Why Are We Talking About Sex?

Sexual health and recovery as well as healthy intimacy are frequent topics of discussion in my group therapy sessions.  In active addiction, the dependency on drugs and alcohol interferes with the ability to experience healthy intimacy.  Emotions are numbed and the ability to form meaningful attachments is impaired.  Often, the desire for sex is severely diminished due to the use of drugs and alcohol.  If sexual activity does occur, it may include risky behaviors that place you at risk for contracting a sexually transmitted disease.  In early recovery, many people experience a renewed interest and desire for sex, but are ill equipped to handle the emotional demands of a new relationship.  This is part of the rationale for the recommendation not to start a new relationship during the first year of sobriety.  Other people struggle with a lack of interest due to diminished libido.  The most important reason for discussing sexual health and recovery is to ensure that the unhealthy behaviors associated with active addiction are not continued in early recovery.  This includes learning how to have healthy intimate relationships.  

Sexual Dysfunction & Addiction

 Sexual dysfunction brought on by drug use and addiction is quite common. Long-term heroin and methamphetamine addicts report that when compared with their drug of choice, sex simply isn’t interesting. Ecstasy users report that because their experiences on the drug were so intense, it made it difficult to “feel anything” – including sex – when not using the drug. 

Decreased Libido

Many long term abusers of drugs report a decreased libido – especially women. This is largely attributed to drugs like marijuana, cocaine and heroin that cause hormonal disruptions. These problems are typically the of a decrease in testosterone – a sexual hormone that controls desire and libido. 

Erectile dysfunction in men caused by drug addiction can sometimes be confused with a decreased libido as the male attempts to mask the problem by not having sex. In most cases erectile dysfunction is caused by low testosterone levels as a result of drug use, but can also be caused by circulatory and pulmonary issues caused by the use of opiates.

Effects of Medication on Libido

Depression is a common complaint among patients early in recovery.  Mood disturbances can be due to the effects of long-term drug and alcohol use, a symptom of Post-Acute Withdrawal Syndrome, or an organic issue that may have pre-dated the addiction.  Antidepressant medications may cause a decline in libido or sexual functioning despite improvement of depression.  In one study, up to half of patients prescribed an SSRI reported a decrease in libido with continued use.

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