JERNEJ: The event is part of a series of talks on chemsex and takes place within the program “Stop HIV”, implemented by the ŠKUC Association (section ŠKUC Magnus) with the support of the Ministry of Health and the City of Ljubljana.

More information about chemsex is available on the website www.kemseks.si

The purpose of the project is harm-reduction through raising awareness about drug use and sexual safety for gay, bisexual and transgender men. The website contains information on safer drug use and safer sexual practices as well as David’s chemsex self-care plan, about which we will talk later.

Various statistics show that approximately 1 in 5 gay men used drugs during sex at least once in the past year.

Why is it important for us to talk about this?

Sex and drugs are still a taboo theme in our society, which means people find it hard to talk about their drug use, especially in connection with sex. Users find information and self-help strategies from their friends, which might not always be accurate. Information on our website was created in partnership with the association DrogArt and Legebitra, with the goal to offer users as much accurate and comprehensive information as possible. Through it, users can also find ways for professional help in the sector of NGO or in the medical sector.

And now I will quickly introduce David.

David Stuart was the first to name and identify Chemsex as an emerging gay cultural phenomenon. He developed the world’s first chemsex support services, and he fought relentlessly for greater chemsex awareness by encouraging and stimulating cultural dialogue and discussion within our international gay, bi and queer communities. He continues to support international governments and communities to manage the cultural phenomenon from a place of kindness, sex positivity, and cultural competence. In addition, his kindness and sex-positivity are a place of inspiration for a lot of us working with chemsex, as it opened a method where we could talk about the problems of our community in a non-judgemental way, thus feeling accepted by our peers and ourselves.

Hello David and welcome to the event.

DAVID: Hello and thanks for having me. 

JERNEJ: So, let just start with the video, and then we take over, or would you like to say something before it?

DAVID: No. A friend of mine made the film, I think it’s better if we talk about it a little bit after than before.

 JERNEJ: Very well, thank you.

10 min video clip

JERNEJ: And we are back. Thank you for presenting us this video David. But let’s start with a more general viewpoint and with the first question. So, what is chemsex, why do we define it as a gay phenomenon?

DAVID: Chemsex could be what you just saw in the video I suppose. It is a gay phenomenon where gays, men hook up on Grindr to have sex, on particular kinds of drugs. So, usually, it’s methamphetamine, mephedrone or GHB, or GBL, because these are the ones causing most harm obviously, but of course, it does vary in different cities around the world. It is different from sexualised to drug use because it’s a very cultural thing. You just saw the stuff on the screen, and it’s kind of complicated. What you just saw in that film was kind of a glamorized version of a kind of nice functioning organized party. Almost like they got designed invitations and they all came at the right time and they all had nice shorts, everyone looked fit and well and … It is somehow a lot more chaotic than that, sometimes it’s just two people hooking up for a couple of hours and then going on to another place or whatever. So, that was a stylized version of chemsex, but, what was accurate about it, I think, was so much can happen over a two or three day period such as friendships and kindnesses, looking out for each other, love or affection, or togetherness, sexiness, and freedom, and joy, brotherhood, and all this kind of things, but also jealousies, competitiveness, lack of consent, overdoses, there is rape, I mean I hope it’s not too common, but we lose our ability to consent quite a lot or to judge another person’s ability to consent. So, in a sense that film showed what chemsex is, what it can be, so many different things. But it’s just such a unique cultural thing that we gays get, you know we get Grindr, we get hooking-up, we get orgies, we get bums and dicks and sharing drugs and multiple partners and all these kinds of things, we get that. So, rather than just sending all of those people off to heroin clinics, so the straight people who work there, who understand the straight homelessness and crime and poverty and all the kind of things that you would see in a heroin clinic, it needs cultural competency. And so, the next question: Chemsex is such a gay thing that it deserves gay-focused support services, and in order to do that we have to name this phenomenon. So, it’s not just sexualized sex use, it’s not a 30-year old married woman who smokes marihuana so that she can have sex with her husband once in a while so that she can enjoy it a bit more, that’s not chemsex, you know. We need a kind of a place and support services around the world, where the chemsex, as you and I know it, is really understood. Cultural competency. So, chemsex has been the word that has come to define that phenomenon, and it is a good thing because it does help us develop the right kind of support services.

JERNEJ: Let’s put it a bit more into historical context. When we look at the LGBT history and so on, especially the gay history, there is an important part of the history that is an HIV/AIDS epidemic. How did the HIV/AIDS epidemic influence chemsex? Is there a relation?

JERNEJ: Let’s put it a bit more into historical context. When we look at the LGBT history and so on, especially the gay history, there is an important part of the history that is an HIV/AIDS epidemic. How did the HIV/AIDS epidemic influence chemsex? Is there a relation?

DAVID: There is. I mean It’s not that chemsex is all about HIV or HIV is the only consequence of chemsex, it’s just the most public health obvious one, if you know what I mean. There’s a lot of consequences. Sometimes chemsex is just fun, sometimes just pleasure, sometimes the consequences are quite manageable and it doesn’t bother a person, or sometimes the consequences are bothering but a person can manage them, but sometimes the consequences are about psychosis, sexual assault, sometimes it’s a slow degradation, a slow descent into depression or slow descent into a sort of more addictive, dependent use, more frequent use, maybe it’s an inability to enjoy sober sex, or sex without chems afterward. So, there are lots and lots of consequences of chemsex, including happy ones and joyful, pleasurable ones. But when we are looking at different kind of epidemics, the heroin epidemic, most of the harms are crime, poverty, physical dependence, so they need to prescribe some methadone, for the dangerous withdrawal symptoms. So, most of the harms are about crime, societal, violence, danger, and homelessness on the streets. Chemsex doesn’t look anything like that at all. It can, if it gets quite extreme, but usually the consequences we are looking for are the ones which we can measure the most so we can develop public health responses. So, chemsex and HIV are connected purely because there are cities in the world that don’t have PrEP, there are cities in the world where people don’t have good access to HIV prevention tools or campaigns or awareness. So, chemsex is usually about a high number of partners and not caring much about condoms, and sort of clusters of people where new HIV infections exist, and can be passed on. So, HIV is a very, very real consequence of chemsex, especially so in cities where there is a trouble to access HIV prevention and care.

JERNEJ: In chemsex we have a plethora of topics intertwining with each other, we have sex, we have drugs, we have HIV and STD prevention, psychological issues, and so on, and I think it’s fair to say in the beginning that some chemsex can be problematic and some chemsex is not so problematic. But we will come to that later. So, let’s talk about the chems, let’s talk about these drugs. Drugs usually answer to certain needs of people taking them, that’s why we take them, but what do these drugs do for chemsex users. Why do we take them?

DAVID: All drugs, whether it’s chems or not, in nearly all cases the reason we use drugs or alcohol is because it makes us feel better. Now, it might be good, it might just be because we need to feel numb, sometimes that’s a really good reason because sometimes being numb is better than the alternative. And in regard to chems sometimes it’s about pleasure, but sometimes when it becomes a problem it’s usually because … if people felt good when they are having sex sober than they might not be really that attracted to chems, but if a person struggles to enjoy disinhibition, pleasure, relaxing into the gay sex experience, then they might feel inhibited, there might be things in their head blocking the pleasure, so they might learn that drugs are more than just enhancing the pleasure, they also provide the freedom that they didn’t feel without the drugs. An example might be; if I was raised in a catholic home and when I’m trying to enjoy gay sex with my boyfriend or with a lover, you know, as a grownup, still in the bedroom is god always there judging me, and I feel ashamed afterward or during; or it might be just that voice of your really homophobic uncle who every time you see him as a child is sort of saying antigay stuff, it might be bullying you heard at school, ‘that’s so gay that’s so gay’. Whenever you are being gay in bed with a lover these voices and noises are there. And of course, HIV can be a noisy one too. Sometimes it’s hard to just lie back, enjoy the sex because you have to think about protection, think about protection, think about protection, or maybe just feeling ‘diseased’ because you know you are not coming to terms with the diagnosis. So really, just the simple act of feeling pleasure during sex can be quite complicated for a lot of gay people, and chems fix that, they do, chems fix that really well. That’s why in a very large numbers all around the world, we, gay men, have really adopted chems because they that job really well. Ecstasy did it ok, but it’s better for dancing, marihuana is more about chill, and cocaine sort of, you know, talky, talky, talky, it’s kind of ok for sex too, but chems: crystal meth, mephedrone, and G, oh they really hit the sexy spot, they are really good for sexual disinhibition, and it’s not like just a couple of gay men are doing it; it took off with Grindr in the middle of HIV epidemic, in massive, very large numbers all over the world with not a lot of discussion about how to do it safely. With no chemsex support services existing anywhere, and naïve people sending those people to heroin addiction clinics, when actually what they need is help to learn how to enjoy gay sex when they are in bed.

JERNEJ: We talked about gay shame, you explained it really nice, the problem of shame in sex, but one other issue that we talk a lot about in chemsex is loneliness. How is it about that? At least I have a feeling that loneliness also comes out of this shame in one way but there are a lot more factors to this gay loneliness. Finding it hard to connect with others. Could you share your view on this with us?

DAVID: For some people, loneliness is an intrinsic part of the gay experience. For instance, intimacy is something we learn as children; so, I might be lying on a sofa, my family might be really nice, full of love and compassion and kindness. When I am lying at home, I should feel relaxed, my hair can be a mess, and if I’ve got spots on my face or my hair is out of place, that would be terrible at school, because I might get bullied, but at home, I should be able to feel relaxed and safe. And if I fart while I’m watching television my sister would just go, ‘’uh uh’’ and giggle, and we laugh about it and it’s no shame, it’s intimacy and safety and it’s comfort. But for a lot of gay people growing up in heterosexual households, even though they are surrounded by a loving family, they are keeping a secret, this shame, this, “I’m gay, there is something wrong with me, I’m different, there’s something wrong with me, what if they’d found out, I better act more straight, oops, did that show my camp, do I need to keep a secret, what’s wrong with me, what’s different about me”. And just that very act of keeping secrets and overthinking things is loneliness. You know, you can feel very lonely, even when you are surrounded by your loving family. Even as we become adults. The majority of us know loneliness. And what we do find, as we explore our sexuality as teenagers is that a solution to loneliness is sex. And we’ve got that at our doorsteps.

We created a brilliant gay-positive, sex-positive culture where we don’t have to get married before we have sex, we don’t have to, where we can have open relationships, we can reinvent and just invent the way we want our gay lives to be. So through defiance, and hard work, and activism, throughout the years, we have created a gay culture which does fix loneliness.  But there are different kinds of loneliness, you know, sometimes accidents happen and sometimes the culture, like hook-up culture can turn into a way of exacerbating loneliness. So, a person who was as a child feeling lonely, grownup found sex as a way to ease loneliness but is creating more loneliness because they might not have the skills to maintain relationships or to resolve conflict, or it’s just part of a habit of hooking-up, next, hooking-up, next, hooking-up, rejection, next, hooking-up, rejection, next, and we get caught up in that circle that’s very lonely too, even though they’re surrounded by lots and lots of sex and lovers and people, but it can be very lonely. And of course, people who decide to stop doing chemsex because of the chem problems for instance, they can find themselves suddenly very lonely. Because without chemsex they’ve lost a community, they’ve lost an activity, and a hobby and a pastime and a pleasure; and people struggling to have sober sex, for enjoying that kind of sex without drugs, there’s another kind of loneliness. So, loneliness is all around us really, it’s kind of hard work to create a life that doesn’t have loneliness in it, and we do need to talk about that more in our gay lives, what real loneliness is and what real authentic connections with other people are, what community really is, what participating in a community is, not just being a passive member of a community. Things like that.

JERNEJ: Now, gay culture by itself is quite expecting of its members also in the way of physical outlook, of certain physis and also in a sense of acting, I mean acting the part, so, you have to be in a sense on a top, and I find that quite demanding and I believe that a lot of community members also find it quite demanding. Could you share your thoughts on that?

DAVID: Yeah, I do agree. Again, we’ve created our own culture, and I think we created during some crazy years. We were fighting for gay rights when they were closing down the bathhouses and saunas because of AIDS. We were fighting for gay sex in different kinds of gay lives and gay families when the whole world was hating us because of AIDS and HIV. You know, we fought; we’ve created our gay sexual positivity in a climate of defiance and anger. Could you just repeat the main part of your question, because I just went completely blank?

JERNEJ: …Apart from the straight world, there are expectations of the gay community which is also being demanding of its members.

DAVID: High expectations. In all cultures hierarchies develop, you know. In some cultures, like in white American New York City bankers, you are ferocious, the culture is not going to be kind, but cold, ferocious, and achieving. In other cultures, the best, highest you can be in the hierarchy of power might be a doctor, where there are other people below you are just, I don’t know, patients, or other people with less education, but in another culture might be the teacher who is the highest form of power and culture within a structure. In gay hook-up culture, if you are fit and sexy, you will thrive. If you are fit and sexy, you will not be lonely. If you are fit and sexy you won’t have to cue for the guestlist of the nightclub. If you are fit and sexy, you will have friends gather around you. If you are fit and sexy, you’ll have the right clothes that look good on you … If you are fit and sexy you will find your love. If you are fit and sexy, everything will work out fine. But it doesn’t work that way, because when you’re trying to ferociously cope within a structure like that, you learn tricks to cope, and the tricks we all need to learn is to Instagram ourselves to look better than we are, to block people rather than dialogue with them to make them see I’m sexy. You know, I might not look sexy but I might feel it, and I might be sexy in a way I communicate, but I get blocked before I have an opportunity to do this. And so, rather than having high expectations of looking good and feeling sexy,… we need a dialogue again of what sexy actually means. And If I wanna have sex with you, what does that mean? Does it mean I just want to be physically aroused by what I see in front of me or does that mean more? And I need to figure that out before I have sex with you. And if I’m offering some things to you, my sexiness isn’t just what I look like, there is more; are there things about the way I smile or when my voice goes up and down while I communicate to you, while I recognize, by instinct, what turns you on and do it out of generosity. There’s a whole lot of sexy things about me, more than just the way I look. But in a blocking hook-up culture with high expectations, rather than learning how to communicate these things, you just up your game and up your game, and you block faster than them, and you maybe do steroids to get a nicer body or you perform sex rather than authentically connecting with somebody.

JERNEJ: Just for our guests, I think that we should explain the hook-up culture a bit. What does it actually mean? Just the basic mechanism of finding guys when we are on Grindr or when we are on certain apps, one looks at pictures, one connects with them. But I also think that here it comes to a bit of a loss of this true authentic connection that we can create when having a conversation in a physical space with each other. So, you have this picture for which everyone is selling. Is there anything you would like to add about this culture?

DAVID: Just that there was a time that all the guys like me, I don’t wanna guess your age, but all the guys like me that we would meet usually like in a bar, usually a gay bar. Sometimes it wasn’t necessarily so open. It was naughty and it was illegal, so, there might have been black painted windows, so there might’ve been some shame around it, but if it was you that I was meeting in a bar, I’m not gonna agree to have sex with you immediately, I’m gonna buy you a drink. And over the course of about 20 minutes, maybe less maybe more, we might, not with words, but with gestures and face signals, and facial expressions, we might figure out that, yes this is becoming something sexy. It might take our first date, or a second date or a third date, or it might just take 10 minutes, but that is an important 10 minutes. Hook-up culture is very much about not connecting or communing or having that bonding 10 minutes or more. It’s about liking the way that this person is selling themselves with that picture and those words, and I need to have an understanding of my sexual and emotional needs, and I need to understand how to communicate them, and I need to do that without meeting you, based on a picture, using 140 characters and a photoshopped image of my abdominals and some emoticons. And I just have this weird little toolkit to negotiate one of the most intimate and vulnerable, potentially hurtful and rejecting kinds of situations that a human being can experience. And we’re trying to do all of that without any training on how to do this. No one teaches us how to write a Grindr profile, no one teaches us how to sell ourselves beyond just what we look like, no one teaches us how to bond and negotiate and flirt online before agreeing to something or how to let somebody down. If I have time, another example would be, when I was my sluttiest, if I can use that word, when I was my most out there, it was a one-night stand so I would get drunk, I would wake up next morning next to a new lover and I couldn’t remember his name. It would be nice if I could just block and he’s gone. But I had to somehow let him know gently that I couldn’t remember his name, maybe I did wanna see him again maybe I didn’t, even if I didn’t, I have to somehow be polite, because I’m in his house and have a conversation, maybe we disagree on a prime minister of the day and there are problem-solving communication skills that are essential to human beings that even in a one night stand I was practicing and learning and getting better at. These communication skills of how to reject somebody, how to receive rejection, how to be polite, how to say I don’t know your name or I don’t really want to see you again but I did have a nice time. All these kinds of things. But with hook-up culture we just don’t get the opportunity to learn those skills. And instead we are learning other skills which are kind of ‘block’, ‘move on’, ‘block’, ‘move on’.

JERNEJ: So, that puts a lot more pressure on all of us, and especially we can now see how does chemsex answer to these needs and this stress of finding new people, at least in some ways. So, let’s get back to, so we put a bit of context but we usually talk about chemsex and we say that some chemsex is problematic and some chemsex is not problematic. When is chemsex problematic?

DAVID: Well, sometimes it is problematic, sometimes it’s not and then there is a whole world in-between when you are not sure or it might be, or my mum thinks it’s problematic but I don’t. So, the best kind of support we can do is figure out … it comes down to: there is a chemsex and there are the consequences, and to weigh them up, it’s called a decisional balance. Is it worth it for me? Pros and cons. And the person, only the person using drugs, doing chemsex, can make that decision. Sometimes a doctor will say: “You caught HIV because of this. You must stop. ”And that’s a doctor deciding it’s a problem, not the person. It might be a mum saying: “I never see you anymore, whenever we have a free weekend, you vanish, you don’t want to come and see me.” So, for the mum, the son has a chemsex problem, but the son is like, I’m having the time of my life, you know, I’m capable of prioritizing. When I want to see my mother or when I want to do this and that, I have the right to do that prioritizing. It really becomes a problem when a person decides that it is. For some people, it’s when they have one bad experience and they go: “It’s not worth it for me. That was a problem, I stopped.” For some people, they feel awful after but that’s better than giving up the drugs. I would rather feel yuck for three days, every Monday, Tuesday, Wednesday, then stop doing drugs, because it’s worth it for me. So, that’s a decisional balance a person might make. It might be when a person I guess becomes HIV+, that might be a sign. It might be the point when somebody thinks that they might want to make some changes, but it might not. It might be because you are missing days at work on a regular basis or missing days at university. It might be because you experience paranoia every time that you do it and even though it feels great for two days, day three is horrendous. It might be that you want to do it maybe six times a year, or four times a year, or on special holidays, but it’s becoming a problem because I am doing it almost every weekend, so I might need some help with this. So, it’s problematic in varying degrees for different people. For me, the reason I stopped doing it, is because I just realized that I was having a lot of amazing times with people, people, they were telling me: ‘You are sexy, I want to be with you, it’s all about you in this moment, there might be other people on my bed but I’m paying attention to you. You are sexy, I’m telling you you are. This feels good. But also, what I was learning in-between their lines were, in-between other words I just heard people were sort of saying, ‘you are gonna feel like shit on Monday, and you might miss work and you might be really worried about this, but I won’t be there. You’ll be blocked. I’ll be doing something else. But I don’t care. So, come on, take your clothes off, let’s do this’. And I was like, yes, OK, OK, we can. Weekend after weekend, after weekend, I was saying It’s OK to disrespect myself, kind of. But that was my judgment, and I decided that it was a problem. I went to get help. I was lucky, I found chemsex support services. Well, I didn’t, I created them, but I found places where I went looking for where they’ve talked about gay sex, that’s where I went and I didn’t go to the heroin clinic. And I was lucky, I was able to make the changes that suited me, with kind people, that helped me to do that. That’s how it should be.

JERNEJ: Thank you for sharing with us. You were just mentioning … when defining problematic chemsex you mentioned there is always this other person, that understands our practice as problematic. It is quite common that people who overdo chemsex, start to lose their safety nets, I mean social safety nets. A lot of connections with friends who are either straight or gays who are not into chemsex, are cut off and so on. Could you share something about that? How can a chemsex user prevent that?

DAVID: It’s quite hard to prevent that in a sense because we are not talking about marihuana or nicotine or alcohol. We are talking about drugs that are very powerfully linked to dopamine, very powerfully so, linked up to our sex. So, imagine two parts of the brain. On this side of the brain, you’ve got your Darwinian brain. That’s the bit that is primal and goes back centuries and centuries. It’s like pleasure and reward. The sunlight is pleasurable to me because I pursue good weather so I can survive. Food is pleasurable and I need that to survive. And when the food tastes yuck I vomit because it’s dangerous to me. So, I have all of these senses that are about instinct: survival, urgency, fight or flight, the impulse to fight when I’m in danger. This is the dopamine, Darwinian side of our brain. There’s another side of our brain which is kind of a cognitive brain, they are the networks and sparks … The cognitive brain thinks. It calms, it makes a decision reflecting on tomorrow and last week and is it a good idea or not, does it interfere with other plans I’ve got. A cognitive brain can do math and logic, and can consider the future and past, and consequences. Now, when you do drugs, chems are much more linked to that Darwinian, dopamine part of the brain than the other. So, the more frequently you use them the more powerful that desire is. So, when you suddenly decide to try to stop for one weekend, they crave; this part of the brain is saying, “where are they, where are they, they are urgent, they are part of our survival”. They’re linked to this, telling you you must do them. sending you a craving, sending you a craving, sending you cravings, cravings. So, you get all these instincts to use them, which are more powerful than your cognitive brain that says: ‘’…but I don’t want to this weekend’’; this side is stronger. Now, we all have different abilities to negotiate that, but the more you use chems the more complicated it can be to make rational choices about whether to use them or not. It can be more of an emotional craving, a powerful choice, impulse, and we need help with that. So, when that gets out of control, when a person starts losing the ability to choose drugs with reason but instead is just acting on cravings impulsively, then things get bad. Psychosis is one of the most common things with crystal meth. Anyone in a state that’s awake for two or three days and does crystal meth is probably going to experience a kind of drug-induced psychosis. It’s kind of like feeling paranoid, ‘’they are whispering about me, they don’t really want me here, are they putting strange things in the drugs, do they have an agenda, do they kind of want to hurt me, they’re intentionally trying to infect me with something, are they filming me secretly, they put on YouTube, they are evil and they have some agenda about me I just don’t know what it is’’. That feeling can accelerate. It’s very frightening and is very common, so lots of people experience that on the third day of their chemsex session. It’s very traumatising, but then they do it again because of the nature of those two sides of the brain. And then there is … GHB is one of the most dangerous drugs in the sense that it’s so easy to overdose on this drug. So, in London we have like about two people overdosing and dying nearly every month, because it’s so easy. 1ml of G might be enough to make you feel good but 1.5ml of G might be enough to kill you. So, if you just knock it back. And we do have lots and lots of overdoses that don’t lead to deaths, many of them, other overdoses that are deaths, and also it can become physically addictive too. , So, G is one of those drugs that some people find themselves taking it every hour of every day, just because they are physically dependant or they are using it the way you might use a sleeping pill and you can’t go without your sleeping pill. There are some serious consequences and addiction, you know, the more you use the drug. You might not experience any of those things, but if you do it every weekend, a gentle depression starts to creep in, a lack of enthusiasm for life, a lack of gusto. And if an opportunity comes pass, if you haven’t done drugs in like two months you might go: ‘’Opportunity! Oh wow, I know exactly what to do with that and I’m gonna do it.’’ But after partying another day: ‘’I’m tired today’’, and that can become a constant state. And that leads to people not achieving their goals, it can lead to real depression, it can lead to self-harm, it can lead to lives falling apart and sorts of things. 

JERNEJ: So, usually it starts quite innocently … In most drug use we can observe certain cycles from innocent experimentation to a stage when problematic symptoms arise. Chemsex is quite complicated. It combines sex, drugs, addiction to sex and drugs, and addiction to drugs. It’s an amazing phenomenon. Could you describe this cycle for the problematic chemsex? Some people have the ability to stay without, to hold themselves back, and don’t go into this. But, for the sake of the debate, what is this cycle in general.

DAVID: Typically, year one person doing chems and chemsex, is kind of like: ‘’wow, that’s amazing, this is how sex was meant to feel like, I feel so free and disinhibited and horny and liberated, wow!’’ That’s over the first year, it’s fun and quite pleasurable, and there might be some terrible comedowns, but it is usually quite manageable for a period of time. In year two, a person might have tried injecting once or twice, not by choice, but just someone else in the room made it available and then they thought… OK; and so it’s a gentle introduction to opportunistic injecting. It might lead to some more STIs or diagnosis of some sort in the year two or three. And in the year three it’s accelerated to the point where if I have a free holiday, a bank holiday, like an extra three days on a weekend, and you say: “What do you wanna do with that most of all in the whole world? I wanna do drugs.” And it’s like when that becomes your main thing that you are looking forward to, when you are missing barbecues or you don’t see your mum and you are not going to the cinema with your friends, that has become that much of a priority, that’s kind of year three. Year four it’s becoming quite regular. More injecting, probably some more of those side-effects, like psychosis or paranoia, that depression creeping in, so, ”I’m not gonna do drugs this weekend.” ”Why not? I’m so depressed anyway, the drugs will make me feel better, I’m gonna do them”. And in this cycle of use with this constant, ”Have I got a problem or not? I like this, but I don’t”..” I should do something but I’m too scared and there must be something wrong with me and I don’t wanna think about it and I’ll just do drugs and not think about it anymore”. And by year six it could be people sort of using every weekend or more, sort of injecting or might be physically dependent on G, or having periods like that. Missing days at work, losing their jobs or not paying their rent or things like that. So, that’s typical, that’s quite general, we see that quite a lot. There are some people that can put some boundaries in place, like: “If I’m going to do chemsex,’’ I might say: ”I want 30% of my sex life to be with chems and I want 70% of my sex life to be sober.” That’s a boundary. And if I start crossing my boundary, If I find that in the last two months 80% of my sex is on chems, then I’m going to do something about it. I’m gonna go talk to a drugs worker and help get that boundary. It might be: “I will never inject and I‘ll always have a full months break between every session.” And when I find that I’m using every three weeks, it’s time; I’m going to say: “Ok, I’m aware that I’m crossing my boundaries and go talk to like a drugs adviser or someone like where you work to help me get my boundaries back together. A person that is really good with boundaries, and knows exactly what they will do or they won’t do, how frequently they will and how frequently they won’t and knows whenever they cross their boundaries, they’re going to get some help. That’s a skill that anyone engaging in chemsex deserves, and it’s a good drugs workers’ job, it’s the job of all gay charities and sexual health clinics to really help gay men with these boundaries. Because chemsex is common, drugs are very available when we’re hooking-up, they’re very pleasurable and gosh – they need really good boundaries. That’s the most important thing. That’s such an important tool we gay communities need right now and most of us don’t have it.

JERNEJ: That’s true. We try, but sometimes it feels like that we are quite left to ourselves, on our own. 

DAVID: It’s an awful thing, you know, when you see people with awful drug problems and it’s not their fault. It’s just because no one ever taught them the basics. It’s awful. We should be doing more as communities, you know.

JENREJ: I completely agree. You started talking about help. So, you need the boundaries, you need to go to an adviser, to get help and set the boundaries, and so on. Of course, we need some cultural competence for that when working with gay people. Most LGBT persons, and I think this is especially true for more eastern you go in Europe, less they trust authorities, like police, but we will keep police out of it, also doctors, a lot of, I think that at least half of the people don’t tell their general practitioner about their sexual orientation, let alone that they are using drugs and sex. So, these are all things that are quite personal and most of these people seek help in LGBT organizations. These LGBT organizations are usually activists, they are quite unfounded, so they receive low funds, which means that they cannot really employ medical professionals and so on, and this is a huge problem when it comes to chemsex. When a problematic user needs more than just peer-to-peer guidance, they need professional help. What would you advise these professionals outside of LGBT organizations? How should they approach a chemsex user?

DAVID: Understanding first that it’s a gay cultural issue that … you can teach someone therapy, psychotherapy, psychosexual therapy and you can put them through those things, you can teach them how to manage addiction and tools to manage this, but ultimately when it comes to chemsex … Like, someone might go to rehab, a residential rehab where they get loads of therapy and intensive stuff and they’re kept away from all temptations and when they leave the rehab, maybe after three months, they’re alone on a Saturday night in their bedroom, they’re bored, they’re lonely, they’re horny and they’ve got an app on their phone. So, that moment, whenever you are thinking about chemsex support, just think about that moment. You’re bored, you’re lonely, you don’t have a lot of good social skills, you’ve got an app on your phone that fixes all these things, there’s lots of drugs available in the app and I need something now. And I could choose to not do it and there would be another loneliness issue for me in this evening or I could choose to do it. So, whoever, when I’m talking to professionals, I would take it into that moment, what does your patient or that person need in that moment. Well, they do need skills, that really is true, there’s a lot of people, there are a lot of peer support services, there’s a lot of guys in the world, guys who do use chems, or have used chems in the past, volunteering gay organizations to help their mates in their community understand how to use drugs safely and stuff. And that’s brilliant, we need lots of them, we need lots more of them, but they can’t be it, they can’t be the only thing, because one thing I know as someone who has worked with tens of thousands of guys who are engaging in chemsex is they need professional support. When you are saying … people might come to me saying: “David, David. Hi. It’s Tuesday, I did drugs again Saturday, Sunday, and Monday. Help, I did it again. I don’t know why I’ve had such a bad comedown, these bad consequences. Yeah, I love it, I don’t even want to think about stopping. So, don’t tell me I have to stop, and don’t you dare call me an addict or anything like that. I wanna do what I wanna do. But help, because I’m gonna do it again and I don’t wanna do it again this weekend, but I know I will and I will want to, so, fix that!” And you are like, wow. My point is you need real skills, therapy skills to manage that. Because it is frightening when you keep doing the same thing every weekend with incredible consequences that no one sees, because everyone just sees you high and having fun. They never see you alone and paranoid on Monday, worried about this repetition in cycle, they never see you scratching at your arms or losing your job and having that panic. They just see you having fun. They say: “Yeah, he is fine, he can handle his drugs.” But when you are alone at that moment and you are saying: “Help me. There must be something wrong with me. And I don’t know what it is, because I don’t wanna do it this weekend, but I will. But I don’t know why.” There’s a certain kind of drugs worker that knows why and knows what to do, knows how to work with parts of the brain, Darwinian part of the brain and the cognitive part of the brain, to help someone make a practical choice, focus on the goal that they want to achieve. It might be ‘not using just this weekend’. Even though, when Saturday night comes, boom, boom, boom, there’s all these amazing things going on in their head compelling them to use. We can’t just stick them in a room with a bunch of peers who’ve done drugs and teach them harm reduction information. What they need in addition to that is very skilled support that helps them manage that complicated moment that’s happening in their head when they’re making a decision to use drugs or to not use drugs. That is a highly complicated volatile moment with lots of things going on in the brain influencing that decision. And you need very good skills and you need good skilled therapists and drugs workers to do that work. And my message to any healthcare provider or any city that’s trying to create chemsex support in their cities is: My god, invest in that skill! The population of people you’re trying to support, they deserve more than just support from their peers and their community, they deserve investment in skilling, the skills required to help a person with those kinds of things. Drugs are dangerous things, people die. People are physically addicted, people could die from withdrawal symptoms, people are having incredible psychosis where they actually need very skilled management or they’ll go away and harm themselves more. We need really skilled people doing chemsex support. So, please, do the work, do your learning, and contribute your learning to the LGBT organizations, workers, multidisciplinary teams to share the skills. Please don’t just leave it to the gay communities because you think they’ve got that, that’s all gay and they’ve got that. They need you. They need skill.

JERNEJ: Thank you for that. You created a Chemsex care plan, which is also translated into Slovenian and available on our website.

DAVID: Thank you for doing that. Thank you for the translation. That was brilliant.

JERNEJ: So, this Chemsex care plan is usable by users as well as medical practitioners to help us make change in chemsex participation. It defines triggers in the environment, and objectively assess our drug use. I found it as quite a useful tool and I believe people should know more about it.

DAVID: I’ve designed it specifically because I was talking to or being approached by so many people around the world. Sometimes health professionals who say: “Oh, I don’t know what to do with a chemsex patient?”, sometimes it’s by guys who were doing chemsex, something like: “I really need to not use this weekend, but I’m scared and I will do it anyway. How do I do this?” And I thought, how do I help all of them? So, it’s really by creating a tool. It’s not perfect, but it’s designed because there’s a lack of chemsex support at the moment and skill. Essentially if you log on it helps you to choose the goal to work towards. It helps you to identify a goal and asks you how important it is to you, because if it’s not important to you, don’t do this. It doesn’t work. It’s Saturday night, you’re horny, you’re lonely and you got chems on your brain, you didn’t want to do drugs this week but you really don’t care about that right now, what you need is to remind yourself of why was important you have a goal in the first place, to have it written down somewhere, to have some commitment to it, refreshing of why it’s important to me. Get back into that headspace that you were in on Tuesday, when you wanted to do this. That is all embodied in an interactive page by page program online which you can do yourself at home and it just guides you into how to achieve a goal, how to find your motivation for it, how to use the craving management skills to keep you focused on that goal even when transient opportunities might arise. So, it’s how to care about something bigger even in that moment of a craving and it teaches you how to do that.

JERNEJ: And it’s also usable for medical practitioners or therapists…

DAVID: Sometimes there might be a sexual health nurse in a country, maybe it’s in Taiwan and this nurse doesn’t have much experience of chemsex and it’s a little bit frightening for him or for her. And this nurse says: ”OK, patient, I asked you if you do drugs and you said yes, I don’t know how to help you. I don’t know anything about chemsex, I’ve never heard of it. But we go on this website together, we go do the tool together and answer the questions”, and then in the space of just 15 minutes the patient has a plan of a goal he wants to work towards, how important it is to him, the skills he can use to manage cravings when they happen, how to be prepared for them, and how to stay focused on this. We do that all in 15 minutes and we print it out or send it home or send him the link and this nurse suddenly has helped this person to create a plan and goal with the skills to accomplish it.

JERNEJ: Wonderful. Now we are five minutes past eight and I believe we should open the floor for questions. So, dear audience, if there are any questions for David or for me you can type it or put your microphone on. We have a first question from Guest 1.

GUEST 1:   As a therapist, I wonder if chemical sex is more a matter of drug abuse or sex addiction. What I hear is that people have existential distress that they face by going back to the old ways after treatment.

DAVID: Yes, I would agree. So, it’s definitely a mixture of both. When sex is linked to that Darwinian part of the brain I was talking about, you know, sex is about survival, actually, it is mostly about survival of the species, so, it’s really programmed into our instinctive way. It’s crucially important, our sex drive, and our brain knows it. It’s more powerful than logic sometimes. We all know it. The potential for that to be invested into a point where our cognitive brain doesn’t have any influence anymore, if you overdo it, if you become heavily dependent on it, if you teach this part of the brain that this sex you’re having is crucially important don’t stop it, then when you try to stop you will get cravings and reminders to keep doing it, because that’s just the way it works. So, drugs are the same. Drugs trigger dopamine, they make us feel so good, they’re about reward and pleasure, reward and pleasure, and it’s about this side of our brain. If we do it regularly, it is crucial. The fact that they’re both happening, some people just do drugs but without the sex, and some people just use sex in a compulsive way without the drugs. But with chemsex you have it all going on. So, it just means that when people have developed this kind of relationship to sex and drugs in chemsex, they’ve kind of got double problem. And that means double the work to try to deal with it. It does mean that when they’re trying to make changes that they can’t, it is very distressing and it is kind of an existential distress, because I think: ” There is something wrong with me, will I ever enjoy sex again, will I ever enjoy drugs again, I never seem to enjoy sex without them, this is a meaning of life and death for me, it’s not just a choice, it is like I can’t live life without this, this joy and this pleasure and these things that are so crucial to my existence”. So, it is an existential distress for them. My first job would be, when talking to someone about this, it seems like a huge impossible problem, but it’s actually very simple. It’s just learning how to achieve goals, learning how to retrain the brain to enjoy sex, retrain the brain to prioritize pleasure and wellbeing, to prioritize other accomplishments, and you did it just through repetition and support and information as you know, you are a therapist. And it works. My main job is taking the drama and the existential drama out of it, and just saying: “It’s just simple, it’s just biology. That’s what happens to our brains when we do drugs so we can help you to fix it.” And look at them: “Oh, so I’m not schizophrenic, I’m not in a nightmare, now I don’t need to go to rehab.” No, no, no, no, it’s just a physical normal behaviour which we can help you change.

JERNEJ: Thank you. Do we have any more questions? Do we have any more questions? Oh, we have one. Guest 2, go ahead.

GUEST 2: Hi everyone. Thank you for organizing this event. I think it’s very useful and informative. Actually, what I was wondering the whole time, because you were talking all the time about chemsex services and the offer, but what about this year. We all know COVID-19 happened, which, not because of COVID itself, but more because of the response to COVID a lot of services have simply shut down or in best case scenarios some of them moved online. How is maybe from your experience, David, and also Jernej from your experiences in Slovenia, how did it affect the whole scene? I assume that the level of loneliness increased during the lockdown, parties are not going on, the clubs, everything is closed. What is the thing you think, we’ve learned, we should not repeat in the second wave, and if there is something positive that came out of the whole situation?

DAVID: For me it was a mixed bag of many different things, there were profound changes. It is always upsetting. There were many people who were coming to see me every week saying: “I think I have a chemsex problem. Can you help? I have trouble stopping. Can you help?” And as soon as we had to lockdown and they had to stop doing drugs and sex, because the government told them to, because of the health of many other people, because it was important, suddenly those people were saying: “Oh, I can stop.” And they were surprised that they could stop. All the time they thought they had a problem, they needed help to stop, but when it was important enough, they sort of could. So, that was good for people that learned happy news; I do have a discipline after all. If something is important to me and if it’s that urgent, I can do this. That’s a happy thing. There are other people too, who are opposite, who never thought they had a problem. They weren’t accessing support, but suddenly when they can’t have sex or when they are not supposed to or when it’s some harm to communities, they find that they couldn’t stop. Or lots of people who had their use under control, but they started sort of masturbating more alone because of lockdown and that became a problem for them, and their use became bigger than it had been before. People who thought they had their use under control suddenly found themselves needing urgently company because they were so lonely and isolated; the need to go out and hook-up was extreme. Because you couldn’t go clubbing anymore, because you couldn’t have coffee or dinner anymore. The go-to, the automatic thing that they felt that was the best, obvious was to have sex because that fixes all of those problems. And that led to more drug use too sometimes. So, for me it was a mixed bag. And there were a lot of people who … it’s not really chemsex I think it’s more classic addiction but when you can’t be alone. That’s something, that I think, all addicts, people who define themselves as addicts, sort of identify with this. Being alone without any distraction, without a wine or something or a person or a phone or a television or something to distract me and keep me occupied. All I can hear is the thoughts in my head and hyper-conscious of my feelings, and I hate that. I need something to make that stop and drugs and cravings can become more powerful… That was the most profound thing for me. It woke those people up. Being alone is awful for some. And because chems are so available on Grindr, on an app and in our culture, that was where they go to, to fix their problem. And that was the hardest work for me. Like you say there were a lot of problems with support being available. Not too much in my experience, I mean, I find adapting … I will actually send in an email afterwards some of that online support that you can do by email or Zoom, which is structured. So, even if you don’t want to Zoom with somebody, you can just read the email and it might be as simple as sending – Let’s say I am worried about my drug use and I want to have a weekend off, I don’t wanna think about the rest of my life, I’m not gonna give up drugs or anything, but I do need one weekend off. So, I’m going to email Jernej today and say: “Hi, Jernej, I’m committing to not doing drugs for the next 7 days. It’s important to me because I need to break this cycle, I’m starting to feel it’s affecting my happiness and if I change my mind, I will spend one hour thinking about it first. I will spend one hour, I will leave the room, I’ll think about next week, I’ll calm down, I’ll have a shower and then I’ll email you at the end of the hour and say if I’m gonna use or not.” So, at least that’s kind of encouraging me to have some conscious cognitive calmer thinking in the middle of the craving moment. And if you do that repeatedly week after week after week, that becomes stronger and you become better at it and you get better at it and better at it, until … When cravings happen, it doesn’t matter because you can think your way through them and choose whether to do drugs or not rather than just act on a compulsion. And that can be done just by email, by emailing Jernej every week. I have many people that would do that with me every week, from all over the world. It works.

JERNEJ: Thank you. Next question is from Guest 3: ”You were talking about boundaries. Do you know many gays are there who are users of chemsex but they don’t cross boundaries and they don’t have problems with addiction? What is the percentage?”

DAVID: Oh. I don’t know. I see more of the people with problems, so, I don’t see the people that don’t have a problem, so I can’t judge their number. But if I was going to put a percentage on it, I’m guessing and it’s not a fair thing from me to do … There are some people that have very good boundaries. Just by nature or by upbringing. For instance, somebody who decided they were going to study in extra, further education. So, at age 12 they had to decide what subjects they were gonna study at school at age 13, because they had a plan of planning ahead. They had to think ahead. So, when they were age 15 and 16, they had to choose which subjects to study now in order to achieve that bigger goal. And after thinking ahead, calm and reflect and plan for the future and plan, and maybe when they are studying and doing their exams, their friends say: “Come out with us drinking on Sunday.” They go: “No, no, no, I can’t, because I’m going to sacrifice this thing that I enjoy, because I have got a bigger goal that I’m working towards.” And they are practicing in their teenage years how to sacrifice things to achieve a bigger goal. Now imagine that person suddenly, is 25 years old and they have Grindr with them. Then imagine another person, who at age 15, after having maybe a troubled background, they leave school to go and work in a bar. They are taught that if you take your shirt off when you’re serving drinks, you will get more tips and that makes more money. And they don’t necessarily learn by practicing all of the sacrificing something for a bigger goal, they might not be a bit brought up in their further education thing or it might just be the boundaries that you were taught as a child. A person that has good boundaries and has practiced it, and knows how to focus on a bigger goal and make sacrifices for this, that person will have less of a problem with drugs than the other person. So, even the best boundaried person needs skills and boundaries. You need to say, you need to know, this is what I won’t do, no matter how good it feels. This is what I’m going to do no matter how lonely I am. This is what I will do or won’t do. And figure that out for themselves. Not a lot of people have that skill. It’s not something we are taught at school, it’s not something we experience in families very much. It’s something that some people learn by accident, and a lot of us don’t. So, I would say … no, I wouldn’t put a number on it. I just can’t. But it’s very, it’s a very complicated skillset to learn, to manage chems successfully and not a lot of us have it.

JERNEJ: Thank you David. Are there any other questions? Oh, yes. Guest 4: ”Somewhat similar thoughts… the way of professional help we’ve heard about is quite cognitive, and it addresses only the behavioral level, but in my view as therapist working quite a lot with non-chemical addictions, I find the analytical work much more important – e. g. acceptance issues (self-acceptance, feelings of being accepted by the others), understanding the drive mechanisms in oneself…”

DAVID: I agree. The way it usually works is, I think that those qualities you mentioned, if someone is very skilled and robust about those things, they probably won’t develop problematic use of drugs, you know, because they have those things sorted out. But, when a person is using drugs, as I said, crystal meth every weekend for two or three days and is doing this every weekend and having a difficult comedown on Monday, Tuesday or Wednesday, they probably wouldn’t engage in therapy very well. I think that psychosexual therapy is crucial for anyone engaging in chemsex. Counselling and therapy where you learn boundaries and analysis, where you figure out reasons why you do things, and you have that, really. Everyone deserves that. First, we address the behaviour, because if a person can’t control their drug use and they will keep missing their appointments, or have neurochemical imbalance because of the drugs and they can’t really engage in the emotional work that the therapist is asking them to do, all the analytic work, then first we must address behaviour. So, a drugs worker like me, my job is to prepare a person with goal achievement boundaries, help them to learn how to manage their cravings, so that they are in control of their drug use and their cravings. And then when they have those skills, they are ready to engage in therapy. So, secondly, after the drugs worker has done his job, they might be more stable, confident, have an ability to manage the drugs and they can now engage in therapy. In an ideal situation. Do you agree? I’m not a therapist so I should be telling therapists who to do their job.

JERNEJ: Guest 4 would you like to join the conversation?

DAVID: I shouldn’t have put her on the spot. But I’m not a therapist, much more of a drugs worker, and it’s really important to me that if someone is using drugs in a problematic way and they say: “Hi, David. I’ve been using drugs a lot and that’s really becoming a problem, and I need some help. I think it’s because I was abused as a child or because of a rape thing that happened a few years ago …” And they are using drugs every weekend. It’s really important that I don’t go or don’t talk about those issues, because if I do talk about them and raise up those issues it might make them more triggered in the week, so, they might, by talking about those issues and unearthing them they might be more likely to use drugs, even more dangerously than they did last week, because they are upset. So, drugs workers know to focus on behaviour only, until their use and their choice to use is under control. And then they are emotionally ready to deal with a very complicated stuff. Without that, they’re being in a relapse danger.

Guest 4: I agree completely. The first condition to join the therapy in my practice is abstinence. Which doesn’t mean that they stay that way through the process but we are able to discuss a relapse. 

DAVID: Not all therapists think that way but there are a lot that do. I think that, when you are really engaging in therapy in the right way, in therapy, there is a moment that comes when you go: “Oh. Aw. I realize my own role in things. Auch. It hurts to realize this.” And it takes such courage and reflection, calm, and safety provided by the therapist for that moment to happen. Just neurochemically. And if you are using drugs, particularly chems, because they are so profoundly impactful on the neurochemistry that it’s quite hard to be reflective, calm, and kind to yourself when your brain is in a state of neurochemical imbalance because of lots and lots of drugs. So, I like people to engage in therapy when they have more balance here.

JERNEJ: OK, thank you. Is there any other question? Or a thought perhaps?    

DAVID: Is anyone … I’m curious about what it’s like in your cities or in your country? When you guys are online, do you get offered chems much? Do you think it’s a problem in your city? Or do you think it’s under control? Are you worried about your communities, your friends? I see people nodding. OK. No, no, no, it’s ok, it’s not a sort of thing you need to talk about, it’s kind of a personal question. But I would like to say, because it seems like we are finishing, I would like to say thank you for being a brilliant audience and to Jernej, and to all of you working here, we met because you volunteered to translate the Chemsex care plan and that moved my heart very, very much. And I don’t worry about our community when I know there are people like yourselves who will sacrifice an hour of your evening to have this discussion. That means that you care about your communities and that’s brilliant. That’s what makes it all worthwhile, doesn’t it?

JERNEJ: It does. Thank you, David, for these kind words and I really want to thank every participant who joined us today, because I find it really important that we all work together in helping our community. Nobody can do it by themselves and everyone who comes in contact with somebody from our community or anybody else who needs help. It’s really good that we have the knowledge of a particular cultural background where the person comes from. So, I really thank you a lot for participating in this process. Thank you all very much. And the other thing, if anybody needs anything, any more resources, you can always contact us on our website, www.kemseks.si, you can see it on the screen. We will answer as fast as possible, and I really invite you to check the self-help plan that David prepared. Thank you all very much.

DAVID: Thank you and goodbye everybody.