Chemsex

Chemsex, described accurately

Chemsex is the intentional use of drugs before or during sex, in order to facilitate, prolong or intensify it.

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. In Bangkok it is a substantial and largely invisible presence in the expatriate scene, and it is one of the very few things nobody discusses 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 they fail.

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.

The Bangkok particular

Two things make this different here.

Crystal methamphetamine is cheap and abundant in Thailand in a way it is not in Europe, which changes the economics of escalation entirely.

And the expatriate scene is small. Everybody knows everybody, and the person you would consider seeing locally may well be part of the same community. That is not a reflection on Thai or expatriate clinicians. It is arithmetic, and it is the reason a great many people here never seek help at all.

I am outside that network. I do not know your employer, your friends, or anyone you might see at the weekend.

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.

Practicalities

Sessions are fifty minutes, weekly, by secure video, from anywhere in Thailand. In English or French. Confidential in the ordinary professional sense, and with no local overlap.

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 · trauma · sex and pornography addiction

In crisis in Thailand: Samaritans of Thailand English line 02 113 6789, press 2, anonymous and staffed around the clock. Department of Mental Health hotline 1323. In an emergency, go to the emergency department of an international hospital.

This page is for information and does not replace medical assessment. GHB and GBL overdose is a medical emergency.