{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:26:45Z","timestamp":1787027205712,"version":"build-2736575974"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>Chemsex, defined as the intentional use of psychoactive substances in sexual contexts, is increasingly prevalent among gay and bisexual men and is associated with a range of mental, physical and social implications. This study aimed to test a contextual behavioral model examining how psychological inflexibility, loneliness, intimacy difficulties, and internalized homophobia contribute to hypersexuality and sexualized substance use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted with 252 Spanish-speaking participants who reported engaging in sexualized substance use within the past year. Standardized self-report measures were used to assess psychological processes and behavioral outcomes. Structural equation modeling was employed to examine direct and indirect effects among variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The proposed path model demonstrated excellent fit (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.002,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.967; CFI\u202f=\u202f1.000; RMSEA\u202f=\u202f0.000). Psychological inflexibility showed the strongest association with both hypersexuality (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and substance use (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.25,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01), with a significant indirect effect via hypersexuality. Loneliness was also associated with both outcomes and showed mediated effects. Internalized homophobia was associated with hypersexuality but not with substance use. Intimacy was not a significant predictor. The model explained 42.1% of the variance in hypersexuality and 27.2% in substance use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study offers a novel contribution by modeling chemsex-related behaviors as forms of experiential avoidance shaped by psychological inflexibility, loneliness, and internalized homophobia. The findings highlight the potential utility of Acceptance and Commitment Therapy (ACT) in reducing chemsex vulnerability by promoting psychological flexibility and values-based living.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2025.1672471","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T06:22:54Z","timestamp":1763446974000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A contextual behavioral model of chemsex: structural equation modeling of psychological predictors of hypersexuality and drug use"],"prefix":"10.3389","volume":"16","author":[{"given":"Rub\u00e9n","family":"Rico","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Montesinos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"ref2","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1080\/0092623x.2012.665816","article-title":"Sexual compulsivity scale: adaptation and validation in the spanish population","volume":"39","author":"Ballester-Arnal","year":"2013","journal-title":"J. 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Drug Policy"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/00918369.2025.2496202","article-title":"Experiences of loneliness among gay men: A systematic review and Meta-synthesis","author":"Brumfield","year":"2025","journal-title":"J. Homosex."},{"key":"ref7","doi-asserted-by":"crossref","DOI":"10.4324\/9781315757421","volume-title":"Structural equation modeling with AMOS: Basic concepts, applications, and programming","author":"Byrne","year":"2016"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1037\/ort0000567","article-title":"The impact of psychological flexibility on sexual identity stress and well-being among lesbian, gay, and bisexual individuals","volume":"91","author":"Chan","year":"2021","journal-title":"Am. J. 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Psychol."},{"key":"ref19","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4324\/9781315211404-7","article-title":"Chemsex among men who have sex with men: A social psychological approach","volume-title":"Psychological perspectives in HIV care: an inter-professional approach","author":"Jaspal","year":"2020"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1088747","DOI":"10.3389\/fpsyt.2023.1088747","article-title":"Study protocol: hypersexual and hyposexual behavior among adults diagnosed with alcohol- and substance use disorders\u2014associations between traumatic experiences and problematic sexual behavior","volume":"14","author":"Jepsen","year":"2023","journal-title":"Front. 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Behav."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"112464","DOI":"10.1016\/j.drugalcdep.2024.112464","article-title":"\u201cA way to liberate myself\u201d: A qualitative study of perceived benefits and risks of chemsex among gay, bisexual, and other men who have sex with men in Almaty, Kazakhstan","volume":"264","author":"Lunchenkov","year":"2024","journal-title":"Drug Alcohol Depend."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1037\/0033-2909.129.5.674","article-title":"Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence","volume":"129","author":"Meyer","year":"2003","journal-title":"Psychol. 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Sex. Med."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1182222","DOI":"10.3389\/fpsyg.2023.1182222","article-title":"Influence of psychological inflexibility and mindfulness on hypersexuality and sexual satisfaction in a Spanish sample","volume":"14","author":"Ortega-Otero","year":"2023","journal-title":"Front. Psychol."},{"key":"ref9005","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.jcbs.2021.06.006","article-title":"Spanish adaptation of Awareness, Courage and Responsiveness Scale: Preliminary psychometric properties in non-clinical samples","volume":"21","author":"Ortiz-Fune","year":"2021","journal-title":"Journal of Contextual Behavioral Science"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1037\/ccp0000508","article-title":"A transdiagnostic minority stress treatment approach for gay and bisexual men's syndemic health conditions","volume":"88","author":"Pachankis","year":"2020","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref9006","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1037\/hea0000180","article-title":"A Minority Stress \u2013 Emotion Regulation Model of Sexual Compulsivity among Highly Sexually Active Gay and Bisexual Men","volume":"34","author":"Pachankis","year":"2015","journal-title":"Health Psychology"},{"key":"ref9007","doi-asserted-by":"publisher","first-page":"35","DOI":"10.21134\/haaj.v10i1.35","article-title":"Spanish Validation of the Drug Abuse Screening Test (DAST-20 y DAST-10)","volume":"10","author":"P\u00e9rez G\u00e1lvez","year":"2010","journal-title":"Salud y drogas"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"100465","DOI":"10.1016\/j.ijchp.2024.100465","article-title":"Psychological characteristics associated with chemsex among men who have sex with men: internalized homophobia, conscientiousness and serostatus as predictive factors","volume":"24","author":"Rodr\u00edguez-Exp\u00f3sito","year":"2024","journal-title":"Int. J. Clin. Health Psychol."},{"key":"ref9009","doi-asserted-by":"publisher","first-page":"123","DOI":"10.7334\/psicothema2011.239","article-title":"Measuring experiential avoidance and psychological inflexibility: The Spanish version of the Acceptance and Action Questionnaire \u2013 II","volume":"25","author":"Ruiz","year":"2013","journal-title":"Psicothema"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.3390\/jcm10081662","article-title":"Chemsex practices and health-related quality of life in Spanish men with HIV who have sex with men","volume":"10","author":"Ruiz-Robledillo","year":"2021","journal-title":"J. Clin. Med."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1007\/s00406-024-01856-2","article-title":"What chemsex does to the brain-neural correlates (ERP) regarding decision making, impulsivity and hypersexuality","volume":"275","author":"Schwarz","year":"2024","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1136\/sextrans-2017-053439","article-title":"Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013\u20132016","volume":"94","author":"Sewell","year":"2018","journal-title":"Sex. Transm. Infect."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1007\/s13178-012-0103-4","article-title":"Youth viewing sexually explicit material online: addresing the elephant on the screen","volume":"10","author":"Smith","year":"2013","journal-title":"Sex Res Soc Policy"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/j.cbpra.2023.05.002","article-title":"Acceptance and commitment therapy approach for problematic Chemsex among men who have sex with men","volume":"31","author":"Strika-Bruneau","year":"2023","journal-title":"Cogn. Behav. 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