Substance Use, Sexual Pleasure and Recovery among gbMSM: Addressing Sexual Satisfaction in Addiction Interventions

Background.

Interventions addressing sexualized substance use (SSU) among gay, bisexual, and other men who have sex with men (gbMSM) often focus solely on addiction, leaving sexuality secondary in recovery or harm reduction. When addressed, it is usually around the theme of biological risks and prevention (HIV, STBBI). Although biological risks are important, they are not the main motivations to engage in SSU. Sexual pleasure and satisfaction remain primary motivations to engage in SSU and should be addressed during the intervention.

This presentation aims to address the development of knowledge in sexuality (e.g. sexual pleasure, sexual satisfaction) to support the recovery of gbMSM who have sexualized substance use practices.

Methods.

In-depth interviews were conducted with 20 gbMSM adults who had problematic substance use and who engaged in SSU practices within the past year in Quebec, Canada. Thematic analysis of their experiences and perspectives, including their sexual satisfaction and their recovery regarding SSU, were made. Results were analyzed and interpreted with a sexual health framework and the support of somebody with lived experience.

Results.

The participants' narratives emphasized the recurring theme of pleasure. The psychoaffective dimension of sexuality, encompassing the gratification of giving and receiving pleasure, plays a pivotal role in fostering SSU practices to intensify pleasure and attain heightened sexual satisfaction. Diversifying sexual practices to enhance enjoyment is also associated with the pursuit of pleasure. Substance use, acting as a gateway to sexual exploration, reciprocally fuels the desire to use. The pleasure derived from both drug use and sexuality emerges as a significant factor contributing to sustained SSU. Based on their perspective, participants explained how to regain this sexual satisfaction while in recovery. Participants, driven by a sense of transgressing personal boundaries, expressed a motivation to alter their sexual practices involving substance use, aiming to restore self-respect, reduce usage, or achieve abstinence and regain their sexual life.

Conclusions.

This study indicates the importance of considering the element of pleasure in interventions related to substance use. It underlines the importance of exploring the enjoyment associated with such behaviour, acknowledging this sexual aspect, and engaging in a dialogue with gbMSM who are looking to modify their substance use by addressing SSU with a particular focus on incorporating their sexual needs, regaining their sexual satisfaction and by being sex positive.