A randomized feasibility study of a positive psychology journaling intervention to support recovery from substance-use disorders.

BACKGROUND: Individuals in early recovery face significant biopsychosocial stressors causing a preponderance of negative affect. Novel interventions are needed to improve mood and well-being to support recovery. Positive Recovery Journaling (PRJ) combines elements of positive psychology, behavioral activation, and journaling to emphasize what is going right and to encourage small, positive steps that align with an individual's values to make life in recovery more rewarding and therefore more reinforcing. Our objective was to determine PRJ's feasibility, acceptability, and impact on a set of strengths-based, multidimensional aspects of recovery, including satisfaction with life, happiness with recovery, and commitment to sobriety. METHODS: The study randomized adults in substance-use disorder treatment (N = 81) to PRJ or control. Those in PRJ were asked to practice PRJ daily and complete online surveys for four weeks; those in the control group completed online surveys for four weeks. We used multi-level modelling to determine intercept and slope for feasibility and acceptability outcomes as well as to compare differences in recovery indicators between treatment and control at baseline and Weeks 2, 4, and 8. We conducted intention-to-treat and per-protocol analyses for each recovery indicator. RESULTS: Participants were 53 % female, and 26 % Black, Indigenous, People of Color (BIPOC) and mean age of 39 years. PRJ participants attended 71 % of groups and completed 56 % of the daily PRJ entries. Treatment and control groups rated their study tasks (PRJ for the treatment group, surveys for the control group) as equally easy; however, the PRJ group rated PRJ as significantly more satisfying, helpful, and pleasant. Treatment and control were not significantly different on any recovery indicator. In post hoc analyses, we found that for those with <90 days sobriety at baseline (51 %), PRJ had a statistically significant beneficial effect for satisfaction with life, happiness with recovery, and numerous secondary recovery indicators. DISCUSSION: Results suggest a positive impact of PRJ on numerous recovery indices for those in earliest recovery. Integrating PRJ into support services among those with <90 days sobriety could reinforce what is going well in recovery to encourage its continued maintenance and thereby improve treatment outcomes.

The 12-Step Pathway to Spiritual Growth and Gratitude and Its Relationship With Well-Being Among the Members of Sexaholics Anonymous in Poland.

Despite the well-established role of mutual-aid groups in addiction treatment, no research has yet explored the role of the 12-step pathway in spiritual growth and gratitude, or its direct and indirect relationships with well-being among individuals with compulsive sexual behavior disorders (CSBD). The purpose of the current study was to examine the number of 12 steps completed as an antecedent of spiritual growth and gratitude and its relationship with well-being among members of Sexaholics Anonymous (SA). The sample consisted of 80 individuals (72 men and 8 women) attending SA meetings in Poland. The study variables were measured using the Daily Spiritual Experiences Scale, Gratitude Questionnaire, Satisfaction with Life Scale, Positive and Negative Affect Schedule, and a single question regarding the number of 12 steps completed. A path analysis showed that the number of 12 steps completed was negatively and directly related to negative affect. Moreover, the number of 12 steps completed was related to higher spiritual growth, which was directly related to higher levels of life satisfaction and lower levels of negative affect, and indirectly, through gratitude, to higher levels of life satisfaction and positive affect. The results suggest that spiritual growth, rooted in the 12-step program, and its ability to increase gratitude, may promote recovery from CSBD.

Gossip and Addiction Recovery in Rural Communities.

Features of rural life, such as low population density and greater distances from urban areas, could worsen the prospects of addiction recovery for rural residents. Gossip is a central feature of rural life, and studies have shown that being the target of it can worsen health and well-being. However, no previous study has focused on the impact of gossip on addiction in rural communities. The current study employed semi-structured interviews with individuals in recovery, as well as addiction providers, to create a conceptual model of the relationship between gossip and addiction recovery in a rural region of Minnesota. The conceptual model depicted a bi-directional relationship between the individual and the community and suggested that gossip transforms from negative to positive over the course of addiction, early recovery, and long-term recovery. These data demonstrate that education at both the community and individual levels could support the transition to long-term recovery.

Helping Clients Engage With Remote Mutual Aid for Addiction Recovery During COVID-19 and Beyond.

Face-to-face mutual-aid meetings such as Alcoholics Anonymous shuttered with the onset of COVID-19. Research could not be conducted quickly enough to provide guidance for how to respond. However, two powerful tools could be leveraged: the research on mutual aid conducted before the pandemic and the vast number of virtual resources that proliferated with the onset of the pandemic. This article reviews the existing mutual aid research and its relevance to COVID-19, describes the diverse array of virtual resources, and provides recommendations for successful engagement with virtual mutual aid during COVID-19 and beyond.

Identifying strengths in youths at substance use treatment admission.

Background: Clinicians have been required to assess client strengths at substance use treatment admission for two decades. Yet little is known about identified strengths in this population that could make it easier for clients to accept having this illness. Objectives: This study explored the profile of clients' strengths and whether strengths varied by background characteristics and constructive use of time. Methods: Data were collected with validated instruments at treatment admission. Substance dependent youths (N = 195, 52% female, aged 14-17, 30% minority), their legal guardians, and admission counselors completed an open-ended prompt about client strengths. Qualitative responses of identified strengths were coded by theme. Univariate comparisons linked count of identified strengths and patient characteristics. Results: Youths had an average of three identified strengths (SD = 1.99) at admission, and 9% did not identify any strengths. Interpersonal strengths were most prevalent (73%), followed by generic intelligence (45%), and grit (31%). Female gender, not having a parent with a high school diploma, narcotic dependence, and shorter duration of consecutive days sober were associated with fewer strengths. Conclusion: Highly sociable, hard-working, and smart were prominent strengths in the sample. Each day sober corresponded with more identified strengths, which may encourage those in early recovery. Identifying strengths can help clients find meaningful sober recreation and may be particularly useful tools for girls and those with low parental education. Developing standards for using identified strengths in treatment planning and consensus on the taxonomy of strengths are topics for future research.

GRATITUDE WHILE DRINKING, GRATITUDE WHILE RECOVERING: A STUDY OF ALCOHOL USE DISORDERS.

Background: For decades researchers have debated whether those diagnosed with alcohol use disorders can return to non-problematic drinking. Now, recovery researchers are measuring aspects of wellbeing in addition to aspects of pathology, producing surprising findings that have added to the debate. Recent studies show that some with alcohol use disorders who continue to drink endorse high levels of positive psychosocial functioning. Objectives: Employ trait gratitude as a marker of wellness to answer the following questions: how do individuals who continue to drink but endorse high gratitude at follow-up differ from peers at baseline? Does trait gratitude correlate differently with demographic, psychosocial, and clinical factors for abstinent members of Alcoholics Anonymous (AA) versus actively drinking non-AAs? Methods: 275 individuals with alcohol dependence were assessed for trait gratitude at 2.5-3-year follow-up in a naturalistic, longitudinal study. The sample was assessed on psychosocial and clinical indicators at baseline and follow-up. Results: Drinkers who endorsed high gratitude had higher socioeconomic status, greater levels of positive spirituality, more stable personality indicators, less addiction severity, fewer negative life events, and fewer psychiatric symptoms than their peers at baseline. For actively drinking non-AAs, trait gratitude correlated differently, and positively, with years of education, income, and purpose in life compared with sober AA members. For AA members, gratitude correlated with AA involvement and length of sobriety. Discussion: Across multiple domains, a subset of drinkers report doing relatively well despite meeting criteria for alcohol dependence. Trait gratitude correlates differently with other constructs for AAs versus non-AAs, indicating that gratitude for recovery might be contextually sensitive, operating differently within and without the structure of AA.

Longitudinal Relationship between Forgiveness of Self and Forgiveness of Others among Individuals with Alcohol Use Disorders.

Previous research has suggested that forgiveness of self and forgiveness of others might function differently over the course of addiction recovery. However, we know little about the longitudinal process of these dimensions of forgiveness for individuals addressing alcohol-use disorders. Increased knowledge would inform the content and sequencing of intervention strategies. Three hundred and sixty-four individuals managing alcohol dependence participated in a 30-month longitudinal study, reporting their capacity to forgive self and to forgive others every 6 months. Findings indicated that a) participants were more forgiving of others than themselves, b) both types of forgiveness increased over time, c) forgiveness of self increased more rapidly than forgiveness of others, and d) while increases in both types of forgiveness predicted increases in the other type, the effect of forgiveness of others on forgiveness of self was twice as strong as the reverse effect. Implications for facilitating forgiveness in treatment are discussed.

Longitudinal Differences in Spirituality and Religiousness between Men and Women in Treatment for Alcohol Use Disorders.

This study compares men and women with alcohol use disorders on levels and trajectories of spirituality and religiousness over 30 months while controlling for critical covariates. Men (n=92) and women (n=65) entering abstinence-based treatment were assessed for drinking behavior, spirituality, and psychosocial variables in a longitudinal panel study. Multiple regression tested for baseline differences and multi-level models tested for differences from baseline to 6 months (early recovery) and from 6 to 30 months (later recovery) in seven dimensions of spirituality/religiousness. Between baseline and 6 months, women had higher scores than men for forgiveness of others and lower scores than men for negative religious coping. Between 6 and 30 months, the acceleration of positive change in self forgiveness was significantly greater for women than men. Differences in negative religious coping and forgiveness might relate to differences in shame and guilt and their resolution by gender. Future research should examine whether gender differences in spirituality serve as an asset to women as they pursue addiction recovery.

Decreased Drinking and Alcoholics Anonymous are Associated with Different Dimensions of Spirituality.

Alcoholics Anonymous (AA) is a spiritual program and involvement in it has been associated with increases in spirituality. Some who pursue recovery outside AA also use spirituality for support. Decreasing drinking without AA involvement might result in spiritual change, but this has not been explored in previous research. This study investigates drinking and AA behavior to determine their association with seven dimensions of subsequent spirituality. METHODS: A 30-month panel study recruited 364 individuals with alcohol dependence. Multilevel models examined drinking and AA at six months as predictors of both the levels and trajectories of seven dimensions of spirituality assessed five times over 6 - 30 months. RESULTS: Controlling for AA involvement, less drinking was associated with higher levels of purpose in life, self-forgiveness, and spiritual/religious practices. Controlling for drinking, greater AA involvement was associated with higher levels of positive religious coping, daily spiritual experiences, forgiveness of others, and spiritual/religious practices. Neither AA nor drinking predicted trajectories of spirituality. Data visualizations identified a pattern of elevated purpose in life and self-forgiveness among individuals who were abstinent and among individuals who drank less intensely. CONCLUSIONS: Reduced drinking influenced aspects of spirituality that have been shown to respond to experience and maturation. AA was associated with aspects of spirituality embedded in the 12 steps which have been shown to be responsive to learning and modeling. This knowledge has the potential to inform decisions about recovery options, and contributes to theoretical understandings of the nature of spiritual change over the course of addiction recovery.

Gratitude, abstinence, and alcohol use disorders: Report of a preliminary finding.

Gratitude is a central component of addiction recovery for many, yet it has received scant attention in addiction research. In a sample of 67 individuals entering abstinence-based alcohol-use-disorder treatment, this study employed gratitude and abstinence variables from sequential assessments (baseline, 6months, 12months) to model theorized causal relationships: gratitude would increase pre-post treatment and gratitude after treatment would predict greater percent days abstinent 6months later. Neither hypothesis was supported. This unexpected result led to the theory that gratitude for sobriety was the construct of interest; therefore, the association between gratitude and future abstinence would be positive among those already abstinent. Thus, post-treatment abstinence was tested as a moderator of the effect of gratitude on future abstinence: this effect was statistically significant. For those who were abstinent after treatment, the relationship between gratitude and future abstinence was positive; for those drinking most frequently after treatment, the relationship between gratitude and future abstinence was negative. In this preliminary study, dispositional tendency to affirm that there is much to be thankful for appeared to perpetuate the status quo-frequent drinkers with high gratitude were drinking frequently 6months later; abstinent individuals with high gratitude were abstinent 6months later. Gratitude exercises might be contraindicated for clients who are drinking frequently and have abstinence as their treatment goal.

Counselors' Perspectives of Positive Psychology for the Treatment of Addiction: A Mixed Methods Pilot Study.

Little is known about the use of positive psychology interventions (PPI) in addictions treatment. Questionnaires and interviews with alcohol and substance use disorder counselors explored theories of how PPIs might work, the degree to which they are used, and downsides. Results suggested that positive and pathology-based themes were attended in equal proportion, that substance abuse treatment should help clients develop a good life in recovery; that counselors already use PPI; and that PPI might counter negative cognitions and affect. Reservations for using PPI included relying on PPI exclusively and employing PPI indiscriminately without regard to client characteristics.

Alexithymia, emotional dysregulation, and recovery from alcoholism: therapeutic response to assessment of mood.

This study is a secondary analysis of a randomized controlled trial that tested the effects of a gratitude intervention on well-being in a sample of individuals in outpatient treatment for alcohol use disorder (AUD). Follow-up qualitative interviews unexpectedly revealed that participants found the Positive and Negative Affect Schedule (PANAS) to be helpful to their recovery in the ways that it asked them to identify and rate their emotions. Participant statements were purposively sampled and analyzed using grounded theory methods to produce a conceptual framework illustrating the process of mood identification and its sequelae. Evidence of existing alexithymia and emotional dysregulation, dominance of negative mood, and increasing ability to identify, accept, and regulate mood as part of recovery was found. Findings suggest that emotion regulation is a compelling topic for those in recovery from AUD, and may deserve a more prominent role in treatment.

Feasibility, Acceptability, and Impact of a Web-based Gratitude Exercise among Individuals in Outpatient Treatment for Alcohol Use Disorder.

This mixed-methods pilot study examined the feasibility, acceptability, and impact of a web-based gratitude exercise (the 'Three Good Things' exercise (TGT)) among 23 adults in outpatient treatment for alcohol use disorder (AUD). Participants were randomized to TGT or a placebo condition. The intervention was feasible with high rates of completion. Participants found TGT acceptable and welcomed the structure of daily emails; however, they found it difficult at times and discontinued TGT when the study ended. Participants associated TGT with gratitude, although there were no observed changes in grateful disposition over time. TGT had a significant effect on decreasing negative affect and increasing unactivated (e.g., feeling calm, at ease) positive affect, although there were no differences between groups at the 8 week follow up. Qualitative results converged on quantitative findings that TGT was convenient, feasible, and acceptable, and additionally suggested that TGT was beneficial for engendering positive cognitions and reinforcing recovery.

Trajectories of alcohol use over time among adults with alcohol dependence.

This study sought to identify trajectories of drinking behavior change over time in a sample of adults with current alcohol use disorder (AUD). We conducted secondary analyses of seven waves of data from a prospective longitudinal study of 364 adults (mean age=44.0 years, SD=12.8 years) who met criteria for DSM-IV alcohol dependence (AD), 74.4% of whom were entering alcohol treatment. Participants were followed for 2 1/2 to 3 years with in-person interviews every 6 months. Results from latent class growth analyses of drinks per drinking day over 3 years indicated five trajectory classes: 1) Moderate Baseline→Slow Decline; 2) Heavy Baseline→Stable Abstinent; 3) Heavy Baseline→Slow Decline; 4) Heaviest Baseline→Steep Decline, and 5) Heaviest Baseline→Stable Heavy. Findings are consistent with previous research and suggest that these trajectory classes might represent longitudinal phenotypes of alcohol involvement across diverse samples. Treatment modality, Alcoholics Anonymous involvement, and purpose in life were associated with diverse trajectories of drinking behavior among adults with AD. AA involvement was associated with higher odds of membership in trajectory classes that showed declines in drinking from baseline, and having higher purpose in life predicted lower odds of membership in the Heaviest Baseline→Stable Heavy class. AA involvement predicts different pathways of recovery characterized by stable abstinence, steep declines, and/or slower declines in drinking over time. Higher purpose in life may protect against chronic heavy drinking by strengthening motivations to pursue goals that are unrelated to substance use.

A longitudinal study of drinking and depression as predictors of insomnia in alcohol-dependent individuals.

Insomnia and depressive symptoms are common symptoms among alcohol-dependent (AD) patients. AD individuals (N = 364) were assessed during 2004-2009 in the Midwestern United States at baseline and 6-month intervals with the Sleep Problems Questionnaire, Time-Line Follow-Back interview, and the depression subscale of the Brief Symptom Inventory. Hierarchical Linear Modeling was used to analyze the data in this longitudinal study. When modeled separately, both quantity of drinking (p < .01) and depression (p < .001) predicted insomnia severity, controlling for time, age, and gender. Drinking also predicted depressive symptoms (p < .001), and its effect on insomnia was mediated by depression severity (p < .001).

The effect of drinking goals at treatment entry on longitudinal alcohol use patterns among adults with alcohol dependence.

BACKGROUND: Drinking goals at treatment entry are a promising, yet under-studied mechanism of change in alcohol use following treatment. It is not known who, upon treatment entry, is likely to desire abstinence as a drinking goal and whether desiring abstinence as a drinking goal influences alcohol use following treatment. METHODS: Data from a 2.5-year longitudinal study of alcohol-dependent adults from 3 treatment sites is examined in a secondary data analysis. At treatment entry, participants reported sociodemographic and clinical characteristics, as well as whether they desired abstinence as a drinking goal or not. At each subsequent wave, participants reported their alcohol use. RESULTS: Bivariate analyses showed that individuals from a VA outpatient treatment site, men, and racial or ethnic minorities were most likely to desire abstinence as a drinking goal at treatment entry. Multi-level mixed effects regression models indicated that individuals who at baseline desired abstinence as a drinking goal sustained higher percentage of days abstinent and higher percentage of days since last drink 2.5 years following treatment entry, compared to individuals who did not desire abstinence. CONCLUSIONS: Understanding who is most likely to desire the specific drinking goal of abstinence can assist clinicians in anticipating client response to goal setting. Furthermore, by understanding the benefits and risks associated with drinking goals, clinicians can focus attention to individuals who desire a more risk-laden goal, including goals of non-abstinence, and tailor interventions, including motivational interviewing techniques, to support effective goals.

Multiple dimensions of spirituality in recovery: a lagged mediational analysis of Alcoholics Anonymous' principal theoretical mechanism of behavior change.

Alcoholics Anonymous (AA) states that recovery is possible through spiritual experiences and spiritual awakenings. Research examining spirituality as a mediator of AA's effect on drinking has been mixed. It is unknown whether such findings are due to variations in the operationalization of key constructs, such as AA and spirituality. To answer these questions, the authors used a longitudinal model to test 2 dimensions of AA as focal predictors and 6 dimensions of spirituality as possible mediators of AA's association with drinking. Data from the first 18 months of a 3-year longitudinal study of 364 alcohol-dependent individuals were analyzed. Structural equation modeling was used to replicate the analyses of Kelly et al. (Alcohol Clin Exp Res. 2011;35:454-463) and to compare AA attendance and AA involvement as focal predictors. Multiple regression analyses were used to determine which spirituality dimensions changed as the result of AA participation. A trimmed, data-driven model was employed to test multiple mediation paths simultaneously. The findings of the Kelly et al. study were replicated. AA involvement was a stronger predictor of drinking outcomes than AA attendance. AA involvement predicted increases in private religious practices, daily spiritual experiences, and forgiveness of others. However, only private religious practices mediated the relationship between AA and drinking.

Review of the application of positive psychology to substance use, addiction, and recovery research.

Advances in positive psychology have grown exponentially over the past decade. The addictions field has experienced its own growth in a positive direction, embodied by the recovery movement. Despite parallel developments, and great momentum on both sides, there has been little crosspollination. This article introduces positive psychology and the recovery movement, describes the research on positive psychology in the addictions, and discusses future avenues of theory, research, and intervention based on a positive-psychology framework. A systematic review of positive psychology applied to substance use, addiction, and recovery found nine studies which are discussed according to the following themes: theoretical propositions, character strengths and drinking, positive psychology and recovery, positive interventions, and addiction: feeling good and feeling bad. The current scholarship is scant, but diverse, covering a wide range of populations (adults, adolescents, those in and out of treatment), topics (character strengths, recovery, positive affect), and addictive behaviors (work addiction, cigarette smoking, and alcohol use disorders). There is diversity, too, in country of origin, with work originating in the U.S., U.K., Poland, and Spain. The rigorous application of the lens, tools, and approaches of positive psychology to addiction research generally, and to the aims of the recovery movement specifically, has potential for the development of theory and innovation in prevention and intervention. Further, because the work in positive psychology has primarily focused on microsystems, it may be primed to make contributions to the predominantly macrosystems focus of the recovery movement. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

The Role of Religiousness on Substance-Use Disorder Treatment Outcomes: A Comparison of Black and White Adolescents.

This study compares 41 Black and 124 White adolescents at intake and discharge from a residential treatment program for substance-use disorders. Study data were obtained as part of a larger study (N = 195) that sought to assess the relationship of helping behavior and addiction recovery. This post-hoc analysis aims to identify cultural strengths that may be associated with recovery from substance-use disorders among Black adolescents. Using regression analyses and controlling for the severity of substance use and background variables that distinguish racial groups, religious practices and behaviors at intake were examined. Specifically, Black youth and White youth were compared on treatment outcomes, including alcohol or drug use during treatment, drug craving, 12-Step work, and 12-Step helping. The burden of health and socioeconomic disparities at intake did not disproportionately disfavor Black adolescents. Outcomes related to 12-Step measures were similar between Black and White youth. White adolescents reported higher craving scores at discharge, and Black adolescents were more likely to use drugs during treatment. High levels of religiousness at treatment intake were linked to greater 12-Step work and greater 12-Step helping at discharge. High levels of religiousness at intake were not related to drug use during treatment or to craving scores at discharge. The relationship between intake levels of religiousness and treatment-related outcomes did not differ by race.

Alcohol and drug use among sexual minority college students and their heterosexual counterparts: the effects of experiencing and witnessing incivility and hostility on campus.

PURPOSE: Research suggests that discrimination contributes to increased substance use among sexual minorities. Subtle discrimination and witnessing mistreatment, however, have received little attention. Using minority stress theory as a conceptual framework the authors examined the intersection of sexual orientation, experiencing and witnessing incivility and hostility, and students' alcohol and drug use. The authors hypothesized that experiencing/witnessing incivility/hostility would mediate the relationship between sexual minority status and drinking and drug use, as well as problematic use of these substances. METHODS: Data were taken from a campus climate survey (n = 2497; age mean [M] = 23.19 years; 61% female; 17% sexual minorities). Controlling for demographics, logistic regressions depicted specifications for each path of the mediation analysis and bootstrapping was used to assess the significance of each sexual minority-mistreatment-drinking/drug use path. RESULTS: Experiencing incivility mediated the relationship between sexual minority status and problematic drinking. Sexual minority college students were more likely to personally experience incivility (adjusted odds ratio [AOR] = 1.87; 95% confidence interval [CI] = 1.51-2.33), which was associated with greater odds of problematic drinking (AOR = 1.64; 95% CI = 1.35-2.00). The mediation path was significant at P < 0.001. Further, witnessing hostility mediated the relationship between sexual minority status and problematic drinking. Sexual minority college students were more likely to witness hostility (AOR = 1.87, 95% CI = 1.48-2.36), which was associated with greater odds of problematic drinking (AOR = 1.53; 95% CI = 1.24-1.90). The mediation path was significant at P < 0.01. CONCLUSION: The results provide further evidence for minority stress theory and suggest that clinical alcohol use interventions with sexual minorities need to assess personal incivilities and witnessing interpersonal mistreatment, especially hostility. Campus climate interventions that address subtle discrimination as well as harassment and violence may help reduce problematic drinking.