6/11/2014
Steve Adelman, MD
Director, Physician Health Services, Inc.
Clinical Associate Professor of Psychiatry
UMASS Medical School
Men’s Health Symposium – June 11, 2014
Is this a typical male suffering from a
substance use disorder?
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6/11/2014
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Substance-Related Disorders (DSM-5)
 Substance Use Disorders (substance abuse &
substance dependence)
 Substance-Induced Disorders (intoxication,
withdrawal, mental disorders)
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Physiological Dependence (hallmarks = tolerance,
withdrawal)
Addictive Disorders (addictive behaviors, not
substance use)
Alcoholism?
Addiction (drugs)?
Addiction Psychiatry vs. Addiction Medicine
(AAAP; ASAM; ABAM)
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Steven A. Schroeder, M.D. - N Engl J Med 2007;357:1221-8.
Trends in Percent of High School Students Who
Have a Substance Use Disorder
(by Gender)
2002
2004
2006
2008
2009
Total
15.4
14.8
13.6
12.8
11.9
Females
14.5
15.3
13.4
13.2
12.3
Males
16.2
14.4
13.8
12.4
11.4
Source: CASA analysis of the National Household
Survey on Drug Use and Health (NSDUH), 2009.
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6/11/2014
Teens Ages 12-17
 Prevalence of Illicit Drug Use = for Males and
Females (9.5%)
 Females > Males in Nonmedical Use of
Psychotherapeutic Drugs (3.2% vs. 2.4%)
Everyone Surveyed (All Ages)
 Rate of Current Illicit Drug Use - M > F (11.6%
vs. 6.9%)
 M > F: Multiple Drugs; Marijuana (2X);
Cocaine (3X); Hallucinogens (2X)
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Availability of Addictive Substances
The Profit Motive
Cultural Factors
Public Policy
Socioeconomic Factors
Stress & Trauma
Psychological Make-Up, Personality,
& Temperament
Co-Occurring Mental Disorders
Genetic Vulnerabilities
The “Hijacked Brain”
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Experimentation
Initiation
Physiological Dependence
Help-Seeking & Remediation
Achieving Abstinence
Maintaining Abstinence (Recovery)
Preventing Relapse; Relapse
“Getting Back on the Horse”
63% of adult men drink (30 days)
24% of adult men binge drink (30 days) –
double the rate of women who binge
Men have higher rates of alcohol use
disorders (double) and secondary M&M
Fatal MVAs – men are twice as likely as
women to have been intoxicated
Male violence (assaults, successful suicides)
significantly associated with drinking
Risky sexual behavior (and its complications)
associated with drinking
CDC
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6/11/2014
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Alcohol – Same as General Population
Tobacco – Double
Drug use
◦ Review of literature (Ostrow and Stall, 2008) found higher
rates of drug use for MSM vs heterosexual/all men
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Marijuana – 3.5 to 3.9 times higher for MSM
Amphetamines – 2.2 to 12.2 times higher for MSM
Cocaine – 2.5 to 6.6 times higher for MSM
Hallucinogens – 3.3 times higher for MSM
Opiates – 2.4 times higher for MSM
From: Overview of Health Disparities Affecting Gay and Bisexual Men
in the United States - Richard J. Wolitski et al., CDC, 2007 APHA
Presentation
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Mental disorders commonly co-occur with
SUDs include:
ADHD, Anxiety, Mood, Personality,
Psychosis, PTSD
Mental disorders that predominate in men
include: ADHD, ASD, ASPD, Battle trauma
What do we know about the co-occurrence of
SUDs with other mental disorders?
Other relevant conditions include:
Pain (acute, chronic); Substance-induced
neurocognitive disorder
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Often a factor in various phases of the addictive process
Why “typical” guys may be at risk:
 Differential “nurturing” (gender bias)
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Deficit in self-soothing
Emotional distress may be denied, ignored,
minimized until……………
Inability to tolerate extreme emotional distress
What, me get help?
Psychoactive substances that rapidly diminish
emotional distress abound………
Welcome to the vicious cycle of a substance use
disorder!
He didn't threaten me: he didn't rape me with direct force. It was a kind
of subtle and indirect the way he did it. I think I said something like,
"What are you doing?" and all he said was, "Shhhhhhhh." He went all the
way, and not just once. A few weeks later it happened all over
again……………No one knows that I went through this, and no one
knows how much I was affected by it. When I was young, I didn't really
know what to make of what had happened. As I got older and I could
begin to grasp it, I began to look at this as a statement of what kind of
a person I was. A piece of shit, a stutterer, worthless. That’s how I
looked at myself and I was sure that that’s how others saw me as well.
Later on I managed not to think about it very often. It’s the kind of
thing that guys on the street who use drugs hide from one another, no
one talks about it. So I kept it buried inside……………….. The first time
I drank I felt a lot of pain and self-pity and started to cry. It was kind of
a release. Before long I was drinking with the guys every day.
Sometimes I'd even drink by myself at home. I'd grab a bottle and drink
the minute my parents walked out the door. Alcohol took me
somewhere else. An escape. It made me feel different - better. I was
used to feeling crummy, always down on myself. Suddenly I'm feeling
good. A wonderful, new experience!
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