A Guide to Addiction and Recovery for Men
Men are more likely than women to develop addiction, with some estimates showing men’s rates nearly twice that of women.1 Commonly abused substances among men include alcohol, marijuana, and heroin. Reasons for use may include trauma, abuse, mental health disorders, or chronic pain. Left untreated, addiction can lead to damaged relationships, loss of employment, health problems, and even death.
Some rehab programs place additional focus on issues commonly seen in men, such as anger management and war-related PTSD.
Which Drugs Do Men Typically Abuse?
Men are more likely to use almost all types of illicit drugs than women.3 Street drug use and misused prescription medications are more likely to lead men to visit the emergency room or fatally overdose than women.3
Drugs that men typically abuse include:
- Alcohol. Men report rates of alcohol use nearly twice that of women, and alcohol is the most common drug of choice reported by men seeking treatment.1,2,3 Approximately 20% of adult males abuse alcohol.2
- Marijuana. Men commonly report abusing marijuana, with nearly 20% of the male population seeking treatment reporting marijuana as their primary substance of abuse.1 Marijuana use in males is correlated with more severe addiction, increased risk of mental health disorders, other substance use issues, and personality disorders.3,5
- Heroin. Among men who seek treatment for addiction, 15% report using heroin, and they are more likely to use larger amounts, use heroin intravenously, and use for longer periods than women.1,3
- Prescription drugs. Nearly 8% of men seeking treatment for addiction report abusing prescription painkillers.1 Men are less likely to seek treatment for misuse of prescription drugs than women, especially in the over 65 age group.1 In 2014, 5 million men reported misusing prescription painkillers within the last year versus 4 million women.5
- GHB. GHB can decrease inhibitions, which may contribute to unsafe sex practices and an increased risk of contracting HIV and other sexually transmitted diseases.6
- Amphetamines. Gay or bisexual men are more likely to use methamphetamine, which raises the likelihood of contracting or passing on HIV or other sexually transmitted infections through risky sexual behavior or shared needles. American males over the age of 25 use amphetamines or methamphetamine at similar rates to women.1,14
- Steroids. Men are twice as likely to use synthetic testosterone to build muscle, improve performance in sports competitions, lower body fat, and increase endurance.11 In 2004, over 1 million Americans reported using steroids, including high school students.11
Why Do They Abuse Drugs?
Men abuse drugs for a variety of reasons, and a number of risk factors can predispose them to developing a substance use disorder. These can include:
- Combat-related trauma: Substance use among men in the military is increasing, especially alcohol. Men who have been exposed to combat and deployed more than once are at a higher risk of developing a drug or alcohol problem.12 Substance use brought on by military trauma can be due to injuries sustained in warfare, the stress of multiple deployments, and the development of posttraumatic stress disorder (PTSD). In 2008 alone, nearly half of all soldiers engaged in binge drinking, with higher rates seen in those with more exposure to war.12
- Physical, emotional, or sexual abuse: Exposure to trauma during childhood is a strong risk factor for the development of a substance use disorder. Teenagers who have been physically or sexually abused are 3 times more likely to misuse or become addicted to substances.13 The severity of addiction, especially to cocaine, is strongly linked to the amount of childhood abuse.13 For some gay or bisexual men, experiencing discrimination, homophobia, or aggression because of their sexual orientation can lead to the development of a substance use disorder.14
- Mental health disorders: Males with a mental health disorder, especially those with a diagnosis of PTSD or other severe mental illness, are more likely to also experience a co-occurring substance use disorder.13,15
- Chronic pain: This type of pain is often treated with prescription opioid painkillers, and men are more likely to misuse prescribed pain medication.5 Opioid painkillers can cause physical dependence, and in some, can lead to the development of a substance use disorder.
- Work-related stress: Stress related to employment can increase the likelihood of men developing a substance use disorder. Men may use alcohol or drugs to cope with stress or unwind either before, during, or after work. Chronic stress can also cause changes in the brain that increase the risk of addiction and increase sensitivity to cravings and compulsive behaviors.17
What Are Some Signs of Drug or Alcohol Abuse?
Some general symptoms of addiction have been identified, and they can vary depending on the substance(s) being used. Warning signs of addiction in men include:16
- Continued use of alcohol or drugs after it has caused or worsened physical or mental health issues.
- Continuing to use alcohol or drugs even when it causes an inability to perform important tasks at work, home, or school.
- Developing tolerance, which means more of the substance must be taken to achieve the desired effect.
- Experiencing overwhelming cravings for alcohol or drugs.
- Going through withdrawal when substances are stopped or reduced dramatically.
- Quitting or cutting back on recreational, social, or work-related activities that interfere with substance use.
- Repeated use of alcohol or drugs in situations that can be physically dangerous, such as while driving.
- Spending large amounts of time getting, using, or recovering from substance use.
- Unsuccessful attempts or a strong desire to cut back or stop using.
- Using more of a substance or for a longer period than planned.
Specific substances have physical symptoms that can be observed when the person is under the influence or abusing the drug. These can include:
- Lack of coordination, slurring, smell of alcohol, or an unsteady gait when drinking.16
- Dry mouth, increase in appetite, and red eyes when using marijuana.16
- Drowsiness (“nodding off”), slurring, or tiny “pinpoint” pupils when using opioids such as heroin or opiate painkillers.16
- Chills, dilated pupils, drastic increase in energy, sweating, or weight loss with amphetamine use.16
- Acne, aggression, decreased libido, enlargement of the breasts, hair loss, irritability, mood swings, and shrinking of the testicles with steroid use.11
What Are Some Other Conditions That Addicted Men Suffer From?
Men are more likely to report co-occurring mental health and substance use disorders than women.3 The symptoms of both conditions can be worse, last longer, and be more difficult to treat than either condition alone. Common mental health disorders seen in men abusing drugs or alcohol include the following:
- Mood disorders, such as bipolar disorder or depression, can predispose men to addiction, especially to alcohol, marijuana, and opiates.16 This addiction can be brought about from efforts to self-medicate or just to feel better.
- PTSD is strongly linked to misuse and addiction to marijuana, stimulants, and opioids.16
- Anxiety disorders can be a risk factor for the development of an addiction to alcohol and marijuana.16 In turn, use of marijuana can exacerbate anxiety among some men.16
- Schizophrenia or other psychotic disorders are more common among men with substance use disorders, especially alcoholism.16 Mental health symptoms often predate the addiction, but can be worsened by the effects of alcohol or drugs.15,16 Substance use may be an effort to relieve the symptoms of the mental illness.
- A personality disorder, such as antisocial personality disorder, is a risk factor for the development of alcohol, marijuana, and stimulant use disorders.3,5,16 An addiction to marijuana is commonly seen among those with paranoid or obsessive-compulsive personality disorders as well.16
- Attention-deficit hyperactivity disorder (ADHD) often occurs in conjunction with addictions to marijuana or stimulants, such as cocaine or amphetamines.16 Since amphetamines are generally prescribed to treat ADHD, abuse of illicit stimulant drugs may be the result of efforts to self-medicate.
- Gambling addiction is often seen with alcohol or stimulant addiction.16 An addiction to gambling may resemble a substance use disorder, as the person displays similar signs and symptoms.
- Sex addiction may occur alongside substance use disorders when the drug taken decreases inhibition, impairs judgment, and raises libido, which is sometimes the case with alcohol, cocaine, GHB, and amphetamines. Sex addiction is also related to difficulty with impulse control, which is highly correlated with all substance use disorders.16
How Is Substance Abuse Treated in This Group?
Substance use disorders are treated using a variety of therapeutic techniques.
- Individual and group counseling are frequently used in substance use treatment. Individual therapy allows patients to explore factors that contributed to their addiction, and they have privacy to discuss topics that may be uncomfortable to address in a group. Group therapy provides a forum where individuals at varying stages of recovery can provide support and feedback to one another, helping members get through difficult situations and celebrating large and small successes in recovery.
- Twelve-step treatment techniques involve a spiritual foundation and the understanding that addiction is a chronic, progressive disease that cannot be overcome solely on willpower. This type of technique involves surrendering and accepting support from peers and a higher power.
- Medication-assisted treatment uses prescribed medications to help manage withdrawal, reduce cravings, and support abstinence. For opioid addiction, medications can include methadone and buprenorphine to ease symptoms of withdrawal and prevent relapse, and naltrexone to prevent relapse. For alcohol, Antabuse (disulfiram) can be used to maintain sobriety, as it makes individuals experience a violent and unpleasant reaction to alcohol. Naltrexone can be used to block the pleasurable effects of alcohol, and Campral (acamprosate) can help rebalance brain chemicals in people recovering from alcohol abuse. Medications work best when paired with behavioral therapies.
- CBT, or cognitive behavioral therapy, is a highly effective technique for treating substance use disorders, especially alcohol, marijuana, cocaine, and amphetamines.18 Some aspects of CBT include looking at the pros and cons of continued drug use, monitoring thought patterns to identify cravings before they are overwhelming, identifying and avoiding risky situations, and practicing effective relapse prevention skills.
- DBT (dialectical behavior therapy) was initially developed to prevent suicidal behaviors in individuals with severe mental illness. But it has been adapted to treat individuals with substance use disorders and co-occurring mental illness. DBT skills involve a focus on change and acceptance, and the therapy occurs in a group format, along with individual sessions, both in person and on the telephone. For substance use treatment, there is an emphasis on harm-reduction techniques.
- Motivational interviewing is a technique that helps individuals with addictions to become willing to stay in treatment and change their behaviors. Practitioners assist patients in identifying the pros and cons of recovery and enhance their motivation to change.
- Therapies specific for PTSD include cognitive processing therapy (CPT) and prolonged exposure (PE). CPT helps patients manage intrusive thoughts, while PE lets them re-experience the trauma in a safe environment. In order to be most effective, both the PTSD and the substance abuse should be treated at the same time. Medications can be used to manage symptoms of PTSD, withdrawal, and cravings, and they should ideally be paired with behavioral treatments.
In general, the treatment process begins with detox, then transitions to formal counseling, learning skills focused on relapse prevention, and medication as needed.
Although rehab for men and women is often similar, some men may have specific treatment needs. These can include:
- Learning how to manage and express anger appropriately.
- Dealing with trauma.
- Using family or couples therapy to mend strained relationships.
- Managing and treating co-occurring disorders.
- Receiving vocational or educational support.
Some facilities or practitioners may incorporate holistic techniques to supplement counseling. These can include spiritual practices, such as meditation, or physical activities, such as working out, yoga, or outdoor activities.
What Types of Programs Are Available?
Recovery programs for men can include:
- Detoxification. This form of treatment takes place in a safe, medically supervised facility where symptoms of withdrawal can be managed, and support and monitoring is provided around the clock to identify and treat any potential complications.
- Inpatient rehab. This is a residential form of treatment, where men live at the facility for the duration of treatment, which generally lasts from 1-3 months. Staff are available around the clock for treatment and support, and therapy is provided through intensive individual and group sessions, along with psychiatric or medical care as needed.
- Luxury inpatient treatment. These facilities are more expensive. But the additional cost includes posh amenities, more individualized treatment, and cutting-edge therapies that may not be available at traditional inpatient facilities, such as animal-assisted and spa treatments.
- Executive inpatient rehab. At this type of program, businessmen have access to telephones and computers so that they can stay in touch with their companies while receiving high-quality treatment.
- Outpatient rehab. This form of treatment allows people to live at home and participate in daily routines while receiving treatment several times a week in both group and individual sessions. They also receive medication-assisted treatment to help manage cravings or co-occurring mental health disorders.
- Specialized treatment programs. These programs treat sub-populations with specific needs, such as LGBT clients, veterans, or adolescents. Being around peers can make it easier and more comfortable to discuss sensitive topics.
Many men seek treatment for addiction. In 2011, nearly 67% of the 1.8 million people who sought treatment were male.1 Still, many men might be reluctant to reach out for help. Knowledge of programs geared specifically toward them could increase the number of men who seek treatment.
How Much Is Rehab, and How Do You Pay?
The cost of rehab can vary depending on various factors, such as the location, type of facility, length of stay, and whether or not the person has insurance.
- State- or county-funded facilities may be less expensive, while luxury or executive treatment facilities are pricier.
- Inpatient treatment is more expensive than outpatient treatment, since 24-hour care, more intensive group and individual sessions, housing, and meals are all included in the cost.
- The longer the stay, the higher the cost of treatment.
Detox facilities can cost $600-$1,00 per day, and the length of stay depends on how long it takes for the substance to clear a person’s body. For a 30-day inpatient stay, the cost can range from $400 to $900 per day, depending on the type of facility. Outpatient treatment can cost between $100 to $500 per treatment session.22
Most insurance plans include some sort of substance use treatment coverage, which can cover most or all of the cost of treatment. Those without insurance may be able to obtain state-funded insurance to help pay for treatment.
Most facilities will work with patients to develop a payment plan if necessary, or offer financial assistance. For some people, borrowing from friends and family or using crowdfunding sites such as GoFundMe can help pay for treatment. Loans, standard credit cards, health care credit cards, or flexible spending accounts (FSAs) can also help people afford rehab.
What Happens After Rehab?
Men leaving treatment will have to re-learn skills, such as how to live without using alcohol or drugs. They may need to find housing that is stable and supportive of recovery, change groups of friends, find or change jobs, and learn to adjust to a change in family dynamics.
Many rehab centers help men develop an aftercare plan from the beginning of treatment. Aftercare is individualized to help patients remain sober, and it can include outpatient treatment, private therapy, 12-step meetings, and/or sober living options. Sober living and long-term residential treatment provide structure and monitoring, and teach men how to be accountable for their actions as they slowly learn how to readjust to society while sober.
The resources below can help men find the right treatment, get support, and maintain sobriety.
- Alcoholics Anonymous. This website provides information about AA, assistance in locating a meeting, and literature about the fellowship and the 12 steps.
- Narcotics Anonymous. NA is another fellowship welcoming individuals in recovery (or wishing to get clean) from any and all substances. Information, meeting lists, and literature are available through this site.
- Dual Recovery Anonymous. DRA is a 12-step fellowship for those who struggle or are in recovery from substance use and a mental health disorder.
- SMART Recovery. This is a non-spiritual, research-based fellowship that relies on proven therapeutic techniques to help members stay sober.
- The Linehan Institute. This website provides information about DBT and how to find a treatment provider who is trained in this specific technique.
- The National Suicide Prevention Lifeline. Individuals with addictions, especially when combined with a mental illness, may feel hopeless and ready to give up. This website provides a 24/7 hotline, along with an online chat with a trained operator who can help one get through a crisis.
- Substance Abuse and Mental Health Services Administration. (2014). Gender differences in primary substances of abuse across age groups.
- Becker, J.B., and Hu, M. (2008). Sex differences in drug abuse. Frontiers in Neuroendocrinology, 29(1), 36-47.
- National Institute on Drug Abuse. (2016). Substance use in women.
- National Institute on Drug Abuse. (2016). Gender difference in prevalence of drug abuse traced to opportunities to use.
- National Institute on Drug Abuse. (2016). Substance use in women and men.
- New York University. (2017). Substances – GHB.
- National Institute on Drug Abuse. (2016). MDMA (ecstasy/molly).
- United Nations Office on Drugs and Crime. (2017). General prevalence – “Ecstasy”-type substances.
- Drug Enforcement Administration. (2015). Drugs of abuse.
- United Nations Office on Drugs and Crime. (2017). Prevalence of use of ketamine in the general and youth population (per cent).
- U.S. Department of Justice. (2004). Steroid abuse in today’s society.
- National Institute on Drug Abuse. (2013). Substance abuse in the military.
- Khoury, L., Tang, Y.L., Bradley, B., Cubelis, J.F., and Ressler, K.J. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depression and Anxiety, 27(12), 1077-1086.
- Centers for Disease Control and Prevention. (2016). Substance use.
- Mangrum, L.F., Spence, R.T., and Steinley-Bumgarner, M.D. (2006). Gender differences in substance-abuse treatment clients with co-occurring psychiatric and substance-use disorders. Brief Treatment and Crisis Intervention, 6, 255-267.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. P490-497, 509-516, 523-527, 541-548, 561-567, 585-589.
- Sinha, R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105-130.
- National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: a research-based guide (3rd edition).
- Dimeff, L.A., and Linehan, M.M. (2008). Dialectical behavior therapy for substance abusers. Addiction Science and Clinical Practice, 4(2), 39-47.
- U.S. Department of Veterans Affairs. PTSD and substance abuse in veterans.
- Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45, HHS Publication No. (SMA) 15-4131, Rockville, MD.
- American Addiction Centers. (2017).