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. 2025 Mar;44(3):711-722.
doi: 10.1111/dar.13999. Epub 2025 Jan 29.

Exploring experiences of talk therapies among gay and bisexual men seeking to reduce or abstain from using crystal methamphetamine in the context of chemsex

Jack Freestone  1   2   3 , Bo Justin Xiao  2 , Krista J Siefried  3   4   5 , Adam Bourne  1   6 , Nadine Ezard  3   4   5 , Lisa Maher  1   7 , Robert Stirling  8   9 , Louisa Degenhardt  5 , Rick Varma  1   10 , Garrett Prestage  1 , Mohamed Hammoud  1
Affiliations

Exploring experiences of talk therapies among gay and bisexual men seeking to reduce or abstain from using crystal methamphetamine in the context of chemsex

Jack Freestone et al. Drug Alcohol Rev. 2025 Mar.

Abstract

Introduction: Some gay and bisexual men who have sex with men (GBMSM) who use drugs to enhance sex (chemsex/party and play) may experience harms and seek talk therapies. GBMSM who practice chemsex may not access drug services because of anticipated stigma and the perception that these services lack chemsex expertise. Barriers to services are documented, however, little is known about the service experiences of chemsex engaged GBMSM.

Methods: Semi-structured interviews were conducted with 24 participants reporting current practice of sexualised use of methamphetamine and/or gamma hydroxybutyrate. Interviews explored experiences of counselling and psychology services, participant's treatment goals and challenges. Data were transcribed verbatim and analysed in NVIVO14 with a qualitative description methodology.

Results: Most in our study sought to reduce the frequency of methamphetamine use and used methamphetamine only in sexual contexts. When engaging with counsellors and psychologists in alcohol and other drug or mental health services for the general adult population, most censored the sexual drivers and types of sexual behaviours incumbent in their methamphetamine use. Participants' reliance on drugs for sex was spoken about as a major barrier to reducing methamphetamine. Sexual self-censorship within services inhibited participants' abilities to access meaningful support and achieve treatment goals.

Discussion and conclusions: Counsellor and psychologists working with GBMSM around drug use, must ask about context of drug use and sex. Training and supervision around sexual therapies for those working alongside GBMSM who practice chemsex may be beneficial. Research on treatment approaches to support the sexual wellbeing of people who practice chemsex is required.

Keywords: health services; methamphetamine; qualitative research; sexual and gender minorities; sexuality.

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Conflict of interest statement

For the duration of this study, the first author Jack Freestone and the second author Bo Justin Xiao were employed at ACON, a community organisation that receives funding to deliver tailored services to lesbian, gay, bisexual, transgender and queer communities in New South Wales Australia. The first author was employed by ACON while he conducted this research. As indicated in the text, ACON is, a community organisation that specialises in health promotion and clinical services for sexuality and gender diverse communities in New South Wales. This research was funded by an NHMRC Partnership Grant.

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