*The individuals in this piece are composites, combining details of several psychotherapy patients to protect privacy.

Ben’s initial exposure to alcohol was the bitter scent on his Dad’s breath. As a kid, he watched the post-work pilgrimage to the fridge for a cold one. It was a contradiction he couldn’t then put into words – alcohol was unappealing yet tempting enough to make him steal a sip. Like the sound of a starting gun, the crack of a can opening signaled his Dad’s departure into parts of manhood unknown, where both laughter and arguments got louder.

By the age of 17, Ben and his buddies were following suit. On weekends, his high school crew would guzzle cheap drinks, repurposing them into tools of competition, one-upping each other to “hold” their liquor, ribbing, ragging, telling tall tales, and confiding secrets into the dwindling hours.

Ben’s boozing grew less reckless and more rationalized as he entered the working world. Alcohol’s ability to power down his prefrontal cortex– the brain’s CEO – became a way to reduce stress or increase social confidence. But eventually he realized that the confidence and belonging that drinking gave him were being outweighed by surges of anxiety and deep loneliness, even in the company of his closest pals.

“I want to graduate from my drinking habits,” he confided to me during one therapy session, “but don’t know how…”

There are different ways to help people like Ben to loosen alcohol’s grip. But from a therapeutic perspective, one intervention that gets left out involves bringing a gendered lens into conversations about behavior change.

Alcohol keeps unmotivated men stuck in unique ways, and men need motivation and direction today more than ever. Ben’s story is unremarkable, and that’s because it reflects the struggle of many men today.

The problems related to alcohol skew male. Men are twice as likely as women to be hospitalized for alcohol-related reasons. Around two-thirds of deaths from drinking in excess are among males, totaling nearly 120,000 yearly deaths in the U.S.

Disconnected men seek escape

Young people are lonelier than ever; for men, that’s often a byproduct of not feeling needed or valuable, and retreating to the reliable embrace of alcohol or drugs.

Men report fewer intimate friends than women, and two-thirds of young men feel no one truly knows them. The U.S. Surgeon General has even sounded the alarm on the epidemic of loneliness. Such loneliness makes men vulnerable to deceiving remedies – like alcohol, where buying a buddy a drink is more than just a gesture—it’s an antidote to loneliness: ‘I’m going to let my guard down with you.’ ‘I trust you with my unfiltered self.’

Alcohol overuse is too often a desperate grasp for connection in social life that not only feels more distant and fragmented – but is. Men’s civic engagement has significantly declined since the mid-20th century. There are fewer male spaces, making the getting together of guys fewer and far between and, as a result, more desperate.

What’s also troubling and apparent is the growing class divide where drug and alcohol use hit the working class more viciously. Men without a college degree have more than a three times higher rate of death from alcohol as those with a BA.

Alcohol and masculinity

Alcohol use has been found in research to be closely linked to ideas of gender and masculinity. Alcohol consumption doesn’t seem to act as a surrogate marker for femininity: but it often does for masculinity. Hard drinking is more performative and public in men, too. Alcohol-related harms for men often play out in public or social settings, like violence or property damage, while women, on average, tend to face more ‘private repercussions’ like “blackouts.”

Hard drinking can quickly correct for a lack of athleticism, power, money, height, looks, or competence in masculine-coded hobbies. Alcohol motivates men to throw caution to the wind and embark on far-flung adventures; for a few hours, yes, it unearths dirtier jokes, outgoingness, and even tighter hugs that feel unnatural when sober. It builds us up to let us down, ‘hanging us over’ from the previous night, leaving us insecure and confused about our priorities.

Men also use alcohol for a broader range of stressors than women. It is a mistake then, for the treatment of alcohol-related issues to overlook the role of gender.

Alcohol carries the curse of conflicting functions, particularly in those who drink alcohol more intensely and mindlessly. In its overuse, it’s a ship with opposing rudders, steering toward short-term pleasure and long-term harm, acting on an array of neurotransmitters like dopamine, GABA, glutamate, opioids, and serotonin, producing stimulating and sedating effects. Alcohol provides clarity only to cloud judgment, instills courage that can lead to recklessness, fosters bonding followed by isolation, and promises freedom but breeds dependence.

Drowning sorrows

Alcohol, in darker moments, sharpens the sense of being a burden and not belonging. The suicide rate is four times higher for men. Among “deaths of despair,” alcohol is a contributor, heartbreakingly involved in about one in four deaths by suicide. Alcohol increases the risk of suicide more for men than for women, reducing the gap between impulse and action – say, a reach for a firearm.

My young male patients are initially surprised to learn that alcohol is classified as a “depressant,” but then they remember the self-hatred of hangovers. Men diagnosed with depression drink alcohol more frequently and in greater amounts than women with depression. Men are diagnosed with alcohol use disorders more frequently than anxiety or depression, yet we tend not to ask for help.

Ask, don’t tell

When facing a controversial issue, a common defense is to “split” it into good or bad, toxic or tonic. But as a therapist, I strive not to make alcohol so black or white. How could I? The business of alcohol helped draw me to my now-wife – then a stranger across the bar.

I’m more interested in men’s relationship to alcohol. For some, this means seeing more fully the connection between our drinking and a sturdy sense of masculinity.

“People tend to focus way too much on the drinking,” a clinical supervisor once reminded me, reciting an old Irish saying. “But they forget about the thirst.”

Alcohol abuse or dependency isn’t a problem but rather an attempted solution to a problem. The antidote is clarity about what purpose alcohol serves – if anything. Helping others get to this point begins with shifting the spirit of conversation from inquisition to inquisitive. So: “I’m genuinely curious about the ways alcohol works for you, can you tell me more about that?” Not: rather than “How many drinks did you have?”

8 strategies to manage alcohol use

Based on my experience as a therapist (and as a man), I’d suggest the following strategies:

1) Pinpoint the “thirst”. Think about what alcohol is doing for you. Discuss it with your friends or therapist, or write about it. Once you start documenting its benefits, you become more aware of what keeps cravings going. Getting more granular than it “helps me with stress.” Know exactly why you’re drinking before any outing where drinks are served. This will transform drinking from muscle memory into more of a choice.

If you expect to drink, ask yourself – what exactly is this adding? Is there another way to achieve bonding, intimacy, consolation, an emotional escape, creativity, emotional expression, or stress relief? Maybe alcohol gets you there after one or two drinks, but will a third or fourth add to that desired aim?

2) Widen the gap between alcohol and bigger missions. Find ways to reconcile the benefits of change with the costs of maintaining the status quo.

What do you want to achieve? Do you seek financial independence? A long-term partner? Do you want to figure out what you want? If so, is a round of drinks getting you closer? Maybe it is – who am I to say? I ask you to ask yourself.

Draw a straight line between alcohol and your bigger missions because alcohol has a way of indirectly scuttling them with its conflicted steering.

3) Practice saying “no.” Hold the line. Play a game of Socratic self-dialogue before drinking, and keep it non-confrontational: If I don’t drink with friends tonight, what happens? My friends will pressure me to. Ok, then what?  Maybe they’ll see me as dull or not meeting expectations as the ‘fun guy.’ Ok, say that’s true. Why does that matter to you so much? 

This inoculates you from the experience of having your masculinity snatched if you don’t drink or submit to the peer pressure of taking that shot. This can give you confidence to say “no” without justification.

4) There’s an aloneness to drinking less. But that’s a sign. When you’re going sober or drinking in moderation, and others are going hard, it’s isolating. Make efforts to find others on your level, where curiosity, ideas, and support, as opposed to alcohol, are centerpieces. When you’re ready to graduate from reckless boozing, it often means (nonjudgmentally) moving on from old friendships and building the courage to find new ones.

5) “Drinking is borrowing happiness from tomorrow…” This quote, made famous by podcaster and author Tim Ferris, will help you with steps one through four.

Alcohol makes us myopic. It saps energy and motivation days after. When you know there will be drinks, keep that next-day, next-week mindset.

6) Don’t mix up wanting with liking. One hypothesis offers evidence that our brain has different systems for “wanting” and “liking” rewards. Wanting is driven by the dopamine system, whereas liking involves a separate neural circuitry. Addiction occurs when the desire of “wanting” gets amplified above and beyond actual enjoyment. Remind yourself of this.

7) Cravings can’t last forever. Patience is your friend. The anticipation of a treat causes a surge in dopamine, fueling your craving, but the effect is often short-lived. Learn effective breathing methods. Practice mindfulness. Do a burst of exercise. Take a walk in nature and expand your visual field.

Whether a lifelong drinker, abstainer, or somewhere in between, as an adult man, you, like me, probably have a long list of alcohol-related war stories and cautionary tales. That’s because alcohol relentlessly confronts us across our lives, defining us, forcing a constant decision on how we will relate to it.

The question for all of us, and especially for men is: Do we let alcohol steer us, or do we take the helm?

Jett Stone

Dr. Jett Stone is a clinical psychologist, writer, and organizational consultant.