Substance abuse and addiction can significantly impact sexual health. People who abuse drugs and alcohol are at higher risk of struggling with physical side effects that impact their libido and sexual performance.
They are more likely to contract sexually transmitted diseases due to less situational awareness, lowered inhibitions, poor decision-making, and physical or mental incapacitation. Abusing substances increases the risk of sexual assault.
Sexual health, as defined by the World Health Organization (WHO), is a state of physical, mental, and social well-being that relates to sexuality. Positive, respectful approaches to sexual relationships, along with pleasurable and safe sexual experiences, are at the core of sexual health.
These experiences and relationships must be free of discrimination, coercion, and violence. This includes the ability to consent, which means that the people involved in sexual activity are able — legally, mentally, and physically — to consent to the act. People who are not legally adults, who are mentally or physically incapacitated, or who do not specifically say “yes” are not giving consent.
Surviving sexual trauma can lead to depression, anxiety, post-traumatic stress disorder (PTSD), and other mental health problems that increase the risk of substance abuse to self-medicate.
It is important for addiction treatment to include an assessment of mental and physical health, so the addiction treatment plan can include therapy for co-occurring mental health disorders and associated trauma that affect sexual health.
Recent medical research indicates that alcohol is the drug that most affects erectile capacity, or sexual arousal, in men. A 2013 study of 905 men included 550 who had been diagnosed with substance abuse related to alcohol, cocaine, heroin, marijuana, speedballs (cocaine and heroin combined), and multiple other substances.
The study found that the men who had abused drugs struggled with sexual performance years after receiving substance abuse treatment.
The study focused on four areas of sexual performance:
Researchers found that, overall, the study group that struggled with substance abuse had a moderately to significantly impaired sexual performance compared to the control group. Once they determined this was the case, researchers examined side effects according to the substance abused.
This intoxicating substance had the most direct and long-lasting effect on sexual arousal in particular and sexual performance in general.
During peak periods of substance abuse, people who struggled with cocaine addiction reported high levels of sexual desire and excitement.
This drug affected orgasms the most, but there were also some effects on other parts of sexual performance.
Arousal and orgasm were the most impacted, with some lingering effects on other aspects of sexual performance.
The combination of cocaine and heroin was found to most often impact sexual pleasure, with slight effects on desire.
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Drug and alcohol abuse are both associated with higher risk of infectious diseases, including sexually transmitted infections (STIs). Any substance that leads to mental impairment, from lower inhibitions to losing awareness of reality, can lead to poor decision-making. This increases the risk of unsafe sexual practices that can lead to contracting an STI.
Drugs most associated with a higher risk of risky sexual behaviors and STI transmission include the following:
Excessive alcohol consumption, particularly binge drinking, leads to lowered inhibitions, poor judgment, slower physical and mental reactions to surroundings, and blacking out or experiencing temporary memory loss. This increases the risk of unprotected sex, which can lead to contracting an STI.
Both prescription painkillers, like hydrocodone and oxycodone, and illicit opioids, like heroin, are associated with a higher risk of STI transmission, especially HIV and hepatitis C. This is because many people who abuse these drugs inject the substance intravenously. People who inject drugs (PWID) are more likely to share needles or use needles repeatedly, which increases the risk of many kinds of infections, including blood-borne viral infections.
Abusing meth has been linked to having more sexual partners and engaging in riskier sexual behaviors, such as not using a condom. This increases the risk of contracting HIV, hepatitis C, and other STIs. People who abuse meth may inject the drug, which adds to the increased risk of contracting a blood-borne pathogen.
Crack cocaine, in particular, leads to rapid stimulation in which the person may make risky decisions due to feeling intense energy. This includes engaging in unprotected sex.
People who abuse illicit drugs like meth, cocaine, and heroin are also at risk of spending all their money on substances of abuse and losing their jobs. This is why they quickly run out of financial resources to obtain more drugs. This may lead the person to trade sex so that they can get more of the drug they struggle with, and that increases their risk of contracting an STI.
Many statistics have focused on HIV, hepatitis C, and other viral disease transmission rates; however, syphilis has also been increasing among PWID.
Healthy sexual experiences require consent. People who are intoxicated are not considered able to consent, but they are at risk of being involved in risky sexual behaviors. While some people may appear to choose risky sexual behavior, the intoxicated person is often not able to say “no” or is not aware of what is happening to them. This is sexual assault.
The term sexual assault covers a broad range of sexual behaviors that occur without the explicit consent of the victim. These may include the following:
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about 50 percent of severe trauma injuries and sexual assaults involve at least one party drinking too much alcohol. Binge drinking is particularly associated with an increased risk of sexual assault.
Participating in binge drinking not only increases the risk of physical harm like alcohol poisoning and car accidents, but it also increases the risk of blacking out, poor memory, physical impairment, and a loss of awareness of surroundings. These conditions all increase the risk that you may be the victim of a sexual assault.
Abuse of other substances was also associated with an increased risk of being a victim of sexual assault. A study involving 255 women and adolescent girls who sought medical treatment after sexual assault found that 72.9 percent reported recent substance abuse before the assault, which included use of alcohol, marijuana, and other illicit drugs.
About 40 percent reported a prior substance abuse history, and 12.2 percent reported prior substance abuse treatment history.
Most of the participants reported that sexual assault had preceded substance abuse, indicating that trauma and self-medication behaviors were closely associated. The study also noted that some assailants used drugs or alcohol as a way of incapacitating their victim. It concluded that referrals to substance abuse treatment for those seeking post-assault medical care, and vice versa, could benefit many women and adolescent girls.
Evidence-based treatment for substance abuse increasingly includes associated treatment, or referrals to treatment, to manage physical effects of drugs or alcohol. This includes STI treatment and managing damage to organ systems in the body.
Addiction treatment also includes an increased focus on mental health, including treating post-traumatic stress disorder (PTSD), anxiety, and depression, which can all be associated with trauma from a sexual assault, contracting an STI, or suffering physical harm.
Overcoming chemical dependency is one step to abstinence and improved health, but managing the other areas of stress in life with better social and medical programs will reduce the risk of relapse.
Sexual Health. World Health Organization (WHO). Retrieved April 2019 from https://www.who.int/topics/sexual_health/en/
Sexual Consent. Planned Parenthood. Retrieved April 2019 from https://www.plannedparenthood.org/learn/relationships/sexual-consent
(January 17, 2013) Drug Abuse Impairs Sexual Performance in Men Even After Rehabilitation. Science Daily.com. Retrieved April 2019 from https://www.sciencedaily.com/releases/2013/01/130117105736.htm
How Can Using Drugs Put Me at Risk for Getting or Transmitting HIV? HIV.gov. Retrieved April 2019 from https://www.hiv.gov/hiv-basics/hiv-prevention/reducing-risk-from-alcohol-and-drug-use/substance-use-and-hiv-risk
(July 19, 2018) Persons Who Inject Drugs (PWID). Centers for Disease Control and Prevention (CDC). Retrieved April 2019 from https://www.cdc.gov/pwid/index.html
(February 14, 2019) Two Crises in One: As Drug Use Rises, So Does Syphilis. Kaiser Health News (KHN). Retrieved April 2019 from https://khn.org/news/two-crises-in-one-as-drug-use-rises-so-does-syphilis/
Sexual Assault. Rape, Abuse & Incest National Network (RAINN). Retrieved April 2019 from https://www.rainn.org/articles/sexual-assault
What are the Risks? Rethinking Drinking: National Institute on Alcohol Abuse and Alcoholism (NIAAA). Retrieved April 2019 from https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/Whats-the-harm/What-Are-The-Risks.aspx
(October 24, 2018) Fact Sheets – Binge Drinking. Centers for Disease Control and Prevention (CDC). Retrieved April 2019 from https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm
(April 2013) Prior Substance Abuse and Related Treatment History Reported by Recent Victims of Sexual Assault. Addictive Behaviors. Retrieved April 2019 from https://www.ncbi.nlm.nih.gov/pubmed/23396174
(January 2018) What is Drug Addiction Treatment? National Institute on Drug Abuse (NIDA). Retrieved April 2019 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/what-drug-addiction-treatment