A familiar but newly resurfaced pattern among high-functioning men: business drinking that turns into marathon episodes of cocaine use, sex, disappearance, and remorse.
- Alcohol is often the “permission giver” that lowers inhibitions and opens the door to a cocaine and sex binge.
- Cocaine can have powerful aphrodisiac effects that reinforce a compulsive cocaine-sex connection.
- Early treatment must focus on interrupting the “setups” that precede the alcohol-cocaine-sex binge cycle.
Over the past two years or so, I’ve seen a striking increase in the number of high-functioning men in my private practice struggling with a binge pattern I once saw routinely. It was commonplace among patients I treated during the cocaine epidemic of the 1980s (Washton, 1989a), but in the intervening three decades had become relatively uncommon.
The pattern is intermittent rather than continuous, but when it occurs it is often dramatic. A business dinner or night out with coworkers and other professional associates begins with heavy drinking. Cocaine enters the picture, sometimes right at the restaurant or bar, and the evening becomes a marathon binge of alcohol, cocaine, and sex, often moving to a strip club and then a hotel room with escorts until the next morning or beyond. What follows is also familiar. Calls and texts from spouses go unanswered. The person goes “radio silent,” then resurfaces exhausted and riddled with shame, anxiety, and remorse.
Seeing this pattern reappear after so many years creates a powerful sense of déjà vu. In the early to mid-1980s, I was among a relatively small group of addiction specialists calling attention to a rapidly growing but largely hidden cocaine problem among middle- and upper-income Americans (Washton, Gold, & Pottash, 1984). Cocaine was at that time widely regarded as relatively benign and nonaddictive, yet those seeking my help described patterns of compulsive out-of-control use causing serious psychological, relationship, financial, and occupational consequences. I later described this problem and its treatment in my first book on cocaine addiction (Washton, 1989b).
”But This Only Happens Occasionally”
These men usually are not using cocaine daily or even weekly. They may go weeks or months between episodes with little desire for cocaine in between, making the pattern easy to minimize or dismiss as a “problem,” let alone an “addiction.” The salient issue is not how often this happens, but what happens once it starts. If sporadic use repeatedly produces prolonged binges, deception, sexual risk-taking, disappearance, or relationship damage, infrequency should not be confused with control.
Alcohol Is Often the “Permission Giver”
For many, cocaine is not where the cycle begins. Alcohol removes inhibitions and opens the door. It is the “permission giver.” When not intoxicated, these men may have no intention of obtaining cocaine or pursuing paid sex. After several drinks, judgment changes, inhibitions dissolve, and cocaine suddenly seems like a good idea.
Cocaine and Sex Can Become a Powerful Pairing
Research and clinical experience show that cocaine and other stimulants have strong aphrodisiac effects in a significant number of male users (Rawson et al., 2002). It can intensify sexual arousal, fantasies, preoccupation, and disinhibition, sometimes fueling hypersexuality and a wide range of sexual acting out behaviors. Cocaine and sex can become tightly paired, each reinforcing the other. Sexual cues may trigger cocaine use, just as cocaine may trigger hypersexuality. Treatment needs to assess this connection directly.
”Do I Have to Stop Drinking Completely?”
A common question is: “Do I have to give up alcohol completely to quit cocaine? My goal is to become a social drinker without having it lead to cocaine and everything else that follows.” Treatment should determine whether drinking actually can be separated from cocaine use. For some, carefully defined limits may prove workable. For others, alcohol is such a powerful gateway that abstaining is safer and easier. A period without alcohol can help break the alcohol-cocaine-sex connection and permit a more realistic evaluation later of whether moderate drinking is feasible.
Recognizing the “Setups”
A key task in early treatment is to identify the “setups” for the next binge (Washton & Zweben, 2009). The binge does not start when cocaine appears. It may begin days earlier with an upcoming business trip, dinner with a particular client, reconnecting with certain colleagues, or deciding, “I’ll go out, but this time I’ll keep it under control.” Mapping the overt and covert events that preceded earlier binges helps identify the earliest links in the chain and short-circuit the process before momentum takes over.
When Partying Is Part of the Job
Breaking this pattern can be especially difficult when coworkers, supervisors, or clients are involved. As discussed in my earlier Psychology Today post, “Executive Binge Drinking: When the ‘Off Switch’ Disappears,” executive roles and corporate cultures can facilitate heavy drinking and conceal its consequences. Drinking, cocaine, strip clubs, and paid sex may become intertwined with client cultivation and male bonding: “This isn’t just partying. It’s part of doing business.” Refusing to participate may feel as though it could jeopardize a client relationship, job status, or acceptance by influential colleagues. Treatment must address these realities rather than simply advising someone to “avoid triggers.”
Confidentiality Matters
For executives, physicians, attorneys, financial professionals, and others with visible careers, fear of exposure can deter treatment. Discreet, confidential outpatient care can offer a practical alternative to more disruptive treatment while allowing people to continue working and meeting family responsibilities.
Good Prognosis
The good news is that this pattern can change. Prognosis is often quite good when high-functioning people are willing to make necessary changes: leaving events earlier, declining invitations, avoiding certain people or venues, or finding new ways to entertain clients. In many cases, abstaining from alcohol, at least temporarily, greatly improves the chances of breaking the pattern. People who have a history of succeeding in demanding areas of life often bring useful strengths to treatment: persistence, problem-solving ability, discipline, and the capacity to make difficult decisions when they understand what is at stake. With appropriate help and sustained effort, breaking the alcohol-cocaine-sex cycle is an achievable goal.
A version of this article originally appeared in Dr. Arnold Washton’s column on Psychology Today.
References
Rawson, R. A., Washton, A., Domier, C. P., & Reiber, C. (2002). Drugs and sexual effects: Role of drug type and gender. Journal of Substance Abuse Treatment, 22(2), 103-108.
Washton, A. M. (1989a). Cocaine abuse and compulsive sexuality. Medical Aspects of Human Sexuality, 23, 32-39.
Washton, A. M. (1989b). Cocaine addiction: Treatment, recovery, and relapse prevention. W. W. Norton.
Washton, A. M., & Zweben, J. E. (2009). Cocaine and methamphetamine addiction. W. W. Norton. See “Stimulants and Sex,” pp. 54-73.
Washton, A. M. (2025, December 18). Executive binge drinking: When the “off switch” disappears. Psychology Today.
Washton, A. M., Gold, M. S., & Pottash, A. C. (1984). Upper-income cocaine abusers. Advances in Alcohol & Substance Abuse, 4(2), 51-57.