated earlier, for many of the people with this dual disorder, the substance of choice is meth, cocaine, or some other stimulant, mostly because stimulants can lower inhibitions, increase sexual intensity, and enable marathon sex – especially if erection-enhancing drugs like Viagra, Levitra, and Cialis are also in the mix. That said, other drugs, including alcohol, opiates, and benzodiazepines are also used in conjunction with sex. Sometimes they are used to disinhibit and reduce sexual shame. Other times they may be used at the end of a stimulant/sex binge as a way to ‘come down’ and get some rest.

Nearly always, substance/sex addicts report extensive histories of substance abuse, typically with multiple failed attempts to become and remain sober. Many have been to substance abuse rehab several times, always leaving the facility determined to stay sober but eventually relapsing related to the unacknowledged, untreated sexual half of their addiction.

This occurs because such a person is not just a substance addict and not just a sex addict. Instead, he or she is a substance/sex addict. Substance use and sexual behaviors are linked, possibly even fused. If the addict is engaging in one activity, he or she is or soon will be engaging in the other. For this individual, treating one half of the problem without also treating the other half is unlikely to result in any sort of lasting success. Until both halves of the addiction are treated concurrently, long-term sobriety and healing are probably not in the cards.

For more information about substance/sex addictions, join my weekly webinar on Wednesdays at 5 p.m. Pacific. There you can ask questions specific to your situation. If you are interested in treatment for a substance/sex addiction, visit the Seeking Integrity website.