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Gratitude practices reinforce recovery from addiction, pilot study finds

Amy Krentzman of the U of M’s School of Social Work discusses the connection between positive psychology and recovery.

Gratitude practices are common in addiction treatment and recovery. Amy Krentzman, assistant professor of social work at the University of Minnesota’s College of Education and Human Development, wants to find out more about how — and why — they work.

“Recovery in Alcoholics Anonymous has always involved gratitude,” Krentzman said. “Substance abuse counselors also report encouraging gratitude and positive social engagement for their clients. But no one has done the research to back up the belief that these kinds of practices work. I’d like to do that.”  

Since coming to Minnesota nearly two years ago, following a four-year postdoctoral appointment at the University of Michigan, Krentzman has been working to expand on the public’s understanding of the ways positive psychology can support recovery from addiction.

For an academic with a clear interest in the treatment of substance abuse disorders, landing a tenure-track job in Minnesota, with its history of substance-abuse treatment centers, was a dream come true.

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“For me to get this job in this state was absolutely fantastic,” she said. “I’m thrilled. This is a wonderful place to be doing this kind of research. This is a great community of people who care deeply about recovery issues.”

Krentzman and I spoke earlier this week.

MinnPost: What is positive psychology?

Amy Krentzman: Positive psychology is the scientific study of wellness, rather than illness, or pathology.

One way I’ve started to describe it is while a focus on pathology can help a person go from a negative state to a neutral state, a focus on positive psychology can help a person go from a neutral state into the positive zone. In other words, the absence of mental illness does not necessarily equal the presence of wellness or happiness. There is more there that can be put under the scientific lens and more health and happiness that can be achieved. 

MinnPost: How did you make a connection between positive psychology and recovery?

AK: I do research on addiction recovery. I feel there has been less research in that area, and there are still many strategies that we can learn that can help inform our methods of addiction treatment.

The way positive psychology comes into play in the long-term recovery phase is this: People in addition recovery often do very well. They flourish. Life is better than it ever was once they have put their addictive behaviors behind them. Even though this happens for a number of people, we don’t know a lot about it. And feelings of flourishing and positive affect are central to positive psychology.

I want to see how positive psychology strategies can be used to reinforce long-term recovery.

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MP: How did you first become interested in the connections between positive psychology and recovery?

Amy Krentzman
Amy Krentzman

When I began doing research on this period of recovery, I was talking to a colleague, and she said, “Of course you’ve been reading about positive psychology. You should read this great anthology about flourishing in life.” I hadn’t given much thought to the potential impacts of positive psychology on recovery, and I hadn’t read the book, so I went out and got a copy. As I read through the book, with every chapter I thought, “There are so many implications for addiction recovery here.”

So I dug deeper into the research and saw that very little had been done about the connections between positive psychology and addiction recovery. I saw that this could be an area that could produce valuable information for people.

I looked at the positive psychology practices that were out there in the literature. Out of those I thought a focus on gratitude would be the most compelling one to study for addiction recovery. Gratitude is a frequent topic in recovery circles and appears as a theme in Alcoholics Anonymous literature.

MP: So you decided to do a study. Tell me about your methods.

AK: I started with a pilot study back when I was a postdoc at the University of Michigan. I randomized two groups of people who were in treatment for alcohol-use disorders. I divided them into a treatment group and a control group. 

Every day for 14 days, members of the treatment group were asked to complete a daily gratitude practice. For the practice, I chose a well-respected positive psychology exercise known as “the three good things.” Every day, the subjects in the treatment group were asked to think of three good things that they had experienced that day and why they thought those good things happened.

The control group answered six other unrelated open-ended questions.

MP: What did you learn?

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AK: What we found at the end of the study was that performing a daily gratitude practice had a very interesting effect on mood. Over those 14 days, the people in the gratitude group felt an increase in unactivated positive mood. They felt more calm, serene, peaceful and at ease than the subjects in the control group. The gratitude group also felt less negative affect. They were less irritated, angry or upset. They reported a significant decrease in negative mood.

After the study was over, I interviewed the participants. I asked questions like, “What it was like to be in the study? What were the exercises like? What effect did they have on your mood?”

People in the gratitude group said the exercises helped to brighten their cognition and activated an ability to think about the positive side of life. Interestingly, the exercises also had the effect of reinforcing their recovery. A lot of times, subjects would say things like, “When I experienced the good thing, it happened because I am sober. I am in recovery.”

What was happening was that once or twice a or three times a day participants were saying to themselves, “There are good things in my life that are happening because I am sober.” Gratitude practices reinforce recovery.

It’s important to add that this just was a pilot study. It still needs to be replicated with a larger sample to make sure that what we found holds up.  

MP: Have you done other research on possible connections between positive psychology and recovery?

AK: I did another study of addiction counselors. I asked them to tell me to what degree they are already using positive psychology practices in their work with clients. Many said that they already recommend gratitude practices to the people the work with. The counselors told me that gratitude seemed to help the people they worked with.

MP: So you’re saying that positive psychology techniques are something that people in recovery circles have known was effective for some time, but they just haven’t had the science to back it up?

AK: Yes. Since the 1980s, addiction scholars have said that to help people recover and stay sober for a lifetime, you have to help them find ways to live good lives without drugs or alcohol. When a person in recovery enjoys their life, relapse becomes something that costs far too much. You don’t want to lose your good life by falling back into drug or alcohol abuse.

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Positive psychology has been around since 1998. There have been aspects of helping people to live well that have been part of addiction interventions but we haven’t studied them well enough.

There is a body of research on the benefits of helping people get engaged in positive sober activities and how helping people choose and try out those new activities could be reinforcing of sobriety. Now we have a new angle for looking at what we’ve been doing all along.

MP: If we already know that these strategies work, why is it important to conduct research on their efficacy?

AK: To provide concrete evidence that it works and to find out how it works.

MP: So that would explain your focus on gratitude practices, for instance.

AK: Yes. And the roots of gratitude go deeper back in human history than the positive psychology movement. It is part of longstanding religious traditions and part of the human experience that goes back very deep in our history.

I was curious about the effectiveness of popular gratitude practices like gratitude journals. The idea that we intentionally practice gratitude: What are the benefits to that? What happens as a result? That has been a relatively new idea that came from the positive psychology movement.

If we understood that better, perhaps we’d be in a better position to ask, “How do we recommend using a gratitude practice, what does it do to reinforce recovery and how does it function in a social work?”

MP: On the flip side of this issue, is there a connection between negative mood and chemical abuse?

AK: Negative mood is deeply implicated in theories of why people, even healthy people without alcoholism, might drink. Negative mood is part of what motivates people to drink. Once addiction sets in, it is a vicious circle. It’s the nature of addiction that makes it harder for people to experience pleasure. Negative mood continues to motivate people to drink in order to feel better.

Once addictive cycles set in, it becomes harder to experience pleasure, and negative mood dominates. Negative mood also is a well-known predictor of relapse among people who are trying to stay sober.