Alcohol and/or Drug Rehab in a Gender-Specific Setting

Thursday, January 11, 2018
Michael Rass

Men are more likely than women to use almost all types of illicit drugs, reported the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2014, and illicit drug use is more likely to result in emergency department visits or overdose deaths for men than for women.

Men have a much higher rate of alcohol use disorder (AUD). According to the 2015 National Survey on Drug Use and Health (NSDUH), 15.1 million adults ages 18 and older had AUD. Sixty-five percent were men—9.8 million men compared to 5.3 million women.

Alcohol also kills men in disproportionate numbers. According to the National Institute of Health, an estimated 88,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. 62,000 of them are men. Two-thirds of all admissions to alcohol and/or drug rehab programs are male clients.

There are specific reasons for this discrepancy. In their 2016 study Sex differences, gender and addiction, Jill B. Becker, Michele L. McClellan, and Beth Glover Reed state that “gender and sex differences in addiction are a complicated interaction between sociocultural factors and neurobiological sex differences” and that “researchers in the social and natural sciences have demonstrated that addictions and consequences of addictions differ by biological sex and also by gender.”

Addiction is a complicated condition involving many different factors as Becker, McClellan, and Reed explain: “Individual differences in genetics, personality traits, extent of social support, experiences or trauma during development, and whether one is male or female are all thought to contribute to how someone responds to drugs of abuse and whether one develops compulsive behaviors associated with an addiction.”

When it comes to alcohol or substance use and addiction, gender differences abound. Males start using drugs at an earlier age. Men abuse drugs more often and in larger amounts. Males are more likely to abuse alcohol and tobacco. Men are more likely to engage in binge drinking (the consumption of five or more drinks in a short time period).

Since men have specific needs and issues when it comes to substance use, and/or drug rehab should reflects that. “In the past, the term gender-responsive has meant woman-centered,” write Stephanie Covington, Dan Griffin, and Rick Dauer in Helping Men Recover. “This came from the need to develop programming for women in a field that assumed that male and female addicts would respond to the same type of services.”

Covington pioneered a gender-responsive approach to addiction treatment for women but men, too, have a better chance of achieving lasting recovery from addiction if they undergo therapy in an environment free from sexual distractions and focused on their specific needs.

North Bay Recovery Center in San Rafael near San Francisco is an alcohol and drug rehab center that was designed exclusively around the unique needs of men. North Bay believes that effective alcohol and/or drug rehab for men needs to take into account the life experiences and the impact of living as a man in a society still dominated by males.

The True Self

“I see alcohol and drug rehab as a time for transformation. It’s about reconnecting to the self and understanding, ‘Who am I?’ It’s about asking, ‘What type of man am I? What does being a man really mean?’ says Cassandra Gabriel, the clinical director at North Bay Recovery Center.

“Many men have been brought up to assume they have to be the strong one in all situations,” explains Gabriel. “They feel they should always have it together. They need to be the main provider of the family, and consider showing emotions too effeminate.” These distorted assumptions about manhood can lead to serious pathologies.

Dr. Covington has written that “addiction is the chronic neglect of the self in favor of something or someone else: the object of addiction.” Addiction cuts a man off from his true self. He numbs his emotional pain so he no longer knows who he really is or what his feelings are.

“Recovery is a process of finding, knowing, and caring for the self in a deep and powerful way,” write Covington, Griffin, and Dauer. “In the recovery process, the individual grows less dependent on the object of addiction.”

Caring for the self also means making yourself vulnerable. This is often perceived as being unmanly. Accepting that there are things beyond one’s control is often hard for men. Due to their socialization, men frequently have trouble recognizing their feelings. “Men with substance use disorders often don’t know what they are feeling and have limited vocabularies for articulating their feelings,” write Covington, Griffin, and Dauer. “Feelings are not ‘manly.’ Anger, indifference, and sarcasm often become the catch-alls for the variety of feelings men have.”

All of these are strong reasons for a gender-responsive approach to alcohol and/or drug rehab. “In the company of fellow males, men are typically more comfortable opening up, and more comfortable being vulnerable,” says Gabriel. And they won’t feel judged by fellow patients of the opposite sex. At North Bay’s alcohol and drug rehab center, men can work on recovering their true self without the distracting presence of female peers.

“We have seen quite a few clients come through North Bay who had been to coed alcohol or drug rehab program before,” says Gabriel. “Often that was big contributor to their relapse. They left rehab with a new girlfriend and that new relationship was what they were focusing on the whole time during treatment.”

The Power of Brotherhood

At North Bay sexual distractions are excluded and the focus is on male bonding instead. North Bay's addiction treatment program is built around a "hub and spokes" model. In the central hub, men participate in daily treatment sessions before retiring to their personal space in a “spoke” where they eat, sleep and enjoy leisure time.

“The hub and spokes environment mimics the real world,” explains Gabriel. “They have a very comfortable home or “Life House” where they eat, sleep, hang out, and spend a lot of their down time. In the morning they wake up and just like going to work or school they come to the “Skill House” in the center. This model provides a healthy separation. When it’s time to go to the center, clients know it’s time to get down to business, it’s time for therapy and groups.” It is the setting for formal treatment where clients work hard on their recovery. When they go back to their Life House they know it is a safe space where they can take it easy. “We want to keep them safe but not in a bubble disconnected from everything, that’s just not realistic nowadays,” says Gabriel. “But it’s individually based, with consideration for their symptoms, their cravings, what we feel they are ready for.”

Clients might have therapeutic assignments but mostly they can really just relax. They can occupy a single room, or share a double in the Life House. Clients prepare their own breakfast; lunch and dinner are cooked by professional chefs. The Life House setup allows for a lot of spontaneous bonding. No need to go food shopping, North Bay provides fully stocked pantries and fridges. That leaves plenty of time for chatting, discussing recovery literature, playing board games, foosball, or ping pong. The men learn to trust each other in a safe place.

Making new friends and learning to trust them makes it easier for the men to open up in therapy sessions about the underlying issues that drives most substance use disorders. This is crucial to their recovery from addiction to drugs and alcohol.

“One of the most significant challenges is getting men to enter and stay in treatment,” write Covington, Griffin, and Dauer in Helping Men Recover. “Although men represent 70 percent of the treatment population, they are much less likely than women to voluntarily see services and much less likely to finish services once they have begun. Because expressing one’s feelings is one of the main objectives of treatment, this is often a barrier for men.”

Building Healthy Relationships

Sharing, as part of a healthy relationship, is often much harder for men than for women. Most men see themselves as needing to be independent and emotionally detached. Allowing yourself to be vulnerable is often seen as breaking the rules of masculinity. Opening up about one’s feelings frequently induces what psychiatrist Stephen Bergman has termed “male relational dread.”

If a woman, yearning to feel closer, explores a man’s feelings, the man often starts to experience emotional discomfort, and retreats. “The paralytic feeling of dread is familiar to many men. It contains a sense of failure, humiliation, shame, and paranoia. It is part of normal male development - and it is hell on relationships,” writes Bergman.

“As with women, the sources of men’s misery are in disconnections, violations, and dominances and in participation in relationships that are not mutually empowering,” Bergman writes in A New Psychology of Men. Many men enter an alcohol and/or drug rehab with a history of failed relationships. They may have been disconnected, disempowering, and abusive. They live in a society that allows men to behave this way and conditions many women to tolerate such behavior.

The Impact of Trauma

Male socialization is not the only reason for the frequent lack of real intimacy and the prevalence of failed relationships among substance users. A large number of men who seek help from an alcohol and/or drug rehab with an addiction have experienced debilitating trauma in their lives.

Trauma has been defined as “direct personal experience of an event that involves actual or threatened death or serious injury; threat to one's physical integrity, witnessing an event that involves the above experience, learning about unexpected or violent death, serious harm, or threat of death, or injury experienced by a family member or close associate.” (DSM-IV)

Many mental and behavioral health conditions are related to trauma. Addiction is one of them. Antisocial personality disorder and post-traumatic stress disorder are common co-occurring conditions for men in an alcohol and/or drug rehab program.

In the famous CDC-Kaiser Permanente Adverse Childhood Experiences study conducted with 17,000 patients, many different stress-inducing experiences during childhood have been linked to various forms of substance abuse and impulse control disorders.

In Hooked, a short guide to the underlying mechanics of addiction, Arwen Podesta, M.D., offers the simple formula: Biology (genetics and epigenetics) + Stress (especially trauma) + Drug = Risk of Addiction. If addiction runs in the family and people are traumatized by events in their life, the risk of developing a substance use disorder increases significantly.

Basically, the response to a traumatic event can lead to a painful emotional state which in turn can prompt three reactions: retreat (isolation, depression, anxiety), self-destructive action (substance abuse, self-harm, suicidal action), or destructive action (aggression, violence, rage).

Frequently, all three outcomes coincide. A man suffering unbearable emotional pain caused by a traumatic experience can become depressed, and engage in substance abuse, and display violent behavior. All of which will further contribute to his emotional pain, possibly escalating the drug and alcohol use and exacerbating the depression.

Unmanaged Anger

When feeling inadequate, hurt, or threatened, men all too frequently react with excessive anger, partly because they are biologically primed to do so. What served homo sapiens well in prehistoric survival situations can easily turn into pathology when caused by relentless stress in the modern world.

Repetitive outbursts of rage are a sign of dysfunction, which is acknowledged by many spiritual traditions. It is not without reason that anger is regarded as one of seven deadly sins in Christianity and considered a “mind poison” in Buddhism.

The frequent and aggressive expression of anger can turn into a dangerous habit, explains an anger management handbook published by the Substance Abuse and Mental Health Services Administration (SAMHSA):

“Anger can become a routine, familiar, and predictable response to a variety of situations. When anger is displayed frequently and aggressively, it can become a maladaptive habit. A habit, by definition, means performing behaviors automatically, over and over again, without thinking.”

Anger engages brain circuits similar to addiction, as Jean Kim, M.D. explains on

“What happens is that anger can lead to similar “rushes” as thrill-seeking activities where danger triggers dopamine reward receptors in the brain, or like other forms of addiction such as gambling, extreme sports, even drugs like cocaine and methamphetamines. Anger can become its own reward, but like other addictions, the final consequences are dangerous and real, and people follow impulses in the moment without regard to the big picture.”

Male Sexuality and Addiction

Another human behavior engaging the reward system of the brain is sexuality. Men are often socialized to think about sex purely as an act of physical intercourse with another person—with deplorable consequences. Since addiction is a biological, psychological, social, and spiritual disease, it typically has a severe impact on sexual behavior and functioning.

“Men who are addicted often struggle with the following sexual issues: sexual dysfunction caused by the use of alcohol and other drugs, shame and guilt about sexual behavior when under the influence and in sobriety, confusion about sexual identity, the effects of sexual abuse, confusion about sex and love, and concerns about being sexual when sober.” (Helping Men Recover)

In order to attain a sustained recovery from addiction, men need to learn how to cope with emotional pain without using alcohol and illicit drugs, how to manage feelings of anger and frustration appropriately, how to deal with any co-occurring behavioral issues, and how to engage in healthy romantic relationships. To deal with this spectrum of issues, North Bay’s alcohol and drug rehab offers its clients a wide variety of therapeutic modalities.

Treatment at North Bay Recovery Center

On a typical day, North Bay clients get up shortly after 7am, make breakfast, and get ready for the day. “They do a community check-in with support staff where they might read a text from AA, NA, or Refuge Recovery literature,” says Gabriel. “They could also talk about how they are feeling that morning, what they are struggling with, and whether they experience a lot of cravings at the moment.”

It’s a good litmus test to find out what’s going on before the men arrive at the center at nine weekday mornings. “They have two therapy sessions in the morning with different topics according to the schedule for the week. At noon, they go back to their Life House for lunch prepared by our chefs. After lunch, they have a little bit of downtime, and they can relax, take a nap, or read,” says Gabriel. “Three days a week they come back to the center at 2pm for another 75-minute process group.”

The morning groups at the alcohol and drug rehab center are more structured with topical themes such as relapse prevention, psychodrama, medical group, aftercare planning, and art therapy. Afternoon groups are more open. Clients can bring up any topic they want to talk about. “It could be anything from ‘I had a very difficult conversation with my wife’ or there might be disagreements within the house,” says Gabriel. “Clients can choose any topic they would like to process out and get feedback from peers and therapists.”

Holistic Health Model

Because addiction is such a complicated disease affecting so many important aspects of a person’s life, the North Bay approach to alcohol and/or drug rehab is based on a holistic health model of addiction. “We provide a wide variety of treatment options as part of a highly individualized treatment plan for each client. In order to address the physical, emotional, psychological, and spiritual aspects of the disease of addiction, we offer in-depth trauma therapy, grief-and-loss counseling, yoga, acupuncture, anger management, music therapy, and art therapy,” explains Gabriel.

“In addition, we sometimes take part in discussions at Spirit Rock, an insight meditation center in Woodacre founded by renowned Buddhist teacher Jack Kornfield. We offer nature outings, outdoors meditation groups, and mindfulness training. We also go to the beach to make land art—whatever works best for the client. North Bay Recovery Center’s alcohol and drug rehab program is in such a beautiful location and we try to maximize the benefits of that, helping men connect with nature,” says Gabriel.

North Bay recognizes the prevalent nexus between co-occurring psychiatric conditions and substance abuse disorders. Dual-diagnosis clients receive comprehensive and caring treatment for both addiction and co-occurring conditions. “A lot of men come to North Bay with addiction and mental health concerns,” says Gabriel. “Under that umbrella, we often encounter secondary addictions, and a very prevalent one among men is sex addiction. So for people struggling with that, the gender-specific environment at North Bay provides a safe space to gain some separation from the opposite sex. Secondary addictions are addressed with in-depth therapy as well.”

The Importance of Fellowships

In addition to the many therapies offered at North Bay’s alcohol and drug rehab, man may join meetings hosted by a variety of mutual-help groups. “Every day of the week, clients go to a recovery group in the community. That’s another component for them to feel plugged into the community,” explains Gabriel. “They can connect with potential sponsors or make new friends, who are also in recovery. We want to expose them to fellowships because that’s very important for their recovery. Clients can choose what meetings they would like to attend. We work with AA, NA, Refuge Recovery, and SMART Recovery. It really depends on the person or group. North Bay even offers Marijuana Anonymous meetings. We really try to accommodate each person’s individual interests while in alcohol or drug rehab.”

Spiritual Care

North Bay believes that having a strong, reliable spiritual foundation is essential to recovery. “It’s important to see each client as an individual with different needs and a different background,” says Gabriel. Many of our clients are in a spiritual quest, but many don’t necessarily have a concept of a higher power or feel attached to any particular religion, so they don’t have a spiritual practice.” It is important for men in rehab to explore their spirituality, to try find their place in the universe.

In his correspondence with Bill Wilson, the co-founder of Alcoholics Anonymous, Swiss psychologist Carl Jung wrote that “craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness."

At the San Rafael, California-based alcohol and drug rehab, "spiritual" is defined as anything that moves men in treatment closer to health in body, mind and spirit. One of the goals of rehab is to help each patient identify, and put into practice, his own, unique, personal spiritual path. “We hope to make the men in treatment curious about spirituality,” says Gabriel. “It’s typically something that’s been lacking in their life for quite some time.”

One of the challenges in helping men to reconnect to their spirituality is that they may see spirituality as “too feminine.” Again, it is their socialization that makes them more outcome oriented and more comfortable with materialistic concepts whereas recovery can be seen as a journey in which the process of discovery is as important as achieving the final goal. Connecting to a higher power and believing in something greater than oneself have helped many men who come to North Bay’s alcohol and drug rehab program overcome addiction and achieve a stable and lasting recovery.