Thursday, 28 January 2016
What is Chemsex?
It is the behaviour of intentional sex under the influence of psychoactive drugs, mostly among men who have sex with men (MSM).
The drugs used are predominantly mephedrone (GHB) or butyrolactone (GBL) and crystalised methamphetamine. These drugs are often used to facilitate sexual activities lasting several hours and, sometimes, days with multiple sexual partners.
What are the drugs used?
Mephedrone and crystal meth are physiological stimulants increasing the heart rate and blood pressure, triggering euphoria and sexual arousal. GHB and GBL are powerful psychological disinhibitor and also a mild anaesthetic.
These drugs thus increase sexual pleasure with less inhibitions. They sustain arousal and chemically induce a feeling of instant rapport with sexual partners.
Chemsex: an epidemic.
Chemsex behaviours is prevalent in London amongst the gay scene. Researchers also observe the same behaviours in other big cities around the world.
The regulation and monitoring of sex establishments such as saunas make Chemsex behaviours more difficult to engage in. Therefore, most Chemsex behaviours happen in private sex parties, in someone’s home, behind closed doors. These sex parties are also called ‘chill out’ parties. The great escalator to Chemsex behaviours is hook-up apps, such as Grindr, where it is easy to find the nearest ‘chill out’. In a big city, one can be walking into someone’s flat for a ‘chill out’ in only a few minutes.
It is so prevalent amongst gay men and MSM that health professionals are starting to call it the new epidemic affecting the gay scene. It is a hidden epidemic, that causes significant harm to the individuals engaging in Chemsex and the wider gay community.
We call it an epidemic because:
A UK study conducted in 2013 found that 3,000 gay men a month reported using recreational drugs when presenting to a sexual health clinic.
A survey conducted by David Stuart and Johannes Weymann, specialist at 56 Dean Street clinic reported the following worrying statistics:
Out of 874 MSM patients at the first presentation:
70% reported no chem-free sex in previous 6 months.
98% had never accessed statutory drug use support
This is suggesting that a majority of people engaging in Chemsex do not have sex without drugs (or sober sex) for a long period of time. The more people engage in Chemsex, the harder it is to have sober sex.
The Gateway to Chemsex is psychological.
The survey also reveals that Chemsex behaviour tends to accelerate:
Immediately after an HIV diagnosis
Immediately following the break-up of a relationship
Following migration to London
This is an interesting observation. It means that the gateway to Chemsex is mostly psychological: to self-medicate negative feelings regarding HIV diagnosis and relationships ending. It also tells us that gay people who come to London from smaller towns or countries where it is not so comfortable being gay fall into Chemsex rapidly because there is no model on how to manage sexual and romantic feelings with other men. This confirms what I hear in my consulting room on a regular basis:
‘I don’t know any gay men who have steady boyfriends’
‘I have never met someone who doesn’t cheat’
‘All gay men go saunas’
‘What does it mean to have an intimate relationship?’
‘I don’t even know what intimacy means.’
The messages that gay men get from the gay scene is largely about body perfection and is a highly sexualized environment. This brings on an immense pressure to conform to having a great body and always performing sexually. People coming to London may be battling against a set of high expectations in order to be accepted by the gay community. I often hear:
‘My body is just not good enough’
‘I feel ugly most of the time’
‘Who would want me?’
‘I want a boyfriend. I want to feel loved. That is all. But it is so difficult to find one boyfriend who is happy to stick around. It must be because I’m not good looking enough. Or perhaps I’m crap in bed’.
‘I often feel so anxious about having sex. What if my cock is too small? What if I can’t get an erection? It would be disaster’
‘I’m so anxious with the anal thing. I would be mortified if it gets… messy’
Engaging in sex can be tricky: the anxiety of being rejected because their body is not good enough, which in turns, may create erectile problems, which then transforms into ‘I’m not good in bed’, which seems to be the worst that one can be in the gay scene.
As mentioned above, the drugs used increase sexual arousal and decrease inhibition. In an instant, the drugs give the illusion that all of these terrible pressure and anxiety disappear. As soon as one is in the chemical haze of feeling instantly connected sexually with multiple partners, it is the equivalent to finally finding the key to intimacy, connection, acceptance.
It makes sense, therefore, that Chemsex is prevalent in the gay scene. It seems like it is the ‘cure’ to what the gay community has been suffering from: low self-worth.
Chemsex and the trauma of the gay community: the context that we can’t ignore.
The gay community has a traumatic past. Gay people were jailed and homosexuality was pathologised as a mental health disorder until 1967. Harassment continued a long time after 1967, with many gay men and women fighting for equal rights, marching in the streets whilst stones were thrown at them throughout the 70’s and 80’s. The AIDS crisis in the 80s added another layer of large scale trauma in the gay community. Today, although the UK is one of the wonderful leading countries in LGBT equal rights, where gay men and women can get married, we still hear stories from too many countries where gay men still get jailed and killed. When gay people hear those stories, they can relate to it straight away.
Homophobia is still very much alive.
Chemsex is the illusion of the antidote to homophobia: an instant, deep connection with multiple people, in a safe bubble.
Chemsex, internalised homophobia and shame.
There is another side to the trauma of homophobia. It is insidious, toxic and contagious, just like a virus. When one is feeling rejected because of who they naturally are, a deep psychological phenomenon happens: shame.
Most gay men have a sense of being different from other boys, usually as far back as they can remember, in early childhood. Of course, then, the young boy cannot put words like ‘gay’ or ‘sexuality’ or ‘homophobia’ into those uncomfortable feelings. So, instead, he has to make sense of those feelings the best he can. Often, the young boy translates those feelings into simple phrases such as: ‘There is something wrong with me’. Or ‘I am bad’. Or ‘I am wrong’. Or ‘I am not good enough’. These simple phrases feel so true at the time that they become embedded in the psyche, they become core beliefs, and the young boy grows up until adulthood retaining those core beliefs. By adulthood, those core beliefs are so deep-seated that they are even unconscious. However, being unconscious does not mean dormant. In fact, it is the opposite. Those unconscious core beliefs are dynamic, and they often pull the strings and run the show. It means that an intelligent fully grown man can make decisions based on core beliefs rather than on the reality is that in front of him.
Those core beliefs become triggered especially in situations when we feel vulnerable. We mostly feel vulnerable when we go on a first date. When we have sex. When we try to connect to others. When we want to be liked. When we want to feel accepted. Those core beliefs are the great motor of one of the most distressing human feelings: shame.
Chemsex is prevalent amongst the gay scene because it provides an instant psychological relief to the most painful feelings that many gay men have in common. So why is it bad?
The survey conducted by David Stuart and Johannes Weymann reveals that:
Chemsex episodes of between 12 to 48 hours are the norm:
12% reported one partner per episode
32% reported 2 or 3 partners per episode
45% reported between 4 and 10 partners per episode
11% reported 10 or more partner per episode
HIV+ve patients not on medications:
64% reported zero condom use for intercourse
10% reported using condoms for intercourse less than 50% of the time
HIV+ve patients on medications:
25% reported zero condom use for intercourse
51% reported using condoms for intercourse less than 50% of the time
HIV –ve patients:
30% had accessed one course of PEP in the previous 2 years
25% had accessed between 2 and 10 courses of PEP in the previous 2 years.
10% reported zero condom use for intercourse
40% reported using condoms for intercourse less than 50% of the time
These statistics show that the likelihood of contracting HIV when engaging in Chemsex is very high. When one feels the illusion of being free of shame, and having an instant deep connection to multiple sexual partners, it is much harder to engage the rational brain about the reality and the consequences of sexual behaviours. In fact, thinking about reality is not desirable because it would spoil the euphoria state that feels so good at the time.
The Chemsex Study published in March 2014 by Adam Bourne, David Reid, Ford Hickson, Sergio Torres Rueda and Peter Weatherburn looked at the links between Chemsex and sex, relationships and intimacy. It supports the psychological evidence that I observe in my psychotherapy consulting room: Chemsex is not only a drug problem. It is a sexual problem, sometimes covering other sexual problems such as erectile dysfunctions. It is a relational problem. It is an intimacy problem. It is a self-esteem and self-worth problem, including body image. It is an internalised homophobia problem. It is governed by deep-seated shame and deep-seated core beliefs about the self.
We form habits, addictions and compulsive behaviours by frequently going down the same pattern of behaviours. In the brain, it creates what we call a neuro-pathway. The more we engage in the behaviour, the stronger the neuro-pathway gets. And the stronger the neuro-pathway gets, the weaker other, healthier neuro-pathways get.
It means that pretty soon, it becomes impossible to feel sexual without drugs.
Sex and drugs become fused, it hijacks the natural arousal template of the individuals. Cues become distorted: for example, the sight of the iphone can be arousing if the individual has the habit of starting the Chemsex behaviour with Grindr, because on iphone there is Grindr, and on Grindr there is Chemsex. The thought of drugs can be the arousing element, rather than the sex itself, etc.
Other than high HIV transmission rate, and the hijacking of sexual arousal, Chemsex has many more negative consequences.
After Chemsex behaviours, when the drugs wear off, there is a crash into reality. When it happens, the negative core beliefs come back with a vengeance, usually much more acute than before starting Chemsex. People often feel intensely ashamed, angry with themselves, disgusting, depressed, anxious, ill, etc.
What seemed to be the ‘magic pill’ to the underlying shame actually makes it worse. And when we feel worse, we need to self-medicate more. A lot of gay men are trapped in that dark cycle of feeling bad and self-medicate, and they can’t see a way out. Indeed, when in that cycle, it is very hard to see a way out, unless you access professional and specialist help.
Other negative consequences include:
1- More sexual problems: The Chemsex Study (2014) reports: ‘Many participants described how drugs could significantly increase sexual desire or libido, but at the same time diminish sexual performance. Erectile dysfunction under the influence of crystal meth and mephedrone was very widely reported, as was retarded ejaculation.’
2- Difficulties maintaining a job, sometimes leading to losing a job.
3- Difficulties maintaining relationships and friendships.
4- Feeling more and more alienated from the rest of society, including the gay community, unless it is within the Chemsex users.
5- Feeling depressed and living in despair.
6- And, of course, the ultimate negative consequence is death. Chemsex does a lot of harm to the body as well as psychologically. Taking an overdose and passing out is common. Many young gay men in their early 30’s with no medical problems died as a direct result of Chemsex. In fact, often, patients come to me for help when they know a friend who died of Chemsex. It is the wake up call that gives them the courage to face their problem and seek professional help.
What does therapy addressing Chemsex look like?
1- First, we have to address what is urgent: addressing the present behaviours to start to be safe and stopping the self-harming behaviours.
2- Addressing behaviours to seek more balance in life: how to self-care and nurture ourselves. How to recognise when we are not feeling good about ourselves.
3- Addressing intimacy issues. Recognising intimacy. Learning to feel vulnerable and intimate without resorting to drugs.
4- Addressing relationship issues. Finding the map to navigate relationships and connections.
5- Addressing sexual issues. Re-connecting with the natural arousal template and getting to know ourselves sexually.
6- Addressing self-esteem and self-worth. Healing the shame and internalised homophobia. Identifying the negative core beliefs and change them to more reality-based, positive core beliefs.
7- Re-connecting with your daily needs and making the healthy choices to meet those needs.
The therapeutic process is challenging but it is the best gift of love to give to yourself. It is a place where you can start to make long-lasting changes and reconnect to your true self. The investment in therapy is so much less costly than drugs and its negative consequences.
I am a specialist in sex and relationship therapy with years of experience working with gay men. If you feel trapped in the negative cycle of Chemsex, help is available:
you can call me on 07958320565 or e-mail me on: email@example.com
If you are not sure about therapy, or if you can't afford the private fees, please do not stay without support! Access 56 Dean Street Clinic in Soho. It is a free NHS service and it is the world’s leading clinic in Chemsex support.