Pain is a universal experience across people of all genders. How do we know when something hurts inside? It keeps coming back; first, it disrupts, then colors all aspects of everyday life. There are many shades of emotional hurt that can be emotionally crippling. Anger, grief and jealousy – are all hurtful emotional states. They are experienced and can be a part of our life for years. How we manage these painful experiences as men can be a challenge. While recent studies suggest sexes don’t feel pain the same way,1 the evidence on sex differences in pain is mixed and potential biopsychosocial factors may play a role.2
Sex and gender are distinct concepts that do not align for many individuals. We are born as humans and not all of us fall within the binary labels of male or female. Many women do not get the female label at birth and not all men get the male label at birth.
Although not all men are the same, having a difficulty talking about pain openly and getting hurt even more by the society that disapproves of such emotional disclosures is often part of being raised to conform to the male gender role. Instead, some men shut it inside, conceal it, and act it out in aggressive behaviours. There is a sense of emotional constriction that emerges and takes over. Although we can endure more than we think we can, there’s only so much pain that one can endure or tolerate. We adapt and will develop our own treatment plan to release, dull, or numb the painful emotional experiences.
Alcohol is one option that many men use to manage or numb their emotional experience. It is a cheap and easy way to dissolve the pain when talking about it is not an option. Emotional pain and drinking problems often go together especially among men. Drinking to cope with pain and other negative emotions has many health risks, and it increases likelihood of alcohol use disorder. The consequences of such emotional suppression are monstrous.
How can men learn to talk about themselves and their pain? It is about learning an emotional language and standing up to a definition of masculinity that is narrow and prescriptive. Most men are often neither allowed nor trained in the language of emotion or emotional regulation at a young age. It is a process of re-learning emotional regulation and language as adults, but this can be difficult to do on your own. Our emotional world influences how we live and relate to each other, and how we interact in the world. Having the capacity to express our emotions can influence how we use alcohol and can correlate to how men are able to use and benefit from treatment for an alcohol use disorder.
Men, women and all non-binary folk who drink excessively respond to talk therapy differently. Some studies showed that intensive and motivational counselling may be somewhat better at reducing severity of alcohol problems among women than men. For example, a study with Californian clients enrolled in addiction treatment found that women had greater odds of reducing their alcohol use by at least 50% than men.3 It also found that being female and having higher levels of education were associated with greater reduction in alcohol consumption. The authors believe that the results of their study, and other studies, suggest that “women may respond differently to therapy than men.”
Another study of Intensive Motivational Interviewing for women with concurrent alcohol problems and methamphetamine dependence focused on the therapeutic relationship or alliance between the client and the therapist.4 The study used two versions of Motivational Interviewing: standard and a 9-session intensive treatment. Women who had alcohol problems on top of methamphetamine use disorder fared better in the intensive treatment than in the standard version. Women tended to have stronger therapeutic alliances than men during the later sessions.
What does this research suggest? It may suggest that research still has long ways to go to account for the reality of intersex and trans lives because it is missing in most studies.5 It may also suggest that having access to your emotions and an emotional language could influence how treatment is received and how effective it is in reducing the reliance on alcohol as an emotional regulator, regardless of one’s gender. Helping people who drink above the low-risk drinking guidelines to identify their emotional experiences and attaching words to these experiences can be a critical component in the reduction of alcohol consumption.
Men participating with other men in groups designed to expand and decrease emotional constriction and increase the use of emotional language may help men reduce their alcohol use. Men’s groups can also push up against the “male code” that men do not talk about their feelings or their own sense of vulnerability with other men. This is a code that all boys are exposed to when being raised to conform to the male gender role and such a code is one source of shame that men experience when they have feelings and want to talk about them. Standing up to and working to un-learn this code is critical and occurs in the company of other men. Men learn to pay attention to what they are experiencing, identify through language what this experience is, and learn to express their emotions to and with other men. Because of the ongoing gender socialization process, this process is critical to our physical health and emotional well-being.
Pay attention to your use of alcohol and other substances. What are you feeling? What are you not talking about? What is this doing to you? How is it influencing your life? We can do this differently. Reach out and talk with someone. Open your emotional world to others with care.
References:
- Dance A. Why the sexes don’t feel pain the same way. Nature. 2019;567(7749):448-451.
- Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL, 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. The journal of pain. 2009;10(5):447-485.
- Nyamathi A, Shoptaw S, Cohen A, et al. Effect of motivational interviewing on reduction of alcohol use. Drug Alc Depend. 2010;107(1):23-30.
- Korcha RA, Polcin DL, Evans K, Bond JC, Galloway GP. Intensive Motivational Interviewing for women with concurrent alcohol problems and methamphetamine dependence. Journal of Substance Abuse Treatment. 2014;46(2):113-119.
- Lowik AJ, Hoong P, Knight R. Where is the Science? A Critical Interrogation of How Sex and Gender are Used to Inform Low-Risk Alcohol Use Guidelines. Journal of addiction medicine. 2020;14(5).
The authors of this blog post are Dr Matt Modrcin and Jan Klimas. The article first appeared on the former Matt Modrcin’s blog.
If you enjoyed reading this content, you might also like to read more about the pain research here