Characterization of Problematic Alcohol Use Among Physicians: A Systematic Review Occupational Health

Substance Abuse in Men

For a man with OCD and a co-occurring substance use disorder, the substance use disorder may have originated in an attempt to cope with overwhelming and disabling anxiety. Substance abuse treatment can be complicated by men’s resistance to giving up a drug that they believe necessary to their emotional survival, by anxiety that arises from the emotional intensity of treatment, and sometimes, by deficits in social skills important for recovery from substance abuse. As with other anxiety disorders, a licensed behavioral health service provider with specific training in the treatment of anxiety disorders should diagnose and treat OCD, which should be treated concurrently with the substance use disorder. George is a 26-year old client in an inpatient substance abuse treatment program for men with co-occurring disorders. This is his first admission for substance abuse treatment, but he has, since early adolescence, been treated for various mental disorders, including depression, attention deficit hyperactivity disorder, panic disorder, and mixed personality disorder.

  1. If men are more likely to regularly use substances, peer group influence may also play a role in the cycle of male substance misuse, especially during adolescence.
  2. According to 2006 data, men were more than 3 times as likely to be violent offenders as women.
  3. Clinical examples and tips are offered to guide behavioral health clinicians in treating men from these diverse populations.
  4. Otherwise, the legacies of masculine socialization can impede the process of healing from trauma by keeping men from connecting with the painful feelings that result from it.
  5. The problem is further complicated by traditional beliefs that men should be the head of the household and men’s fear of ridicule for not filling that role; the shame men may feel at disclosing family violence is compounded by the shame of not being able to keep their partners under control (Straus 1999).

Consequences of Addiction

Substance Abuse in Men

As a result, gay men in substance abuse treatment settings may be more cautious about coming out and discussing issues related to relational/social aspects of their substance abuse experiences or their primary relationships. As with gender considerations, the sexual orientation of the client and counselor should be considered when assigning counselors to substance abuse treatment clients. If a gay client is matched with a gay counselor, the issue of sexualized transference will most likely need to be addressed. It is not always possible to match clients and counselors with regard to sexual orientation, so counselors need to explore and challenge their own sexual orientation biases and beliefs to work effectively with gay men in substance abuse treatment settings. However, gay and bisexual men are significantly more likely than heterosexual men to seek treatment for substance use and/or mental disorders (Grella et al. 2009a).

Understanding Alcohol Use Disorder

Notably, most of these studies have identified reductions in substance use (or abstinence) and treatment retention as primary outcomes of interest. Given that women and men differ substantively in negative health and psychosocial effects of substance use, future studies should explore gender differences in the effects of treatment on other outcomes of interest (e.g., quality of https://sober-home.org/alcohol-poisoning-symptoms-causes-complications/ life, measures of mental and physical health). Gender differences in treatment response to other pharmacotherapies have not been consistently demonstrated. Studies of opioid agonist therapies have also not indicated significant gender differences, including studies of both buprenorphine (McHugh et al., 2013; Potter et al., 2013) and methadone maintenance (Potter et al., 2013).

orking With Specific Populations of Men in Behavioral Health Settings

There were 134 respondents who said that they had struggled or currently struggle with an addiction to drugs or alcohol. Nearly 41% of the 175 males surveyed said that they had a substance use disorder in the past or have one now, compared to only 28.5% of the 225 females who took the survey. There were similar gender discrepancies when respondents were asked about which of their family members struggled with an addiction. Exploring this issue with a higher number of participants would provide a deeper and greater understanding on the subject of traumatic childhood experiences and drug abuse. A quantitative study in Iceland could better illuminate the link between childhood trauma and drug abuse.

Substance Abuse in Men

Stereotypes of men who abuse substances may reinforce traditional ideas about gender and family such that these men, more so than others, are quickly but inappropriately dismissed as indifferent, uninvolved, irresponsible, and irrelevant (McMahon and Giannini 2003; Parke and Brott 1999). The importance of child custody for women and the value of programs that treat women with their children have been recognized for some time (CSAT 2004b), but clinicians and researchers still tend to minimize the roles played in the lives of their children by men who abuse substances (McMahon and Rounsaville 2002). Losing custody of their children can affect men’s substance use; some men enter treatment due to their concern for their children (McMahon and Rounsaville 2002), and men who have children are more likely to complete treatment (Rabinowitz and Marjefsky 1998). Conversely, lack of contact with one’s children is correlated with increased substance misuse among men (Grill et al. 2001).

Additionally, rates of suicide are almost four times greater for men than for women, although substances are commonly found in both males and females who complete suicide. According to federal data from 2014, 40 percent of deaths by suicide involved alcohol intoxication, 30 percent involved opioids, and 21 percent involved marijuana. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (HHS) that leads public health efforts to advance the behavioral health of the nation.

He recently completed an intensive outpatient treatment program and was referred to individual counseling as part of his continuing care plan. He was given several counseling options and chose to make an appointment with Jennifer, a 28-year-old White American woman who has worked at the outpatient substance abuse clinic for 2 years. Because men may be particularly uncomfortable with emotional expression or have difficulty identifying and understanding their own emotions early in treatment, the clinician should carefully monitor the emotional intensity of initial interactions, offering men time to compose themselves if needed.

For example, questions were added to the substance use disorder (SUD) section that assessed craving or a strong urge to use various substances. Third, the criteria used to categorize SUD among NSDUH respondents changed from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to the fifth edition (DSM-5), causing differences in who is classified as having an SUD. For this alone, the DSM-5 SUD estimates from 2020 are not comparable with the DSM-IV SUD estimates from previous years. The Biden-Harris Administration continues to prioritize the behavioral health needs of Americans.

Both Lewis (1971) and Scheff (1987) observe that some men externalize—holding others responsible for their actions—to shield themselves from experiencing shame. He has been assigned as the primary counselor for Kurt, a 45-year old bank executive who was referred to treatment through his company’s employee assistance program. He had been a heavy drinker most of his adult life; because of the stress of the economic downturn and his bank teetering on the brink of bankruptcy, Kurt has been getting drunk three to four times a week and recently started taking tranquilizers to deal with his anxiety. Jim states that this is Kurt’s first experience in counseling or treatment and that he is very resistant to Jim’s recommendation to attend Alcoholics Anonymous (AA) meetings as part of his continuing care plan. Substance misuse can materialize from many different factors in someone’s life, including a family member’s addiction, influences from friends or genetic disposition to risky behaviors.

This made direct comparisons difficult and outlined the need for a large population-based study assessing the prevalence of problematic alcohol use based on an internationally accepted definition and standardized reporting. Furthermore, although this review included studies from across the globe, which increases the applicability and external validity of the review, cultural factors related to drinking patterns make it challenging to compare patterns of problematic alcohol use between countries. Lastly, given the number of articles retrieved in our initial literature search, we excluded articles that reported on binge drinking only.

The term “depressive symptoms” is generally applied to a state of sadness, depressed mood, the blues, or related feelings and behaviors that do not meet diagnostic criteria for a DSM-IV-TR (APA 2000) mood disorder. People with such symptoms may experience considerable emotional https://sober-home.org/ pain and significantly impaired functioning in some areas. CSR can be transient and nondebilitating, or it can result in major psychological disorganization. Normally, with support and treatment, symptoms diminish in a relatively brief period of time (1 to 2 months).

It is crucial that both male and female counselors explore their own biases and assumptions about men. Clinicians should ask themselves, “What is my first thought and immediate reaction to a male client who cries in a session? Do I directly or indirectly praise or encourage male clients who work long hours at the expense of their families? Do I assume that men respond to cognitive-behavioral therapy better than emotionally supportive therapy because men are rational?

Men enter treatment with multiple needs, as their substance abuse has likely affected every aspect of their lives. Often, a man’s behavior involves him with a system (e.g., the criminal justice system) that may require his treatment providers to interact with that system. In other cases, other systems may be required to provide for a man’s specific needs (e.g., housing). Some such systems (medical services, VA services, and vocational rehabilitation) have already been covered in this TIP; two more that involve many men in treatment (housing and homelessness services and the criminal justice system) are discussed in the following sections. A study by Arndt and colleagues (2004) found a positive association between abstinence and full-time employment for men after treatment. For more information on the relationship between employment and treatment success, as well as integrating vocational training into substance abuse treatment programs, see TIP 38, Integrating Substance Abuse Treatment and Vocational Services (CSAT 2000a).

Download, read, and order free NIMH brochures and fact sheets about mental disorders and related topics. To learn more about alcohol treatment options and search for quality care near you, please visit the NIAAA Alcohol Treatment Navigator. Health care professionals use criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to assess whether a person has AUD and to determine the severity, if the disorder is present. Severity is based on the number of criteria a person meets based on their symptoms—mild (2–3 criteria), moderate (4–5 criteria), or severe (6 or more criteria).

Substance Abuse in Men

Overall, the program is much more rule-bound than the equivalent program for women at Albuquerque Health Care for the Homeless. Estimated rates of substance abuse are similar for veterans and nonveterans, but male veterans receiving treatment are more likely than male nonveterans to report alcohol as the primary substance of abuse (59 percent and 40.4 percent, respectively; HHS, SAMHSA, OAS 2008a). Veterans treated in VA facilities (see advice box on the next page) have significantly more problems than patients in non-VA facilities with employment, education, legal issues, and co-occurring mental and medical disorders (Veterans Health Administration 1996).

Men are often embarrassed or reluctant to self-disclose emotions, such as sadness or anxiety, so clinicians should consider acknowledging (e.g., through counselor self-disclosure) fears many men share about relationships, health, abandonment, career, and financial issues. Sometimes, self-disclosure is not warranted; therapists should not reveal personal information if they feel uncomfortable doing so or lack the training to do so properly (Forrest 2010). Counselors should try to gauge those expectations, as research suggests that clients who expect self-disclosure will respond by giving more information when their expectations are met (Dixon et al. 2001). Self-disclosure, when done in the best interests of the client, can help move sensitive topics into the open, thus giving clients permission to begin talking about them.

Conducting a thorough medical and mental health assessment at admission can minimize the risk of these disorders going untreated, even if the program itself cannot provide that treatment. Screening and assessment for mental illness must also be ongoing; clients with one type of disorder are at increased risk of later developing disorders of another type. Moreover, the symptoms of a substance use disorder can mask co-occurring mental disorder symptoms at any point in treatment.

Some had experienced relapses and believed them to have occurred due to their poor mental health. Individuals with a history of childhood trauma and subsequent drug abuse are predisposed to relapsing after a period of sobriety, when facing difficult and distressing situations. Previous research has repeatedly revealed the incentive for relapsing to be the desensitization of feelings when individuals have been subjected to a great deal of distress (Garami et al., 2018; Heffner et al., 2011; Wadsworth et al., 1995). June marks National Men’s Health Month, an opportunity to examine the prevalence of drug misuse and substance use disorders (SUDs) in men.

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