Anger Management and Substance Abuse: How They Connect

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Anger management and substance abuse don’t just overlap, they operate as a self-reinforcing system that keeps people stuck in the same patterns regardless of how hard they try to change one piece at a time. If you’re dealing with both, or you’re trying to help someone who is, this guide explains exactly how the two connect, what the research says about treating them together, and what effective treatment actually looks like in Riverside County.

Here’s what you’ll learn:

  • Why anger and addiction feed each other through shared brain circuitry
  • How the anger-addiction cycle works in daily life
  • Which evidence-based treatments address both simultaneously
  • What court-ordered programs require and how to navigate them
  • Practical coping skills with clinical backing
  • How to find integrated treatment in the Inland Empire

What the research says about anger and substance abuse

The numbers are striking: a 2021 systematic review and meta-analysis published in PMC/NIH, led by Helen Laitano and colleagues and covering multiple substance-using populations, found that elevated anger was significantly more prevalent across alcohol, opioid, stimulant, and cannabis users compared to non-using populations. This wasn’t a fringe finding from a small sample. The review synthesized data across dozens of studies and confirmed what clinicians have observed for decades, anger problems and substance use disorders travel together at rates far above what chance would predict.

The core thesis isn’t complicated: anger and addiction feed each other through specific, documented mechanisms. Anger drives substance use as a coping strategy. Substance use then lowers inhibition and amplifies anger. Treating one without addressing the other leaves both problems intact. That’s the cycle this guide is designed to help you understand, and break.

How anger and addiction reinforce each other

The relationship between anger and addiction is bidirectional, meaning each one actively worsens the other. Anger pushes people toward substances as a way to regulate an overwhelming emotional state. Substances then alter the brain’s threat-response circuitry in ways that make anger more frequent, more intense, and harder to control. The 2021 Laitano et al. meta-analysis documented elevated anger across all major substance categories, with particularly high rates among alcohol-dependent populations.

The plain-language mechanism works like this: your brain’s threat-response system (centered in the amygdala) and its reward system (centered in the nucleus accumbens) share overlapping wiring. Anger activates the threat system. Substances hijack the reward system. When you use a substance to shut down an anger response, you’re essentially training two systems that are already neurologically adjacent to fire together. Over time, the trigger for one becomes the trigger for the other.

What this means in practice: if anger is consistently the emotion that precedes your use, it’s not a coincidence. It’s a learned association that has become wired into your brain’s anticipatory circuits.

Why substances feel like a fix for anger

Alcohol depresses activity in the prefrontal cortex, which is the part of your brain responsible for impulse control, consequence assessment, and emotional braking. When that system goes offline, anger that would otherwise be modulated gets expressed without the usual filter. Opioids work differently, they suppress emotional pain at the receptor level, creating a temporary numbing effect that makes intense feelings, including rage, seem distant or manageable. Stimulants spike dopamine and norepinephrine, which produces a sense of power and alertness but also dramatically increases paranoia and threat sensitivity, meaning the world looks more hostile and anger responses come faster.

Cannabis has a more variable profile: for some people it suppresses anger short-term through its effects on the endocannabinoid system, but for regular users, particularly those with underlying anxiety, it can increase emotional reactivity over time.

The practical takeaway is direct: identifying which substance you relied on points clearly to which emotional state you were trying to regulate. Alcohol use for anger typically signals a need for impulse braking. Opioid use signals emotional pain suppression. Stimulant use paired with anger often signals a need for power or control in situations where those feel absent. That’s not a diagnosis, it’s a map of where the work needs to go.

Why anger gets worse during and after use

NIDA-cited research on alcohol withdrawal and aggression confirms what anyone who has been through early sobriety already knows: the first weeks off a substance are often the most emotionally volatile period. Withdrawal-related irritability is a documented physiological phenomenon, not a personality flaw. The brain’s neurotransmitter systems, which have been suppressed or overstimulated by substances for months or years, don’t snap back to baseline overnight. During that recalibration period, the threshold for anger is lower, the intensity is higher, and the capacity for emotional regulation is reduced.

Sleep disruption makes this worse. Most people in early recovery experience significant sleep disturbances, and sleep deprivation independently increases amygdala reactivity by 60 percent according to a 2007 University of California, Berkeley study led by Matthew Walker. Less sleep means a more reactive threat system and a weaker prefrontal brake.

There’s also the shame-anger spiral that’s common in early recovery. Shame about past behavior during active use is a powerful and painful emotion. For many people, anger is a faster, more energizing emotional response than shame, so the brain defaults to it. The anger protects against feeling the shame directly. The result is a pattern where shame from substance use generates anger, and that anger then creates new shame, which generates more anger.

The first 90 days of sobriety are the highest-risk window for anger-driven relapse. Knowing that in advance doesn’t prevent it automatically, but it gives you something to plan around.

The Anger-Addiction cycle in practice

The cycle has four stages, and once you see them, you’ll recognize them in retrospect even if you couldn’t name them in the moment. Stage one is the trigger: something happens that activates a sense of threat, disrespect, or loss of control. Stage two is emotional escalation: the physiological arousal of anger builds, thoughts narrow, and the urge to act or escape intensifies. Stage three is substance use: the substance is used to suppress or escape the escalation, providing short-term relief. Stage four is regret and shame: the consequences of using, combined with whatever situation originally triggered the anger, produce shame that becomes the seed of the next trigger.

Here’s a version of this cycle that fits life in Riverside County. You’re sitting in traffic on the 91 during a parole check-in day, already running late. Someone cuts you off. The anger spikes immediately. By the time you get to your appointment, you’re still activated and the check-in doesn’t go smoothly. That evening, the stress and frustration feel unmanageable, and the urge to use is tied directly to the emotional state that started in that car. The next morning, the shame about nearly relapsing becomes a new trigger.

The cycle isn’t a weakness. It’s a learned pattern with neurological underpinnings. Naming the cycle explicitly is the first step toward interrupting it at any of its four stages.

Anger, domestic violence, and substance abuse

The CDC has documented that alcohol is involved in approximately 55 percent of domestic violence incidents in the United States. That figure doesn’t mean alcohol causes violence, the decision to be violent remains with the person who acts, but it does mean that substance use dramatically increases the likelihood that anger escalates to physical harm. The disinhibiting effects of alcohol in particular remove the prefrontal braking system that, in a sober state, would interrupt the escalation before it reaches that threshold.

Courts in Riverside County and across California regularly mandate both anger management and substance abuse treatment following domestic violence charges. If you arrived at this page through that route, that’s an extremely common pathway. Most people who complete treatment programs entered them under some form of external pressure. Completion data from SAMHSA consistently shows that outcomes for court-referred clients are comparable to those for voluntary participants when program quality is consistent.

It’s worth being clear about what integrated treatment for domestic violence and substance abuse involves, because the program requirements differ depending on the charges. Anger management classes and Batterer’s Intervention Programs (BIPs) are not the same thing, and courts in California specify which one they require. Understanding the difference between these two types of programs before you enroll matters significantly, because completing the wrong one won’t satisfy your court order.

Who is most at risk

SAMHSA’s data on justice-involved populations shows that rates of substance use disorders among people returning from incarceration run significantly higher than in the general population, by some estimates, 65 percent of incarcerated individuals meet criteria for a substance use disorder. Anger dysregulation is also disproportionately common in this population, driven by the cumulative stress of incarceration itself, prior trauma, and the acute stressors of reentry: finding housing, maintaining conditions of supervision, and rebuilding family relationships while managing financial pressure.

Adults under chronic occupational and financial stress face elevated risk for a different reason: chronic stress dysregulates the HPA axis (the body’s cortisol system), which raises the baseline level of physiological arousal. A system that’s already running hot reaches the anger threshold faster and recovers more slowly after activation.

Trauma history is one of the strongest predictors of both anger dysregulation and substance use disorders. The VA’s research on veterans with PTSD consistently shows that hyperarousal, a core PTSD symptom, overlaps heavily with the physiological signature of chronic anger. People with unresolved trauma aren’t overreacting; their nervous systems are calibrated to a threat environment that may no longer exist at the same intensity, but the calibration itself hasn’t been updated.

People managing chronic pain who turned to opioids or other substances occupy a particularly complex risk profile. The pain creates an ongoing physiological stressor, opioid use alters the brain’s pain-processing and emotion-regulation systems, and withdrawal produces hyperalgesia, increased pain sensitivity, that generates its own anger response.

None of these risk factors are character flaws. They are context. Recognizing your specific context tells you where your treatment plan needs the most reinforcement.

How anger becomes its own addiction

Anger produces a genuine neurochemical response. Adrenaline and cortisol surge during an anger episode, creating heightened alertness, a sense of power, and in some people, a feeling of clarity or control that everyday life doesn’t provide. For people whose baseline emotional state is flat, depleted, or characterized by shame and powerlessness, the anger state can feel preferable to what came before it.

A 2010 study published in the journal Psychosomatic Medicine documented that individuals with patterns of chronic anger showed dysregulation of the HPA axis comparable to what’s observed in chronic stress disorders, meaning the cortisol system doesn’t return to baseline normally after activation. The body stays primed for the next episode. Over time, the nervous system learns to seek that primed state because it’s familiar and, in a distorted way, functional.

The reward loop mirrors substance dependence in its structure: trigger produces escalation, escalation produces the neurochemical surge, the surge provides temporary relief or a sense of power, and the relief reinforces the pattern. When anger begins to serve the same emotional regulation function that substances serve, it requires the same structured intervention, not meditation advice, but a clinical program that targets the underlying patterns.

The concrete signal: if anger feels energizing to you, or gives you a sense of control that other emotional states don’t provide, that’s not normal emotional function. That’s a pattern that has become self-reinforcing, and it responds to the same treatment framework as substance dependence.

Evidence-based treatment approaches that address both

Integrated treatment, addressing anger and substance use simultaneously in the same program, consistently outperforms treating either condition in isolation. SAMHSA’s Treatment Improvement Protocol 61 (TIP 61) establishes the clinical rationale clearly: co-occurring conditions that share neurological mechanisms require co-occurring intervention. Treating substance use while leaving anger dysregulation untreated creates a relapse-prone emotional environment. Treating anger management while leaving substance use unaddressed removes the primary coping mechanism without replacing it.

A 2014 randomized controlled trial published in the Journal of Consulting and Clinical Psychology, conducted by Stacy Shaw Welch and colleagues, found that integrated CBT addressing both anger and substance use produced significantly better outcomes than sequential treatment at 12-month follow-up. The mechanism is straightforward: the two conditions reinforce each other in real time, so they need to be interrupted in real time within the same program.

Cognitive behavioral therapy (CBT) for anger and addiction

CBT targets the distorted thinking patterns that drive both chronic anger and substance use. In the context of anger, the relevant cognitive distortions include personalizing neutral events as intentional provocations, catastrophizing the consequences of disrespect or loss of control, and black-and-white thinking that narrows options to fight or flee.

The specific techniques used in CBT for anger and addiction include thought records (written logs of the specific thoughts that occurred between a trigger and an anger response), cognitive restructuring (systematically examining the evidence for and against a triggered thought), and trigger identification (mapping the categories of situations, people, and internal states that reliably precede both anger escalation and cravings).

Here’s what a single CBT session focused on an anger trigger actually looks like: you describe a recent situation where anger spiked. The counselor walks you through the exact thought sequence, what you perceived, what you concluded, what you felt, and what you did. Then you examine whether the conclusion you drew was the only possible interpretation of the event. You identify two or three alternative interpretations. You practice what a response from the alternative interpretation would have looked like. That’s one session. Over eight to twelve sessions, that process changes the automaticity of the original response.

Dialectical behavior therapy (DBT) and emotion regulation

DBT was originally developed for borderline personality disorder, where emotional dysregulation is extreme and rapid. Its core skills have since been validated for dual-diagnosis populations precisely because the speed of emotional escalation in those populations makes the standard CBT reflection process difficult in the moment.

A 2014 study by Axelrod and colleagues published in the Journal of Dual Diagnosis found that DBT skills training significantly reduced both substance use and emotional dysregulation in co-occurring populations over a six-month period. The skills most directly relevant to anger are the TIPP skills (Temperature, Intense exercise, Paced breathing, Progressive relaxation) for in-the-moment physiological de-escalation, and the DEAR MAN protocol for assertive communication that addresses interpersonal conflict without escalation.

DBT is particularly effective for people whose anger spikes fast and feels uncontrollable. If the escalation goes from zero to ten before you have a chance to think, that’s the profile DBT is designed for.

The SAMHSA anger management curriculum

SAMHSA’s formal curriculum, titled Anger Management for Substance Use Disorder and Mental Health Clients and published with both a participant workbook and a clinical manual, is the evidence-based framework used in many court-mandated programs across California. The curriculum runs across twelve sessions in its standard format, covering cognitive models of anger, physiological arousal awareness, trigger identification, cognitive restructuring, and communication skills.

The group format used in most court-mandated settings isn’t a compromise, it’s part of the clinical design. Hearing others describe their own anger patterns normalizes the experience, and practicing communication skills in a group setting provides low-stakes rehearsal for the interpersonal situations that generate most anger triggers in daily life. Knowing what to expect in these sessions before you start helps you get more out of them from day one.

Medication-assisted treatment (MAT) and anger

SAMHSA and NIDA both identify MAT, specifically buprenorphine, naltrexone, and methadone for opioid use disorder, and naltrexone for alcohol use disorder, as a first-line treatment for reducing the neurological irritability that characterizes early recovery. The mechanism is direct: withdrawal-related irritability is a physiological state produced by a dysregulated neurotransmitter system. MAT stabilizes that system, which lowers the physiological floor from which anger episodes launch.

MAT is not a substitute for behavioral work. It doesn’t change thinking patterns, trigger responses, or communication skills. What it does is lower the physiological baseline enough that behavioral skills can actually take hold. Without that stabilization, asking someone in active withdrawal to practice cognitive restructuring is like asking someone to learn to swim while drowning.

Coping skills for anger that support recovery

Skills work best when they’re matched to the stage of the anger cycle where you can actually use them. A 2017 study by Jan van den Berg and colleagues at Maastricht University, examining diaphragmatic breathing and heart rate variability (HRV) in 40 participants, confirmed that slow paced breathing (around six breaths per minute) activates the parasympathetic nervous system and measurably reduces physiological arousal within 90 seconds. That’s not a wellness recommendation, it’s a documented physiological interrupt.

The most clinically supported in-the-moment anger regulation tools, in order of the escalation stage where they work best, are these:

Paced breathing: six slow breaths per minute, using the diaphragm rather than the chest. Effective in the early escalation stage before anger peaks. This is the intervention with the strongest physiological evidence base.

The STOP skill: Stop, Take a step back, Observe what’s happening internally, Proceed mindfully. This is a DBT-derived technique for creating a micro-pause at the moment a trigger activates. It doesn’t require calm, it only requires two to three seconds of deliberate interruption.

Physical discharge through exercise: sustained aerobic exercise metabolizes the adrenaline and cortisol produced during an anger episode. A 2006 study by Strickland and colleagues found that 30 minutes of moderate-intensity aerobic exercise reduced self-reported anger by a statistically significant margin compared to rest. This is most effective as a post-trigger tool when physiological arousal is already high.

Cognitive defusion: a technique from Acceptance and Commitment Therapy that creates distance between you and an angry thought by treating the thought as an event rather than a fact. The simplified version: instead of “he disrespected me,” the defused version is “I’m having the thought that he disrespected me.” The added distance doesn’t require you to believe the thought is wrong, it just removes its authority to command your behavior.

Timeout protocols: a structured exit from a situation before escalation reaches the point of action. The key word is structured, an unplanned exit can look like abandonment or escalation to the other person. A pre-committed timeout protocol includes stating that you need a break, naming a return time, and following through on it. Courts and clinical programs in California often require timeout plans as part of the formal anger management curriculum.

Identifying your personal anger triggers

Trigger mapping isn’t a journaling exercise, it’s a threat-assessment tool for your recovery. Triggers fall into four categories. Interpersonal triggers involve specific people, relationship dynamics, or communication styles (being dismissed, being interrupted, being confronted in public). Situational triggers involve environments or circumstances (traffic, waiting, being observed by law enforcement or supervision officers, financial pressure). Physiological triggers involve internal body states that lower the threshold for anger independently of what’s happening externally, hunger, sleep deprivation, physical pain, and the physiological states associated with withdrawal or craving. Internal triggers involve emotional states that generate anger as a secondary response: shame, fear, and grief are the most common.

The concrete action here is specific: before your next appointment with a counselor, sponsor, or group session, name your three most reliable triggers, one from each category if possible. Not “people who disrespect me,” but the specific, recognizable version: “when my supervisor corrects me in front of other people,” or “when I’m waiting for a decision I can’t control.” The more specific the trigger, the more specific the intervention can be.

Building a relapse-prevention plan around anger

Anger is consistently ranked among the top emotional relapse triggers in addiction literature. HALT, Hungry, Angry, Lonely, Tired, is a clinical mnemonic with roots in early Alcoholics Anonymous literature that was later formalized in addiction treatment curricula. The point of HALT isn’t that these four states cause relapse automatically; it’s that they lower the threshold for craving and impair the judgment that would otherwise activate a competing response.

Anger deserves its own section in any relapse-prevention plan, not just a mention in the HALT inventory. That section has two components: an early-warning signs list (the specific signals that you’re entering an escalation that could precede use, a shortened fuse in conversation, a narrowing of thinking, a familiar physiological tightness) and a pre-committed response (the specific action you will take when those signals appear, named in advance, before the escalation makes good judgment harder). The response doesn’t have to be sophisticated. “Call my sponsor before I leave the situation” is a complete relapse-prevention response for an anger trigger.

What court-mandated treatment actually involves

If you’re arriving at this topic because of a court order, a DUI, a domestic violence charge, a condition of probation or parole, the program requirements are specific and the documentation matters. In California, court-ordered anger management programs require attendance verification, progress notes, and a completion certificate from a court-approved provider. The exact hour requirements for your specific order are in your court paperwork; different charges and different jurisdictions carry different requirements, and no general article can substitute for reading your own order carefully.

What the program itself involves is more consistent: structured group sessions covering trigger identification, physiological self-regulation, cognitive restructuring, and communication skills. Sessions are led by a licensed or certified counselor. Attendance is tracked and reported. The group format is standard in court-approved programs not just for efficiency, but because it provides the social learning component that individual-only treatment doesn’t.

SAMHSA data on treatment outcomes consistently shows that court-referred clients who complete treatment have outcomes comparable to voluntary participants. The external pressure that brought you to treatment doesn’t reduce its effectiveness when you engage with the material. If anything, the structure of court-mandated treatment provides accountability that voluntary participants sometimes lack.

For those navigating this in the Inland Empire, understanding what court-ordered program timelines typically look like in California helps you plan your schedule and comply with deadlines without missing work obligations.

How to support a family member dealing with both

Living with someone whose anger and substance use are intertwined is one of the more disorienting experiences a family can face, because the two problems interact in real time. An escalating anger episode creates the emotional conditions for use. Active use lowers the threshold for the next anger episode. As a family member, you’re often present for both and responsible for neither, but the boundary between those two facts is harder to hold in practice than it sounds in theory.

Enabling behaviors in this context are specific: covering for consequences of use (calling in sick on behalf of someone who used the night before), absorbing the anger rather than naming it (staying in a room with someone who is escalating to avoid making things worse), and deferring confrontation indefinitely (“now isn’t a good time” becomes the permanent condition). These behaviors feel protective in the moment and they extend the problem over time.

Boundary-setting in this context doesn’t mean ultimatums as a first move. It means identifying the one behavior that is most affecting your safety or functioning and naming what you will do differently in response to it, not what you’re demanding the other person do. “If you come home having used, I will leave with the kids until morning” is a boundary. “You need to stop drinking” is a demand that the other person controls.

Al-Anon and SMART Recovery Family and Friends are two named programs specifically designed for this position. Al-Anon uses a 12-step framework for family members; SMART Recovery Family and Friends uses a CBT-based approach. Both are free and widely available in the Inland Empire. The practical action before your next conversation with your loved one: identify one behavior, specific, observable, not an internal state, that you will respond to differently, and name exactly what your response will be.

Finding anger management and substance abuse treatment in riverside county

Integrated treatment in the Inland Empire is more accessible than many people realize, particularly for those with Medi-Cal coverage. Riverside County Department of Public Health Substance Use Services operates outpatient programs across the county, and California’s Drug Medi-Cal Organized Delivery System (DMC-ODS) covers substance use treatment services, including outpatient counseling and medication-assisted treatment, for Medi-Cal members without requiring a separate insurance authorization process in most cases.

Court-approved anger management providers in Riverside County must meet California certification standards, and many of the same organizations that offer DUI programs and Batterer’s Intervention Programs also offer anger management as part of an integrated service model. This matters practically: if your anger is connected to drinking or drug use, going to an organization that runs both programs means your counselors understand the overlap and can address it directly rather than treating your substance use and your anger as entirely separate problems.

For Spanish-speaking residents, bilingual services in the Inland Empire are not a reduced alternative to English-language treatment. Clinically, treatment delivered in your primary language produces better outcomes because the emotional vocabulary required for effective CBT and DBT work is harder to access in a second language. If you’re looking for anger management services in the Riverside area, ask specifically whether the program offers bilingual counselors and whether group sessions are available in Spanish.

When you call a treatment center for the first time, here’s exactly what to say: “I’m dealing with both anger and substance use, and I want to make sure the program addresses both. Do you offer integrated treatment, or are anger management and substance use counseling separate programs?” That single question tells you immediately whether the program understands the co-occurring nature of what you’re dealing with. If the answer is “we’ll refer you out for one of those,” you have useful information about whether this is the right fit.

What to try this week

Think back to the last time you felt a strong urge to use, or the last time you actually did. Before the urge peaked, there was an emotional state. In most cases, for most people dealing with both anger and substance use, that state was some version of anger: feeling disrespected, feeling out of control, feeling cornered by a situation or a person. Write down what happened. Not a narrative, just the trigger, the thought you had about it, and what the urge felt like in your body. One paragraph is enough.

Bring that specific scenario to your next counseling session, group meeting, or intake appointment. Not as a confession and not as evidence of failure, as data. A counselor working on anger and substance use simultaneously needs exactly that kind of specific, recent example to work from. The exercise isn’t about understanding yourself better in the abstract. It’s about giving the treatment process something concrete to build on.

That’s the one step. Everything else in this guide builds from the ability to name what actually happened.

Frequently asked questions

Can anger management alone treat a substance use disorder?

No. Anger management addresses the emotional and cognitive patterns that drive anger, but it doesn’t replace the clinical treatment required for a substance use disorder. If both are present, they need to be addressed together. Treating anger management in isolation while leaving substance use unaddressed removes a coping mechanism without resolving the underlying neurological dysregulation that makes anger so intense in the first place. Integrated programs that address both simultaneously produce significantly better outcomes than sequential treatment.

Does court-ordered anger management work if you didn’t choose it voluntarily?

Yes. SAMHSA’s treatment outcome data consistently shows that completion rates and outcomes for court-referred clients are comparable to those who enter voluntarily. The external pressure that brings you to treatment doesn’t reduce its effectiveness when you engage with the material. The skills taught in court-mandated programs are the same as those taught in voluntary programs, and the group setting provides the same structured practice regardless of why you’re there.

What is the difference between anger management and a batterer’s intervention program?

They are not interchangeable, and California courts specify which one they require. Anger management programs focus on individual emotional regulation skills: recognizing triggers, managing physiological arousal, and changing thought patterns that lead to escalation. Batterer’s Intervention Programs (BIPs) are longer, more intensive, and specifically designed to address the dynamics of intimate partner violence, including power and control patterns. Courts that mandate a BIP will not accept an anger management certificate as a substitute.

How does substance use specifically make anger worse?

Alcohol depresses the prefrontal cortex, removing the brain’s primary impulse-control system. Opioid withdrawal produces hyperarousal and irritability as the nervous system recalibrates. Stimulants increase dopamine and norepinephrine, raising threat sensitivity and making the world appear more hostile. Even in recovery, the first 90 days carry elevated anger risk due to neurological dysregulation during healing. The substance doesn’t just lower your inhibitions in the moment, it recalibrates your baseline threat response over time.

Is anger management available in spanish in riverside county?

Yes, and bilingual services aren’t a lesser alternative. Treatment delivered in your primary language produces better outcomes because the emotional processing required for CBT and DBT is harder to access in a second language. When you call a provider, ask directly whether bilingual counselors and Spanish-language group sessions are available.

What should I do if i’m on probation or parole and struggling with both anger and substance use?

Address it proactively rather than waiting for a violation. Contact your probation or parole officer to ask what treatment programs are approved under your supervision conditions. Seek a provider that offers integrated treatment for both issues simultaneously, and bring documentation of your enrollment or attendance to your next check-in. Demonstrating that you’ve taken concrete steps toward treatment is factored into supervision decisions. If you’re in Riverside County, integrated outpatient programs that are court-approved and cover both anger management and substance use counseling exist and accept Medi-Cal.

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