heroin photo Alcoholics Anonymous is an organization that has helped millions of alcoholics manage their drinking problems over the years. The AA 12-step program has in recent years also been useful to many opioid addicts. However, it does not cure them; there is another issue that is directly related to substance abuse, having to do with anger management. AA does not pay enough attention to this. It emphasizes forgiveness.

In general, substance abusers, whether the substance is an opioid or alcohol, do not deal with anger effectively. One group uses the substance to dull the pain of their anger. These imbibe quietly, often when they are alone, using the substance to “drown their sorrows.” If they get high enough, they can blunt their pains for a while.

Another group uses the drug as an excuse to act out the anger. This is the belligerent addict. Such addicts are the most blatant examples of those falling under the category of “substance abusers.” When they are in their belligerent mood, it is like they have changed from Dr. Jekyll to Mr. Hyde. They feel entitled to say anything or do anything they want. Bar room fellows (we refer to them as enablers) find such addicts entertaining, but their spouses find them anything but.

However, there is a secondary benefit to using substances like opioids to deal with one’s anger. By drowning one’s sorrows alone (and thereby rejecting all who want to help them) or by belligerently acting anger out, addicts in either case derive a measure of relief from their anger by deflecting it. This part of the addiction lifestyle is partly effective in dealing with anger and stress.

However, once the addict goes through recovery and stops taking the drug, he or she loses this secondary benefit of addiction. The addict no longer has the faulty, albeit partly effective, methods of coping with anger. Alcoholics Anonymous, unfortunately, labels drug addiction as a disease and emphasizes managing the drug problem and does so quite well. But, as I said, it does not pay enough attention to coping with anger or to stress release, and especially not to exploring the roots of that anger.

Popular slogans from AA with regard to changing what can be changed and not trying to change things that can’t be changed, and learning to tell the difference, are fine and good but do not get to the nitty-gritty of anger management. One of the 12 steps of AA has to do with forgiveness. But forgiveness does not deal with the main problem that many drug addicts have, that of denying and internalizing their anger in order to maintain an aura of niceness and civility.

It is good to forgive those we are angry at, for sure. Bottled up angers and resentments take their toll on our health. But one cannot just forgive through an act of will. Sometimes people in 12-step programs convince themselves that they have forgiven somebody, but unconsciously they have not really forgiven them. It is just a pose, to get the approval of the AA community. You cannot really forgive until you go through the process of working through anger and of mourning the various memories and sadness that underlie the addiction. You cannot reach the state of forgiveness until you are psychologically ready to reach it. And even when you do, forgiving someone does not mean trusting. If people have been toxic to you, you can forgive them as you forgive yourself for your past transgressions, as we are all human. But you must nevertheless take precautions against toxic people and maintain your distance. Learning to do this is another part of recovery.

If an drug addict goes through recovery but does not work through the anger, he or she is likely to have a relapse. The drug has become his go-to high, since his natural high, dopamine, is no longer working. Dopamine, a neurotransmitter, has been replaced by the drug of choice and it is hard for the drug adict to feel any happiness from dopamine (a sober high), because dopamine has become ineffective from disuse. Both factors—the ineffectiveness of dopamine and the unresolved anger contribute to the addict’s depression and urge to use the drug again.

I have known former alcoholics and opioid addicts who have successfully stopped for years. They have religiously gone to meetings and have seemed to be in perfect health. But they are not in perfect health because they have maintained the sobriety but avoided resolving the anger gnawing away inside. And then, quite suddenly, they have suffered heart attacks or developed some form of other sickness such as cancer.

This is what can happen when you don’t deal with your anger effectively. When you internalize anger and accumulate stress, your arteries harden and become narrower, leading to blood clots. Also your immune system weakens. This becomes an added risk for heart attacks, cancer, Alzheimer’s, and other diseases.

To solve the opioid epidemic in America we need to do more than try to control it. We also need to teach people how to cope with their anger and stress in a more effective way. This requires more than the 12-step program. It requires therapy. Until the addict resolves the anger, he or she cannot truly forgive.