Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual

Abstract

FOREWORDSubstance use and abuse often coexist with anger and violence. Data from the Substance Abuse and Mental Health Services Administration's National Household Survey on Drug Abuse, for example, indicated that 40 percent of frequent cocaine users reported engaging in some form of violent behavior. Anger and violence often can have a causal role in the initiation of drug and alcohol use and can also be a consequence associated with substance abuse. Individuals who experience traumatic events, for example, often experience anger and act violently, as well as abuse drugs or alcohol.Clinicians often see how anger and violence and substance use are linked.Many substance abuse and mental health clients are victims of traumatic life events, which, in turn, lead to substance use, anger, and violence.Despite the connection of anger and violence to substance abuse, few treatments have been developed to address anger and violence problems among people who abuse substances. Clinicians have found the dearth of treatment approaches for this important issue disheartening.To provide clinicians with tools to help deal with this important issue, the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration is pleased to present Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual.The anger management treatment design in this manual, which has been delivered to hundreds of clients over years, has been popular with both clinicians and clients. This treatment design can be used in a variety of clinical settings and will be beneficial to the field.Pamela S. Hyde, J.D.AdministratorSubstance Abuse and Mental Health Services AdministrationPeter J. Delany, Ph.D., LCSW-CDirectorCenter for Substance Abuse TreatmentSubstance Abuse and Mental Health Services AdministrationINTRODUCTIONThis manual was designed for use by qualified substance abuse and mental health clinicians who work with substance abuse and mental health clients with concurrent anger problems. The manual describes a 12-week cognitive behavioral anger management group treatment. Each of the 12 90-minute weekly sessions is described in detail with specific instructions for group leaders, tables and figures that illustrate the key conceptual components of the treatment, and homework assignments for the group participants. An accompanying Participant Workbook is available (see Anger Management for Substance Abuse and Mental Health Clients: Participant Workbook, Reilly, Shopshire, Durazzo, & Campbell, 2002) and should be used in conjunction with this manual to enable the participants to better learn, practice, and integrate the treatment strategies presented in the group sessions. This intervention was developed for studies at the San Francisco Veterans Affairs (SFVA) Medical Center and San Francisco General Hospital.Cognitive behavioral therapy (CBT) treatments have been found to be effective, timelimited treatments for anger problems (Beck & Fernandez, 1998; Deffenbacher, 1996; Trafate, 1995). Four types of CBT interventions, theoretically unified by principles of social learning theory, are most often used when treating anger disorders:* Relaxation interventions, which target emotional and physiological components of anger* Cognitive interventions, which target cognitive processes such as hostile appraisals and attributions, irrational beliefs, and inflammatory thinking* Communication skills interventions, which target deficits in assertiveness and conflict resolution skills* Combined interventions, which integrate two or more CBT interventions and target multiple response domains (Deffenbacher, 1996, 1999).Meta-analysis studies (Beck & Fernandez, 1998; Edmondson & Conger, 1996; Trafate, 1995) conclude that there are moderate anger reduction effects for CBT interventions, with average effect sizes ranging from 0. …