Does “one more” often turn into “more than you intended?”

Do you find having sex to be difficult or “impossible” without being under the influence?
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Do your loved ones protest against your drinking or use?

Do you find that your behavior is drastically different “under the influence” than “sober?”
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Is using alcohol or drugs to have sex “normal?”

Addictions and substance use disorders can be difficult to detect, especially in times and contexts when drinking and use are encouraged. The following are some criteria used in the DSM-V to differentiate between casual and problematic use:

• Taking the substance in larger amounts or for longer than you're meant to.
• Wanting to cut down or stop using the substance but not managing to.
• Spending a lot of time getting, using, or recovering from use of the substance.
• Cravings and urges to use the substance.
• Not managing to do what you should at work, home, or school because of substance use.
• Continuing to use, even when it causes problems in relationships.
• Giving up important social, occupational, or recreational activities because of substance use.
• Using substances again and again, even when it puts you in danger.
• Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
• Needing more of the substance to get the effect you want (tolerance).
• Development of withdrawal symptoms, which can be relieved by taking more of the substance.​

Interplay Between Sex and Substances

Being sexual and using substances both have significant payoffs and it’s understandable that many people are drawn to both behaviors, often simultaneously. The following is a partial list of some possible consequences related to substance abuse and sex:

• Violation of personal sexual boundaries (that might be less likely to occur sober)
• Having sex without being fully present to the experience/sensations, including failure to recall past sexual experiences
• Unwanted transmission of sexually transmitted infections (STIs)
• Unplanned pregnancy
• Possible financial consequences associated with decisions around substances and/or sexual practices
• Difficulty with sexual functioning (e.g. erections, ejaculation, lubrication, orgasm, etc.)

What to Do If You Think You Might Have a Problem

1. Take stock of the situation. Cultivate an awareness of your use. How much are you using? Is your use consistent or more context-dependent? You can’t change what you don’t know.
2. Set SMART (specific, measurable, attainable, realistic, time-bound) goals. Set yourself up for success by envisioning the change you wish to see. When you have a target, it can be easier to start taking the steps necessary to modify your behavior. You may also gain insight into the behavioral change process and reasons underlying your use.
3. Increase accountability. Change is hard enough, there’s little sense in doing it alone. Find a trusted mental healthcare provider and recovery support groups (peers and mentors) to facilitate your recovery journey. 

It may not seem like much, but you might be surprised by how something small like an adjustment to your drinking or use can have positive ripple effects in your life. Many clients have noted marked improvements in their work/life balance, relationships, and sex lives to name a few. Part of this transformation involves identifying core reasons for “acting out” with substances e.g., escapism, loneliness, trauma, depression/anxiety, etc. If connection is the antidote to problematic use, it follows that managing or even eliminating use can lead to radical differences (for the better) in relating and sexual fulfillment. In therapy, you can realize empowerment by altering your dependence on substances. 

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Therapy Goals Individualized to You

Not everyone has to give up everything! You may find that your life improves drastically with some boundaries around your drinking or use without resorting to full abstinence. Sometimes it’s simply a matter of determining what those boundaries are (and adhering to them) and working with a professional to support you. One of the most important elements to recovery is an open mind! 

Meet James Chadwick, a Minnesota sex therapist with training and specialization in the intersection of substance abuse disorders and sexuality.

“Drugs, and especially alcohol, are an indelible part of our culture, and addictions involving them are increasingly common. It may be that you are looking to change your relationship with drugs and alcohol, or terminate it altogether. The intersection between sex, relationships, gender identity, sexual orientation, and use can be complex, multi-faceted, and difficult to sort out. Whatever your goals and boundaries around your use, I look forward to supporting you in your journey!”
~James Chadwick, MSW LICSW

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