Journaling to Support Recovery from Alcohol and Other Substance Use Disorders: Feasibility Results from a Randomized Controlled Pilot

Abstract

Purpose: Positive psychology, behavioral activation, and journaling have been shown to improve affect and decrease addictive behavior among individuals with SUD and AUD. We combined aspects of these approaches in “Positive Recovery Journaling” (PRJ), a daily writing practice, to improve wellbeing in early recovery. In this pilot randomized controlled trial, we sought to determine the feasibility and acceptability of PRJ in a study conducted remotely during COVID 19. Methods: Participants (N = 81; M = 39 years old, 46% indicating alcohol as primary addiction) were recruited from three treatment centers in the Upper Midwest. Individuals randomized to PRJ learned the technique over 8 group sessions and practiced it daily for 4 weeks followed immediately by completion of daily assessment instruments. The control group only completed daily assessment instruments. Feasibility and acceptability were assessed by recruitment, retention, rates of journal upload, and group attendance. We used multilevel models to compare the treatment and control groups’ average ratings of study activities as difficult, easy, satisfying, pleasant, and helpful. Results: Of patients who met inclusion criteria (N = 86), 81 (94.2%) agreed to participate. Attendance at group sessions ranged from zero to eight (M = 5.3, SD = 2.8); three (7.1%) attended zero groups and 15 (35.7%) attended all eight groups. The 42 treatment group members submitted 584 journal entries (ranging from 0 to a maximum of 28, M = 13.9, SD = 9.7). Survey completion rates at the 1-month follow-up were 53.4% for the treatment group and 71.8% of the control group (X2 p = .072). Participants rated study activities as equally easy and not difficult. The treatment group rated PRJ as significantly more satisfying, pleasant, and helpful (all at p < .001), showing high acceptability of PRJ especially since the control group reported benefitting from the daily surveys. Conclusions: This population showed a strong interest in journaling. Despite the challenges of conducting a study remotely during COVID 19, it was still possible to recruit and retain a treatment sample who attended the majority of group sessions and rated PRJ as no more difficult, and yet more satisfying, pleasant, and helpful, than the control group’s activities.