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Applications of Positive Psychology to Substance Use Disorder

Positive psychology (PP) is a science of positive subjective experience, positive individual traits and positive institutions.1 It strives to improve the quality of life, and prevent mental and physical illness that can arise when life appears depleting and overwhelming. PP centers on individuals possessing qualities and characteristics that can allow them to flourish in times of stress and in times of happiness.1 PP uses empirical research to determine factors and actions that lead to individual well-being, positive outlook and thriving communities.

Positive psychology treatment approaches are emerging around the world and expanding the conceptual framework in which addiction is treated. Positive psychology recognizes recovery may be understood as a function of moving toward a positive adaptation in life.2Research in the treatment of addiction and positive psychology widens our focus from reducing dysfunctional behaviors to creating meaningful and positive experiences that lead to a positive life.2
Research shows that alcohol-dependent persons have an increased responsiveness to the affectivity of stress and alcohol craving. Positive affect (i.e., positive emotional state) shows an association with lower stress and reduced alcohol craving, while negative affect (i.e., negative emotional state) is subsequently associated with higher alcohol craving.3Furthermore, Ciarrocchi and Brelsford (2009) found that coping with emotions using substances was related to decreased well-being and increased emotional stress, while a sense of purpose in life and positive affect related negatively with the use of substances for emotional coping.4 Therefore, individuals with alcohol dependence may increasingly benefit from cultivating more positive emotions in order to regulate responses to stress.

Although not many studies have been published to date, current research provides themes geared toward improving substance abuse recovery, such as establishing "recovery capital."5 Incorporating more recovery capital—spirituality, life meaning and social support—into substance abuse individuals' everyday lives generates a greater likelihood of positive recovery outcomes.2

Varying Characteristics
Positive psychology research aims to identify specific characteristics that may be different between substance abuse and non-substance abuse populations. The constructs of hope and life purpose may be lacking in individuals who develop and continue to experience psychiatric symptoms and substance abuse. A small study found that hope significantly correlates with purpose in life and social support, and a lack of hope contributes to increased psychiatric symptoms among individuals who are 6 months or more into recovery.4 Furthermore, regardless of the amount of alcohol or drug use, Ciarrocchi & Brelsford, (2009) found parallels between purpose in life and positive affect from spiritual and religious practices and beliefs.4
Some researchers have proposed that spirituality and social support may be underlying factors to positive substance abuse outcomes. Though research on Alcoholics Anonymous (AA) is challenging because of the somewhat limiting practice of anonymity, one analysis indicates strong affiliates of the AA program tend to display strong psychological benefits.6 Members of AA with at least one year of sobriety and a high score on an AA Affiliation Scale presented significant links to gratitude, optimism, spirituality and purpose in life, regardless of length of sobriety.6

A research study tested the impact of gratitude on positive affect and alcohol use. Individuals with Alcohol Use Disorder (AUD) from an outpatient treatment setting participated in a mixed methods randomized control intervention for 14 days. Every day participants were required to write three good things (TGT) that happened in a day and why they happened. Data was collected by daily web surveys and then followed by telephone or in-person interviews at the end of the intervention and at intervals post-intervention. Over the course of the 14-day intervention, negative affect decreased while unactivated positive affect (e.g., feeling calm) increased significantly in the TGT group as compared to the control group.7 This study suggests that incorporating gratitude into those diagnosed with AUD may have a positive impact on recovery, and frequent moments of gratitude might be beneficial for lasting recovery.7

Character Strengths and Virtues in Recovery
Research on personal principles suggests that certain moral and character strengths may prevent pathology and increase resiliency to challenges in life.8 In positive psychology, moral strengths (called virtues) are positive traits related to moral behavior and a good life.9 These comprehensive virtues are courage, justice, humanity, temperance, wisdom and transcendence. Positive psychology studies virtues, as well as character strengths, in order to identify common factors for prevention and recovery from alcohol and drug addiction.

One of the character strengths that may be especially helpful to enact in the recovery process from substance abuse is grit. Substance use disorders are chronic conditions and require consistent and sustained effort to deal with life-long adversities. Grit is the trait-level ability to be persistent and focused in the pursuit of long-term goals, which may promote sustained recovery.10, 11 Studies have shown that people with high levels of grit persevere through difficult tasks and obstacles in their attempt to reach long-term goals.10, 11

Therapeutic modalities in positive psychology (called positive psychotherapy, or PPT) are concerned with building personal strengths. In addiction treatment, PPT is a process of building a positive, satisfying and reinforcing life in recovery.12 Specific positive psychotherapeutic techniques are designed to further three components of happiness and recovery: positive emotion, engagement and flow, and meaning in life. Possessing these positive factors creates an opportunity to build a foundation for a successful life in recovery from alcoholism and addiction.13 PPT attempts to amplify the intensity and duration of positive emotions about the past, present and future. Creating engagement in life and finding flow means involvement and absorption in work, intimate relations and leisure activities.14 Building a meaningful life brings a sense of satisfaction from belonging to or serving something bigger than oneself. Positive interventions by definition build pleasure, engagement and meaning.

Building positive emotion, engagement and meaning may actually counter the disorder itself. Tugade & Fredrickson (2004) found that positive emotions induced in the lab were related to more rapid dissipation of negative emotions, and even reversed the cardiovascular after effects of negative emotion.13 A positive psychological intervention of clinically depressed patients in 1995 showed that positive emotion displayed counteractive effects to psychological disorders.15 Participants in a 15-week intervention study met weekly to read about and apply strategies for increasing their satisfaction in various domains of life. After the study concluded, psychological measures of the clinically depressed patients showed that more than half of them no longer met the diagnostic criteria of the disorder.15

Furthermore, even simply talking about positive psychotherapy components can promote recovery. A small sample of 10 at-risk adolescents with issues of substance misuse was given eight weekly interventions of group work and discussion around various principle themes of positive psychology (e.g., positive emotions, gratitude, optimism, strengths). Four survey measures were used to test subjective happiness, orientation to life, positive and negative affect, and alcohol dependence. There was an increase in subjective happiness, optimism and positive emotions between the beginning and 14-weeks post intervention milestones, and a decrease in drinking behavior compared to the control group with no intervention.16 The positive intervention group showed an increase in happiness and a decrease in drinking behavior overall.16

Prevention research tells us there may be human strengths that act as buffers against mental illness and problematic behaviors. These traits are precisely what positive psychology aims to reinforce. Learned optimism—the idea of learning to dispute self-defeating and catastrophic thoughts, can act as a preventative trait toward depression and anxiety in children and adults.1 Building buffering strengths such as courage and perseverance, increasing optimism and hope, raising self-esteem, and increasing confidence in the ability to problem-solve and achieve goals are identified as therapeutic factors that promote recovery.2 The concept of increasing personal buffering strengths to prevent psychopathology applied toward the field of addiction and recovery may be valuable to future research on substance abuse prevention.

The Hazelden Betty Ford Foundation Experience

The idea of formal Positive Psychotherapy (PPT) is new to the field of addiction and therefore is not always recognized when techniques are employed. The Hazelden Betty Ford Foundation implements principles of positive psychology throughout their services, noted on their mission statement "We are a force of healing and hope for individuals, families and communities affected by addiction to alcohol and other drugs." PPT includes instilling hope, building buffering strengths and changing perspectives of life narration.11, 17 A small pilot study exploring positive psychology techniques in substance use disorder treatment found that addiction counselors were employing PPT themes in their sessions over half of the time without necessarily identifying their methods as explicitly PPT.12

How to Use This Information
Positive psychology states that addiction recovery can be understood as a process of moving toward positive adaptations in life. PPT and related techniques aid in uncovering strengths that help us move closer toward our ideals. Recovery from addiction can be difficult, and so invoking specific buffering traits may help in the journey toward a positive life. Some of these traits include courage, interpersonal skills, rationality, insight, optimism, honesty, perseverance, future-mindedness and finding purpose.

Questions and Controversies

How do we know positive psychology is not just a trend, emerging in relation to the rise in self-help and happiness popularity?

Methods of positive psychology have been implemented and studied for decades. In the 1900s, scholars set in motion a foundation of better understanding constructs such as success, happiness and well-being. Seminal research included Lewis Terman's work with intellectual genius and giftedness, John B. Watson's identification of effective parenting styles, and Carl Jung analysis of spirituality and self-discovery. More recently, the selection of Martin Seligman as the American Psychological Association's president in 1996 and his desire to integrate happiness and well-being into the field of psychology brought positive psychology to mainstream awareness. Today, the field of positive psychology looks into topics like evolutionary perspectives of happiness, positive personality traits, implications for mental and physical health, and fostering excellence.14
"Positive psychology (PP) is a science of positive subjective experience, positive individual traits and positive institutions centering on individuals possessing qualities and characteristics that can allow them to flourish in times of stress and in times of happiness.1

1. Seligman, M. E. P. (2001). Positive psychology, positive prevention and positive therapy. Handbook of Positive Psychology, 2, 3-12.
2. Krentzman, A. R. (2012). Review of the application of positive psychology to substance use, addiction and recovery research. Psychology of Addictive Behaviors, 27(1), 151-165.
3. McHugh, R. K., Kaufman, J. S., Frost, K. H., Fitzmaurice, G. M., & Weiss, R. D. (2013). Positive affect and stress reactivity in alcohol-dependent outpatients. Journal of Studies on Alcohol and Drugs, 74(1), 152-157.
4. Ciarrocchi, J. W., & Brelsford, G. M. (2009). Spirituality, religion and substance coping as regulators of emotions and meaning making: Different effects on pain and joy. Journal of Addictions & Offender Counseling, 30(1), 24-36.
5. Laudet, A. B., & White, W. L. (2008). Recovery capital as prospective predictor of sustained recovery, life satisfaction and stress among former poly-substance users. Substance Use & Misuse, 43(1), 27-54.
6. Zemansky, T. R. (2006). The Risen Phoenix: Psychological transformation within the context of long-term sobriety in Alcoholics Anonymous (Order No. 3184801). Available from ProQuest Dissertations & Theses A&I. (305350801).
7. Krentzman, A. R., Mannella, K. A., Hassett, A. L., Barnett, N. P., Cranford, J. A., Brower, K. J., Higgins, M. M., & Meyer, P. S. (2015). Feasibility, acceptability and impact of a web-based gratitude exercise among individuals in outpatient treatment for alcohol use disorder. The Journal of Positive Psychology, 10(6), 477-488.
8. Sandage, S. J., & Hill, P. C. (2001). The virtues of positive psychology: The rapprochement and challenges of an affirmative postmodern perspective. Journal for the Theory of Social Behaviour, 31(3), 241-260.
9. Dahlsgaard, K., Peterson, C., & Seligman, M. E. P. (2005). Shared virtue: The convergence of valued human strengths across culture and history. Review of General Psychology, 9(3), 203-213.
10. Crede, M., & Tynan, M. C. (2016). Much ado about grit: A meta-analytic synthesis of the grit literature. Journal of Personality and Social Psychology. Advance online publication. https://doi.org/10.1037/pspp0000102
11. Duckworth, A. L., Peterson, C., Matthews, M. D., & Kelly, D. R. (2007). Grit: Perseverance and passion for long-term goals. Journal of Personality and Social Psychology, 92(6), 1087-1101. http://dx.doi.org/10.1037/0022-3514.92.6.1087
12. Krentzman, A. R., & Barker, S. L. (2016). Counselors' perspectives of positive psychology for the treatment of addiction: A mixed methods pilot study. Alcoholism Treatment Quarterly, 34(4), 370-385.
13. Tugade, M. M., & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology, 86(2), 320-333.
14. Seligman, M. E., Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55(1), 5-14.
15. Grant, G. M., Salcedo, V., Hynan, L. S., Frisch, M. B., Puster, K. (1995). Effectiveness of quality of life therapy for depression. Psychological Reports, 76(3), 1203-1208.
16. Akhtar, M., & Boniwell, I. (2010). Applying positive psychology to alcohol-misusing adolescents: A group intervention. Groupwork, 20(3), 6-31.
17. Seligman, M. E. P., Rashid, T., and Parks, A. C. (2006). Positive psychotherapy, American Psychologist, 61(8), 774-788.


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