Substance Abuse: Anger Management, a Neglected Topic in Substance Abuse Intervention

A long standing issue

Problems managing anger has always been a concern for patients suffering from addictive disorders. Pioneering research by my mentor, Dr. Sidney Cohen at the UCLA Neuropsychiatric Institute demonstrated the relationship between, anger, violence and the use of alcohol and or cocaine. One of the most popular articles written by Dr. Cohen, was entitled, “Alcohol, the most dangerous drug known to man”. In this and other publications, Dr. Cohen systematically demonstrated the causal relationship between cocaine and alcohol abuse and aggression. Much of this research was done in the 70s and 80s.

Anger has always been a factor in substance abuse intervention. Unfortunately, until recently, it has been overlooked or treated as an after thought by substance abuse programs nationwide. Substance use and abuse often coexist with anger, aggressive behavior and person-directed violence. Data from the Substance Abuse and Mental Health Administration’s National Household Survey on Drug Abuse indicated that 40 % of frequent cocaine users reported engaging in some form of violence or aggressive behavior. Anger and aggression often can have a causal role in the initiation of drug and alcohol use and can also be a consequence associated with substance abuse. Persons who experience traumatic events, for example, often experience anger and act violently, as well as abuse drugs or alcohol. This is currently occurring with recently returned combat veterans from Iraq.


Substance abuse and dependence has grown beyond even the bleakest predictions of the past. In the United States alone, there are an estimated 23 million people who are struggling (on a daily basis) with some form of substance abuse or dependence. The toll it is having on our society is dramatically increased when we factor in the number of families who suffer the consequences of living with a person with an addiction, such as:

o Job loss

o Incarceration

o Loss of child Custody

o DUI’s

o Domestic Violence/Aggression

o Marital problems/divorce

o Accidents/injuries

o Financial problems

o Depression/anxiety/chronic anger

Unfortunately, most substance abusers may not even be aware that they have an underlying anger problem and do not “connect” their anger problem to their alcoholism, drug addiction and substance abuse. Therefore, they do not seek (or get) help for their anger problem. But more often than not, their anger is the underlying source of their disorder. Anger precedes the use of cocaine and alcohol for many alcohol and cocaine dependent individuals. Anger is an emotional and mental form of “suffering” that occurs whenever our desires and expectations of life, others or self are thwarted or unfulfilled. Addictive behavior and substance abuse is an addict’s way of relieving themselves of the agony of their anger by “numbing” themselves with drugs, alcohol and so on. This is not “managing their anger”, but self medication.

When we do not know how to manage our anger appropriately, we try to keep the anger inside ourselves. Over time, it festers and often gives rise to even more painful emotions, such as depression and anxiety. Thus, the individual has now created an additional problem for themselves besides their substance abuse, and must be treated with an additional disorder. Several clinical studies have demonstrated that anger management intervention for individuals with substance abuse problems is very effective in reducing or altogether eliminating a relapse.

Medical research has found that alcohol, cocaine and methamphetamine dependence are medical diseases associated with biochemical changes in the brain. Traditional treatment approaches for drug and alcohol dependency focus mainly on group therapy and cognitive behavior modification, which very often does not deal with either the anger or the “physiological” components underlying the addictive behavior.

Anger precedes the use of cocaine for many cocaine-dependent individuals; thus, cocaine-dependent individuals who experience frequent and intense episodes of anger may be more likely to relapse to cocaine use than individuals who can control their anger effectively. Several clinical trials have demonstrated that cognitive-behavioral interventions for the treatment of mood and anxiety disorders can be used to help individuals with anger control problems reduce the frequency and intensity with which they experience anger.

Although studies have indirectly examined anger management group treatments in populations with a high prevalence of substance abuse, few studies have directly examined the efficacy of an anger management treatment for cocaine-dependent individuals. A number of studies demonstrating the effectiveness of an anger management treatment in a sample of participants who had a primary diagnosis of post-traumatic stress disorder have been conducted by the Department of Veterans Affairs. Although many participants in these studies had a history of drug or alcohol dependence, the sample was not selected based on inclusion criteria for a substance dependence disorder, such as cocaine dependence. Considering the possible mediating role of anger for substance abuse, a study examining the efficacy of anger management treatment in a sample of cocaine-dependent patients would be informative.

Anger management as an after thought

In spite of the information available to all professional substance abuse treatment providers, anger management has not received the attention which is deserved and needed for successful substance abuse treatment. Many if not most substance abuse programs claim to offer anger management as one of the topics in its treatment yet few substance abuse counseling programs include anger certification for these counselors.

Typically, new substance abuse counselors are simply told that they will need to teach a certain numbers of hours or sessions on anger management and then left to find there own anger management information and teaching material. These counselors tend to piece together whatever they can find and present it as anger management.

Despite the connection of anger and violence to substance abuse, few substance abuse providers have attempted to either connect the two or provide intervention for both. In the Los Angeles area, a number of primarily upscale residential rehab programs for drug and alcohol treatment have contracted with Certified Anger Management Providers to offer anger management either in groups on an individual basis for inpatient substance abuse clients. Malibu based Promises (which caters to the stars) has contracted with Certified Providers to offer anger management on an individual coaching bases.

It may also be of interest to note that SAMSHA has published an excellent client workbook along with teacher’s manual entitled, Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual [and] Participant Workbook. This publication free and any program can order as many copies as needed without cost. There is simply no excuse for shortchanging substance abuse clients by not providing real anger management classes.

Limited anger management research

What has been offered as anger management in substance abuse programs has lacked integrity. The Canadian Bureau of Prisons has conducted a 15 year longitudinal study on the effectiveness of anger management classes for incarcerated defendants whose original crime included substance abuse, aggression and violence. One of first findings was that in order to be useful, the anger management model used must have integrity. Integrity is defined as using a client workbook containing all of the material needed for an anger management class, consistency among trainers in terms of how the material is taught and a pre and post test to document change made by clients who complete the class. It is not possible to determine the effective of anger management which is fragmented and not based on any particular structure of theoretical base.

Anger management training is rarely integrated into substance abuse treatment At the present time, anger management is rarely integrated into any model of substance abuse intervention. Rather, it is simply filler tacked on to a standard twelve step program,

Trends in anger management and substance abuse treatment.

Several years ago, the California state legislature established statewide guidelines for all state and locally supported substance abuse programs. This legislation is included in what is commonly referred to as proposition 36. As a result of this legislation, all substance abuse counselors must have documented training in anger management facilitator certification. This training requires 40 hours of core training plus 16 hours of continuing anger management education of a yearly basis.

What is Anger Management?

Anger management is rapidly becoming the most requested intervention in human services. It may be worthwhile to define what anger management is and is not. According to the American Psychiatric Association, anger is a normal human emotion. It is not a pathological condition therefore; it is not listed as a defined illness in the Diagnostic and Statistical Manual of Nervous and Mental Disorders. Rather, anger is considered a lifestyle issue. This means that psychotherapy or psychotropic medication is not an appropriate intervention for teaching skills for managing anger.

The American Association of Anger Management Providers defines anger management as a skill enhancement course which teaches skills in recognizing and managing anger, stress, assertive communication and emotional intelligence. Anger is seen a normal human emotion which is a problem when it occurs too frequently, lasts too long, is too intense, is harmful to self or others or leads to person or property directed aggression.

The Anderson & Anderson anger management curriculum is currently the most widely used model of anger management in the world. This model includes an assessment at intake which is designed to determine the client’s level of functioning in the following four areas, anger, stress, communication and emotional intelligence. The intervention/classes which are provided teach skills in these four areas. Post test are administered after course completion to determine the success or lack thereof of the program.

In Summary

All anger management programs should conduct an assessment at intake for substance abuse and psychopathology and all substance abuse programs should assess all participants for the current level of functioning in recognizing anger, stress, assertive communication and emotional intelligence.

All substance abuse programs should have their intervention staff certified in anger management facilitation.

Guidelines should be established to determine the number of hours/sessions that each client will receive in teaching skill enhancement in anger management, stress management, communication and emotional intelligence.

Anderson & Anderson
The Directory of Anger Management Providers
American Association of Anger Management Providers

Article Source:



Teen Substance Abuse – A picture video I made for an adult sunday school class about teen substance abuse. Images from google, Music: 30 Seconds to Mars – To Kill.


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16 Responses to Substance Abuse: Anger Management, a Neglected Topic in Substance Abuse Intervention

  • Phuryy says:

    ouldnt handle her? coke. took a sketchy drug for one thing. stay with pot, alcohol in moderation and nothing else.

  • manmythlegend12 says:

    Lol, this video is crap. There are plenty of drugs that are extremely beneficial for teens to understand their place in the world and to help them figure out difficult situations if used appropriately.

    And substance abuse in teens happens for the SAME exact reasons that? it happens in adults: kids want to have a good time so they take a drug that temporarily relinquishes them of all responsibilities and problems. Don’t try to act like it’s just a teen thing. All age groups do drugs and drink.

  • rodswebdesign says:

    brilliant? video

  • staranjela says:

    great? video thanks

  • jayejayeee says:

    some sweet info here?

  • TheAdhd128 says:

    beer pong sucks it impedes my ability to get drunk heres a drinking game drink drink drink drink drink drink drink drink drink drink drink…and if you drink so much your friend has? to drive you home you win.

  • georgia31765 says:

    @thedirtynasty i don’t belive that i readare u crazy?????u think that there are no facts or reasons that these drugs are bud???????
    here is a fucken -fuct ::AMY WINEHOUSE 1983-2011 ONE OF THE BIGEST? TALENTS IS GONE….,.!!!!!!!
    Is this fuct good enough for you….?????

  • musicvidz9 says:

    2:27 that is one badass skeleton right there?

  • b00ger901 says:

    I also want to add another drug to the ones that have been listed. One very powerful and addictive drug and it’s used? by a lot of people today and not only is it legal but many find consuming the drug to be harmless. They will claim they are responsible enough to not overdose or cause any serious harm to their bodies, but what happens when they lose control? I am of course talking about the psychoactive drug caffeine. Who’s with me? We should be teaching responsibility not ignorance!

  • domvasta says:

    DUI doesn’t indicate abuse, but rather a lack of judgement, being over .08BAC is a fairly common thing, it only takes about four beers then getting in a car. the real problem is constant heavy drinking, or constant drug use. occasional drug use can even be beneficial to a person’s mental health as it relieves stress and allows them to? enjoy themselves more. the problem is when the use of drugs starts negatively impacting other areas of their life, that’s when they need help, not jail.

  • Kellyannk308 says:

    You said something that I must correct you on WHY ASSUME THEY ARE BAD? This is part of the stigma and? a reason why you don’t understand them and another reason why 12 step treatment and religion don’t work in helping someone overcome substance abuse. Sometimes, people are just hurting inside and don’t have the skills to cope–It doesn’t mean they are all morally flawed.

  • zwhip408 says:

    agree with evrything except the weed? part. weed duznt fuck u up. and God is a hoax

  • zemusorzeromus says:

    I love? drugs. Used in appropriate amounts, all they do is increase the joy of life. Weed all the way, pills and booze too.

  • magla345 says:

    i? would like to know what can be done about persons promoting teen drug abuse on youtube.

  • schlegelt says:

    If you can’t take drugs and continue to create a good life, you are weak. If you’re weak, chances are you wouldn’t have a very fulfilling life anyways.?

  • SparkPlugMovies1 says:

    there is a 2 sided story to drugs and the use of drugs i have experienced all sorts of drugs but the bad thing is is that i experienced them starting at age 13, there are things that can be experienced throughout life but no substance should be taken as a road, but as a bridge. what i mean by that is its ok to smoke pot or try shrooms a couple times but not all the time. you? only have one life to live make the best out of it. because once you die its all over.

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