Objective:The aim of this study Was to evaluate the relationship between alexithymia and aggression among men with substance dependence. In addition, we wanted to control the effect of variables such as depression and anxiety on this relationship. Methods: Participants were 200 consecutively admitted substance-dependent inpatients. Patients were assessed with the Toronto Alexithymia Scale-20, the Buss-Perry Aggression Questionnaire, the Beck Depression Inventory and the State-Trait Anxiety Inventory. Results: Of the substance-dependent inpatients, 34.0% (n=68) constituted a group suffering from alexithymia. Rates of being unemployed, being married, duration of education, and current age did not differ between the groups, whereas age at onset of regular substance use was lower in the group with alexithymia. The alexithymic group had higher scores of aggression, depression, as well as trait and state anxieties. A hierarchical linear regression analysis demonstrated that the difficulty in identifying feelings (DIF) factor of alexithymia was related with aggression, although chronic anxiety contributed to this relationship particularly in the anger and hostility dimensions of aggression. Conclusion: Trait DIF may be directly related with aggression, whereas state DIF may be a way of coping among those with chronic anxiety and may be indirectly related with cognitive and affective components of aggression. The relevance of these relationships for prevention and treatment of substance dependents deserves interest in further research.