Stéphane, a volunteer with the French community organisation AIDES, set the tone for the recent 3rd European ChemSex Forum in Paris when he explained why he continues to use drugs in sexual situations. There are multiple reasons, many of them shared by other people, he said.
“Firstly, the idea of pleasure is essential,” he said.
“There is also the fear of not being able to do without, as well as the fear of not being up to the mark.
“The disinhibition allows me to forget for a moment my body that I find hard to accept, and particularly the way other people look at me and their hurtful comments.
“And the loneliness experienced by many gay men is definitely a factor that encourages this behaviour.”
The discussions at these chemsex meetings have moved on since the first forum was held in London in 2016. Whereas there was plenty of survey data at the first forum, more attention is now being given to the complexity of people’s experiences. At the recent meeting in Paris, there were three closed sessions for ‘chemsex veterans’ and the main conference included many more personal testimonies.
Most men’s involvement with chemsex begins by seeking pleasure, even if it does not always remain care free. Jan Großer, a psychiatrist and activist based in Berlin, defined pleasure as a positive feedback mechanism that motivates us to repeat an action. As well as the intrinsic reward of sexual (physical) pleasure, sex can also have rewards in terms of bonding, belonging and identity.
There may be rewards in terms of helping us understand what makes us special as individuals, who we belong with and what qualities other people see in us. It may give us status, whether as half of a couple or as part of a group that sees itself as sexually adventurous. Sex can be a time away from day-to-day difficulties and satisfy our sense of adventure and curiosity.
However, some of these potential rewards may be in conflict with each other. “You may experience intimacy or you may experience being admired, but it’s very difficult to experience both,” he said. “Admiration is usually something very much linked to performance, while intimacy is something that has to do with being able to reveal yourself and feel secure and accepted in doing so.”
Rewards may be positive (they make you feel good) or negative (they remove some pain or distress). Großer argued that negative rewards are particularly relevant in relation to both sexual behaviour and substance use. Pleasure may result from successful defence against internal conflict and the resulting feelings of shame, anxiety, ambivalence and loneliness.
Elise Nelis, a psychiatrist and sexologist at GGZ inGest in Amsterdam, described one of her patients. He was brought up in a small town by religious parents who rarely talked about their emotions or feelings. They were generally negative about sexuality and, concerned about their judgement, he did not come out as gay until he was 28. He found his HIV diagnosis a few years later very difficult – he blamed himself, had feelings of self-hate and was afraid of never having another relationship. He had problems with depression, low libido and erectile dysfunction.
He said that crystal meth finally gave him sexual confidence and allowed him to let go of his boundaries. However, it did not resolve his underlying issues of self-stigmatisation, low self-worth and loneliness.
Jan Großer said that there are several ways people deal with feelings of shame – to rationalise them, to project them onto other people, to launch an aggressive counter response (‘how dare you?’), to seek validation, to pretend they are not there, and to avoid them to the extent that we do not feel them. Drug use can numb difficult feelings and is very often an avoidance behaviour.
“If your defence is successful, you may not even be aware that you are going through these conflicts and you may not even feel these feelings,” Großer said. “This doesn’t mean that these conflicts aren’t there, they will just play out in other ways.”
Adam Schultz, an activist and chemsex veteran based in London, said that services need to focus on each person’s specific issues. “It’s never about sex and it’s never about the chems: it’s about the person who is trying to escape,” he said.
He also said that it’s a misconception to think of chemsex users in terms of chaotic lives. He said they are often people who have the burden of having too much control in their lives and of trying to be ‘too good’. In his case, he had stability, a successful career and a relationship. But he was unhappy and wanted adventure and a feeling of freedom.
“The drugs came and the disinhibition allowed this other person to emerge,” he explained. “But because that person was denied his voice for so long, when it took over, it didn’t want to let go.”
Monty Moncrieff of London Friend said that an important aspect of the therapeutic groupwork that his organisation offers is encouraging men to be emotionally intimate and honest with each other. This is sometimes a new experience for men whose previous interactions with other gay men were mostly sexual. “Those sessions go way beyond just looking at the drug issue,” he said. “It’s looking at identity, relationships, sober sex, and anxiety around intimacy.”
Dr Alexandre Aslan, a medical doctor and sexologist leading on chemsex issues at the St Louis Hospital in Paris, said that just as HIV had transformed gay sexuality in the early days of the epidemic, chemsex was doing so now.
He described how chemsex can interfere with the usual sexual response cycle. Drugs and porn may mean that men bypass the first phase – of desire (sexual thoughts and interest) – and go straight to the second phase, of physical arousal. However, the drugs can often create problems specifically with erectile function – in the arousal phase – and make orgasm difficult to achieve, resulting in a ‘plateau’ phase that is never-ending.
Many men also find it difficult to go back to having sex without drugs. “It is very challenging to help to unlearn the connection between strong substances and sexuality after a history of chemsex,” commented Arnd Bächler of the counselling organisation Schwulenberatung Berlin.