EP 2:31: Chemsex And the Brain with Stephen

The AfterMeth: Gay Men Recovering from Crystal Methamphetamine Addiction

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Supplimental Study Guide: https://www.drdallasbragg.com/newsletters/blog/posts/brain

In this episode, host Dr. Dallas Bragg speaks with Dr. Stephen Naulls, a psychiatrist based in Brighton, UK, about his groundbreaking research initiative "Chem Sex and the Brain." Dr. Naulls explains the significant gap in current research: while individual substances like crystal meth have been studied, no brain imaging research exists examining Chemsex as a unique phenomenon involving polysubstance use (crystal meth, GHB/GBL, mephedrone, and ketamine) combined with sexual activity. He defines Chemsex as inextricably linked to the LGBTQ+ community's experience of minority stress, historical trauma from the HIV/AIDS crisis, and shame around queer sexuality. He also describes that not all chemsex involvement is necessarily problematic. Dr. Naulls shares how his interest began as a medical student encountering dismissive treatment of Chemsex users in emergency departments, recognizing that established addiction pathways existed for other substances but not for this population.

The conversation delves into the neurobiology of addiction, focusing on dopamine pathways and how brain imaging technology can reveal changes in the ventral tegmental area and nucleus accumbens—the brain's main reward centers. Dr. Naulls is currently recruiting participants in the UK for brain scanning studies to understand both short and long-term neurological impacts of Chemsex use. He emphasizes that comprehensive harm reduction requires understanding all the harms first, and hopes this research will reduce stigma by demonstrating the biological impact on the brain. The episode concludes with encouraging news that drug-induced psychosis is reversible with proper psychiatric treatment, and Dr. Naulls stresses the need for better cultural competence among mental health providers when working with the Chemsex-using population.

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