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When anger is the drug of choice: cognitive and behavioral techniques can help clients avoid aggressive responses.

First, we should rename this article "When aggression is the drug of choice," because that more accurately describes the problem we must address in our clients. Anger is a normal emotion. We all get angry--at ourselves, at situations, at others, at the universe.

Aggression, on the other hand, is a behavior, not an emotion. Often it is triggered by anger--and that's the good news, because we can learn new ways to respond to those triggers. But first, let's identify what constitutes aggressive behavior.

Sure, throwing fists, objects, etc., constitutes aggression. So too does yelling, threatening and pounding the table. But aggression can be a lot more than assaultive behavior. Simply glaring at another person, pointing a finger at someone when speaking, rolling one's eyes or audibly sighing when the other is speaking--these are all aggressive behaviors. They can become bad habits that often lead to more dramatic confrontations.


What's behind the anger?

In my personal and professional experience, anger usually emerges when we are facing uncomfortable feelings such as fear, shame, hurt, sadness, embarrassment, etc. It is often chronic and borne out of the fear that we're not being understood, appreciated, loved or respected. For many, aggression is a mask that hides those uncomfortable feelings. Unfortunately, many of our clients grew up in house-holds that catered to the aggressive person, allowing him or her to believe that this behavior is acceptable.

Then there's the person who "discovers" his anger only after putting down his drug(s) of choice. I view this more as a switched addiction. ("I can't drink, so how do I cope with all these painful feelings?") For this person, angry outbursts can provide a sense of control, a rush of energy, maybe even some much-needed attention.

And how about people in recovery who have used passivity or helplessness as a survival technique? For them, the pent-up need for self-advocacy can burst forth with surprising ferocity.

Society harbors a popular misconception that we inherit our anger from one or both parents. This would be a nice cop-out, but the truth is that aggressive behavior is not genetic. We may have learned the behavior from our parents, but we didn't inherit it. It is a learned behavior that therefore can be unlearned.

The "benefits" of aggressive behavior

Unfortunately, aggressive behavior can get our needs met, at least in the short term. It can be an effective way to manipulate others, even to earn a level of respect in certain communities (such as on the street or in jail). Being rewarded for our aggressive actions reinforces the habit. And the longer we cultivate the habit, the more ingrained it becomes.

Another potential benefit of being aggressive is that it can feel good. The adrenaline rush may release tension (momentarily), but the consequences usually outweigh the benefits.

The consequences

In the long run, the chronically angry person usually alienates family and friends, creating a backlash of resentment and, ultimately, an audience that no longer will tolerate the aggressive conduct.

The most obvious consequences of angry outbursts are arrests, jail time, injury to self and others, loss of important relationships, loss of employment, etc. And then there are the emotional consequences of guilt and shame, exacerbating already low self-esteem. Just as with our drugs of choice, we find ourselves saying: "I did it again! How did that happen?"

Another consequence of chronic aggressive behavior is the detrimental effect on physical health. Keeping blood pressure and heart rates elevated over long periods of time (via the "fight or flight" response) creates stress that can lead to heart disease and hypertension.

An aggressive client doesn't break the habit quickly or easily. A combination of cognitive and behavioral interventions can help the client challenge his/her thinking and, ultimately, change behavior.

Cognitive restructuring

From a cognitive perspective, we encourage clients to challenge their "irrational beliefs"--to ask themselves some questions, such as:

* In the greater scheme of things, how important is this issue?

* What might this other person be thinking?

* Why do I feel the way I do? What's the fear behind my feeling?

Misguided thinking often includes words such as "should," "never," "always" and "must". For example, when a client says, "People should obey the rules," I'll invite him to challenge that irrational belief ("People should obey the rules, but they often don't.") When a client says, "I always screw up," I'll point to his past successes as well as today's efforts to get well.


As clinicians, we have a wonderful opportunity to introduce clients to the idea of choice. Aggression is a learned behavior--which is good news and bad news.

The good news is there is hope for behavioral change (if it were genetic, there'd be less optimism.) Clients can learn to avoid words such as "never" and "should." They can challenge their knee-jerk reactions and learn new ways to respond to stressful situations. They can learn to soothe themselves and to interact with others in a mature and thoughtful manner.

The bad news is there now is a responsibility to choose the appropriate behavior. Many clients have enjoyed the comfort of saying, "I'm an angry guy. It's who I am, so leave me alone." By stressing that they have a choice, and by praising the positive steps they take, we can help clients make better decisions in response to their angry feelings.

Behavior modification

From a behavioral perspective, many clients need to learn basic living skills, such as eating balanced meals, exercising regularly and socializing with safe, sober people. I teach clients relaxation techniques, from deep breathing exercises to guided imagery (visualization) regimens. These can be useful in preventing the stress that leads to anger, and they can be employed in the heat of battle when an explosion is imminent.

Having fun can offer an effective antidote to angry outbursts. But learning how to have fun can be challenging to someone in early recovery. Addiction professionals are well-positioned to model healthy social interactions, to help clients get the most from their recovery meetings, and to praise clients as they fortify their social network and their recovery.

We also can teach our clients the basics of conflict resolution--how to advocate for themselves without being aggressive or showing disrespect for others. These can be the most basic skills, often foreign concepts to our clients. They include:

* Finding some common ground;

* Exhibiting empathic listening skills (I model these for clients);

* Validating the opinion of others;

* Avoiding name calling;

* Agreeing to disagree, without aggression;

* Taking a "time out" when things get heated; and

* Avoiding small rooms/keeping a distance from the other person.


Preventing a relapse to aggressive behavior is like preventing a relapse to drug use. In both cases, clients must identify triggers to relapse, avoid high-risk situations, and learn new coping mechanisms.

If a client does relapse to aggressive behavior, this offers an opportunity to examine what part of the relapse prevention plan was not working. Was there an irrational belief that went unchecked? Was the client hungry, angry, lonely or tired? Were old (dangerous) behaviors sneaking back into the client's life?

Using cognitive restructuring and behavioral modification, we can help our clients recognize their addiction to anger and aggression, and help them learn new responses to old triggers.


Brian Duffy, LMHC, LADC-I, is a Mental Health Counselor at SMOC (South Middlesex Opportunity Council) Behavioral Health Services in Framingham, Mass. He wrote on client relationships in early recovery in the September/October 2011 issue. His e-mail address is
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Title Annotation:Feature
Author:Duffy, Brian
Publication:Addiction Professional
Geographic Code:1USA
Date:Jul 1, 2012
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