I work with high-functioning men and women, and I tend to find that they engage in binge drinking. Let's use, for example, a lawyer who's able to put a box around the alcohol or drug use from Monday to Friday. But come Friday afternoon, the obsession kicks in, the thought kicks in and they're off to the races. And they cram a week's worth of drinking into a weekend. So they're able to contain that drinking during the week, but then the pressure to use just builds up and they completely overuse.
What do we need to know about male addicts in particular?
Males are much less willing to ask for help. They'll struggle with their addiction in secrecy and isolation for much longer than women, who are more relationship-oriented. There's a real sense of pride and ego that goes along with it. They think they can handle it, that they're not out of control, that they're masters of their destiny.
And then there are also three big defenses: denial, rationalization and minimization. Men will deny they have a problem, or they'll minimize it – "Yeah, I got drunk last weekend. It's no big deal." Or they'll rationalize it: "I have a really stressful job, and I make a lot of money, so I deserve to drink. Leave me alone." It's much harder to get to them and to really show them the insidious and destructive nature of their disease.
So how do we get through to men?
The important thing is to use "I" terms instead of "you" terms. Say, "I feel really unsafe and insecure when alcohol gets introduced to this relationship," so you're doing it in a way that's really nonthreatening. Because if you point your finger and say, "When you drink, you turn into a jerk," you're not going to get very far with that conversation. The other thing that's critically important is to have gender-specific interventions. Have a man speak with a man; have a woman speak with a woman.
Not every addict is able to overcome the disease. Why doesn't rehab work for everyone?
Because, first of all, their pride and ego get in the way. They think they have all the answers, and that they don't need to listen to what they were told in rehab – and by the way, what they paid a significant sum of money for. They basically say, "I have this under control, I don't need to comply with the terms of my aftercare program," and their life intervenes. They put their career before their sobriety, they put their relationship before their sobriety. And because the disease is so chronic and progressive, and so insidious, they need to be diligent about putting their recovery first. Because whatever they put in front of their recovery is going to be the second thing they lose – the first being their recovery. It's a lifelong process.
Is a monthlong rehab stay adequate?
People think 28 days is appropriate – that they can go in and get cleaned up and have all the solutions. But we find that the outcome rate improves exponentially with the longer stays. It takes the brain 90 days to rewire itself and learn a new habit or unlearn old behaviors. So 90 days is a really critical element here. And we really need to treat it in a systemic way – we need to address the family situation, the work environment and the underlying emotional life. We need to look at it in a contextual frame rather than just an isolated frame. Addiction is very complicated and complex, so we need complicated and complex solutions.