Men make up 70 to 80 percent of the population in substance use treatment programs, but women represent about 70 to 80 percent of the group providing the services in these programs. That does not by definition constitute a problem, but it does help call attention to what has been a historical challenge in meeting the needs of the majority of addiction treatment patients.
In recent years, the gender-specific needs of male patients have received growing attention, with guidance modeled largely after the greater volume of research around gender-sensitive treatment for women. But while this has led to a growth in men’s treatment groups as well as male-only treatment and recovery programs, a leading speaker and author in men’s relationships says the vast majority of programs don’t take the deep dive needed to understand how beliefs about masculinity affect recovery outcomes.
“A lot of men’s programs unintentionally reinforce traditional masculinity that is counterproductive to long-term recovery,” Dan Griffin, co-creator of the Helping Men Recover curriculum that integrates theories of addiction, trauma and male psychosocial development, told ADAW. “There is not enough inquiry on masculinity and the internalized beliefs about masculinity. There needs to be a focus on ‘How are my ideas about being a man affecting my recovery and my relationships?’”
While Griffin says men’s treatment issues increasingly are being discussed at professional conferences, he still sees the same absence of raised hands in his audiences when he asks how many attendees received training in these topics in graduate school or as part of their professional credentialing requirements. There simply has been no systemic look at these issues at the training level, he says.
At Metropolitan State College of Denver, a faculty member in the Integrative Healthcare program will begin offering a one-credit course on men and recovery next semester. At the outset, this will be only an elective course for students in the school’s addiction studies program. When he has presented on the topic of masculinity as it relates to addictions, even before a group of male treatment professionals, “It seems that the men were hearing this for the first time,” Steven Rissman told ADAW. “That was surprising to me.”
Meeting men’s needs
Griffin, who last week in Huntington Beach, California, presented a free workshop on Helping Men Recover in an event sponsored by the Coastal Recovery, offers several potential measures for determining whether a treatment program is male-focused in name only or genuinely in practice. A strict count of male versus female clinical staff is not particularly telling, he says, but if there are no men on a program’s staff, that should raise a red flag.
His assessment of programs also seeks information about the type and extent of training staff members have received, and how far into the organization that has reached. “Some programs will have one counselor who is deemed as being the guy who ‘gets it,’” Griffin said. “But the techs in that center haven’t been trained. Young guys in recovery can undermine what the rest of the program is doing.”
A significant component of a program’s work with men, Griffin says, involves how staff responds when a man in treatment reacts with anger (or, in the pejorative way of characterizing this, “acts out”). It is important for programs to accept that men affected by unaddressed trauma will externalize in responses of rage. “If a program uses power and control to shut the door on that, without using a trauma-informed lens, that reinforces negative aspects of masculinity,” Griffin said.
This has been an area of transformation at the Jaywalker Lodge treatment and recovery program for young men in Colorado, explained founder Bob Ferguson. He told ADAW that in the time current CEO Dirk Eldredge (who has a background in intervention) has led the organization, atypical discharges from the program have dropped by more than 50 percent. The reason: “He has reoriented the team toward a clinical intervention, not a punitive one,” Ferguson said of the CEO.
The roots of this issue, says Metropolitan State’s Rissman, can be found in how boys are raised in society. From an early age, boys learn that the definition of being male means not talking about feelings, and not revealing. “The boy code for everything is ‘Just fine,’” Rissman said.
“Then we’re puzzled about why, when we get to a certain age, there’s no place to go with any of this,” he said. “We gave men anger as their only outlet, and then we took that away because we recognized that other people were hurt.”
In treatment settings, the temptation becomes one of controlling men’s behavior rather than giving voice to it, Rissman said. “In group, when a man can’t communicate, we punish,” he said.
Rissman points the finger in part toward clinical professionals who haven’t processed their own trauma and their own beliefs about gender. He compares this to what happens in the general health setting, where a man will tend not to reveal something important to his doctor.
“Of course he won’t, because the doctor is not able to invite it,” he said. “He has his own hang-ups about being able to reveal.”
While Jaywalker Lodge serves men only, Eldredge says its clinical staff is around two-thirds female (total staffing is split about evenly, as many Jaywalker alumni work in nonclinical roles in the organization). The organization believes women and men can be equally successful in working with men in treatment and recovery settings.
Griffin has found, in fact, that perhaps the most effective structure in men’s group therapy involves having one man and one woman as co-facilitators of a group. “Their interaction models healthy interactions between the genders,” he said. Men and women working together in professional settings can help erase misconceptions that the genders often bring to the table.
Ferguson outlines three guiding principles he says have helped Jaywalker Lodge in its work with men over the past 15 years:
- “Men are much more afraid of becoming invisible and insignificant in their recovery than they are to die in their addiction,” he said. Therefore, programs need to emphasize all the good things that can come in recovery, rather than use scare tactics about relapse that ultimately don’t work, he said.
- Men’s ability to form intimate relationships with other men is a greater predictor of positive recovery outcomes than their ability to form a therapeutic alliance with a counselor while in treatment. In hiring staff, therefore, Jaywalker looks for individuals who can help facilitate bonds among the men in the program.
- “Men engage at a different level in community than they do in containment,” Ferguson said. Therefore, Jaywalker emphasizes the importance of getting out of a traditional therapeutic setting and encouraging men’s involvement in community work and adventure activities. He and Eldredge added that art and music therapy have become an important element in Jaywalker’s programming, which maintains a 12-Step foundation. “Those haven’t historically been areas of focus in men’s treatment,” Ferguson said.
Having a men’s group, or even being a program that treats only men, doesn’t guarantee that a program is being sensitive to the core issues that most affect treatment outcomes for men.