CoOccurring Disorders | Anger | Addiction | Recovery Connection

CoOccurring Disorders | Anger | Addiction | Recovery Connection

CoOccurring Disorders and the anger, addiction, and recovery connection is important to understand when assessing how best to help someone treat their addiction and succeed in long-term recovery.

Today’s guest author, Joe Koelzer, delves into the complexities of this connection in his article shared below. Joe holds a Masters Degree in Spiritual Psychology from the University of Santa Monica and is Co-Founder and CEO of The Clearing, a non-12 Step Dual Diagnosis center. In the creation of The Clearing’s program, Joe realized his long-held dream of teaching the Principles of Spiritual Psychology to others.

CoOccurring Disorders and the Anger, Addiction and Recovery Connection by Joe Koelzer

You know what happens when you try to push an inflated beach ball down under water, don’t you? That’s right – it keeps popping back up. Well, our emotions are like an inflated beach ball; they always want to rise to the surface and find safe expression. And when we resist that process, we precipitate stress.


Joe Koelzer, Co-Founder and CEO of The Clearing, focuses his post on the CoOccurring Disorders, anger, addiction and recovery connection.

To be fair, many of us were taught to do everything in our power to keep our emotions held down. In dysfunctional families children learn early on that it’s not okay for them to feel or express anger. (It may be okay for Mom and Dad to get mad, but not the kids.)

As a result, children grow up expending a great deal of energy pushing down their anger … and that can contribute to mental health issues in the future.

The truth is that shoved-down anger has a tremendous effect on mental health.

In this post, I’ll discuss the interplay between buried anger, mental health conditions, and addictions. I’ll cover the reasons why many people don’t feel safe enough to express their anger constructively … and how stuffing it down is a dangerous choice.

Finally, I’ll explore a model for releasing your anger and healing underlying hurts so that you can move forward.

What’s the Deal with Dual Diagnosis (aka CoOccurring Disorders)?

While unexpressed anger isn’t a mental health issue in and of itself, it does play a significant contributing role in conditions such as depression and anxiety … two conditions which are common companions in dual diagnosis.

Dual Diagnosis is defined as a mental health concern coupled with an addiction. Examples of dual diagnoses include alcoholism and depression, or Posttraumatic Stress Disorder (PTSD) and anxiety.

As the co-founder of The Clearing, a residential dual diagnosis treatment program, I welcome a lot of participants who have depression and anxiety along with addiction issues.

And although for most of the twentieth century the rehab industry operated on the premise that addiction and mental health issues were separate entities, research shows us that they are closely connected.

Mental Health and Addiction Overlap

According to a 2005 study published in the Journal of American Medical Association (JAMA), Risk Factors for Relapse in Health Care Professionals With Substance Use Disorders, 50% of physicians studied had both a substance abuse issue and a concurrent mental health issue.

In short, addiction and mental health concerns go hand in hand. It’s no coincidence that there’s so much overlap between them.

As my colleague and fellow The Clearing co-founder Dr. Scott Alpert said in a recent interview:

“To me, addiction is really a symptom of a mental health issue. And generally speaking, we all have some mental illness going on. It’s just the severity of it that is key. Many people are dealing with anxiety and depression, but when it gets to the extreme and we don’t have the resources inside to deal with it properly, then we need to go seek out professional help to work through it.”

The Specific Role of Anger in Mental Health

Now that I’ve established the connection between mental health issues and addiction, let’s zero in on the specific role of anger.

Anger has a distinct purpose and function. Though there’s a common misconception that anger is always a harmful, negative force, anger actually serves a vital purpose in a healthy life.

In her bestselling memoir Leaving the Saints, Dr. Martha Beck writes:

“Anger is the immune system of the psyche, necessary despite its dangerous, volatile energy, because it is the only healthy response to injustice.”

By this definition, anger isn’t something we can take or leave. Rather, it’s an essential part of our internal guidance system. It’s the voice inside of us that says we’re hurting. It’s the part of us that says, “No, this is not right for me; something needs to change.”

When you look beneath anger, you’ll find that there’s always a hurt that’s present. Anger arises in response to an emotional injury.

The Dangers of Explosive and Unexpressed Anger

Some people with dual diagnosis express a lot of anger with little visible cause. For example, individuals with Intermittent Explosive Disorder can fly into a rage at the drop of a hat. In many cases they use drugs and alcohol to self-medicate the intensity of their feelings.

In these cases, anger is the individual’s preferred mode of self-expression. Often we see a refusal to express other emotions, particularly sadness.

However, what we see much more often in addiction treatment is a refusal to express anger. The person’s default mode is deep depression and intense anxiety … two mental health conditions that are all about a refusal to feel “taboo” emotions.

Depression, Anxiety, and Anger

One helpful definition of depression is “anger turned inward.” Individuals dealing with depression don’t want to risk letting their anger out, so it gets stuffed down.

Many of us weren’t taught healthy ways to give voice to our anger, so we hide it away. We don’t want to hurt anyone else, so we hurt ourselves instead, since this unexpressed anger causes harm to our health and wellbeing.

Anxiety arises when we refuse to feel both our hurt and our anger. Since we’ve cut ourselves off from both of these feeling states, we have a kind of internal ping-pong effect as our energy bounces back and forth between the walls we’ve built around our hurt and anger. (When the back-and-forth accelerates, we move into panic.)

Fortunately, it is possible to break free from this exhausting pattern.

The Anger-Hurt-Loving Model

The way out of this cycle is to learn constructive ways to express your anger, to make it okay for you to actually feel the hurtful episodes of your own life.

Once you do that, you have an opportunity to apply love to the parts inside that hurt. And when you apply love to hurt, you heal.

As Dr. Bernard Golden writes in his book Overcoming Destructive Anger:

“… Your capacity for healthy anger rests on your ability to summon and accept self-compassion. To deal with the hurt associated with anger and to let go of anger, you must develop self-compassion.”

The Anger-Hurt-Loving model is based on the Principles of Spiritual Psychology as developed by Drs. Ron and Mary Hulnick, the founding faculty and co-directors of the University of Santa Monica. It involves …

  • Giving yourself permission to be honest
  • Expressing your true thoughts and feelings of anger in a safe place and manner
  • Identifying the underlying hurt beneath the anger (If you’re stuck, use the sentence, “I’m angry because …” to begin identifying the upset)
  • Cultivate self-compassion for the past parts of yourself that were hurt
  • Offer those wounded parts of yourself the love they need to heal

(Here, I want to note that this model is just one piece of an integrative approach at The Clearing. Some of our participants do require medication for a mental disorder, and our approach fully supports the use of medication as a healing tool when needed.)

Listening to Anger’s Message

Anger helps us to clarify what is and isn’t right for our particular lives. It empowers us to say no to what we don’t want. It allows us to set boundaries, speak our truths, and step away from unhealthy relationships and scenarios.

When we listen to our anger, we have an opportunity to grow and develop. We have a chance to look closely at our feelings of upset, to ask, “What is the unresolved issue behind this feeling of anger? What need isn’t being met?”

In sum, anger is like any other emotional upset in that it’s an invitation to look more closely at ourselves. And when we become willing to work with our anger, we can improve our mental and emotional health.

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