Anger Management Based Alcohol Treatment

Integrated Therapy for Anger and Alcohol Use Disorder

Kimberly Walitzer, Jerry Deffenbacher, Molly Rath

• Publisher: Academic Press
• Year: 2018
• Print ISBN: 9780128127094
• eBook ISBN: 9780128127100
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

Anger Management Based Alcohol Treatment: Integrated Therapy for Anger and Alcohol Use Disorder is an innovative, hands-on guide that introduces clinicians to research-based anger management skills for treating clients with alcohol use disorder. Research has demonstrated an important infl uence of anger-related emotions on drinking behavior and risk for relapse among individuals with drinking problems. This book will empower clinicians to address clients' alcohol use and anger emotions through an effective blend of cognitive, relaxation, and sober coping skills. This combination of skills offers clinicians a concrete method for helping clients manage anger-related emotions and disconnect the anger–alcohol linkage, thereby improving clinical outcomes.The book also features useful ideas for client self-monitoring and accessible tools for evaluating progress in treatment. Three case studies are presented and followed to illustrate the full course of treatment. Practical therapeutic techniques are explained and demonstrated through clinical dialogue examples. This book is ideal for developing clinicians, for experienced clinicians looking to enhance skills, and as an instructional text in training programs.- Empirically-based sobriety and anger management coping skills that are easily integrated- Step-by-step guidance and useful tips for treatment implementation- Reproducible handouts, forms, and assessment tools- Brief reviews of empirical literature, research fi ndings, and suggested readings- Three intensive case studies with detailed examples of clinical dialogue

Section III

Anger Management Based Alcohol Treatment Techniques

Outline

• Chapter 7 Self-Monitoring and Self-Awareness
• Chapter 8 Sobriety Skills
• Chapter 9 Relaxation Coping Skills
• Chapter 10 Cognitive Coping Skills
• Chapter 11 Coping Skills Rehearsal
• Chapter 12 Relapse Prevention
• Chapter 13 Putting It All Together

Chapter 7

Self-Monitoring and Self-Awareness

Abstract

Monitoring health-related behaviors, including alcohol consumption, increases self-knowledge, insight, and understanding of behavior change. A hallmark of anger management based alcohol treatment, recording of alcohol-related and anger-related behaviors, intensity, and consequences facilitates both the client’s and therapist’s insights into the client’s experience. The client monitors the frequency and quantity of alcohol consumption, the frequency and intensity of anger-related emotions, the content and impact of angry cognitions, and the synergistic relationship between anger-related emotions and alcohol involvement. An informative and straightforward monitoring form is recommended and provided to facilitate the client’s daily recording of these experiences. Strategies to enhance adherence and compliance with daily self-monitoring include provision of a clear rationale for the monitoring, identifying and problem solving barriers to monitoring, and providing encouragement and support for this important and critical component of anger management based alcohol treatment.

Keywords

Self-monitoring; adherence; alcohol use; angry thoughts; angry feelings; angry behaviors; cravings; coping efforts

Chapter Points

• 
  Self-monitoring is a useful behavioral strategy to increase self-knowledge, gain insight, and evaluate change over time.
• 
  Regular self-monitoring of the various elements of anger emotions and alcohol use is a hallmark of this treatment approach.
• 
  “Target exercises” are therapeutic tasks, including self-monitoring, that the client is encouraged to complete between sessions.

Questions for Self-Reflection

• 
  What is your opinion on the effectiveness of self-monitoring?
• 
  What experience, if any, do you have tracking your own behaviors?
• 
  What do you do when a client does not complete home practice exercises or worksheets?

David: Now that I’m listening and looking out for anger, I realize it’s everywhere in my life! I can get pissed off at just about anything and I usually do! I wrote a lot down on the log this week and probably could’ve done more. I’m still pretty shocked by this. I think that fact that I’m not drinking is helping me tune in more too. I’ll have to tell my wife at some point but I don’t want to hear “I told you so.” That would piss me off. Ironic, huh?

Rationale for Self-Monitoring

A highly effective way to increase knowledge about ourselves is to objectively, dispassionately, and routinely observe and record our behavior. The process of tracking, or self-monitoring one’s own behavior, is an important strategy for gaining insight into our experiences, understanding how frequent and intense our emotions and responses are, and evaluating changes over time. In our case, the practice of observing behavior and monitoring it is a hallmark of anger management based alcohol treatment and the cornerstone on which insight and change is built. The self-monitoring process begins in the first treatment session and continues throughout the program.

Monitoring health-related behaviors in order to improve health is a common strategy. Foci of health-related behaviors amenable to self-monitoring include smoking (with a goal of smoking cessation), diet (with a goal of improved nutrition and/or weight change), exercise (with a goal of improved physical fitness), and excessive alcohol use (with a goal of drinking reduction or abstinence). Research has demonstrated that self-monitoring, as a component of behavior change therapy, helps improve these outcomes (van Achterberg et al., 2010; Michie et al., 2012). With regard to tracking for Alcohol Use Disorder behavior change, self-monitoring may include entries for amount of alcohol consumed, craving ratings, triggers, description of the setting, coping strategies used, effectiveness rating of the coping strategies, and mutual-help group involvement. As mentioned above, the goal of self-monitoring these thoughts, behaviors, and feelings is, in part, to increase knowledge into drinking quantities and frequencies. Clients often underestimate the quantity of alcohol consumed, especially when translated to standard drinks. Self-monitoring these domains may also produce important insights into high-risk situations and coping efforts.

How many did I have?

Knowing that a client has, for example, five “drinks” per day tells us little about the precise amount of alcohol consumed. Thus, we collaborate with the client in reporting alcohol quantities in terms of standard drinks. In the United States, a “standard drink” is any drink that contains approximately 14 g of ethanol (pure alcohol). This is about 0.6 fluid ounces or 1.2 tablespoons. Fig. 7.1 is the display that we use with the client to facilitate reporting of alcohol quantities in terms of standard drinks.

Figure 7.1 A standard drink explanation chart.

The premise for anger management based alcohol treatment is that anger-related emotions are intertwined with drinking and related problems. Therefore, self-monitoring also includes reporting on dimensions and aspects of anger. Specifically, the self-monitoring target exercises for anger-related emotions include report on their intensity, situational, inter- and intrapersonal triggers, anger-increasing cognitions, and coping strategies. Perhaps most importantly, clients are asked to reflect on the linkages between anger-related emotions and craving for alcohol or drinking. Examples of questions used to explore these connections include the following: On any given day, are cravings for alcohol triggered by any anger-related emotions? Is drinking a method to cope with anger-related emotions? Does alcohol consumption influence the experience of anger-related emotions? If so, does drinking calm these emotions or intensify them? Do the linkages between anger-related emotions, drinking, and craving change from day to day? If so, what are the inter- and intrapersonal factors and situational characteristics that are associated with this variability? And, finally, do these linkages change over the course of anger management based alcohol treatment? Clearly, the therapeutic insights gleaned from the client’s ongoing daily self-monitoring of these circumstances will inform and guide therapy and will allow the client and therapist to track changes (and hopefully improvements!) over the course of therapy.

In the initial treatment session, we introduce the practice of daily self-monitoring as the first in a series of “target exercises.” In the first session, the client is provided with a dai...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedications
• About the Authors
• Acknowledgments
• Section I: Foundations of Anger Management Based Alcohol Treatment
• Section II: Assessment and Preparation
• Section III: Anger Management Based Alcohol Treatment Techniques
• Section IV: Other Topics and Issues
• Appendix I. Assessment Interviews and Questionnaires
• Appendix II. Client Handouts and Worksheets
• References
• Index