A new study published last month in the journal Sexualities offers a glimpse at how women navigate sexuality while in recovery from substance abuse.
"For the women in our study," the authors write, "the transition from the subcultural drug context into a life without drugs presents a real challenge, especially in managing to decipher the rules and expectations in sexual matters. Basically, this includes everything from flirting to post-coital behavior. Being unaccustomed to managing the different codes in sexually charged situations can create confusion and insecurity and ultimately threaten the individual's sexual confidence and self-esteem."
The qualitative research included interviews with 16 heterosexual women, ranging in age from 26 to 55. Participants reported a history of drug use with either heroin or amphetamine for between three and 35 years. All of the women, with one exception, used amphetamine in connection with sexual activity. At the time of the interviews, all were sober. Researchers asked the women to share what their sexual experiences were like during the period of time they abused drugs, and later, when they exited that lifestyle. Additionally, participants evaluated how they viewed themselves and talked about what strategies they undertook as they worked to become sober.
While each person's experience was different, the interviews revealed some recurrent themes. For example, participants in general reported heightened sexual pleasure while on amphetamines. Their self-esteem was enhanced, which made them feel uninhibited and "experience a sense of sexual agency to a greater extent than when in a drug-free state."
"However," the study's authors note, "their stories also seemed to indicate a shift over time. What was initially regarded as a positive and sometimes adventurous and unbounded broadening of one's sexual repertoire gradually transformed into something repetitive, diminishing and mechanical."
Once they stopped using, many participants admitted feelings of shame from past experiences, as well as uncertainty in regards to how sex functioned without drugs. They worried about what their partners expected from them, which sometimes resulted in feeling insecure about their bodies. Signe, who had been clean for four years, said, "I feel a bit damaged when it comes to sex. I expect more, perhaps. It was pretty amazing and all that, but now that you've become well again … I'm terrified of sex."
As a result, some women reported simply swearing off men—especially if they'd experienced sex negatively during their drug abuse, such as being forced into sex work. One woman, Ulla, said it was just better to be alone than risk relapsing into old habits and being hurt again: "I realize more and more how horrible it is – a very distorted view of men. I do know that all men aren't the same as those I've been involved with. There is an abundance of nice men, but I'm not drawn to them . . . the betrayals linger on somehow. I'm scared of letting go of control."
despite the strong connection between drugs and sexuality, there is a gap of knowledge when it comes to the role and meaning of sexuality during this process.
Others chose to pursue relationships with men who were completely different from past sexual partners, men who "represented a conventional life." Researchers found, though, that often participants were unsatisfied with their choices.
Another strategy some women undertook in navigating their new drug-free sex lives was to take up with a man with a similar history and abstain from sex. One woman told researchers, "I don't think I've ever been without sex for as long as I have now. And it's such a relief not to have to do it! It is pretty much an unspoken rule that we should wait with it, we'll deal with it further along the way."
The study concluded that an important part of the adjustment period to a drug-free lifestyle is for women to evaluate their previous experiences, including their sexual ones, however difficult it may be.
Anette Skårner is a professor of social work at University of Gothenburg, Sweden, and lead author on the study. She says research on the exit process from drug abuse is relatively extensive, but "despite the strong connection between drugs and sexuality, there is a gap of knowledge when it comes to the role and meaning of sexuality during this process."
Her goal with this work, she tells Broadly, is for people to realize "the importance of a non-stigmatizing perspective on sexuality and drug use."
"Our results point to the fact that there is a need among the women to gain perspective on and to process the sexual experiences from their previous lives as drug users," she says. "A key factor in this process is a non-moralizing approach to sexuality from professionals in drug treatment and from significant others in their personal life." This way, she explains, women can overcome feelings of shame and guilt that may be associated with their past experiences and develop new, healthy sex lives.