When substance abuse treatment providers first hear about the sexual health curriculum developed by Douglas Braun-Harvey, MFT, CGP, CST, they think it's about sex addiction, sex linked to crystal methamphetamine, sexually transmitted diseases, pregnancy, or even sexual rule-breaking in treatment programs. In fact, the curriculum, which is designed specifically for providers, helps patients avoid relapse to substance abuse--a central goal of any treatment program.
For drug-sex linked addiction, in which substance abuse is connected with sexual experiences, relapse is more likely if sexual health is not addressed in substance abuse treatment, says Harvey, the author of Sexual Health in Drug and Alcohol Treatment, a facilitator's manual for running sexual health groups. "Many patients have drug-sex linked addiction, which means that their sexual life is so merged with their drug use, they become the same," he says. When they find they have to abstain from the drugs or alcohol as part of being in recovery, this threatens their sexual life as well. And that, in turn, threatens their recovery.
"I never even thought of sex as something I could do sober,'" someone newly in recovery might think to themselves, says Braun-Harvey. Or, '"I've always had a couple of drags of pot first, that's been the history of my marriage.'" Basically, what these patients say when they want to start having sex in early recovery is: '"Now what do I do?'"
With most people in treatment having started their drug or alcohol use in their teens, it's safe to say that their sexual life has been affected, says Richard M. Siegel, MS, LMHC, CST, a Florida-based sex therapist who was a sexuality educator for addiction treatment programs for 15 years. "Almost everyone in treatment has probably never had sex sober," he says, noting that for most addicts, drinking and drug use starts during the teen years. "They're thinking, 'Maybe I can handle being sober, but I can never think about having sex again because I don't know if I know how to do it.'"
Most counseling staff in drug and alcohol treatment don't feel prepared to discuss sexual health, says Siegel, who encountered significant resistance to any changes when he worked in addiction treatment programs. Even programs that hired him to educate patients about sexual health didn't do anything differently once his presentations were over. Siegel hopes that treatment programs will take advantage of Braun-Harvey's approach to start their own groups.
Issues such as sexual desire are rarely discussed in treatment programs, says Braun-Harvey. If someone's erotic fantasies involved drug use before treatment, then these same fantasies could trigger a relapse after treatment. "How can you even talk about this in treatment as a relapse risk factor, if there's no model to even discuss masturbation?" he asks.
In an example of sexual activity in a treatment program, Siegel was providing a regular sexual health group at a treatment program which had an adolescent facility. The executive director found a condom in the parking lot that had clearly been tossed out of the window of the adolescent unit. Siegel, who provided the nursing director with condoms for the teens for weekends when they left the facility, was called into the office and asked to explain what was going on. It turned that that the teens had made holes in the walls between rooms--behind the bureaus--and were going in and out of each others' rooms at night. The treatment center's solution was to take away the condoms.
"Instead of labeling this as inappropriate acting-out behavior, the treatment center should have worked on developing a healthier attitude toward sexuality in general," says Siegel. "Yes, people should be concentrating on their treatment, and not pairing off, but the best thing about a sexual health curriculum is that people can talk about it, instead of hiding it. …