A Man’s Guide to Recovery

So much has been written about drug and alcohol recovery for women (and rightfully so), that sometimes it can seem a little difficult for men to get the information and resources they need to address the topic of addiction treatment from a male perspective. A man’s guide to recovery isn’t about undermining the challenges sober women face – it’s about answering the questions men have about what rehabilitation means for them as husbands, brothers, fathers, sons and men.

A Man’s Problem

Part of the reason why women may have struggled getting information about addiction is that historically, drug and alcohol abuse was seen as a “man’s problem,” even though female physiology renders women more at-risk for intoxication than men. It has only been relatively recently, since women have entered the workforce en masse, that the issue of women being problem drinkers has arisen.^[1]

Nonetheless, according to the National Institute on Alcohol Abuse and Alcoholism, drug and alcohol addiction is more prevalent among men than it is women. Men are two times more likely than women to develop a drug problem; and in the case of alcohol, men are three times more likely than women to develop such a problem.^[2]

This may be due to the fact that even though women have a lower drinking threshold, alcohol ignites a greater sense of pleasure in male brains than it does in women’s brains. A study conducted by researchers at Columbia and Yale Universities found that alcohol caused a greater release of the dopamine neurotransmitter in the brains of male test subjects, giving them stronger feelings of being rewarded for their activity.^[3] It is the same concept behind why people experience good, positive sensations after an enjoyable activity, and why addicts are drawn back to a particular act.

While men primarily drink to boost their positive moods, they also self-medicate to cope with social problems that may be unique to their gender, especially ones that go unreported and underestimated. Issues like depression, domestic violence, concerns of gender identity, sexual health, and custody rights are often covered and marketed from a female perspective, and with good reason^[4] — however, men are often left with no voice in the debate and an unwillingness to raise the issue, both for fear of appearing unmanly and giving an impression of being misogynistic.^[5]

The Culture of Silence

The culture of silence surrounding men’s health and their problems (addiction or otherwise) can be a significant barrier to getting treatment. Across most cultures, men are encouraged to be reticent and not to go to others for help. Therefore, while women are quicker to spot substance abuse problems and address them by seeking health care assistance, men put themselves at risk. Men may refuse to see their drug or alcohol behavior as an addiction, or they may refuse to believe that their behavior causes problems for anyone else. According to the Campaign Against Living Miserably, 69 percent of men refuse to believe that their drug and alcohol consumption is anyone’s problem but their own.

If men feel they don’t need treatment for their problems, this creates a stigma for the men who would otherwise seek help.^[6] Men are often praised for embodying the “strong and silent” cultural norm, but this puts men in a place where they may feel like admitting that they’re in trouble would be a compromise of their masculinity.^[7] A researcher at Rutgers University went so far as to say that such deeply held ideas about masculinity and gender identity are a “core cause” of poor health in men.^[8]

However, the price paid for this silence primes men for mental health disorders and their devastating effects. In the United Kingdom, suicide is the biggest cause of death in men under 50 years of age. According to The Guardian, 75 percent of these men did not go to a mental health counselor – partly because they were reluctant to appear weak and partly because they did not recognize (or did not want to recognize) the signs of their depression.^[9]

As a result, men have a greater chance of developing substance abuse problems than women. Researchers in the Journal of Abnormal Psychology report that men tend to externalize their emotions – that is, they take their frustrations and pent up anger out on the environment around them (as opposed to internalizing emotions, which is what women tend to do).^[10] Men who conform to this pattern will react impulsively and aggressively to stressors, which can manifest as a drug or alcohol abuse problem.^[11] Perhaps furthering the hasty and uninhibited compulsions, men tend to finance their drug habits through the employment of criminal methods more than women do.^[12]

In fact, a psychiatrist who specializes in drug and alcohol addiction tells The Telegraph that men take drugs because they have a genetic predisposition towards engaging in dangerous behavior.^[13] That may explain why men use drugs for reasons that fall in line with the mentality of traditional gender roles, perhaps as a way of “reclaiming” gender identity that their mental health problem has taken away.

According to a literature review conducted by Westminster College, the most common reasons for men to engage in substance abuse may include:

• The exhilaration that comes from risk (impulsive, reckless behavior)
• Increased sexual prowess
• Increased stamina and concentration for work (earning power and being the breadwinner)^[14]

In women, by contrast, the most typical reason for drug abuse is to escape the emotional distress of sexual abuse.

Men in Recovery

Understanding the nature of male drug and alcohol addiction is vital to knowing how to treat the problem, especially for men who started self-medicating as a result of an issue that threatened their sense of masculinity and identity as a man. This may mean finding a therapist or treatment center that can guide a man through the recovery process while simultaneously helping him learn a more balanced, positive, and healthier approach to understanding his gender.

This should be done with the knowledge that some male patients may be in a recovery program against their will, for the reasons explained above. They may also be there as a result of institutional pressure (e.g., as a condition for employment or a reduced criminal sentence).^[15]

One method of assuaging concerns might be through the use of cognitive behavioral therapy, or CBT. According to the National Alliance on Mental Illness, CBT helps the patient understand the roots of their harmful thoughts and feelings, and how these manifest into expressions of self-destructive behavior.^[16]

With regards to male addiction recovery, a therapist might help their patient learn how and why the question of protecting their masculinity became so all-encompassing as to be a source of mental distress, culminating in substance abuse. Once this connection has been defined, the therapist will show the patient how they can “unlearn” the association, such that asking for help or admitting weakness is not a sacrifice of masculinity, but a natural, normal and healthy way of approaching a difficult situation.

Treatment might also entail the sensitivity of exploring topics that a man might not be comfortable bringing up in a mixed group, or to a female health care or mental health specialist, such as sexual impotency as a cause or result of their drug abuse. Treatment settings that are wise to the range of problems facing men – everything from hair loss to a loss of sense of self as the result of a divorce or professional termination – will be the most effective in helping men recover from the personal trauma and the addiction that they cultivated as a result of it.

Research has shown that men and women benefit from treatment programs that are constructed with the patients’ genders in mind. The Westminster College literature review found that structure in inpatient programs was a critical component in helping men overcome their drug problem, reducing their rate of relapse. When exposed to the freedom of outpatient programs that women seemed to prefer, men tended to struggle more.

Similarly, men who participated in group activities and group therapy had much lower relapse rates, probably because drinking among men is more of a social ritual than it is with women (who tend to drink in isolation). Men, therefore, are capable of discussing their drinking more openly with other men who have shared the same experience, so incorporating this paradigm into a treatment program will be of great benefit for a man looking to become sober.

Motivational Interviewing

Different forms of therapy might include a tactic like motivational interviewing, where the therapist literally motivates the patient to find the inspiration to take control of his life from within. The Substance Abuse and Mental Health Services Administration says that motivational interviewing helps the patient through the process of self-actualization,^[17] which Psychology Today defines as an individual growing to fulfilling his highest needs.^[18]

For a man, self-actualization (and motivational interviewing) might mean the therapist helps him learn how he can be the best kind of father, husband or son he can be, while simultaneously understanding that acknowledging the pressure that comes from those roles is not a violation of masculinity.

Adventure Therapy

Another form of therapy that might be useful for a man in therapy is adventure therapy, where men are encouraged to partake in outdoor activities like camping, hiking, fishing, or endurance courses. Having men work together fosters an environment where asking for help, depending on others, and being honest about weaknesses and insecurities is presented in a positive and progressive light. Presenting these lessons against the backdrop of activities that are considered to be within the traditionally male purview further provides a frame of reference and perspective for the recovering man.^[19]

Life Coaching

For a more one-on-one situation, a recovering man can retain the services of a life coach. Like a sports coach, a life coach helps their client learn ways to push through the barriers and obstacles that present themselves in everyday life. In the same way that there are some coaches who work with their client on overcoming anxiety issues in the workplace, or others who help their clients manage their anger in healthy and constructive ways, there are life coaches who will work with a sober man on how he can balance his responsibilities and obligations as a man. This is done while focusing on positive and productive responses to the challenges and stressors caused by those responsibilities – especially if those stressors are related to the man’s identification of his gender role and are what drove him to self-medicate to try and cope.

A life coach will set realistic goals and tasks for a client to work on. This may include keeping a journal of progress (and setbacks), or taking on small, everyday challenges to overcome the compulsion to take drugs or drink, while accomplishing things that speak to his identity as a man – for example, balancing a checkbook or settling monthly bills, and learning how to deal with financial difficulties in a better manner than interpreting those difficulties as a failure of manhood.^[23]

The Family Dynamic

Family can be one of the biggest catalysts of a substance abuse problem, and therefore can pose a significant risk for relapse. Alcohol and drug addiction are oftentimes considered a “family disease,” so it is important that the people in the man’s closest social circle – his partner, children, siblings, parents, close friends, etc. – be made part of the treatment process. Family therapy entails educating key people in the addict’s life about the entire spectrum of combinations that drove their loved one to start abusing drugs and alcohol, including their own behavior. This is not intended to transfer responsibility away from the patient, but to get his family fully involved and engaged with the rehabilitative process.

To this effect, the therapist will work with the family to understand how they may have missed the signs, or unwittingly encouraged their husband, father, son, or brother to develop a drug problem. They may be required to remove all access to, and even possession of, alcohol in the house. They may have to learn new methods of healthy and affirming communication, gradually diminishing any areas of stressful interpersonal interactions that add undue tension to the domestic unit.^[25]

Sober Living

Other resources for recovering men may include sober living arrangements. “Sober living” refers to a living arrangement where an addict shares a private home with a number of other men in recovery. The idea behind sober living is to give a patient a place of security, structure, and solidarity with similarly recovering people, before the full-on reintegration back into everyday life. This is especially useful for patients who do not have family and friends to whom they can return after they complete their formalized treatment, or for men who are looking to learn how to live in a controlled, safe environment before finding their own place to live.

Standard practices of sober living homes for residents include:

• Submitting to random urine tests
• Submitting to random searches for evidence of substance abuse
• Holding down a job or going to school
• Paying rent on time
• Adhering to curfew
• Attending regular support meetings

These dynamics give sober men the sense of organization and clarity they need for keeping the compulsion to drink at bay. The first three months following discharge from a treatment center are the most likely time for a relapse to occur, so it is vital that this time is spent with people who can support and encourage the patient in a way that is insightful and empathetic.^[20]

It is also important that the patient be in an environment where the culture of drugs or alcohol is not present. For some heterosexual men, controlling and restricting interactions with women might remove the temptation to use alcohol as part of a courtship ritual (where alcohol has been shown to have a strong causal relationship in “disinhibited” sexual behavior).^[21]

The Journal of Psychoactive Drugs conducted a study of 245 people who entered a sober living house after finishing treatment. Seventy-seven percent of that population were men, with most of them reporting that jail or prison accounted for their normal housing situation for the preceding six months. The authors of the study found “positive [long term] outcomes” for the study population: everything from lowered relapse rates, lowered incarceration rates, and increased mental health status. Participants who attended regular 12-step meetings had much better alcohol and drug outcomes, as well as better reports on their overall mental health.^[22]

Ultimately, any man’s recovery is about the emotional support and care he receives from the people who look up to him.