Chemsex: what it is and how to recover
Most of the men we see who are struggling with chemsex do not arrive at a psychology clinic first. They arrive at a sexual health service. This piece is about what chemsex actually is, what it has been giving the men who use it, why it stops working, and what recovery involves that standard drug treatment often cannot offer.
Published
Dr Michael Yates, Clinical Psychologist and Psychosexual Specialist
Most of the men we see who are struggling with chemsex do not arrive at a psychology clinic first. They arrive at a sexual health service. Often it is a repeat sexually transmitted infection (STI). Sometimes it is a conversation with a nurse who notices a pattern. Sometimes it is a crisis, an overdose or a frightening sexual event that breaks through the surface of what has become, for many, a carefully maintained routine. The psychological work begins later, once the immediate harm has been managed, or sometimes not at all.
This piece is for the men who have reached that point. For partners who have found out and do not know what kind of support exists. And for anyone, at any stage of involvement, who has started to notice that what once felt like a choice no longer quite feels like one.
What chemsex is
Chemsex is the use of specific drugs during planned sexual activity. The three most commonly involved are crystal methamphetamine, mephedrone, and GHB/GBL (fast-acting liquid sedatives with a narrow gap between a working dose and an overdose). It is primarily, though not exclusively, a phenomenon within gay, bisexual, and other men who have sex with men. The settings range from one-to-one encounters arranged through apps, to small home gatherings sometimes called chillouts, to larger organised parties. Sessions can last a few hours or several days.
What makes chemsex a distinct thing, rather than simply gay men taking drugs, is the specific interplay between the substances, the sexual context, the communities in which it happens, and the psychological functions it serves. None of those can be understood in isolation.
The margin between a dose that works and a dose that causes loss of consciousness is narrow.
Which is why GHB and GBL are, across UK chemsex services, the substances most associated with overdose and death.
Why it begins
To understand chemsex, we have to start where most writing does not: with why it starts, and what it gives the men who engage in it.
Many of the men we work with will tell us, with complete honesty, that chemsex gave them some of the most significant sexual and social experiences of their lives. The conversations they had at three in the morning at a chillout. The sense of community. The feeling of being accepted by other gay men without the social hierarchies that can make the wider gay scene feel exclusive or hostile. Access to their own sexuality, including parts of it they had carried enormous shame around for years, that suddenly felt not just permitted but celebrated. Drugs, in that context, did not feel like a problem. They felt like a solution, sometimes the only solution, to things that had been causing pain for a long time.
This matters, because any attempt to address chemsex that does not take that starting point seriously will fail. If a man can see that the person in front of him understands what chemsex has been giving him, the conversation about what it is now costing him becomes possible. Skip that part, and the conversation shuts down.
What the men we work with describe is that chemsex often enters their lives at a point of real vulnerability. Apps offered sex but not depth. Mainstream social spaces were not fully accepting. Chemsex, and particularly the chillout and party circuit, offered something different: a community of other gay men where being fully sexual felt safe, where difference was not just tolerated but shared, where conversations happened that just did not seem possible elsewhere. That community function is not incidental. It is central to why men keep going back, and it is one of the things that has to be rebuilt if recovery is going to hold.
The escalation pattern
The difficulty is that the community function and the harm accumulate alongside each other. The scales tip gradually. What starts as occasional use with people you know becomes more frequent. The sexual and drug experiences that felt extraordinary start to require more of the substance to replicate the same intensity. The social network narrows: friendships outside the scene drift because the lost weekends are hard to explain, the comedowns are hard to manage professionally, and the emotional world of someone deep in a chemsex pattern becomes harder to share with people outside it.
The pattern underneath is one I recognise across most presentations of compulsive sexual behaviour. What began as something that brought genuine pleasure and served a genuine function starts to be used primarily to escape, fix, or avoid difficult feelings. Those feelings might be loneliness. They might be the comedown from the previous session. They might be shame about the behaviour itself, which then drives the behaviour in a loop that accelerates over time. Underneath all of that, very often, is the alarm inside us, the part of the brain that switches on when something feels dangerous or overwhelming, running hot after years of navigating life as a gay or bisexual man without being given adequate tools to manage the emotional landscape that entails.
The places and practices that originally felt like safety become the source of the harm.
The cruel irony of chemsex, and it is genuinely cruel, is that what starts as a space of belonging and liberation ends, for many men, in danger, isolation, and a depth of shame that can feel impossible to speak about to anyone. The places and practices that originally felt like safety become the source of the harm.
What support looks like
In the UK, the main route into support for chemsex remains sexual health services. Specialist chemsex teams in those clinics have been central to developing both clinical and harm-reduction approaches in this area. For men whose primary need is around drug dependence, specialist drug treatment services are the right starting point. For men whose use of GHB/GBL has created physical dependence, medical supervision of withdrawal is not optional: GHB/GBL withdrawal can, in a small number of cases, be life-threatening, and this is one of the situations where medical input must come before psychological work.
Time To Talk About Sex is not a substitute for those pathways. It is something that runs alongside or after them, addressing the specifically psychological side: the shame, the job the behaviour has been serving, and the long work of building a sexual life that does not depend on substances.
Why standard drug treatment often does not fit
The most common approach to chemsex outside specialist services runs through an addiction frame. The drug use is identified as the problem; abstinence from the drug use is the goal. For some men, at some points in their journey, that is the right approach. For a man whose GHB/GBL use has reached the point of physical dependence, or whose methamphetamine use is severe enough to have produced psychotic symptoms, drug treatment in the traditional sense is urgent and important.
But for the majority of the men we see, the abstinence-first frame does not fit, and can actively make things worse.
Drugs entered these men's sexual lives because they were doing something: answering anxiety, reducing shame, providing access to community, giving permission to explore a sexuality that had been locked down. Asking a man to simply stop the drug use, without addressing any of those underlying drivers, asks him to abandon something that was, however costly, the only access he had to something he needed. Most men either refuse, because some part of them correctly understands this, or they attempt abstinence and relapse because the original unmet need is still there and the pattern reasserts itself. This produces more shame, which fires up the alarm inside him further, which drives a return to the behaviour: a self-fulfilling loop of failure.
The programme does not prescribe an outcome. It starts from a different question: what has this been bringing you, what have you been looking for in it, and who do you want to be sexually? From those questions, men develop their own frame, their own values, their own sense of what a sexual life that serves them actually looks like. Some arrive at abstinence. Others arrive at a changed relationship with the behaviour. Both are valid, because both are grounded in the man's own understanding of himself.
What the work involves
The early work focuses on understanding the job the behaviour has been doing. Why did chemsex enter the picture? What was it providing that was not available through other routes? What sits underneath and keeps it going? This requires a space in which a man can be honest about both the pleasures and the costs, without being pushed toward a predetermined conclusion.
The middle work focuses on building the capacity to manage the difficult feelings that chemsex was being used to switch off. The anchor within us, the part of us that can rest, feel safe, and feel connected without needing anything from outside to make it happen, is often underdeveloped in men who come to this work. Building it takes time, practice, and repetition. It happens in large part through the group itself, where men learn that they can share something honest about their inner life with other men and not be rejected for it.
The later work addresses the sexual side specifically. What does a sexual life look like that is grounded in what you actually value, not driven by the drug-use pattern? For many men this involves a long process of recalibrating arousal after extended chemsex use, rebuilding a relationship with the body, and cultivating an inner sexual world that does not depend on the level of stimulation drugs provide. What that recovery arc actually looks like, over years, is covered in the companion essay Sober sex after chemsex.
For men who are currently in chemsex
If you are reading this and recognising your own pattern, a few things are worth knowing.
That is not a disqualification from support. It is exactly where the work starts.
You do not have to have stopped, or want to stop, before you ask for help. The most common reason men in chemsex do not come forward is that they believe asking for help means being told to stop immediately, and they are not ready to commit to that, even though they can sense something needs to change. That is not a disqualification from support. It is exactly where the work starts.
The questions worth asking of any potential service are: do they understand chemsex specifically, or will they treat it as generic drug misuse? Do they understand gay and bisexual men's lives, or will you have to spend half your energy explaining your context? Do they work from an abstinence-only frame, or can they work with you from where you actually are?
If you are in immediate crisis, if you have taken too much GHB or GBL or are concerned about someone else who has, call 999. If you are struggling right now and need to talk to someone, Switchboard LGBT+ helpline is available on 0800 0119 100.
Questions men often ask
What is chemsex?
Chemsex is the use of specific drugs to enhance and prolong sexual experience. It is something disproportionately experienced by gay, bisexual and other men who have sex with men, but not exclusively. The drugs most commonly involved are methamphetamine (crystal meth), GHB/GBL, and mephedrone.
Which drugs are typically involved in chemsex?
The three drugs most commonly associated with chemsex are crystal methamphetamine, GHB/GBL (gamma hydroxybutyrate and gamma butyrolactone), and mephedrone. They are sometimes used individually but more often in combination, which significantly increases both the intensity of the experience and the associated risks.
Is chemsex a form of addiction?
This is a nuanced question. For some people, prolonged and repeated use of these substances can create genuine physical dependencies that are difficult to break. The health risks from sustained use are serious and real. For many others, chemsex does not lead to addiction in the traditional sense, there may be no measurable physical dependency, but the pattern becomes compulsive in that drugs have become necessary to feel confident, sexual, or connected. Without them, sex can feel impossible. We would describe this as compulsive sexual behaviour rather than addiction, but the lived experience of feeling unable to stop can feel very similar.
Do I have to stop drugs completely to recover from chemsex?
This depends entirely on the individual. For some people, the cumulative impact of chemsex on their physical, psychological and relational health makes stopping completely the right choice, and that is a decision many people do make. For others, the work is less about complete abstinence and more about examining the relationship with drugs, whether there is a way to make choices that are safe, values-driven and boundaried. We do not prescribe an outcome. We work with you to understand what you want, and what is realistic and safe for you.
How does recovery from chemsex differ from standard drug treatment?
It depends on the level and pattern of drug use. For some people, where use has become very frequent and has significantly impacted everyday life, accessing drug support first, including a formal detox programme, may be the right starting point. For most of the men we work with, however, that is not necessary. Chemsex differs from other substance misuse in that it tends to happen in specific social and sexual contexts rather than as continuous everyday use. The focus of the work here is not detox but understanding: why the drugs entered the sexual picture, what they have been providing, and what alternatives might allow you to move forward with a sexual life that feels manageable, safe and connected to your values.
Why can't I stop using drugs in sexual situations, even though I know they're harming me?
Because the drugs have often provided something that has allowed us to cope or connect in ways that previously didn't feel possible, at least at first. Chemsex can facilitate sexual experiences of an intensity and freedom that feel genuinely unlike anything else: a sense of liberation, connection, arousal and confidence that many men have not been able to access in other ways. Stopping means giving up something that felt powerful and meaningful, often at a point where nothing else has been built in its place. At the heart of most compulsive behaviour is the struggle to stop something that has helped us escape, avoid, or manage other things that have felt difficult. This programme addresses that directly, not by telling you to stop, but by helping you understand what the behaviour has been doing and what might be possible instead.
I've only done chemsex a few times. Does that count?
It depends on the relationship you feel you currently have with it. For some people, occasional chemsex is simply part of a wider sexual repertoire that feels manageable and enjoyable. That is not a problem and does not need treatment. But if you have done it a few times and you are already noticing that it is starting to pull you in directions you didn't expect, affecting your ability to have sex in other ways, or producing consequences that are hard to manage, then it is worth talking about. The question is not how many times you have done it, but how it is sitting in your life right now.
Can I recover from chemsex without going into rehab?
Yes, and the vast majority of people we work with do not go to rehab. For a small number of people where drug use has escalated to a level that significantly impacts everyday functioning, we may support you in accessing drug services that include more intensive support. But for most men who come to us with chemsex concerns, the work takes place in a therapeutic setting: structured group therapy that helps you understand the pattern, what has driven it, and how to move forward differently. That is what this programme offers.
Can I join the programme if I'm still using?
Yes. We carry out a full assessment at the beginning of the programme to understand your current pattern of use and its impact on your life. A significant number of men come into the programme still using chemsex at times. Working through periods of use, understanding triggers and vulnerabilities, and learning to respond differently are central parts of the programme. You do not need to have stopped before you start. We will review this with you continuously as we work together.
Do I have to be completely drug free to get help?
No. We do not require abstinence as a condition of access. We recognise that drug use in sexual contexts is part of many people's sexual lives, and asking someone to stop completely before they have even had the chance to understand why it has developed the way it has is not how we work. Part of the process is understanding what relationship you want with drugs in the longer run. We support people on whatever that journey looks like, whether that involves reduction, stopping, or finding a way to engage that is safe and values-aligned.
Why does sober sex feel frightening after chemsex?
Because chemsex artificially elevates arousal, prolongs experience, and enables an intensity that is simply not replicable without substances. For many men, the drugs have also done something else: they have masked anxieties, worries and self-consciousness around sex and the body that were already present. When those supports are removed, all of that comes back at once, often undiluted. Being sexual without anything to soften those fears can feel overwhelming. This is one of the most important parts of the work we do: supporting men to understand what is underneath those fears and to begin building confidence and connection in the body and with partners without needing substances to make that possible.
Does everyone who has chemsex develop compulsive sexual behaviour?
No. We only work with people who feel their relationship with chemsex has become out of control in some way. If chemsex features in your sexual life without causing significant negative impact, and the experiences you are having are broadly in line with your values and what you want for yourself, it is not a clinical problem. What we are interested in is your current experience: whether it feels out of control, whether it is producing consequences you didn't foresee, and whether you want something to change.
If what you have read here feels familiar, this is what the programme was built for.
A six-month group therapy programme for men whose sex lives have started to feel out of control. Available across the UK.
See how the programme works