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This mixed systematic review analyses 10 articles to identify the relationship between chemsex and psychosis.  Psychotic symptoms were found to have a prevalence of 6.7-37.2% making it one of the most frequent psychiatric diagnoses within this population.  Up to 69% of participants reported to have a substance use disorder prior to engaging with chemsex, with trends in slamsex, polydrug use and smoked methamphetamine demonstrating a three-fold increase in risk of psychosis.  Further risk factors were explored in the context of health and social history, trauma, and the social experience of gay and bi-sexual men, with proposed links to attachment style and subsequent sexual behaviours.  Whilst the research narrative is one of public and personal health risk, it also acknowledges the recreational and social nature of chemsex in terms of connection and sexual freedom.

Treatment suggestions are focused on psychotherapeutic interventions to build identity resilience, improve self-efficacy, self-esteem, and positive distinctness. Based on the role of substances in chemsex and the prevalence of substance use disorder within chemsex cohorts, abstinence focused interventions were deemed most appropriate in modifying risk behaviours and outcomes.


How do we feel about chemsex?  Clinically, this article provides a broad oversight of sexual risk behaviours and the health and social drivers behind these.  Arguably, chemsex falls outside of societal norms and expectations relating to sexual behaviour and relationships, which is where this article provides the opportunity to reflect on personal values and beliefs around sex and relationships, the beliefs or assumptions we hold regarding alternative sexual cultures, and how this may inform our clinical practice. 

In acknowledging the cultural element of chemsex, there comes a need to balance strategy and intervention, with respect and promotion of autonomy, self-expression and identity in sexuality, relationships, and recreation.  Consideration must be given to the narrative within health and support settings, so as not to imply pathology or moral failing that requires cure and correction, and risks further stigmatisation, shame, and disengagement from potential support networks.  Engaging individuals in chemsex discussions as we would with drug and alcohol harm reduction could provide a valuable platform for connection, by demonstrating interest, accepting personal choice, and foster dignity and validation. Offering focused interventions and making positive connections provides the opportunity to learn and become visible within chemsex communities.

Are we asking questions? Do we want to ask questions? What questions should we ask?  This article should enable practitioners to answer these, promote safety and empower positive decision making, whilst continuing to acknowledge the human condition and freedom this affords.

Article taken from our latest Clinical Update, edited by Hannah Stephens, Independent Prescriber - Substance Misuse Services. 

Articles featured in this Clinical Update:

  • Chemsex and Psychosis: A Systematic Review

  • Social Representations of Responsibility in Gambling among Young Adult Gamblers: Control Yourself, Know the Rules, do not become Addicted, and Enjoy the Game...

  • Neuropsychological Performance, Substance Misuse, and Recidivism in Intimate Partner Violence Perpetrators

  • Adverse Childhood Experiences: Piloting a Group Therapy Program Using Psychoeducation, Music Therapy, and the Creative Arts for Adults with Complex Concurrent Disorders in an Inpatient Setting

  • Identification and Treatment of individuals with attention-deficit disorder/hyperactivity disorder and substance use disorder: An expert consensus statement

  • Addiction of High Dose Benzodiazepine: Verona detox approach with Flumazenil

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