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Anger management in addiction recovery – INTERVIEW with Dr. Angela Browne-Miller, Ph.D.

Anger affects addiction recovery

Substance use and abuse often coexist with anger and violence. In fact, many people in addiction recovery credit anger (and fear) as the driving force behind drug and alcohol use. And while some doses of anger can be healthy, others are not. In fact, chronic or explosive anger can affect your entire health in addiction recovery: your physical and mental health, your relationships, and even your work-life including your job position.

If you have problem managing your anger, you probably know how hard it is to understand or look at the behavior objectively. In some peaceful moments, regret may arise, but you may still find it difficult to locate another expression of your anger in those challenging moments. Take hope! You can develop healthy anger management strategies. And here we speak with someone who can help you learn more about them.

Meet Dr. Angela Browne-Miller

Today, we have the unique opportunity to talk with Dr. Angela Browne-Miller about anger management in addiction recovery. Dr. Angela®, as she is known, earned her two Ph.D.’s and two masters degrees at UC Berkeley. She is founder and director of ADDICTION STOPPERS®, working with people all over the U.S., offering treatment programs and workshops to help change lives and heal.

Dr. Browne-Miller can be reached at:

DrAngela@DrAngela.com

 

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Dr. Browne-Miller is author of over fifty books including:

TRANSCENDING ADDICTION (see new 2nd edition),.and

FOR KNOWING NO HURT HO HARM

And, she is editor of these must-read collections:

INTERNATIONAL COLLECTION ON ADDICTIONS

VIOLENCE AND ABUSE IN SOCIETY

Both these collections bring together people around the US and world who are doing cutting edge work in these fields.

ADDICTION BLOG: Dr. Browne-Miller, what is anger?

DR. ANGELA BROWNE-MILLER PH.D.: Anger is not a simple thing. Anger, like other emotions, is a complicated matter, one with a multitude of characteristics and causes. Even defining anger risks reducing anger to something far more simple than it is.

So often, clients arrive in my anger management therapy telling me they generally just feel two emotions: “mad” and “not mad.” Very soon, in learning about anger management, clients see that anger is actually the expression of many different emotions such as:

  • stress
  • anxiety
  • frustration
  • hurt
  • pain
  • fear
  • abandonment
  • loss
    …and more

And once the matter of recovery is also on the table in anger management, the sense of being angry can be all of these emotions plus various feelings linked to the addiction/s themselves such as cravings, fear of relapse, fear of triggers, fear of “the old” self, troubled feelings toward a co-addict, and more.

But first let me note that anger is often quite normal and even healthy, a common experience and often not a problem. In fact, recognizing and then expressing one’s anger in safe ways can be helpful and even healing.

Where anger becomes a problem is when it affects oneself or others in counterproductive, detrimental, negative — undesirable, unhealthy, unsafe — ways. So it is best to talk in terms of healthy versus problem anger, functional versus dysfunctional anger. I find that helping anger management clients see the differences among types of anger is essential.

Unfortunately, too often detrimental, unhealthy, and unsafe anger arises and is expressed without the angry person realizing (until much later) that this is detrimental anger that could be prevented (or expressed differently). And even when anger is understood to be anger, this anger may not be easy to see coming or to control once it arises. There is a lot for clients to learn about unseen as well as obvious anger: knowing what anger is; what the forms of anger are; how to see this anger; and how to manage this anger.

ADDICTION BLOG: What’s the purpose of anger?

DR. ANGELA BROWNE-MILLER PH.D.: The function of what we today call “anger” is likely one developed during evolution to help us address danger. In this sense, our (and other animals’) fight or flight (or what I call in my book, FOR KNOWING NO HURT NO HARM, the fight, flight, and freeze–FFF) response allows us to respond to dangerous situations rapidly in order to protect ourselves. As I explain in the book, this FFF response seems to be all too often running awry these days.

Unfortunately, too often detrimental, unhealthy, and unsafe anger arises and is expressed without the angry person realizing (until much later) that this is detrimental anger that could be prevented (or expressed differently). And even when anger is understood to be anger, this anger may not be easy to see coming or to control once it arises. There is a lot for clients to learn about unseen as well as obvious anger: knowing what anger is; what the forms of anger are; how to see this anger; and how to manage this anger.

ADDICTION BLOG: What are the main signs of an anger problem?

DR. ANGELA BROWNE-MILLER: Everyone benefits by understanding more about anger, and by knowing the signs of an anger problem. A great deal of anger is expressed in ways we do not associate with anger. So here, I am offering just a few of the more obvious signs of a problem with dysfunctional anger, listing these questions excerpted from my ANGER AWARENESS AND MANAGEMENT GUIDE FOR CLIENTS, COUNSELORS, AND THERAPISTS.

I encourage my clients to get to know their anger, to ask themselves these questions (among others) to start:

START BY ASKING YOURSELF SOME GENERAL QUESTIONS:
1. Do I often feel angry? How often?
2. Do I get angry at the drop of a hat, on impulse, without seeing my anger coming?
3. Do I feel that I can control my anger?
4. Do I feel that my anger controls me?
5. When I get angry, do I feel anxious, aggressive, violent, out of control in some way?
6. When I am angry, do I physically act on my anger by breaking something, or hitting someone, or hurting myself in some way?
7. When I get angry, do I say mean or hurtful things to others and or to myself?
8. Do I look back on my angry events and wish I had not acted on my anger? Am I ever surprised at my angry events?
9. Do other people tell me my anger surprises them, that it makes no sense?
10. When I want something and do not get it, how do I feel? And how do I respond?
11. When I think someone is rude or mean to me, how do I feel? And how do I respond?
12. Are there things people do or say that I find hurtful and then difficult to get over, difficult to forgive?
13. Do I hold grudges, resentments, for a long time?
14. When I feel hurt, does this hurt sometimes turn to anger?
15. Do I find myself angry in ways that relate to feelings of past hurts? Do I know when memories of past hurts are making me respond to present time things in angry ways? Have there been events (such as abuse, assault, robbery, etc.) in my life that have harmed or hurt me? Have I recovered from these events or do I feel I still carry the effects of these events? If I do, then again the question, do past hurts bring out present time anger?
16. Do I know when I am under stress? How does stress relate to my anger? Can I list the ten most stressful things in my life? Can I look at each of these and see how I respond to them? Do any of these stressful things make me upset, anxious, sad, afraid, angry?
17. Do I sense any links or sequences of some sort between any of the stress I feel and any of the anger I feel?

AND, ADD TO THE ABOVE QUESTIONS THESE THAT APPLY TO ANGER IN ADDICTION RECOVERY PROCESSES:

18. When I feel stress, do I feel tempted to return to my problem addiction pattern? How do I know this, what are the signs?
19. When I feel anger, do I feel tempted to return to my problem addiction pattern? How do I know this, what are the signs?
20. Do I feel (my or others’) stress presents a problem in my (or others’) recovery?
21. Do I feel (my or others’) anger presents a problem in my (or others’) recovery?
22. What, if anything, addiction-related does my or others’ stress and or anger trigger in me?
23. Can I think through, and then list, the actual sequence/s of stress triggering me into my problem addiction/s?
24. Can I think through, and then list, the actual sequence/s of anger triggering me into my problem addiction/s?

ADDICTION BLOG: What anger management tools do you teach your clients?

DR. ANGELA BROWNE-MILLER: The above anger awareness questions are part of my Anger Awareness Tool, Part 1. Next, I ask my Self Care, Part 1 questions such as:

1. Do I, at this time, have healthy outlets for stress and activities that help with stress reduction?
2. Do I, at this time, have healthy outlets for anger and activities that help with anger control?
3. Do I, at this time, feel that I have effective ways of managing my anger?
4. Do I work on managing my anger on a daily basis?
5. What do I do to control, lower, and safely express my anger?
6. Do I have active sports or hobbies that serve as an outlet for my feelings of stress, anxiety, frustration, fear, anger, etc.?

Working with clients to help them understand and gain control over their anger is a complex process. Ideally there is time to work through many levels of anger and to process the understandings being gained.

In my work with anger management clients, I teach many tools, too many to list here in total. Let me just say a few words about some of the sets of tools I teach.

1. STOP NOW TOOLS
(1-a) 10-20 SECOND SLOW DOWN RULE
However long or brief an anger management program may be, there are some tools to be learned right away. One of these primary tools is what I call the: 10 to 20 SECOND SLOW DOWN RULE. Now, many anger management programs encourage people with anger management issues to count to 4 before responding to an event or person who they find irritating, anxiety provoking, angering. Four seconds is said to be the time it takes to move a behavior out of the impulse realm and into the conscious realm. I have found that while this counting before responding is good, a 10 to even 20 second count is still more effective in slowing response time and giving the anger management client time to actually think about what he or she is about to do or say. So, I teach a 10-20 second slow down rule, having clients practice these while in anger management therapy so that this slowing down is a skill that has already been practiced before experiencing anger again.

I have a whole list of STOP NOW TOOLS I teach. Rather than explain them all here I will just add the second tool in my first category:

(1-b) TIME OUT IS GOOD FOR YOU TOOL
This TIME OUT IS GOOD FOR YOU TOOL teaches the value and process of taking a time out before things escalate, even before you know you are angry.

2. ANGER AWARENESS TOOLS
(2-a) ANGER AWARENESS TOOLS, Part 1
I have listed some of the questions I use in this tool set above.
(2-b) I discuss other ANGER AWARENESS TOOLS in my workshops, books, and other publications.

3. SELF CARE TOOLS
(3-a) I list some of the first SELF CARE AWARENESS TOOLS above.
(3-b) I discuss other SELF CARE AWARENESS TOOLS in my workshops, books, and other publications.

I have other categories of tools as well. I would need a few hours to teach or even list all the tools I teach here. Just come to my sessions, workshops, or retreats to get the full amazing experience of being more and more in touch with yourself, your process, your recovery, your healing.

ADDICTION BLOG: How is anger clinically assessed?

DR. ANGELA BROWNE-MILLER: Elsewhere I write in more depth about terms such as assessment and diagnosis, and condition, disorder, and disease. Here, I will make just a few notes about these terms, the first being that too frequently these terms are thrown around without full understanding of them. It is important to use terms correctly so we don’t confuse our clients.

Next, a few notes of clarification:

(a)  A clinical assessment is usually, in clinical settings, conducted to arrive at a clinical diagnosis.
(b)  General anger itself is not a disorder, although some professionals have suggested that a diagnostic category for unhealthy anger be brought into the range of diagnoses included in the Diagnostic and Statistical Manual V (DSM-5).
(c)  Because anger is so many things, takes so many forms, has so many causes, a single diagnosis for anger would tend to reduce anger to an “it all looks the same” sort of diagnosis.
(d)  Of course, presently the clinical diagnoses that relate to anger are, in some opinions, not speaking directly about anger. There are however several categories in the current DSM-5 that include anger as a symptom. The more and more frequently applied diagnosis of Intermittent Explosive Disorder (IED) is one among several often used. Other often used diagnoses include: Conduct Disorder; Disruptive Disorder; Impulse Control Disorder; Depressive Disorder; and Anxiety Disorders such as PTSD. These are all are examples of commonly used clinical diagnoses when clinicians are working with clients with anger management issues. As is explained in great depth in the collection I put together to include 100s of chapters from people working in over 20 countries, VIOLENCE AND ABUSE IN SOCIETY, anger takes many many forms, has many faces, and deserves a range of diagnostic labels as well as underlying diagnoses.
(e)  I add the matter of underlying diagnoses here because quite often there are deeper diagnoses at work behind the anger such as pre-existing injury, abuse, mental health, personality, and other issues. For example, sexual assault/rape survivors may not always receive efficient or enough treatment, if any, and then may find themselves years later dealing with difficult to explain angers. Another example is personality issues, even Personality Disorders, that can underlie some angers: as in the Obsessive Compulsive Personality Disorder (OCPD) that can trigger suffering when goals and demands are not being met; and as in one of the most prevalent diagnoses, Narcissistic Personality Disorder (NPD) that includes frequent rage reactions when needs for attention, admiration, and control, are not met. NPD diagnoses are quite prevalent these days. In fact, these days many domestic violence batterers group leaders are reporting a high frequency of narcissistic personality characteristics among their participants, and perhaps even disorders themselves. (Note again, characteristics are not necessarily disorders and only trained diagnosticians should diagnose the disorders themselves.)

It is very important in both anger management and addiction recovery work that underlying conditions are not overlooked. Quite frequently, addictions and angers are calls from the underlying conditions asking for attention. In working with many drug and nondrug addicted persons over the years, I have found at least 30% to 50% of these persons to have underlying issues (whether these be histories, conditions, or other situations) that warrant attention.

I am not saying that all people with anger management (or addiction) issues have underlying personality or other disorders, or even characteristics of such disorders, not at all. Nor am I saying that all persons with anger or addiction issues have personal histories of being abused or harmed in other ways. Still, we must be clear that clients’ underlying conditions and personal histories may be playing a big part in their present day angers and addictions.

ADDICTION BLOG: What’s the goal of anger management programs?

DR. ANGELA BROWNE-MILLER: An anger management program works to help clients identify and understand anger, and then to express this anger in safe and healthy forms. Most anger management programs also teach personal accountability processes and tools for controlling one’s anger.

A voluntary anger management client seeks to learn about and work on his or her behavior. A court ordered (or other directed) anger management program has goals that meet the requirement of the court or other referral source as well as general anger management program goals.

Ultimately, the primary goal of an anger management therapy group or program is to work with clients toward increasing control of their anger, to reduce that anger’s harm and danger to self and or others.

And the primary goal of anger management therapy in addiction recovery is all of the above plus many other things such as:

(a)  understanding very important links and possible links between anger and relapse.
(b)  taking a deep look at where unexpressed or poorly expressed anger may be interfering with, or can potentially interfere with, recovery.
(c)  taking a deep look at where the recovery process itself may bring out hitherto unseen angers that are revealed once the addiction (drug/alcohol, other problem pattern) haze recedes.

I have also done a lot of work in the area of co-addiction and co-addict roles in anger and recovery issues. And of course, I have also worked in the area of intimate partner violence and abuse. But I will save discussing all this for another time. This area is complex and calls for time looking at emotional, physical, and other abuse in relationships as well as other expressions of anger, fear, and pain – and how all this relates to addiction recovery processes.

ADDICTION BLOG: Anger and fear have been identified as two (2) of the main emotional drivers of substance abuse. Can you elaborate about how anger compels drug or alcohol use?

ANGELA BROWNE-MILLER: We live in a world that tells us to drug our feelings, to drown our pain, to use chemicals or other addictive behaviors such as:

  • gambling
  • eating
  • spending…

…to deny fear, frustration, anxiety, pain, and anger. Just check out most people’s medicine chests, just watch a range of movies and commercials, just see how sex, drugs, gambling, spending, compulsive behaviors and addictions are considered escapes.

What I have seen in clients is a drugging of pain, fear, anxiety, and yes, of anger itself. Working through recovery with clients I see them come forward with memories, emotions including angers, that surface further once addictive patterns begin to recede. It is important to watch for anger that starts to surface as people move deeper into recovery, as they are growing more in touch with feelings and memories they may have been blocking out with addiction to substances or other activities.

ADDICTION BLOG: How does anger control us in other ways?

ANGELA BROWNE-MILLER: When we do not control our anger, it then controls us, it then controls us on most every level. Anger then begins to express itself directly and indirectly in our actions, words, feelings, decisions we make about life, even decisions we make from moment to moment. The expressed anger releases itself both predictively (such as “he will always blow up when you bring up money”) and also in the form of sudden unexpected outbursts over major and even minor things (such as “she just got angry at someone else because she lost her own wallet).

Basically, uncontrolled anger can take over whether or not we see this happening. Uncontrolled anger can interfere with recovery, can take over any healing process.

UNCONTROLLED ANGER CAN HARM RECOVERIES.
UNCONTROLLED ANGER CAN DESTROY LIVES.

ADDICTION BLOG: How do you assess how long a person can/should remain in anger management training? What are some of the personal factors that you consider?

ANGELA BROWNE-MILLER: In my experience, 12 weeks is a good introduction to, and practice of, anger management. However, when there are actual and repeating problems resulting from a person’s uncontrolled anger, 52 weeks is a better anger management therapy length.

In terms of anger management in recovery from addiction/s, I have seen that in addition to that basic 12 week introduction to anger management I mention above, a return to anger management so that this 12 weeks is repeated or extended often even to a full year program is most useful. In fact, I even have clients I worked with years ago who call me these days and want to come in for “more anger work” so as to help them stay on their healthy recovery tracks.

ADDICTION BLOG: How is individual anger management different than group therapy for anger?

ANGELA BROWNE-MILLER: For many years now, I work with individuals, couples, families, groups, also schools, workplaces, and programs. I find great value in all these forms of psycho-education and therapy.

Sometimes there are very personal reasons for individual therapy, such as privacy and safety of self or others including the client as well as the client’s family, friends, and co-workers. And, individual therapy is the opportunity for very deep and very personalized work which is often very valuable.

However, group work can also be wonderful. I have run many anger management and batterers groups and find the group setting to offer peer feedback, modeling of communication and interaction, and identification with personal development processes. The powerful transformative process of working with a group over time is so moving.

ADDICTION BLOG: How many people in addiction recovery do you think can benefit from anger management therapy?

ANGELA BROWNE-MILLER: Short answer is everyone.

But let me say more here: Given how unseen shifts in our lives and in our bodies and minds can bring about ongoing and unforeseen shifts in anger levels and expressions of anger, it is important for everyone to learn about anger, its forms, its signs, and its management. So, just about everyone in addiction recovery–just as is true for just about everyone not in addiction recovery–can benefit from anger management information and training, and for many also anger management therapy.

Where anger management therapy (in addition to a few classes about anger management) can be valuable, even essential, is when learning a few simple things about anger and its management is not enough to help with issues and events that originally brought on that anger and or addiction, or new issues that come into being during recovery from the anger or the addiction itself. Therapy can be very useful in working with the emotions and memories that surface as anger management is being learned, as well as the underlying issues that can mess with recoveries.

ADDICTION BLOG: Can you tell us a little bit about your personal experience with anger?

ANGELA BROWNE-MILLER: Some profound experiences in my own life brought me to working with substance- and non-substance- addicted persons who had been abused, beaten, raped, robbed, and wronged in other ways as well.

I knew early on I would spend my life helping people cope with and recover from addictions and abuses. Very early on, I first worked with teens who had been labeled “emotionally disturbed” and “chemically dependent.” I saw their rage and pain. I saw their fear. I knew right away that anger management was part of this work, and that helping people cope with their anger was going to have to be present at all levels and in working with all ages.

I then worked in the addiction field for many years, and found time and again the anger in so many of the drug and non-drug addictions. I then worked for several years with victims of crimes and abuse, and with perpetrators of these crime and abuses. And there I found that at least two-thirds of these crimes and abuses involved substances, and that addiction itself was prevalent. I now teach a range of workshops and retreats for clients and professionals about all this such as my ADDICTION STOPPERS® EVENTS: ADDICTION, RECOVERY, AND EMOTION [WORKSHOP] and WORKING THROUGH AND GAINING CONTROL OF ANGER FOR A NEW WAY OF LIVING YOUR LIFE [RETREAT].

ADDICTION BLOG: Is there anything else you would like to share with Addiction Blog readers?

ANGELA BROWNE-MILLER: Recovery from problem addiction as well as from controlling dysfunctional anger are ongoing processes, quite often inextricably linked processes. I have seen remarkable recovery processes, remarkable transitions and transformations among people on the recovery journey. I have watched the light of hope and life return to people’s eyes as they bravely walk the path into self that recoveries from addictions and angers map for us.

ADDICTION BLOG: We hope to answer your questions about getting help for anger here. If you want to learn more or share your own experiences, please don’t hesitate to write in the comment section. We will do our best to provide you with personal and prompt responses.

 

To reach DR. BROWNE-MILLER, or to sign up for her programs and sessions, email

DrAngela@DrAngela.com

To find DR. BROWNE-MILLER’s books on Amazon, see these URLs:
TRANSCENDING ADDICTION
FOR KNOWING NO HURT HO HARM
INTERNATIONAL COLLECTION ON ADDICTIONS
VIOLENCE AND ABUSE IN SOCIETY

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