The metabolic by-products of alcohol—acetylaldehyde, among
others—and the depletions of dopamine often cause as much irritability
as the alcohol itself. Substance abusers who were relaxed and happy the night
before can become holy terrors the morning after. This sort of rebound
effect is characteristic of substances that work primarily as depressants, such
as cannabis, barbiturates, and benzodiazepines. Marijuana intoxication can
also cause acute paranoid states that can easily lead to explosions into anger.
Stimulants of all kinds, including caffeine, cocaine, and amphetamine,
lead to increased arousal and agitation. Anger is seldom far behind. The
most important thing to remember about the relationship of substance
abuse and anger is that the substance abuse must be treated first. No treat-
ment for anger control, neither therapy nor medication, will work on peo-
ple who are actively abusing substances.
Most of the strategies for dealing with explosions into anger that I
present here won’t work either. It is not possible to reason with someone
who is intoxicated. Don’t even try, especially if you’ve been indulging
yourself. The most effective approach for intoxicated anger is to get away
as quickly as possible and deal with the situation at a later time.
GENERALIZED ANXIETY DISORDER. We’ve seen how anxiety brings out
the desire to control. When anything or anybody refuses to be controlled,
anxious people get upset. Generalized anxiety can lead to irritability and
carping, but seldom to full-blown explosions. On the receiving end, it feels
more like being pecked to death than having your head bitten off. I
include the disorder here because of its prevalence rather than its severity.
People differ widely in their perception of the intensity of anger
directed at them. What one defines as irritability, another may call rage.
Regardless of how you label the emotional state, the approaches for dealing
with explosions into anger vary only slightly.
DEPRESSION. Depressed people don’t like much of anything, and some-
times they express that dislike with outbursts of anger. Usually, the anger
doesn’t have much energy behind it, but occasionally, especially in agi-
tated phases, the depressed can work up a good head of steam. People who
are turning anger inward can sometimes turn it outward as well.
Also, since antidepressants are the medication of choice for anger
problems, there are those who maintain that all anger is really depression.
214 ❧Explosions into Anger