Episode #120

Sex is a vital part of who we are as humans. It’s a way to connect with others. A way to have pleasure. Research tells us that sex is super beneficial for our health and well-being. Experiences vary wildly depending on the people and the circumstances. For our clients who are entering into recovery, sex is a really important topic.

Having sexual experiences that involve substances is really common. So what happens when a person has to navigate sexual experiences without the use of substances? It can be tricky to navigate and today we’ll talk about the things that should be addressed and considered. 


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance use from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance,

 Welcome back to the All Things Substance podcast. This is episode 120.  Today we’re gonna be talking about sex, and specifically sex as it relates to recovery. When you do a search online about sex recovery and addiction. You come across a lot of things about sex addiction or even love addiction, but that is not what we’re talking about today. 

That is a very different topic and one that I talked about a little bit in the last episode  when I was interviewed on Andrea Owens podcast and I’ve also covered it in a couple episodes back around episode 16 & 17, somewhere around there when I interviewed two different experts on sex and porn use.  If you haven’t had a chance to hear those interviews, you can do so at betsybyler.com/podcast.

What we’re talking about today is what sex and intimacy is like in relationships and out of relationships when it comes to recovery from substances. Studies have shown that sex is extremely beneficial to our health. That it activates a variety of the neurotransmitters in our brains and in other organs in the body. Some benefits of sex could be lower blood pressure, better immune system, better heart health, and perhaps including lower risk for heart disease, improved self-esteem, decreased depression and anxiety, immediate natural pain relief, better sleep, increased intimacy and closeness with a sexual partner or overall stress reduction, both physiologically and emotionally. 

I remember a treatment video that we used to show back in treatment centers when I worked in them called 28 days with Sandra Bullock. And in that film the counselor, played by Steve Buschemi:  Said that they should get a plant when they get out of treatment, and that after a year, if the plant is still alive,  they should get a pet, and if after two years both of those things are still alive, then they can start to date. I don’t know if that is necessary.

What is necessary is managing expectations and behaviors around sex when someone moves into recovery. Sex is an integral part of who we are as humans. It is not something that is just for procreation,  but instead something that is vital to who we are. There are certainly folks who identify as asexual and for the majority of people, that is not going to be their experience. 

When I thought about how to start today’s episode, I decided that I wanted to go to AASECT, which is the American Association of Sexual Educators, Counselors and Therapists. They are the leading expert and  our standard for sex therapy in the United States.

Their mission is that they are devoted to promoting sexual health by the development and advancement of the fields of sexual therapy, counseling, and education. Asecs mission is the advancement of the highest standards of professional practice for educators, counselors, and therapists.

AASECT affirms the fundamental value of sexuality as an inherent, essential and beneficial dimension of being human.  In general, AASECT opposes all psychological, social, cultural, legislative, and governmental forces that would restrict, curtail, or interfere with the fundamental values of sexual health and sexual freedom that they espouse.

AASECT also opposes all abuses of sexuality, including but not limited to, harassment, intimidation, coercion, prejudice, and the infringement of anyone’s individual sexual and civil rights. When I talk about sex today,  I’m talking about the people who, for them there is sexual need and experiences in their life, past, present, or future.

Sex is something that some of us got well trained on when we were in grad school and for others we didn’t. I think that the MFTs probably got better training than a lot of us, and perhaps the psychologists. But I know for myself that wasn’t something we covered. It was something that I had to pursue postgraduate work, and I’ve done some training that was AASECT sponsored and certified, and I found it extremely helpful. 

When I went into the field, I was not prepared for the amount of time I would spend talking about sex, but I talked about it and still do all the time. I would talk about it with pre-teens when we’d be talking about relationships and consent and puberty, and as well with my teens when they were sexually, whether they were sexually active or not. 

I talk about it with my adult clients all the time. I talk about it with my partnered clients and my non-partner clients. It’s something that most people have: a desire to have a good sex life. That they have sex an adequate amount according to what is fulfilling and healthy is generally what people mean when they say they have a good sex life. 

Healthy in the sense that it’s done in a way that is pleasing to both them and their partner. Sometimes there isn’t a partner and it’s simply taking care of sexual pleasure by themselves through masturbation.

I have been fond of saying that substances are a part of normal human behavior. I would say that even more normal is sexual behavior. So when it comes to addiction recovery or substance use, recovery sex is something that should be on the menu of topics that gets discussed. However, there are not a lot of resources when it comes to this extremely important issue. It’s part of curriculums, but more so in the last several years maybe. 

However, most treatment programs that I have known of, haven’t had very big focus. Sex just wasn’t something that really focused on, even though every single person that we’ve worked with that has addiction or has substance use issues, even if it’s not quite addiction, has had experiences with sex and substances. 

Substances are built to go right along with sex. Substances are about feeling good and so is sex. There really isn’t another reason  to have sex unless you are trying to create a human. The majority of the time though, sex and sexual pleasure is not about having children. It is about pleasure. The reason people use drugs and alcohol is for pleasure. Putting the two together is natural.  

As we think about our clients and our own experiences, we are going to find that substances have played a part in our sexual experiences. It doesn’t necessarily have to be in a bad way. It can be that somebody had a really great sexual experience and there was wine involved or some kind of drink, and that they recall that being.

The alcohol would help relax somebody and cool some nerves so that they’re not as nervous or it might impact their willingness to engage in something new. There are plenty of ways that substance use and sex can go together in a way that isn’t harmful.

The trouble is that what we’re talking about here is when it is impacting somebody’s sexual choices in a negative way. The most classic example is somebody going out to a bar and drinking a few and ending up hooking up with someone in a way that they might not normally. I don’t know a lot of folks who have spent a lot of time in bars who have not had that experience.

When we are out, going to bars and hanging out with friends and trying to relax and quote, let loose, it is normal to wanna find somebody to spend that time with in it more than a friendly manner. That’s part of the reason people go to bars, is to look for someone that they have a romantic or sexual interest in. 

I think most people would say it’s typically not the place you’re gonna meet the love of your life, but most people aren’t looking for that. They’re looking for a night or they’re looking for an experience.

There are changes that take place that when people have alcohol they may act in a way that is more them because they’re less inhibited, or they may act in a way that isn’t them at all. Everybody’s experience with alcohol is gonna be really different.

There are substances that are more likely to be paired  with sex. Certainly alcohol is one of ’em because that’s our most popular drug of choice, so to speak. It is a mood altering substance and therefore a drug in this sense, marijuana or a weed sometimes is associated with sex, but not quite. There really isn’t much of a heightened arousal profile for. 

Typically it’s the stimulants like cocaine or meth or speed or ecstasy. Ecstasy is part stimulant and part hallucinogenic, but it is highly correlated with sexual behavior. There is a more extreme version of sex and substances being intertwined, and that’s called chemsex.

There are pockets of people that use the substance and have sex deliberately to combine the two for a specific feeling. We won’t spend a ton of time on this because that’s not really the point of where we’re at today, but I did wanna mention it.

 So it’s all genders and all orientations. However, typically when someone’s talking about this, they’re talking about men who have sex with men, and this particular subculture where people are using stimulants. Typically when it comes to drugs, we’re talking about meth, G h b, cocaine. Ketamine, and ecstasy. 

When sex and substances are put together, typically there can be more of a careless choice in a partner. Lack of protection, whether it’s birth control or condoms or other kinds of preventative measures.

Part of the reason that sex is so intertwined is  that both substances and sex work on the dopamine system and  our body is looking for pleasure. That is part of what keeps us alive.  Pleasure, from food or sex or substances, helps drive us. They are basic human urges. 

 When we’re talking about recovery, people are coming from a position where they have been abusing substances to the point that it became problematic. There are going to be sexual experiences that are intertwined with their drug or alcohol use.  We are going to find it. 

 When we talk about recovery, they’re learning to navigate all kinds of situations.

They’re learning to navigate going into party situations, celebrations, bars, restaurants.  They have to worry about navigating relationships with their family, which are often stressful and with work and with. So then we add in romantic relationships. Most of us are going to be partnered at one time or another in our lives. 

We tend to find another person that we are romantically and sexually attracted to and join with them for a time. As a person in recovery, that has its own challenges. To begin with: where does that other person, the potential partner, fall on the spectrum of being in recovery? Are they a normal substance user? As in not using problematically and have never used problematically? Or are they somewhere on the spectrum? If they have problems themselves, then that’s another person’s recovery that can often become an issue. 

People will meet each other in recovery meetings  and end up partnering because they have this in. It’s especially hard for certain groups of folks to find friends outside of a recovery environment. I’ve talked about this before, that I think that men in general and specifically straight men, have a really difficult time socializing when there isn’t, without specific things being a part of it.

And part of that is the taboo of being seen as being gay, feminine or whatever that is. They don’t wanna come off in a certain way, and so they can’t hang out with other guys. Their choices are the recovery community or church, or potentially a sports league or something that’s related to an activity.

But very often, anything that’s not part of a church or a recovery community has alcohol involved, and I don’t know what that’s about. It just is, at least culturally speaking, here in the United States. For women, we have our own struggles socializing in different ways, but I find that it’s easier for women to strike up conversations and hang out with other women without there being this taboo, so to speak, about whether or not we’d be interested in them romantically speaking.

For sex specifically, the majority of people have a good and healthy sex life. The definition of that, of course, is gonna vary from person to person. People in recovery though, are no different as sexuality is an inherent part of who we are.

I wanna describe the three different kinds of sexual experiences that I’m talking about when it comes to people in recovery. Intimate sex and casual sex, and then impulsive sex. Intimate sex  Is sex for the purpose of intimacy, to deepen a relationship, to connect as an expression of feelings in that relationship. Whether it’s a short-term relationship or long-term relationship, or married or whatever that’s the point of intimate sex. 

When I talk about casual sex, I don’t mean it in the way of where it’s dirty or wrong. What I’m talking about is when people who are adults choose to engage in sexual activity that is consensual and with clear boundaries.  and sober in terms of being not intoxicated.

When people are intoxicated that’s a different story, and I’m not saying that you can’t have good, healthy drunken sex with somebody.  I think there probably are these experiences, but I’m talking about more generalities. 

Impulsive sex I am classifying as a decision to have sex that is satisfaction to an urge related to substances. I’m gonna go out, I’m gonna get lit and I’m gonna hook up with somebody, or  I’m gonna get high and I’m gonna go have sex to enhance the high.

This is more about frantic, driven, need to fulfill an urge. Typically isn’t gonna be the best sex because we’re talking about people who are not totally in their right mind, not totally present, not able to take in all of the things that are happening around them in a way that they’re gonna be able to participate in and remember later. 

What I’m looking for when someone has a sexual experience is that they were totally present, not dissociated, not checking out in other ways and connected to the person that they are having a sexual experience with. Whether they are the giver or the receiver or both, that they are fully aware and present with that person of who this is, that they’re doing this thing with. When someone is intoxicated, that’s typically not what’s happening. When it’s over and when the intoxication of whatever it is wears off there is the aftermath of that. 

When we’re talking about recovery, having sexual experiences that are more of the impulsive kind, even if they’re not driven by substances, can be a precursor to relapse. Having those experiences where someone has a serious drive to do something impulsive and it feeds that impulsive drive. 

Addicts and alcoholics and people who are moving into problematic using have those drives, and that’s part of the thing we’re trying to move away from is these fix hits of dopamine, so something that takes not very long to accomplish. So it’s not a deep pleasure  in the sense that it lasts a long time. It’s quick, it’s relatively easy to attain, and it satisfies that urge. What happens after that moment is irrelevant because we’re just meeting the need. That is not the same kind of sex that I am suggesting that people in recovery should have, which is a little more planning.

So certainly if they wanna have casual sexual relationships, they can figure out how to do that within their value system. And,  within the confines of whatever kind of sexual expression they want to get into, they can do that. 

 If somebody wants to engage in a kink community where they go to a club and they’re doing scenes with other folks who are adults and are not intoxicated and are able to consent fully,  I don’t have a problem with.  That can exist and be in recovery. We don’t need to have people in committed relationships in order for them to have sexual expression. It’s a matter of the attitude with which they’re going into it, which is, I want to have pleasure with this type of person, and I want to experience it in its fullest.

Whatever that experience is gonna be.  impulsive sex is almost never that.  I don’t know that casual is really the right word as opposed to intimate, but that is what I’ve got for now.

Here are the things I wanna distinguish with my. I wanna talk with them about what their sexual experiences were while they were using, whether they felt like their substance use increased the negative sexual behavior or not, and what they feel like they need to do going into recovery about.

Having an honest and frank conversation with them about how substances may have contributed to some not great outcomes when it comes to sex is super vital. We can’t assume that anyone’s sexual experience is gonna be exactly the same.  For me, I’m also coming from a really sex positive stance.

Some of the trouble with the literature that’s out there right now is we’re just moving into a place where more sex positive conversations can even happen. Sex therapists, several years ago, were still seen as deviant, and I think in some circles it’s that way now. It’s just recently I’ve been seeing training offerings for things about kink or non-monogamy and other types of sexual interactions. That’s a new thing for our field. In a lot of ways, we have come from a monogamous vanilla background for the most part. Having a wider lens for different types of sexual expression is newer. And so a lot of the literature isn’t there, first of all. And the literature that is there about sex and recovery can often be a little shaming.  

Working with someone who’s moving into recovery means that you need to plan how they’re gonna manage sex  and sexual relationships or sexual experiences. When they are not using, they’re coming from a better place of being able to think about their sexual experiences, what they liked about them, and what they didn’t like about them. 

This is really similar to how we work with people on our relationships. A lot of times when someone’s getting out of a relationship or coming to me and talking about previous relationships, I’ll talk with them about what was good in that relationship and what they learned that they don’t like and don’t want to tolerate in the.

We take that experience and talk about how that translates into character traits in a partner or red flags that they need to be aware of. The same thing goes for sex. As we look back on our own sexual experiences, we have ones that are better than others. We have ones that we would never want to repeat again, and going forward, we want our clients in recovery to be thinking about that as.

So they’re thinking about the times that they’ve had good sexual experiences, and what were the common denominators there. If someone’s never had sexual experiences outside of a substance use situation, then we wanna talk about what that’s gonna look like for them? What kind of feelings might they have? What kind of anxieties they might have, and how to overcome them.

We wanna talk about the kind of sex life that represents something healthy for them. What does a healthy sex life mean for that person specifically speaking. Who would it be with what kind of relationship, if any, what kind of commitment level is that person gonna have with the person that they’re having sex with? What about porn or masturbation? What is their relationship like with that and what are their values on it? 

What is in a green zone for them when it comes to sexual expression? Sometimes it’s easier to find out what’s in the red zone. People don’t necessarily know what they want, but they can tell you what they don’t want. And think about putting that in a red category of this is a no-go. These are the things you don’t want. Working backwards from there to find out what’s in the green zone and what’s in the yellow. Yellow being things that are a little risky that might pop up and that they have to pay attention to. 

If the person isn’t going for complete abstinence and they’ve had a drink or two, what does that mean about their availability for sexual experiences? This is often a trial and error where people figure out what it is they can no longer do because it doesn’t serve them anymore.

Giving them a view of  what a healthy sex life would entail, is super helpful in helping them weed out what’s getting in the way of them having. A lot of times sex has a ton of shame around it, and so there’s a lot of work to be done. 

As we’ve been talking today, the assumption is that people are ready for healthy sex. The problem is, when they’re not. When they have a lot of hangups and a lot of shame and they aren’t really sure how to resolve that, it could be about the sexual expression itself. It could be about fantasies that they have that they wish they didn’t or feel bad that they have them at all. It could be about sexual attraction to specific genders. There are a lot of things that drive people to use and shame is one of the biggest things among them.

Sex is very often,  coupled with shame in a lot of ways. There are rules that we have in our societies about sex when it comes to people and gender and age and ability level, and there’s a lot of hangups that even those of us who consider ourselves to be sex positive have to pay attention.

I have found that as well. I found it for myself as a person in my twenties, and then as a married person, and then as a mom, and then as a mom of adults. Sex is something that if you’re gonna be the sex positive parent that you need, that’s gonna come with some challenges. 

 If you have never had training, if you’ve never had training on the topic of sex and sexual expression, I encourage you to go to the AASECT website and I’ll have a link in the show notes and look at the trainings that they offer or that they certify.

They have so many that it will initially feel like, oh my gosh, and getting into the deep end quickly. But there are some very beginning ones that are really helpful. I remember feeling a little chagrined at taking beginning sex education, but I hadn’t had it in grad school. I certainly had it in undergrad and I remember it with 250 people in a classroom at Michigan State with all sorts of people  from all different walks of life. It was fascinating and humorous. 

I find that this is an area that when we are able to talk about it in a way that is frank and upfront and hesitant at all that our clients really respond well. I wanna bring sex into the conversation in a way that people can expect that it’s just a normal part of our conversation in the very same way that I talk about substances. 

The most important thing moving into recovery is for the person to have a view of their future sex life. What do they want? What do they not want, and how are they gonna get it?  In a way, this should also be a conversation about romantic relationships and what they want and what they don’t want.

Oftentimes when people are  using substances problematically, they aren’t thinking about what they want. They’re just in the middle of whatever it is they have. And they might want something different, but this is what they have and so this is where they’ll. 

Recovery is a time to look forward, to think about how to arrange your life in a way that is going to give you the most of what you want out of it and that is our whole gig. Helping people find the way to the life that they want to a life that is worth living to quote the DBT folks. I wish I could tell you that there were great resources about sex and recovery.  right now, I’m not seeing them. There are a lot of really good podcasts and books out there from therapists and specifically sex therapists and researchers talking about sex and sexuality. But  it’s still early days. I think it’s gonna take a while for it to be sex and substance use, or sex and addiction. That’s a natural outgrowth of research and study, but it’s not quite there yet.

So if you have somebody that is using substances or has used substances problematically, the chances are that’s gonna be intertwined somehow with their sexual history and their sexual future. 

I would be remiss if I didn’t mention the fact that sex can often become a replacement for substances. That if somebody can’t use, because if they start drinking, they won’t stop or if they start using, they won’t. Sometimes sex or and sexual experiences can become a substitute because what the person is looking for is relief from emotion potentially, and the spike of pleasure and sex is effective. It’s more effective than anything else we can do physically without a substance.  

When we’re talking about people moving into recovery, whether they’re just starting or thinking about it or have been in recovery, this is a super pertinent topic and  I encourage you to talk about past experiences and finding out the pros and the cons of them, and helping them get a vision for what they want it to look like in the future. and what might get in the way of them having the healthy sex life that they would like.

I will put resources in the show notes of places to find good information about sex and sex therapy, about sexuality from our field perspective so that you can check that out. I’ll also link the couple of episodes that I have as well in case you’re interested in listening to it. 

For next week’s podcast, I’m not sure which interview is gonna happen first. I have three interviews scheduled on different topics and I’m not certain which one will be ready to go first. So it’s gonna be a surprise what we talk about. I hope you’ll join me for that podcast. And until then, have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.

Helpful Links 



Vision of Sexual Health | AASECT:: American Association of Sexuality Educators, Counselors and Therapists

About AASECT | AASECT:: American Association of Sexuality Educators, Counselors and Therapists

Understanding Chemsex: Essentials for Treating the Addictive Fusion of Drugs and Sex | NAADAC

How Important Is Sex in a Relationship?

10 Surprising Health Benefits of Sex