Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jan-Feb;44(1):103-110.
doi: 10.1590/1516-4446-2020-1133.

Anger and substance abuse: a systematic review and meta-analysis

Helen V Laitano  1   2 , Amanda Ely  1   2 , Anne O Sordi  1 , Felipe B Schuch  3 , Flavio Pechansky  1 , Thiago Hartmann  1 , Juliana B Hilgert  1 , Eliana M Wendland  4 , Lisia Von Dimen  1 , Juliana N Scherer  1 , Alessandra Mendes Calixto  1 , Joana C M Narvaez  4 , Felipe Ornell  1 , Félix H P Kessler  1
Affiliations
Meta-Analysis

Anger and substance abuse: a systematic review and meta-analysis

Helen V Laitano et al. Braz J Psychiatry. 2022 Jan-Feb.

Abstract

Objective: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU).

Methods: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched.

Results: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 non-users, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p ≤ 0.00, inconsistency index [I2] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users.

Conclusion: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. PRISMA flow diagram of systematic review and meta-analysis.
Figure 2
Figure 2. Meta-analysis: comparison of anger levels between users and non-users of psychoactive substances. 95%CI = 95% confidence interval.
See this image and copyright information in PMC

References

    1. Czermainski FR, Lopes FM, Ornell F, Pinto Guimarães LS, Von Diemen L, Kessler F, Martins de Almeida RM. Concurrent use of alcohol and crack cocaine is associated with high levels of anger and liability to aggression. Subst Use Misuse. 2020;55:1660–6. - PubMed
    1. Kwako LE, Koob GF. Neuroclinical framework for the role of stress in addiction. Chronic Stress (Thousand Oaks) 2017 Feb;1:2470547017698140. doi: http://10.1177/2470547017698140. Epub 2017 Apr 10. - DOI - PMC - PubMed
    1. Cougle JR, Summers BJ, Allan NP, Dillon KH, Smith HL, Okey SA, et al. Hostile interpretation training for individuals with alcohol use disorder and elevated trait anger: a controlled trial of a web-based intervention. Behav Res Ther. 2017;99:57–66. - PubMed
    1. Forgays DK, Spielberger CD, Ottaway SA, Forgays DG. Factor structure of the State-Trait Anger Expression Inventory for middle-aged men and women. Assessment. 1998;5:141–55. - PubMed
    1. Lievaart M, Franken IH, Hovens JE. Anger assesment and clinical and non-clinical populations: further validation of the State-Trait Anger Expression Inventory-2. J Clin Psychol. 2016;72:263–78. - PubMed