Introduction
• Enhancing quality of life during early abstinence is a 
compelling strategy for reducing relapse. 
• Gratitude practices have been shown to improve affect 
(Dickens, 2017; Krentzman et al., 2015).
• Activity scheduling has been shown to promote enjoyment 
of daily activities (Daughters et al., 2008). 
• Journaling helps express emotion leading to better health 
outcomes (Smyth, 1998).
Gratitude and Positive Activity Planning to Support Recovery from 
Alcohol and Substance Use Disorders
A.R. Krentzmana, K.E. Goodenoughb, R. Banerjeea, S.B. Daughtersc
Results
Discussion and Conclusions
• For many, the journal would feel validating and function as a mirror, providing perspective on past, present, and future self. 
• Increased awareness of the good and bad from “today” could inform intentions and planning for the future.
• Participants valued the ability to track the negative as well as the positive.
• For some clients, poor literacy might pose a significant obstacle. 
• Planning for the future was disagreeable for some.
• Participants found the left side of the page (past 24 h review) more acceptable and feasible than the right side of the page 
(future planning). Standardized behavioral activation therapy for substance use, involving activity planning, has been found to 
be acceptable to participants with high rates of treatment retention (Daughters et al., 2008, 2017; Magidson, 2011). Further work 
should reconcile the difficulties found in the current study with previous research where similar tasks were more acceptable.
• Future work will examine the efficacy of integrating gratitude journaling into existing standardized behavioral activation therapy 
for substance use, namely LETS ACT (Daughters et al., 2008, 2017; Magidson, 2011). 
aUniversity of Minnesota School of Social Work, St. Paul, MN; bMinnesota Chapter of the National Association of Social Workers, St. Paul, MN; 
cUniversity of North Carolina--Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC
This research was supported by the Office of the Vice President for Research at the University of Minnesota
and the Minnesota Agricultural Experiment Station
Method
• In-depth semi-structured interviews to ascertain perspectives 
of the journaling practice. 
• The journaling practice was presented and briefly practiced 
by participants.
• Interviews were audio recorded, transcribed, analyzed for 
themes (Braun & Clarke, 2006), and interpreted for 
relationships among themes.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.
Daughters, S. B., Magidson, J. F., Anand, D., Seitz-Brown, C. J., Chen, Y., & Baker, S. (2017). The effect of a behavioral activation treatment for substance use on post-treatment abstinence: a randomized controlled trial: Behavioral activation for substance use. Addiction. https://doi.org/10.1111/add.14049
Daughters, S., Braun, A., Sargeant, M., Reynolds, E., Hopko, D., Banco, C., & Lejuez, C. (2008). Effectiveness of a brief behavioral treatment for inner-city illicit drug users with elevated depressive symptoms: The Life Enhancement Treatment for Substance Use (LETS Act!). Journal of Clinical Psychiatry, 69, 122–129.
Dickens, L. R. (2017). Using gratitude to promote positive change: A series of meta-analyses investigating the effectiveness of gratitude interventions. Basic and Applied Social Psychology, 39(4), 193–208. https://doi.org/10.1080/01973533.2017.1323638
Krentzman, A. R., Mannella, K. A., Hassett, A. L., Barnett, N. P., Cranford, J. A., Brower, K. J., … Meyer, P. S. (2015). Feasibility, acceptability, and impact of a web-based gratitude exercise among individuals in outpatient treatment for alcohol use disorder. Journal of Positive Psychology. https://doi.org/10.1080/17439760.2015.1015158
Magidson, J. F., Gorka, S. M., MacPherson, L., Hopko, D. R., Blanco, C., Lejuez, C. W., & Daughters, S. B. (2011). Examining the effect of the Life Enhancement Treatment for Substance Use (LETS ACT) on residential substance abuse treatment retention. Addictive Behaviors, 36(6), 615–623. https://doi.org/10.1016/j.addbeh.2011.01.016
Smyth, J. M. (1998). Written emotional expression: effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66(1), 174.
References
Setting and Sample (N=33)
• Rural counties, upper Midwestern USA
• 61% individuals in recovery, 15% treatment providers, 24% 
treatment providers in recovery; length of abstinence 11 days 
to 36 years (M=11 years, SD=13 years)
• 55% female
• 18-73 years of age (M=50 years, SD=16 years)
• 88% white, 12% other (black, Latino/a, multiracial)
• Education: 24% high school diploma, 27% bachelors degree, 
9% masters degree
• Never married 36%, married 24%, divorced 30%
Overall, the 
journaling 
practice was 
perceived to be 
feasible and 
acceptable…
Feasibility
79% found the practice feasible, e.g.: “nothing too difficult,” “faster than I thought it would be,”  “a really easy way to journal,” “simple,” “all on one 
page instead of all over the place,” easier than looking at a “blank sheet of paper” wondering “what do they want?” 
Acceptability
82% offered favorable impressions: “This is just a marvelous piece,” “I love it”
27% initially had objections to “journaling” but liked the practice after thorough introduction: “That’s my kind of journaling. Just a phrase.”
21% were ready to get started “I’m so pumped, I’m going to buy a notebook after this” 
18% expressed more moderate intentions: “I should show this [to the sober house manager],” “I could see using this for [my treatment group],” “I 
can … talk to my sponsor … and see how we could put it in play.” 
…with two 
exceptions: 
writing and 
planning,
which garnered 
mixed reviews
Positive Views of Writing
Individuals felt writing was beneficial, you would “get it out of your head,” 
when you “write it down, you’ve released it”
Negative Views of Writing
Apprehension related to writing: “I have a hard time concentrating,” 
“writing and all that kind of stuff, I’m not so good at it,” “I don’t know how to 
spell"
A practitioner stated, “Just knowing how hard [homework is], this looks 
insurmountable;” similarly, an individual in recovery said, “It’s paperwork so 
it’s overwhelming.” 
Practitioners mentioned obstacles such as clients’ limited education: 
“some of my clients only made it to 3rd grade so they get embarrassed to 
write stuff” and cognitive disability: “I have some TBI clients who call me 
three times a day with the same question.”
Positive Views of Planning
Planning would help prioritize tasks… “I didn’t have time for my 
walk today, moving it up on the priority list” …and provide reminders: 
“it might remind me like, ‘well, why don’t you take two hours tomorrow 
and do [something joyful]?’”
Negative Views of Planning
Planning might engender burdensome thoughts “I hate remembering 
what I have to do in my home” and could cause disappointment: “My 
fear would be, I’d start it and then wouldn’t follow through…it would 
feed into my negative thoughts;” “I don’t want to set myself up for too 
many projects.” For some, “tomorrow” seemed uncertain: “I don’t 
know if I am going to … be able to … do things … because you don’t 
know if you are going to make it today.” 
The practice 
would aid 
recovery by 
increasing 
awareness of 
“what is” and 
focusing
attention on 
both the 
positive and 
the negative
Increased awareness of what is: “a vision…of my day and … where I am,” “you’re aware of your day more,” “be more aware of themselves, and 
more aware of what’s going on in their life day to day,” often acknowledging something that might otherwise go unnoticed: “you put it down on 
paper and you face yourself with it;” “you get it out and you can see it, you can say, oh, yeah, that did happen today.”
Tracking the positive would…
Draw attention to what’s going well: “because when you’re journaling in 
recovery, you tend to just write about all the bad things that you’ve gone 
through” 
Give one’s self credit for what is going right: “map out and see your 
successes” 
Increase awareness of positive change: “I did that two weeks ago and 
now look where I am”
Provide opportunity to practice gratitude
Tracking the negative would:
Identify issues that need attention: “what I need to work on and 
change” 
Put negative things into perspective: “the dog peed on the 
floor…like how big is that compared to me going through withdrawals 
9 months ago” 
Inspire improvement: “tomorrow I’m going to try harder” 
• We developed a brief journaling intervention to encourage 
past 24 hour review and upcoming 24 hour planning to 
improve quality of life in recovery and reduce relapse. 
• The journaling practice uses standard lined journals with 
column headings under which individuals make bullet-
pointed lists. 
• On the left-hand page, past 24 hours is recalled, itemizing 
“good” and “bad” things that happened and things for which 
one is grateful.
• On the right-hand page, activities for the upcoming 24 hours 
are planned via headings representing valued life domains. 
1. What are your observations and thoughts about this 
journaling practice?
2. How can this practice be helpful to individuals in recovery, if 
at all?
3. What might be a downside to this practice, if any?
Intervention
Questions We Asked