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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.

A familiar but newly resurfaced pattern among high-functioning men starts with business drinking that turns into marathon episodes of cocaine use, sexual escapades, disappearance, and remorse.

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........

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