Self-Forgiveness as a Critical Factor in Addiction and Recovery: A 12-Step Model Perspective

Self-Compassion and Self-Forgiveness in Alcohol Risk, Treatment and Recovery: A Systematic Review

INTRODUCTION

Self-compassion and self-forgiveness are two self-focused, positive coping approaches that may reduce risk of problem drinking and/or aid in treatment/recovery from alcohol use disorder. The present systematic review aimed to evaluate support for the unique and complementary roles of self-compassion and self-forgiveness in alcohol outcomes.

METHODS

A systematic literature search yielded 18 studies examining self-compassion, 18 studies examining self-forgiveness and 1 study examining both constructs in alcohol outcomes.

RESULTS

Findings suggest greater self-compassion and self-forgiveness relate to lower likelihood of problem drinking. Self-forgiveness was considerably more researched in treatment/recovery outcomes than self-compassion; self-forgiveness-based interventions appear able to improve drinking-adjacent outcomes, and self-forgiveness may increase across various alcohol treatments. Finally, research suggests that associations of self-compassion and/or self-forgiveness with alcohol outcomes could be driven by numerous factors, including coping-motivated drinking, depression, psychache, social support perceptions, mental health status and/or psychiatric distress.

CONCLUSIONS

Self-compassion and self-forgiveness both appear protective against harmful alcohol outcomes. Nevertheless, many questions remain about the role of self-forgiveness and, particularly, self-compassion in alcohol treatment and recovery outcomes. Future research should examine whether targeted interventions and/or adjunctive therapeutic supports designed to increase self-compassion or self-forgiveness can reduce alcohol use disorder symptoms to facilitate alcohol treatment and recovery success.

Beyond HIV shame: the role of self-forgiveness and acceptance in living with HIV

Research is developing regarding the beneficial association of spirituality with numerous health outcomes in people living with HIV (PLWH); however, little attention has been paid to the association of these variables with forgiveness and acceptance of HIV status. This cross-sectional study used a sample of 648 PLWH from the United States aged 18-61 to test the mediating effects of forgiveness and acceptance of HIV status on the relationship of spirituality and life satisfaction. As expected, self-forgiveness and acceptance straightforwardly and serially explained the links between spirituality and life satisfaction, while forgiveness of others was not a significant mediator for this relationship. The data obtained suggest that spirituality and self-forgiveness are two important targets for future experimental research, and therapeutic interventions on these variables may have a synergistic effect of increasing acceptance and improving well-being in PLWH.

Self-Forgiveness and Self-Condemnation in the Context of Addictive Behavior and Suicidal Behavior

Addictive behavior and suicidal behavior are serious individual- and public-level health concerns. For those struggling with either or both, self-condemnation is a common experience, especially with respect to shame, guilt, and self-stigma. Self-forgiveness, a construct common to both religiousness/spirituality and positive psychology, may be an effective tool in addressing the self-condemnation inherent to those struggling with addictive behavior and suicidal behavior. In this review paper, we discuss (1) the nature and definition of forgiveness, (2) theoretical modeling developed regarding the general association of forgiveness with health, (3) theoretical modeling developed regarding the specific association of forgiveness with better outcomes related to addictive and/or suicidal behavior, (4) the relevance of shame, guilt, and self-stigma to the development and maintenance of addictive and suicidal behavior, and (5) the role of self-forgiveness in addressing self-condemnation, especially shame, guilt, and self-stigma. Little work explicitly focused on the association of self-forgiveness with shame, guilt, and/or self-stigma has been done. However, empirical evidence is accumulating in support of other associations proposed in the Forgiveness-Addiction-Recovery Association (FARA) Model described herein. As such, it is likely that similar support will be found when the focus is deliberately turned to shame, guilt, and self-stigma.

Protocol for an RCT on cognitive bias modification for alcohol use disorders in a religion-based rehabilitation program

INTRODUCTION

Alcohol-related cues trigger relapse in patients with alcohol use disorders (AUDs). These cues may automatically activate motivational approach tendencies. Through computerised cognitive bias modification (CBM), the tendencies of patients with AUD to approach alcohol can be reduced. The present protocol describes a training intervention with approach bias modification (ApBM) incorporating religion-related stimuli as an alternative to alcohol to improve the effectiveness of CBM in a religion-based rehabilitation centre. AUD is often related to patients' religious attitudes in this treatment context. The religion-adapted ApBM, therefore, combines training in avoidance of alcohol-related motivational cues and an approach to religion-based motivational cues. This combination's effectiveness will be compared with a standard ApBM and to a sham ApBM.

METHODS AND ANALYSIS

Using a double-blind multiarm parallel randomised controlled trial procedure (ratio 1:1:1), 120 patients with AUD will be randomised into 1 of 3 conditions (religion-adapted ApBM, standard ApBM or sham ApBM) with personalised stimuli. The interventions are delivered over 4 consecutive days during an inpatient detoxification programme in addition to treatment as usual. Assessments occur before the start of the training and after the fourth training session, with follow-up assessments after 1 and 4 months. A multivariate analysis of variance will be used with the primary outcomes, the percentage of days abstinent and meaning in life 4-month follow-up. Secondary outcomes include differences in reported training satisfaction and symptoms of AUD.

ETHICS AND DISSEMINATION

This study has been reviewed and approved by the Medical Research Ethics Committee Academic Medical Center Amsterdam (Reference number: 2020_251). Further, study results will be published in peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBER

NL75499.018.20.

Aging successfully, but still vulnerable: Late life experiences of older adults who have recovered from alcohol use disorder

OBJECTIVE

The population of older adults suffering from alcohol use disorder (AUD) is increasing worldwide. Recovery from AUD among older adults is a challenging process which can lead to amelioration in these individuals' physical, mental, familial and social domains. However, little is known about the life experiences of older adults who have recovered from AUD.

METHOD

A qualitative-naturalistic approach was implemented. Semi-structured in-depth interviews were conducted with 20 older adults, age 60 +, who had recovered from AUD for periods ranging from 1 to 9 years.

RESULTS

Three main categories emerged from the content analysis: a) Regrets, self-forgiveness and a desire to remedy past wrongs; b) successful aging and eagerness to live; c) enduring challenges. These categories reflect the complex and multidimensional experiences of older adults who have recovered from AUD.

CONCLUSION

Older adults who recover from AUD report experiencing successful aging. They are willing to engage in new ventures in late life, live actively and age healthfully. However, despite their positive outlook, older adults recovering from AUD are a vulnerable population, especially when they experience marginalization as post-AUD older adults. This underscores the need to reach out to this population and the host of challenges they face to provide supportive treatments and interventions from interdisciplinary professionals who can guide their recovery from AUD and help them flourish in late life.

Forgotten Variables and Older Men in Custody: Negative Childhood Events, Forgiveness, and Religiosity

The study tested a mediational model linking negative childhood events through forgiveness of self and social support to religiosity using data from a convenience sample of 261 men aged 45-82 years residing behind prison walls. The Developmental Model of Adaptation provided the study's conceptual model for investigating the associations among the study variables. The study tested a mediational model linking the distal past (negative childhood events) to the outcome, religiosity, through forgiveness, and social support. The final model demonstrated the association of negative childhood events with religiosity through forgiveness of self (not forgiveness of others or situation) and social support. The study's findings suggest that at intake and during time in confinement, middle-aged and older men in prison should be assessed for and offered interventions aimed at helping them cope with the trauma of childhood events, achieve self-forgiveness, seek social support, and express religiosity as important for sustaining their well-being.

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.

A qualitative longitudinal study of the first UK Dual Diagnosis Anonymous (DDA), an integrated peer-support programme for concurrent disorders

Purpose

Dual Diagnosis Anonymous (DDA) is a peer-led programme developed in the USA, which aims to address mental and addictive disorders in an integrated manner. This study is part of a mixed-methods evaluation of the first DDA pilot in the UK, and the purpose of this study is to explore the impact and mechanism of change of the programme through the perspective of DDA attendees, facilitators and the funding commissioners.

Design/methodology/approach

Six DDA members were interviewed three times over a period of 12 months, the facilitators were interviewed twice and the commissioner was interviewed once. The qualitative longitudinal data were analysed using a trajectory thematic analysis.

Findings

DDA attendance was perceived to have had a positive impact on five main areas: acceptance of self, of others and from others; social functioning; self-development; recovery progression; and feeling of hope. The possibility of addressing both mental health and addiction at the same time was a key factor in the recovery process. The facilitators observed that DDA had contributed to integrate members into employment and education, while the commissioner stressed the importance of joint commissioning and sustainability.

Originality/value

The longitudinal approach provided a unique insight into the recovery process of DDA members. Being able to address the mental health as well as the substance use problems was considered to be a fundamental strength of DDA in comparison to the single purpose peer-support fellowships.