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Heroin Addiction and Related Clinical Problems: 2026, 28: 19-28

Compulsive Sexual Behaviour within Opioid Use Disorder: A Narrative Review of a Behavioural Marker of Addiction Severity

Usman Riaz, Gautam Shanmuga Dharmar Balasubramania Pandian, Rahul Bangar, and Pawan Angara

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-4

Summary: Background: Compulsive sexual behaviour (CSB), often conceptualised as sexual addiction, has increasingly been reported in patients with substance use disorders (SUDs), yet its clinical significance in opioid addiction remains insufficiently defined. Emerging evidence suggests that CSB may reflect reward-system dysregulation rather than an independent disorder. This review examined CSB within the clinical and neurobiological framework of opioid and polysubstance use disorders, exploring its relevance as a potential dimension of addiction severity. Methods: A narrative review of psychiatric, neurobiological and clinical literature was conducted, focusing on studies addressing compulsive sexual behaviour among individuals with opioid use disorder, heroin dependence and polysubstance addiction. Evidence on epidemiology, neurobiological mechanisms, clinical assessment and treatment implications was integrated within an addiction-spectrum perspective. Results: Available findings indicate that compulsive sexual behaviour occurs more frequently in patients with severe and polysubstance addiction profiles, particularly among opioid-dependent individuals. Alterations in reward processing, affect regulation and interoceptive sensitivity, closely related to endogenous opioid system functioning, appear to contribute to the emergence of compulsive sexual behaviours. CSB was consistently associated with impulsivity, emotional dysregulation and increased clinical complexity, suggesting its role as a marker of addiction severity rather than a distinct behavioural addiction. Evidence also indicates potential interactions between CSB, opioid agonist treatment and residual psychopathology during stabilisation phases. Conclusions: Compulsive sexual behaviour may be better conceptualised as a dimensional expression of opioid-related addiction processes and reward dysregulation. Systematic assessment of sexual behaviour within addiction services may improve clinical characterisation, risk stratification and treatment planning in patients with opioid and polysubstance use disorders, while further research integrating neurobiological and longitudinal clinical data is required to clarify its role within the psychopathology of opioid addiction.

Keywords: Sexual addiction; compulsive sexual behaviour; hypersexuality; non-paraphilic sexual behaviour