Review of the application of positive psychology to substance use, addiction, and recovery research

A randomized feasibility study of a positive psychology journaling intervention to support recovery from substance-use disorders

BACKGROUND

Individuals in early recovery face significant biopsychosocial stressors causing a preponderance of negative affect. Novel interventions are needed to improve mood and well-being to support recovery. Positive Recovery Journaling (PRJ) combines elements of positive psychology, behavioral activation, and journaling to emphasize what is going right and to encourage small, positive steps that align with an individual's values to make life in recovery more rewarding and therefore more reinforcing. Our objective was to determine PRJ's feasibility, acceptability, and impact on a set of strengths-based, multidimensional aspects of recovery, including satisfaction with life, happiness with recovery, and commitment to sobriety.

METHODS

The study randomized adults in substance-use disorder treatment (N = 81) to PRJ or control. Those in PRJ were asked to practice PRJ daily and complete online surveys for four weeks; those in the control group completed online surveys for four weeks. We used multi-level modelling to determine intercept and slope for feasibility and acceptability outcomes as well as to compare differences in recovery indicators between treatment and control at baseline and Weeks 2, 4, and 8. We conducted intention-to-treat and per-protocol analyses for each recovery indicator.

RESULTS

Participants were 53 % female, and 26 % Black, Indigenous, People of Color (BIPOC) and mean age of 39 years. PRJ participants attended 71 % of groups and completed 56 % of the daily PRJ entries. Treatment and control groups rated their study tasks (PRJ for the treatment group, surveys for the control group) as equally easy; however, the PRJ group rated PRJ as significantly more satisfying, helpful, and pleasant. Treatment and control were not significantly different on any recovery indicator. In post hoc analyses, we found that for those with <90 days sobriety at baseline (51 %), PRJ had a statistically significant beneficial effect for satisfaction with life, happiness with recovery, and numerous secondary recovery indicators.

DISCUSSION

Results suggest a positive impact of PRJ on numerous recovery indices for those in earliest recovery. Integrating PRJ into support services among those with <90 days sobriety could reinforce what is going well in recovery to encourage its continued maintenance and thereby improve treatment outcomes.

The Lived Experiences of Individuals and Coping Strategies in the Context of Internet Gaming Disorder: A Qualitative Study Within Higher Education Setting in Uganda

Background

Internet Gaming Disorder (IGD), recognized as a mental disorder in both the Diagnostic and Statistical Manual (DSM-5) and International Classification of Diseases (ICD-11), poses significant threats to physical, social, and mental well-being. This study aims to delve into the experiences of individuals grappling with IGD.

Methods and Materials

The study employed an interpretive phenomenology, conducting interviews with 10 graduate students at Makerere University. Participants were purposefully sampled until data saturation was achieved during interviews, which took place between May and July 2023. An interview guide facilitated data collection (Supplementary File 1), and thematic analysis was manually applied for data interpretation, utilizing intuition and imaginative approaches.

Results

The findings revealed that the majority of participants started gaming during childhood, starting with offline games. Exposure to gadgets and games, idle time, and stress emerged as key triggers for IGD. Participants reported experiencing sleep deficits, deteriorating interpersonal relationships, declining job performance, unhealthy eating habits, academic challenges, and wastage of money and time. The study also identified strategies employed by participants to mitigate their gaming behaviors, such as refraining from purchasing data, seeking support from friends, and uninstalling the game app, although relapses were common.

Conclusion

The study highlights a global pattern of early initiation into gaming, emphasizing the need for early intervention and preventive measures. Factors such as easy accessibility and affordability of gaming platforms, idleness, and stress play significant roles in motivating internet gaming, contributing to a higher prevalence among the studied population. The research underscores the adverse effects of IGD on students, affecting academic performance, interpersonal relationships, and job performance. Notably, participants demonstrate agency in addressing IGD through practical coping strategies, including controlling data access, seeking social support, and uninstalling games. These coping mechanisms provide valuable insights into the complex nature of addressing IGD and form a basis for developing targeted interventions and support systems within the higher education setting in Uganda.

A mixed methods experience sampling study of a posttraumatic growth model for addiction recovery

Problematic substance use and addiction is a growing crisis in the United States. As a result, identifying factors that effectively promote addiction recovery is, currently, of particular societal importance. Informed by evidence that-while addiction can be perpetuated by stress-related impulsivity and decreased self-regulation-perceived social support is protective against addiction, we test a model for addiction recovery as a form of posttraumatic growth (PTG), focused specifically on close relationships and personal strength-two domains of PTG. In an initial study, we found that perceived social support and impulsivity predicted number of relapses in individuals in a substance use disorder recovery program. Using experience sampling, we then observed that experiencing a stressful event predicted impulsive behavior. However, experiencing closeness with others-a domain of PTG-was directly associated with perceived social support, and both predicted positive emotional states, which were, in turn, inversely associated with experiencing a stressful event. Further, when experiencing a stressful event, personal strength-also a domain of PTG-was inversely associated with impulsive behavior and was predicted by both perceived social support and positive emotional states. Finally, in a follow-up experiment, we found that an ecological momentary intervention targeting perceived social support decreased impulsivity and increased self-regulation-an aspect of personal strength-in a dose-dependent fashion. Taken together, our findings: (1) support a PTG model for recovery; (2) provide evidence for processes by which close supportive relationships are protective against addiction and relapse; and (3) indicate that self-regulation is responsive to a short in-the-moment perceived social support intervention. We suggest that these findings support the theory that addiction is a social disease in the sense that close personal interactions and supportive relationships: (a) buffer against stress-related impulsivity, thereby protecting against addiction and relapse; and (b) increase personal strength, thereby decreasing the probability of impulsive-including addictive-behavior and promoting recovery.

Positive Psychology Intervention (PPI) Program for Persons Who Use Drugs (PWUDS): A Pilot Study

Building on the premises of Positive Psychology, this undertaking conducted a pilot study of the designed 14-session Positive Psychology Intervention (PPI) program established based on the character strengths and virtues (CSV) of persons who use drugs (PWUDs) to assess its usefulness, delivery details, and impacts. Conducted in one of the biggest Drug Abuse Treatment and Rehabilitation Center in the Philippines, 24 PWUDs were randomly selected by the program staff to participate in its pilot run while securing all necessary ethical guidelines and requirements. Via within-subjects pretest-posttest experimental design, the especially adapted and developed tools were used to assess the PWUDs' progress as they were facilitated by the said program. Results yielded significant improvements in the PWUDs' mental wellbeing (M = 1.29, SD = 0.35; t(21) = 9.30, P < .00001), life satisfaction (M = 1.82, SD = 0.24; t(21) = 9.89, P < .00001), and psychological functioning (M = 1.65, SD = 0.19; t(21) = 8.58, P < .00001). Moreover, the PWUDs regarded the designed PPI program very highly and experienced it with positive outcomes, especially for their CSVs. Further improvement of the said program centers around proper time allotment, number of participants in the program sessions, appropriate activities per session, including specific ice breaker games, activity materials needed, and the proper sequencing of each session. These data are used to improve the PPI program structures and components. Pertinent conclusions about the gathered data were drawn, and relevant recommendations were also thereby provided.

A mathematical model with nonlinear relapse: conditions for a forward-backward bifurcation

We constructed a Susceptible-Addicted-Reformed model and explored the dynamics of nonlinear relapse in the Reformed population. The transition from susceptible considered at-risk is modeled using a strictly decreasing general function, mimicking an influential factor that reduces the flow into the addicted class. The basic reproductive number is computed, which determines the local asymptotically stability of the addicted-free equilibrium. Conditions for a forward-backward bifurcation were established using the basic reproductive number and other threshold quantities. A stochastic version of the model is presented, and some numerical examples are shown. Results showed that the influence of the temporarily reformed individuals is highly sensitive to the initial addicted population.

Understanding the Shared Meaning of Recovery From Substance Use Disorders: New Findings From the What is Recovery? Study

Background

Substance use disorder (SUD) resolution typically involves a long-term, comprehensive process of change now widely referred to as "recovery." Yet, definitions of recovery vary substantially, producing significant confusion. To support formal recovery definitions, we aimed to systematically identify recovery elements that are central to those in recovery and shared regardless of subgroup/pathway.

Methods

Data were from the What is Recovery? Study, involving a diverse, national, online survey of people in recovery (N = 9341). Surveys included a 35-item recovery measure reflecting 4 domains; participants reported whether or not each element definitely belonged in their recovery definitions. Analyses examined item endorsements overall and among 30 subgroups defined a priori (by sociodemographics, substance use characteristics, and help-seeking history) to determine where items met study-specific centrality thresholds (ie, endorsement by ⩾80% and top-10 ranking, by endorsement level). We then classified items as "core" if meeting centrality thresholds both overall and for all 30 subgroups, and "prevalent" if meeting centrality thresholds overall and for 26 to 29 subgroups.

Results

Four "core" recovery elements emerged, including a process of growth or development; being honest with oneself; taking responsibility for the things one can change; and reacting in a more balanced way. Four "prevalent" recovery elements also emerged, referencing the ability to enjoy life and handle negative feelings without substance use; abstinence and/or nonproblematic substance use; and living a life that contributes. Subgroups differing most in their endorsements included those reporting mild/moderate SUD severity; non-abstinent recovery; and no specialty treatment or mutual-help group attendance.

Conclusions

Recovery elements identified here partially reflect some stakeholder definitions, but offer greater specificity and include novel elements (eg, personal integrity). Elements may point to areas of functioning that are damaged in the addiction process and can support an addiction-free life. Findings should inform institutional recovery definitions; SUD services and research; and communications about recovery.

The role of Neurochemicals, Stress Hormones and Immune System in the Positive Feedback Loops between Diabetes, Obesity and Depression

Type 2 diabetes mellitus (T2DM) and depression are significant public health and socioeconomic issues. They commonly co-occur, with T2DM occurring in 11.3% of the US population, while depression has a prevalence of about 9%, with higher rates among youths. Approximately 31% of patients with T2DM suffer from depressive symptoms, with 11.4% having major depressive disorders, which is twice as high as the prevalence of depression in patients without T2DM. Additionally, over 80% of people with T2DM are overweight or obese. This review describes how T2DM and depression can enhance one another, using the same molecular pathways, by synergistically altering the brain's structure and function and reducing the reward obtained from eating. In this article, we reviewed the evidence that eating, especially high-caloric foods, stimulates the limbic system, initiating Reward Deficiency Syndrome. Analogous to other addictive behaviors, neurochemical changes in those with depression and/or T2DM are thought to cause individuals to increase their food intake to obtain the same reward leading to binge eating, weight gain and obesity. Treating the symptoms of T2DM, such as lowering HbA1c, without addressing the underlying pathways has little chance of eliminating the disease. Targeting the immune system, stress circuit, melatonin, and other alterations may be more effective.

Results of a pilot study examining the effect of positive psychology interventions on cannabis use and related consequences

BACKGROUND

Young adults experience high rates of cannabis use and consequences. Cross-sectional work has linked positive psychological constructs (e.g., savoring) to less cannabis use and consequences, and positive psychological interventions (PPIs) have shown promise in targeting other substance use behaviors. This pilot study sought to provide an initial test of PPIs to reduce young adult cannabis use and consequences.

METHODS

Adults (18-25 years old) who endorsed at least weekly past-month cannabis use (N = 59, 69.6% men, 41.1% White) reported their baseline cannabis use and consequences. Participants were randomized to complete one of three daily exercises (Savoring, Three Good Things, or a control) along with daily text message surveys for two weeks, then completed a follow-up survey at the end of the two weeks.

RESULTS

Paired samples t-tests indicated that participants in the Three Good Things group showed medium to large reductions in frequency of weekly cannabis use (p = .08, gav = -0.57) and cannabis-associated consequences (p = .08, gav = -0.57) from baseline to follow-up. In the Savoring and control groups, there were not significant changes in frequency of weekly cannabis use (Savoring: p = .39, gav = 0.20; Control: p = .96, gav = 0.01) nor cannabis-associated consequences (Savoring: p = .84, gav = 0.05; Control: p = .45, gav = -0.18). Participants in both positive psychology conditions reported the exercises were easy to complete, providing evidence for acceptability.

DISCUSSION

Results provide initial support for the feasibility and potential promise of a text-message based PPI as a harm reduction approach for cannabis users. A larger clinical trial is warranted to test the effects of such interventions with adequate statistical power.

Assessment of the Short Grit Scale in patients with substance use disorder: Psychometric properties and patient characteristics

Background: Recovery from substance use disorder requires sustained effort and perseverance. Hence, the resilience factor of grit may be important for people in recovery. Little research has been conducted on grit in patients with substance use disorder (SUD), especially in a large and varied sample.Objectives: To analyze the psychometric properties of the Short Grit Scale (Grit-S) in patients with SUD and to use demographic and clinical characteristics to predict variance in Grit-S scores.Methods: Participants completed the Grit-S and other self-report measures. Psychometric properties of the Grit-S were assessed in outpatients (N = 94, 77.7% male) and a hierarchical regression predicted Grit-S variance in inpatients (N = 1238, 65.0% male).Results: The Grit-S demonstrated good internal consistency (α=.75) and strong test-retest reliability (adjusted r = .79, p < .001). Mean Grit-S score was 3.15, lower than other clinical samples reported in the literature. Regression modeling indicated a moderate, statistically significant association between demographic and clinical characteristics and Grit-S scores (R2 = 15.5%, p < .001). Of particular interest, the positive factor of recovery protection showed the strongest association with Grit-S of all variables assessed (β=.185 vs. β = .052-.175 for the remaining significant independent variables).Conclusion: The psychometric properties of the Grit-S in patients with SUD support its use in this population. Moreover, the particularly low grit scores among inpatients with SUDs and the association of grit scores with substance use risk and recovery factors suggest that grit could be useful as a treatment target in this population.

Moderating the impact of the COVID-19 pandemic on children's and adolescents' substance use, digital media use, and mental health: A randomized positive psychology addiction prevention program

OBJECTIVE

Previous research suggests that well-being interventions are effective in moderating substance and digital media use and improving mental health. This study evaluated the feasibility and preliminary efficacy of a school-based Positive Psychology Addiction Prevention (PPAP) intervention aimed at reducing substance and digital media use and increasing the mental health of school children during the COVID-19 pandemic.

METHODS

The sample was composed of 1,670 children and adolescents (Mean age = 12.96, SD = 2.01) from six elementary and secondary schools in Israel who were randomly assigned to the PPAP intervention (n = 833) or the waiting-list control conditions (n = 837). A three-year longitudinal repeated-measures randomized control design was used to examine modifications in substance use, digital media use, and psychological symptoms in the intervention and control groups assessed on the pre-test (before the outbreak of COVID-19, September 2019), the post-test (May 2021), and the 12-month follow-up (May 2022).

RESULTS

The 12-month prevalence of tobacco use, alcohol use, and cannabis use decreased significantly from the pre- to the follow-up period in the intervention group, and increased significantly in the control group. Daily digital media use increased during the pandemic period in both groups, with a significantly higher increase in the control group. The intervention group reported significantly lower psychological symptoms and negative emotions, and greater positive emotions and life satisfaction after the intervention and at follow-up compared to the control group.

CONCLUSIONS

The COVID-19 pandemic has profoundly disrupted the lives of children and adolescents. Well-being and addiction prevention interventions may be effective in improving the mental health of school children during pandemics and crisis periods.

Prevalence and Risk Factors of Internet Gaming Disorder Under the COVID-19 Pandemic Among University Students in Macao

Introduction

During the COVID-19 pandemic, the zero-tolerance policy implemented in Macao affected university students' life and learning styles.

Objectives

This study aimed to investigate the prevalence of internet gaming disorder (IGD) and analyze its risk factors among university students of Macao amid the COVID-19 pandemic.

Methods

Two hundred and twenty-nine university students were recruited by convenience sampling. The cross-sectional investigation was conducted using the 9-item Chinese version of the IGD Scale, the Chinese Version of the Self-Compassion Scale, and the Chinese version of the Brief Resilience Scale.

Results

The prevalence was 7.4%. Compared to Non-IGD gamers, the IGD gamers were more likely to be the older, male gender, with a longer gaming history, with more game hours per day in the last month, and with a lower self-compassion score and resilience.

Conclusion

The prevalence of IGD increased. Students who are the older, male gender, with more gaming time, low self-compassion, and low resilience, have a high possibility of IGD.

The role of positive affect in the association between stress and college student alcohol use

OBJECTIVE

To examine the associations among stress, positive affect, binge drinking, and coping drinking motives.

PARTICIPANTS

Students (n = 351, M_age=19.7, 74.6% female) at a northeastern public university.

METHODS

Participants completed an online survey assessing perceived stress, frequency of experiencing positive emotions, frequency of binge drinking, and coping drinking motives.

RESULTS

Stress and positive emotions were not significantly related to frequency of binge drinking but were significantly correlated with coping motives for drinking. Regression analyses with all predictors, age, and gender in the model revealed the same: stress and positive emotion were not significantly related to binge drinking but were significantly related to coping motives. The interaction between stress and positive emotions predicting frequency of binge drinking or coping motives was nonsignificant.

CONCLUSIONS

Findings suggest the utility of exploring positive emotions in risk and resilience research focused on college student drinking and of targeting positive emotions to decrease students' coping-related alcohol use.

Character Strengths' Change During COVID-19

The COVID-19 had negative effects on individuals and nations worldwide. However, based on literature suggesting that crises can trigger growth, we propose that it may have also triggered individuals' character strengths development, especially among those having experienced moderate levels of difficulty during the pandemic and having received social support. The participants' (N = 1700) 24 character strengths were assessed twice: before and during COVID-19. At the second assessment, participants also reported the level of impact COVID-19 had on their lives, and their perceived social support. MANOVA analysis revealed a general increase in character strengths, with significant - but mainly negligible or small - increases in 17 strengths: appreciation of beauty and excellence, bravery, prudence, creativity, curiosity, fairness, gratitude, honesty, hope, judgment, kindness, leadership, perspective, self-regulation, social intelligence, spirituality, and zest. Across the 24 strengths, the reported level of COVID-19's impact (i.e., low, moderate, or high) was not associated with different changes during the pandemic. Univariate analyses showed that such changes were significant only in curiosity, forgiveness and kindness. The multivariate effect of social support on changes in character strengths was significant. Specifically, it enhanced the increase in love, prudence, curiosity, forgiveness, gratitude, honesty, hope, judgment, leadership, humility and zest during COVID-19, although the interactions effect sizes were small. The results suggest that, in the time frame examined in this study, character development processes triggered by COVID-19 were evident, yet specific changes in strengths were relatively mild. Some of these processes may have been enhanced by social support.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-022-00575-6.

Correlates of optimism among patients in substance use disorder inpatient treatment

BACKGROUND AND OBJECTIVES

Early recovery from substance use disorder (SUD) is often characterized by hopelessness and despair about the future. Optimism, or the expectation that good things will happen, may provide a buffer against despair, and motivate adaptive goal engagement and coping. Study objectives were to (1) compare levels of optimism among individuals in substance use disorder inpatient treatment to other populations and (2) examine correlates of optimism.

METHODS

This exploratory study utilized a cross-sectional survey design. Participants (n = 355) completed self-report measures assessing sociodemographic and clinical characteristics. The main variable of interest, optimism, was assessed by Life Orientation Test-Revised scores. Multivariate regression was used to examine the association among sociodemographic and clinical variables and optimism.

RESULTS

Our sample (n = 342) scored lower on optimism (mean = 11.7) than general population and SUD patients reported in the literature (range = 13.0-18.5). Optimism was higher for SUD inpatients who were college-educated and those with higher scores on the recovery protection factor, while greater anxiety severity was associated with lower optimism scores.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

This study contributes to emerging research on the association between optimism and SUDs. Optimism has not been previously studied among patients in acute, short-term inpatient SUD treatment and doing so may be clinically useful in addressing low optimism as an obstacle to motivation for treatment. Bolstering optimism may be a promising target for intervention and future research.

Savoring Interventions Increase Positive Emotions After a Social-Evaluative Hassle

Achieving a high quality of life is dependent upon how individuals face adversity. Positive psychological interventions are well-suited to support coping efforts; however, experimental research is limited. The purpose of the current research was to examine whether different savoring interventions could increase important coping resources (i.e., positive emotions) in response to a social-evaluative hassle. We completed an experimental mixed subject design study with a university student sample. All participants completed a hassle induction task and were then randomly assigned into different intervention groups. Positive emotion ratings were collected at three points in time (baseline, post-induction task, post-intervention). Results revealed a significant time x intervention interaction effect, such that individuals in the savoring the moment intervention reported higher levels of positive emotions (at post-intervention) compared to individuals assigned to the true control group, guided imagery control group, and savoring through reminiscence intervention. Such findings represent a significant extension to savoring theory and offer support for savoring the moment exercises as a primary prevention strategy to bolster effective responses to social-evaluative hassles.

The efficacy and mechanism of positive psychological intervention on well-being for colostomy patients: a randomized controlled trial

AIMS

The positive psychology intervention (PPI) is an effective therapy designed to motivate individuals' positive quality and power, to help them survive in an adverse situation, and to establish a high-quality personal and social life. This study aims to evaluate the efficacy and mechanism of PPI on the psychological capital, psychological distress, and life satisfaction among colostomy patients.

METHODS

Patients (n = 120) with permanent stomas were recruited and randomly assigned into two groups. Patients in the experimental group (n = 60) received standard care and PPI, whereas patients in the control group (n = 60) only received standard care. The psychological capital, psychological distress, and life satisfaction were measured and compared between two groups before the intervention, the immediate post-intervention, and follow-up.

RESULTS

All 120 patients completed the study. The hope, optimism, resilience, psychological distress, and life satisfaction score of the experimental group were significantly higher than those of the control group at T1 and T2 (P < 0.05). Self-efficacy score of the experimental group had no significant difference at the two time points after the intervention than the control group (P > 0.05). Changes in hope and resilience which belong to psychological capital mediated the intervention's efficacy on changes in PPI on life satisfaction (β = 0.265, P = 0.005; β = 0.686, P = 0.002).

CONCLUSIONS

PPI could effectively improve psychological capital, psychological distress, and life satisfaction among patients with stomas. Besides, our findings add novel support that increased hope and resilience are the active ingredients that promote intervention change.

Effects of Psychological Distress and Coping Resources on Internet Gaming Disorder: Comparison between Chinese and Japanese University Students

The high prevalence of Internet gaming disorder (IGD) among Asian youth indicates an urgent need to identify protective factors and examine their consistency across Asian cultures in order to facilitate cost-effective interventions. Based on the transactional theory of stress and coping, this study collected data of 1243 online gamers (45% males; 18-25 years) through an anonymous survey from universities in China and Japan and investigated whether three coping resources (i.e., mindfulness, coping flexibility, and social support) serve to protect Chinese and Japanese youth from the impact of psychological distress on IGD tendency. After adjusting for the measurement non-invariance across samples, we found that Japanese students reported higher levels of IGD tendency and psychological distress than Chinese students. The results of multiple-group SEM analyses showed that, after controlling for other predictors, mindfulness served as the strongest protective factor against IGD across samples. Moreover, the buffering effect of mindfulness on the association between psychological distress and IGD tendency of female (but not male) students was observed. Our findings highlighted the cross-cultural invariance of the impact of psychological distress and coping resources on IGD in Chinese and Japanese youth, which can be considered in future IGD prevention programs.

"It inspires me and suddenly the ideas come": exploring the use of cultural venues in mental health care

AIMS

This study aimed to explore the experiences of a group of adults with a history of substance misuse taking part in a novel, multi-centre cultural intervention: Creative Conversations, including the impact of the project on participants' mental health.

METHODS

A qualitative approach was used including a Visual Matrix and observation in order to explore the experiences of 10 participants recruited from drug and alcohol services.

RESULTS

The results indicated positive impacts on mental health including a growing sense of competence, engagement, social integration and a sense that the project provided therapeutic support that translated into integrating creative activities into their everyday habits.

CONCLUSIONS

Cultural interventions like Creative Conversations demonstrate positive impacts on mental health, engaging individuals who may find it difficult to access services such as those with substance misuse issues, and play an important role in sustaining and promoting mental wellbeing in the community. Despite positive findings, projects such as this require adequate staff training and sustained funding in order to provide wider benefits to those with mental health problems.

Psychometric properties of the Chinese version of the modified Yale Food Addiction Scale version 2.0 (C-mYFAS 2.0): Prevalence of food addiction and relationship with resilience and social support

PURPOSE

This study aimed to examine the psychometric properties of the Chinese version of the modified Yale Food Addiction Scale 2.0 (C-mYFAS 2.0) and to analyze the prevalence of food addiction among Chinese college students and its relationship with resilience and social support.

METHODS

A total of 1132 Chinese college students completed the C-mYFAS 2.0, BES, EAT-26, PHQ-9, GAD-7, TFEQ-18, CD-RISC-10, and PSSS. Confirmatory factor analysis was used to evaluate the factor structure of the C-mYFAS 2.0 and psychometric properties were assessed. Test-retest reliability was evaluated in a sub-sample (n = 62). Spearman correlation and logistic regression were used to examine the relationship between resilience, social support, and food addiction.

RESULTS

The prevalence of food addiction according to the C-mYFAS 2.0 was 6.2%. Confirmatory factor analyses suggested a single-factor structure (comparative fit index = 0.961). The C-mYFAS 2.0 had good test-retest reliability and internal consistency (Kuder-Richardson's α = 0.824). Good convergent validity was indicated by correlations with binge eating, eating disorder symptoms, depressive symptoms, generalized anxiety symptoms, uncontrolled eating, emotional eating, and BMI (ps < 0.001). Appropriate divergent validity was reflected by no association with cognitive restraint. Finally, binge eating was significantly predicted by C-mYFAS 2.0, depressive symptoms, and eating disorder symptoms (ps < 0.001), confirming incremental validity. In addition, our study found that poorer resilience and social support were related to food addiction (ps < .001).

CONCLUSIONS

The C-mYFAS 2.0 is a brief but reliable and valid screening instrument for food addiction among Chinese college students. In addition, we found that resilience and social support were negatively associated with food addiction.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

An exploration of thriving over time in recovery

INTRODUCTION

Emerging models of recovery have redirected the traditional focus on relapse prevention to an emphasis on wellness. According to this new framework of recovery, aspects of thriving can strengthen recovery and prevent relapse in substance use. However, the empirical support for these models is sparse. To fill the gap in the literature, the authors sought to predict the risk of relapse based on factors of thriving.

METHOD

Participants consisted of a stratified sample of 412 adults in early, middle, and late stages of recovery (based on length of time in recovery) who the study recruited via Qualtrics Online Panels. We utilized a sequential regression to examine the ability of factors of thriving, the influence of time in recovery and demographic variables to predict relapse risk.

RESULTS

Thriving, length of recovery, and demographics significantly predicted risk of relapse (p < .001, R² = 65%), with Thriving accounting for 55% of the variance (ΔR² = 55%).

CONCLUSION

These findings demonstrate that the natural developmental process that comes from the passage of time dedicated to recovery is significant but thriving or the quality of that time serves as a stronger protective factor preventing relapse. Addiction treatment and prevention specialists could benefit from including thriving in conceptual models and interventions for recovery. Further, these findings provide support for holistic models of addiction recovery.

Suicidal ideation predicted by changes experienced from pre-treatment to 3-month postdischarge from residential substance use disorder treatment

PURPOSE

Individuals with substance use disorders (SUD) are at an elevated risk for suicide. Abstinence and drug-related treatment outcomes remain integral to SUD treatment, but recovery incorporates more than just the absence of substance use or mental illness and including positive mental health indices in assessment and treatment of suicidality is needed.

AIMS

The current study investigates the role of traditional indicators of recovery, as well as positive psychology constructs, in predicting suicidal ideation following residential SUD treatment.

METHOD

The study utilized a longitudinal design with baseline and 3-month postdischarge follow-up assessments of 791 individuals who attended residential SUD treatment in Australia.

RESULTS

Rates of suicidal ideation decreased from baseline to follow-up, and the magnitude of change in most indices was associated with suicidal ideation at follow-up assessment. In a hierarchical logistic regression, baseline suicidal ideation, as well as a reduction in psychological distress, increase in refusal self-efficacy, and increase in self-forgiveness, emerged as significant predictors of follow-up suicidal ideation. The final model correctly classified 98.8% of participants as not experiencing SI, and 8.7% of participants as experiencing SI at follow-up, resulting in a total predictive accuracy of 86.9%.

CONCLUSIONS

The results suggested that changes in traditional recovery indices may facilitate reductions in suicidality. As a whole, changes in positive psychology indices did not add to the ability to predict suicidal ideation once traditional indices had been accounted for, but this does not preclude the importance of these indices to SUD treatment and suicide prevention efforts.

Study protocol for a cluster randomised controlled trial of The Illicit Project, a digital, neuroscience-based substance use intervention for secondary school students

Older adolescence (16-19 years) is characterised by an increase in alcohol and illicit substance use, however limited age-appropriate prevention programs exist to target this critical group. Schools are increasingly opting for web-based programs to deliver health education due to their effectiveness, accessibility and scalability. This study outlines the web-based adaptation of a neuroscience-based harm reduction program targeting older adolescents known as, The Illicit Project, and the study protocol to evaluate its effectiveness. A cluster randomised controlled trial will be conducted with Year 10, 11 and/or 12 students (aged 16-19 years) from 8 secondary schools across New South Wales, Australia. Participating schools will be randomised into the control group (health education as usual) or the intervention group (The Illicit Project program; a three-lesson, web-based program delivered fortnightly over 6 weeks) and will complete four web-based assessments at baseline, 6-, 12- and 24-months post baseline. Primary outcomes are the quantity and frequency of substance use, alcohol-related harms and drug literacy levels, with the 12-month follow-up, the primary end point. Secondary outcomes include intentions to use alcohol and other drugs in the future and risk perceptions. This trial has been registered with Australia and New Zealand Clinical Trials Registry (ACTRN12620000805976). Intervention effects will be estimated using multilevel mixed effects models with an intention-to-treat sample. This is the first evaluation of a web-based, age-appropriate neuroscience-based prevention program for substance use targeting older adolescents.

Recovery Capital and Symptom Improvement in Gambling Disorder: Correlations with Spirituality and Stressful Life Events in Younger but Not Older Adults

Although age-related differences have been reported in gambling disorder, prior studies have not examined how age may influence recovery in gambling disorder. Recovery may be influenced by positive factors (e.g., spirituality and recovery capital) and negative factors (e.g., depression, anxiety, and stressful life events). The current study examined associations between these positive and negative factors and gambling disorder DSM-5 symptom improvement in younger and older adults. Younger (less than 55 years of age; n = 86) and older (55 years or older; n = 54) adults, with lifetime gambling disorder treated currently or within the past 5 years in five treatment centers in Israel were assessed using structured scales on past-year and lifetime DSM-5 gambling disorder, intrinsic spirituality, recovery capital, anxiety, depression and stressful life-events. Among younger adults, recovery capital and intrinsic spirituality were associated with gambling disorder symptom improvement. Among older adults, only recovery capital was associated with gambling disorder symptom improvement. Correlations between recovery capital and spirituality (z = 2.34, p = 0.02) and recovery capital and stressful life events (z = 2.29, p = 0.02) were stronger in younger than in older adults. Recovery capital is an important resource that should be considered across older and younger adults with gambling disorder. Spirituality and stressful life events may operate differently across age groups in gambling disorder. Future studies should investigate whether the findings may extend to other groups and the extent to which promoting recovery capital should be integrated into treatments for gambling disorder.

Suffering and Salutogenesis: A Conceptual Analysis of Lessons for Psychiatry From Existential Positive Psychology (PP2.0) in the Setting of the COVID-19 Pandemic

The COVID-19 pandemic has had a widespread effect on the thoughts, emotions and behavior of millions of people all around the world. In this context, a large body of scientific literature examining the mental health impact of this global crisis has emerged. The majority of these studies have framed this impact in terms of pre-defined categories derived from psychiatric nosology, such as anxiety disorders, depression or post-traumatic stress disorder. These constructs often fail to capture the complexity of the actual experiences of the individuals being studied; more specifically, they describe these experiences exclusively in terms of disease, while neglecting their potentially adaptive or “salutogenic” aspects. Similarly, discussion of psychological assistance for these individuals has largely been confined to a reiteration of “evidence-based” psychological or pharmacological techniques which can be delivered using remote access technology. In the context of the COVID-19 pandemic, these approaches are likely to be of mixed efficacy. Conversely, “negative emotions” or distressing psychological experiences may actually be functional in the setting of a disaster or crisis, serving to minimize harm, maximize social coherence and compliance, and facilitate adherence to safety measures. The limitations of the “conventional” approach are, to a certain degree, inherent to the prevailing medical model of mental health. Beyond these considerations lies the concept of “salutogenesis,” a term which refers to the innate capacity of individuals to create and maintain health and well-being in the face of adversity. Using principles derived from the second wave of positive psychology (PP2.0), particularly its emphasis on the totality of human experience and the possibility of deriving meaning and character growth from suffering, this paper conceptually analyses the relevant aspects of salutogenesis and PP2.0, and proposes an alternate approach for addressing mental health concerns during the COVID-19 pandemic. Such an approach, while acknowledging the utility of the conventional medical-psychotherapeutic model in specific cases, reduces the risk of medicalizing human experience, and provides individuals and communities with opportunities for growth and adaptation. The benefits of this proposal could potentially extend far beyond the current crisis, offering an opportunity for the field of psychiatry and mental health research to move away from a purely “disease-centered” model.

Negative Recovery Capital in Gambling Disorder: A Conceptual Model of Barriers to Recovery

Recovery from any addiction, including gambling, involves continuous efforts to improve wellness despite the obstacles and challenges. The recovery capital (RC) model is a holistic conceptual framework operationalized along a continuum ranging from positive internal and external RC resources that enhance recovery to negative recovery capital (NRC) which are defined as obstacles that impede individuals from coping with their addiction. Although previous studies have conceptualized the positive side of the RC model, no study has systematically explored NRC. This study develops a model that maps and conceptualizes the elements that impede recovery from gambling disorder (GD). In the current study, 133 individuals with a lifetime GD were interviewed about the factors that have hindered their recovery. A content analysis identified 14 NRC categories that were classified into four domains: Human NRC (urges and uncontrolled urges, cognitive distortions, inaction, sensation seeking, stressful life events, negative emotions, ability to conceal, a lack of motivation to recover), Social NRC (lack of social or familial networks, conflictual or dangerous social networks), Community NRC (an environment that encourages gambling, money lenders), and Financial NRC (financial distress and debt, money as a risk factor). The discussion centers on a holistic perspective of the elements that hinder recovery from GD, and calls for intervention methods that aim to minimize NRC to provide more holistic solutions to GD and possibly other addictions.

Internet Gaming Disorder, Risky Online Behaviour, and Mental Health in Hong Kong Adolescents: The Beneficial Role of Psychological Resilience

In the present cyber age, Internet gaming disorder (IGD) and risky online behaviour are prevalent, and adolescents are especially vulnerable to such emergent problems. Few studies have explored the protective factors that mitigate harm caused by IGD and various common risky online behaviours. This study examined the prevalence of IGD and risky online behaviour, their hypothesised associations with depressive symptoms, and the beneficial role of psychological resilience as an underlying psychological mechanism. The participants included 1,099 Chinese junior secondary school students (33% boys, mean age = 13.5 years, age range = 10-17 years) who completed a battery of validated self-report questionnaires at their schools. The results revealed that 4% of the participants were at high risk of IGD and 6% were at an overall risk level of IGD. Depressive symptoms were positively associated with IGD and risky online behaviour, and psychological resilience mediated both of these associations. These results imply that clinicians and teachers should incorporate psychological resilience training into intervention approaches to mitigate IGD and risky online behaviour.

An instrument for assessing progress in substance use disorder treatment: a pilot study of initial reliability and factor structure of the Treatment Progress Assessment-8

New instruments are needed to assist substance use disorder (SUD) clinics in monitoring client treatment progress. This paper describes the development of an 8-item monitoring tool and results from a pilot to understand the tool's structure and reliability. 393 clients completed the tool upon treatment entry. A factor analysis resulted in a 2-factor solution: SUD symptoms and treatment progress. Multiple regression analyses showed that clients in inpatient detoxification had lower scores than those in less intensive levels of care. Acceptable internal consistency reliability was found. This study shows promise for the tool and sets the stage for future validation work.

Drug and alcohol workers’ view of positive psychology in the treatment of coexisting problems

Purpose

Positive psychology (PP) interventions have been suggested to be beneficial in the treatment of dual diagnosis (DD). The purpose of this paper is to investigate the perspective of psychosocial intervention (PSI) workers to explore the potential of a positive strengths-based approach in DD recovery.

Design/methodology/approach

A qualitative approach was employed with PSI workers who attended and observed a positive intervention delivered to DD clients. A focus group explored what these practitioners are already doing that resembles PP and their opinion regarding the utility of such interventions in recovery.

Findings

Findings revealed that practitioners were already engaging in positive practice, however, randomly and infrequently with limited impact. Although this new approach was found valuable, potential challenges were identified and a possible discrepancy between staff views of clients and clients’ views of themselves in terms of their potential was detected.

Research limitations/implications

The study involved a small and homogeneous sample. Further research is necessary to investigate staff views and ways of integrating PP with traditional treatment.

Practical implications

Rather than merely attending to the psychological problems and dealing with symptoms, it is also necessary to directly target well-being to enable people to flourish with consideration of their readiness to change.

Originality/value

Addressing a gap in the literature, the present study explored positive themes in current practice and forms part of the evaluation of a newly developed strengths-based approach for individuals with coexisting problems.

Recent Advances in Cognitive Behavioral Therapy For Digestive Disorders and the Role of Applied Positive Psychology Across the Spectrum of GI Care

BACKGROUND

Although cognitive behavior therapies (CBTs) have shown great promise in the reduction of symptom burden from as well as anxiety around various gastrointestinal (GI) disorders, there are substantial issues involving the scalable delivery of such interventions within the clinical setting of a gastroenterology practice, leaving most patients without access to psychological care.

GOALS

This paper discusses the application of positive psychology principles and techniques for adoption by various GI providers to initiate early, effective psychological care for patients with GI disorders, saving CBTs for more complex cases.

STUDY/RESULTS

Authors provide a comprehensive framework of patient well-being known as REVAMP, which is consistent with CBT principles, and elaborate on research and interventions that can be adopted within the gastroenterology practice setting. Building positive resources can bolster patients with GI disorders against comorbid psychological and psychiatric distress.

CONCLUSIONS

Positive psychology interventions can be implemented within gastroenterology practice. Research is necessary to evaluate the efficacy and acceptability of positive psychology interventions among patients with different digestive disorders and baseline psychological characteristics, as well as the feasibility of administration by different clinicians in the gastroenterology practice setting.

The Buffering Effect of Character Strengths on Depression

Abstract. The transition from high school to college can be very stressful for Turkish students because they may experience value conflicts and adjustment issues, which can trigger the development of mental health problems. Character strengths can serve as a buffer against psychopathology. The aim of the study was to examine perceived stress and negative attributional style as mediating factors between character strengths and depression among Turkish college students. Bootstrap testing approach was implemented to compute direct and indirect effects and total effect in the mediation analysis. Altogether 235 students from two Turkish universities participated in the study. The results showed that character strengths were associated with lower levels of depression and it was negatively associated with perceived stress and negative attributional style. The results also indicated that perceived stress and negative attribution style completely mediated the relationship between character strengths and depression among Turkish college students. These findings suggested the need to develop empirically supported interventions that can promote character strengths toward reducing stress, negative attributions, and depression in this population.

Implementations of a text-message intervention to increase linkage from the emergency department to outpatient treatment for substance use disorders

AIM

To determine acceptability and explore potential usefulness of a text messaging (SMS) program aimed at increasing attendance at outpatient treatment for substance use disorders (SUD) after emergency department (ED) referral.

METHOD

A retrospective analysis of 377 adult patients from 2 urban EDs seeking treatment for SUD (opioids (n = 168), alcohol (n = 188), benzodiazepines (n = 21)) referred to outpatient treatment and offered an SMS program which included daily (1) motivational messages focused on positive thinking, (2) ecological momentary assessments (EMA) related to craving with tailored behavioral strategy messages, (3) EMA of drug use with tailored feedback to reduce abstinence violation effects, and (4) reminders about treatment location and phone number. We assessed acceptability by examining opt-in rates, EMA completion rates over the first week and end-of-program qualitative feedback. We assessed how individuals who opt in differ in outcomes from those who opt out by examining rates of outpatient SUD treatment attendance recorded from the medical record.

RESULTS

167 patients (44%) opted in to the SMS program. Over 7 days, around 33% of EMA were completed. Median helpfulness score was 8 (IQR 6 to 10) out of 10 and 84% would recommend the SMS program to someone else. Individuals who opted in to the SMS program had higher rates of SUD treatment initiation than individuals who did not opt-in (70.7% vs. 40.9%).

CONCLUSIONS

We found evidence supporting acceptability and potential usefulness of an automated text message program to assist treatment attendance for some individuals with SUDs discharged from the ED. A controlled trial is needed to examine whether SMS program exposure is associated with improved treatment attendance compared to standard care.

The interplay among stress, frustration tolerance, mindfulness, and social support in Internet gaming disorder symptoms among Chinese working adults

INTRODUCTION

Internet gaming disorder (IGD) is a growing mental health threat across age groups, but existing literature regarding IGD mainly focuses on student populations. Empirical investigation of the risk and protective factors in adult populations is warranted. This study aimed to fill the research gap by examining whether stress and 3 positive psychology factors (ie, frustration tolerance, mindfulness, and social support) are associated with IGD symptoms in working adults. It was also the first attempt to test the buffering effects of these positive psychology factors on the relationship between stress and IGD vulnerability.

METHOD

This cross-sectional study was conducted in Shenzhen, China. We recruited 327 full-time working Chinese adults (mean age = 31.93 years), who had online gaming experience and voluntarily completed an anonymous questionnaire with DSM-5 criteria to measure their IGD symptoms.

RESULTS

Internet gaming disorder symptoms were positively correlated with stress and negatively correlated with the 3 positive psychology factors, among which mindfulness emerged as the most salient protective factor. Moreover, mindfulness, but not frustration tolerance and social support, was found to significantly alleviate the relationship between stress and IGD.

DISCUSSION

Our findings provide supportive evidence for the protective and moderating roles of positive psychology variables against IGD among Chinese working adults. Workplace-based prevention programs may take the identified factors into account to help promote individuals' personal resources to mitigate development of IGD.

Creativity and innovation: Skills for the 21st Century

Abstract Creativity and innovation have been highlighted as essential skills for the 21st century, especially if we consider that both skills can promote human potential by eliciting positive aspects of the individual. These skills have been valued in different contexts. The purpose of this text is to discuss the notions of creativity and innovation as independent constructs and to discuss the relationships between these concepts according to the scientific literature. Three different propositions will be presented, namely, treating these constructs as synonyms, as distinct from each other or as complimentary.

Inclusion of Alcoholic Associations Into a Public Treatment Programme for Alcoholism Improves Outcomes During the Treatment and Continuing Care Period: A 6-Year Experience

Aims

To investigate whether inclusion of self-help groups into the hospital treatment programme improves the prognosis of alcohol dependence through the treatment period; and to examine therapeutic adherence and prognosis during continuing care.

Method

Patients attending the treatment programme at the 'Hospital 12 de Octubre' were randomized into two groups. In Group A (n = 123), patients received the usual treatment included in our programme, whereas in Group B (n = 126), patients also attended self-help groups. Patients were assessed with psychological scales at baseline, at the end of the treatment period and after completing the continuing care visits. Data were collected over a total of 6 years.

Results

During the treatment period, patients in Group B accumulated more months of abstinence and dropped out less. During continuing care, patients in Group B accumulated more months of abstinence and therapeutic adherence was higher. Variables that were associated with these results during the continuing care period were: visits to the GP, scores on anxiety, impulsivity and meaning of life scales, and belonging to the group that attended the alcoholic associations.

Conclusions

Mutual help groups incorporated into a public treatment programme appear to improve outcomes during treatment and on into continuing care. This experience supports cooperation between public health centres and alcoholic associations in treating alcoholism.

Short Summary

Including alcoholic associations into the public treatment programme for alcoholism of the 'Hospital 12 de Octubre' in Madrid was shown to be associated with better outcomes in terms of months of accumulated abstinence, dropout rates and therapeutic adherence, during the treatment and continuing care periods.

Acceptability of an Opioid Relapse Prevention Text-message Intervention for Emergency Department Patients

OBJECTIVE

To explore whether a text message-based relapse prevention intervention (Preventing and Interrupting Early Relapse [PIER]1) is acceptable to treatment-seeking adults with opioid use disorder (OUD) after Emergency Department (ED) discharge using mixed-methods design.

METHODS

Adults seeking care in an urban ED for OUD (n = 20; mean age 22; 55% female; 75% white race) completed a baseline survey, and were invited to enroll in PIER1, which was delivered in 7-day blocks, with the option to re-enroll at the end of each block, up to 4 blocks. PIER1 included a morning "push" message focused on positive thinking, adaptive coping feedback tailored to twice-daily assessments of craving severity and contextual correlates of craving, and end-of-day feedback on daily opioid use and goal commitment. Participants were asked to complete a follow-up phone interview after the first 7 days of PIER1. Transcripts were thematically coded.

RESULTS

Seventeen out of 20 participants enrolled in PIER1. In the first 7 days, response rates to text-message assessments averaged 30%. Ten out of 17 participants re-enrolled after 7 days. Main themes from follow-up interviews (n = 9) included ease of use, social connection, and self-empowerment. Participants desired more personalized support and the ability to communicate through text messaging with another person about their struggles. Event-level data suggest that higher craving severity increased risk of opioid lapses.

CONCLUSIONS

In this mixed-methods intervention development study, we found conflicting evidence supporting an automated text-message intervention providing relapse prevention support for treatment-seeking individuals with OUD discharged from the ED. Qualitative feedback suggests that PIER1 could be useful and acceptability enhanced through personalized human support.

Smiling Instead of Smoking: Development of a Positive Psychology Smoking Cessation Smartphone App for Non-daily Smokers

PURPOSE

The usefulness of mobile technology in supporting smoking cessation has been demonstrated, but little is known about how smartphone apps could best be leveraged. The purpose of this paper is to describe the program of research that led to the creation of a smoking cessation app for non-daily smokers, so as to stimulate further ideas to create "smart" smartphone apps to support health behavior change.

METHOD

Literature reviews to evaluate the appropriateness of the proposed app, content analyses of existing apps, and smoking cessation sessions with non-daily smokers (n = 38) to inform the design of the app.

RESULTS

The literature reviews showed that (1) smoking cessation apps are sought after by smokers, (2) positive affect plays an important role in smoking cessation, (3) short, self-administered exercises consistently bring about enduring positive affect enhancements, and (4) low treatment-seeking rates of non-daily smokers despite high motivation to quit indicate a need for novel smoking cessation support. Directed content analyses of existing apps indicated that tailoring, two-way interactions, and proactive features are under-utilized in existing apps, despite the popularity of such features. Conventional content analyses of audio-recorded session tapes suggested that difficulty in quitting was generally linked to specific, readily identifiable occasions, and that social support was considered important but not consistently sought out.

CONCLUSION

The "Smiling Instead of Smoking" (SIS) app is an Android app that is designed to act as a behavioral, in-the-pocket coach to enhance quitting success in non-daily smokers. It provides proactive, tailored behavioral coaching, interactive tools (e.g., enlisting social support), daily positive psychology exercises, and smoking self-monitoring.

Prevalence and associated factors of Internet gaming disorder among community dwelling adults in Macao, China

Background and aims Internet gaming disorder (IGD) has been mainly studied among adolescents, and no research to date has examined its prevalence in general Chinese adult populations. This study estimated the prevalence of probable IGD in community-dwelling adults in Macao, China. Associations between IGD and psychological distress (i.e., depression and anxiety) as well as IGD and character strength (i.e., psychological resilience and purpose in life) were also tested. Methods A random, representative sample of 1,000 Chinese residents (44% males; mean age = 40.0) was surveyed using a telephone poll design from October to November 2016. Results The estimated prevalence of probable IGD was 2.0% of the overall sample and 4.3% among the recent gamers (n = 473), with no statistically significant sex and age effects observed (p > .05). The two most prevalent IGD symptoms were mood modification and continued engagement, despite negative consequences. Probable IGD respondents were more vulnerable to psychological distress (25.0% and 45.0% for moderate or above levels of depression and anxiety, respectively) than their non-IGD counterparts. They also reported a lower level of psychological resilience than non-IGD respondents. No significant buffering effect of the two character strength variables on the distress-IGD relationship was found. Discussion and conclusions These results provide empirical evidence that IGD is a mental health threat not only to adolescents but also to adults. IGD was significantly associated with psychological distress, which should be addressed in conjunction with IGD symptoms in interventions. Inclusion of gamers of both sexes and different age groups in future prevention programs is also recommended.