Working With Chemsex What Does It Give Your Client

When working therapeutically with chemsex, one of the most useful questions may not simply be:

“What is chemsex doing to this client?”

but:

“What is chemsex giving him?”

A client may already understand many of the consequences of his chemsex use. He may know about the comedowns, lost weekends, impact on work or relationships, sexual risks, financial cost, or the increasing difficulty of enjoying sex without drugs.

And yet the behaviour continues.

For different clients, chemsex may provide very different things.

It may offer: • sexual confidence • connection and belonging • freedom from self-consciousness • permission to explore sexual desires • escape from difficult thoughts or feelings • relief from loneliness or shame • validation and the experience of feeling desired • intensity, excitement and novelty

If we ask a client to reduce or stop chemsex, we may therefore be asking him to give up much more than drugs.

We may be asking him to give up one of the few places where he feels sexually confident, connected, uninhibited, desirable or able to escape from himself.

That raises an important therapeutic question:

If he gives up chemsex, what is he losing?

If chemsex gives him confidence, how might he begin developing sexual confidence without relying entirely on intoxication?

If it gives him connection, what is happening in his relationships and social life when he is sober?

If it gives him sexual permission, what does he believe about his desires when he isn't high?

If it provides escape, what is he trying not to feel?

And if it provides intensity, what has happened to pleasure, excitement and novelty elsewhere in his life?

Understanding these functions does not mean minimising the risks or consequences of chemsex.

It means recognising that behaviour which continues despite significant consequences may still be serving an important psychological function.

Sometimes a client's first explanation is simply:

“Sex is better.”

But what exactly is better?

Perhaps he doesn't worry about his body.

Perhaps performance anxiety disappears.

Perhaps he feels more desirable.

Perhaps intimacy becomes easier.

Perhaps desires he normally feels ashamed of suddenly feel permissible.

The therapeutic conversation can then move beyond:

“How do we stop this behaviour?”

towards:

“What psychological job is this behaviour doing?”

That distinction can help identify what the therapeutic work may actually need to address.

Chemsex: Clinical Resources for Therapists

This video is the first in a professional series for psychotherapists, psychologists, counsellors, sex therapists and other clinicians working with gay and bisexual men around chemsex, PnP, sexuality, relationships and substance use.

The series continues with: 2. When Insight Isn’t Enough: Why Clients Continue Chemsex Despite Understanding the Pattern

Exploring what happens when a client understands his chemsex remarkably well but insight still doesn't translate into behavioural change.

3. Chemsex Freedom for Therapists: Supporting Clients Between Sessions

Exploring how structured daily work can support clients outside the therapy room and potentially complement ongoing therapeutic work.