“I Couldn’t Just Say ‘Can You Go Home Please’”: Exploring UK Adults’ Freedom to Negotiate Alcohol- and Drug-Involved Sexual Experiences

There is limited research on how substance use impacts people's freedom to negotiate sexual activity with others, particularly in distinguishing between alcohol and drug use. This study addressed that gap by exploring how substance use can both extend and constrain sexual negotiation. A mixed-methods online survey of 354 UK adults aged 18-40 examined sexual consent across sober, alcohol-, and drug-involved experiences. This paper focuses on the qualitative data for substance-involved sex only. Three themes were constructed from the data using Reflexive Thematic Analysis: (1) Substance use can facilitate sexual negotiation with others; (2) Substance use opens up new sexual opportunities; (3) Sexual refusal is constrained by relational and event-based influences. Participants described how drugs such as MDMA and cannabis enhanced mutuality and communication, sometimes disrupting traditional sexual scripts. However, gendered power dynamics, social pressures, and time and event-based constraints continued to limit sexual refusal, especially for women. These findings suggest that while drug use can involve ethical and consensual sexual experiences, it can also reinforce existing inequalities. Further research is needed to explore how different drugs, and social contexts, shape (un)ethical substance-involved sexual behavior.