Chemsex and the Brain

Welcome to this study guide designed to help you dive deeper into the neuroscience behind chemsex and what it means for your recovery journey.

Dr. Stephen Naulls is pioneering research that could change how we understand and treat chemsex addiction. This guide will help you process the information from the episode and apply it to your own healing.

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Understanding What Chemsex Really Is

Chemsex isn't just "sex on drugs." As Dr. Naulls explains, it's a specific phenomenon within the LGBTQ+ community involving four main substances—crystal meth (Tina), GHB/GBL, mephedrone, or ketamine—used in a sexual context.

What makes it unique is its connection to the historical trauma our community has experienced: the AIDS crisis, growing up in environments that shamed our sexuality, and the rejection we've faced on dating apps and in queer spaces.

This definition matters because understanding the "why" behind chemsex helps remove shame. You weren't just "having fun that got out of hand." You may have been unconsciously trying to overcome deep-seated feelings of danger, shame, or inadequacy around your sexuality. That's not weakness—that's a human response to trauma.

What does this mean for you? Recognizing that chemsex emerged from legitimate pain can help you approach your recovery with more compassion. You're not broken; you're responding to wounds that need healing.

Your Brain on Chemsex: The Science

Here's what's happening in your brain when you engage in chemsex:

 There's a pathway called the mesolimbic pathway—your brain's main reward highway—that connects two areas and uses dopamine as its messenger.

Every time you do something rewarding (eat chocolate, exercise, or use Tina), dopamine floods this pathway, making you feel good.

Chemsex is particularly powerful because it hits this pathway from two directions: the drugs activate it chemically, and the sexual behavior activates it naturally.

You're essentially supercharging your brain's reward system. Over time, this pathway can become altered—either overstimulated in the short term or potentially less responsive after chronic use.

The good news? Dr. Naulls confirmed that psychosis is reversible with treatment. Your brain has plasticity—it can heal and rewire itself. Recovery isn't just about stopping the drugs; it's about giving your brain time and support to repair.

The Healthcare Gap: Why Your Therapist Might Not Get It

One of the most validating parts of this conversation is acknowledging that many mental health professionals don't understand chemsex.

You may have tried to explain your experience to a therapist only to see shock on their face, or had a psychiatrist dismiss your struggles. This isn't your fault, and it doesn't mean your experience isn't valid.

Dr. Naulls admits that psychiatry has a "problematic history" with the queer community and that cultural competence is still being developed. Services are fragmented—you might see a sexual health doctor for STIs, an emergency doctor for an overdose, and a psychiatrist for psychosis, but rarely does anyone connect the dots.

What this means for you: Keep advocating for yourself. If a provider doesn't understand chemsex, you can educate them or find someone who does. Specialized treatment centers and therapists with chemsex training do exist. Don't give up because the first person didn't get it.

Why This Research Matters to Your Story

Dr. Naulls' research on chemsex and the brain isn't just academic—it's about dignity and validation.

When we can prove that chemsex creates measurable changes in brain structure and function, it becomes harder to dismiss as "just needing to pull yourself together." It's biological. It's real. It's not a moral failing.

This research also paves the way for better harm reduction advice. Right now, we can't fully inform people about the long-term effects of chemsex on the brain because we don't have all the data. Once we do, people can make truly informed decisions about their use.

Reflect on this: How would it have changed your journey if someone had explained the neurobiological impact of chemsex before you started? What information do you wish you'd had?

Final Thoughts: You're Not Alone in This

One of the most powerful takeaways from this conversation is that chemsex exists at the intersection of trauma, biology, behavior, and community. It's complex—and that complexity is precisely why you shouldn't judge yourself harshly for struggling with it.

Dr. Naulls is doing this research because people like you matter. Your brain matters. Your recovery matters. And the fact that the medical community is finally starting to take chemsex seriously means that better treatment, better understanding, and better outcomes are on the horizon.

Remember: Psychosis is reversible. Your brain has plasticity. Recovery isn't built in a day, but every day you're giving your brain a chance to heal is a victory.

If you're struggling, reach out. Whether it's to a psychiatrist for medication support, a specialized therapist, a support group, or a research study that needs participants—your next step forward is waiting.

Resources Mentioned:

• Chemsex and the Brain Research: www.chemsexbrain.com
• Instagram: @chemsexbrain
• For UK listeners: Consider participating in the brain imaging study if you're currently using or are a gay man with no chemsex history (control group)

Keep moving forward. Keep healing. You've got this. 💚

Dallas

5 Reflective Questions

1. How does understanding the trauma-based origins of chemsex change the way you view your own experience? Does it help you feel more compassion toward yourself?
2. When Dr. Naulls described the dopamine reward pathway, did anything click for you about your cravings or patterns of use? Can you identify moments when your brain was "chasing that high"?
3. Have you encountered healthcare providers who didn't understand chemsex? How did that experience affect your willingness to seek help? What would you want them to know?
4. Dr. Naulls mentioned that "not all chemsex is innately harmful." What's your reaction to that statement? How do you personally define harmful versus non-harmful use?
5. Knowing that psychosis is reversible and that your brain has plasticity, what does this give you hope for? What changes have you already noticed in your thinking or memory since reducing or stopping use?

5 Journal Prompts

1. The Shame Story: Write about a time you tried to explain your chemsex use to someone (a friend, family member, or healthcare provider) and felt misunderstood or judged. What did you need from them that you didn't receive? How can you give that to yourself now?
2. Mapping Your Reward System: Reflect on what activities or experiences light up your dopamine pathway in healthy ways now. What brings you genuine pleasure without substances? If you're struggling to identify these, write about what used to bring you joy before chemsex entered your life.
3. The Gap in Your Care: Think about the fragmented healthcare you may have received. Write a letter to your ideal treatment team describing exactly what comprehensive, culturally competent care would look like for you. Be specific about what you need.
4. Rewriting Your Brain's Story: Dr. Naulls talked about neuroplasticity—your brain's ability to change. Write about the cognitive changes you want to see in yourself. What mental abilities do you want to strengthen? What new neural pathways do you want to build?
5. The "Why" Behind Your Use: Explore the deeper reasons you engaged in chemsex beyond "it felt good." What feelings were you trying to escape or overcome? What needs were you trying to meet? Write without judgment—just observe and understand.

5 Action Exercises

1. Brain Health Audit: This week, research and implement three brain-healthy practices. This could include: brain games like Sudoku (as Dallas mentioned), omega-3 supplementation, meditation, adequate sleep, regular exercise, or learning a new skill. Document how you feel after one week of consistent practice.
2. Find Your Specialist: Research and compile a list of 3-5 therapists, psychiatrists, or treatment centers in your area (or available online) that specifically advertise experience with chemsex or sexualized drug use. You don't have to contact them yet—just knowing they exist is empowering. If you're in the UK, consider signing up for Dr. Naulls' study at chemsexbrain.com.
3. Create Your Education Packet: If you have a current therapist or doctor who doesn't fully understand chemsex, create a simple one-page explanation drawing from this episode. Include the definition, the four main substances, and the unique challenges of chemsex. Share it at your next appointment.
4. Harm Reduction Inventory: Make an honest assessment of where you are right now. Are you actively using? Trying to cut back? Abstinent? Based on your current stage, research one harm reduction strategy you could implement this week. This might be: testing your substances, not using alone, setting time limits, or having naloxone on hand.
5. Advocate for Research: Support the advancement of chemsex research by taking one concrete action: Share Dr. Naulls' study information with others who might be eligible, follow @chemsexbrain on Instagram and engage with the content, or sign up for their mailing list to stay informed. If you're eligible and local to Brighton, consider participating in the study.