- Reserach shows that that 30 percent of mortality caused by violence is attributable to alcohol.
- Alcohol inhibits prefrontal cortex activity, thus impairing reasoning, impulse control, and emotional regulation.
- Research has shown that thought suppression may contribute to alcohol-related aggression.
- How anger and alcohol interact need to be addressed in alcohol treatment programs as well as in psychotherapy.
When asked what prompted his seeking my help, Ryan stated, “I went to a bar with some friends. I knew what I was doing. I drank until I was intoxicated. I picked out some guy, just some random dude, to start a fight with.”
Many people enjoy alcoholic drinks as a way of relaxing, sometimes to reduce the tension of socializing or to quiet an overactive mind. Some then become more mellow, others more outgoing. Some become sad or nostalgic. By contrast, some individuals’ alcohol consumption contributes to their anger, hostility, and even aggression. Ryan offered a more extreme example of this type of interaction. In his case, he was already predisposed to anger arousal before he had his first drink.
I’ve observed this pattern over several decades in helping clients deal with anger. This interaction makes perfect sense. Alcohol, like fatigue, diminished sleep, stress, and certain drugs, inhibits the activation of the prefrontal cortex, that part of our brain responsible for problem-solving, judgment, and overseeing and managing emotions. This disinhibiting aspect of alcohol in effect paves the way for feelings to dominate thoughts and behavior.
The World Health Organization reported that alcohol use is more closely associated with aggressive behavior than any other type of psychotropic substance (Beck & Heinz, 2013). Additionally, they reported that 30 percent of mortality caused by violence is attributable to alcohol (WHO, 2009).
Consuming alcohol can serve as a distraction from a range of negative feelings, including anger. And all too often, as in Ryan’s case, it reflects displacement, directing anger toward a target that is not the source of an individual’s original anger. Under the influence of alcohol, those already predisposed toward anger may vent or, more seriously, direct their anger toward a target that might be experienced as less threatening than the original target.
Identifying those factors that might contribute to heightened anger when consuming alcohol is important for individuals who have anger issues and those who treat them. Increasingly, research offers answers to determine this interaction.
Personality and the Propensity to Become Aggressive When Intoxicated
Research has explored the association of certain personality traits with the vulnerability to become angry when consuming alcohol. In one such study, 15,701 individuals, including men and women, were asked to complete questionnaires regarding personality traits, anger-hostility, alcohol consumption, and violence (Jones et al., 2020). It found that agreeableness was inversely associated with violence in both genders.
Alcohol was associated with 11 percent of the effect for males but showed no association with women. Anger-hostility was associated with violence in both sexes, but alcohol was only significantly associated with impact for males. Extroversion was associated with violence and alcohol use in both males and females. The take-away was that reducing alcohol consumption in men, who are disagreeable and have anger/hostile traits, would have a small but significant effect on reducing violence.
Another study explored the relationship between Posttraumatic Stress Disorder (PTSD), alcohol use, and violence (Blakey et al., 2018). This was a massive study of 33,215 individuals with no history of active military combat. An increase in anger after trauma and the use of alcohol to cope with PTSD symptoms were stronger predictors of physically aggressive or violent acts than a lifetime diagnosis of PTSD without anger.
An earlier study found that alcohol use enhanced aggression primarily among individuals who showed a heightened disposition for such behavior (Eckhardt and Crane, 2008). They assessed 70 participants who were divided into two groups. One consumed alcohol, and the other consumed a placebo. They were directed to engage in a task with the potential to trigger aggressive verbalizations, with those who consumed alcohol showing significantly more such behavior.
A more recent study of 249 male and female heavy drinkers with a history of past-year intimate partner violence found that acute alcohol intoxication moderated the impact of problematic alcohol use on an attentional bias toward anger (Massa et al., 2019). Specifically, it found that problematic drinkers may be more likely to attend to aggressogenic stimuli while intoxicated, and that is, they were more likely to experience certain cues as aggressive.
Mental rigidity and alcohol consumption have been explored as contributing to domestic violence. One such study included 136 men with a history of intimate partner violence (IPV) (Estruch, 2017). The individuals who had higher mental rigidity had lower empathy and perception of the severity of IPV. Additionally, they reported higher alcohol use and hostile sexism than those lower in mental rigidity.
Another study of 249 heavy drinkers similarly found that alcohol intoxication predicted higher levels of IPV in those who reported low psychological flexibility (Grom et al., 2021).
Research has shown that thought suppression may contribute to alcohol-related aggression. One study supporting this finding enlisted 245 men with a history of heavy episodic alcohol use (Berke et al., 2020). They completed surveys assessing their endorsement of traditional masculine norms, use of thought suppression, and both trait and alcohol-related aggression. It was found that thought suppression mediated the association between the toughness masculine norm and alcohol-related aggression.
The Impact of Anger on Constriction of Perception and Assessment
Some studies highlight the impairment caused by alcohol consumption on processing emotional faces. One such study involved a sample of 85 social drinkers who were described as being low or high trait anger based on their responses to the anger expression index of the State-Trait Anger Expression Inventory-2 (STAXI-2) (Eastwood et al., 2020). They first consumed alcohol and were asked to recognize the emotions of different faces on a computer task. Specifically, they exhibited a reduced capacity to detect sadness and fear and a reduced tendency towards seeing happiness. While the study did not support a significant difference between groups high and low in anger, these results support the notion that such impairment in facial recognition may contribute to aggressive responding.
Another study that explored the impact of alcohol consumption on facial recognition found that individuals with alcohol use disorder exhibited a bias toward misidentifying emotional facial expressions as hostile or disgusted (Freeman et al., 2018). Interestingly, those in the control group tended to misidentify expressions as happy.
The Failure to Consider Future Consequences and Its Impact on Aggression
Researchers evaluated the failure to consider future consequences as a significant risk factor for aggression (Bushman et al., 2012) In this study, 495 social drinkers were assigned to a group that consumed alcohol or a placebo group. They were also required to respond to the Consideration of Future Consequence Scale (CFC). It was found that those scoring lower became significantly more aggressive than those who had higher ratings on the CFC. The findings were explained by emphasizing that concern for the future involves greater prefrontal cortex resources that help inhibit the excessive impact of alcohol.
Over time Ryan came to better understand factors that contributed to his drinking, including his anger and increased aggression when drinking. Therapy assisted him in recognizing how past wounds contributed to his vulnerability to both anger and alcohol use. After much consideration, he eventually joined an alcohol treatment program as I helped him grieve his wounds and manage his anger.
Anger management and alcohol treatment programs must recognize and educate participants about the relationships between alcohol and anger. It’s equally important that psychotherapists highlight this interaction both with clients who consume alcohol and those in relationships with them. Additionally, this information should also be taught in schools to expand their understanding and hopefully reduce the prevalence of alcohol-related aggression.
Beck, A; Heinz, A. (2013) Alcohol related aggression-social and neurological factors. Dtsch Arztebl Int 110(42): 711-5. DOI: 10.3238/arztebl.2013.0711
Jones, R., Van Den Bree, M., Zammit, S., and Taylor, P. (2020). https://journals.sagepub.com/doi/10.1177/0886260520978178
Blakey, S. Love, H., Lindquist, L., et. al. (2018). Disentangling the link between posttraumatic stress disorder and violent behavior: Findings from a national representative sample. Journal of Consulting and Clinical Psychology, Vol. 86, No. 2, 169-178.
Eckhardt, C. and Crane, C. (2008). Effects of alcohol intoxication and aggressivity on aggressive verbalizations during anger arousal. Alcoholism, Vol. 28, No. 6, 855-864.
Massa, A, Subramani, O., Eckhardt, C., et. al. (2019) Problematic alcohol use and acute intoxication predict anger-related attentional biases: A test of the alcohol myopia theory. Psychol Addict Behav, 33(2), 139-143.
Estruch, S., Martinez, A., Robledillo, N., et. al., (2017) The role of mental rigidity and alcohol consumption interaction on intimate partner violence: a Spanish study. Journal of Aggression, Maltreatment and Trauma, Vol. 26, No. 6, 664-675.
Grom., J, Maloney, M., Parrott, D., et. al. (2021) Alcohol, trait anger, and psychological flexibility: A laboratory investigation of intimate partner violence perpetration. Journal of Contextual Behavioral Science, Vol. 19, 100-107.
Berke, D., Leone, R., Parrott, D., et. al. (2020) Drink, don’t think: The role of masculinity and thought suppression in men’s alcohol-related aggression. Psychology of Men & Masculinities, 21(1), 36-45.
Eastwood, A., Penton-Voak, I., Munafo, M., et. al. (2020). Effects of acute alcohol consumption on emotion recognition in high and low aggressive drinkers. Journal of Psychopharmacology, 34(11), 1226-1236.
Freeman, C., Wiers, C., Sloan, M., et. al. (2018) Emotion recognition biases in alcohol use disorder. Alcoholism: Clinical and Experimental Research, Vol. 42, No. 8, 1541-1547.
Bushman, B, Giancola, P., Parrott, D., et. al. (2012) Failure to consider future consequences increases the effects of alcohol on aggression. J Exp Soc Psychol, 48(2) 591-595