Anger Management, a Neglected Topic in Substance Abuse Intervention

A long standing issue

Problems managing anger has all the time been a concern for patients suffering from addictive disorders. Pioneering study by my mentor, Dr. Sidney Cohen at the Ucla Neuropsychiatric invent demonstrated the association 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 association in the middle of cocaine and alcohol abuse and aggression. Much of this study was done in the 70s and 80s.

Angeles Drug Los Rehab

Anger has all the time been a factor in substance abuse intervention. Unfortunately, until recently, it has been overlooked or treated as an after conception 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 observe on Drug Abuse indicated that 40 % of frequent cocaine users reported piquant 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.

Anger And Substance Abuse

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 community is dramatically increased when we factor in the amount of families who suffer the consequences of living with a man 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 basal 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 basal 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 conduct 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 personel has now created an further problem for themselves also their substance abuse, and must be treated with an further disorder. Some clinical studies have demonstrated that anger administration intervention for individuals with substance abuse problems is very effective in reducing or altogether eliminating a relapse.

Medical study has found that alcohol, cocaine and methamphetamine dependence are medical diseases associated with biochemical changes in the brain. Customary medicine approaches for drug and alcohol dependency focus in general on group therapy and cognitive behavior modification, which very often does not deal with whether the anger or the "physiological" components basal 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. Some clinical trials have demonstrated that cognitive-behavioral interventions for the medicine of mood and anxiety disorders can be used to help individuals with anger control problems cut the frequency and intensity with which they experience anger.

Although studies have indirectly examined anger administration group treatments in populations with a high prevalence of substance abuse, few studies have directly examined the efficacy of an anger administration medicine for cocaine-dependent individuals. A amount of studies demonstrating the effectiveness of an anger administration medicine in a sample of participants who had a Customary analysis of post-traumatic stress disorder have been conducted by the branch 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 administration medicine in a sample of cocaine-dependent patients would be informative.

Anger administration as an after thought

In spite of the data available to all expert substance abuse medicine providers, anger administration has not received the attention which is deserved and needed for victorious substance abuse treatment. Many if not most substance abuse programs claim to offer anger administration as one of the topics in its medicine yet few substance abuse counseling programs comprise anger certification for these counselors.

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

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

It may also be of interest to note that Samsha has published an exquisite client workbook along with teacher's by hand entitled, Anger administration for Substance Abuse and mental health Clients: A Cognitive Behavioral Therapy by hand [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 administration classes.

Limited anger administration research

What has been offered as anger administration in substance abuse programs has lacked integrity. The Canadian Bureau of Prisons has conducted a 15 year longitudinal study on the effectiveness of anger administration classes for incarcerated defendants whose Customary crime included substance abuse, aggression and violence. One of first findings was that in order to be useful, the anger administration model used must have integrity. Integrity is defined as using a client workbook containing all of the material needed for an anger administration 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 unblemished the class.
It is not possible to settle the effective of anger administration which is fragmented and not based on any particular structure of theoretical base.

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

Trends in anger administration 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 generally referred to as proposition 36. As a supervene of this legislation, all substance abuse counselors must have documented training in anger administration facilitator certification. This training requires 40 hours of core training plus 16 hours of chronic anger administration instruction of a annual basis.

What is Anger Management?

Anger administration is rapidly becoming the most requested intervention in human services. It may be worthwhile to define what anger administration is and is not. Agreeing to the American Psychiatric Association, anger is a normal human emotion. It is not a pathological health therefore; it is not listed as a defined illness in the Diagnostic and Statistical by hand of Nervous and mental Disorders. Rather, anger is determined 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 administration Providers defines anger administration as a skill enhancement procedure 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 man or property directed aggression.

The Anderson & Anderson anger administration curriculum is currently the most widely used model of anger administration in the world. This model includes an estimation at intake which is designed to settle 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 procedure completion to settle the success or lack thereof of the program.

In Summary

All anger administration programs should conduct an estimation 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 administration facilitation.

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

Anger Management, a Neglected Topic in Substance Abuse Intervention