Sex Like You Can't Even Imagine

Abstract

The past five years have witnessed a great increase in the use of the stimulant drugs crystal methamphetamine and smoked cocaine (crack) as part of a pattern of hypersexual behavior inextricably interwoven with substance dependence. With these patients, the problems are not independent, and exist almost exclusively in the company of one another. The paper describes a framework for evaluating patients and assessing their readiness for treatment in office based individual treatment that is informed by psychoanalytic principles. Typical resistances at each stage of treatment are described, with clinical recommendations for management. Common transference and countertransference paradigms are described. The paper includes psychoanalytic exploration of the possible meanings of the experience of drug/sex addiction, abstinence and fantasies that often precede relapse.

Key Words:

• Crystal methamphetamine
• crack cocaine
• sexual addiction homosexuality
• psychoanalytic
• transference