Table of Contents
Overview of Chemsex: Trends and Substance Use
In recent years, the phenomenon of “chemsex,” defined as the use of psychoactive substances to enhance sexual experiences, has gained significant attention, particularly within the LGBTQIA+ community. The substances involved often include synthetic cathinones, gamma-hydroxybutyric acid (GHB), ketamine, methamphetamine, and MDMA (Ecstasy) among others. These drugs are used with the intention of prolonging sexual experiences and intensifying feelings of pleasure and connection (Schifano et al., 2025).
The interest in chemsex has surged, particularly in urban centers. For example, studies have indicated that approximately 16.3% of men who have sex with men (MSM) in Brighton, UK, reported engaging in chemsex in the past month, with similar trends observed in cities like Manchester and London (Schmidt et al., 2025). This increasing prevalence raises concerns about the associated health risks, including sexually transmitted infections (STIs), mental health issues, and substance use disorders.
The drugs commonly associated with chemsex are often chosen for their stimulating or disinhibitory effects. For instance, stimulants like methamphetamine and cocaine are used to enhance sexual performance and increase sexual arousal, while GHB is favored for its disinhibitory properties, facilitating increased sexual encounters, often without protection (Schifano et al., 2025). The combination of these substances can result in polydrug use, which dramatically escalates the risks of adverse health outcomes, including acute medical emergencies and long-term psychological issues (Schifano et al., 2025).
Table 1: Common Substances Used in Chemsex
| Substance | Effects | Risks |
|---|---|---|
| Methamphetamine | Increased energy, euphoria, enhanced libido | Anxiety, paranoia, cardiovascular issues |
| Cocaine | Increased alertness, confidence | Addiction, heart attacks, seizures |
| GHB/GBL | Disinhibition, relaxation | Overdose, amnesia, respiratory depression |
| MDMA | Emotional closeness, heightened sensory perception | Hyperthermia, dehydration, serotonin syndrome |
| Ketamine | Dissociation, analgesia | Urinary issues, psychological disturbances |
Clinical Implications of Chemsex-Related Behavior
The implications of chemsex are profound and multifaceted, particularly concerning mental health and substance use disorders. The use of these substances can lead to significant impairments in psychological functioning and increase the risk of developing personality disorders (Pérez et al., 2025). Personality disorders, characterized by rigid and maladaptive patterns of behavior and inner experiences, can exacerbate the challenges faced by individuals engaged in chemsex.
Research shows that individuals with personality disorders, particularly those within Cluster B (e.g., borderline, antisocial), may be more prone to engage in chemsex due to their impulsive and risk-seeking behavior (Pérez et al., 2025). The interaction between personality disorders and substance use can create a feedback loop where substance use exacerbates the symptoms of the disorder, leading to further reliance on drugs to cope with emotional distress.
Furthermore, chemsex can lead to a range of clinical issues, including increased vulnerability to STIs due to risky sexual behaviors, mental health crises, and potential overdose. A multidisciplinary approach that integrates mental health support, substance use treatment, and sexual health education is essential to address the complexities of chemsex and its impact on individual well-being (Pérez et al., 2025).
Personality Disorders and Substance Use: A Complex Link
The interplay between personality disorders and substance use is intricate and multifactorial. Approximately 40% to 60% of individuals with personality disorders also exhibit substance use disorders (American Psychiatric Association, 2023). This overlap complicates treatment outcomes, as the maladaptive behaviors characteristic of personality disorders can hinder engagement with traditional treatment modalities.
Specifically, the use of substances in the context of chemsex can be seen as a maladaptive coping mechanism for individuals with personality disorders. For example, individuals with borderline personality disorder may use substances to manage emotional instability and interpersonal conflicts, leading to a cycle of dependence and exacerbation of symptoms (Pérez et al., 2025).
Moreover, the bidirectional relationship between substance use and personality disorders suggests that treating one without addressing the other may result in suboptimal outcomes. Innovative treatment approaches that focus on integrated care, including psychotherapy, pharmacotherapy, and harm reduction strategies, are crucial for effectively managing both substance use and personality disorders in individuals engaged in chemsex (Pérez et al., 2025).
Innovative Treatments for Chemsex-Related Disorders
Emerging treatment strategies for individuals engaged in chemsex and struggling with personality disorders focus on a combination of pharmacological and psychosocial interventions. One promising area of research involves the use of medications that target the neurobiological underpinnings of both substance use and personality disorders.
Table 2: Innovative Treatments for Chemsex-Related Disorders
| Treatment Type | Description | Evidence of Efficacy |
|---|---|---|
| Psychotherapy | Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) | Effective for reducing symptoms of personality disorders |
| Pharmacotherapy | Medications like mood stabilizers and antidepressants | Can help manage symptoms of underlying mood disorders |
| Harm Reduction Programs | Education on safe drug use, sexual health, and mental well-being | Proven to reduce risky behaviors and improve health outcomes |
| Virtual Reality Therapy | Engaging patients in VR scenarios to practice coping strategies | Emerging evidence suggests effectiveness in reducing symptoms of paranoia and delusions (Jeon et al., 2025) |
Additionally, innovative therapies such as virtual reality (VR) are being explored to provide immersive experiences that can help individuals practice coping strategies in a controlled environment. Early studies indicate that VR therapy may reduce symptoms of paranoia and enhance coping skills, thus supporting individuals in navigating their experiences with chemsex and associated mental health challenges (Jeon et al., 2025).
Future Directions in Chemsex and Personality Disorder Research
Future research on chemsex and personality disorders should focus on understanding the underlying mechanisms that contribute to the co-occurrence of these conditions. Longitudinal studies that track individuals over time can provide valuable insights into the predictors of chemsex engagement and the development of personality disorders.
Furthermore, there is a need for more comprehensive studies that assess the effectiveness of integrated treatment approaches, particularly those that combine pharmacological with psychosocial interventions. The development of tailored interventions that consider individual differences in personality traits and substance use patterns may enhance treatment outcomes for this population.
In addition, expanding research to include diverse populations and settings will help to identify culturally relevant factors that influence chemsex behaviors and associated mental health outcomes. This is particularly important in understanding how stigma and discrimination impact access to care and treatment engagement among individuals from marginalized communities (Pérez et al., 2025).
FAQ
What is chemsex?
Chemsex refers to the practice of using psychoactive substances to enhance sexual experiences, particularly among men who have sex with men (MSM).
What substances are commonly used in chemsex?
Common substances include methamphetamine, cocaine, GHB/GBL, MDMA, and ketamine.
How does chemsex impact mental health?
Chemsex can exacerbate existing mental health issues, increase the risk of developing substance use disorders, and lead to risky sexual behaviors, which can have serious health implications.
Are there treatments available for individuals engaged in chemsex?
Yes, treatments often include a combination of psychotherapy, pharmacotherapy, and harm reduction strategies. Innovative approaches such as virtual reality therapy are also being explored.
What should I do if I or someone I know is struggling with chemsex?
It is important to seek support from healthcare professionals who can provide guidance and resources tailored to individual needs.
References
- American Psychiatric Association. (2023). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Jeon, E. J., Li, L., Le, T. H., Kim, W.-S., Odkhuu, S., Kang, C. Y., Setiani, A., Rami, F. Z., & Chung, Y.-C. (2025). Virtual reality therapy targeting ideas of reference in patients with psychosis: a single-blind parallel-group randomized controlled trial. Psychological Medicine, 1-12. https://doi.org/10.1017/S0033291725000959
- Pérez, M., et al. (2025). Psychological, social factors, and smoking behavior mediated the effects of cannabis use on personality disorders: A Mendelian randomization study. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2025.1411587
- Schifano, F., et al. (2025). Drugs Used in “Chemsex”/Sexualized Drug Behaviour—Overview of the Related Clinical Psychopharmacological Issues. Brain Sciences, 15(5), 424
