Background: Sex, relationships, and substance use often go hand in hand. Despite this, the impact of sex and relationships on recovery are often overlooked in the field of substance use disorder treatment (SUDT). This study aims to explore sex, relationships, and relapse risk for people in recovery and as an overlooked area of importance in SUDT.

Method: This qualitative study uses semi-structured interviews with people currently and/or formerly in prison, together with ethnographic field data from four high security prisons in Norway, collected between July 2021–April 2022.

Results: Common sources of anguish around sex after release and recovery included both forming new and maintaining long-term relationships with partners at a different stage in their recovery, dating and initiating sexual relationships with new partners, concerns about sexual performance and fears around attaining sexual pleasure without chemical enhancements.

Conclusion: The implications that sex, dating and intimate relationships may have for individual relapse to substance use, can and should play a greater role in both SUD treatment and preparation for release from prison. These problems are exacerbated in carceral settings and should be considered when planning re-entry to the community and in the development of individual relapse prevention strategies.