Few standardized interventions for anger management have been developed for use in drug abuse treatment. The incidence of anger is especially high among cocaine abusers, complicating treatment. The proposed research develops, refines, and pilot tests a cognitive-behavioral intervention for anger management in drug abusers, and develops measures to assess its efficacy. We will conduct pilot studies to determine the extent to which the intervention can decrease anger, violent behaviors, and substance abuse. We have developed an anger management treatment, administered it to a sample of veterans with diagnoses of substance abuse and Post-Traumatic Stress Disorder (PTSD) at the San Francisco Veterans Affairs Medical Center, and outlined a preliminary draft of a treatment manual Preliminary analyses indicated that anger and violence decreased across treatment, suggesting that an effective anger management intervention could be developed if refinement of the manual continued. In the proposed research we manualize our treatment through an iterative process of trial application and revision. We will conduct 12 anger management treatment groups in a sample of 60 male combat veterans diagnosed with PTSD and cocaine abuse, who have been identified as having anger control problems. We will revise the manual on this sample of male veterans and extend the anger management treatment by conducting 4 groups in a sample of 32 female cocaine abusers, who have been identified as having anger control problems. We will develop measures of therapist adherence, violent behavior, and anger management strategies, concurrently, as we manualize our treatment. The last three cohorts of subjects (n=18-24) will be compared with matched patients who cannot attend the group because of scheduling problems. In both male and female samples of cocaine abusers, outcome variables will be anger, as assessed through standardized inventories, and violent behaviors, as assessed through self- and other-reporters. Variables will be assessed at baseline, and at weeks 4, 8, 12, and at 3-month post- treatment follow-up. During each week of treatment, urine toxicology screens will be used to assess cocaine, as well as opioids, amphetamines, benzodiazepines, and tetrahydrocanabinol. This research will produce a treatment for anger management for substance abusers with anger control problems, and will accrue knowledge about anger, violence, and drug use in cocaine abusers.

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National Institute on Drug Abuse (NIDA)
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University of California San Francisco
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