Sexuality and Substance Use: The Impact of Tobacco, Alcohol, and Selected Recreational Drugs on Sexual Function

Article excerpt

INTRODUCTION

Throughout history and across cultures, alcohol, recreational drug use and sexuality have been closely intertwined. For example, alcohol has often been considered to be "... a powerful facilitator, promoter, disinhibitor, and common accompaniment to sexual behavior of all types" (Rosen, 1991, pp. 120-121). Smoking cigarettes has traditionally been associated with glamour, sophistication, and enhanced attractiveness. Advertising often attempts to associate alcohol consumption with sexual attractiveness. Many recreational drugs are thought to be aphrodisiacs and, in general, substance use is often considered a facilitating social-psychological prelude to sexual activity. While there is a well established mythology concerning the relationship between sexuality and substance use, many people, including educators and health professionals, are less certain about the current medical/scientific understanding of the impact of substance use on sexual functioning.

The purpose of this article is to review and summarize the available scientific literature on the impact of consumption of tobacco, alcohol, methamphetamine, cocaine, and marijuana on sexual function. The findings of the available research are summarized in the context of the immediate impact of consumption and in terms of the impact that may result from regular, prolonged use of a substance. This information will be of general interest but also of particular use to educators and counsellors in assisting their students and clients in making informed decisions about substance use.

A presentation and discussion of research on the impact of substance use on sexuality must take into account several important considerations. First, many substance users report a beneficial impact of consumption on sexuality (e.g., increased sexual enjoyment). Second, all the substances considered in this review are, or can be highly addictive and prolonged, heavy consumption of these substances carries a high risk for significant detrimental health outcomes. Third, this important reality should be factored into informed decision-making around substance use. Fourth, it should be noted explicitly that with the exception of tobacco and alcohol, possession of the substances considered in this article is illegal.

There are some significant methodological issues in the research on this topic which should induce a good measure of caution in drawing definitive conclusions about the impact of substance use on sexuality. First, the impact of specific substances on specific phases of human sexual response has, in many cases, not been directly examined in the scientific literature. Second, as other reviewers have noted, much of the research in this area relies on small, non-representative samples and self-report data from volunteer users obtained in uncontrolled studies (Peugh & Belenko, 2001). It has also been noted that the effects of substance use on sexuality are mediated by, among other things, dosage level, duration of use, history and characteristics of the user, and the social/ environmental context in which the substance is consumed (Rosen, 1991). With these caveats in mind, there is sufficient research available to make some observation, albeit tentatively, about the impact of different substances on sexual function.

THE CONCEPTUAL DISTINCTION BETWEEN SEXUAL ENJOYMENT/PLEASURE AND THE AROUSAL AND ORGASM PHASES OF SEXUAL RESPONSE: AN IMPORTANT CONSIDERATION IN THE EXAMINATION OF THE IMPACT OF SUBSTANCE USE ON SEXUALITY

In order to clearly articulate the known impact of substances on sexual function it is important to clarify what is meant by sexual function and its relationship to sexual pleasure/enjoyment. Various models of human sexual response have been proposed (Hyde, Delameter & Byers, 2004). These models range, in terms of complexity, from very basic to highly intricate. In reality, human sexual response is multifaceted and subject to a wide array of biological, psychological, contextual, and interpersonal factors (Basson, 2004). …