The Nature of Addiction and Addiction Treatment
Addiction is a chronic and often relapsing disorder that develops when the pleasure circuits in the brain get overwhelmed, in a way that can become chronic and sometimes even permanent.
It is often preceded by other emotional problems. Many people engage in potentially addictive activities to escape discomfort—both physical and emotional. The roots of addiction reside in activities associated with sensation-seeking and self-medication.
New thinking reflects the belief that addiction is functional: it serves while it destroys. We do it to feel good or feel better. Ultimately, addiction is about the complex struggle between acting on impulse and resisting that impulse. And anger is often a major part of that struggle.
But fortunately, there are treatments for addiction that can work. Typically this involves medication, especially during withdrawal, therapy and support groups, in addition to the supportive role of the family and friends.
Why is Anger So Common During Addiction Treatment?
In the “fight or flight” response, a key survival mechanism, anger can play a constructive role. It may mask our fear in battle or arm us with self-confidence in a serious argument. But these moments are rare. And for most of us, experiencing anger from time to time, if appropriately managed, is a natural part of life.
But disproportionate or chronic anger is most commonly felt in day-to-day instances where it is often unnecessary or even counter-productive.
Many living with addiction know that anger well, both prior to and during treatment. And it’s in withdrawal during detox where they come face-to-face with the need to look at their anger management for the first time. This has a number of elements:
Loss of control:
A typical characteristic of unhealthy anger is the loss of control. That is exactly a defining characteristic of addiction as the addict loses control of their ability to manage their substance abuse.
Dual diagnosis:
Addiction and anger management issues often co-occur because both are often rooted in similar underlying causes which trigger angry or unhealthy reactions.
These causes may include childhood trauma, poor self-esteem, grief, a family history of anger management problems, or addiction itself, giving rise to mental health issues such as anxiety or depression among others.
Anger and denial with others:
People with addiction can become quickly enraged when their substance use or addictive behaviors are addressed by family and friends or in the workplace.
This often manifests as defensiveness, denial or physical or verbal attacks at others raising the issue. As a result, loved ones or friends are pushed away.
Anger and shame with self:
Those with addiction issues frequently feel intense anger directed at themselves for being in the situation they are in and unable to stop using alcohol, drugs or other behaviors such as gambling.
Filled with the shame of hurting their loved ones or letting down their employer, their anger is fuelled with the shame of hurting their loved ones, losing their job, or experiencing the stigma of addiction. And in a vicious cycle, they use drugs or gamble to self-soothe, repeating the problem, if not worsening it.
Understanding Emotional Issues and Addiction Treatment
The prevalence of anger as a response during addiction treatment doesn’t just start with the withdrawal process; it typically starts even before the addiction with a lack of emotion regulation. Here are some examples of what that may look like:
- Threatening those around them, such as shouting, swearing or insulting, which may worsen when a person consumes alcohol or drugs
- Being physically aggressive if they can’t access drugs or alcohol, including hitting, kicking, or pushing to release anger
- Emotional blackmail. Giving someone the “silent treatment” or refusing to support a loved one without ever expressing why they are angry in the first place.
- Blaming others for their dependence on behaviors or substances
- Blaming others for adverse outcomes
- Seeking vengeance. The individual may begin imagining different ways of hurting the person that wronged them to “teach them a lesson.”
- Avoiding the anger. Individuals may consume more substances to avoid their anger, so they don’t have to deal with it.
- Others feel like they are “walking on eggshells” when the addict abuses substances
- Struggles to let go of past rage and past negative experiences, yet are only satisfied when they have access to their drug of choice
- Hostile body language, actions and language such as door slamming, throwing objects, swearing or driving recklessly if they are unable to access their ‘fix’
Family and friends usually struggle for long periods of time before the person accepts that therapy and counseling are critical to help them understand and process such intense emotions effectively.
Relapse Triggers
One view of relapse is that it’s a gradual process that begins weeks and sometimes months before an individual picks up a drink or drug, and that there are three stages to relapse: emotional, mental, and physical.
Triggers can happen throughout the entire process, motivating the addict to return to using.
Unresolved anger can be a major stimulus for those triggers as the addict replays past scenarios of using and believes they can return without consequences.
Relapse is not a failure but an indication that more support, possibly with a different approach to treatment, is required to continue the recovery journey. Common triggers that may lead to relapse include:
- Stress
- Easy access to alcohol or drugs
- Revisiting people or places associated with using
- Social isolation
- Illness
- Major life transition
- Boredom
Difficulties Managing Anger Outbursts and Emotions
Many people in recovery have difficulty managing their anger. Developing awareness of anger responses and the ability to see cues that might trigger an anger response are key first steps.
Immediate techniques to do this include:
- Timeouts: Take a few deep breaths and thinking instead of reacting
- Deep-breathing exercises: Take several deep breaths, and try to release any tension you might have in your body.
- Thought stopping: When a thought you’d rather not have begins creeping into your consciousness, you identify it as unwanted or intrusive and then take action to push it away.
- The Aggression Cycle: Learn to see and feel the buildup, explosion, and aftermath of anger. Then try an alternate strategy
- Progressive muscle relaxation: Sensing tension as you become aware of different parts of your body, then letting it go
- Cognitive Behavioral Therapy techniques: Identifying negative thoughts and reframing them positively
How to Cope with Anger During Treatment
In addition to regular therapy sessions which provide a safe space to explore and resolve underlying issues contributing to anger, these techniques have proven effective for learning anger management in treatment:
- Deep breathing exercises: Reduce physical tension and create a sense of calm
- Relaxation techniques: Yoga, mindfulness meditation, and progressive muscle relaxation can help to reduce stress and promote relaxation.
- Journaling: Writing down your emotions can help to reduce the intensity of anger
- Physical activity or exercise: Can help to release tension and build healthy coping skills
- Developing positive communication skills: Learning how to express needs and feelings without aggression is key to managing anger in a healthy way.
- Seeking out supportive relationships: Having the support of friends and family can be an important part of managing anger in recovery
Sources
[A] Melemis SM. Relapse Prevention and the Five Rules of Recovery. Yale J Biol Med. 2015 Sep 3;88(3):325-32. PMID: 26339217; PMCID: PMC4553654.
[B] Anger Management for Substance Use Disorder and Mental Health Clients. 2019. Substance Abuse and Mental Health Services Administration (SAMHSA).
