Anger Management

February 14, 2015


“Anger management is a critical skill for all addiction professionals. These online courses from SAMHSA are important resources.” ~ Terence T. Gorski (The Publications of Terence T. Gorski)

SAMHSA Newsletter on Anger Management Courses

Everyone experiences anger from time to time. It’s a normal emotion. But intense or prolonged anger can jeopardize employment, relationships, education, and even freedom. Those who struggle to control their anger are increasingly finding their way to behavioral health professionals for assistance. It is precisely for this reason that SAMHSA has created resources and a new a online course to help.

We see it in our schools, workplaces, families, and out in public – the person who yells, hits, or throws things – and sometimes sparked by something as small as a missed parking space. In a culture where time is short, anger can surface quickly and with intensity. And anger can erupt into physical violence.

– The Centers for Disease Control’s 2010 National Intimate Partner and Sexual Violence Survey, found that one in ten 9th to 12th graders had been physically hurt on purpose by a boyfriend or girlfriend.

– SAMHSA’s 2012 National Survey on Drug Use and Health: Mental Health Findings revealed that nearly 19 percent of youth receiving mental health services have trouble controlling anger.

– In 2009, the Bureau of Justice Statistics’ National Crime Victimization Survey reported more than a half million nonfatal violent crimes took place at work.

– Prisons and jails are even worse, where 38-50 percent of inmates experience persistent anger and irritability. When the problem results in an arrest or other disciplinary action, there often is a referral or requirement to engage in some therapy or treatment to help manage the intense emotion and prevent additional similar experiences.

The Anger Control Plan
(excerpt taken from SAMHSA’s new Anger Management for Substance Abuse and Mental Health Clients course)

1. Take a time out (formal or informal).
2. Talk to a friend (someone you trust).
3. Use the Conflict Resolution Model to express anger.
4. Exercise (take a walk, go to the gym, etc.).
5. Attend 12-step meetings.
6. Explore primary feelings beneath the anger.

Typically, when someone gets angry, there are responses that are physiological (becoming flushed, burst of energy and arousal, etc.), cognitive (thoughts that occur in response to an event), emotional (feeling afraid, discounted, disrespected, impatient, etc.), and behavioral (sarcasm, swearing, crying, yelling, throwing, etc.).

Problem anger occurs when someone experiences anger as a chronic irritability or a full-on rage – as an emotion experienced too intensely or too often. The consequences of long-term anger issues can lead to arrest, injury (self or others), adverse effects on important relationships, job loss, or treatment program ejection. Some groups have a higher risk of experiencing problems with anger, including individuals with substance use disorders, traumatic brain injury, post-traumatic stress disorder, and personality disorders.

Working with Angry Clients

“Anger management” is currently the most searched term on the SAMHSA website. This reality speaks both to the need for support around this issue and the practical benefit of SAMHSA resources like the Anger Management for Substance Abuse and Mental Health Clients: Participant Workbook and the newly launched Anger Management for Substance Abuse and Mental Health Clients course. The course is especially designed for anyone working with a person who struggles to control anger, but particularly substance abuse and mental health clinicians.

The Five Steps of the Conflict Resolution Model
(excerpt taken from SAMHSA’s new Anger Management for Substance Abuse and Mental Health Clients course)

Step 1: Identify the problem that is causing the conflict.

Step 2: Identify the feelings that are associated with the conflict.

Step 3: Identify the impact of the problem that is causing the conflict.

Step 4: Decide whether to resolve the conflict.

Step 5: Work for resolution of the conflict: How would you like the problem to be resolved? Is a compromise needed?

The online course takes approximately two to three hours to complete and uses a cognitive behavioral approach to working with angry clients. It covers a range of topics including how people respond to getting angry (passively, assertively, aggressively, or passive-aggressively), how to manage anger with people with traumatic brain injury or post-traumatic stress disorder, and how to assess anger and readiness for anger treatment. The course also includes a description of the cognitive behavioral therapy approach, treatment model overview, and other important information about anger management. The course is based on the Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual (also available in Korean and Spanish) and the Anger Management for Substance Abuse and Mental Health Clients: Participant Workbook (also available in Korean and Spanish).
In addition to behavioral health service providers, the course may also prove useful for human resource and other managers, school teachers and administrators, those working in the criminal justice system, or anyone experiencing anger issues. Upon completion of the course, certification is provided for continuing education credit.

Anger Management for Substance Abuse and Mental Health Clients: A Cognitive Behavioral Therapy Manual (also available in Korean and Spanish)

Anger Management for Substance Abuse and Mental Health Clients Participant Workbook (also available in Korean and Spanish)

Resources on the Internet

My Depression Management Plan

January 16, 2015

By Terence T. Gorski

Read Terry Gorski’s Book: Depression and Relapse

Major depression is a serious problem for many people, including people in recovery from alcoholism and other chemical addictions. Many people suffer from depression in recovery and I was no exception. After more than twenty-five years of sobriety, depression nearly took me down.

I figured out a way to manage it. Part of the process of figuring out what to involved researching depression and writing a book about what I learned from the process. The book Depression and Relapse.

I wrote this blog today because I have friend suffering from depression in recovery. I wrote a summary of the things I did to help myself get through the dark times. I thought it might be helpful to others.

Let me know what you think. If you have survived serious depression and used some tools or techniques that helped but aren’t listed here, add them in a comment and be sure to identify yourself and a link to your blog or website so I can properly reference the source. It might help send some traffic your way. So, let’s get on with it.

To manage my severe depression I had to self-monitor it’s severity four times per day (breakfast, lunch, dinner, and before bed).
I used a ten point scale:

0 = No Depression/Normal Mood;

1 – 3 = Mild Depression: It is a nuisance, but I can put it out of my mind and do all of my acts of daily living.

4 -7 = Moderate Depression: It is a nuisance but at times is so severe and drains so much energy that at times I can’t stay focused on my normal daily tasks. At other times I can.

7 -9 = Severe Depression: I get yo and try to function but I usually can’t complete my daily acts of living so I shrink my world by avoiding things.

10 = Disabling: The depression is so bad that I can barely function at all. I can’t get out of bed, I can’t do basic tasks, and no matter what anyone says or does I feel buried by the depression.

I kept a log four times per day and started looking for pattens. I noticed my depression would move through my life in up-and-down cycles. There were times of the day when I was more depressed no matter what was going on. There were other times of the day when the depression wasn’t as bad. I began to see that there were predictable cycles to the severity of my depression symptoms.

I noticed that the depression started to increase and get worse at certain times of the day. Knowing this allowed me to anticipate when I would be the most depressed and avoid scheduling important things during those times. I also learned the times when I tended to be the least depressed and most functional. This allowed to plan my most important activities during those time.

I also noticed weekly cycles. On certain days of the week I would be more depressed than on others. In other words, I could anticipate the really bad days and the better days.

I began doing things to try and manage the depression symptoms. I kept it simple:

– I scheduled alone time for 15 – 30 minutes a day and just distracted myself with pleasant mindless things.

– I took a twenty minute walk each day.

– I started to do brief (3 – 5 minute) sessions of mindfulness meditation.

Here is how I did it:

I also used a meditation technique called Magic Triangle Relaxation Methof. It is described here:

It wasn’t easy to manage the depression and most people didn’t understand what I was going through. They would ask me: “Why don’t you just snap out of it?” The answer was easy: “I can’t because I have a depressive illness!”

Many of the people I knew were really angry because I wasn’t able to work as hard or be there for them in the ways I was before I got depressed.

One of the things that kept me going was the research that showed how serious episodes of clinical depression tend to run a course of about nine to eighteen months. Each major depressive episode tends to go through three stages:

Stage 1: Gradual increase in the frequency and severity of depression symptom episodes.

Stage 2: The period of most frequent and intense symptoms. This is the stage where most people seek help because the depression is causing life problems. It’s much better to recognize depression in stage one and make managing the emerging symptoms as a top priority. When I did this I found stage 2 would to be shorter and the depression symptoms less severe and disabling. Yes, I had more than one ride on this roller coaster to dark side of depression. I learned from each ride and used it to make the next ride shorter and more manageable.

Stage 3: A period of gradual Symptom reduction until a normal mood (whatever that is) returns.

What I found is that I had always suffered from a chronic low-grade form of depression called Dysthymia. I also discovered depression ran in my family so I considered low grade depression to be normal.

I also paid attention to my automatic thoughts that made my depression worse. I figured out how to actively challenge my automatic depressive thinking. Both my personal experiences and the research I reviewed on the cognitive therapy of depression were the same:

1. There are automatic thoughts that made my depression worse.

2. When I let these depressive thoughts bounce around in my brain my depression kept getting worse.

The depressive thoughts that make depression worse are:

1. This is awful (Awful means worse than it could ever be).

2. This is terrible (terrible means that there will be serious losses of everything that I value).

3. It’s always been this way, I’ve never had a single moment in my life when I wasn’t depressed.

4. It will always be this way. I won’t ever be able to feel better.

5. I can’t stand the way I feel! (Although it is obvious I could stand it because what else could I do?)

6. I can’t do anything about it. There is nothing I can do to make the symptoms even in a little bit better.

7. I am helpless and hopeless in the face of my depression.

8. There is nothing I can do! I can’t do anything to manage the depression or make myself feel even a little bit better for a few minutes.

9. Being depressed proves that I am no good as a person.

10. My depression has robbed me of everything I value and has made me a helpless, useless, crazy person.

Before I figured all of this out, I became suicidal. I felt the compulsion to end myself. The impulse to commit suicide was so strong and persistent it was difficult to resist.

I had to tell close friends about it. I put all potential suicide tools in the hands of friends with clear instructions not to let me have them back. This included my guns, and anything in the medicine cabinet that could be lethal. There are many over-the-counter medications that can kill you with as few as thirty pills. 

How did I know this? The Internet is a wonderful tool for the suicidal. I put the prescription medications I was taking in the hands of someone else who would give me the daily doses of prescribed medication.

Recognizing and managing my suicidal preoccupations and compulsions is a story for another time.

I also used prayer and meditation. This helped me to transcend or rise above the worst symptoms of depression and to find a meaning in my suffering.

It is important to remember that THIS TO SHALL PASS. Depression is not forever and there are things you can do to reduce the severity and duration of depressive episodes.

Read Terry Gorski’s Book: Depression and Relapse

The exercises in the COGNITIVE RESTRUCTURING FOR ADDICTION WORKBOOK can be easily applied to depression.

The principles of 12-Step Programs can also be helpful. See Understanding the Twelve Steps.

Depression and Suicide – Understanding The Relationship

August 19, 2014


By Terence T. Gorski, Author

People don’t die from suicide. They die from the untreated fatal symptoms of the illness of depression. The core symptoms of depression are related with the brain chemistry balance which creates hopelessness, despair, and suicidal ideation. In other words, death by suicide is most often the fatal last symptom of chronic depression.

So people don’t die from suicide. Suicide is the immediate cause of death, but the illness of depression is what creates the urge to die. Let’s compare this way of thinking to other terminal illnesses.

When people die from cancer, their cause of death can be various horrible things such things as seizure, stroke, or pneumonia. When someone dies after battling cancer, and people ask “How did they die?” you never hear anyone say “pulmonary embolism”, the answer is always “cancer”. A Pulmonary Embolism can be the final cause of death with some cancers, but when a friend of mine died from cancer, he died from cancer. That was it. And when someone has suicide as the immediate cause of death they die from “Depression”. Depression often coexists with alcoholism and other drug addictions. They die from coexisting disorders with depression as the cause of the terminal symptom of depression.

Suicide is not a choice. People don’t make the decision to kill themselves if they are mentally and physically healthy. The word “suicide” gives many people the impression that “it was his or her own decision,” or “he or she chose to die.” Thus is very different from the way that we think about people who die from cancer, chronic heart disease, or AIDES. We see people with these illnesses as fighting to live and being overcome be the terminal symptoms of a progressive illness.

Depressed people fight for their lives against the disease of depression and die from the progressive symptoms of hopelessness and despair.

The real problem is that depression is a misunderstood condition. People somehow assume people suffering from depression choose to be depressed, choose to be hopeless, choose the chronic unbearable pain of depressive illness and ultimately choose to commit suicide when they believed they had other choices. The stigma associated with both depression and it’s terminal stage symptom of suicide is extreme. It causes people to hide their illness due to the feeling of guilt (I must be doing something wrong that causes my depression) and shame (my depression results from being a worthless person somehow inherently dysfunctional). When the illness is hidden and people feel ashamed of having it they are less likely to seek proper diagnosis and treatment.

Many people have little sympathy for people who are depressed and suicidal. Those who commit suicide are generally blamed for the pain their suicide caused to others rather than being empathized with for the pain they suffered that led to despair. In our current cultural misunderstanding of depression we should be able to pull ourselves out of depression by pulling up on our own shoelaces.

Let’s see if we can get a new and more helpful perspective of suicide as the fatal symptom of a long-term battle with the chronic disease of depression.

Depression is an illness, not a choice of lifestyle. It’s not the same as feeling sad, being down, getting discouraged or having a bad day. Depressed people can’t just “cheer up” and get over their depression by somehow choosing to feel better. Just as we can’t choose not to have cancer or use will power to get rid our tumors, we can’t just choose not to be depressed and use will power to get rid of the pain Nd hopelessness. When someone commits suicide as a result of Depression, they die from Depression – an illness that kills millions each year. Depressed people do not voluntarily become depressed nor do they voluntarily stay depressed. Most people suffering from depression fight back against their depression every day. The shame of being depressed, however, stops people from admitting they have an illness and researching all possible treatment options.

There are lifestyles that promote health and well bring and minimize the risk of developing chronic life-style related illness. These healthy lifestyles can delay the onset of depression and prepare a person with skills for managing the symptoms before the depression becomes debilitating. Depression, however, follows the same patterns of prevention as other illnesses. Healthy living and avoiding risk factors can delay the onset of symptoms. Knowing the early symptoms can result in early identification and being open to seeking a combination of biological, psychological, social and spiritual approaches to managing symptom episodes. Relapse prevention and early intervention strategies can lead to shorter episodes of less severe symptoms and radically extend the length and quality of life. The inherent level genetic predisposition, limited lifestyle options, and lack of access to effective diagnosis, treatment, and community support for recovery will make a big difference in the course of the illness and how well it is managed.

It is hard to know exactly how many people actually die from depression each year because the statistics only seem to show how many people die from “suicide” each year and because of the stigma of death by suicide the cause of death is often misrepresented. Another problem that confuses the issue is that not everyone who commits suicide suffers from depression.

But considering that one person commits suicide every 14 minutes in the US alone, we clearly need to do more to battle this illness, and the stigmas that continue to surround it.

Perhaps depression might lose some its “it was his own fault” stigma, if we start focussing on the illness, rather than the symptom. People don’t die from suicide. They die from Depression. Death by suicide is not usually a choice, although some people do consciously and rationally choose to end their lives. This issue involves people with debilitating terminal or disabling illnesses and involves the moral and political issue of “the right to die.” This is a different issue than suicide as an involuntary result of severe depression. The depression removes the choice by creating biochemical brain balances that create chronic pain, hopelessness and despair.

There is hope. There are disease management strategies that help people to manage the CHRONICALLY RELAPSING DISEASE of depression. The key is a healthy lifestyle that prevents or delays or the onset of symptoms, recognizing the symptoms early and knowing treatment options and resources.

The book DEPRESSION AND RELAPSE discusses the management of depression especially when the depression coexists with addiction.

Alcohol Use in the United States, 2012

August 12, 2014




Prevalence of Drinking:

In 2012, 87.6 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 71 percent reported that they drank in the past year; 56.3 percent reported that they drank in the past month.1

Prevalence of Binge Drinking and Heavy Drinking:

In 2012, 24.6 percent of people ages 18 or older reported that they engaged in binge drinking in the past month; 7.1 percent reported that they engaged in heavy drinking in the past month.2

Alcohol Use Disorders (AUDs) in the United States:

Adults (ages 18+): Approximately 17 million adults ages 18 and older (7.2 percent of this age group) had an AUD in 2012. This includes 11.2 million men (9.9 percent of men in this age group) and 5.7 million women (4.6 percent of women in this age group).3
About 1.4 million adults received treatment for an AUD at a specialized facility in 2012 (8.4 percent of adults in need). This included 416,000 women (7.3 percent of women in need) and 1.0 million men (8.9 percent of men in need).4

Youth (ages 12–17): In 2012, an estimated 855,000 adolescents ages 12–17 (3.4 percent of this age group) had an AUD. This number includes 444,000 females (3.6 percent) and 411,000 males (3.2 percent).5
An estimated 76,000 adolescents received treatment for an AUD at a specialized facility in 2012 (8.9 percent of adolescents in need). This included 28,000 females (6.3 percent of adolescent females in need) and 48,000 males (11.7 percent of adolescent males in need).6

Alcohol-Related Deaths:

Nearly 88,0007 people (approximately 62,000 men and 26,000 women8) die from alcohol related causes annually, making it the third leading preventable cause of death in the United States.7

In 2012, alcohol-impaired-driving fatalities accounted for 10,322 deaths (31 percent of overall driving fatalities).9

Economic Burden:

In 2006, alcohol misuse problems cost the United States $223.5 billion.10

Almost three-quarters of the total cost of alcohol misuse is related to binge drinking.10

Global Burden:

In 2012, 3.3 million deaths, or 5.9 percent of all global deaths (7.6 percent for men and 4 percent for women), were attributable to alcohol consumption.11

Alcohol contributes to over 200 diseases and injury-related health conditions, most notably alcohol dependence, liver cirrhosis, cancers, and injuries.12

In 2012, alcohol accounted for 5.1 percent of disability adjusted life years (DALYs) worldwide.11

Risk Factor For Premature Death

Globally, alcohol misuse is the fifth leading risk factor for premature death and disability; among people between the ages of 15 and 49, it is the first.13

Family Consequences:

More than 10 percent of U.S. children live with a parent with alcohol problems, according to a 2012 study.14

Underage Drinking:

Prevalence of Underage Alcohol Use:
Prevalence of Drinking: 2 out of 5 15-year-olds report that they have had at least 1 drink in their lives.15 In 2012, about 9.3 million people ages 12–20 (24.3 percent of this age group) reported drinking alcohol in the past month (24.7 percent of males and 24 percent of females).16

Prevalence of Binge Drinking:

Approximately 5.9 million people (about 15 percent) ages 12–20 were binge drinkers (16.5 percent of males and 14 percent of females).16

Prevalence of Heavy Drinking:

Approximately 1.7 million people (about 4.3 percent) ages 12–20 were heavy drinkers (5.2 percent of males and 3.4 percent of females).16

Consequences of Underage Alcohol Use:

Research indicates that alcohol use during the teenage years could interfere with normal adolescent brain development and increase the risk of developing an AUD. In addition, underage drinking contributes to a range of acute consequences, including injuries, sexual assaults, and even deaths.17

Alcohol and College Students:

Prevalence of Alcohol Use:
Prevalence of Drinking: In 2012, 60.3 percent of college students ages 18–22 drank alcohol in the past month compared with 51.9 percent of same-age peers not in college.18

Prevalence of Binge Drinking: 40.1 percent of college students ages 18–22 engaged in binge drinking (5 or more drinks on an occasion) in the past month compared with 35 percent of same-age peers not in college.19

Prevalence of Heavy Drinking: 14.4 percent of college students ages 18–22 engaged in heavy drinking (5 or more drinks on an occasion on 5 or more occasions per month) in the past month compared with 10.7 percent of same-age peers not in college.20

Consequences—Researchers estimate that each year:
– 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor-vehicle crashes.21

– 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.21

– 97,000 students between the ages of 18 and 24 report experiencing alcohol-related sexual assault or date rape.21

– Roughly 20 percent of college students meet the criteria for an AUD.22

– About 1 in 4 college students report consequences from drinking, including missing class, falling behind in class, doing poorly on exams or papers, and receiving lower grades overall.23

Alcohol and Pregnancy:

The prevalence of Fetal Alcohol Syndrome (FAS) in the United States was estimated by the Institute of Medicine in 1996 to be between 0.5 and 3.0 cases per 1,000.24

More recent reports from specific U.S. sites found the prevalence of FAS to be 2 to 7 cases per 1,000,24 and the prevalence of Fetal Alcohol Spectrum Disorders (FASD) to be as high as 20 to 50 cases per 1,000.25

Alcohol and the Human Body:

Among all cirrhosis deaths in 2009, 48.2 percent were alcohol related. The proportion of alcohol-related cirrhosis was highest (70.6 percent) among decedents ages 35–44.26

In 2009, alcohol-related liver disease was the primary cause of almost 1 in 3 liver transplants in the United States.27

Alcohol has been identified as a risk factor for the following types of cancer: mouth, esophagus, pharynx, larynx, liver, and breast.28

Health Benefits of Moderate Alcohol Consumption:

Moderate alcohol consumption, according to the Dietary Guidelines for Americans, is up to 1 drink per day for women and up to 2 drinks per day for men.29

Moderate alcohol consumption may have beneficial effects on health. These include decreased risk for heart disease and mortality due to heart disease, decreased risk of ischemic stroke (in which the arteries to the brain become narrowed or blocked, resulting in reduced blood flow), and decreased risk of diabetes.30

In most Western countries where chronic diseases such as coronary heart disease (CHD), cancer, stroke, and diabetes are the primary causes of death, results from large epidemiological studies consistently show that alcohol reduces mortality, especially among middle-aged and older men and women—an association which is likely due to the protective effects of moderate alcohol consumption on CHD, diabetes, and ischemic stroke.31

It is estimated that 26,000 deaths were averted in 2005 because of reductions in heart disease, stroke, and diabetes from the benefits attributed to moderate alcohol consumption.32

Expanding our understanding of the relationship between moderate alcohol consumption and potential health benefits remains a challenge, and although there are positive effects, alcohol may not benefit everyone who drinks moderately.

Alcohol Use Disorder (AUD): AUDs are medical conditions that doctors diagnose when a patient’s drinking causes distress or harm. The fourth edition of the Diagnostic and Statistical Manual (DSM–IV), published by the American Psychiatric Association, described two distinct disorders—alcohol abuse and alcohol dependence—with specific criteria for each. The fifth edition, DSM–5, integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder, or AUD, with mild, moderate, and severe subclassifications.

Binge Drinking:

NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This usually occurs after 4 drinks for women and 5 drinks for men—in about 2 hours.33

The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking as drinking 5 or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days.34

Heavy Drinking: SAMHSA defines heavy drinking as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days.

NIAAA’s Definition of Drinking at Low Risk for Developing an AUD:

For women, low-risk drinking is defined as no more than 3 drinks on any single day and no more than 7 drinks per week. For men, it is defined as no more than 4 drinks on any single day and no more than 14 drinks per week. NIAAA research shows that only about 2 in 100 people who drink within these limits have an AUD.

Substance Use Treatment at a Specialty Facility:

Treatment received at a hospital (inpatient only), rehabilitation facility (inpatient or outpatient), or mental health center to reduce alcohol use, or to address medical problems associated with alcohol use.

Alcohol-Impaired-Driving Fatality: A fatality in a crash involving a driver or motorcycle rider (operator) with a BAC of 0.08 g/dL or greater.

Disability Adjusted Life Years (DALYs):

A measure of years of life lost or lived in less than full health.

Underage Drinking: Alcohol use by anyone under the age of 21. In the United States, the legal drinking age is 21.

For more information, please visit:

1 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

2 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

3 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

4 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

5 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

6 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

7 Centers for Disease Control and Prevention. Alcohol use and health. Available at:

8 Centers for Disease Control and Prevention. Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Available at:

9 National Highway Traffic Safety Administration. 2012 Motor vehicle crashes: Overview. Available at:

10 Centers for Disease Control and Prevention. Excessive drinking costs U.S. $223.5 Billion. Available at:

11 World Health Organization. Global status report on alcohol and health, p. XIV. 2014 ed. Available at:

12 World Health Organization. Global status report on alcohol and health, p. XIII. 2014 ed. Available at:

13 Lim, S.S.; Vos, T.; Flaxman, A.D.; et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2224–2260, 2012. PMID: 23245609

14 Substance Abuse and Mental Health Services Administration (SAMHSA). Data spotlight: Over 7 million children live with a parent with alcohol problems. 2012. Available at:

15 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

16 Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2012 National Survey on Drug Use and Health: Summary of national findings. NSDUH Series H-46., HHS Publication No. (SMA) 13–4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. Available at:

17 National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol Alert, No. 67 “Underage Drinking,” 2006. Available at:

18 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

19 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

20 Substance Abuse and Mental Health Services Administration (SAMHSA). 2012 National Survey on Drug Use and Health (NSDUH). Available at:

21 Hingson, R.W.; Zha, W.; and Weitzman, E.R. Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18–24, 1998-2005. Journal of Studies on Alcohol and Drugs (Suppl. 16):12–20, 2009. PMID: 19538908

22 Blanco, C.; Okuda, M.; Wright, C. et al. Mental health of college students and their non-college-attending peers: Results from the National Epidemiologic Study on Alcohol and Related Conditions. Archives of General Psychiatry 65(12):1429–1437, 2008. PMID: 19047530

23 Wechsler, H.; Dowdall, G.W.; Maenner, G.; et al. Changes in binge drinking and related problems among American college students between 1993 and 1997: Results of the Harvard School of Public Health College Alcohol Study. Journal of American College Health 47(2):57–68, 1998. PMID: 9782661 pdf/10.1080/07448489809595621

24 Stratton, K., Howe, C., Battaglia, F., eds. 1996 Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: Institute of Medicine National Academy Press, 1996.

25 May, P.A.; Gossage, J.P.; Kalberg, W.O.; et al. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Developmental Disabilities Research Reviews 15(3):176–192, 2009. PMID:19731384

26 Yoon, Y.H., and Yi, H.Y. Surveillance Report #93: Liver Cirrhosis Mortality in the United States, 1970–2009. Bethesda, MD: NIAAA, 2012. Available at:

27 Singal, A.K.; Guturu, P.; and Hmoud, B.; et al. Evolving frequency and outcomes of liver transplantation based on etiology of liver disease. Transplantation 95(5):755–760, 2012. PMID: 23370710 (Please note: The “almost 1 in 3” figure aggregates the total number of transplants necessitated by alcoholic cirrhosis, alcoholic liver disease plus hepatitis C virus infection, and 40 percent of transplants necessitated by hepatocellular carcinoma.)

28 National Cancer Institute. Cancer Trends Progress Report, 2009–2010 Update. Available at: 91&coid=906&mid

29 U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, p. 31. Available at:

30 U.S. Department of Agriculture. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, pp. 355, 359. Available at:

31 U.S. Department of Agriculture. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, pp. 355–356. Available at:

32 Danaei, G.; Ding, E.L.; Mozaffarian, D.; et al. The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Medicine 6(4):1–23, 2009. PMID: 19399161

33 National Institute on Alcohol Abuse and Alcoholism (NIAAA). NIAAA Council Approves Definition of Binge Drinking. NIAAA Newsletter Number 3, Winter 2004. Available at:

34 Substance Abuse and Mental Health Services Administration (SAMHSA). Binge Drinking: Terminology and Patterns of Use. Available at:

Last reviewed: July 2014


June 6, 2014

20140606-163003-59403433.jpgby Terence T. Gorski

ADDICTION is a pattern of compulsive use of alcohol and other drugs, described in DSM IV as A Substance Use Disorder.

In this blog I am going to use the term PSYCHOPATHY interchangeably with the terms ANTISOCIAL PERSONALITY DISORDER (ASPD) and SOCIOPATHY. These three terms describe essentially the same personality disorder marked by the following symptoms:
– a lack of empathy,
– a compulsive pattern of challenging authority, breaking rules, and victimizing others;
– the refusal to accept responsibility for the consequences personal behavior;
– the tendency to lie, cheat, steal, and manipulate others with little concern for the consequences; and
– the tendency to avoid responsibility by blame the victim or the enforcer when caught by the consequences of their own behavior.

A PERSONALITY DISORDER is an habitual pattern of believing, perceiving, thinking, feeling, acting, and relating to others that begins in early childhood, persists into adulthood, affects many areas of life and causes problems in social and occupation functioning.

Addictive disorders, described in the DSM as Substance Use Disorders, are not personality disorders. Addiction is a condition marked by:
– the obsession with and compulsion to use alcohol and other mind-altering substances;
– a compulsive pattern of use resulting in a loss of control over the ability to self-regulate the quantity, frequency, and duration of substance use; and
– secondary life and health problems caused by the progressive loss if control.

Psychopathy and addiction, although they share some characteristics, are not the same type of disorder. Some, but not all people suffering from addiction also have psychopathy. Some, but not all people suffering from psychopathy also abuse or become addicted to alcohol and other drugs. These are coexisting or co-occurring disorders that are different in kind.

Psychopathy is a personality disorder. Addiction is not!

There is no evidence that there is any personality style or disorder that causes addiction. People with all variations of healthy personality styles and personality disorders can become addicted.

The research suggests that chronic stage alcoholism and drug addiction creates some symptoms that look like the symptoms of antisocial disorder.

As people stabilize from acute withdrawal and post acute withdrawal (PAW), these symptom rapidly decrease as measured by standard personality tests within the first thirty days of sobriety.

Therefore, it is important to indicate days of sobriety and neuropsychological stability before deciding if antisocial behaviors are long-term personality traits or temporary traits related to the pain and dysfunction of withdrawal.

The diagnostic criteria that separate Psychopathy (Antisocial Personality Disorder), from the other cluster B personality disorders (Histrionic, Narcissistic, and Borderline) are not well established and tend to overlap. It is estimated that about 3-5% of the population suffer from ASPD (which is marked by violating laws and social norm)s, and as many as 20% are socially conforming psychopaths who lack empathy, challenge authority, victimize others, are deceptive, and do not learn from experience.

These socially conforming psychopaths wreak havoc and destruction all around them and destroy lives but are skilled at shifting the blame onto others (flipping the script) and avoiding legal consequences.

Alcoholics and prescription drug addiction have about the same incidence of psychopathy as the general population. In late stage addiction, the severe symptoms of intoxication, withdrawal, and post acute withdrawal can look like the symptoms of ASPD especially in a society that highly stigmatizes addiction.

People who use and/or become addicted to illicit (illegal) drugs are another story. Psychopaths are drawn to illegal drugs by their compulsion to challenge authority, break rules, and find excitement through extreme manipulation and risk-taking behavior. As a result, the incidence of antisocial behavior and psychopathic personality disorders is higher among illegal drug addicts than in alcohol or presciption drug addicts.



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