THEY ARE NOT AT FAULT
Men’s Issues in Treatment
Mark Greenberg, M.A.
Michael’s House The Treatment Center For Men
Palm Springs, California
GOALS AND OBJECTIVES
Identify the special needs of male patients in
treatment for addiction.
Identify the main arguments in the
controversy regarding the use of medications
in the context of abstinence-based treatment.
Describe societies messages to the
Describe ten characteristics of men in the
Rarely have we seen a person fail who has thoroughly
followed our path. Those who do not recover are people
who cannot or will not completely give themselves to this
simple program, usually men and women who are
constitutionally incapable of being honest with themselves.
There are such unfortunates. THEY ARE NOT AT
FAULT; they seem to have been born that way. They are
naturally incapable of grasping and developing a manner of
living which demands rigorous honesty. Their chances are
less than average. There are those, too, who suffer from
grave emotional and mental disorders, but many of them do
recover if they have the capacity to be honest.
“To be deeply committed to
negotiations, to be opposed to a
particular war or military action, is not
only considered unpatriotic, it also casts
serious doubt on one’s manhood”
Myrian Miedzian “Boys will be Boys”
What behaviors young men consider
appropriate comes, in part, from the
lessons they learn from television and
E.g., Huesmann and Miller, 1994
“American Kids spend 24 hours a week
watching 26,000 murders on television
by the time they reach 18, maybe the
most important statistic of modern life.”
“By reflecting and magnifying our worst
aspects (television) significantly
aggravates these tendencies, especially
in children, whose values and attitudes
are in the process of being formed.”
Myriam Miedzian, “Boys Will Be Boys: Breaking
the link between Masculinity and Violence”
The amount of violence, sex, and
profanity in today’s average PG-13
rated movie approaches that of an R
rated movie in 1992.
Parents Television Council, 2002
VIOLENT VIDEO GAMES
Academic achievement was negatively related
to overall amount of time spent playing video
Exposure to a graphically violent video game
increased aggressive thoughts and behavior.
Exposure to violent video games will increase
aggressive behavior in both the short and
Craig Anderson, Department of Psychology, University of
Karen Dill, Department of Psychology, Lenoir-Rhyne
COLUMBINE HIGH SCHOOL
Harris and Klebold launched assault
murdering 13 and wounding 23 before
turning guns on themselves.
Harris and Klebold enjoyed playing the
bloody, shoot-’em-up video game
Doom, a game licensed by the U.S.
military to train soldiers to effectively
“At the age of twelve, A boy
starts imitating a man, and
he just goes on doing that
for the rest of his life.”
“THE ABSENCE OF PROFANITY WILL
OFFEND NO ONE.”
From the Desk of Bill W.
we think, is the root of our troubles.”
“Above anything, we alcoholics must be
rid of this selfishness. We must, or it
Alcoholics Anonymous pg. 62
Terminal Uniqueness must be overcome
“This short word somehow
touches about every aspect
of our lives.”
Alcoholics Anonymous pg.
“We all have sex problems.We’d
hardly be human if we didn’t.
What can we do about them?”
Alcoholics Anonymous pg. 69
PURSUIT OF BRYANT
OVERLOOKS RAPE CASE
“This week Kobe Bryant becomes a free
agent. NBA superstar Kobe Bryant. And
all through the NBA owners and general
managers and coaches are staying up all
night trying to figure out how to sign him.
They don’t care that he’s a rape suspect.
They don’t even pretend to care.”
Michael Rosenberg, Detroit Free Press
TREATMENT OF ADDICTION
AND MENTAL HEALTH
“Bodily and Mentally different from his
Alcoholics Anonymous pg. 30
“There are those too, who suffer from
grave emotional and mental disorders,
but many of them do recover if they
have the capacity to be honest.”
Alcoholics Anonymous pg. 58
MENTAL HEALTH AND
ECA Study (1990)
45% of those with alcohol disorder, 72%
of those with drug disorder had at least
one other psychiatric disorder.
78% of alcoholic men met lifetime criteria
for another psychiatric disorder.
Journal of the American Medical
37% of alcohol abusers
53% of drug abusers
Also have at least one serious mental illness
Psychiatric Disorder Increased Risk for
Substance Abuse Disorder
Antisocial personality disorder 15.5%
Manic episode 14.5%
Panic Disorder 4.3%
Major Depressive Episode 4.1%
Obsessive-compulsive disorder 3.4%
National Mental Health Association
ADDICTION AND ATTENTION
23% of patients (adolescents and adults)
with substance use disorders have ADHD.
Treatment of children with ADHD with
stimulants has a “protective effect” with
regard to development of substance use
ADHD not treated in childhood, occurrence of
substance use disorders have a 2-3 times
increase over the rest of the population.
ADHD treated in childhood have ½ the risk of
developing substance use disorders than the
rest of the population.
Wilens et al Pediatrics 2003
TREATMENT OF ADDICTION AND
MENTAL HEALTH DISORDERS
Non medication treatments of anxiety,
depression and ADHD
Psychotherapy-group and/or individual
12 Step Support Groups-AA,NA,CA, etc.
Wait 3 to 4 weeks into treatment to give
Obvious history of Mental Health Disorder preceding
substance use or during abstinence periods of at least
one month duration
Or symptoms so severe safety is a concern
– I.e. psychosis from methamphetamine
Gives them a chance to a sober life to
develop some form of spiritual guidance
“It works-it really does”
Alcoholics Anonymous, “Into Acton” page
Benefits of Long Term/Extended
1. Peer support
2. Provides a surrogate family type of support
that extends the treatment process into the
full 24 hour period each day.
3. Family of origin issues.
4. Increased time of clearing.
5. Treatment team has more time to evaluate
patients after they clear.
6. Removal from a relapse environment provides
the energy needed to recover.
THE BIG BOOK
Page 45, “Well, that’s exactly what this book
is about. Its main object is to enable you to
find a Power greater than yourself which will
solve your problem.”
Page 77, “Our real purpose is to fit ourselves
to be of maximum service to God and the
people about us.”
Page 98, “Burn the idea into the
consciousness of every man that he can get
well regardless of anyone. The only condition
is that he trust in God and clean house.”
Trust in God, Clean house, and help others
79% of Americans believe spiritual faith
can help people recover from disease
63% of Americans think physicians
should talk to patients about spiritual
ADDICTION, THE TWELEVE
Provide a framework for personal
change through spiritual principles
Provide hope for the hopeless
Can be used for more than just
A good tool for living life
“WE MAY HAVE HAD CERTAIN SPIRITUAL
BELIEFS, BUT NOW WE BEGIN TO HAVE A
“WE HAVE ENTERED THE WORLD OF THE
SPIRIT. OUR NEXT FUNCTION IS TO GROW
IN UNDERSTANDING AND EFFECTIVENESS.
THIS IS NOT AN OVERNIGHT MATTER. IT
SHOULD CONTINUE FOR A LIFETIME.”
Alcoholics Anonymous, “Into Action”