Knowing the Differences
The Center for Dependency, Addiction and Rehabilitation (CeDAR) at the University of Colorado Hospital offers gender responsive, trauma informed treatment for men and women with substance use and psychiatric disorders. Gender responsive can be defined as: creating a treatment environment through site selection, staff selection, program development, and program content and materials, that reflects an understanding of the realities of men’s lives and that addresses and responds to their challenges and strengths” (Covington, S., Griffin, D., Dauer, R., 2011).
There is accumulating evidence suggesting that gender is an important variable in addiction treatment and prevention. Studies have shown that gender differences are present in all phases of drug abuse to include initiation, escalation of use, progression to addiction, withdrawal, relapse and treatment (Carroll, M., Lynch, W., Roth, M., Morgan, A, Cogrove, K., 2004). These differences present various challenges and barriers. Therapeutic approaches at CeDAR address these specific challenges in order to ensure optimum therapeutic benefit and encourage sustained recovery.
From the emerging literature, men tend to begin substance use at a much earlier age than women (NSDUH Report, 2004). Due to earlier onset of use, the progression of the disease of addiction will yield different consequences for men who become dependent more quickly. Compared to women, men are more affected in the areas of education, work history and life goals. There is also a difference in gender experiences with the criminal justice system. Conduct problems and social deviance are more prevalent in the male gender. The rate of relapse differs and CeDAR’s clinical experience shows there are more chronic relapsing men entering treatment than women. In order to address these male specific consequences, therapeutic approaches utilized at CeDAR will focus on gender-specific cognitive, emotional and behavioral interventions, moral reasoning skills, and transition into employment and life goals.
The social-psychological development of males creates specific “man rules” that men follow consciously and unconsciously. These “rules” allow men to navigate through life and guide the way in which they interact in their relationships. Men learn “what acceptable behavior” is in order to “be a man.” For example, men are raised to ignore emotions and not express them unless it is through anger and/or aggression. Men are constantly reminded to not “be weak.” The therapeutic community is extremely important in addressing and changing these false belief systems. CeDAR provides an environment in which men can feel safe and begin to engage in the discussion of how these unspoken “man rules” have affected them and continue to affect them to date.
With the help of CeDAR clinical staff and the Family Program, interventions are used to begin building stronger bonds and help integrate the male patient into the family system. Women with addiction are more likely to be intricately involved with their children and their family and men are more likely to “abandon” their family and/or be more emotionally detached. Therapy focuses on dealing with guilt, shame and core beliefs about the male role in the family system.
CeDAR’s treatment model is congruent with practice skills, attitudes and policies that successfully work together ensuring gender responsive optimum care. CeDAR recognizes recovery is more likely to occur with culturally competent knowledge and skills compatible with the backgrounds, families and communities of the population it serves.
Through male-specific curriculum and education, CeDAR utilizes therapeutic approaches sensitive to the social construction of gender, impact of abuse, trauma, and sexuality which will ultimately strengthen the recovery process and deepen internal changes. There is a clinical focus on the social roles and cultural expectations placed on males. These expectations result in gender-specific stigma and stereotyping that may be detrimental to lasting recovery if not addressed. Treatment at CeDAR, aims at assisting the male gender with lowering defenses, becoming amenable to the therapeutic process, and improving treatment outcomes.
Becker, JB., Hu, M., (2008). Sex Differences in Drug Abuse. Frontiers in Neuroendocrinology, Vol29 (1), p 36-47.
Carroll, M., Lynch, W., Roth, M., Morgan, A, Cogrove, K., (2004). Sex and Estrogen Influence Drug Abuse. Trends Pharmacol. Sci. 25. p 273-279.
Covington, S., Griffin, D., Dauer, R., (2011). Helping Men Recover: A program for treating addiction. San Francisco, CA: Jossey-Bass
National Survey on Drug Use and Health, Data Collection Final Report, 2004