How a gratitude and positive activity journal supports recovery from alcohol and other substance use disorders: a framework derived from grounded theory

Abstract

Purpose: Improving subjective wellbeing in recovery is a compelling strategy to reduce relapse. Positive Peer Journaling (PPJ) is a daily journaling practice that combines positive psychology with behavioral activation to increase subjective wellbeing in recovery and thereby reduce relapse. We conducted a pilot feasibility study of PPJ that included the collection of qualitative data from audio-recorded interviews of participants describing their experience using PPJ. The purpose of the current study was to analyze these qualitative data to produce a theoretical model describing how PPJ might support sustained abstinence.

Methods: Participants were 15 women receiving residential treatment for addiction (M= 37 years, SD=10; 73% with household income < $15,000; 70% with civil or criminal court cases; 90% with trauma history; mean length of sobriety 48 days, SD=32). The journal leverages positive psychology exercises (gratitude practices and acts of kindness), values exercises, and activity scheduling to review the past day and plan the next day. Interview transcripts were transcribed verbatim, and analyzed using thematic analytic techniques and grounded theory methodology to capture themes in the data, study the ways in which the themes were related, and build a theory to describe how the journal might work to support recovery.

Results: Although participants typically reported negative mood, reviewing the past day helped them to perceive life in recovery more positively. Participants reported that planning the next day helped them to remember to complete tasks they usually forgot, which produced positive emotions including pride and confidence. Positive emotion and satisfaction with life are key elements of subjective wellbeing.

Conclusions: Increased subjective wellbeing as the result of PPJ could help increase the discrepancy between active substance use and life in recovery which in turn would encourage taking the action necessary to maintain sobriety. Our findings also might describe how gratitude practices operate in addiction recovery more generally. In future work we will pilot PPJ in a randomized control trial to obtain further evidence of feasibility, acceptability, and impact.