Anger Management and Temper Control: Critical Components of Posttraumatic Stress Disorder and Substance Abuse Treatment † Patrick M. Reilly, Ph.D.*; H. Westley Clark, M.D., J.D., M.P.H.*; Michael S. Shopshire, Ph.D.**; Ervin W. Lewis, M.D.* & Donna J. Sorensen, Ph.D.*** Abstract—Recent studies have shown associations among combat experience, PTSD, anger and hostility, and involvement in violence. Clinical observations of veterans enrolled in the Substance Use/Posttraumatic Stress Disorder Team (SUPT) program at the San Francisco Veterans Affairs Medical Center revealed relatively high levels of anger and aggressive behavior, including physical assaults and property damage. In response to this anger and aggressive behavior, an anger management treatment was added to the SUPT program’s treatment of substance abuse and PTSD. Anger management consisted of a 12-week cognitive-behavioral group treatment. Session topics included identifying the physical, emotional, and situational cues to anger, developing individualized anger-control plans, recognizing and altering destructive self-talk, utilizing time- out, practicing conflict resolution techniques, and using the group to discuss and evaluate high-risk anger situations. Special attention was given to self- monitoring anger-escalating behavior (using an anger meter) and avoiding negative consequences. This article describes the components of the anger management treatment. A clinical vignette is also presented to illustrate the benefits of anger management treatment. Keywords—anger management, posttraumatic stress disorder, substance abuse, treatment †This article was supported in part by National Institute on Drug Abuse grant 1R18DA06097. *San Francisco Veterans Affairs Medical Center and Department of Psychiatry, University of California, San Francisco. **Department of Psychiatry, University of California, San Francisco. ***San Francisco Veterans Affairs Medical Center, Substance Abuse Programs. Please address reprint requests to Patrick M. Reilly, Ph.D., Substance Abuse Programs, San Francisco Veterans Affairs Medical Center (116E), 4150 Clement Street, San Francisco, California 94121. Posttraumatic stress disorder (PTSD) requires comprehensive and intensive treatment. The recurrent and intrusive distressing recollections that are a central feature of PTSD may require behavioral therapy or long-term psychotherapy. PTSD in Vietnam combat veterans poses particular problems that may complicate these treatments. According to the National Vietnam Veterans Readjustment Study (NVVRS), 22.2% of male Vietnam veterans with a current PTSD diagnosis suffered from alcohol abuse and dependence, in contrast with 9.2% of male Vietnam veterans without a current PTSD diagnosis (Kulka et al. 1990). The NVVRS data also show that 6.1% of Vietnam veterans with a current PTSD diagnosis