Anger Management Offers Adjunct to Treatment
For many people who abuse substances, anger may be a particularly challenging concomitant problem. Anger and violence often play a causal role in the initiation of drug and alcohol use, yet they can also be a consequence of substance abuse.
The inappropriate or frequent expression of anger can have damaging consequences such as police arrest, physical injury, alienation from loved ones, or termination from a treatment or social service program.
"Despite the connection between anger and substance abuse, few treatments have been developed to address anger among people who abuse substances," said H. Westley Clark, M.D., J.D., M.P.H., Director of SAMHSA's Center for Substance Abuse Treatment (CSAT). "Clinicians have found the dearth of treatment approaches disheartening."
In response to this need, CSAT recently published both a manual for service providers and a participant workbook titled Anger Management for Substance Abuse and Mental Health Clients.
The publications are for use as part of a 12-week treatment program of cognitive behavioral group therapy to help people in recovery learn skills to manage their anger and diminish the destructive impact it can have on their lives.
The treatment model of cognitive behavioral therapy combines relaxation, cognitive, and communications skills interventions. The relaxation interventions are targeted at the emotional and physiological components of anger, while the cognitive interventions target thought processes such as hostile appraisals and attributions, irrational beliefs, and inflammatory thinking. Enhanced communications skills counter deficits in assertiveness and improve conflict resolution abilities.
The intervention provides lessons on topics such as ways clients can identify situations that trigger anger and ways they can measure the degree of their anger. Participants develop personal anger control plans, which they modify as they learn strategies for coping appropriately. Strategies include breathing and muscle relaxation exercises as well as the technique of "timeouts" to think instead of to react.
Participants learn the A-B-C-D model developed by Albert Ellis to conceptualize anger management treatment. The approach consists of identifying irrational beliefs and disputing them with more rational or realistic perspectives. "A" stands for an activating "red-flag" event. "B" represents our beliefs about the activating event and our interpretations of it. "C" stands for the emotional consequences of these beliefs about the event. "D" stands for dispute, in which we examine our beliefs and expectations to determine if they are unrealistic or irrational.
For example, a client may receive feedback on a work project from a supervisor. Receiving this feedback is the activating event (A). The client may believe (B) that the supervisor is being critical and dislikes him. The consequence (C) is that the client may feel demeaned. The final component is for the client to examine his or her beliefs to determine if they are realistic and, if not, to dispute them (D).
The manual describes each 90-minute session in detail with specific instructions for group leaders, tables, and figures illustrating key concepts, and homework assignments for participants. The companion participant workbook provides clients with a summary of core concepts, worksheets for homework assignments, and space to take notes during the sessions.
The treatment model can accommodate clients from different racial or cultural groups and can be used with both men and women. Also, it has been effective when used with non-substance-abusing clients in an outpatient mental health clinic.
The treatment is based on research conducted with support from the National Institute on Drug Abuse and the Department of Veterans Affairs (VA) to the San Francisco VA Medical Center, San Francisco Treatment Research Center, Department of Psychiatry, University of California, San Francisco. SAMHSA funded the preparation and publication of the manual and workbook based on the research.
"This project is an example of the kind of effort we encourage through SAMHSA's new Science-to-Services agenda," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "The focus is to identify successful practices developed through research and bring them to the community in an accessible format. We want to take the knowledge generated through research on mental and addictive disorders and enable service providers to put it to use immediately."
Patrick M. Reilly, Ph.D., and Michael S. Shopshire, Ph.D., wrote the manual and also developed the workbook together with Timothy C. Durazzo, Ph.D., and Torri A. Campbell, Ph.D.
To obtain copies of the manual and the workbook, contact SAMHSA's National Clearinghouse for Alcohol and Drug Information, at P.O. Box 2345, Rockville, MD 20847-2345. Telephone: 1 (800) 729-6686 (English and Spanish) or 1 (800) 487-4889 (TDD). Or order from SAMHSA's Web site at www.samhsa.gov.
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