Psychoactive Substance Uses and Sexual Behavior

Document Type : Original Article

Author

Assistant Professor, Departement of Psychology, Institute for Humanities and Cultural Studies, Tehran, Iran.

Abstract

Introduction: The relationship between psychoactive substances and sexual behavior is an increasingly important area of research in substance use, primarily due to the prevalence of high-risk sexual behaviors among individuals with substance dependence. The aim of this study was to examine the various relationships between the use of different psychoactive substances and sexual behavior.
 
Method: This study employed a narrative review methodology. To collect data, relevant articles were searched using the keywords  substance use, functions and dysfunctions, sexual behaviors, and  sexual assault. using Google Scholar and PubMed, as well as the NOORMAGS, SID, and Irandoc databases.
 
Results: Behavioral substance use is relatively common. Acute substance use can enhance or improve sexual function and facilitate sexual behavior by reducing inhibitions. Chronic substance use is linked to sexual dysfunctions, such as decreased libido and erectile dysfunction. Additionally, substance use contributes to high-risk sexual behaviors and increases the incidence of sexually transmitted infections (STIs). Substance-facilitated sexual assault is prevalent, yet it is often underreported.
 
Discussion and Conclusions: Evaluating the relationship between substance use and sexual behavior is a crucial component of comprehensive assessment and treatment planning. The clinical benefits of addressing these issues can be substantial, ranging from a reduction in risky sexual behaviors to an enhancement of individuals' quality of life.

Keywords


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    1. Li J, Liu H, Li J, Luo J, Koram N, & Detels, R. Sexual transmissibility of HIV among opiate users with concurrent sexual partnerships: an egocentric network study in Yunnan, China. Addiction (Abingdon, England). 2011; 106(10): 1780–1789. https://doi.org/10.1111/j.1360-0443.2011.03459.x
    2. Armour S, & Haynie DL. Adolescent Sexual Debut and Later Delinquency. Journal Of Youth And Adolescence. 2006; 36(2), 141–152.
    3. Hallinan R. Sexual Function and Alcohol and Other Drug Use. In N, el-Guebaly G, Carrà., M, Galanter., A.M, Baldacchino. (eds) Textbook of Addiction Treatment. 2021Springer; Cham.
    4. Nevendorff L, Schroeder SE, Pedrana A, Bourne A, Stoové M. Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta-analysis. Journal of the International AIDS Society. 2023; 26(1): e26054. https://doi.org/10.1002/jia2.26054
    5. Ghadigaonkar DS, Murthy P. Sexual dysfunction in persons with substance use disorders. Journal of Psychosexual Health. 2019; 1(2), 117-121.
    6. Palha AP, & Esteves M. (2008). Drugs of abuse and sexual functioning. In R. Balon (Ed), Sexual Dysfunction. 2008; Karger. 131–149. https://doi.org/10.1159/000126628
    7. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's comprehensive textbook of psychiatry. Wolters Kluwer (10th edition). 2017.
    8. Boland R, Verduin M, Ruiz P. Kaplan and Sadock's Synopsis of Psychiatry. Wolters Kluwer 2022. (12th edition).
    9. Feaster D J, Parish CL, Gooden L, Matheson T, Castellon PC, Duan R, et al. Substance use and STI acquisition: Secondary analysis from the AWARE study. Drug and alcohol dependence. 2016; 169: 171–179. https://doi.org/10.1016/j.drugalcdep.2016.10.027
    10. Bruno A, Scimeca G, Marino AG, Mento C, Micò U, Romeo VM, et al. Drugs and sexual behavior. Journal of psychoactive drugs. 2012; 44(5): 359–364. https://doi.org/10.1080/02791072.2012.736801
    11. Carroll JF, McGinley JJ, Mack SE. Exploring the self-reported sexual problems and concerns of drug-dependent males and females in modified, therapeutic community treatment. Journal of substance abuse treatment. 2001; 20(3): 245–250. https://doi.org/10.1016/s0740-5472(01)00164-7
    12. El-Bassel N, Gilber L, Rajah V. The relationship between drug abuse and sexual performance among women on methadone. Heightening the risk of sexual intimate violence and HIV. Addictive behaviors. 2003; 28(8): 1385–1403. https://doi.org/10.1016/s0306-4603(02)00266-6
    13. American Psychological Association. Publication manual of the American Psychological Association (7th ed.). 2020.
    14. Edmundson C, Heinsbroek E, Glass R, Hope V, Mohammed H, White M, et al. Sexualised drug use in the United Kingdom (UK): A review of the literature. International Journal of Drug Policy. 2018; 55: 131-148. https://doi.org/10.1016/j.drugpo.2018.02.002
    15. Pufall EL, Kall M, Shahmanesh M, Nardone A, Gilson R, Delpech V, et al. Sexualized drug use (‘chemsex’) and high‐risk sexual behaviours in HIV‐positive men who have sex with men. HIV medicine. 2018; 19(4): 261-270. https://doi.org/10.1111/hiv.12574
    16. Zemishlany Z, Weizman A. The impact of mental illness on sexual dysfunction. Sexual dysfunction. 2008; 29: 89-106. https://doi.org/10.1159/000126626
    17. Gómez-Núñez MI, Molla-Esparza C, Gandia Carbonell N, Badenes Ribera L. Prevalence of Intoxicating Substance Use Before or During Sex Among Young Adults: A Systematic Review and Meta-Analysis. Archives of Sexual Behavior. 2023. 1-24. https://doi.org/10.1007/s10508-023-02572-z
    18. Ssekamatte T, Nalugya A, Mugambe RK, Wagaba B, Nakalembe D, Mutebi A, et al. Prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda. BMC public health. 2023; 23(1): 1-13. https://doi.org/10.1186/s12889-023-15679-8
    19. Foxman B, Aral SO, Holmes KK. Common use in the general population of sexual enrichment aids and drugs to enhance sexual experience. Sexually transmitted diseases. 2006; 156-162. https://doi.org/10.1097/01.olq.0000187210.53010.10
    20. Bellis MA, Hughes K, Calafat A, Juan M, Ramon A, Rodriguez JA, et al. Sexual uses of alcohol and drugs and the associated health risks: a cross sectional study of young people in nine European cities. BMC public health. 2008; 8: 155. https://doi.org/10.1186/1471-2458-8-155
    21. McElrath K. MDMA and sexual behavior: ecstasy users' perceptions about sexuality and sexual risk. Substance use & misuse. 2005; 40(9-10): 1461–1477. https://doi.org/10.1081/JA-200066814
    22. Zemishlany Z, Aizenberg D, & Weizman A. Subjective effects of MDMA (‘Ecstasy’) on human sexual function. European Psychiatry. 2001; 16(2), 127-130. https://doi.org/10.1016/s0924-9338(01)00550-8
    23. Rawson, RA, Washton A, Domier CP, & Reiber C. Drugs and sexual effects: role of drug type and gender. Journal of substance abuse treatment. 2002; 22(2): 103–108. https://doi.org/10.1016/s0740-5472(01)00215-x
    24. McKay A. Sexuality and substance use: The impact of tobacco, alcohol, and selected recreational drugs on sexual function. The Canadian journal of human sexuality. 2005; 14(1/2): 47.
    25. Halikas J, Weller R, Morse C. Effects of regular marijuana use on sexual performance. Journal of Psychoactive Drugs. 1982; 14(1-2): 59-70.
    26. Moser A, Ballard S‌M, Jensen J, Averett P. The influence of cannabis on sexual functioning and satisfaction. Journal of Cannabis Research. 2023; 5(1): 1-11. https://doi.org/10.1186/s42238-022-00169-2
    27. Rosen RC. Alcohol and drug effects on sexual response: Human experimental and clinical studies. Annual review of sex research. 1991; 2(1): 119-179.
    28. Smith DE, Moser C, Wesson DR, Apter M, Buxton ME, Davison JV, et al. A clinical guide to the diagnosis and treatment of heroin-related sexual dysfunction. Journal of Psychoactive Drugs. 1982; 14(1-2): 91-99. https://doi.org/10.1080/02791072.1982.10471916
    29. Palha AP, Esteves M. A study of the sexuality of opiate addicts. Journal of Sex &Marital Therapy. 2002; 28(5): 427-437. https://doi.org/10.1080/00926230290001547
    30. Chessick RD. The pharmacogenic orgasm in the drug addict. Archives of General Psychiatry. 1960; 3(5): 545-556. https://doi.org/10.1001/archpsyc.1960.01710050095010
    31. Seecof R, Tennant FS. Subjective perceptions to the intravenous “rush” of heroin and cocaine in opioid addicts. The American journal of drug and alcohol abuse. 1986; 12(1-2), 79-87. https://doi.org/
    32. Smith AM, Ferris JA, Simpson JM, Shelley J, Pitts MK, Richters J. Cannabis use and sexual health. The journal of sexual medicine. 2010; 7(2 Pt 1): 787–793. https://doi.org/10.1111/j.1743-6109.2009.01453.x
    33. Redmond Jr DE, Kosten TR, Reiser MF. Spontaneous ejaculation associated with anxiety: psychophysiological considerations. The American journal of psychiatry. 1983; 140(9): 1163-1166. https://doi.org/10.1176/ajp.140.9.1163
    34. Peugh J, Belenko S. Alcohol, drugs and sexual function: a review. Journal of psychoactive drugs. 2001; 33(3): 223-232. https://doi.org/10.1080/02791072.2001.10400569
    35. Hafen BQ, Soulier D, Black C. Amphetamines Facts and Figures: Facts, Figures, and Information. Hazelden Publishing.1990.
    36. Semple SJ, Patterson TL, & Grant I. The context of sexual risk behavior among heterosexual methamphetamine users. Addictive behaviors. 2004; 29(4): 807-810. https://doi.org/10.1016/j.addbeh.2004.02.013
    37. Kurtz SP. Post-circuit blues: motivations and consequences of crystal meth use among gay men in Miami. AIDS and Behavior. 2005; 9: 63-72. https://doi.org/10.1007/s10461-005-1682-3
    38. Kirby T, Thornber-Dunwell M. High-risk drug practices tighten grip on London gay scene. The Lancet. 2013; 381(9861): 101-102. https://doi.org/10.1016/s0140-6736(13)60032-x
    39. Stuart, D. ChemSex and care-planning: One year in practice. HIV nursing. 2015; 15(2), 24-28. View of ChemSex and care-planning: One year in practice
    40. Mohammed H, Were J, King C, Furegato M, Nardone A, Hughes G. Sexualised drug use in people attending sexual health clinics in England. Sexually transmitted infections. 2016; 92(6): 454-454. https://doi.org/10.1136/sextrans-2016-052740
    41. Giorgetti R, Tagliabracci A, Schifano F, Zaami S, Marinelli E, Busardò FP. When “chems” meet sex: a rising phenomenon called “chemsex”. Current neuropharmacology. 2017; 15(5): 762-770. https://doi.org/10.2174/1570159X15666161117151148
    42. Donnadieu-Rigole H, Peyrière H, Benyamina A, & Karila L. Complications related to sexualized drug use: what can we learn from literature?. Frontiers in neuroscience. 2020; 14: 548704. https://doi.org/10.3389/fnins.2020.548704
    43. Gilbart VL, Simms I, Jenkins C, Furegato M, Gobin M, Oliver I, et al. Sex, drugs and smart phone applications: findings from semistructured interviews with men who have sex with men diagnosed with Shigella flexneri 3a in England and Wales. Sexually transmitted infections. 2015; 91(8): 598-602. https://doi.org/10.1136/sextrans-2015-052014
    44. Heinsbroek E, Glass R, Edmundson C, Hope V, & Desai M. Patterns of injecting and non-injecting drug use by sexual behaviour in people who inject drugs attending services in England, Wales and Northern Ireland, 2013–2016. International Journal of Drug Policy. 2018; 55: 215-221. https://doi.org/10.1016/j.drugpo.2018.02.017
    45. Mostafa T, Alghobary M. Substance abuse and male sexual dysfunction: what lies beneath?. Sexual Medicine Reviews. qead011. 2023. https://doi.org/10.1093/sxmrev/qead011
    46. Derby CA, Mohr BA, Goldstein I, Feldman H. A, Johannes CB, McKinlay JB. Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk?. Urology. 2000; 56(2): 302-306. https://doi.org/10.1016/s0090-4295(00)00614-2
    47. Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Preventive medicine. 2000; 30(4): 328-338. https://doi.org/10.1006/pmed.2000.0643
    48. Dorey G. Is smoking a cause of erectile dysfunction? A literature review. British Journal of Nursing. 2001; 10(7): 455-465. https://doi.org/10.12968/bjon.2001.10.7.5331
    49. Gades NM, Nehra A, Jacobson DJ, McGree M E, Girman CJ, Rhodes T., et al. Association between smoking and erectile dysfunction: a population-based study. American journal of epidemiology. 2005; 161(4): 346-351. https://doi.org/10.1093/aje/kwi052
    50. Natali A, Mondaini N, Lombardi G, Del Popolo G, Rizzo M. Heavy smoking is an important risk factor for erectile dysfunction in young men. International journal of impotence research. 2005; 17(3): 227-230. https://doi.org/10.1038/sj.ijir.3901275
    51. Sullivan ME, Keoghane SR, Miller MAW. Vascular risk factors and erectile dysfunction. BJU international. 2001; 87(9): 838-845. https://doi.org/10.1046/j.1464-410x.2001.02211.x
    52. Wolf R, Shulmam A. Erectile dysfunction and fertility related to cigarette smoking. Journal of the European Academy of Dermatology and Venereology. 1996; 6(3): 209-216.
    53. Salari N, Hasheminezhad R, Abdolmaleki A, Kiaei A, Shohaimi S, Akbari H, et al.The effects of smoking on female sexual dysfunction: a systematic review and meta-analysis. Archives of women's mental health. 2022; 25(6): 1021-1027. https://doi.org/10.1007/s00737-022-01281-1
    54. Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU international. 2004; 94(9): 1310-1313. https://doi.org/10.1111/j.1464-410X.2004.05162.x
    55. Vuong C, Van Uum SH, O'Dell LE, Lutfy K, & Friedman TC. The effects of opioids and opioid analogs on animal and human endocrine systems. Endocrine reviews. 2010; 31(1): 98–132. https://doi.org/10.1210/er.2009-0009
    56. Cushman P. Sexual behavior in heroin addiction and methadone maintenance. New York State Journal of Medicine. 1972.
    57. Mintz J, O'hare K, O'brien CP, Goldschmid J. Sexual problems of heroin addicts. Archives of General Psychiatry. 1974; 31(5): 700-703. https://doi.org/10.1001/archpsyc.1974.01760170088014
    58. Masters WH, Johnson VE, Kolodny RC. Masters and Johnson on sex and human loving. 1986. https://doi.org/
    59. Pizzol D, Demurtas J, Stubbs B, Soysal P, Mason C, Isik AT, et al. Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis. American journal of men's health. 2019; 13(6): 1557988319892464. https://doi.org/10.1177/1557988319892464
    60. Calabrese, G. Nonalcoholic compounds of wine: the phytoestrogen resveratrol and moderate red wine consumption during menopause. Drugs under experimental and clinical research. 1999; 25(2-3): 111-114.
    61. Nordmann R, Ribiere C, Rouach H. Ethanol-induced lipid peroxidation and oxidative stress in extrahepatic tissues. Alcohol and Alcoholism. 1990; 25(2-3): 231-237. https://doi.org/10.1093/oxfordjournals.alcalc.a044996
    62. Rivier C, Rivest S, Vale W. Alcohol‐induced inhibition of LH secretion in intact and gonadectomized male and female rats: Possible mechanisms. Alcoholism: Clinical and Experimental Research. 1992; 16(5): 935-941. https://doi.org/10.1111/j.1530-0277.1992.tb01896.x
    63. Silva SM, Madeira MD, Ruela C, Paula-Barbosa, M. M. Prolonged alcohol intake leads to irreversible loss of vasopressin and oxytocin neurons in the paraventricular nucleus of the hypothalamus. Brain research. 2002; 925(1): 76-88. https://doi.org/10.1016/s0006-8993(01)03261-9
    64. Carmichael MS, Humbert R, Dixen J, Palmisano G, Greenleaf W, Davidson JM. Plasma oxytocin increases in the human sexual response. The Journal of Clinical Endocrinology & Metabolism. 1987; 64(1): 27-31. https://doi.org/10.1210/jcem-64-1-27
    65. Blaicher W, Gruber D, Bieglmayer C, Blaicher A M, Knogler W, Huber JC. The role of oxytocin in relation to female sexual arousal. Gynecologic and obstetric investigation. 1999; 47(2): 125-126. https://doi.org/10.1159/000010075
    66. Macdonald PT, Waldorf D, Reinarman C, Murphy S. Heavy cocaine use and sexual behavior. Journal of Drug Issues. 1988; 18(3): 437-455.
    67. Weatherby NL, Shultz JM, Chitwood DD, McCoy HV, McCoy CB, Ludwig DD, et al. Crack cocaine use and sexual activity in Miami, Florida. Journal of psychoactive drugs. 1992; 24(4): 373-380. https://doi.org/10.1080/02791072.1992.10471661
    68. Mireku-Boateng AO, Tasie B. Priapism associated with intracavernosal injection of cocaine. Urologia internationalis. 2001; 67(1): 109-110. https://doi.org/10.1159/000050961
    69. Hirshfield S, Remien RH, Walavalkar I, Chiasson MA. Crystal methamphetamine use predicts incident STD infection among men who have sex with men recruited online: a nested case-control study. Journal of medical Internet research. 2004; 6(4): e71. https://doi.org/10.2196/jmir.6.4.e41
    70. Buffum J, Moser C. MDMA and human sexual function. Journal of psychoactive drugs. 1986; 18(4): 355–359. https://doi.org/10.1080/02791072.1986.10472369
    71. Battjes RJ, Leukefeld CG, Amsel Z. Community prevention efforts to reduce the spread of AIDS associated with intravenous drug abuse. AIDS and intravenous drug use: Future directions for community-based prevention research. 288. 1990.
    72. Rhodes T, Stimson GV, Quirk A. Sex, drugs, intervention, and research: from the individual to the social. Substance use & misuse. 1996; 31(3): 375-407. https://doi.org/10.3109/10826089609045817
    73. Schilling RF, el-Bassel N, Schinke SP, Nichols S, Botvin GJ, Orlandi MA. Sexual behavior, attitudes toward safer sex, and gender among a cohort of 244 recovering i.v. drug users. The International journal of the addictions. 1991; 26(8): 859–877. https://doi.org/10.3109/10826089109058926
    74. Lehman JS, Allen DM, Green TA, Onorato I M. HIV infection among non-injecting drug users entering drug treatment, United States, 1989-1992. Field Services Branch. AIDS (London, England). 1994; 8(10): 1465-1469.
    75. Gossop M, Griffiths P, Strang J. Sex differences in patterns of drug taking behaviour: A study at a London community drug team. The British Journal of Psychiatry. 1994; 164(1): 101-104. https://doi.org /10.1111/j.1360-0443.1994.tb03356.x
    76. Powis B, Griffiths P, Gossop M, Strang J. Heterosexual anal intercourse, health risks and drug use: A review with special attention to drug users. Drug and Alcohol Review. 1995; 14(2), 223-229. https://doi.org /10.1080/09595239500185281
    77. Meandzija B, O'Connor PG, Fitzgerald B, Rounsaville BJ, Kosten TR. HIV infection and cocaine use in methadone maintained and untreated intravenous drug users. Drug and Alcohol Dependence. 1994; 36(2): 109-113. https://doi.org /10.1016/0376-8716(94)90092-2
    78. Darke S, Hall W, Carless J. Drug use, injecting practices and sexual behaviour of opioid users in Sydney. Australia. British Journal of Addiction. 1990; 85(12): 1603-1609. https://doi.org/ j.1360-0443.1990.tb01649.x
    79. Longshore D, Hsieh SC. Drug abuse treatment and risky sex: evidence for a cumulative treatment effect?. The American journal of drug and alcohol abuse, 1998; 24(3): 439-451. https://doi.org/10.3109/00952999809016908
    80. Staton M, Leukefeld C, Logan TK, Zimmerman R, Lynam D, Milich R, et al. Risky sex behavior and substance use among young adults. Health & Social Work. 1999; 24(2): 147-154. https://doi.org/10.1093/hsw/24.2.147
    81. Molitor F, Truax SR, Ruiz JD, Sun RK. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. Western journal of Medicine. 1998; 168(2): 93.
    82. Mulry G, Kalichman SC, Kelly JA. Substance use and unsafe sex among gay men: Global versus situational use of substances. Journal of Sex Education and Therapy. 1994; 20(3): 175-184. https://api.semanticscholar.org/CorpusID:147624548
    83. Schafer J, Blanchard L, Fals-Stewart W. Drug use and risky sexual behavior. Psychology of Addictive Behaviors. 1994; 8(1): 3. https://doi.org/10.1037/0893-164X.8.1.3
    84. Singer N. Understanding sexual risk behavior from drug users' accounts of their life experiences. Qualitative Health Research. 1995; 5(2): 237-249. https://doi.org/10.1177/104973239500500207
    85. Frosch D, Shoptaw S, Huber A, Rawson RA, Ling W. Sexual HIV risk among gay and bisexual male methamphetamine abusers. Journal of substance abuse treatment. 1996; 13(6): 483-486. https://doi.org/10.1016/s0740-5472(96)00098-0
    86. Amzat J, Kanmodi KK, Aminu K, Egbedina E. A. Drug‐facilitated sexual assault in Africa: A scoping review of empirical evidence. Public health challenges. 2023; 2(3): e119.