Most of what makes treatment harder for men happens before anyone walks through a door. The federal treatment protocol written on this subject says plainly that men are generally ambivalent about seeking help for behavioral health problems [1]. That ambivalence is the thing this page is about.
Start with what this page can and cannot settle. Whether a particular campus is running a men’s group on the week you would be admitted is an admissions question, and the assessment call is where it gets answered. What can be said here is what the campus this page routes to publishes: The Ranch Tennessee in Dickson, Tennessee runs medical detox, residential and inpatient care, inpatient rehab for mental health, a partial hospitalization program, an intensive outpatient program and aftercare planning. The clinical approaches described below come from SAMHSA’s protocol on the behavioral health needs of men [1], which shapes how clinicians work rather than which door you walk through.
What follows is drawn from that protocol rather than from assumptions about how men behave. It covers what clinicians are trained to expect at a first appointment, what shame does in a room, what anger work and emotional literacy work actually mean, how time away from work gets handled, and what the medical side of an assessment looks for. It is written for a man deciding whether to make a call, and for the person who is trying to get him to make one.
Our page on addiction treatment sets out the general ladder of care. This one is about the parts of it that land differently.
Why asking for help is harder for men
The reason is not that the problem is smaller. It is that asking is itself the thing being avoided.
SAMHSA’s protocol on the behavioral health needs of men puts it directly: men are generally ambivalent about seeking help for behavioral health problems [1]. It also tells clinicians that certain male clients feel threatened by or uncomfortable with the help-seeking process [1]. That is not a complaint about men. It is an instruction to the people running the appointment.
It changes how a good first meeting is run. The protocol advises clinicians to spend time initially talking with a client about neutral topics, such as his work or hobbies, before beginning screening and assessment [1]. It suggests two questions as the way in: “Why are you here now?” and “For help with what problem?” [1]. If a first appointment opens with small talk about your job rather than a questionnaire, that is a clinician following the protocol, not one avoiding the subject.
Our page on careers and groups most affected by addiction covers who is most exposed, which is a different question from who asks for help.
Shame, help-seeking and how programs work with it
Shame is the mechanism, and the protocol names it precisely. Strong feelings of shame and inadequacy may arise whenever a male client consciously or subconsciously perceives that he is not living up to socially defined norms of male behavior, such as not asking for help and not being emotionally vulnerable [1].
Read that carefully, because it is a trap with two jaws. The norm says do not ask for help. Asking for help therefore breaks the norm. And breaking the norm produces the shame that makes asking harder next time.
Programs work with this rather than around it. The protocol advises avoiding competitive exchanges, comments or questions that might provoke shame [1]. It notes that in some settings, talking while walking can decrease the intensity of direct eye contact and allow a client to dissipate excess energy, which may help make some men more comfortable during initial sessions [1]. A clinician is also told to carefully monitor the emotional intensity of initial interactions, because men may be particularly uncomfortable with emotional expression early in treatment [1].
None of that is softness. It is the difference between a man who comes back for a second session and one who does not.
Anger, trauma and emotional literacy work
Emotional literacy work is not about producing feelings on demand. It is about being able to tell one feeling from another, which is a skill and can be absent.
The protocol describes a range of deficits here. They run from a profound absence of any emotion, sometimes called alexithymia or being emotionally frozen, to a more common difficulty in recognizing and expressing specific emotions such as anger, sadness or shame [1]. It notes that difficulty handling emotions is sometimes a symptom of a mental health condition and sometimes the result of transient or chronic stress [1], which is why this is assessed rather than assumed.
Anger gets its own treatment planning. The protocol tells clinicians to consider approaches found effective with men, or with men who have particular characteristics such as a high degree of anger [1], and it sets out anger management counseling techniques as a named intervention [1]. Anger is treated as a presenting problem with methods attached, not as a personality to be tolerated.
Our page on counseling approaches used in treatment describes the therapies these techniques sit inside.
Work, provider identity and taking time away
The conflict here is between two norms, not between treatment and a job.
The protocol says so in as many words: a clinician can highlight the ways adherence to traditional norms about help-seeking behavior may conflict with or undermine other gender norms about being gainfully employed, a good husband and a good father [1]. Staying at work and staying unwell are not actually the same choice, and naming that out loud is part of the clinical work.
The practical side has a federal answer. The Family and Medical Leave Act allows eligible employees of a covered employer to take job-protected, unpaid leave, or to substitute accrued paid leave, for up to a total of 12 workweeks in any 12 months, including where the employee’s own serious health condition makes them unable to perform the functions of the job [2]. An employee generally has a right to return to the same position or an equivalent one, and an employer may require certification to substantiate the leave [2]. Whether your own employment falls inside that, and what your contract adds, is a question for a lawyer rather than for this page.
One thing belongs here rather than later, because it is what men try instead of taking leave. Stopping heavy drinking alone, quietly, over a weekend, is the version that carries medical risk. SAMHSA’s consensus panel writes that delirium and seizures are the two most pathologic responses seen in alcohol withdrawal, and that the major goal of medical management is to avoid seizures and a special state of delirium called delirium tremens [4]. The same chapter carries the other half of that asymmetry: unlike alcohol and sedative withdrawal, uncomplicated opioid withdrawal is not life-threatening [4].
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988.
Starting an assessment at our Tennessee campus
The Ranch Tennessee is in Dickson, Tennessee, and runs medical detox, residential and inpatient care, inpatient rehab for mental health, a partial hospitalization program, an intensive outpatient program and aftercare planning. The campus describes a full continuum of care for drug and alcohol addiction, and because those tiers sit on one campus, a step down in level of care happens in the same place.
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The Ranch Tennessee is part of our family of treatment centers. See the Ranch Tennessee campus.
Group work with men, and what changes in it
A group is where most of the work happens, and the protocol’s guidance about shame applies hardest there.
The advice to avoid competitive exchanges, comments or questions that might provoke shame [1] is a rule about group rooms as much as about one-to-one sessions. A group of men can turn into a ranking very quickly, and a group that has become a ranking has stopped being treatment. What a skilled facilitator is doing, much of the time, is keeping that from happening.
The protocol also treats the clinician’s own reactions as part of the equipment rather than as noise. It tells male counselors that one of the most important things they can do is address countertransference reactions in clinical supervision and consider them in their own practice [1]. It adds that a male counselor’s own experience of being vulnerable with a clinical supervisor may be used to better understand clients’ feelings [1]. Someone in the room demonstrating that a strong feeling can be said out loud and survived is, for a lot of men, the new information.
Whether a particular campus is running a group of a particular shape on the week you would be admitted is a question for admissions rather than for a web page. Ask it directly on the call.
Fatherhood and family repair
Repair is taught as a skill here, which is a more useful frame than treating it as something that either happens or does not.
The protocol is explicit that many men with substance use disorders need to learn nurturing skills in their roles as husbands and fathers, and that counselors can teach and model affirming, caring, nurturing, forgiving and patient behavior [1]. It adds that emotional vulnerability is critical if men are to be nurturing, loving and caring husbands and fathers [1]. The emotional literacy work two sections up is not a detour from family repair. It is the thing that makes family repair possible.
Family involvement is also built into the clinical process from the start. SAMHSA’s detoxification protocol describes practitioners seeking the involvement of a patient’s family, employers and other significant people when appropriate and with release of confidentiality [3]. The condition at the end of that sentence matters: involvement happens with your authorization, not around you.
Physical health and the medical work-up
The medical side of an assessment is looking for things a man may not connect to his substance use at all.
The protocol covers several. It records that methadone decreases the amount of sperm ejaculated [1]. It says many men are not aware and should be informed that marijuana use has also been associated with increased rates of a number of male-specific cancers, including prostate, testicular and penile cancer, as well as a range of other health problems [1]. That sentence carries its own hedge — associated with — and it keeps it here.
Withdrawal is the part that has to be managed rather than endured, for the reason given further up this page. That is why medical detox is a level of care with medical staff in it rather than a week of willpower, and it is worth asking at assessment what medical cover a campus has on the unit overnight.
Where that care happens runs on a published ladder. The detoxification protocol’s placement chapter sets out five adult detoxification levels of care, from ambulatory detoxification without extended onsite monitoring through to medically managed intensive inpatient detoxification [5]. Our page on levels of care sets out the main ASAM levels of treatment, which is the ladder a detox stay steps onto rather than the detox ladder itself.
Aftercare that holds
Aftercare is not the optional part, and the protocol treats the handover as a clinical task in itself.
SAMHSA’s consensus panel is blunt that detoxification is not substance abuse treatment and rehabilitation [3]. It describes detoxification as three components — evaluation, stabilization, and fostering the patient’s entry into treatment [3] — and defines that third component as preparing the patient for entry into treatment by stressing the importance of following through with the complete continuum of care [3].
For a man who has just spent a week proving he can get through withdrawal, that is the sentence to sit with. Getting through withdrawal is the evidence that the hard part is survivable, not the evidence that it is finished. Our pages on inpatient rehab and outpatient rehab cover what the tiers after detox involve, including the ones people do while still working.
There is a specific reason the days straight after detox are the dangerous ones. Withdrawal reduces the person’s tolerance to the medicine, so someone who has just gone through it can overdose on a much smaller dose than they used to take [7]. MedlinePlus puts the other half of it as plainly: most people need long-term treatment after detox [7].
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988.
Ask, on the admissions call, when discharge planning starts. On a well-run stay the answer is early.
Frequently Asked Questions
Why is asking for help harder for men? Because asking is itself the thing being avoided. SAMHSA’s protocol on the behavioral health needs of men states that men are generally ambivalent about seeking help for behavioral health problems, and that certain male clients feel threatened by or uncomfortable with the help-seeking process. It also names the mechanism. Strong feelings of shame and inadequacy may arise whenever a male client perceives that he is not living up to socially defined norms of male behavior, such as not asking for help and not being emotionally vulnerable. The norm and the remedy are in direct conflict, which is why a good first appointment is run the way it is.
Will my employer or licensing body be told? Leave and disclosure are separate questions. On leave, the Family and Medical Leave Act gives eligible employees of a covered employer up to 12 workweeks of job-protected, unpaid leave in any 12 months, with a general right to return to the same or an equivalent position, and an employer may require certification. On disclosure, a treatment program seeks the involvement of employers only with a release of confidentiality. What your own contract or license adds is a question for a lawyer.
What is anger management counseling in rehab? It is a named intervention rather than a general attitude. The protocol tells clinicians to consider approaches found effective with men, or with men who have particular characteristics such as a high degree of anger, and it sets out anger management counseling techniques among those approaches. It sits alongside emotional literacy work, because the protocol describes deficits running from a profound absence of any emotion, sometimes called alexithymia, to a more common difficulty in recognizing and expressing specific emotions such as anger, sadness or shame. Anger is treated as a presenting problem with methods attached.
Do Marketplace plans have to cover rehab? Marketplace plans have to. Mental health and substance use disorder services are essential health benefits, which covers behavioral health treatment such as psychotherapy and counseling, and mental and behavioral health inpatient services. An employer plan is a separate contract with its own network and its own rules, so a specific answer comes from verifying your own policy rather than from a general one.
What happens in the first appointment? Expect it to open with something ordinary rather than a questionnaire. The protocol advises clinicians to spend time initially talking with a client about neutral topics, such as his work or hobbies, before beginning screening and assessment, and it suggests two questions as the way in: “Why are you here now?” and “For help with what problem?”. One call is enough to start it, and it ends without a commitment if you want it to. Have your insurance card nearby. If you are in crisis rather than planning, call or text 988.
Sources
- Substance Abuse and Mental Health Services Administration. (2013). Chapter 3: Treatment Issues for Men. Treatment Improvement Protocol (TIP) Series, No. 56. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK144290/
- Legal Information Institute. 29 CFR § 825.100 — The Family and Medical Leave Act. Cornell Law School. https://www.law.cornell.edu/cfr/text/29/825.100
- Center for Substance Abuse Treatment. (2006). Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. Detoxification and Substance Abuse Treatment, TIP Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64119/
- Center for Substance Abuse Treatment. (2006). Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances. Detoxification and Substance Abuse Treatment, TIP Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
- Center for Substance Abuse Treatment. (2006). Chapter 2: Settings, Levels of Care, and Patient Placement. Detoxification and Substance Abuse Treatment, TIP Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64109/
- Centers for Medicare & Medicaid Services. Mental Health and Substance Abuse Health Coverage Options. HealthCare.gov. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
- National Library of Medicine. Opiate and Opioid Withdrawal. MedlinePlus Medical Encyclopedia, National Institutes of Health. https://medlineplus.gov/ency/article/000949.htm
This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.
Author
Chief Medical Officer,
The Recovery Village
