Fact Sheet 3 – VAS of chemsex craving: the worst score decides

Preamble – What is a VAS?

A VAS (Visual Analogue Scale) is used to give a score from 0 to 10 to a subjective sensation.

• 0 = not at all (no urge)

• 10 = maximum imaginable (irresistible urge)

Objective

To help the clinician (and, by extension, the patient / buddy) to:

• quickly measure the intensity of craving in a chemsex context,

• decide on the level of safeguards to put in place,

• track progress from one session to another.

Central principle: in chemsex, craving fluctuates.
It is not the average that guides safety: it is the peak.

When to use it?

• Beginning of consultation (identifying / framing the risk).

• Before a weekend, a holiday period, a vacation, an event.

• During follow-up, to objectify improvement or vulnerability.

• After a borderline evening (to understand the moment when things tipped over).

Indicative duration of use: 5 minutes.

Content of the sheet

• 4 questions (4 moments) to rate craving from 0–10.

• A simple rule: we keep the worst score.

• A "traffic light" correspondence:

  • 0–3 : Basic HR (Harm Reduction)

  • 4–6 : intermediate measures

  • ≥ 7 : written safety plan (sheet 4)

The 4 key questions to ask (VAS 0–10)

Objective: identify the deciding moment (the highest), not just "here and now".

Core question:
« On a scale of 0 to 10, how strong is your urge / need to consume or consume again? »

1. Average (last month / last weeks)

• « On average lately, where are you at? » → __/10

2. Recent peak (most intense moment)

• « At the highest point, recently, how high did you go? » → __/10

3. Current (here and now)

• « Right now, while we are talking about it, where are you at? » → __/10

4. Typical trigger (highest-risk scenario)

• « If you imagine THE situation where it is hardest to say no (app, location, person, loneliness, fatigue, after a hit...), where would you be at? » → __/10

✅ Max VAS (worst score of the 4) = __/10

➡️ This score decides the safeguards, even if the current VAS is low.

Rapid decision = level of safety

🟢 Max VAS 0–3: Basic HR

• Simple preparation: sleep / hydration / nutrition (before & after)

• Clear boundaries (schedule, context, people, sexual safety)

• Work on triggers + "before / after" rituals

• Screening / prevention depending on context

🟠 Max VAS 4–6: intermediate measures (organization)

• Buddy (sober or "stable") + point of contact

• Strategies for spacing out / avoiding the "automatic" urge escalation

• Exit / return plan (time, place, transport)

• Reduce risky mixing (priority: safety)

🔴 Max VAS 7–10: written safety plan (sheet 4)

• « No managing by ear »: we anticipate while perspective is still there

• Concrete checklist (buddy, STOP, return, rules for taking, emergencies)

• Plan written and shared (at least with the buddy)

Possible wordings (psychoeducation)

a) Removing guilt

• « The score is not meant to judge you, it is meant to adjust your safety. »

b) “Officer-you” vs “party-you”

• « Beyond 7, it won’t be the office-you making decisions. So we prepare now. »

c) Empowerment

• « The objective is not to be perfect: it is to come back alive and in one piece. »

Warning signals
(strengthen safety even if VAS < 7)

Strengthen safeguards / discuss written plan if:

• history of loss of consciousness, "black-out", difficult awakening (possible GHB/GBL)

• episodes of paranoia / delirium / agitation, prolonged confusion

• suicidal ideation, self-aggression, severe crash

• violence, uncertain consent, unsafe context

📌 In case of vital doubt during a party: 15 / 112.

Mini-tracking section

Date: ____ / ____ / ____
Average: __/10 | Peak: __/10 | Current: __/10 | Trigger: __/10

✅ Max VAS: __/10 → Zone: 🟢 / 🟠 / 🔴
Decision / safeguards: ___________________________