Joe, a 32-year-old gay man, abuses meth while he compulsively looks for and engages in anonymous sex in bathhouses and other sex-focused venues – often for days on end without even pausing to sleep. Recently he was fired from his job for repeatedly failing to show up.
Marie, a 20-year-old college student, has gotten involved with a string of men who provide her with meth and/or cocaine – for partying, to enhance sexual activity, and also as a way to stay thin. Recently she has begun turning tricks in exchange for drugs.
Robert, 51 and married for 29 years, spends most of his weekends holed up in cheap motel rooms, snorting large amounts of cocaine, masturbating to online porn, and having sex with drug-abusing prostitutes. His wife has threatened to leave him if his behavior doesn’t change.
Approximately half of all self-identified sex addicts also have a history of substance abuse/addiction – usually alcohol, marijuana, cocaine or meth, or “party drugs” like Ecstasy, Ketamine, and GHB. While some sex addicts abuse substances as a way to tolerate or manage the emotional discomfort they experience related to their sexual acting out, others abuse substances in combination with their sexual acting out, taking drugs as a way to enhance, extend, and reinforce the intensity of their addictive sexual activity. Co-occurring abuse of stimulant drugs (like cocaine and methamphetamine) is particularly common among sex addicts. Sometimes these dual sex/stimulant abusers disappear into multi-day sex/drug binges. Males with this issue also tend to abuse erection-enhancing medications like Viagra, Cialis, and Levitra. And both genders can get hooked on benzodiazepines or off-the-shelf cold remedies, used as a way to “come down” when the binge finally ends.
Over time, sex addiction and drug abuse, particularly stimulant drug abuse, can become so tightly intertwined that one inevitably triggers and leads to the other. In other words, for some addicts, compulsively seeking/having sex and simultaneously abusing cocaine or meth (or another addictive substance) can become a single, paired addiction with interrelated, coexisting, complementary triggers and behaviors. For these addicts, the cycles of sexual addiction and drug addiction spin in concert.
Much of the time, men and women with this fused sex/stimulant addiction present in treatment with lengthy drug relapse histories. Usually they’ve expended significant financial and other resources seeking chemical sobriety, only to relapse when the perpetually untreated sexual half of their addiction pops up. In other words, these addicts enter drug abuse rehab and do their best, truly hoping for lasting sobriety, but the link between their sexual behaviors and their drug abuse is neither recognized nor addressed. Then they are released, they re-enter the real world confident and hopeful, and they go to meetings and get a sponsor and maybe they even work the 12 steps. Everything looks bright and sunny for them, until eventually they seek out the sexual intensity they’re accustomed to. This, of course, puts them right back in touch with the people, places, and things that have facilitated not only their sexual addiction, but their drug addiction. Before they even realize it, they’ve relapsed yet again. Sometimes, after multiple failed attempts at long-term chemical sobriety, these individuals lose hope, returning to treatment seeking nothing more than a respite from drug use – a few brief weeks of safety during which they can recharge their batteries before returning to active addiction.
Needless to say, this is not the hoped-for result when treating substance abuse issues (or any other type of addiction).
Sadly, the fusion of sexual addiction with stimulant drug use is double-trouble in terms of risks and potential consequences. In addition to all of the usual consequences of sexual addiction, these dually addicted men and women must deal with the debilitating physical, mental, and emotional effects of cocaine and meth abuse – rotting teeth, deviated septum, drug-induced psychosis, manic periods followed by depressive periods, inability to focus, impotence, anhedonia, paranoia, delusions, and more. And even before these typical stimulant drug side-effects kick in, users are at risk for other serious consequences because their decision-making process is greatly compromised when high. In short, while disinhibited by drugs, thoughts of safer sex may fly out the window – especially among sex addicts accustomed to marathon sessions with multiple partners. This, of course, greatly increases the risk for unwanted pregnancy and STDs. Even worse, addicts in long-term relationships have a tendency to contract STDs that they then transmit to their unsuspecting spouses and partners.
As mentioned above, men and women with a fused sex and stimulant addiction typically enter treatment for their drug abuse, only to have their co-occurring sexual addiction minimized or possibly even ignored – usually due to staff and/or client discomfort with and/or ignorance about sexual issues in general and sexual addiction in particular. Even in the rare instances when the client’s sexual issues are recognized, most drug abuse treatment providers gloss over the problem because “it only happens when the client is using,” or perhaps because they feel it is best dealt with later on as part of the recovering addict’s 12-step program (in steps 4 through 9). What these clinicians have failed to recognize is the fact that compulsive sexual behavior only happens when the client is high is far less important than the fact that compulsive sexual behavior always happens when the client is high. As a result, men and women with extensive histories of linking sexual activity and stimulant drugs are typically treated for only half of their addiction. Their shame and secrets about past and present sexual fantasies and behaviors are not addressed, nor are they educated about how they might be able to safely and healthfully engage in sexual activity post-treatment.
When sexual behavior patterns and stimulant drug abuse become deeply interrelated, the sexual issues must be treated in concert with the drug addiction, with clinicians in full awareness of the fact that either activity can trigger a relapse. It is a mistake to assume that getting a client chemically sober will also resolve his or her sexual issues (or vice versa, if the individual is seeking primary treatment for sexual addiction). In short, to achieve long-term sobriety with either addiction, both must be dealt with. Otherwise the client may not heal from either.
It is only when clinicians recognize and address the co-occurring nature of sexual addiction and stimulant abuse that individuals who have both issues can have their treatment needs fully rather than partially met. Treating their sexual addiction and their drug addiction simultaneously is the only real way to help them gain the necessary insight into the entire nature of their addiction – helping them to identify their triggers (both sex and drug-related), to reduce their shame (especially their sexual shame), and to see what healthy, non-addictive sexuality might look like. Treating sex and drug addicts in this much more holistic fashion, examining the complete spectrum of their addiction, is by far the best (and perhaps the only) way to effectively assist them in the formation and maintenance of lasting sobriety and a productive, happy, addiction-free life.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He is author of Cruise Control: Understanding Sex Addiction in Gay Men,and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships. For more information you can visit his website, www.robertweissmsw.com.