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Anger Management in Detained Addicts: Prevention of Crime and Drug Use

This study examines the effectiveness of a cognitive-behavioral anger management program in detained drug users to control anger, improve emotion recognition and regulation, and enhance assertiveness. Results show significant improvements in anger levels and assertiveness.

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Anger Management in Detained Addicts: Prevention of Crime and Drug Use

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  1. Felice A. Nava, MD, PhD DirectorPenitentiary Medicine and DrugAbuse Unit Padua Director of ScientificCommittee of the Italian Society of Addiction Medicine (FeDeSerD) Felice Nava, MD, PhD Direttore U.O. Sanità Penitenziaria Azienda ULSS 6 Euganea – Padova Direttore Comitato Scientifico Nazionale FeDerSerD Anger Management in Detained Addicts for the Prevention of both Crime and Drug Use: a Controlled Cognitive Behavioral Trial in an Attenuate Custody Prison

  2. Disclosures • Grant/research support: Gilead • Speaker honoraria: D&A Pharma, Gilead Sciences and Reckitt Benckiser • Consulting fees: Gilead Sciences, Indivior, Laboratorio Farmaceutico CT, Merck Serono, Molteni Farmaceutici, Mundipharma Pharmaceuticals, Reckitt Benckiser, MartindalePharma

  3. Anger Definition - An internal, mental, subjective feeling state with associated cognition and physiological arousal patterns - Anger is a basic emotion and not a secondary emotion DiGiuseppe R, Chip Tafrte R., Understanding Anger Disorder, 2006; Oxford University Press

  4. Anger is not… - Aggression: overt behaviour enacted with the intent to do harm or injury to a person or object • Hostility: a personality trait evidenced by cross-situational pattern of anger with verbal or behavioural aggression • Irritability: increased sensitivity to environmental stimulation that causes physiological arousal and tension without cognitive mediation, that results in a lowered threshold to anger (affective arousal without cognition) • Hate: long-lasting predisposition to dwell on the transgressions committed by a person held in general disdain and condemned for their transgression or traits (cognition without affective arousal) DiGiuseppe R, Chip Tafrte R., Understanding Anger Disorder, 2006; Oxford University Press

  5. Anger in offenders • Anger is a significant problem in offenders (Myers WC, Monaco L, 2000; J Forensic Sci; 45: 698-701) • In detained drug users anger may be strictly correlated with relapse both in crime and drug use (Oberleitner LM et al., 2000; J Subst Abuse Treat; 45: 313-318) • Some experience have shown that anger management for offenders may improve the control of emotions associated with aggressive and antisocial behaviors (Hutchinson et al., 2017; Behav. Cogn. Psychother, 45: 1-15; Wilson et al., 2013; Crim Behv Ment Health, 23: 356-371)

  6. Aims of the Study • In a prison setting of attenuate custody for detained drug users in Padua (a sort of therapeutic community with an elevated intensity of care) we performed on 26 subjects a 12 weeks based group of cognitive behavior anger management in order to control: • anger • emotion recognition and regulation • assertiveness

  7. Sample of the Study

  8. Methodology of Anger Management • Session 1: Content of sessions, rules of the course • Session 2: Triggers for angry behaviour, understanding the consequences of temper loss • Session 3:Cycle of angry behaviour, importance of body language in signalling anger • Session 4: Replacing aggressive body language with non-aggressive body language • Session 5: Importance of thoughts. Using ‘non-angry’ thoughts. The parts of an angry incident i.e. before, during and after • Session 6: Using non-angry thoughts before, during and after angry incidents. Importance of self-praise following avoidance of anger-loss • Session 7:Importance of bodily arousal in relation to angry behaviour Learning how to wind down • Session 8: Relaxation techniques to help cope with feeling wound-up • Session 9: Choosing how you behave towards others • Session 10:Learning to express anger assertively • Session 11:Recognising and dealing with criticisms and insults. Peer group pressure and how to deal with this • Session 12: Identifying high-risk situations and lapse/relapse • Breakdown of sessions 12 x 2 h over 1 week

  9. Results - Significant improvements were found from pre-post test treatment of the following measures….

  10. Anger (on Anger Disorder Scale) The graph displays percentiles for each of the ADS Scale. The data are expresses as mean + SD. SD was not more elevated of 14.5 DiGiuseppe R, Tafrte R., 2005 The Anger Disroder Scale: Manual. Toronto, Ontario, Canada, Multi Health System

  11. Anger (on Anger Disorder Scale): Follow up The graph displays percentiles for each of the ADS Scale. The data are expresses as mean + SD. SD was not more elevated of 14.5 DiGiuseppe R, Tafrte R., 2005 The Anger Disroder Scale: Manual. Toronto, Ontario, Canada, Multi Health System

  12. Assertiveness (on SIB) The graph displays the normative data for SIB. The data are expresses as mean + SD. SD was not more elevated of 6.4 Arrindell WA et al., 2004. Valutazione del comportamento interpersanale ed assertivo, Erickson, Trento

  13. Assertiveness (on SIB): Follow up The graph displays the normative data for SIB. The data are expresses as mean + SD. SD was not more elevated of 6.4 Arrindell WA et al., 2004. Valutazione del comportamento interpersanale ed assertivo, Erickson, Trento

  14. Alexithymia (on TAS-20) The graph displays the normative data for TAS-20. The data are expresses as mean + SD. SD was not more elevated of 6.7 Bagby et al., 1994; J. Psychosomatic Res; 38:23-32

  15. Alexithymia (on TAS 20): Follow up The graph displays the normative data for TAS-20. The data are expresses as mean + SD. SD was not more elevated of 6.7 Bagby et al., 1994; J. Psychosomatic Res; 38:23-32

  16. Conclusion • Anger management is effective in reducing anger in detained drug users • Anger management is also able to improve emotion recognition and assertiveness • These effects are persistent at a follow-up at 3 months • Anger control can prevent relapse both in crime and drug use • An anger training management should be included in each therapeutic program for drug users in prison

  17. Acknowledgement Livia Zuliani – Penitentiary Medicine and Drug Abuse Unit in Prison Padua Isabella Barbon – Penitentiary Medicine and Drug Abuse Unit in Prison Padua Giulia Branciforti – Penitentiary Medicine and Drug Abuse Unit in Prison Padua Giuseppe Stroscio – Penitentiary Medicine and Drug Abuse Unit in Prison Padua Carmine Gargiulo – Penitentiary Medicine and Drug Abuse Unit in Prison Padua Silvana Cilia – Institute of Cognitive Behaviour Therapy Padua Ezio Sanavio – University of Padua

  18. Felice Nava, MD, PhD Director Penitentiary Medicine and Drug Abuse Unit in Prison Padua Tel. 049-8214904 Fax 049-8214908 felicealfonso.nava@aulss6.veneto.it Director Scientific Committee Italian Society of Addiction (FeDerSerD) www.federserd.it http://www.felice-nava.it felnava@tin.it

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