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Toxic Masculinity. Why Boys Will Talk about Male Substance Abuse BUT not Mental Health.

Updated: Jan 28

"American men are subjected to a culture where the standards of masculinity are literally killing them." - Benita N. Chatman, PhD, American Journal of Men's Health

Teen boys and girls drink alcohol and use drugs at roughly the same rates. But male substance abuse is considered more acceptable and “normal” by parents, peers, and society in general. While girls are encouraged to talk about their feelings, boys are still socialized to be “tough” and to “man up” when they express vulnerability or self-doubt.

As a result, teen boys are far less likely than girls to talk with friends or family about being depressed, anxious, or suicidal. Yet they’re willing to talk openly with peers about binge drinking, drug use, and other risky behaviors—even though these behaviors are typically symptoms of those same mental health challenges.

Male Attitudes Towards Substance Abuse and Mental Health

While awareness about the harmful impact of gender stereotyping is gradually increasing, pervasive and outdated ideas about how men and women do or should act continue to have an outsize influence on teen behavior and attitudes. These social norms are perpetuated by movies and TV shows that depict male substance abuse and related risky behavior as “cool” and exciting. For teen boys, these expectations can have significant negative effects on their choices around drug and alcohol use, as well as their ability to talk about and seek treatment for mental health issues.

Research shows that males perceive substance use as less dangerous than females do, and are also more susceptible to peer influence to drink and use drugs. In addition, problematic alcohol-related behaviors such as binge drinking are seen as socially acceptable for adolescent boys, and even considered “masculine.” These attitudes put boys at higher risk for substance abuse, including becoming dependent on multiple substances, according to a study conducted by Johns Hopkins University, the University of Minnesota, and the Bloomberg School of Public Health. Male teens are also at a higher risk of using over-the-counter drugs, compared with female teens.

Teen boys’ low mental health literacy—their ability to recognize and discuss their own or others’ mental health—complicates the issue. Because they don’t open up about their feelings, they don’t receive the support or treatment they need. Lacking other ways to cope with distress and emotional pain, they turn to teen substance abuse as a form of self-medication.

Taking Down ‘Locker Room Culture’

Las Vegas Raiders defensive lineman Carl Nassib gave the world a powerful example of healthy masculinity and what it looks like to speak your truth. He became the first active NFL player in history to announce that he is gay. “I have agonized over this moment for the last 15 years,” Nassib said in his Instagram post. “Only until recently, thanks to my family and friends … did it seem possible for me to say publicly and proudly that I am gay.”

Carl Nassib’s coming out and the support he received from the NFL and his fellow players, along with well-wishers around the world, are proof that norms around gender identity and sexual orientation are changing. However, the fact that he struggled with the decision for so long illustrates the ongoing influence of societal expectations for men, both gay and straight.

These expectations are magnified for male athletes. The locker room is often described as ground zero for toxic masculinity—a culture of homophobia, sexism, and machismo. As retired NFL player Wade Davis, who came out after leaving the sport, puts it, “There’s a certain type of macho that one knows that they have to perform in order to attempt to be accepted.” This locker room culture—which extends far beyond the locker room—is harmful not only for LGBTQ men, but also for straight and cisgender men.

How Toxic Masculinity Keeps Boys from Talking About Mental Health

Girls are socialized from birth to be more expressive, emotional, and vulnerable. Consequently, they tend to be more comfortable expressing sadness, hopelessness, or self-esteem issues, and experience less shame around these feelings. That’s why girls’ mental health conditions are more often recognized and treated, and why statistics show that girls have higher rates of trauma, anxiety, and depression.

Boys, meanwhile, are expected to be rough, to push boundaries, and to withdraw and deal with their problems on their own rather than reaching out for help. Consequently, their mental health issues manifest not only in male substance abuse but also in anger, aggression, and risk-taking behaviors like fighting, driving while impaired, and criminal activities, such as vandalism, stealing, arson, and assault.

Such behaviors are often seen as “acting out” or examples of the idea that “boys will be boys.” These damaging social expectations around masculinity and how boys and men are expected to behave are collectively known as toxic masculinity. Toxic masculinity negatively impacts males’ relationships with family and peers, increases levels of anxiety and depression, undermines psychological well-being, and prevents boys and men from seeking professional help for mental health issues. Ultimately, it can contribute to physical health problems, specifically by exacerbating heart conditions, and can also heighten an individual’s risk of suicide.

Teaching Teens What Healthy Masculinity Looks Like 

Teen boys get their information about what it means to be a man through parenting, social conditioning, peer behavior, and the media. Data shows that the impact of these male gender norms is significant. A Plan International USA survey of teen boys aged 14–19 found that about a third of them felt “a lot of pressure” to hide their feelings of sadness or anxiety. Other results included the following:

  • 77 percent of teen boys felt some or a lot of pressure to be emotionally strong

  • Close to half of male adolescents felt they should be willing to punch someone if provoked

  • About a third of the teens and 57% of men ages 18-36 felt pressured to join in when their male peers talked about females in a sexual way.

Interestingly, only about a quarter of the young men in the survey described themselves as “very masculine.” It seems that young men are clear about how society thinks they should act, but they don’t believe they’re fulfilling those expectations. For some, that may be purposeful. For others, it may be a source of shame and insecurity.

Essentially, social conditioning around masculinity teaches men to be strong and self-reliant, to avoid intimacy, not to express emotions other than anger, and to manage their problems on their own. As a result, men often find it difficult to share their emotional struggles with friends, family, or healthcare providers. Psychological concerns are equated with shame and weakness, creating intense stigma around both mental health conditions and mental health treatment. Essentially, men are conditioned to suffer in silence.

Consequently, when young men are struggling with trauma, anxiety, depression, grief or suicidal thoughts, they tend to self-medicate or find other unhealthy coping mechanisms rather than reaching out. Therefore, they are more likely to be diagnosed with substance use disorder or conduct disorder, and to engage in reckless or violent behavior. Because aggression and risk-taking are associated with masculinity, men may feel that these behaviors are acceptable, while talking about what they’re going through and seeking help are not.

What does it mean to be a “real man”?

It means speaking and living your truth, whatever that may be. But that’s far easier said than done in a culture where men feel pressured to adhere to outdated and damaging stereotypes of masculinity.

Despite how far we’ve come in dismantling male gender norms over the past decades, men are still expected to act tough and aggressive, and to avoid talking about their emotions or mental health struggles. In a Pew Research Center survey, respondents were asked which traits society values most in men. They ranked strength, toughness, leadership, and ambition among the top qualities, with respectfulness, kindness, and empathy much farther down the list.

Honesty was at the top of the list. That’s ironic, because men often grow up feeling up that they have to hide their true selves and their true feelings in order to be loved and accepted. Instead of establishing their own version of healthy masculinity, they try to fit into a restrictive mold dictated by society.

To counterbalance these societal messages, it’s vital for parents to support teen boys to become aware of this harmful conditioning, and to make choices that support their own and others’ well-being. Boys need education and examples around what it means to be a strong and compassionate man, one who is confident enough to express a full range of emotions and behavior. That includes traits that are traditionally considered “masculine”—like strength, leadership, ambition, providing for and protecting others, and being good at sports—as well as softer qualities, like empathy, humility, and vulnerability.

Starting the Conversation About Mental Health with Teen Boys

To shift the conversation around substance abuse and mental health for boys and men, parents and caregivers need to educate boys about the link between the two, and help them become aware of how society influences them. Here are some ways to talk to teen boys about mental health and help them reframe the way they think about these issues:

  • Fathers, older brothers, and other male mentors can model healthy male communication by talking openly about their emotions and personal struggles without shame. Parents can work on greater awareness of their own cultural biases around gender and how they may unconsciously be communicating to boys that their vulnerability and emotions are unacceptable or shameful.

  • Families can discuss how media perpetuates damaging masculine stereotypes and discuss how those stereotypes affect teens’ behavior and ideas about how they should act.

  • Mentors and parents can expose teen boys to books, movies, and music that feature men being honest and vulnerable about their mental health struggles.

Male substance abuse should not be considered a normal rite of passage or an acceptable way to deal with difficult emotions. Moreover, it’s essential for boys to understand that old ideas of masculinity are harmful to both males and females, and to learn that it’s okay to talk about what they’re going through and get the help they need.

Courtesy of Newport Healthcare


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