A new study has found that anger is more strongly linked to alcohol and tobacco use and their related disorders compared to other substances. The research, published in The American Journal of Drug and Alcohol Abuse, suggests that anger may be a key emotional factor that increases the risk of developing these substance use disorders and hinders recovery. The findings also challenge stereotypes about violence and illicit drug use, highlighting that legal substances like alcohol and nicotine are more closely associated with anger.
Substance use disorders pose a substantial health and economic burden in the United States, affecting millions and costing billions in medical expenses each year. Despite the widespread prevalence of these disorders, only a small percentage of individuals receive treatment, and many who do are at risk of relapse. This makes it important to understand the factors contributing to substance use and disorders.
Anger is one such factor linked to substance use. Unlike other negative emotions, such as fear or anxiety—which often motivate individuals to avoid negative situations—anger is associated with a desire to approach or confront the source of frustration.
This distinction suggests that anger might influence substance use differently from other negative emotions. While anger has been studied in the context of specific disorders like alcohol and tobacco use, less is known about its relationship to other substances and whether it is linked more to general use or specifically to disorders.
“I have developed a program of research surrounding anger’s importance in substance use because it is a relatively understudied emotion in this field,” said study author Krista Miloslavich, a PhD candidate at the University of Illinois Chicago under the mentorship of Margaret Wardle. “We usually focus on emotions like sadness, fear, anxiety and relate that to self-medication. With that being said, it is important to understand which substances or substance use disorders are most affected by anger levels to inform where we should prioritize anger management in mainstream substance use treatments.”
The researchers analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), which included responses from 28,753 American adults. This nationally representative survey provided detailed information about participants’ substance use, substance use disorders, and experiences of anger. Participants were asked about their lifetime use of substances like alcohol, tobacco, cannabis, stimulants, and opioids, and whether they had experienced significant anger that interfered with their daily life. The study also took into account factors such as age, race, and other mental health conditions like depression and anxiety.
The researchers found that anger is associated not only with the use of psychoactive substances but also with the development of substance use disorders, especially involving alcohol and tobacco. Their findings indicate that people who experience anger are at a higher risk of developing problematic use patterns with these substances, beyond just occasional or recreational use.
“People should understand that anger is an important emotional factor that may put people at risk for developing substance use disorders or prevent them from recovering,” Miloslavich told PsyPost.
Interestingly, the study challenges some common stereotypes about anger and substance use. While people often associate anger and violent tendencies with the use of illicit drugs like methamphetamine and cocaine, the research suggests that anger is actually more strongly associated with alcohol and tobacco—substances that are legal and more socially accepted. This highlights a broader and perhaps overlooked issue, as alcohol and tobacco, despite their legality, are more frequently linked to anger-related problems than some illegal drugs.
The findings contradict “common stereotypes of ‘violent junkies’ that are often given to individuals who use illicit drugs,” Miloslavich said. “These results show that more common, legal drugs such as alcohol and nicotine are more strongly associated with anger.”
The study has some limitations that should be considered. Because the data were collected at one point in time and asked about lifetime experiences, it’s not possible to determine whether anger leads to substance use or vice versa. Future research could explore this relationship over time to better understand the cause-and-effect dynamics.
“Research always needs to be interpreted with caution as you can never conduct a perfect experiment,” Miloslavich noted. “Specifically for this study, it is important to know that this data was not collected with a hypothesis in mind. In other words, this dataset was not set up to measure this question, necessarily. Although the research was sound, secondary data analyses such as these are not considered as robust as hypothesis-driven data collection. The major benefits of using a national dataset such as NESARC-III is that we are able to sample from the broader population of the United States in ways that would be impossible for most research done through individual labs.”
Despite these limitations, the findings highlight the importance of considering anger in the prevention and treatment of substance use disorders, particularly for alcohol and tobacco. Anger may play a significant role in both the development and persistence of these disorders. If the mechanisms driving this association can be identified, treatments that focus specifically on managing anger could be more effective for individuals struggling with alcohol and tobacco use disorders, potentially reducing the risk of relapse and aiding recovery.
“My long-term goal with this research is to further the study of anger-related substance use to inform future treatment options,” Miloslavich said. “Right now, anger management is not a huge part of most treatments for substance use and needs to be further studied in order to facilitate that change.”
“I would like to add that these results are not the opinions of the United States government or any of its entities, especially the National Institute on Alcohol Abuse and Alcoholism (NIAAA) who sponsored, directed, and designed the NESARC-III study.”
The study, “Anger is more strongly associated with alcohol and tobacco use and use disorders compared to other substances in American adults,” was authored by Krista Miloslavich and Margaret Wardle.
