Chemsex Can Lead to Psychosis

People who have sex and consume drugs at the same time have a higher probability of developing symptoms linked to the psychotic sphere. Why? In this article we'll explain.

Written and verified by the psychologist Gorka Jiménez Pajares.

Last update: 11 June, 2024

Chemsex is a concept that refers to ‘behaviors that mix sex, drugs, and pleasure’. While this mix of elements and experiences, might seem captivating, it’s attracted the attention of researchers. And they claim that “the practice of chemsex can be a springboard to psychosis.” It seems that these risky experiences are one of the great health challenges facing today’s society.

Indeed, there are multiple undesirable consequences of this practice, both in the medium and long term and on a physical and psychological scale. For example, it’s known that behaviors that gravitate around unprotected sex where drugs are also consumed, increase the risks of suffering from AIDS, hepatitis, and other sexually transmitted diseases.

As far as mental health is concerned, this practice is linked to the development of psychotic symptoms in up to four out of ten users. In fact, psychosis is one of the most frequent clinical disorders suffered by those who practice chemsex. However, it’s far from the only one. It’s also related to a high risk of suffering from depression, social phobia, and anxiety-related disorders.

Sex, drugs, and pleasure: a dangerous cocktail

The kind of individual who practices chemsex is well-defined. They’re usually male, homosexual, and single, aged between 25 and 45, of high socioeconomic status (McCall et al., 2015). Cases of this sexual practice are also reported among the transsexual and heterosexual population, although to a lesser extent.

Among the most consumed substances are the following (McCall et al., 2018):

• Mephedrone. A psychostimulant.
• Methamphetamines. Substances with psychostimulant effects similar to mephedrone.
• GHB (ecstasy). A central nervous system depressant. It produces the perception of pleasure.

Individuals who frequently practice chemsex tend to be polydrug users. This means they consume two or more substances simultaneously and repeatedly. Time is also a crucial element.

As a matter of fact, individuals might engage in chemsex for hours or even days. Therefore, it’s common for the partners with whom they have sex to change several times within the same chemsex ‘session’. If they consume the drugs intravenously, it’s known as slamsex (Drevin et al., 2021).

Chemsex and psychosis: a public health problem

In 2022, Dr. Lucía Moreno-Gámez conducted an investigation. She and his colleagues analyzed the relationship between chemsex and the development of psychotic symptoms. Some of the elements they defined could potentially explain the appearance of psychotic symptoms associated with this practice (Moreno-Gámez et al., 2022). For example:

• Feeling alone
• Substance use.
• Highly stressful events.
• Trauma and post-traumatic stress disorder.
• Infections derived from risky sexual practices.

These factors constitute, in combination, a springboard to mental illness. Yet, the association between chemsex and psychotic symptoms hasn’t been studied to a great extent up until now.

Psychotic symptoms exhibited by those who practice chemsex

In virtually all of the studies that Moreno-Gámez analyzed, psychotic symptoms were mentioned as being prevalent among chemsex practitioners. In fact, the percentage of symptoms of this type ranged from 7.7 percent (Hibert et al., 2021) to 37.2 percent (Gavin et al., 2021).

Within the psychotic symptoms that occur most frequently among chemsex practitioners are paranoid delusions, visual hallucinations, and delusions of self-reference, as well as those of persecution. In most cases, these last less than a month. Consequently, a large percentage of subjects only fulfill the diagnostic criteria for the label of schizophreniform disorder or brief psychotic disorder.

Psychotic symptoms can  be directly linked to drug use over a long period of time (Schreck et al., 2020). In the context of the practice of slamsex, it’s suggested that the risk of developing psychotic symptoms such as those described above is multiplied up to three times (Dolengevich et al., 2019).

A look to the future

As we’ve already mentioned, there’s a risk of developing symptoms of psychosis as a consequence of this pernicious sexual practice. And, it’s a high risk. If we make a comparison between the percentage of psychotic symptoms in the general population and relate it to the percentage of psychotic symptoms in chemsex practitioners, it’s easier to understand (van Os et al., 2009).

• Five out of 100 people experience psychotic symptoms in the general population.
• In the population that practices chemsex, more than 37 out of 100 experience psychotic symptoms.

At the beginning of the practice, a multitude of factors can increase the possibility of individuals carrying out chemsex. For example, trauma, adverse events, and avoidant attachment styles.

In conclusion, this habit includes the use of drugs together with unprotected sex. These are two aspects that, in combination, increase the probability of developing psychotic symptoms.