One of the greatest impediments to success in any treatment program is the shame faced by many individuals with substance use problems. In an NCAD presentation called “Sex Positive Treatment: Where Angels fear to tread,” psychiatrist Doug Braun-Harvey, PhD cited research saying that individuals with “strong sex-drug linked” addictions carry twice the burden of shame into treatment. They also face a higher likelihood of dropping out of treatment, due to the inability of treatment programs and counselors to acknowledge and work with sexual behaviors linked to substance use.
Sex-drug links can occur in a variety of ways, explained Braun-Harvey. He cited a number of examples: a young heroin user, whose first dose caused an intensely emotional experience that triggered her first orgasm—a sensation she associated with the drug; another young woman who traded sex for money to fund her substance use; or users who employ substances to increase libido, prolong sex, or enhance the sexual experience.
“Sex negative attitudes are an impediment to some high sex-drug linked addictions,” says Braun-Harvey. “Sometimes, people are ready to recover from substance use, but get held back” by programs that ignore or avoid discussion of sexual behavior, says Braun-Harvey, who advocates a “sex positive” approach.
“There’s a dilemma about sexual health information. Our culture dictates that, within a room, the person who is most uncomfortable about the issue can limit the conversation.” As a result, “we avoid it [sex] until we can’t avoid it any longer,” said Harvey-Braun, noting that the omission affects treatment programs and counselors alike.
But sexual health issues can’t be avoided, he maintains, since individuals with sex-drug linked addictions face a greater likelihood of failure. In fact, by speaking up within the treatment setting about their behaviors, they may face judgment from their peers or counselors, or perhaps even a diagnosis or referral as a sex addict. In a number of cases, such “sex-negative” environments may lead to expulsion of the individual from treatment.
The solution, pioneered at the Stepping Stone treatment center in San Diego, makes sexual health a central issue in the treatment program, enabling program participants to deal directly with the sexual issues linked to the substance use. For those with a high sex-drug linked behavior, this process seemed to provide a logical and necessary first step toward successful substance use treatment. Braun-Harvey theorized that the sex-positive approach helped consumers to mitigate the remembered intensity of the sexual behavior associated with drug use—one set of relapse triggers, just as the treatment process itself helps to mitigate the consumer’s response to the substance—the other set of triggers.
Using a sex-positive approach the new approach, Stepping Stone cut the dropout rate in its long-term (six to nine month program) from 70 percent to just 10 percent. (See Why we talk about sex.) That program incorporates a sexual health inventory and regular, frank group discussions that enable consumers to have open, positive discussions that build knowledge and understanding about sexuality and the motivations that typically drive human sexual behavior.
Braun-Harvey, who trains sex-positive counseling techniques, is the author of a new book, Sexual Health in Drug and Alcohol Treatment.