Substance Use in the LGBTQIA Community and Chemsex

David Fawcett PhD, LCSW

This workshop will be divided into two parts. The first will cover general issues of substance use in this population, starting with a quick review of the various “letters” in the workshop’s title. Epidemiological trends will be considered, followed by a review or risk factors such as adverse childhood experiences and compound stigma. The first hour will conclude with an overview of best practices for treatment. The second hour focuses on chemsex and a review of this addictive behavior, described as fused drug and sexual acting out. At-risk populations will be reviewed, including psychosocial drivers of the behavior, along with epidemiological trends, a review of the brain’s reward circuitry, the special role of methamphetamine, and special treatment considerations when working with this population, concluding with tips to help clients reintegrate healthy sexuality in recovery.


  1. Participants will describe 4 underlying biopsyochosocial issues for sexual minorities and how they impact both the risk for addiction and best practices for treatment.
  2. Participants will be able to explain the role of dopamine and reward circuitry in the fusion of various addictive behaviors and how this impacts treatment.


PART !             Overview of Substance Use in this Population

  1. Review of the “letters”
  2. Epidemiological trends
  3. Drug trends and patterns for each subgroup
  4. Risk Factors
  5. Impact of adverse childhood experiences
  6. Trauma and addiction in this population
  7. The role of multiple stigmatized identities
  8. Best Practices for treatment

PART 2             Chemsex

A,         Chemsex: who and what

  1. Epidemiological trends
  2. Global patterns
  3. Syndemic with HIV in  certain populations
  4. Production trends, purity and addiction.
  5. Psychosocial aspects of at-risk MSM
  6. Reward Circuity
  7. Natural and unnatural rewards
  8. Brief review of the neurobiology of addition
  9. Meth and the hijacking of the reward circuitry
  10. The special case of methamphetamine
  11. How meth functions in the brain
  12. Physical and psychological effects
  13. The fusion of drugs and sexual behavior
  14. Brain impact, drug triggers and relapse
  15. Clinical strategies for recovery and healthy sexuality
  16. Untangling meth, sex and intimacy
  17. Adapting for brain healing (CBT “light,” etc)
  18. Tips for relapse prevention