Might cultivating feelings of gratitude be key to addiction recovery? Amy Krentzman, a researcher and assistant professor in the University’s School of Social Work, thinks so. Gratitude already plays a role in many addiction treatment and recovery programs. Alcoholics Anonymous, for example, recommends expressing “genuine gratitude for blessings received” in step 10 of the 12-step program. And people in recovery are encouraged to cultivate an “attitude of gratitude,” including writing a gratitude list.

It’s not surprising that gratitude has been the subject of research in the field of positive psychology—the scientific study of wellness, not illness—that emerged in the 1990s. But Krentzman was surprised to find in 2012 that no research had been done on gratitude practices in recovery programs. “Gratitude is a common emotion among people in 12-step recovery programs because it’s a theme in Alcoholics Anonymous literature and at meetings,” she says. 

So, knowing that gratitude practice is considered promising in positive psychology interventions, Krentzman designed an experiment to study the effect of a popular positive psychology intervention called the Three Good Things exercise in relation to recovery. After assembling a team, she conducted the research in early 2013 in a Midwestern community where 23 participants were enrolled in an outpatient program for alcohol addiction.

All were adults, with nearly equal numbers of men and women; 80 percent were white.

After a face-to-face intake assessment, each participant was asked six survey questions via email every day for 14 days. Half the group was asked to describe their sleep, exercise, and caffeine intake over the past 24 hours. The other half was asked to describe three good things that had happened over the past 24 hours and what caused them. Throughout the two weeks, the participants also completed a set of questionnaires to identify and rate their emotions and mood. Eight weeks later, they were invited to talk about the experience.

While the control group’s outlook and experience stayed the same, those who did the Three Good Things exercise experienced a decrease in negative feelings and an increase in feelings of calm and ease—factors known to support and reinforce recovery. “The people in the gratitude group said that the practice pulled them away from habitual negative thinking,” Krentzman says. “It also had the unanticipated effect of reinforcing their recovery, because when they were asked, ‘Why did that good thing happen?’ they would say, ‘Because I’m in recovery now and not drinking.’” Significantly, Krentzman and her team documented that the effects lasted only as long as the practice continued; there was no lingering aftereffect. 

The results of this first formal study of gratitude practice in alcoholism treatment were published in the Journal of Positive Psychology in February 2015. Interestingly, and unexpectedly, participants mentioned in their Three Good Things follow-up interviews that completing a questionnaire about their emotions—the Positive and Negative Affect Schedule, or PANAS for short—was helpful to their recovery. Digging back into the data, Krentzman and a smaller team found evidence that people in the study, like many with addictions, suffered from alexithymia: difficulty identifying, naming, and expressing emotions. In completing the PANAS, they found that their ability to identify, accept, and regulate mood increased. The finding was significant because mood plays such a crucial role in models that explain the motivation to drink. Published in the journal of Qualitative Health Research in 2015, it was the first study to suggest that the PANAS questionnaire might have therapeutic properties for people with addictions. 

Currently, Krentzman is heading up a study looking at whether gratitude increases after substance use disorder treatment, and the effect of gratitude posttreatment on future drinking. She is also about to begin work on a new study to see whether journaling, particularly about things people feel grateful for, and sharing those entries with a designated partner, might be helpful to people in recovery in rural communities where recovery can sometimes be complicated by isolation. 

“Gratitude practice is helpful to everyone, not just people in recovery, because of a psychological phenomenon called the negativity bias, which causes us to react strongly to threatening or problematic events and pay less attention to good or neutral things,” she says. “That bias served an evolutionary function, but it can cause disproportionate focus on worrisome events and relatively muted reactions to good things that happen. Looking back over your day and remembering positive things can help overcome that bias. That’s especially important for people in recovery because negative thoughts can spiral downward and lead to relapse.”