Self-Forgiveness and Gratitude in Recovery from Substance Use Disorders.

Substance use is a multifaceted disorder of the whole person that is manifested on three levels: intrapersonal, interpersonal, and spiritual. Previous research has demonstrated that self-forgiveness and gratitude help build personal and social resources and reinforce the process of recovery from substance use disorders. The aims of the present narrative review article were to (a) explore self-forgiveness and gratitude as psychological mechanisms of behavioral change in recovery through the lens of positive criminology and recovery capital approach, (b) review the practice of self-forgiveness and gratitude in the Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) programs, and (c) present a conceptual model of self-forgiveness and gratitude in long-term recovery. Self-forgiveness and gratitude have been described as positive emotions and prosocial, empathy-based moral virtues that enhance well-being and health by reinforcing the establishment and maintenance of long-lasting positive relationships with self, others, and spirituality. This effect may occur through different levels and psychological mechanisms. This article contributes to the field by presenting the intrapersonal, interpersonal, and spiritual benefits associated with self-forgiveness and gratitude interventions that can initiate and sustain long-term recovery.

Identity Construction in Recovery from Substance Use Disorders.

Long-term recovery from substance use disorders has been described as a process of identity construction, through which the stigma of being a substance user is replaced by a new identity of a non-user. Identity construction has been widely acknowledged as a significant factor in different pathways of substance use cessation, such as self-change and treatment-change. However, almost no articles have discussed the role of identity construction in desistance and recovery among both self-changers and treatment-change. The aim of this narrative review was to explore this subject in the two groups. Based on the recovery capital approach and the social identity model of recovery, I posited that self-changers and treatment-changers undergo different processes of identity construction. Moreover, the prospects for successful identity construction depend upon personal and social resources (recovery capital) that provide identity-building materials such as relationships, attitudes, and role models. This article contributes to the field by presenting the different identity constructions in the process of long-term recovery from SUDs.

The Role of Acceptance and Change in Recovery from Substance Use Disorders.

Long-term recovery (LTR) from substance use disorders (SUDs) has been described as a complex process. It has been proposed that psychological mechanisms can influence the resolution of problematic substance using behaviors and may explain how and why a recovery process works. The aims of this narrative review were to (a) examine acceptance and change as an underlying mechanism in LTR from SUDs; (b) examine the practice of acceptance and change in the Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) programs; and (c) present a conceptual model of self-acceptance and change in LTR from SUDs. Based on dialectical behavioral philosophy and mindfulness-based intervention, I posited that self-acceptance is an underlying mechanism that addresses the cyclical nature of shame, guilt, and SUDs; improves emotion dysregulation; psychological well-being; and activates a change process of recovery from SUDs. This article contributes to the field by presenting the opposing forces of acceptance versus change and their synthesis in promoting LTR from SUDs, and by discussing the practice of acceptance and change in the AA and NA programs.

"You have to start normalizing": Identity construction among self-changers and treatment changers in the context of drug use normalization.

Identity transformation and stigma management have been widely acknowledged as significant factors in various drug-cessation pathways, such as self-change (SC) and treatment-change (TC). These processes involve the employment of symbolic boundaries within which people associate themselves with desired groups and/or distance themselves from less desirable ones. However, the relevance of the drug-cessation pathway to identity construction in an era of drug-use normalization has not yet been explored. The present study used thematic discourse analysis to compare the drug-cessation narrative and the reflected identity construction of 41 former drug users in Israel (25 SCs and 16 TCs). The findings revealed a shared trigger for drug cessation that was related to impaired functionality and a threat to their identity. However, the groups differed in other drug-cessation factors that served their identity-negotiation strategies. The SCs negotiated stigma by distancing themselves from other drugs users, minimizing drug risk, and denying the need for drug treatment. In contrast, the TCs negotiated stigma by distancing themselves from their former user identities, embracing the disease model of drug use, and confirming the necessity of treatment. This identity construction reflects continuous framing of ideals of subjectivity, such as self-regulation, which policy makers and treatment stakeholders should consider in developing services and conveying substance-use policy messages.

Sense of coherence as a recovery capital in recovery from substance use disorders.

BACKGROUND: Recovery from substance use disorders without treatment has long been of interest to researchers and practitioners. The aim of the study was to examine the role of sense of coherence and recovery capital in long-term recovery without treatment and the association between the two concepts. METHOD: This cross-sectional study was conducted among 229 Israeli respondents, 134 of them self-changers and 95 treatment-changers. The respondents completed the Addiction Severity Index, the Sense of Coherence Questionnaire, the Childhood Trauma Questionnaire, and the Recovery Capital Questionnaire. RESULTS: Significant differences between the two groups were found. The self-changers had a higher sense of coherence (p < .001) and reported more cannabis use. No significant group differences were found in recovery capital. The treatment-changers had experienced significantly more child abuse (p < .001) and suffered from severe psychiatric problems (p = .019), compared with the self-changers. Significant correlations were found between higher sense of coherence and lower psychiatric severity (p < .001), lower rate of child abuse (p < .001), and self-change (p = .037). A strong relationship was found between sense of coherence and recovery capital (p < .001), showing that the two concepts were moderately to highly interrelated. CONCLUSIONS: The findings signify the central role of sense of coherence in recovery and the importance of strengthening sense of coherence, which may promote health-related outcomes.

Does Self-Change Occur Among Severely Dependent Substance Users?

The aims of the current study were to examine differences between self-changers (SC) and treatment-changers (TC) in sociodemographic, personal characteristics, severity of substance use disorders (SUDs), and psychiatric problems, and to predict the severity of SUDs, psychiatric problems, and belonging to the SC group. The sample included 229 Israeli respondents (134 SC and 95 TC). Significant differences between the two groups were found. The SC were younger, had a higher sense of coherence, and reported more cannabis use. The TC were involved more in crime and had experienced more child abuse and severe psychiatric problems compared with the SC. No significant group differences were found in the severity of substance dependence. The findings suggested that severity of SUDs did not differentiate between the groups, but the severity of psychiatric problems and history of child abuse did. This indicates a need for treatment interventions targeting all three issues of childhood trauma, SUDs, and psychiatric problems.

Exposure to Family Violence of Israeli Inmates: Does Sex Make a Difference?

The purpose of the current study was to examine differences by sex (a) in history of child abuse and neglect (CAN) and exposure to parental partner violence (PPV); and (b) in the association of CAN and PPV with violent offenses, substance use, suicidal behavior, and psychiatric problems. This cross-sectional study investigated sex differences in CAN and exposure to PPV in a sample of 290 Israeli inmates (65 women and 225 men). Participants completed a self-report measures of the Childhood Trauma Questionnaire, and the revised Conflict Tactics Scale to measure PPV. The findings indicated that the female inmates had experienced significantly more sexual abuse (p < .001), and more exposure to PPV (p = .030), compared with male inmates. Female inmates who had experienced CAN were at higher risk of committing violent offenses than male inmates and female inmates were also more likely than male inmates to have been engaged in suicidal behaviors (39.3% and 18.5%, respectively), and to have had psychiatric problems (40% and 14.2%, respectively). The findings also revealed that psychiatric problems and suicidal behavior can be predicted by CAN and family substance use. The findings highlight the effects of the adverse childhood experience of exposure to CAN and PPV on behavioral problems. Appropriate treatment requires simultaneous intervention that targets all three issues of childhood trauma, substance use disorders, and psychiatric problems for both sexes.

Cognitive Appraisal of Child Abuse Among Israeli Inmates: Does Sex Make a Difference?

Sex differences in child abuse and neglect (CAN) have long interested researchers due to their adverse impact. Cognitive appraisal of CAN may also affect the negative consequences. The purpose of this study was to assess sex differences in (a) the experience and (b) the cognitive appraisal of CAN among 247 Israeli inmates. The findings indicated that female inmates experienced higher rates of total CAN than male inmates. No significant sex differences were found in physical abuse, emotional neglect, or cognitive appraisal of CAN. However, there were significant sex differences in ranking the significance of different dimensions of cognitive appraisal of CAN. Paternal partner violence was a predictor of CAN and its cognitive appraisal for both sexes; maternal partner violence was a predictor of both among female inmates only. Even when male and female inmates share similar family risk factors, their effects may differ by sex. Possible clinical implications are discussed.

Building Recovery Capital: The Role of "Hitting Bottom" in Desistance and Recovery from Substance Abuse and Crime.

The aim of this article is to explore the role of "hitting bottom" as a motivation to initiate a recovery process and desistance from crime and substance use disorders (SUDs), and in building recovery capital (RC). Researchers and practitioners have long been interested in why and how offenders desist from crime. Desistance and recovery from crime and SUDs have also been linked to negative turning points, such as hitting bottom, which represents multidimensional suffering with physiological, familial, social, and criminal implications. The deleterious outcomes of SUDs cause individuals to lose their social and personal resources and hit bottom. According to the conservation of resources model, in the context of actual or potential loss of resources, individuals strive to maintain, protect, and build them. Thus, hitting bottom not only provides the initial motivation for change, but also drives individuals to build personal resources. The prospects for successful recovery are dependent upon the individual's personal and social resources, or RC. This article represents a first step in examining the role of hitting bottom in building RC in the process of long-term recovery. The conclusions may have theoretical as well as practical implications.

Lifetime history of suicidal ideation and attempts among incarcerated women in israel.

BACKGROUND: Evidence indicates that rates of death by suicide are higher among female inmates compared with male inmates and the general population. Despite the high rate of lifetime suicidality, little is known about the predictors of suicidality for these women. OBJECTIVE: The purpose was to examine sociodemographic, criminological, and psychological variables associated with a history of suicidal ideation and suicide attempts among incarcerated women. METHOD: This cross-sectional study investigated a history of suicidal ideation and suicide attempts in a sample of 46 Israeli incarcerated women. Participants completed a confidential interview that included the Addiction Severity Index, the Renard Diagnostic Interview, self-report measures of the Childhood Trauma Questionnaire, and the presence of symptoms of depression. RESULTS: More than half of the women reported a history of suicidal ideation or attempts. Those who reported such a history were characterized by a high prevalence of childhood victimization, early onset of substance abuse, high prevalence of mental health problems, and high prevalence of mental health problems in the family. Child abuse, depression, and family mental health problems are related to suicidal ideation and attempts in incarcerated women. CONCLUSIONS: As the number of women with mental health concerns entering prison grows, corrections staff are faced with increasing challenges to provide services that mitigate the risk of death by suicide. Inquiring about childhood abuse and symptoms of depression and mental health problems, as well as providing treatment for the emotional impact of trauma exposure, may reduce the risk of suicidality in this population. (PsycINFO Database Record

To Punish or Not to Punish-That Is the Question.

Attitudes toward punishment have long been of interest to policymakers, researchers, and criminal justice practitioners. The current study examined the relationship between academic education in criminology and attitudes toward punishment among 477 undergraduate students in three subgroups: police officers, correctional officers, and criminology students who were not employed by the criminal justice system (CJS). Our main findings concluded that (a) punitive attitudes of the correctional officers and police officers at the beginning of their academic studies were harsher than those of the criminology and criminal justice students who were not employed by the CJS, (b) punitive attitudes of the correctional officers at the end of their academic studies were less severe than their first-year counterparts, (c) fear of crime was higher among women than among men, and (d) the strongest predictor of punitive attitudes was a firm belief in the principles of the classical and labeling theories (beyond group). Implications of these results are discussed.

Childhood Abuse and Mental Health Problems: Does Gender Matter?

Gender differences in the relationship between mental health problems and childhood abuse have long been of interest to researchers. The purpose of the present study was to examine gender differences in the relationship between childhood abuse and mental health problems among 110 Israeli inmates (50 women and 60 men). The findings indicated that female inmates reported higher prevalence of physical, emotional, and sexual abuse and were more likely to suffer from mental health problems, compared with the male inmates. Additionally, the findings revealed that more female than male inmates had parents with mental health problems. Female inmates who reported mental health problems in their families also reported higher rates of child abuse relative to male inmates with a similar family history.

"I Wanted to Rebel, But There They Hit Me Even Harder": Discourse Analysis of Israeli Women Offenders' Accounts of Their Pathways to Substance Abuse and Crime.

This study examined women offenders' accounts of their pathways to substance abuse and crime and the intersection between them, to reach a holistic understanding that captures the dynamics of victimization, agency, and gender. Discourse analyses of the accounts of 11 Israeli women offenders indicated differential use of two discourses. Five participants used the victimization discourse, which viewed substance abuse as an attempt to medicate the self that was injured following victimization experiences; two used the agency discourse, which viewed substance abuse as a way to experience pleasure, leisure, and control over their destiny. Four of the participants used these two contradictory discourses simultaneously. The findings indicate the absence of a cultural discourse that encompasses women's complex experience of gender, victimization, and agency. Possible implications for intervention are discussed.

Child abuse, drug addiction and mental health problems of incarcerated women in Israel.

The mental health problems and pathways to drug addiction and crime among female inmates have long been of interest to researchers and practitioners. The purpose of the current study was to examine the possible association between multiple types of childhood abuse, mental health problems, and drug addiction and the incarceration of 50 Israeli women in prison. The findings indicated that female inmates come from risky families with a high prevalence of family mental health problems, parental drug addiction and crime, and sibling drug addiction and crime. Furthermore, they revealed that incarcerated women from risky families were victims of multiple types of childhood abuse and neglect by their parents, as well as their siblings. Overall, the results suggest that the adverse consequences of a family's mental health problems are much more dramatic than we assumed to date, and that women are more likely than men to be the victims of multiple types of childhood abuse and neglect, as well as suffering more severe psychiatric problems, depression, and drug addiction. The implications of these findings are discussed.

Parents' perceptions of their adolescent sons' recovery in a therapeutic community for addicted clients.

A qualitative phenomenological study of parents of addicted male adolescents who were residents of a Jewish therapeutic community (TC) describes and interprets the parents' perceptions of the recovery process. Deep, semistructured interviews with 14 parents provided the data. The parents' perceptions were clustered into three main themes of meaning: (a) the process of change, (b) the experiences of family members in the course of the son's recovery process, and (c) the parents' perception of the treatment at Retorno. According to the parents, the admission of their sons into the TC brought notable relief to the family life, which enabled the whole family to begin a recovery process. The findings support the positive criminology perspective that emphasizes the disintegration-integration vector as significant in the recovery process. Recommendations for intervention planning are provided.

The meaning of suffering in drug addiction and recovery from the perspective of existentialism, Buddhism and the 12-Step program.

The aim of the current article was to examine the meaning of suffering in drug addiction and in the recovery process. Negative emotions may cause primary suffering that can drive an individual toward substance abuse. At the same time, drugs only provide temporary relief, and over time, the pathological effects of the addiction worsen causing secondary suffering, which is a motivation for treatment. The 12-Step program offers a practical way to cope with suffering through a process of surrender. The act of surrender sets in motion a conversion experience, which involves a self-change including reorganization of one's identity and meaning in life. This article is another step toward understanding one of the several factors that contribute to the addict's motivation for treatment. This knowledge may be helpful for tailoring treatment that addresses suffering as a factor that initiates treatment motivation and, in turn, treatment success.

Gender differences in crime, drug addiction, abstinence, personality characteristics, and negative emotions.

The current study examined gender differences in personal and psychological characteristics among drug-abstinent Israeli inmates. The study focuses primarily on three personal variables: sense of coherence (SOC), anxiety, and hostility. Additional factors that were examined are demographic variables, which include background, crime, and drug addiction. The sample included 119 inmates (65 males and 54 females) who abstained from drugs use for two different time intervals--up to one year, and more than one year--and did not receive treatment. Overall, males and females shared similar backgrounds except for a higher rate of sexual abuse among female inmates. No gender differences were found in recidivism. These findings show that drug-addicted female inmates injected drugs to a greater extent than males. They also indicated that male inmates remained abstinent for longer periods than female inmates. Additionally, length of abstinence was related to higher SOC, lower trait anxiety, and less hostility among male inmates compared to female inmates. Among female inmates, length of abstinence was related to lower SOC, higher trait anxiety, and no change in hostility. These findings may indicate the need to require separate gender-oriented therapeutic interventions.

Social support, spiritual program, and addiction recovery.

This study compared personal and emotional modifications of inmates who were recovering addicts and who participated in one of two year-long therapeutic intervention programs, one including social support and experiential spiritual program components (Narcotics Anonymous, NA, meetings and the 12-step course), the other including primarily social support (NA meetings only, without the 12-step program). The hypothesis was that supplementing social support programs with a concrete spiritual program would result in more positive personal and emotional changes. The results seem to support the hypothesis: Inmates participating in the 12-step program demonstrated a higher sense of coherence and meaning in life and a gradual reduction in the intensity of negative emotions (anxiety, depression, and hostility) than those participating in NA meetings without the 12-step program. The research findings demonstrate the importance of the 12-step program as part of a rehabilitation process for drug addicts.