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. Author manuscript; available in PMC: 2022 Jan 1.
Published in final edited form as: J Subst Use. 2020 Aug 28;26(2):212–217. doi: 10.1080/14659891.2020.1807633

Substance use in a sexual context: The association of sex-related substance use motives with substance choice and use behaviors

Jennifer C Elliott 1,2,*, Ashley L Greene 3, Ronald G Thompson Jr 4, Nicholas R Eaton 3, Deborah S Hasin 1,2,5
PMCID: PMC7959098  NIHMSID: NIHMS1621699  PMID: 33732094

Abstract

BACKGROUND.

Substance use before sex is associated with riskier behaviors. Sex-related substance use motives may explain pre-sex substance use. We explored what sex-related motives are associated with alcohol versus drug use, and which motives underlie heavier use.

METHODS.

A sample of 936 participants (50% male, 80% White) completed an Internet survey about sexuality. Those who drank before sex (n=657) reported on six sex-related drinking motives; those who used drugs before sex (n=271) reported on six (parallel) sex-related drug use motives. The frequency of endorsement of each motive between drinkers and drug users was compared with z-distributions. Logistic regressions assessed whether motives were associated with substance use frequency and intoxication before sex.

RESULTS.

Substance use to relax and to get a sex partner to use were more commonly endorsed for alcohol than drugs; substance use to improve performance and enhance experience were more commonly endorsed for drugs. Most motives were associated with alcohol frequency and intoxication before sex. None were associated with drug frequency; some were associated with drug intoxication.

CONCLUSIONS.

Alcohol was generally used to facilitate sex, and drugs to enhance sex. Sex-related drinking motives were associated with drinking before sex; sex-related drug use motives were less predictive.

Keywords: alcohol, drugs, motives, sex

1. Introduction

Approximately 4.3 million Americans drink alcohol regularly before sexual activity (Eaton et al., 2015). Regular drinking before sex is more often observed among those who are single, who have alcohol use disorders, and who have borderline traits (Thompson, Eaton, Hu, Grant, & Hasin, 2014; Thompson, Eaton, Hu, & Hasin, 2017), and is associated with greater risk for sexually transmitted infections among women (Thompson, Eaton, Elliott, Hu, & Hasin, 2018). Sex-related drinking motives and expectancies have been studied as explanations for this phenomenon in various populations, including college students (Brown, Talley, Littlefield, & Gause, 2016), individuals with HIV (Kahler et al., 2015), and patients in emergency departments (Celio et al., 2016) and sexual health clinics (Hutton et al., 2015). Sex-related motives and expectancies both measure cognitions/expectations about a substance that precede or coincide with—and presumably motivate—use, with expectancies referencing the expected effects themselves and motives referencing the desire to use for that expected effect. We use the term “motives” hereafter to discuss trends within this collective literature, and to discuss our items (which are worded as motives). Studies on sex-related drinking motives suggest that individuals drink for various sex-related reasons, including enhancement of sex, to increase sexual risk-taking, and to decrease anxiety about sexual activity. Those reporting more sex-related drinking motives have greater levels of heavy and problem drinking (Banks & Zapolski, 2017; Celio et al., 2016; Messman-Moore, Ward, & DeNardi, 2013; Nash, Katamba, Mafigiri, Mbulaiteye, & Sethi, 2016) and riskier sexual behaviors (e.g., condomless sex, casual partners, greater number of partners, sex while intoxicated) (Brown et al., 2016; Celio et al., 2016; Messman-Moore et al., 2013; Nash et al., 2016). More research on what sex-related drinking motives are most common and most linked to heavy drinking could help to more effectively intervene with such motives in an effort to reduce risky behaviors.

Drugs are also often used in conjunction with sex (sometimes termed “ChemSex” (Giorgetti et al., 2017)). Most research on this topic has focused on samples of men who have sex with men (Hegazi et al., 2017; Melendez-Torres & Bourne, 2016; Pakianathan, Lee, Kelly, & Hegazi, 2016; Schmidt et al., 2016; Sewell et al., 2017; Vosburgh, Mansergh, Sullivan, & Purcell, 2012), with fewer studies of heterosexual samples (Corsi & Booth, 2008). Sex involving methamphetamines (Digiusto & Rawstorne, 2013) and other “party” or “club” drugs (Maxwell, 2005) are commonly studied. Some research suggests that sex-related drug use motives (e.g., drug use to reduce inhibitions, enhance confidence) may explain sex-related drug use (Melendez-Torres & Bourne, 2016; Skalski, Gunn, Caswell, Maisto, & Metrik, 2017). However, the literature on motives for sex-related drug use is limited, fragmented by substance (with some drugs receiving no study), and specific to special populations. Sex-related drug use has been found to be associated with riskier sex (e.g., condomless sex, greater number of partners, transactional sex, group sex) (Hegazi et al., 2017; Sewell et al., 2017), riskier substance use (e.g., injection drug use, heavier drinking) (Hegazi et al., 2017), and more sexually transmitted infections (Giorgetti et al., 2017; Hegazi et al., 2017; Sewell et al., 2017). Therefore, a greater understanding of what sex-related drug use motives are most common and most linked to heavy use may help understand and intervene with these co-occurring risk behaviors, serving an important public health function.

Despite existing literatures on sex-related alcohol and drug use motives, few studies examine the same sex-related substance use motives in relation to both drinking and drug use. One recent study did do so, but focused specifically on young (age<25) nightclub attendees (Palamar, Griffin-Tomas, Acosta, Ompad, & Cleland, 2018), yielding informative conclusions for that subgroup that may or may not generalize to the larger population. Exploring these questions in a more diverse sample would be useful in determining which motives are associated with the choice of alcohol versus drugs prior to sex, and exploring which motives are related to the riskiest levels of use. Thus, this study explored sex-related substance use motives for both alcohol and drug use, as well as their associations with substance use frequency and intoxication.

2. Materials and Methods

2.1. Participants

This exploratory study utilizes data from an Internet survey about sexuality conducted in 2014, using the Amazon Mechanical Turk system (Rodriguez-Seijas, Arfer, Thompson, Hasin, & Eaton, 2017). All participants were required to live in the United States. A total of 1001 participants responded to the survey, which was described as “a survey about sexual feelings and sexual behavior.” Of these, 936 participants passed validity checks, yielding usable data (n=65 were omitted due to very fast response time, inconsistent responding, and/or admitting to moderate to low honesty (Rodriguez-Seijas et al., 2017)). Participants (N = 936) reported varying sexual identities: 79% heterosexual, 13% bisexual, 5% lesbian/gay, and 3% other (e.g., asexual, unknown, pansexual). Half (50%) were male, and 80% were White (10% Black, 8% Asian, 6% Hispanic, 3% Native American; multiple endorsements allowed). Ages ranged from 18 to 82 (median: 30; M = 33.53 [10.66]). Of the full sample, 657 who engaged in pre-sex drinking provided data on sex-related drinking motives, and 271 who engaged in pre-sex drug use provided data on sex-related drug use motives (with 230 reporting both). Participants provided informed consent, and the study was approved by the Institutional Review Board at Stony Brook University.

2.2. Measures

2.2.1. Sex-related substance use motives.

Participants reporting drinking before sex responded to the prompt: “When you drink before sex, what are the primary reasons?”. Participants reporting drug use before sex responded to the prompt: “When you use drugs before or during sex, what are the primary reasons?”. They were asked to endorse any or all that applied. The seven response options following both prompts included use (a) “to get my sex partner to drink” / “to get my sex partner to use a drug”; (b) “to enhance the sexual experience overall;” (c) “to make my sex partner more appealing;” (d) “to improve sexual performance;” (e) “to reduce performance anxiety;” (f) “to loosen up and relax” and (g) “Other” (free response). Participants indicated whether each sex-related substance use motive related to their decision to use alcohol and/or to use drugs before sex by choosing “yes” or “no.” These items were written for the current study (including sex-related substance use motives documented in the literature (e.g., (Banks & Zapolski, 2017; Celio et al., 2016; Kahler et al., 2015; Melendez-Torres & Bourne, 2016)) and generated by the authors) to explore differential endorsement of motives that could be potentially relevant to both alcohol and drugs.

2.2.2. Frequency of substance use before sex.

Participants were asked “How often do you drink alcohol shortly before having sex?” (response options: never, rarely, sometimes, usually, always, unknown). Participants were also asked “How often do you use drugs (not including caffeine, alcohol, or a medication prescribed to you, but including cannabis, cocaine, methamphetamine, poppers, etc.) shortly before or during sex?”, using the same response options. As only participants who used substances before sex were analyzed, never was not endorsed by participants in these subsamples. Very few endorsed “unknown” frequency for either substance (alcohol: n=6; drug: n=7); as these responses were infrequent and uninformative, these participants were excluded from analysis. Remaining response options were dichotomized to represent non-regular use before sex (rarely, sometimes) versus regular use before sex (usually, always), supported by previous analyses (Eaton et al., 2015; Rodriguez-Seijas et al., 2017; Thompson et al., 2014).

2.2.3. Level of intoxication.

Participants were asked “When you drink before sex, how much do you typically drink?” (“not enough to feel an effect,” “enough to feel a slight buzz”, “enough to feel a significant buzz,”‘ “enough to get drunk,” “enough to pass out”). This was dichotomized to reflect low intoxication (no effect, slight buzz) versus high intoxication (significant buzz, drunk, pass out). To assess drug intoxication before sex, participants were asked “When you use drugs before or during sex, how much do you typically use? (low intoxication: “not enough to feel an effect” or “enough to feel a slight effect”; high intoxication: “enough to feel a significant effect,” “enough to feel a strong effect,” and “enough to pass out”). Level of intoxication was measured to elucidate the link between motive and intensity of use; this also avoids challenges of measuring quantity in a standard way across substances.

2.3. Analysis Plan

Analyses were conducted in three phases. First, descriptive information is presented. Second, to assess which motives were more commonly endorsed for sex-related alcohol versus drug use, we compared the frequency of endorsement of each motive made by those drinking before sex versus those using drugs before sex, using z-distributions. Third, logistic regressions (adjusted for gender and age) were used to assess whether each sex-related substance use motive was associated with substance use frequency and intoxication (dichotomized into regular versus non-regular users and high versus low intoxication, respectively), separately for alcohol and for drugs. Motives were examined in separate models. There were low-to-moderate correlations among motives (alcohol items: rs: 0.07-0.28; drug items: rs: 0.01-0.45). All analyses were conducted using Statistical Package for the Social Sciences (SPSS) software version 23.0 (IBM, 2016).

3. Results

3.1. Frequencies of endorsement

For both alcohol and drugs, the most frequently-endorsed sex-related substance use motives were to loosen up and relax (alcohol: 73.8%; drugs: 66.1%) and for “other” reasons (alcohol: 84.0%; drugs: 84.5%) (Figure 1). The least commonly endorsed were to make a sex partner more appealing (alcohol: 3.5%; drugs: 3.7%) and to get a sex partner to use (alcohol: 3.8%; drugs: 0.7%).

Figure 1.

Figure 1.

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Sex-related substance use motives: Endorsement for alcohol versus drug use before sex.

Note. p < .05*; p < .01**; p < .001***

Several motives differed in their frequency of endorsement for alcohol versus drugs. Specifically, substance use to loosen up or relax and to get a sex partner to use were more commonly endorsed for alcohol than drugs; substance use to improve sexual performance and to enhance sexual experience were more commonly endorsed for drugs (ps<0.05; Figure 1). Substance use to reduce performance anxiety, to make a sexual partner more appealing, or for “other” reasons did not differ for alcohol versus drugs.

3.2. Associations with alcohol/drug frequency and intoxication before sex

In adjusted logistic regression models, nearly all motives (get partner to use, enhance experience, make partner more appealing, improve performance, reduce anxiety) were associated with higher alcohol frequency and intoxication before sex (ps<0.05; Table 1). Alcohol use to loosen up and relax was not associated with alcohol intoxication or frequency. No motives were associated with drug use frequency before sex. Certain motives (enhance experience, improve performance, reduce anxiety) were associated with greater drug intoxication (ps<0.05). However, few individuals reported drug use to get one’s partner to use or to make one’s partner more appealing, limiting cell sizes for these analyses (Table 1).

Table 1.

Adjusted logistic regressions: Associations between sex-related substance use motives with substance use frequency and intoxication (dichotomized) before sex.

Sex-related substance use motive Alcohol
Frequency
(n = 650)		 Alcohol
Intoxication
(n = 657)		 Drug
Frequency
(n = 264)		 Drug
Intoxication
(n = 271)
AOR AOR AOR AOR
To Get My Sex Partner to Use 4.218** 5.104** 0.000a 0.720a
 Gender 1.658 1.071 0.692 1.707*
 Age 0.996 0.943*** 0.966* 0.991
To Enhance the Sexual Experience Overall 2.268* 3.165*** 1.511 3.584***
 Gender 1.829 1.110 0.659 1.601
 Age 1.001 0.947*** 0.966* 0.991
To Make My Sex Partner More Appealing 3.879* 3.540* 1.078a 0.881a
 Gender 0.998 1.129 0.679 1.701*
 Age 1.803 0.945*** 0.966* 0.991
To Improve Sexual Performance 4.089*** 2.739** 1.363 3.132**
 Gender 1.793 1.129 0.672 1.697*
 Age 1.001 0.946*** 0.967 0.995
To Reduce Performance Anxiety 3.184** 2.068** 1.604 2.207*
 Gender 1.784 1.123 0.680 1.723*
 Age 1.005 0.947*** 0.969 0.996
To Loosen Up and Relax 1.154 1.019 1.255 0.929
 Gender 1.898 1.164 0.662 1.713*
 Age 0.997 0.945*** 0.966 0.991
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Note. AOR=Adjusted Odds Ratio (covariates: gender, age). Bold indicates significance.

*

p < .05

**

p < .01

***

p < .001.

a

Small cell sizes (i.e., ≤ 5) may limit interpretability of AOR magnitude for certain estimates.

4. Discussion

This study aimed to explore why individuals use alcohol and drugs before sex, and how such motives relate to substance use intensity. Our study yields several informative conclusions. First, it provides data on which sex-related substance use motives are more common overall (to loosen up and relax), and which are less endorsed (to make a sex partner more appealing, to get a sex partner to use). Second, it elucidates which sex-related motives are more likely to be reported specifically for drinking before sex (to loosen up and relax, to get sex partner to use) versus drug use before sex (to improve performance or enhance experience). Third, it suggests that sex-related alcohol use motives are more strongly associated with pre-sex drinking frequency and intoxication than sex-related drug use motives are with drug use frequency and intoxication. Interestingly, although drinking to loosen up and relax was frequently endorsed, it did not relate to drinking frequency or intoxication before sex, suggesting that such motives are commonly reported even among those who engage in light or infrequent drinking before sex.

This study furthers the research to date on sex-related substance use motives, and helps to integrate the largely separate literatures for alcohol and drugs, by providing insight into which motives are associated with the choice of alcohol versus drugs. The literature on sex-related alcohol use motives (Brown et al., 2016; Celio et al., 2016; Hutton et al., 2015; Kahler et al., 2015) generally focuses on special populations, and the literature on sex-related drug use and motives (Hegazi et al., 2017; Melendez-Torres & Bourne, 2016; Pakianathan et al., 2016; Schmidt et al., 2016; Sewell et al., 2017; Vosburgh et al., 2012) generally focuses on men who have sex with men. The one previous study (to our knowledge) that looks at sex-related substance use expectancies endorsed for alcohol versus drugs (Palamar et al., 2018) specifically studied young (age<25) nightclub attendees, a very specific subpopulation. In our sample, men and women were represented in equal numbers, ages range from 18 to 82, and the majority of individuals (79%) were heterosexual, with a substantial proportion (21%) of sexual minority individuals also represented. This allows us to make conclusions with more generalizability to the larger population.

This study should be interpreted with attention to limitations. First, the reported associations are cross-sectional, indicating that results should be interpreted as associations and not as causative factors. Second, an “other” category of motives was highly endorsed, suggesting that some sex-related substance use motives were not captured by the current study’s categories. This indicates that more work is needed in this area, to expand upon our exploratory findings. Third, we do not measure general substance use motives (such as drinking for coping or enjoyment reasons), limiting our ability to compare the prevalence of sex-related substance use motives with general substance use motives. Fourth, due to limited sample sizes for individuals reporting certain sex-related substance use motives (i.e., make partner more appealing, get partner to use), we were unable to break down analyses by specific drug used, or by gender. Further, the majority of drug users in the current study used cannabis, also preventing our ability to examine differences by substance. Future research with larger datasets, including users of a greater array of substances, should determine whether sex-related drug use motives differ by type of drug used, and by the gender of respondents. Fifth, the current study used a convenience sample collected through the Amazon Mechanical Turk system, which has been shown to be younger, more educated, and less likely to be employed than the general population (Paolacci & Chandler, 2014; Ross, Irani, Silberman, Zaldivar, & Tomlinson, 2010). However, the Mechanical Turk system easily accesses hard-to-reach individuals, and yields data more diverse than other convenience samples such as college students (Paolacci & Chandler, 2014).

5. Conclusions

This study provides insights on sex-related substance use motives that individuals endorse regarding their alcohol and drug use, and elucidates which relate most closely to pre-sex substance use frequency and intoxication. This study therefore provides knowledge that could be useful for healthcare providers, mental health providers, and researchers seeking to better understand why individuals use substances in conjunction with sex, and to address problematic behaviors in a relevant way. Future research using longitudinal designs should seek to determine whether these associations are prospective and predictive, providing a clearer indication that intervening with motives are likely to have resulting effects on substance use before sex. Future research could also compare other sex-related motives not measured here between drinkers and drug users, such as sexual risk taking (Banks & Zapolski, 2017; Brown et al., 2016) or increased sexual desire (Nash et al., 2016). Therefore, the current study provides initial findings and impetus to further understand sex-related substance use motives and their associations with substance choice and use intensity in a sexual context.

Acknowledgments

The authors acknowledge the contributions of Kodi Arfer in study design and data collection.

Funding:

This work was supported by the National Institutes of Health (NIH) under grants K23AA023753 and R01AA023163; and the New York State Psychiatric Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Footnotes

Declaration of Interest / Disclosure Statement

The authors declare no conflict of interest.

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