Author: James Anderson

Sex and Gender Differences in Substance Use National Institute on Drug Abuse NIDA

Node-link maps help clients see, in concrete terms, the consequences of life choices. Exhibit 3-1 provides an example of a node-link map to help a client address a cocaine addiction. For more on genograms, see TIP 39, Substance Abuse Treatment and Family Therapy (CSAT 2004b). The continuum of addiction care (CoC) is a connective web that networks recovery services together. Clients can get care for addiction and recover, but any untreated mental conditions may trigger a relapse. Some men choose prostitution primarily as a way to experiment sexually while earning extra money, not as an economic necessity.

These characteristics are confronted with gender-specific addiction treatments, such as men-only recovery programs. Fathers with substance abuse problems are twice as likely to fail to pay child support as those without such problems (Garfinkel et al. 1998). The Child Support Enforcement Program links Federal, State, and local authorities to ensure that orders for child support are followed.

Family Issues: Helpful Resources for Behavioral Health Service Providers

Another benefit to having female behavioral health service providers in facilities serving all-male populations is that they can model healthy male–female relationships for clients. Teamwork, cofacilitation of counseling, and collaborative working relationships between male and female staff members are of benefit to both the clinical team and clients because they provide positive role models for gender cooperation and communication. If clients see men and women interacting in healthy relationships with clear, nonsexist communication, they are likely to learn how men and women should act together. In general, questioning oneself helps overcome stereotypes and gender biases.

1. Girls under age 18 are about three times more likely than boys to experience sexual abuse, but boys are more likely than girls to experience emotional neglect or serious physical injury due to abuse (Sedlak and Broadhurst 1996).
2. Men’s addictions are frequently used to mask physical pain, fit in socially, or to cope with extreme mental burdens.
3. It is often difficult to identify a client with a history of sexual abuse, so routine physical exams that require a client to disrobe or that involve touching a client’s genitalia must be conducted with respect and sensitivity for the man’s privacy.
4. Social stigma tied to substance abuse, co-occurring disorders, other behavioral health problems, failure to meet society’s expectations, and other problems can cause intense feelings of shame among men.

Seeking or being mandated to treatment may feel like a weakness and affront to their sense of masculinity; however, such responses may not apply to a particular male client. The other considerations of which behavioral health service providers need to be mindful follow from an understanding of the factors that define masculinity and male roles in our society, which are discussed in Chapter 1. Men are expected to be independent, self-sufficient, stoic, and invulnerable. Consequently, they may have trouble identifying or expressing weaknesses or problems within treatment, which may be perceived as a lack of trust or an unwillingness to be open with counselors or fellow clients. Men often have concerns about privacy and need reassurance that treatment will pose no threat to their image or standing. They may also have trouble analyzing their own problems, particularly feelings related to those problems.

Differences in Addiction for Men vs. Women

Thanks to the Internet, millions of people can now easily access a wealth of information on just about every topic of interest and effortlessly talk with others despite great physical distance. However, this technology also enables people to find an “impersonal, detached sexual outlet” (Schwartz and Southern 2000, p. 128). Those who seek sexual partners and gratification over the Internet are engaged in what is often referred to as cybersex. Some participants compulsively search for partners for hours, seeking to create various fantasy scenarios; others spend large sums of money on interactive pornography.

Additional material on addressing domestic violence in counseling is offered later in this section. Anger management is another useful adjunct for men trying to address violent behavior. Several studies show that many men with substance use disorders have high levels of anger (Awalt et al. 1999; Giancola 2002b; Parrott and Zeichner 2002; Reilly and Shopshire 2000; Tafrate et al. 2002). Anger can often lead to aggression and violence and can serve as a precipitant for relapse. Teaching men cognitive–behavioral strategies that help them manage their anger can reduce aggression and violence and possibly improve treatment outcomes (Reilly and Shopshire 2000). Although different theories have been proposed for why men commit violent crimes, it does seem clear that gender roles hinder criminal behavior in women and enable it in men.

Belief in controlling substance use can keep men from submitting fully to the guidance and support of rehab. Moments of happiness can lead to denial of addiction or beliefs that you are cured. Addiction treatment helps you manage the condition to keep it from stealing your life. Addictions to sex, gambling, and even food can be a burden on your health and wellbeing. Men may be using their addiction to cope, or they may be “hardwired” to be susceptible to addictive behaviors. While viable, these spaces may make men fall into behaviors that inhibit their ability to confide their struggles.

One of the most difficult issues to address in any counseling context is the sexualized transference that is likely when a female counselor works with a heterosexual male client or a male counselor works with a gay male client. In therapy, the counselor invites the male client to be open to his feelings, be vulnerable, and engage in a kind of intimacy that may or may not be present in other relationships in that client’s life. It is common and normal for the male client to feel emotional and/or sexual attraction for the counselor. Although this is a common occurrence, substance abuse treatment counselors may have received very little training in how to address client transference feelings, particularly sexual feelings. The following clinical scenario offers some options for addressing sexualized transference. How can clinicians overcome gender bias so that it does not negatively affect their work with men in substance abuse treatment?

There are also cultural differences in how individuals are expected to respond to shame. In some cultures, a man may be expected to publicly demonstrate his shame; in other cultures, a man may be expected to strike out in revenge at whomever caused him to feel shame. Most Schedule IV drugs are prescription medications, some of which have been banned by the Food and Drug Administration. Some examples of Schedule II drugs are cocaine, fentanyl, methamphetamine, oxycodone, and hydrocodone.

Female behavioral health clinicians may have, at one time or another, been ignored or belittled by men in authority; sexually harassed; and/or subjected to domestic violence, child abuse, or childhood sexual abuse. As a result, two of the most potent countertransference issues female counselors may experience in working with men are fear and unresolved anger. A female counselor may subconsciously fear that her male clients will ignore, judge, or belittle her, dominate or take over the therapy, or reject her efforts to help. One of the most difficult experiences women face in our society due to gender role socialization and culturally defined gender norms is a sense of being invisible. If a male client ignores the female counselor’s recommendations or belittles the efficacy of the treatment, shame and inadequacy may be activated. A female counselor’s subconscious anger may surface in the therapeutic relationship as cynicism, rejection of the client’s ideas about what works best for him, or being judgmental.

Why Men Develop Addictions

Sexually charged humor may be misconstrued by such a client; even demonstrations by counselors (or clients) of being interested in or concerned about the client can be seen as similar to the interest shown by a sexual perpetrator. It is often difficult to identify a client with a history of sexual abuse, so routine physical exams that require a client to disrobe or that involve touching a client’s genitalia must be conducted with respect and sensitivity for the man’s privacy. A man’s violent behavior can interfere with his substance abuse treatment, and conversely, his substance abuse can interfere with interventions aimed at changing his violent behavior (Bennett 1995; CSAT 1997b).

For these reasons, among others, it is important for fathers to have some contact with their children during treatment, even if only through supervised visitation. Sensitivity to a father’s visitation schedule helps him maintain contact with his children and ensures that custody exchanges proceed smoothly and both mother and father cooperate with the terms of the agreement. Twice in his first week in the program, George had panic attacks that he blamed on fears of being trapped. He had nightmares almost every night and had rushes of feeling overwhelmed and ashamed. He appeared frightened and unable to bond with other male clients in the group.

The Centers for Medicare & Medicaid Services (CMS) finalized expansion of Medicare coverage to include opioid treatment programs delivering MAT (medication-assisted-treatment) effective Jan. 1, 2020. Submitting to treatment means you are ready to learn, open up, and allow others to guide you. You should be aware of a few expectations in men’s addiction care before entering treatment.

Whether or not clients can choose to work with a male or a female counselor, asking about their preference during initial assessment is a way of raising the issue of gender. Clients can be asked not just about dates of previous treatment if applicable, but also about the gender of their primary counselors in those episodes. Counselors can then use this information to inquire about clients’ past experiences with male and female counselors, what their preferences might be, and why. Exploring past counseling experiences and current preferences with regard to counselor gender is a nonjudgmental, empathetic way to let male clients know that their lived experience and preferences matter, even if it is not possible to match clients with their preferences. Johnson (2001) suggests including questions that address gender socialization and counselor gender preferences on the intake form and/or in the initial conversation with a male client. The investigation of compulsive online sexual activity is a relatively recent field of study, and screening and treatment approaches are still in development.

Narcotic Abuse

Although empirical data on how parenting responsibilities affect the treatment seeking and retention of men are not readily available, studies suggest that family can play an important role in motivating a man to enter treatment. For example, Steinberg and colleagues (1997) found that 53.3 percent of their sample (105 men in a couples-based outpatient program for alcohol abuse) said they were motivated by their spouse or family to enter treatment. In analyzing data from the Drug Abuse Treatment Outcome Study, Grella and Joshi (1999) found that opposition to substance use and support for treatment from family members had an effect on men’s entry into treatment that it did not have on women’s entry. Several studies have addressed the comorbidity of substance abuse and sexually abusive or violent behavior.