Co-Occurring Substance Use and Sexual Behavior: The Need for Simultaneous Treatment

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Co-occurring substance use and sexual behavior can refer to many different combinations and reasons for drug use that is coupled in some way with sexual behavior. The various manifestations of co-occurring substance use and sexual behavior are discussed in a previous blog on this site. Whatever form these dual behaviors take, one thing is certain: They are double-trouble when it comes to addiction, consequences, and relapse.

When substance use is consistently mixed/paired/fused with sexual behavior, substances and sex become mutually reinforcing. Over time, a single set of fused cues, triggers, actions, and reactions forms for both behaviors which can complicate the process of healing and recovery for those who are struggling and want to stop. Essentially, anything that triggers a desire for sex (a billboard, a magazine image, an attractive person walking by, the scent of perfume or cologne, etc.) will also trigger the desire to get high, and vice versa.

Over time, substance abuse and sexual behaviors can become very tightly paired, so much so that engaging in one activity inevitably leads to engaging in both. For individuals with this co-occurring issue, substance use and sex essentially become a single behavior.

Unfortunately, the link between substance use and sexual behavior is under-researched. That said, it is clear from the existing data (and a great deal of anecdotal evidence) that a lot of people out there are pairing substance use with sexual compulsivity.

For people with this dual disorder, the substance of choice is typically (though not always) a stimulant drug like cocaine or meth, mostly because stimulants both lower inhibitions and enable marathon sex. Men may add other mood-altering drugs along with Viagra, Levitra, Cialis, and similar medications to the mix (for obvious reasons). And both genders tend to use cold medicine, benzodiazepines, alcohol, other depressants, and recently even heroin to “come down” when the action ends.

These individuals often report extensive histories of substance abuse/addiction, with multiple instances of relapse. When questioned about their sexual behavior as well as their substance use, it becomes clear that their relapses are nearly always tied to emotional stress, relationship and intimacy issues, or sexual behavior. Until very recently, these individuals would repeatedly enter substance addiction rehab, complete treatment thinking they finally had their drug use under control, only to relapse because of relationship stress or sexual behavior.

Because the vast majority of substance abuse treatment programs do not adequately address a client’s relationship and sexual history in an in-depth manner, those aspects of their problematic behavior go unrecognized and untreated. Then, post-rehab and not understanding the dual nature of the addiction (and the dual ways in which it can be triggered), the client searches for the same type of hyper-intense sexual and romantic encounters that he or she is used to, and almost inevitably drugs re-enter the picture.

This occurs because such an individual is not just a substance addict and not just a sex addict. Instead, this person has a problem with co-occurring substance use and sexual behavior. Substance use and sexual behaviors are linked. Drugs and sex are not separate issues; they are a single, paired behavior. If this individual is engaging in one activity, he or she is almost assuredly engaging in the other. For this individual, treating one-half of the problem without also treating the other half significantly heightens the risk for relapse. Until both halves of this paired problem are treated concurrently, long-term sobriety and healing are unlikely.

If you or someone you love is struggling with sex, porn, or paired substance/sex addiction, we offer both inpatient treatment and low-cost online workgroups. For extensive free information, including webinars, podcasts, blogs, resources, and daily inspiration for healing, we urge you to explore our sister website,