The crack sex connection

The little talked about phenomenon that inhibits the recovery process for many individuals addicted to crack cocaine
by Richard Lopez, L.M.S.W.

As a licensed master social worker working with chemically addicted homeless men and women, I have had the opportunity to see first hand how members of this population battle with the recovery process. The individuals with whom I work in Dallas, Texas, are mostly African-American men between the ages of 35 and 68, with a mean age of about 40.

Within this population, I have regularly observed a phenomenon that I've come to call the Crack/Sex Connection. This phenomenon occurs when an individual who is addicted to crack and who had undergone drug treatment (often multiple times) relapses due to a compulsion of ritualized seeking behavior involving crack and sex.

Many chemical addiction treatment programs do an outstanding job of educating and providing recovering persons with the essential tools needed to stay clean and sober. Most programs that treat crack addicts, however, fall short by failing to thoroughly discuss sex as a critical relapse trigger. I say thoroughly because, while many treatment programs currently address sex as a relapse trigger, they nevertheless fail to help addicts understand how they have created a ritual of crack/sex seeking behavior-behavior that often leads to active crack use, leaving the addict in deep despair. Seldom do treatment centers help with sex addiction, either, and those that do treat it often overlook the importance of this ritual.

I am convinced that men who undergo treatment for crack cocaine addiction and sex addiction will require treatment less often. They will work a better quality recovery program, leading to a higher quality of life.

The ritual

During my work with crack addicted homeless men, I have seen this ritual which links sex and crack regularly repeat itself. Dr. Patrick Carnes describes preoccupation and ritual as the first two steps in the addictive cycle (with compulsive sexual behavior and despair being the remaining two) in his groundbreaking book, Out of the Shadows. I quote here from his book:

"For sexual addicts, an addictive experience progresses through a four-step cycle which intensifies with each repetition.
1. Preoccupation-the trance or mood wherein addicts' minds are completely engrossed with thoughts of sex. This mental state creates an obsessive search for sexual stimulation.
2. Ritualization-the addicts' own special routines which lead up to the sexual behavior. The ritual intensifies the preoccupation, adding arousal and excitement.

Sexual addicts are hostages of their own preoccupation. Every passerby, every relationship, and every introduction to someone passes through the sexually obsessive filter. More than merely noticing sexually attractive people, there is a quality of desperation which interferes with work, relaxation, and even sleep. People become objects to be scrutinized. A crowded downtown area is translated into a veritable shopping list of possibilities. Preoccupation leads to a powerful trance-like state.

The trance is enhanced by the sexual addict's ritualization. Professionals have often wondered why sex offenders use the same 'MO' or 'method' each time when it only makes apprehension easier. The answer is simple. A ritual helps the trance. Like a yogi in meditation, the addict does not have to stop and think or disrupt his focus. The ritual itself, like preoccupation, can start the rush of excitement. . . . The rituals contain a set of well-rehearsed cues which trigger arousal." (pp. 6-11)

If not addressed in treatment, these rituals continue to serve as a revolving door to chemical addiction programs. For federal, state, and city agencies that assist this population, the financial cost can be extraordinary. For communities, it can be critical in terms of crime, prostitution, homelessness, lost productivity, joblessness, non-payment of child support-and the list goes on. Crack and sex?

The addictive power of crack cocaine and the drive to obtain it will make some individuals do almost anything. To understand how the crack/sex ritual is formed, it's important to understand how these men are introduced to crack cocaine. Based on informal questions during weekly chemical addiction treatment groups I have facilitated during the past three years and through my work with these men in individual therapy, this ritual grew through contact with women in approximately 50 percent of this population. This estimate is based on answers to this question: "When you took your first hit, were you with someone?"

Approximately 90 percent also answered "yes" to the question, "How many of you have ever used crack to buy sex?" And of particular interest has been their response to the question: "How many of you have relapsed back to crack use because you used crack to buy sex despite not intending to use it yourself?" More than 90 percent of these middle-aged men answered affirmatively. It seems clear that a desire for sex, not crack use, is driving the actions of these men.

Many women will turn to prostitution to meet the needs of their habit. They are known on the streets as "chicken heads," "strawberries," or "rock stars." Regardless of how an individual was led into crack cocaine use, life on the streets holds one certainty: sex will be available on demand, and it will be cheap. Even for those men who were not introduced to crack via a woman, it does not take long to discover the easy access to sex on the streets. Thus begins the pursuit that leads to the ritualized crack/sex-seeking behavior.

While some men claim that they are able to ejaculate during crack use, others say they cannot. In the latter case, these men instead hold on to the memory of the sexual encounter and masturbate with it later on. One client, an affluent 41 year-old African-American male who was married with two children, a computer analyst and a homeowner with two cars and a boat, describes the ritual:

I first met her at a party. After some flirting, she asked me to her apartment. She lit a crack stem and offered me a hit. Although I had never tried crack, I had smoked marijuana a few times in the service. My mind, however, was on what was coming next, and so I took the hit without even a second thought. We had sex, but I was not able to come. Still, it was great. I masturbated all week on the images from that night. I started seeing her regularly, spending money as if I had an endless supply. When my wife started to wonder about my spending, I decided to stop. When I arrived at her apartment with no crack and no money, she kicked me out.

By this time, I had already learned how to buy crack, so I began seeing chicken heads, and smoking in crack houses. Over a period of about two years, I lost my job; my wife left me and took the children; my cars and boat were repossessed; and eventually I lost my house. My credit cards were used to the limit. I had nothing left. I had to live in a shelter in downtown Dallas. I entered into two treatment programs, and each time I thought I could recover from my crack problem, but each time, I failed. I tried to work a few jobs, but when I got the paycheck, my palms would sweat, my breathing would increase, and my mind would go crazy thinking about where I would find some crack, what she [a prostitute] would look like this time, and what could I get her to do.

This situation raises the question posed by an old question: Which comes first, the chicken or the egg? Some psychologists argue that the urge to use crack leads addicts back to old behaviors that include both drugs and sex. I believe, however, that relapse has much more to do with sex than crack. I repeatedly hear clients make such statements as: "Thank you for saving my life. I had given up all hope of recovering from this. [Moreover,] I never thought about the sex part of it, although each time I relapsed, it was while I was looking for sex. I would rationalize what I was about to do, saying to myself, 'I am not going to use; I'm just buying rocks to have sex.' It worked maybe once or twice, but then I'm right back in the game."

I believe that many men, particularly low-income men, are caught in a web of ritualized behaviors involving crack and sex. For them to have any chance of becoming drug-free and rebuilding their lives, treatment must address the crack/sex-seeking ritual. Unfortunately, most treatment programs do not. For the betterment of many low-income communities throughout the country, this crisis desperately needs further research.

Richard Lopez, L.M.S.W., has a bachelors degree and a masters degree in Social Work and an associate degree in Criminal Justice. He works with the Veterans Administration Medical Center in Dallas, Texas, in their Comprehensive Homeless Center, and with the Children First Counseling Center in Grand Prairie, Texas.