Chemsex: What It Is, Why It Is Hard to Stop
Chemsex is the intentional use of drugs before or during sex, in order to facilitate, prolong or intensify it.
Chemsex, described accurately
That definition matters, because the word gets used loosely. It does not mean having taken something at a party and later gone to bed with someone. It describes an arrangement in which the drugs and the sex have fused into one behaviour, planned together, sought together, and no longer easily separable.
It occurs predominantly, though not exclusively, among men who have sex with men. It is present in most large cities — London prominently among them — and it is one of the very few things that goes undiscussed even in communities that discuss everything.
The drugs, and why these three
Three substances do most of the work.
Crystal methamphetamine produces alertness, confidence and prolonged arousal, and dissolves inhibition. It also produces paranoia, and with sustained use a genuine risk of stimulant psychosis.
Mephedrone produces euphoria and a sense of connection and ease.
GHB or GBL are sedatives, and they are the reason chemsex has a body count. The gap between the dose that produces the effect and the dose that produces unconsciousness is unusually narrow, it varies between batches, and alcohol closes it further.
Sessions frequently combine all three. That combination is what makes risk impossible to calculate in the moment, and it is why the safety conversation cannot wait until someone is ready to stop.
Why it is so hard to stop
Most treatment approaches chemsex as a drug problem. That is usually why it fails.
For a great many people, chemsex is the first and only setting in which sex has been possible without shame. The drugs remove not just inhibition but self-consciousness, self-judgement, the sense of being unacceptable, and in some cases a body that has never felt permissible. Sex without those is an extraordinary experience, and it is not surprising that people organise their lives around returning to it.
Which means stopping is not a request to give up a substance. It is a request to go back to intimacy in the condition that made intimacy unbearable in the first place.
Underneath, very often, is something older: shame carried since adolescence, internalised stigma, a history of abuse, a long period of concealment. The behaviour is not the illness. It is the solution someone found to a problem nobody helped them with.
What treatment looks like
It does not begin with a demand for abstinence. Making that a condition of being helped generally ends the conversation rather than the behaviour, and it repeats the judgement that produced the shame in the first place.
It begins with safety. GHB dosing, not mixing with alcohol, not using alone, testing, and a realistic look at what a session actually costs in the days afterwards. This is not permission. It is the recognition that a person who is dead or psychotic cannot do therapeutic work.
Then the material underneath. What the shame is attached to, where it came from, what sex without chemicals would require, and what happened earlier that made concealment necessary. Where there is trauma in that history it is treated as trauma, including with EMDR.
And the isolation, which is usually the part people underestimate. Chemsex tends to shrink a life to the people who also do it, and rebuilding a life that has room for anything else is a large part of what recovery actually consists of.
Where medical help comes first
Some of this is not a psychotherapy problem in the first instance.
GHB and GBL dependence produces a withdrawal that can be severe and requires medical management; stopping abruptly and alone is dangerous. Stimulant psychosis needs psychiatric assessment. An overdose is an emergency. Where any of those apply, that treatment comes before, or alongside, the psychological work — and saying so plainly is part of the job.
When medical treatment comes first
This is psychotherapy, not medical treatment. Withdrawal from alcohol or benzodiazepines can be dangerous and occasionally life threatening, and needs to be managed by a GP, an addiction psychiatrist or a medically supervised detox rather than attempted alone. Where that is what is needed, it is said at the assessment and the referral is made.
The same applies where a psychiatric assessment should come first or run alongside the work, and where the right answer is residential treatment rather than weekly sessions. Therapy does the work that follows stabilisation, and it does that work better once stabilisation is in place.
Working on this
This is not a rehab and does not pretend to be. It is one-to-one specialist psychotherapy with one clinician, weekly, in person in London or by secure video anywhere else, in English or French — for people who will not go residential, and for people who have and now have to live at home.
Confidentiality is often the deciding factor. Scene and expatriate communities are small and overlapping, and a local clinician may be part of the same one. That is arithmetic rather than a criticism, and it is a reason a great many people never ask for help at all.
Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Doctorate of Professional Practice at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.
Related: addiction · sex and pornography addiction · shame
This page is for information and does not replace medical assessment. GHB and GBL overdose is a medical emergency: call 999 in the UK, or your local emergency number.