By Dan Griffin
Treatments will be more effective when we treat men as men.
How much can really be done to improve men’s treatment for addiction? The myth is that men have a hard time engaging in treatment. The truth is that we have a hard time truly engaging men in treatment – meeting them where they are at, speaking to them in their language, and listening to everything they don’t – and cannot – say. The field of addiction treatment has not spent a lot of time creating a true framework for treatment that speaks to men’s unique issues and needs – treatment for men, created by men, with men in mind.
For years now there has been an expectation that addiction counselors need specialized training to work most effectively with women. Despite the fact that 70% of the people going through treatment are men and 70% of the people working in treatment are women, there has never been any such expectation when it comes to men’s treatment and working with men. Until now.
Here are five critical elements for making men’s treatment services more effective:
1. Men’s Socialization Should Be the Context. Given how contrary being in recovery is to “The Rules of Being a Man” that dichotomy and the tension between the two should be a constant context for the conversations we have with men. When we embed this awareness throughout the treatment experience we give men a language for talking about the dissonance they are often experiencing without making it about them. There is nothing wrong with them – they are simply trying to rectify how they have spent their whole lives trying to be certain kinds of men and a core part of who they think they are with the expectations of being in recovery that can often feel quite “unmanly.”
How many men are constantly fighting against the stranglehold that The Rules have over them as they attempt to apply the principles of recovery to their lives? Just look at some men in the recovery community with five, ten, fifteen or more years of sobriety who struggle to be close to someone, share what is really going on with them, struggle with violence and abusiveness, and/or are paralyzed by codependent behaviors? Guaranteed, The Rules are at the heart of so much of this suffering.
Finally, look at any man’s relapse and we guarantee that a major factor was one or multiple Rules that kept him isolated and disconnected from himself and others. When you talk to a man about his relapse in the context of The Rules you help to take away the shame and any belief the man may have about being unable to achieve sobriety because of who he is.
2. Safety First. You need to be focused on safety because the men will not likely talk about it but it is on their minds, in their gut. No matter how a man acts when he first comes into your treatment program – apathetic, belligerent, sarcastic, or overly enthusiastic – you should be thinking in terms of safety. If you were to do this then everything would change. The lens through which you view his behavior would lead you to respond to him differently. Your environment could not help but change as everyone, including staff, in the organization would begin to feel safer. This is a critical element in becoming trauma-informed when providing men’s treatment.
3. Small Groups. If you want men to open up, put them in small groups. And we mean small groups, as in breaking the men out into sets of threes. The effect is transformative. Men who normally would fly under the radar or simply present as though they are less emotionally engaged will show up in a completely different way. The number three is important – two is too easily turned into a conversation and four can split into twos or even lose someone. But three, well there is something almost magical about it.
4. Let’s Talk About Sex. Let’s not just talk about sex but talk about sexuality – the whole thing. What percentage of men’s relapses are directly related to sex? Close to, if not 100%! Not feeling comfortable with engaging in sex while sober, fear of sex, discomfort with themselves sexually, pain from sexual trauma, body image, and many others. Let’s not even talk about men’s use of pornography while they are in treatment programs – let alone once they get out. Let’s definitely not talk about the unhealthy use of porn amongst all of the male counselors out there working with men! Add to that our growing awareness of sex and love addiction and its impact on men and all of our relationships.
Therefore, the real question is: How can we not put a major focus on helping men develop a healthy sense of their sexuality? That is a primary question that everyone who works with men’s treatment services should be asking themselves.
5. Homophobia. How many men’s treatment programs incorporate homophobia into their treatment regimen? Very few. Of course, an addiction counselor can’t simply say to men, “Okay guys, let’s talk about homophobia.” It’s more complicated and requires a high degree of finesse. When we talk about homophobia it goes far beyond a fear or hatred of homosexuals, especially gay men – for us it means men’s fear of men – our fear of getting close to other men and having any kind of intimate connection with them.
If these five elements become incorporated in men’s treatment plans, you will see marked differences – if not a complete transformation – in how men respond to their treatment experience and how effective clinicians feel working with men.