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Learn More. Sex under the influence of drugs or alcohol is associated with high risk sexual behavior. Most men Sex under the influence at the most recent event was more likely to involve anal intercourse, sex with a casual partner, and less condom use. Patients might benefit from interventions targeting sexual behavior and substance use as mutual triggers.

Sexual behavior in the context of substance use is a growing area of scientific focus due to its role as a potential risk factor for the transmission of HIV and other sexually transmitted infections STI. Normative data concerning sex under the influence is limited and its relationship to HIV transmission risk is not well understood. To better understand the link between drug use and sexual behavior, researchers have used approaches such as situational association or event analysis.

A correlational temporal link between sex under the influence and high-risk sex is made in these studies, but it does not permit causal inferences. For example, recent studies have found that the link between sex and drugs may depend on the context of the incident and partner type. Therefore, methods that combine both situational association and event analyses would provide the most complete picture of sexual behavior in the context of drug use. Specific substances may be linked to different sexual effects, user expectations, and levels of sexual risk.

Rawson et al. They found that cocaine and methamphetamine users were more likely to associate drug use with sexual behavior, and reported more positive sexual effects while under the influence, than alcohol and opiate users. We examined not only sexual risk behaviors, but also patient perceptions of enhancements and impairments associated with sex under the influence.

Our initial aim is to identify the prevalence of sex under the influence for a diverse group of men in substance abuse treatment. We hypothesize that sex under the influence will be: 1 associated with sexual risk behaviors sex with a casual partner, sex without condoms and anal intercourse ; 2 associated with sexual enhancements and impairments depending on the type of substance class more enhancements associated with stimulants, and more impairments associated with opiates and alcohol ; 3 associated with temptations to use drugs or alcohol to meet sexual needs and desires.

These treatment programs were diverse in terms of region, population density, and HIV prevalence. Sites were urban e. Philadelphia, PAsuburban e. HIV prevalence data at each site was not collected Beautiful older woman want orgasm Seattle Washington part of this study, but some sites e.

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Specific sites are listed elsewhere. Participants were men aged 18 and above who were in substance abuse treatment, reported engaging in unprotected vaginal or anal intercourse during the prior 6 months, were willing to be randomly ased to one of two interventions and complete study assessments, and were able to speak and understand English. Exclusion criteria included: showing observable, gross mental status impairment — including severe distractibility, incoherence or retardation-- as measured by the Mini Mental Status Exam 21 or by primary clinician report, having a primary sexual partner who was intending to become pregnant while the participant was enrolled in the trial, or being in methadone maintenance treatment for less than 30 days.

The HIV status of participants was unknown. The analyses reported here focused on a subsample of men from the main trial who reported engaging in sex only with women in the prior 90 days.

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Of the men eligible for randomization in the main trial, 43 reported sex with men, 41 reported no sexual activity in the prior 90 days, and one did not answer questions regarding sex under the influence of drugs or alcohol. Participants were not queried about lifetime sexual patterns, thus men who had had sex with men in the past, but not in the prior 90 days, may have been included in the sample. The Sexual Behavior Interview SBI was administered as part of the baseline assessment battery, prior to randomization to intervention condition.

The baseline assessments were administered preferably within 7—but not longer than days after screening for the parent trial. There were no expectations placed on participants to change their drug related behavior while they were waiting to begin the study intervention.

SBI items were administered using the audio computer assisted structured interview ACASI method as it elicits more information about high-risk behaviors than face-to-face interviews. However, some participants may have consumed substances of abuse at less than intoxication levels and still considered themselves under the influence.

To be included in the most recent event analyses, the event had to have occurred in the past 90 days. For some analyses, cases were classified as under the influence if the participant or his partner were under the influence. Participants were also grouped according to the drug of abuse to which they reported being under the influence. Cocaine and methamphetamine were grouped into a stimulant category due to a low prevalence of methamphetamine use.

Analyses compared the various drug use groups while under the influence or not under the influence in the last 90 days, and during the most recent event, on the following domains: demographics, specific sexual acts, condom use, and temptation to combine sex and drugs in the future. For continuous measures t -tests were used. To determine which drugs the men were more tempted to use to meet sexual needs, pairwise comparisons of differences between dependent proportions were calculated. An additional 5. Alcohol, cocaine, heroin and cannabis were the most frequently used drugs.

Men who were not married, in methadone treatment, and who had been employed for fewer days were more likely to report sex under the influence in the past 90 days See Table 2. Similarly, men reporting that they or their partner were under the influence during the most recent event were more likely to be older, not married, in methadone treatment, employed for fewer days, and report there had been more days since their most recent sexual event. Percent of men reporting, for themselves or their women partners, sex under the influence of drugs or alcohol in the last 90 days and during their last sexual encounter.

Regarding specific risky sexual behaviors, men endorsing sex under the influence at the most recent event were more likely to engage in anal intercourse, have a casual versus main partner for that event, and if having vaginal or anal sex with a casual partner, be less likely to use a condom than men denying sex under the influence Table 3. Similarly, men who reported their partner was under the influence during the most recent event were more likely to engage in anal intercourse, receive fellatio, have a casual partner, and if having vaginal or anal sex with a casual partner, be less likely to use a condom than men reporting their partners were not under the influence.

Since being under the influence at the most recent sexual event was associated with being with a casual partner, the sexual behavior data was re-analyzed for regular partners Beautiful older woman want orgasm Seattle Washington. This was done to determine if casual partner status may have explained the differences in specific sexual behavior.

The were unchanged regardless of partner status. Those under the influence were more likely to engage in anal sex when either the participant or his partner was under the influence, and fellatio was performed more often when the partner was under the influence not shown. Sexual acts, condom use and partner type during the most recent sexual encounter as a function of being under the influence. However different drugs were not associated with different sex acts.

Listed in Table 4 are the sexual responses of participants who reported being under the influence during their most recent event. Sexual enhancements and impairments endorsed by participants during their most recent sexual encounter. Sexual enhancements and impairments participants endorse about their female partners during their most recent sexual encounter. For sexual enhancements, only alcohol increased sexual desire, both self and partner and benzodiazepines decreased social inhibition, both self and partner were associated with more enhancements.

Only decreased desire-self heroin and premature ejaculation drugs other than benzodiazepines were differentially associated with being Beautiful older woman want orgasm Seattle Washington the influence. That the prospect of enhancing sex or enhancing sexual opportunities might serve as a relapse trigger is evident in Table 6.

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Men were ificantly more likely to report being tempted to use cocaine compared to all other substances except alcohol to meet these needs. Similarly, men were ificantly more likely to report being tempted to use alcohol compared to all other substances except cocaine and heroin to meet these needs. Men in treatment reporting temptation to use drugs to meet sexual needs in prior 90 days. Heterosexual men in substance abuse treatment commonly reported having sex under the influence of drugs. Being under the influence at the most recent event was characterized by increased prevalence of anal sex, casual partner sex, and less condom use as compared to not being under the influence.

These findings are consistent with the literature linking sex under the influence and high risk sexual behaviors among men who have sex with men 6 and injection substance users. The present study expanded the scope of earlier work as it provided from a sample of in-treatment heterosexual men in urban and rural, and methadone maintenance and outpatient psychosocial programs. Establishing a connection between high-risk behavior and the use of substances is a central issue for both prevention and treatment. A major difficulty is that self-reports are often not entirely accurate, particularly in high risk populations who engage in higher rates of casual sex.

In the first, participants were asked to report the percentage of times sex occurred under the influence of drugs or alcohol over the prior 90 days. In the second, participants were asked to provide a detailed assessment of their most recent sexual event, including the substances used, sexual acts performed, enhancement or impairment secondary to drug use, and use of condoms.

Since some individuals Beautiful older woman want orgasm Seattle Washington have had sex under the influence in the recent past, but not at their most recent event, it is likely that the discrepancy between the two methods points to an underestimate when most recent event analysis is utilized. Regardless of whether rates are accurate or an underestimate, the frequency of sex under the influence over the past 90 days highlights the association between sex and drug use, and the varying effects of specific substances on sexual experience and performance. For treatment purposes, highlighting a connection between the two behaviors is worth clinical focus as it might be a step toward change.

Although event analysis may underestimate the rate of sex under the influence, it encourages the recall of contextual features related to sexual activities. Including similar questions about the relationship between sexual behavior and drug use in clinical practice may strengthen the ability to draw causal inferences that could lead to reductions in risky behavior, for example by pointing out discrepancies between wishes and actual behaviors in motivational interviewing approaches.

Our showed that men in treatment reported many sexual enhancements associated with combining sex and drugs. Studies often cite stimulants as having the strongest association with sexual enhancements. Beyond simply stimulants, however, analyses of the most recent event show a sex-drug connection occurring across multiple substance. The current study only viewed substance use Beautiful older woman want orgasm Seattle Washington sexual enhancements in reference to the most recent sexual event and not to the participants' primary drug of abuse as was done in the Rawson et al.

It is likely that men who had a history of negative experiences of sex under the influence of their primary drug of abuse would be less likely to have been under the influence of that substance at the most recent sexual event. Nor did the assessment ask men to compare sexual enhancements across drugs. Thus a participant could have reported sexual enhancement associated with one substance at the most recent sexual event, but if asked to compare which was most enhancing, might have ranked another substance higher.

Only one impairment, dysorgasmia, was endorsed by nearly half the sample. Although many of the substances of abuse are associated with sexual impairment, the less frequent report of impairment during the most recent sexual event may be because participants who used a particular substance at the most recent event are the least likely to have experienced these impairments in the past.

They may therefore be a biased group who is less prone to impairments with that particular drug while under the influence, or they may be less aware of any negative connection between their substance and sexual performance and thus less likely to have endorsed it on the SBI. Although substance abuse counselors may be reluctant to discuss sexual issues with their clients, 32 these data show that relapse prevention discussions might benefit from acknowledging how sex and drugs are inter-related, as well as encourage individuals to take responsibility for safe sex rather than blame the substance.

Consistent with the decisional balance model often utilized in motivational interviewing, patients could be asked to weigh the pros enhancements and cons impairments associated with sex under the influence.

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A focus on the cons of being under the influence as well as alternative ways to obtain some of the enhancements without substances could be explored. In addition, counselors can point to the sexual satisfaction data from the current study showing that men who did not engage in sex under the influence at the most recent event reported the experience to be more pleasurable than men who did. Nearly three-quarters of men were tempted in the prior 90 days to use drugs to enhance the sexual experience or increase the likelihood of sex. It appears, therefore, that sex is a strong relapse trigger for a variety of substances, not simply for stimulants.

Patients might therefore benefit from interventions that focus on the interplay between sexual behavior and substance use. Future research endeavors might focus on the development and evaluation of such interventions. The authors wish to thank the 23 CTN Regional Research and Training Center and community treatment program site PIs, the 15 site coordinators, the 21 research assistants, the 15 therapy supervisors, and the 29 therapists who worked on this project.

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. National Center for Biotechnology InformationU. Am J Addict. Author manuscript; available in PMC Mar 1. Donald A. CalsynPhD, 1, 2 Sarah J. CousinsBS, 3 Mary A. Sarah J. Mary A. Suzanne R.

Author information Copyright and information Disclaimer. Address correspondence to Dr. Copyright notice. The publisher's final edited version of this article is available at Am J Addict.

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