Imagine if you will the most intense, amazing, and powerful, mood-altering, and mind-blowing meal of your life. Every bite is a smorgasbord of gastronomical orgasmic overload, with each bite propelling you to the next. While eating this meal of a lifetime, you experience extreme feelings of joy, pleasure, fulfillment, satiety, power, and importance. You cannot wait until the next time you can have this delectable delight.
You begin to plan, coordinate, organize, prepare, and fantasize about the next time you can indulge in the gluttonous smorgasbord of good feelings. Soon, you begin having this meal a couple of times per week. You find that the good feelings and pleasure you experienced your first couple of times with his meal does not match the initial event. You attempt to add new foods, new ways of preparing the meal, eating at different times of the day, spending more money on foods, yet you find you cannot match that initial experience.
In no time at all, you are giving up activities that were once important, isolating from loved ones, becoming pre-occupied with your next meal, you begin seeing weight gain, elevated blood pressure and other health issues, and a change in your feelings and emotions. You find after each gluttonous meal that those once good feelings you experienced after eating are replaced by shame, remorse and a promise to change these behaviors.
Well, for many men who have used methamphetamine, their first couple of times using meth and engaging in sexual activity is similar to this meal of a lifetime. The senses are heightened to a degree that cannot be attained or achieved through normal human activity. The initial “high” that is experienced becomes a futile effort in “chasing the dragon” in trying to recreate those first initial experiences. What started out as recreational, part-time use, soon consumes the individual. Once pleasurable and meaningful activities soon become unimportant, boring, and slowly drift out of the individual’s life. The obsession to use methamphetamine takes over and soon the individual experiences a change in their personality, a shift in morals and values, and the consequences of their continued use. Sometimes this happens quickly and other times, slowly.
Now, add the powerful experience of sexual activity to this combustible mix and you have set the stage of an interconnected and difficult challenge to tease apart meth use with sexual activity. Imagine the combined efforts of having sex on meth! A combined overload of Dopamine, Serotonin, and Endorphins followed by the release of Oxytocin post-orgasm and the individual has achieved the elusive, powerful, temporary, and unachievable through natural human efforts, the sexual experience of a lifetime.
Meth and sex neurotransmitters activated during meth use and sexual activity.
So, how does the cycle begin
Typically, many individuals have reported that their first meth use and sexual activity was like no other experience in their life. Meth is a stimulant that initially provides acute psychological effects on the brain including increased confidence, alertness, mood, increased sex drive, increased energy, talkativeness and decreases boredom, loneliness, and timidity. When used, crystal meth causes the user’s brain to produce abnormally high levels of dopamine. Users experience increased energy, prolonged sexual performance and suppressed appetite. It also causes intense sexual desire and lower sexual inhibition which can lead to sexually risky behaviors.
Many men in the gay, bisexual and M2M population report using meth due to cultural factors of internalized homonegativity, oppression and discrimination, shame, loneliness, a need for “false” intimacy, and societal heterosexism and heteronormative culture that views heteronormative behaviors and practices as the “acceptable” norms. Meth use allows individuals to engage in sex/sexual behaviors that fall out of the “accepted norms”, provides a sense of false confidence/self-esteem, and can provide a sense of belonging to a sub-culture that accepts the individual user as they are. Additionally, youth and beauty are revered in this community which set a high standard for anyone that falls outside of these parameters to feel less than or inadequate. The advent of the internet and hook-up apps provides the perfect backdrop and venue for seeking out like individuals who are looking to hook-up and score meth.
Unfortunately, this illusion and the perceived benefits of using meth and engaging in sex can only last so long. Meth use and sex may lead to high risk behaviors including an increase in the number of sexual partners, a decrease in disclosure of HIV status, a decrease in condom use, an increase in the probability of engaging in anal receptive sex, prolonged sexual encounters, intentional unprotected sex and extreme sexual behaviors.
How do we break the cycle
There is no one method of treatment that can address the complex interconnectedness between crystal meth use and sexual activity. Treatment and recovery must be individualized to each person. This may be through total abstinence or a harm-reduction model, or somewhere in between. Research supports that quitting all mood-altering substances (abstinence) increases an individual’s chances of sustained recovery.
Protect Yourself
One thing is for sure: Education, support, and self-introspection are required in order to break the cycle of the meth and sex connection. At PRIDE Institute, we work with hundreds of men each year that meet the criteria for substance use disorder-methamphetamine and report that they live outside of their value system for sexual behaviors. A “diagnosis” of a sexual disorder is not required; it is self-identification by the individual that seeks treatment that determines if the individual engages in sexual behaviors and activities that do not align with their value system and have identified that they cannot engage in sexual activity without the use of substances. We see men from all walks of life; from those who are professionals with a high economic status with minimal consequences related to their use to those who are living on the streets and indigent. As we know, addiction does not discriminate. It is also important to understand that a 28 day stay in a treatment setting does not recovery make. The first step in recovery is to remove the problematic substance and/or behaviors followed by a rigorous and honest look at the behaviors, attitudes, and thinking that keep the individual stuck in a cycle that is difficult to break. Let’s be honest…although not impossible, the rewards and the hijacked brain of those that use meth can make long-term recovery difficult but not impossible. It is not an uncommon phenomenon to see individuals return for a second, third, tenth or fifteenth treatment episode.
Because the pay-offs for using meth and engaging in sex can often be temporarily extremely rewarding and the brain reward system is hijacked by use, this reinforces the perceived pay-offs. It is crucial to have the individual take a look at the underlying issues that support these continued behaviors. As mentioned earlier, self-esteem, body image issues, need for validation, discrimination, shame, lack of confidence, feelings of inadequacy, internalized homo or bi-negativity, or the desire to escape or numb feelings and emotions, can all play into reasons for using. Other reasons may include the desire to feel powerful, seductive, to engage in sexual behaviors that aren’t considered part of the norm. Whatever the issues may be, the client must commit to begin exploring these issues in safe therapeutic relationships. In early recovery, it is also important that an individual commits to abstaining from meth use and sexual behaviors. It is very difficult to do the work that needs to be done if the individual is still engaging in these behaviors. This is not a permanent edict; at PRIDE we have found that individuals need time away from the behaviors in order to fully access their feelings and emotions, and not use these unhealthy coping measures to escape those feelings.
As an individual begins to uncover and articulate honestly the underlying issues that may be contributing to their behaviors, it is important that they also identify and acknowledge the pay-offs they have received from meth use and sexual activity. Whatever the pay-offs may be, it is important for the individual to begin exploring and identifying how these pay-offs can be gained in a healthy manner. If increased self-esteem is a pay-off for meth use, the individual must begin to identify, explore and practice healthy behaviors and thoughts that boost self-esteem.
It is imperative to talk about sober sex and how this may look to an individual. A safe and trusting space with like individuals can help normalize and allow for individuals to talk openly about issues that have led to or kept an individual stuck in the shame cycle. The individual must identify boundaries within their sexual life, and determine which behaviors and activities support their health and does not lead back to meth use. There are several models in the treatment of sexual behaviors that asks the individual to identify behaviors that are always unsafe to them, behaviors that may be unsafe, and behaviors that are always safe. The client identifies these behaviors and sets boundaries according to their where these behaviors fall in their identified boundaries. For example, a client who identifies that they cannot engage in fisting without using meth, then, particularly in early recovery, should avoid engaging in fisting activity. This is not to say that fisting cannot be eventually re-introduced to into the individual’s sexual repertoire, but it must be done slowly, with caution, and a safety plan created, should the client be triggered to use meth during this activity.
Part of this entire process is for the individual to identify their individual values and identify behaviors that support these values. If water sports are part of an individual’s value system and behaviors that do not lead to meth use, then by all means, get your fill. There is not judgment on the behavior. We are all sexual beings and have our likes and dislikes. The issue surfaces if and when a behavior/activity falls outside of the individual’s value system and engaging in these behaviors cannot be done without the use of meth.
It is of the utmost importance for individuals to talk about their likes and dislikes, their feelings and thoughts about sober sex and, moving forward, how these activities can be performed without the use of substances. Fantasy work can be a wonderful tool to help an individual begin identifying what they are seeking in their sexual lives and intimate relationships. The exercise can lead to building trust in a group and can offer insight into an individual.
At PRIDE Institute we have found that a group of individuals with the commonality of meth use and sexual behaviors, after establishing trust with each other, allows individuals to talk openly and without shame about their experiences. To know and understand that there are many other people who have similar or same experiences, is empowering and can help decrease the stigma and shame associated with meth use and sex. By normalizing experiences and talking openly with others about their sexual lives, the hope is that the individual can leave treatment and continue this work in support groups, individual therapy, or an identified meth and sex process group. In addition, there are a host of wonderful workbooks that can be utilized to move the client through recovery.
The interconnectedness of meth use and sexual activity is a difficult bind to break. It is not impossible, but it takes hard work, a willingness to go to any lengths to change, and the ability to be honest and vulnerable. Most individuals we have worked with at PRIDE Institute find comfort, support, and empowerment in doing this work with a group of like-minded individuals with a history of similar or shared experiences. The individual ultimately has to do the work, but they do not have to do it alone.
Now, if I could just quit planning my next meal….
Todd Connaughty, MA, LADC, Director of Clinical Services
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