The Role of Sexual Behaviors in the Relapse Process in Iranian Methamphetamine Users: A Qualitative Study

Mohammad Hadi Safi, Seyyed Jalal Younesi, Asghar Dadkhah, Ali Farhoudian, Masoud Fallahi-Khoshknab, Manoochehr Azkhosh


Background: The awareness of sexual experiences could be an effective factor in preventing high-risk sexual behavior pertaining to relapse during the recovery period of substances. This research explored the role of sexual behaviors among Iranian methamphetamine (MA) users in relapse process.

Methods: The study was conducted with a qualitative approach using content analysis method.
28 participants were selected through purposeful and theoretical sampling. Data were collected based on face-to-face, in-depth, semi-structured interviews based on open-ended questions. Interviews continued until the data saturation had occurred. All interviews were examined in four stages of codes, sub-categories, categories and themes according to the content analysis of explanations and descriptions of sexual behaviors.

Findings: Two main themes were emerged from the analysis of interviews, including extreme pleasure seeking (including the main categories of sexual tunnel vision and sexual totalitarianism) and comprehended threat (including the main categories of internal conflict and external disorganization) as well as 10 subcategories.

Conclusion: The results indicated that sexual behaviors played an important role in relapse process among Iranian MA users and needed to be considered and managed properly in the planning of prevention, treatment, and rehabilitation.


Sexual behaviors; Relapse; Methamphetamine users; Qualitative research

Full Text:



Zhang J, Xie Y, Su H, Tao J, Sun Y, Li L, et al. Prevalence and correlates of depressive symptoms during early methamphetamine withdrawal in Han Chinese population. Drug Alcohol Depend 2014; 142: 191-6.

Sherman SG, German D, Sirirojn B, Thompson N, Aramrattana A, Celentano DD. Initiation of methamphetamine use among young Thai drug users: a qualitative study. J Adolesc Health 2008; 42(1): 36-42.

Tayyebi K, Abolghasemi A, Mahmood Alilu M, Monirpoor N. The Comparison of Self-regulation and Affective Control in Methamphetamine and Narcotics Addicts and Non-Addicts. Int J High Risk Behav Addict 2013; 1(4): 172-7.

Radfar SR, Rawson RA. Current research on methamphetamine: epidemiology, medical and psychiatric effects, treatment, and harm reduction efforts. Addict Health 2014; 6(3-4): 146-54.

Dolatshahi B, Farhoudian A, Falahatdoost M, Tavakoli M, Rezaie Dogahe E. A Qualitative study of the relationship between methamphetamine abuse and sexual dysfunction in male substance abusers. Int J High Risk Behav Addict 2016; 5(3): e29640.

United Nations Office on Drugs and Crime. Global Synthetic drugs assessment Amphetamine-type stimulants and new psychoactive substances. New York, NY: UNODC; 2014.

United Nations Office on Drugs and Crime. World drug report 2015. New York, NY: UNODC; 2015.

Choopan H, Kalantarkousheh SM, Aazami Y, Doostian Y, Farhoudian A, Massah O. Effectiveness of emotion regulation training on the reduction of craving in drug abusers. Addict Health 2016; 8(2): 68-75.

Alam Mehrjerdi Z, Abarashi Z, Mansoori S, Deylamizadeh A, Salehi FJ, Noroozi A, et al. Methamphetamine use among Iranian heroin kerack-dependent women: implications for treatment. Int J High Risk Behav Addict 2013; 2(1): 15-21.

Taymoori P, Pashaei T. Relapse and risk-taking among iranian methamphetamine abusers undergoing matrix treatment model. Addict Health 2016; 8(1): 49-60.

Farhoudian A, Dolatshahi B, Falahatdoost M, Tavakoli M, Farhadi MH. A qualitative study on methamphetamine-related sexual high-risk behaviors in an Iranian context. Int J High Risk Behav Addict In press 2016; e31910.

Sau M, Mukherjee A, Manna N, Sanyal S. Sociodemographic and substance use correlates of repeated relapse among patients presenting for relapse treatment at an addiction treatment center in Kolkata, India. Afr Health Sci 2013; 13(3): 791-9.

Bowen S, Witkiewitz K, Clifasefi SL, Grow J, Chawla N, Hsu SH, et al. Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry 2014; 71(5): 547-56.

Ismail MT, Shadila Alias SN. Binary logistic regression modelling: Measuring the probability of relapse cases among drug addict. AIP Conference Proceedings 2016; 1605: 792-7.

Racz J. Relapse prevention in drug addicts. Neuropsychopharmacol Hung 2013; 15(4): 232-8.

Adi Y, Juarez-Garcia A, Wang D, Jowett S, Frew E, Day E, et al. Oral naltrexone as a treatment for relapse prevention in formerly opioid-dependent drug users: a systematic review and economic evaluation. Health Technol Assess 2007; 11(6): iii-85.

Nordfjaern T. Relapse patterns among patients with substance use disorders. J Subst Use 2010; 16(4): 313-29.

Brecht ML, von Mayrhauser C, Anglin MD. Predictors of relapse after treatment for methamphetamine use. J Psychoactive Drugs 2000; 32(2): 211-20.

Maehira Y, Chowdhury EI, Reza M, Drahozal R, Gayen TK, Masud I, et al. Factors associated with relapse into drug use among male and female attendees of a three-month drug detoxification-rehabilitation programme in Dhaka, Bangladesh: A prospective cohort study. Harm Reduct J 2013; 10: 14.

Seyedfatemi N, Peyrovi H, Jalali A. Sexual activity in relapse process among Iranian drug users- A qualitative study. Life Sci J 2013; 10: 410-4.

Roshani B, Jalali A, Bidhendi SH, Ezzati E, Mahboubi M. Study the causes of relapse among Iranian drugs users in Kermanshah. Life Sci J 2014; 11: 66-71.

Saberi Zafarghandi MB, Mousavi Nik M, Birashk B, Assari A, Khanehkeshi A. Sexual dysfunction among males with opiate dependence undergoing methadone maintenance therapy (MMT). Int J High Risk Behav Addict 2016; 5(4): e37740.

Radfar SR, Cousins SJ, Shariatirad S, Noroozi A, Rawson RA. Methamphetamine use among patients undergoing methadone maintenance treatment in Iran; a threat for harm reduction and treatment strategies: A qualitative study. Int J High Risk Behav Addict 2016; (e30327).

Calsyn DA, Cousins SJ, Hatch-Maillette MA, Forcehimes A, Mandler R, Doyle SR, et al. Sex under the influence of drugs or alcohol: common for men in substance abuse treatment and associated with high-risk sexual behavior. Am J Addict 2010; 19(2): 119-27.

Guss JR. Sex like you can't even imagine: "Crystal," crack and gay men. J Gay Lesbian Ment Health 2000; 3(3): 105-22.

Shariatirad S, Maarefvand M, Ekhtiari H. Emergence of a methamphetamine crisis in Iran. Drug Alcohol Rev 2013; 32(2): 223-4.

Stall R, Paul JP, Greenwood G, Pollack LM, Bein E, Crosby GM, et al. Alcohol use, drug use and alcohol-related problems among men who have sex with men: The urban men's health study. Addiction 2001; 96(11): 1589-601.

Semple SJ, Grant I, Patterson TL. Female methamphetamine users: Social characteristics and sexual risk behavior. Women Health 2004; 40(3): 35-50.

Shoptaw S, Reback CJ. Methamphetamine use and infectious disease-related behaviors in men who have sex with men: implications for interventions. Addiction 2007; 102(Suppl 1): 130-5.

Corbin J, Strauss A. Basics of qualitative research: Techniques and procedures for developing grounded theory. New York, NY: SAGE Publications; 2008.

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15(9): 1277-88.

Guba EG. ERIC/ECTJ annual review paper: Criteria for assessing the trustworthiness of naturalistic inquiries. Educational Communication and Technology 1981; 29(2): 75-91.

Lincoln YS. Emerging criteria for quality in qualitative and interpretive research. Qual Inq 1995; 1(3): 275-89.

Perera B, Reece M, Monahan P, Billingham R, Finn P. Relations between substance use and personal dispositions towards out-of-control sexual behaviors among young adults. Int J Sex Health 2009; 21(2): 87-95.

McKay JR, Rutherford MJ, Alterman AI, Cacciola JS, Kaplan MR. An examination of the cocaine relapse process. Drug Alcohol Depend 1995; 38(1): 35-43.

Assari S, Yarmohamadivasel M, Moghani LM, Sehat M, Narenjiha H, Rafiey H, et al. Having multiple sexual partners among Iranian intra-venous drug users. Front Psychiatry 2014; 5: 125.

Harawa NT, Williams JK, Ramamurthi HC, Manago C, Avina S, Jones M. Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men. Arch Sex Behav 2008; 37(5): 748-62.

Hunter C, Strike C, Barnaby L, Busch A, Marshall C, Shepherd S, et al. Reducing widespread pipe sharing and risky sex among crystal methamphetamine smokers in Toronto: do safer smoking kits have a potential role to play? Harm Reduct J 2012; 9: 9.

Hall KM, Irwin MM, Bowman KA, Frankenberger W, Jewett DC. Illicit use of prescribed stimulant medication among college students. J Am Coll Health 2005; 53(4): 167-74.

Schneider JP, Irons RR. Assessment and treatment of addictive sexual disorders: relevance for chemical dependency relapse. Subst Use Misuse 2001; 36(13): 1795-820.

Sun AP. Relapse among substance-abusing women: components and processes. Subst Use Misuse 2007; 42(1): 1-21.

Yang M, Mamy J, Gao P, Xiao S. From abstinence to relapse: a preliminary qualitative study of drug users in a compulsory drug rehabilitation center in Changsha, China. PLoS One 2015; 10(6): e0130711.

Ibrahim F, Kumar N, Samah BA. Self efficacy and relapsed addiction tendency: An empirical study. Soc Sci 2011; 6(4): 277-82.

Daneshmand R, Shishegar S, Alam Mehrjerdi Z, Fathy Z. The psychological problems of female co-users of opiates with methamphetamine: implications for longer treatment retention. Proceedings of the 8th Addiction Science Conference; 2014 Sep 10-12; Tehran: Iran. [In Persian].



  • There are currently no refbacks.