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Visions Journal

Jim Cullen, PhD

Reprinted from "Men's" issue of Visions Journal, 2005, 2 (5), p. 13-14

Beginning to See the Light

Almost 70% of men who develop alcohol and drug problems also have a history of sexual abuse.1 Until recently, however, little attention was paid to the relationship between sexual abuse and addiction among men.

The majority of investigation and practice discussion has revolved around the concerns of women as survivors of sexual abuse. This oversight has begun to be addressed through more rigorous study of this dual occurrence in men—though no recent major Canadian research has been initiated to address the problem.

The current research raises questions of how men’s issues of addiction and sexual abuse are being addressed in the practice setting, including how addiction counsellors normalize and validate these experiences in a way that supports and allows men to be comfortable in disclosure. Consequently, service providers are beginning to confront these issues in their practices.

From the Research Literature

Sexual abuse histories are highly correlated with addiction among men,2-4 and more specifically, among youth of both genders.5 Furthermore, those men and youth who develop substance abuse problems and have a history of sexual abuse exhibit more extreme alcohol and drug use than the female counterparts.

Despite differences in the reporting of sexual abuse and addiction problems according to gender, the effect of abuse on treatment outcomes for both genders is similar.6 Outcome research highlights that if men receive addiction treatment that addresses their sexual abuse history, they too can benefit from treatment provision.6 Historically, however, men are more apt not to report histories of sexual abuse than their female counterparts and thus are overlooked in terms of treatment interventions that would address sexual abuse and addiction problems.

Narrative From the Field

When I was managing an addiction treatment program, I suspected that many of the men we were serving did not disclose that they were struggling with sexual abuse histories and using substances as a coping method. This suspicion was based on conversations with certain male clients, and reading the limited amount of pertinent research available.

After consulting with staff and clients, as well as the Ministry of Health who funded our program, our agency decided to alter the way we explored trauma histories in assessments of the people we served. While the Ministry of Health standardized assessment included sections on trauma history and on transgender identity as distinct from the binary male and female, the questions were often asked without relevance to the individual’s stated gender. Furthermore, there were no consistent guidelines on how to incorporate normalization and validation, as well as gender sensitivity, into the assessment process.

Given that research indicated men were less likely to disclose abuse, or to make the link between sexual abuse and addiction, a simple gender-sensitive assessment approach was developed. Counsellors were encouraged—in their own style and words—to specifically, but briefly, outline in the trauma section the following points, using the appropriate client-identified, gender-specific term:

 

 

 

  1. Men/women/transgender people often do not report sexual abuse histories due to shame and social stigma.

  2. Many men/women/transgender people who struggle with addiction often struggle with histories of sexual abuse.

  3. We as an agency often work with men/women/transgender people who struggle with these issues.

Over the course of one year, in 2000, individual assessment data, case notes and progress reports were analyzed to see if there was a marked difference in disclosures after the new assessment guidelines had been instituted. We found that sexual abuse disclosures increased by 35% among men, 5% among women and remained the same for transgender people.

The effect on the disclosure rate in men was dramatic. I suspect that, although disclosure was difficult for women and transgender people in our program, those groups are generally more likely to disclose; however, research with these populations also needs to be conducted.

Disclosures did not primarily occur during the assessment phase of treatment, but later, after the counselling relationship had been established. Follow-up with individual clients indicated that many of them felt more comfortable in disclosing their history because the issue had been “named” for them as men.

More Recognition and Research Needed

More research needs to be conducted into the relationship between sexual abuse and addiction among men. Research also needs to be developed to include the identities of transgender people. Studies which assist in the development of practice guidelines concerning this issue are sorely needed.

While I have highlighted only one practice strategy based on my personal experience, I suspect there is a wealth of practice information and expertise that should be made accessible to addiction professionals and evaluated through rigorous measures. If we as professionals and researchers give voice and recognition to this issue, perhaps more men who struggle with both sexual abuse and addiction will access services and seek to address their problems. Furthermore, by raising awareness of sexual abuse, addiction and the needs of men, perhaps the larger societal issues that result in abuse and addiction can begin to be confronted.

 
About the Author

Jim is Assistant Professor at Thompson Rivers University (formerly University College of the Cariboo) and Site Director of the Centre for Addictions Research of BC. He has extensive experience in the provision and management of addiction treatment services, particularly with youth

Footnotes
  1. Ross, H. (1995). DSM-III-R alcohol abuse and dependence and psychiatric co-morbidity in Ontario: Results from the Mental Health Supplement to the Ontario Health Survey. Drug and Alcohol Dependence, 39, 111-128.

  2. Merikangas, K.R., Mehta, R.L., Molnar, B.E. et al. (1998). Comorbidity of substance use disorders with mood and anxiety disorders: Results of the International Consortium in Psychiatric Epidemiology. Addictive Behaviors, 23(6), 893-907.

  3. Atkinson, J.H., Slater, M.A., Patterson, T.L. et al. (1991). Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: A controlled study. Pain, 45, 111-121.

  4. Swendsen, J.D., Tennen, H., Carney, M.A. et al. (2000). Mood and alcohol consumption: An experience sampling test of the self-medication hypothesis. Journal of Abnormal Psychology, 109(2), 198-20.

  5. For a review, see Raimo, E.B. & Shuckit, M.A. (1998). Alcohol dependence and mood disorders. Addictive Behaviors, 23(6), 933-946.

  6. Harrington, R., Fundge, H., Rutter, M. et al. (1990). Adult outcomes of childhood and adolescent depression. Archives of General Psychiatry, 47,465-473.

  7. Rao, U., Ryan, N.D., Birmaher, B. et al. (1995). Unipolar depression in adolescents: Clinical outcome in adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 566-578.

  8. Baker, C.R. (2001). Drug use and mental disorders: An examination of the self-medication hypothesis. Dissertation Abstracts International: Section B: The Sciences & Engineering, 62(3-B), 1310.

  9. Randall, C.L. (2003). Self-medication in social phobia: A review of the alcohol literature. Addictive Behaviors, 28(2), 269-284.

  10. Wilson, G.T., Brick, J. Adler, J. et al. (1989). Alcohol and anxiety reduction in female social drinkers. Journal of Studies on Alcohol, 50, 226-235.

  11. Cox, B.J., Swinson, R.P., Shulman, I.D. et al. (1993). Gender effects and alcohol use in panic disorder with agoraphobia. Behaviour Research and Therapy, 31, 413-416.

  12. Kushner, M.G., Sher, K.J., Wood, M.D. et al. (1994). Anxiety and drinking behavior: Moderating effects of tension-reduction alcohol outcome expectancies. Alcohol Clinical and Experimental Research, 18, 852-860.

  13. Walsh, S.M. (2001). The effect of gender on selected factors of dual diagnoses. Dissertation Abstracts International: Section B: The Sciences & Engineering, 61(3-B), 6726.

  14. Meza, E.D., Cunningham, J.A., el-Guebaly, N. et al. (2001). Alcoholism: Beliefs and attitudes among Canadian alcoholism treatment practitioners. Canadian Journal of Psychiatry, 46, 167-172.

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