Anger is more strongly associated with alcohol and tobacco use and use disorders compared to other substances in American adults.

Background: Anger is elevated in substance use disorders (SUDs) and related to problematic use. However, it is unclear whether anger is elevated in individuals who use substances, is only heightened among those with SUDs, and whether anger is more strongly tied to use of certain substances or SUDs.Objectives: We examine the association between anger, general substance use and SUDs.Methods: Data is N = 28,753 (55% female) respondents from the NESARC-III. Participants endorsing anger and indicating negative functional impact were deemed to have experienced significant anger.Results: Logistic regression examining the relative strength of associations between anger, substance use and SUDs (alcohol, opioid, stimulant, tobacco and cannabis) indicated that having a SUD was associated with anger beyond use alone. Alcohol (adjusted odds ratio [AOR] = 1.45; 95% CI 1.32-1.6) and tobacco (AOR = 1.38; 95% CI 1.27-1.51) use displayed the strongest odds of experiencing anger above and beyond other substances in the model. Similarly, alcohol (AOR = 1.45; 95% CI 1.31-1.62) and tobacco (AOR = 1.46; 95% CI 1.3-1.64]) use disorders had the greatest odds of anger relative to other SUDs. These results were significant after controlling for mood, anxiety disorders, and PTSD and no sex differences were observed.Conclusion: These results indicate that SUDs, particularly alcohol and tobacco use and disorders, are positively associated with experiencing anger beyond just substance use. Research must identify the mechanism driving this association to enhance treatments that target anger.