Managing anger, boosting activity helps substance abusers stick with treatment

August 14, 2002

Encouraging substance abusers to participate in more rewarding activities and manage their negative emotions early in treatment may improve their chances of success, new research suggests.

Previous research has repeatedly shown that participants who stick with their treatment programs for the longest times are most likely to recover and not relapse, explains lead author Carolynn Kohn, Ph.D., of the Kaiser Permanente Division of Research. Prior research also has shown that people whose basic approach to coping with problems is tackling them, not avoiding them, are most likely to succeed in treatment.

The researchers note that the study provides evidence for a link between emotional outbursts and a higher risk of dropping out of treatment, as well as lower risk for patients who engage in rewarding activities that do not involve chemical use.

To determine which specific coping strategies might predict longer -- and therefore more successful -- participation in treatment, Kohn and her colleagues followed 747 adults admitted to an outpatient chemical dependence treatment program. The program consisted of eight weeks of treatment, followed by 10 months of aftercare.

Each participant completed a questionnaire upon admission to treatment that measured reliance on different "approach" and "avoidance" coping strategies. The "approach" strategies included such tactics as attempting to better understand the problem and dealing with it directly. The "avoidance" strategies included avoiding thinking about the problem, becoming involved in substitute activities that provide satisfaction and reducing tension by inappropriately venting negative feelings.

The researchers' findings, reported in the August issue of Alcoholism: Clinical and Experimental Research, confirm that at least one avoidance behavior may be a risk factor for dropping out of treatment. Participants who relied most heavily on emotional discharge, they found, also tended to leave the treatment program earliest.

Extreme emotional expressions were more common among women than men. However, the investigators note, this appeared to be the result not of gender, but of the greater severity of depression and drug use problems among the women. Also, women sought support from others -- an "approach" strategy -- more often than men did.

A more surprising finding, the investigators report, is their observation that seeking alternative rewards was linked to a longer and potentially more productive stay in treatment. This result, according to Kohn, suggests that this avoidance tactic may actually be productive among chemical users.

This interpretation, she adds, is supported by previous findings that chemical users are less likely than the general population to engage in leisure and social activities that are not related to alcohol or drug use.

"This study provides evidence for identifying and decreasing the use of emotional discharge early on in treatment, possibly through the use of intervention strategies such as anger management," the investigators conclude.

At the same time, they note, the results underscore "the importance of clinicians assisting clients in identifying and engaging in new, sober activities," starting early in treatment.
The National Institute on Drug Abuse provided funding for the study.

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