Anger is more strongly linked to alcohol and tobacco use than to illicit drug use

A new study has found that anger is more strongly linked to alcohol and tobacco use and related disorders compared to other substances. The study, published in The American Journal of Drug and Alcohol Abusesuggests that anger may be an important emotional factor that increases the risk of developing these substance use disorders and hinders recovery. The results also challenge stereotypes about violence and illegal drug use, highlighting that legal substances such as alcohol and nicotine are more strongly linked to anger.

Substance use disorders represent a significant health and economic burden in the United States, affecting millions of people and resulting in billions of dollars in medical costs each year. Despite the prevalence of these conditions, only a small percentage of people receive treatment and many are at risk of relapse. Therefore, it is important to understand the factors that contribute to substance use and disorders.

Anger is one such factor related to substance use. Unlike other negative emotions such as fear or anxiety, which often motivate people to avoid negative situations, anger is associated with the desire to approach or confront the source of frustration.

This distinction suggests that anger may influence substance use differently than other negative emotions. While anger has been studied in relation to specific disorders such as alcohol and tobacco use, less is known about its relationship to other substances and whether it is more related to general use or to disorders specifically.

“I developed a research program on the role of anger in substance use because it is a relatively under-researched emotion in this area,” said study author Krista Miloslavich, a doctoral student at the University of Illinois Chicago under the supervision of Margaret Wardle. “We typically focus on emotions such as sadness, fear and anxiety and associate that with self-medication. “With this in mind, it is important to understand which substances or substance use disorders are most affected by anger levels in order to clarify where we should prioritize anger management in mainstream substance use treatment.”

Researchers analyzed data from the National Epidemiological 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 anger experiences. Participants were asked about their lifetime use of substances such as alcohol, tobacco, cannabis, stimulants and opioids and whether they had experienced significant anger that interfered with their daily lives. The study also took into account factors such as age, race and other mental illnesses such as depression and anxiety.

The researchers found that anger is linked not only to the use of psychoactive substances, but also to the development of substance use disorders, particularly those related to alcohol and tobacco. Their findings suggest that people who experience anger are at greater risk of developing problematic patterns of use of these substances beyond casual or recreational use.

“People should understand that anger is an important emotional factor that can increase the risk of 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 illegal drugs like methamphetamine and cocaine, research suggests that anger is actually more strongly associated with alcohol and tobacco – substances that are legal and more socially acceptable. This highlights a broader and perhaps overlooked problem, as alcohol and tobacco, despite their legality, are more commonly associated with anger problems than some illegal drugs.

The findings contradict “common stereotypes of 'violent junkies' often conveyed to people 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 taken into account. Because the data was collected at a specific point in time and asked about life experiences, it is not possible to determine whether anger leads to substance use or vice versa. Future research could examine this relationship over time to better understand the cause-effect dynamic.

“Research always must be interpreted with caution because you can never conduct a perfect experiment,” Miloslavich noted. “Especially for this study, it is important to know that these data were not collected with a hypothesis in mind. In other words, this data set was not necessarily created to measure this question. Although the research was sound, secondary data analyzes such as this are not considered as robust as hypothesis-driven data collection. The primary advantage of using a national data set like NESARC-III is that we are able to sample the broader population of the United States in a way that would be impossible for most research conducted by individual laboratories.”

Despite these limitations, the results highlight the importance of considering anger in the prevention and treatment of substance use disorders, particularly alcohol and tobacco. Anger can play an important role in both the development and persistence of these disorders. If the mechanisms driving this association can be identified, treatments that specifically focus on anger management could be more effective for individuals struggling with alcohol and tobacco use disorders, reducing the risk of relapse and improving recovery support.

“My long-term goal with this research is to advance the study of anger-related substance use to inform future treatment options,” Miloslavich said. “Right now, anger management does not play a major role in most substance use treatments and needs further study to enable this change.”

“I would like to add that these results are not the opinion of the United States government or any of its entities, particularly the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which sponsored, led and designed the NESARC-III study.”

The study, “Anger is more strongly associated with alcohol and tobacco use and use disorders in American adults compared to other substances,” was authored by Krista Miloslavich and Margaret Wardle.