Our society needs to get more curious about how we can improve the wellness of boys and men. It’s also true that much is already known about ways to help boys and men, and this information needs to be more widely propagated and put into practice.
If the grassroots campaign for creating a state commission on boys and men succeeds, there are many ways the commission could help improve the lives of Washingtonians. One is by disseminating high-quality information about what actually works when it comes to helping our male population. For example, did you know the U.S. government published 200 pages of guidelines for addressing the specific behavioral health needs of men? And they’re really good!
The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency of the the U.S. Department of Health and Human Services. SAMHSA publishes best-practices guidelines for treating substance abuse with specific populations. These guidelines are referred to as treatment improvement protocols, they incorporate the experience and knowledge of experts with clinical, research, and administrative backgrounds.
Ten years ago SAMHSA published a treatment improvement protocol on Addressing the Specific Behavioral Health Needs of Men. We want more people to know about this high-quality advice. We wonder how many of Washington’s professionals in the fields of behavioral health and substance abuse treatment know about this treatment improvement protocol. How many of them have received training or information specifically about working with boys and men?
Gender-specific research and best practices
A doctor in Seattle, Richard K. Ries, is mentioned as one of many who have contributed their expertise to the creation of SAMHSA’s treatment improvement protocols. Dr. Ries is currently a professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine.
“This guide addresses specific treatment needs of adult men living with substance use disorders. It reviews gender-specific research and best practices, such as common patterns of substance use among men and specific treatment issues and strategies.” — TIP 56: Addressing the Specific Behavioral Health Needs of Men
If there is stronger organized advocacy for the well-being of boys and men, and if there are more people doing the work (whether inside government or outside), then promoting the implementation of the best research and expertise on helping males is a useful function the advocates should perform.
“New research in the areas of gender studies and men’s studies can help providers understand why men abuse substances and how to address masculine values in treatment.”
See related: Number of Homeless Men and Boys in King County Up 27% from 2022
What should we know about men?
The remainder of this blog post gives a taste of the content in the treatment improvement protocol on Addressing the Specific Behavioral Health Needs of Men. We copy-pasted a collection of excerpts from the executive summary of the document, which is organized into five chapters. We added bolding for emphasis.
Chapter 1: Creating the Context
Concepts of masculinity affect different men to different degrees, but no man is unaffected by them or by the ways in which proper masculine behavior is defined at a societal level. Not all effects of masculine ideologies are negative, however, and traditional masculine values can be helpful or beneficial.
In addition to explaining some of the research on masculinity, this chapter defines other key concepts, such as gender, sex, and substance use disorders. It also presents some basic information on men’s substance use and abuse in relation to that of women. Finally, it discusses the current state of the behavioral health field in regards to male-specific substance abuse treatment and what the future may hold for male-informed treatment.
Chapter 2: Screening and Assessment
Part of the process of tailoring screening and assessment to client needs is being aware of how a man’s beliefs and concerns about his identity as a man affect how he responds to screening and assessment questions and procedures. By doing so, clinicians will be better able to engage men in this process.
Men are often ambivalent about seeking help for health problems (whether related to behavioral or physical health), and clinicians should acknowledge and possibly discuss this ambivalence with the client before assessment commences. Furthermore, many men are typically embarrassed or reluctant to talk about feelings. Providers can acknowledge this difficulty and work with clients to make the process less threatening. Because men are often action-oriented and focused on the concrete, it is helpful to present specific goals in the assessment process and sometimes to use visual representations of their problems and past experiences.
Chapter 3: Treatment Issues
There are pros and cons of having either male or female counselors working with male clients. Because the majority of substance abuse treatment clients are male but most counselors are female, the chapter also includes some ideas about recruiting male counselors.
Although providers may be aware of the possibility that men may commit violent acts, they are less likely to consider that men are often victims of violence as well. Clinicians often do not look for — and men are rarely forthcoming about — histories of childhood physical or sexual abuse or current victimization by domestic partners, and yet these are factors that can have a strong negative effect on treatment.
Behavioral health service providers have become more aware in recent years of the importance of parenting and child custody for women entering treatment, and they have responded with the creation of programs that work with mothers and their children together. Children and other family members can also play an important role in encouraging men to enter treatment, and fears about losing custody of children can inhibit treatment entry. Men’s substance abuse can have lasting effects on their children as well as themselves, and behavioral health services provide an opportunity to improve their parenting skills that many men will gladly take. This chapter provides guidance to clinicians who want to address parenting in treatment programs for men. Reproductive responsibility, child support, and family court involvement are also discussed.
A holistic approach to treatment involves addressing men’s spiritual and/or religious beliefs. Despite conflicting views among researchers and other professionals in the field about the link between spirituality and health, the consensus panel believes that spiritual beliefs and/or practices do influence some men’s desire to abstain from using substances. Alcoholics Anonymous and Narcotics Anonymous are 12-Step organizations that use participants’ reliance on a higher power to aid in the recovery process. These and similar groups have helped many individuals, both men and women, make tremendous progress on their road to recovery.
Chapter 4: Working With Specific Populations of Men in Behavioral Health Settings
Men typically begin using substances at a younger age than women do, and this appears to be a major factor in greater rates of substance use disorders among adult men than among women. Boys and young men may also turn to substance use/abuse for different reasons than girls and young women do. For example, early use of substances by men may be attributable to the fact that they are not adept at addressing emotional pain constructively. A man’s family background, sexual orientation, and cultural/ethnic identities may also affect his choice of substances and the possibility that he will develop a substance use disorder.
Men are less likely to have a serious mental illness than women are, but men make up the majority of adults with co-occurring substance use and other mental disorders in behavioral health settings. This chapter considers rates of different co-occurring mental disorders among men and discusses how the course and presentation of different disorders may differ between the sexes.
This chapter covers special treatment needs of young men (ages 18 to 24) and older adult men (ages 65 and older). Also, research suggests that patterns of substance use/abuse for gay and bisexual men may differ from those of heterosexual men; a discussion of the treatment needs of gay and bisexual men is included.
Employment has been shown to be especially important for men’s success in recovery, and substance abuse is considerably higher among men who are unemployed.
The specific needs of male veterans are addressed.
The criminal justice system is the largest single source of referrals to substance abuse treatment for men, and many other men receive treatment while incarcerated in jails or prisons. It is essential that behavioral health counselors understand the criminal justice system and how to interact with it appropriately.
Homelessness has been associated with substance use disorders and co-occurring disorders among men. Men make up about four-fifths of homeless individuals in substance abuse treatment, but many programs cannot meet their particular needs. This chapter discusses ways programs can improve treatment outcomes for this group of men.
See related: Seattle psychologist Valerie Tarico reviews new online course about male psychology and mental health
Chapter 5: Treatment Modalities and Settings
This chapter covers men’s treatment needs in the context of different modalities (e.g., group therapy, individual therapy, family therapy) and settings (e.g., outpatient, inpatient) and some of the specific types of services that maybe used by programs treating men (e.g., enhancing motivation, money management).
Men tend to be more reticent in group settings than women and less willing to attend such sessions, which can account for somewhat better treatment outcomes for female clients. Providers should try to increase men’s participation in groups. There are both benefits and potential problems involved in male-specific groups, and the chapter discusses some of these considerations.
Family and significant others often play an important role in motivating men to enter treatment. Once in recovery, men appear to stay with their partners more often than women who enter recovery. Couples and family therapy can therefore be important options for men in treatment.
This chapter presents information on common treatment strategies (e.g., motivational enhancement, relapse prevention) and how they may be adapted for use with a specifically male clientele. Men often relapse for different reasons than women; relapse prevention techniques may need to take those differences into account.