Despite a growing interest, chemsex remains insufficiently defined, both as a practice and a potential clinical construct. Studies variably restrict the term to certain psychoactive substances, specific populations, contexts, or intentions, resulting in multiple and partially overlapping conceptualisations. Such definitional heterogeneity may generate non-comparable findings, limit reproducibility, and ultimately hinder theoretical consolidation within the field. Accordingly, this Commentary synthesises the emerging evidence and critically examines the competing definitions and their scientific and clinical implications. In this article we (1) synthesise emerging evidence on chemsex, (2) highlight the current lack of definitional consensus and its methodological and clinical consequences; (3) critically appraise existing definitions by examining their underlying assumptions and operational implications; and (4) outline research directions aimed at refining the conceptual boundaries and empirical characterisation of chemsex, distinguishing between its pathological and non-pathological expressions. There is a lack of a universal and consensual definition of chemsex. International researchers should work towards developing a consensus-based scientific definition of chemsex that could serve as a standardized reference framework, particularly for research requiring homogeneous study populations, such as clinical trials.
Time spent and frequency of engagement are among the most commonly used indicators in the screening and assessment of behavioral addictions and problematic digital technology use. However, their utility as screening or diagnostic markers remains uncertain. This systematic review and meta-analysis assessed how time- and frequency-based measures have been operationalized across behavioral addictions and evaluated their associations with addiction and related outcomes. A systematic search of PubMed, EMBASE, and Scopus identified 125 eligible studies. These studies assessed gaming, problematic internet use, smartphone use, social media use, pornography use, gambling, digital media use, and online shopping behaviors. Time-based thresholds varied considerably across domains. Although most clustered around ≥ 5 h/day for gaming and ≥ 3–5 h/day for internet and smartphone use. However, these values should not be interpreted as validated diagnostic thresholds. Meta-analyses demonstrated moderate positive associations between engagement time and addiction severity for gaming (r = 0.41) (95
This narrative review examines the pathophysiology, clinical presentation, and emergency management of cocaine and amphetamine toxicity in the context of the increasing burden of stimulant-related medical emergencies. Recent epidemiologic trends demonstrate substantial increases in stimulant use, polysubstance exposure, and stimulant-related emergency department visits and overdose deaths. Contemporary clinical guidance emphasizes early recognition of the hyperadrenergic syndrome, prompt benzodiazepine-based sedation, aggressive management of hyperthermia and cardiovascular complications, and integrated medical and psychiatric care. Emerging evidence has also refined the management of cocaine-associated cardiovascular toxicity, including evolving perspectives regarding β-blocker use. Stimulant toxicity represents a complex medical emergency requiring rapid stabilization, aggressive management of agitation and hyperthermia, and continuous monitoring for life-threatening complications. Early recognition and integrated medical and psychiatric care are essential for reducing morbidity and mortality.
This review synthesises qualitative evidence on care experiences within alcohol and other drug (AOD) treatment services in Australia, with a focus on factors influencing engagement, retention, and recovery across diverse populations and service settings. Across 25 qualitative studies, five interconnected themes were identified: relational practice, peer support and mixed staffing models, stigma and privacy, integrated and holistic care, and continuity and safety of treatment environments. Participants described the importance of respectful and consistent relationships with staff, the credibility of peer workers with lived experience, and the impact of stigma on disclosure and engagement. Holistic care, including housing and social supports, was described as closely connected to recovery, while gaps in aftercare and fragmented systems were highlighted as ongoing challenges. The synthesis indicates that AOD treatment experiences are shaped by the interaction of relational, structural, and cultural factors. Care was described as most effective when it extended beyond clinical intervention to include trust, cultural responsiveness, continuity, and practical support. Findings suggest that improving engagement and recovery may require integrated service models, strengthened peer workforce support, and attention to stigma reduction and continuity of care. These insights may inform the design of more responsive, person-centred AOD services aligned with the needs of diverse populations.
The purpose of this review was to summarize and evaluate advancements within the prevalence, etiology, assessment, and treatment of compulsive sexual behavior disorder within sexual minority individuals. Our understanding of the prevalence of compulsive sexual behavior (CSB) and compulsive sexual behavior disorder (CSBD) in sexual minority individuals is limited, with preliminary evidence suggesting sexual minority individuals may endorse CSBD at similar rates to the general population. Recently, the field has moved towards conceptualizing the development and maintenance of CSBD in sexual minority individuals within minority stress theory. Research, assessment, and treatment of CSBD are likely complicated by sexual minority individuals’ experiences of minority stress. While the field has made advances to improve assessment and treatment practices (e.g., through the creation of guidelines), researchers have yet to test the reliability and validity of these advancements within sexual minority individuals. While our theoretical understanding of the etiology, assessment, and treatment of CSBD in sexual minority individuals has improved, greater empirical support is required.
