March Mad-less: Emotional Intelligence as a Tool in Substance Use Prevention


Amid one of the most chaotic NCAA men’s basketball tournaments, this March has truly been full of madness. In short, it’s been a true season of upsets. The most relevant shock though might be that this piece isn’t really going to be about basketball at all…. well, for the most part. This March, we’re going to discuss madness, or rather, anger.

I’m not talking about the kind of anger that spawns from having the ball stolen away with 3 seconds left on the clock that sparks a strategic game plan to get the ball back and win the game; nor the common effective experience we all relate to when a fan from the opposing team brags a little too much after your team takes a loss.

Instead, this month’s blog will explore how chronic, uncontrollable anger relates to the risk factors for developing substance use disorder. Chronic and/or uncontrollable anger is associated with an assortment of health outcomes. It’s been associated with heart disease, diabetes, bulimia nervosa, car accidents, injury, risky behavior, and so much more (Staicu & Cuţov, 2010). But could learned strategies for managing anger and other emotions build up protective factors against the risks of developing substance use disorders?

Our prediction? Integrating several promising components in youth substance use prevention education could be a big win!

What Team?

What is substance use prevention education? I’m glad you asked. Let’s break it down:

Substance use prevention education is exactly what it sounds like. Well-trained prevention experts work with scientists and educators to design evidence-based and data-driven educational curricula that will be provided to youth (usually in schools) with the hope of preventing youth from using illicit drugs, misusing other drugs/medications, and experiencing the associated tragic outcomes like substance use disorder and other chronic health effects.

The realm of substance use prevention education is constantly evolving, though. As a rudimentary component of all public health and wellness efforts, it’s imperative that changes overlap new social and scientific data with frequency and swiftness. Professionals and paraprofessionals throughout the field are constantly updating curriculums, procedures, practices, and resources to reflect accurate results of extensive research.

Making the Right Calls

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute of Drug Abuse (NIDA) are two of the largest and most influential coalitions in substance use science and prevention information. However, numerous organizations across the country share the task of collecting and disseminating data to improve the community health outcomes of prevention education work. Policy makers, grant funders, parents, students, teaching administration, and many other stakeholders often get a voice in prevention education efforts, too. These experts form a zone-defense against substance use and collectively generate ideas about the best strategies in prevention education.

Problems arise though in harboring the capacity to maintain on-going collaboration, and we see locally and nationally implemented practices and curriculums go numerous years without critical, routine updates. As time passes, we miss our shot to get critical information through to those who need it most.

Time on the Clock

After a global pandemic, the world around us has been changing promptly, suggesting that our methods in prevention should too. Addiction scientists from around the world co-authored an article on Drug and Behavioral Addictions During Social-Distancing for the COVID-19 Pandemic. In this article, they explore the new multi-faceted problems of substance use sparked by the pandemic and call to action the multi-pronged solutions required to negate them. The scientific article states,

“We highlight a need to understand SUDs (substance use disorders) as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suit of multi-sectorial actions and strategies to strengthen, modernize, and complement addiction care systems which will become resilient and responsive to future system shocks similar to the COVID-19 pandemic.”

(Jemberie, W.B., et. al, 2020)

Riding the Bench

While there has been an abundance of research that supports that maintaining positive mental wellness is a preventive factor (the opponent of a risk factor) in SUD, learning how to do so is often benched from the evidence-based prevention curriculums.

A study of anger management and coping styles was conducted in 2004 on a group of incarcerated adolescents that found that outwardly expressed anger and avoidant coping were associated with alcohol and marijuana use and use-related consequences (Eftekhari, A. Turner, A.P., Larimer, M.E. 2004).

“Outwardly expressed anger was significantly associated with both alcohol and marijuana use and use-related consequences… results suggest that expression of anger and avoidant coping are independent risk factors for substance use and use-related consequences across two classes of drugs in adolescent offenders.”

(Eftekhari, A. Turner, A.P., Larimer, M.E. 2004)

However, the reality of the sample in this study translating to an adequate representation of all youth across the US is a far stretch. It’s also difficult to frame new prevention programs based on conclusions of research conducted almost 20 years ago. This emphasizes the extent that curriculum designers rely on relevant and recent research, which scarcely exists around this topic.

In fact, almost no recent research had been published on this topic at all until 2016 when scientists studied adolescent anger as a predictor of “poor outcomes” defined as likelihood of drug relapse, alcohol use, difficulty controlling behavior, and arrests just 12 months later.


By extracting and re-evaluating data from NIDA’s Drug Abuse Treatment Outcome Study for Adolescents (DATOS-A) published in 2001, scientists at Yale University’s School of Medicine created a participant anger profile based on their responses to 4 assessments of outburst and aggression history (Serafini, K., et., al. 2016). Each of the 3,382 adolescents, age 11-18, was undergoing a “community-based treatment for adolescent drug problems” in one of 4 cities across the United States (Chicago, Pittsburg, Portland, and Minneapolis). Data was evaluated from both the program intake and 12-month follow-up assessments conducted by NIDA.

Each of the responses to the 4 outburst and aggression questions was then classified as High, Moderate/Normal, or Low Anger. After accounting for numerous factors (treatment, gender, race, age, school enrollment, drug of choice, criminal justice status, overdose history, suicidality, mental health disorders, alcohol, cocaine, or marijuana dependence, etc.) the researchers found only one predictor of “poor outcomes” at the 12-month assessment: High Anger profile categorization.

“Adolescents classified as having High Anger were found to have a more severe constellation of substance use and psychiatric distress at pre-treatment and several worse treatment outcomes at the 12-month follow-up in comparison to the Normal/Low Anger group.”

(Serafini, K., et., al. 2016).

Teaming Up

Knowing this, it’s time for prevention experts to play our part in addressing anger, emotions, coping, and other biopsychosocial components that target preventing SUD onset. Numerous anger-management professionals and healthcare leadership coach, Deborah Munhoz, point to a solution for managing anger: emotional intelligence – the belief that understanding the cause of your anger and frustration results in constructive coping and effective resolution skills.

“It is crucial that teenagers understand the links between how they think, feel, and act.” (Collins-Donnelly, 2012)

All-Star Efforts

Finally, in 2019, a group of Hungarian researchers in substance use prevention education made the connection between an abundance of evidence linking anger and SUD onset and the lack of research on success in implementing emotional intelligence as a strategy to prevent SUD (Kun, B., et. al., 2019). With a group of 2,380 high school students, scientists examined the relationship between emotional intelligence and substance use directly. Check out this instant replay:

“There is substantial evidence for deficits in emotional processing among teenagers with substance use, but few studies have investigated the association between emotional intelligence and adolescent substance use. The aim of the present study was to examine the relationship between the use of tobacco, alcohol, and illicit drugs and the level of emotional intelligence among adolescents… Results demonstrated that greater difficulty in stress management and empathy predicted a higher frequency of tobacco, alcohol, and cannabis use.”

(Kun, B., et. al., 2019)

Ultimately, the research team concluded that though it was not a key factor, emotional intelligence had an individual effect on substance use. They conclude with a call to action to utilize this knowledge in drug prevention programs and SUD interventions. This is where our discussion will conclude, too.

The Sound of the Buzzer

Making the perfect curriculum isn’t an easy task, though. Even beyond the scope of substance use, it’s almost impossible to create and implement any practice for public health prevention that will be effective for everyone everywhere. Rather than strive for perfection, this evidence and the youth in our community support the need for a step forward in a never-ending journey of improvement. This step forward transcends the methods of the past of simply discussing emotions once or briefly in a prevention education curriculum. It, instead, requires a centered focus on the relationship between preventive factors and targeted lessons on how to foster and strengthen those factors (ie. emotional intelligence).

Through necessary updates, prevention education has come a long way from the unrealistic and scare-tactic practices of the past (some that I won’t dare to mention), but there’s still ample room for advancement. Will putting together the evidence we have on the need for emotional intelligence into perspective during design be the next slam dunk in substance use prevention education programs in the U.S., too? We’ll look to all of our prevention experts just like you to make the right call.


1. Eftekhari, A. Turner, A.P., Larimer, M.E. (2004). Anger expression, coping, and substance use in adolescent offenders. Addictive Behaviors. Volume 29, Issue 5. Pp 1001-1008. ISSN 0306-4603. 2. Hser, Y. I., Grella, C. E., Hubbard, R. L., Hsieh, S. C., Fletcher, B. W., Brown, B. S., & Anglin, M. D. (2001). An evaluation of drug treatments for adolescents in 4 US cities. Archives of general psychiatry58(7), 689–695. 3. Jemberie, W.B., et. al, (2020) “Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions.” Perspective Article Front. Psychiatry Sec – Addictive Disorders. Volume 11 -2020. 5. Kun, B., et. al., (2019). The Effects of Trait Emotional Intelligence on Adolescent Substance Use: Findings From a Hungarian Representative. Front Psychiatry. Sec. Addictive Disorders. Volume 10 -2019. 5. Staicu, M. L., & Cuţov, M. (2010). Anger and health risk behaviors. Journal of medicine and life3(4), 372–375. 6. Serafini, K., Toohey, M. J., Kiluk, B. D., & Carroll, K. M. (2016). Anger and its Association with Substance Use Treatment Outcomes in a Sample of Adolescents. Journal of child & adolescent substance abuse25(5), 391–398.