Designing and facilitating a positive sexual health workshop for Chemsex dependent men in a residential addiction treatment setting.
Wednesday 17th November 2021
Written by Mike Power- Addiction counsellor
A Chemsex programs' main emphasis should be to explore sober sex as well as the meaning of positive sexual health and well-being. What is that going to look like in practice? Well, it will look slightly different for each individual, and there is really no right or wrong way of going about it. It does not matter if someone likes to enjoy casual sex, kinks, or has got to a stage in their life where they might enjoy dating or is perhaps looking for a solid relationship. What is important is how each person will manage their sex life in a way that is conducive to positive emotional, mental, physical, and sexual health that is free from any form of addiction.
So, what is positive sexual health and well-being? This is the first question I typically ask clients that are being treated for Chemsex dependency. The usual answer I get is that is it about being aware of sexually transmitted infections alongside HIV prevention strategies like condom use and pre-exposure prophylaxis treatment (PREP) or post-exposure prophylaxis (PEP). That is correct and is worthy of a group workshop on its own. However positive sexual health goes beyond just STI and HIV prevention. So, what is positive sexual health, and how do we create a workshop for this important topic for men with Chemsex dependency?
In 2017 when my then manager and I created the Chemsex Abstinence track, my manager asked me what aspects we should primarily focus on. My answer was that we should focus on the sexual side of the fused dependency. That is because the chemical side of the dependency is treated organically in any addiction-specific treatment centre.
There were 12 workshops in total with one being specifically around positive sexual health. Chemsex was a relatively new phenomenon to my knowledge and nobody at that time had yet concentrated on abstinent-based approaches. This means that we truly built the program from the ground up.
As part of my research for a positive sexual health workshop I came across the World Health Organization definition of positive sexual health which states that "sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence."
This is what the program workshop was based on. Firstly, I would ask the clients how they define positive sexual health as stated above. Their answer will usually, but not always, centre around sexually transmitted infections.
Then me has the facilitator will give the World Health Organisation's definition and I would dissect it into a map using a whiteboard.
Positive sexual health
What does this mean to each individual? What are their sexual ideals now that they are sober? What do they now value about their sexual health and sexuality? It is incredibly important that the therapist does not bring their own biases into the room of what they think positive sex and sexuality are or how they play out. It is not uncommon for a client to want the enjoyment casual sex or kink in there sober intimate life .what is important is how this can be kept safe from addictive substances or detrimental to their physical, emotional and mental well-being.
Positive sexual health also includes having regular health check-ups, adherence to medication if someone is HIV positive, and HIV prevention for negative individuals such as condom use or PREP which results in respectful sexual health.
Respectful sexual health
What does this mean now a person is in recovery? Safety — Protect yourself and your partner(s) from STIs and the negative emotional effects that may come from certain sexual behaviours. This is again down to how everyone defines their own sexual values. It is often worth exploring what it was like for them in their active dependency on Chemsex and to do a comparison to what they value now that they are sober in treatment.
A common theme with many men who engage in Chemsex is a deep sense of loneliness and a deep desire for meaningful connection alongside a real fear of intimacy or vulnerability. The latter part is often responsible for the use of such powerful drugs like methamphetamine as they take away the fear of vulnerability and enable a connection even if it is, in reality, a toxic and false one. There is real work to be done around sexual relationships now that a person is in recovery. In my experience, slow and easy is the best way forward with ongoing support from a culturally competent therapist and a strong peer-lead recovery network such as crystal meth anonymous.
Safe experiences that are free from coercion, discrimination and violence
The final part and a very crucial part of the workshop and one that must be treated with sensitivity: Having pleasurable, safe experiences that are free from coercion, discrimination, and violence.
For many men that are Chemsex-dependent their experiences were far from safe or free of discrimination or sexual violence. A staggering number of gay and bisexual men that came through the treatment program had been victims of sexual assault either historically or as a direct result of being in the underground world of Chemsex. What is even scarier is how there are often little or no boundaries around consent. The main message to get across is that NO means NO ! If someone is not in a fit state to consent that automatically translates to a N0.
It's important that facilitators are aware of everyone's sexual history as well as any possible traumas. If anyone is affected by this last topic it is especially important to give that individual or group extra time before the end of the session. It is also a good idea to finish with grounding exercises such as progressive muscle relaxation and extra one to one support if needed alongside a full risk assessment around traumatic arousal and any other predisposing factors.
Finally, it's important that the group is facilitated by a trained therapist and that the therapist also receives supervision from either there manager or clinical supervisor.
A sexual transmitted infections and a positive sexual health workshop is an important components in the treatment any one seeking recovery from Chemsex dependency.