Positive Psychotherapy for Addiction Recovery — Anabel Salimian

Positive Psychotherapy interventions are helpful tools that can be integrated into the treatment plan of those who are working to overcome an addiction (e.g,. a substance use disorder). Though investigations of positive psychotherapy per se remain sparse, there is  some research on the utility of positive psychotherapy interventions for addiction recovery, which may be applied to the exploration of psychotherapy outcomes (1,2). 

Utilizing positive psychology in the treatment of addiction will expand the current treatment focus from the reduction of dysfunctional and negative behaviors toward the development of positive experiences that will boost a client’s desire for an increased sense of meaning and purpose in their life (1). Cognitive Behavioral Therapy (CBT) approaches have the highest level of empirical support for the treatment of drug and alcohol use disorders (3,4). However, CBT’s impact on retention and long term sobriety continue to show room for improvement. Relapse rates for alcohol use disorder, for example, are roughly between 40% and 60% according to the National Institute on Drug Abuse (NIDA, 2020). There needs to be a shift in treatment focus toward long term recovery and retention of sobriety, and positive psychotherapy interventions may be a key to achieving long term sustainable health.

Positive psychotherapy interventions can play an important role in achieving long term addiction recovery goals. Such practices often involve a journey of self-discovery in which the client explores the motivations, activities, and relationships that are most important to them. In this way, positive psychotherapy can be utilized to redefine the individual in a way that is not characterized by their drug use and associated harmful behavior. A major challenge in overcoming addiction is the difficulty clients have envisioning a future without drug use (5). Using positive psychotherapy interventions  in addiction recovery treatment will allow therapists to help those recovering from an addiction to visualize and plan for a future rooted in happiness and healthy goals. 

Most treatments for addiction (e.g., CBT, Contingency Management, Community Reinforcement Approaches, etc.), focus primarily on the condition of diagnosis and the treatment of the behaviors associated with the diagnosis. For example, clients are taught how to manage cravings and avoid relapse. However, these approaches neglect to teach recovering addicts proper coping and/or life skills for growth and development beyond the diagnosis (6). Therefore, positive psychological interventions will play a significant role in one’s ability to achieve long-term addiction recovery goals by strengthening healthy coping skills related to one’s personality, environment, culture, and relationships by teaching clients the proper fundamentals. Building resilience and holistic growth is what positive psychotherapy can bring to addiction recovery. Examples of potential positive psychotherapy interventions that are applicable in addiction recovery include: the “Best Possible Self” (BPS) exercise (7), “Inventory of Strengths” (8), “Savoring Intentions” (9), and “Gratitude Interventions” (10).

The Hazelden Betty Ford Foundation and the Butler Center for Research posted a scientific update in May 2017 regarding the applications of positive psychology to substance use disorder, discussing previous work that has been done specific to alcohol use disorder and its implications for the future (11). Furthermore, a study by a group in the United States found that implementing a web-based gratitude exercise “Three Good Things” (TGT) among adults in outpatient treatment for alcohol use disorder showed a short-term significant decrease in negative affect and increases unactivated positive affect in those practicing TGT compared to controls (12). These initial findings call for future researchers and psychologists to expand on the effectiveness of these practices. More research is needed to strengthen the validity of these promising approaches as tools for addiction recovery.

Anabel (she/her/hers) is a post-baccalaureate research assistant in the UCSB Carol Ackerman Positive Psychology Clinic. She is passionate about exploring positive psychology in the context of addiction medicine and implications for expanding these practices to the treatment of substance use disorders. Anabel is currently applying to clinical psychology PhD programs while working at UCLA as a research project coordinator in the department of medicine.

References

1. ​​Krentzman AR. Review of the application of positive psychology to substance use, addiction, and recovery research. Psychol Addict Behav. 2013 Mar;27(1):151-65. doi: 10.1037/a0029897. Epub 2012 Sep 17. PMID: 22985057; PMCID: PMC3531570.

2. Ogilvie, L. and Carson, J. (2022), "Positive addiction recovery therapy: a pilot study", Advances in Dual Diagnosis, Vol. 15 No. 4, pp. 196-207. https://doi.org/10.1108/ADD-06-2022-0018

3. Carroll KM, Kiluk BD. Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. Psychol Addict Behav. 2017 Dec;31(8):847-861. doi: 10.1037/adb0000311. Epub 2017 Aug 31. PMID: 28857574; PMCID: PMC5714654.

4. McHugh RK, Hearon BA, Otto MW. Cognitive behavioral therapy for substance use disorders. Psychiatr Clin North Am. 2010 Sep;33(3):511-25. doi: 10.1016/j.psc.2010.04.012. PMID: 20599130; PMCID: PMC2897895.

5. Sussex Publishers. (n.d.). The use of positive psychology in addiction treatment. Psychology Today. Retrieved February 7, 2023, from https://www.psychologytoday.com/us/blog/ending-addiction-good/201407/the-use-positive-psychology-in-addiction-treatment 

6. Schwartz, K. (2022, December 7). Positive psychology: Recovering from addiction: Granite mountain BHC. Granite Mountain Behavioral Healthcare. Retrieved February 7, 2023, from https://granitemountainbhc.com/blog/the-power-of-positive-psychology/ 

7. Carrillo A, Martínez-Sanchis M, Etchemendy E, Baños RM. Qualitative analysis of the Best Possible Self intervention: Underlying mechanisms that influence its efficacy. PLoS One. 2019 May 17;14(5):e0216896. doi: 10.1371/journal.pone.0216896. PMID: 31100085; PMCID: PMC6524817.

8. Proyer RT, Gander F, Wellenzohn S, Ruch W. Strengths-based positive psychology interventions: a randomized placebo-controlled online trial on long-term effects for a signature strengths- vs. a lesser strengths-intervention. Front Psychol. 2015 Apr 22;6:456. doi: 10.3389/fpsyg.2015.00456. PMID: 25954221; PMCID: PMC4406142.

9. Klibert JJ, Sturz BR, LeLeux-LaBarge K, Hatton A, Smalley KB, Warren JC. Savoring Interventions Increase Positive Emotions After a Social-Evaluative Hassle. Front Psychol. 2022 Mar 21;13:791040. doi: 10.3389/fpsyg.2022.791040. PMID: 35386887; PMCID: PMC8978832.

10. Cunha LF, Pellanda LC, Reppold CT. Positive Psychology and Gratitude Interventions: A Randomized Clinical Trial. Front Psychol. 2019 Mar 21;10:584. doi: 10.3389/fpsyg.2019.00584. PMID: 30949102; PMCID: PMC6437090.

11. Positive psychology and substance use disorder. Positive Psychology and Substance Use Disorder. (n.d.). Retrieved February 7, 2023, from https://www.hazeldenbettyford.org/research-studies/addiction-research/positive-psychology 

12. Krentzman AR, Mannella KA, Hassett AL, Barnett NP, Cranford JA, Brower KJ, Higgins MM, Meyer PS. Feasibility, Acceptability, and Impact of a Web-based Gratitude Exercise among Individuals in Outpatient Treatment for Alcohol Use Disorder. J Posit Psychol. 2015;10(6):477-488. doi: 10.1080/17439760.2015.1015158. PMID: 27076837; PMCID: PMC4827271.