Gratitude and Positive Activity Planning to Support Recovery from Alcohol and Substance Use Disorders

Abstract

Purpose: Enhancing quality of life during early abstinence is a compelling strategy for reducing relapse. Gratitude practices have been shown to improve affect, and activity scheduling has been shown to promote enjoyment of daily activities. A simple practice for gratitude and activity scheduling is needed to encourage its regular enactment throughout recovery. We developed a ten-minute-a-day journaling practice to encourage gratitude, goal setting, and positive-activity planning to improve quality of life in recovery and reduce relapse.

Methods: In-depth semi-structured interviews were conducted with 33 individuals (57% in recovery from AUD/SUD, 14% treatment providers, 29% both) to ascertain their perspectives of the journaling practice. The journaling practice was presented to and briefly practiced by participants, who were then probed for subjective, qualitative impressions of it. The journaling practice uses standard journals printed with column headings under which individuals make bullet-pointed lists. On the left-hand page, the past 24 hours is recalled via column headings to promote gratitude: “good things that happened” and “things I am grateful for.” On the right-hand page, activities for the upcoming 24 hours are planned via headings representing valued life domains, i.e., work, social, health, joy, household, recovery, spirituality. Interviews were audio recorded, transcribed, analyzed for themes, and interpreted for relationships among themes.

Results: Participants were 57% female, mean age 50 years, length of abstinence 11 days to 36 years. Participants found the practice acceptable and easy as well as useful to recovery. Participants stated the practice would enable them to express gratitude, plan activities, and set goals; and also to notice change over time, guide self-discovery, identify issues to work on, gain emotional relief, and acknowledge successes. Negative impressions included that for some, setting multiple daily goals might feel overwhelming, failure to follow through on planned activity might produce negative emotion, and weaker writing skills might cause embarrassment.

Conclusions: For many, the journal would function as a mirror, providing perspective on past, present, and future self. Sharing the journal with another person would allow the authentic self to be known. Future work will examine the efficacy of integrating gratitude journaling into existing standardized behavioral activation therapy for substance use, namely LETS ACT.