When it comes to drug use or other various compulsive behaviors, we teach our minds to become highly-effective partners in recreating an experience. This is particularly true when dopamine, the neurotransmitter responsible for creating associations between actions and pleasure, is involved. Dopamine also fuels preoccupation, which is the mental state between our first thought of using and how we ultimately make it happen. Many people find that once the spark of a trigger enters their mind it begins to dominate all other thoughts. They may enter a prolonged period of preoccupation which can last days before they ultimately use. All through preoccupation they may they spend increased hours thinking about getting high, planning to get high, and focusing on related behaviors such as fantasy or pornography.

Any drug or behavior that has the potential for compulsivity or addiction can create triggers. As noted, the common denominator here is dopamine which has a biological role in “rewarding” us with pleasurable feelings when we perform activities that promote bonding and community. Addictive drugs and behaviors hijack this system by replacing our original pro social “rewards” with experiences that release far more dopamine that we could ever get in nature, like intense drug highs and sex under the influence.

Because amphetamines and sexual behavior have the power to release more dopamine than almost anything else, triggers related to chemsex tend to be far more intense than others. For example, methamphetamine releases about 13 times the amount of dopamine of normal daily activities. Our brains are wired to remember this intensity and to help us recreate it through triggers which become powerful roadmaps back to these experiences.

Once triggers are established in the mind of an individual they can be highly persistent, even long after someone gives up using drugs or certain behaviors. It is true that they will diminish with time although my experience is they lie dormant and can be easily reignited. For example, I have had clients in drug abstinence for months and who rarely thought about using anymore. I remember one such case where the man received a text from someone with whom he had shared drugs and sex a year ago. He had not blocked that person or changed his own telephone number. Before he was finished reading the short text, he found himself having physical reminders of using meth. He began to shake and could taste it in his mouth. Sudden and strong cravings almost immediate took over his thoughts.

This can happen to anyone with a history of using drugs or sex in compulsive ways. It often occurs even among therapist, peers, and anyone supporting persons with their chemsex. Listening to the details of someone’s experience – even if it is expressed in clinical terms (not slang) – can be triggering. Therapists might call this a vicarious traumatic response. Our own feelings and triggers are often ignited by such discussions and it is essential to practice self-care. All of the suggestions for managing triggers listed below are useful for workers, peers and allies. In addition to these tools, I have found that support or supervision groups for those workers, occurring separately from their interactions with users, can be extremely helpful in talking through the worker’s own feelings.

The first step in managing chemsex triggers and cravings is self-awareness. This may mean developing a comprehensive list of potential triggers, especially those situations which have been the most triggering recently. They can involve people, places, things, body sensations, emotions, thoughts, times of day or week – in other words almost anything can be associated with and thus trigger an urge to use.

The most direct way to manage cravings is to avoid external triggers altogether if possible. It might be easy to avoid triggering places like bars, clubs, bathhouses and even hookup apps although sometimes our past intrudes. I have had clients who had not used drugs for months yet who were suddenly thrown into severe cravings by receiving an unexpected text from a former using buddy (it’s also a good idea to change your phone number if possible).

Underneath many of these external triggers are internal emotional, mental, and psychological states that can drive someone to compulsively seek out drugs and sex. If you become triggered it is important for you to be able to quickly identify what is happening and take action as early as possible. When triggered, you may start to feel like you have tunnel vision: the larger world disappears, you become hyper-focused, and your heartbeat increases. You may also feel sweaty and start engaging in ritualistic behaviors. Because we can’t escape internal thoughts, emotions and body sensations is important to have other tools besides avoidance.

If you can’t avoid a trigger altogether, then it is useful to employ distracting techniques. You can distract yourself by doing something physical, such as taking a walk, getting exercise, or doing some deep breathing. If you are in a situation that is intensifying your feelings of craving, then you should leave and go somewhere safe. Eat something, drink something, do something – anything that will assist you in shifting that energy of craving. Different methods of distraction and tension release will work for different people. Find out what works for you.

Another effective way of dealing with a craving is to talk to somebody about it while it’s occurring. Don’t wait to reach out. Calling someone and talking can not only distract you from the craving, but they can reduce the feelings of anxiety and vulnerability that may accompany it. Who are five people you can call when you are triggered? Practice using the phone ahead of time, especially when you’re having a good day. Nurturing these supportive relationships will not only make it easier for you to pick up the phone when you are feeling triggered, it will help reduce feelings of loneliness and disconnection that lead you to want to use and sexually act out in the first place.

Riding the wave is another way of dealing with craving. Riding the wave involves allowing the craving to occur, peak, and pass. Instead of fighting or giving in to the thoughts or drive to use, just sit with it. This means paying attention to the experience of craving. Identify specifically where in your body you are experiencing it. What does it feel like, how strong is it, and how does it move or change? Many times, this process can cause the craving to come and go, although having a mindfulness practice in place ahead of time will be very helpful in using this strategy.

One of the things that can lead to or strengthen a craving is “euphoric recall,” which occurs when you selectively remember only the pleasurable aspects of chemsex.. You may start fantasizing about cocaine and sex workers, the feeling of drugs and the rush of taking your first hit, or the sensations of having sex while high on chems. Pour some cold water on this hot fantasy by remembering the negative and distressing aspects of using and afterwards. Having an index card or a note on your phone listing all the negative consequences of your chemsex behavior can be helpful in this regard.

It is also important to identify some of the automatic thoughts that come to mind when you are triggered so you can challenge them. For example, you may have a thought that tells you, “I feel like using now, and I will always feel this way, so I might as well do it.” You can challenge this thought with self-talk by consciously saying to yourself, “Although I feel like using at the moment, I know this will pass and it is not forever, and I will be grateful and relieved that I didn’t.” This could also be done via journaling, which has the effect of slowing down the mind while also providing you with an opportunity to talk yourself out of relapsing.

The common element of all these interventions is realizing ahead of time that it is normal to get triggered and to experience craving. Although it is uncomfortable, reminding yourself in the moment that you can get through it and taking action to help yourself stay sober will greatly diminish the likelihood of your using.

Triggers and cravings are a normal part of trying to get back one’s drug use. Using drugs or acting out is not inevitable. With the proper tools they can be managed and defused.