Alcohol-Adapted Anger Management Treatment: A Randomized Controlled Trial of an Innovative Therapy for Alcohol Dependence

Abstract

A randomized controlled trial for an innovative alcohol-adapted anger management treatment (AM) for outpatient alcohol dependent individuals scoring moderate or above on anger is described. AM treatment outcomes were compared to those of an empirically-supported intervention, Alcoholics Anonymous Facilitation treatment (AAF). Clients in AM, relative to clients in AAF, were hypothesized to have greater improvement in anger and anger-related cognitions and lesser AA involvement during the 6-month follow-up. Anger-related variables were hypothesized to be stronger predictors of improved alcohol outcomes in the AM treatment condition and AA involvement was hypothesized to be a stronger predictor of alcohol outcomes in the AAF treatment group. Seventy-six alcohol dependent men and women were randomly assigned to treatment condition and followed for 6 months after treatment end. Both AM and AAF treatments were followed by significant reductions in heavy drinking days, alcohol consequences, anger, and maladaptive anger-related thoughts and increases in abstinence and self-confidence regarding not drinking to anger-related triggers. Treatment with AAF was associated with greater AA involvement relative to treatment with AM. Changes in anger and AA involvement were predictive of posttreatment alcohol outcomes for both treatments. Change in trait anger was a stronger predictor of posttreatment alcohol consequences for AM than for AAF clients; during-treatment AA meeting attendance was a stronger predictor of posttreatment heavy drinking and alcohol consequences for AAF than for AM clients. Anger-related constructs and drinking triggers should be foci in treatment of alcohol dependence for anger-involved clients.

Keywords: Alcohol dependence; Alcoholics Anonymous Facilitation treatment; Anger; Anger management treatment; Outpatient treatment; Randomized controlled trial.

Figure 1

Participant flow through the randomized controlled trial. I = interview assessment completed. Q = questionnaire assessment completed.

Figure 2

Panel A: Interaction between Treatment Condition with during-treatment change in trait anger on posttreatment drinking problems. Panel B: Interaction between Treatment Condition with end-of-treatment AA attendance on posttreatment drinks per drinking day. Panel C: Interaction between Treatment Condition with end-of-treatment AA attendance on posttreatment adverse alcohol consequences. Each graph plotted the model-generated means at the 25% and the 75% percentiles from the x-axis distributions.