Masculinity and addiction: a narrative review of therapeutic interventions for men with substance-use disorders

Introduction
Despite men representing the lion’s share of substance use disorder (SUD) treatment clients, the detrimental influence of traditional masculinity is rarely addressed in SUD treatment. The aim of this review is to provide an overview of the specific approaches applied in therapeutic work with men and their masculinities in SUD treatment programmes.

Material and methods
A narrative scientific literature review was conducted on the topic of masculinity and its relations with SUD. Two main therapeutic programme models were identified, the first based on traditional understandings of masculinity and the second taking into account men’s specific needs and problems arising from gendered cultural expectations. The literature reviewwas supplemented by examples of good therapeutic practice from Switzerland, Germany, Italy, the USA and the UK.

Results
Four key issues were identified as good practice in working with men with SUD: (a) traditional masculinity and the set of characteristics and expectations associated with it, (b) fatherhood and the relationship with the father, (c) the experience of sexual problems and the trauma of sexual abuse and (d) aggressive behaviour and the experience of violence.

Conclusions
SUD treatment could benefit from problematising masculinity and what constitutes it, reflecting on gendered identity traits and developing alternative models of masculinity that include health-promoting behaviours. Framing the barriers associated with masculinity in terms of cultural expectations can help to reduce the burden of guilt experienced by male patients and to increase the reflexivity on cultural norms and stereotypes.