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Treatment of Chemsex with EMDR

Gerard Ilaria, LCSW outlines how to treat chemsex with EMDR.

Neuroscience of Sex and Drug Addiction

Biochemical, functional neuroimaging, genetic studies, and treatment research have suggested a strong neurobiological link between behavioral addictions such as sex addiction and substance use disorders.

Grant, Potenza, Weinstein and Gorelick found addictive behaviors and SUD’s to overlap in multiple areas, including comorbidity, course (chronic relapse), genetic contribution, neurobiology (brain glutamatergic, opioidergic, serotonergic, dopamine mesolimbic systems), phenomenology (craving, intoxication, withdrawal), tolerance, and treatment response. (Grant, 2006) Grant J.E., Brewer J.A., Potenza M.N. The neurobiology of substance and behavioral addictions. CNS Spectr. 2006;11:924–930.

Childress et al. conducted a study in which they took fMRI scans of cocaine addicted patients presented with rapid (33 millisecond), preconscious visual cues (drug-related images). The same subjects were later shown preconscious sexually related visual cues (erotic images). The researchers found activation of the same limbic system/reward circuitry in subjects shown sexual cues as when shown drug-related cues.

In their literature review of the neuroimaging studies of the human sexual response cycle, Georgiadis and Kringelbach concluded, “it is clear that the networks involved in human sexual behavior are remarkably similar to the networks involved in processing other rewards” Childress A.R., Ehrman R.N., Wang Z., Li Y., Sciortino N., Hakun J., Jens W., Suh J., Listerud J., Marquez K., Franklin T., Langleben D., Detre J., O’Brien C.P. Prelude to Passion: Limbic Activation by “Unseen” Drug and Sexual Cues. PLoS ONE. 2008;3:e1506. doi: 10.1371/journal.pone.0001506. PMC free article Georgiadis J.R., Kringelbach M.L. The human sexual response cycle: Brain imaging evidence linking sex to other pleasures. Prog. Neurobiol. 2012;98:49–81. doi: 10.1016/j.pneurobio.2012.05.004.

In “Natural rewards, neuroplasticity, and non-drug addictions”, Olsen states, “there is a glut of evidence that natural rewards are capable of inducing plasticity in addiction-related circuitry”.

Olsen cited fMRI studies showing gambling, shopping, sex (orgasm), video games, and the sight of appetizing food to activate the mesocorticolimbic system and extended amygdala in the same manner as do drugs of abuse.

Olsen concluded that “Extensive data suggests that eating, shopping, gambling, playing video games, and spending time on the internet are behaviors that can develop into compulsive behaviors that are continued despite devastating consequences” (Olsen, 2011) Olsen C.M. Natural rewards, neuroplasticity, and non-drug addictions. Neuropharmacology. 2011;61:1109–1122. doi: 10.1016/j.neuropharm.2011.03.010. [PMC free article]


Concurrent sex and drug use, or Chemsex

Chemsex is using certain substances immediately before or during sexual activities to facilitate, prolong and/or intensify sexual experience, mainly by some communities of men who have sex with men (MSM).

Chemsex is referred to in the MSM community as PNP (Party and Play)

Hook up apps and sex worker ads will indicate PNP, or no drugs.

PNP has become normalized in the MSM community

Four substances are typically associated with chemsex: methamphetamine, mephedrone, GHB/GBL, and ketamine. (Frontiers in Psychiatry November 2020)

Crystal Meth (T, or Tina) can be smoked in a glass pipe like crack or injected (slamming) or used rectally (booty bump). The high can last 12 hours, prolonging sexual activity

Mephedrone (bath salts) can be insufflated, swallowed, injected, or smoked. The high can last 6+ hours.

GHB/GBL “G”, or liquid ecstasy-swallowed or in capsules- high can last 4 hours.

Ketamine “Special K” can be insufflated, swallowed, smoked in a cigarette, or inserted rectally and is short acting.

These drugs induce euphoria, dissociation, and allow for sex and kink that can be endured beyond normal sober limits of pain or discomfort.

•“To start with, there is increasing evidence that DA's role in reinforcement is more complex than just coding for reward per se (hedonic pleasure) and that stimuli that induce fast and large DA increases also trigger conditioned responses and elicit incentive motivation to procure them.” Addiction Beyond Dopamine Reward Circuitry,” Volker 2011

•There is a commercial network in the gay male community that takes advantage of the combined power of drug and sex addiction. Websites use video, profiles, and chat to link addicted men with imagery and communications that start the cascade of excitation which leads to purchase of sex from PNP sex workers or connection to drug using men seeking Chemsex.

•Just viewing video of men smoking crystal meth can be enough stimulus to lead to procurement of sex and meth from sex workers or other chemsex users.


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