Gratitude is an example of a recovery tool that is grounded in experiential knowledge. A tool used across history in a myriad of mutual support communities. It evolved from indigenous recovery community trial and error practices. That is to say that people in recovery for a very long time have been practicing gratitude as a tool because they found it helpful. Knowledge in respect to the practice of gratitude was then transferred intergenerationally. Passed down in oral tradition and incorporated into informal mutual aid processes long before there was an academic research base that has helped us to understand how it works, why it works, and under what conditions.
If we truly value recovery we need to value what people have learned works for them in their own recovery communities. If we want to learn better ways to transmit recovery, we would be well advised to pay attention to what people have learned experientially or has been passed down either formally or informally within and across recovery communities historically. Failure to do so is inconsistent with a recovery orientation.
The use of gratitude as a tool is one of the first things many people learn to explore in recovery culture. This is one of the reasons that people who want to understand how recovery initiation occurs should consider what William White, in his paper on the Frontiers of Recovery Research described as ways of knowing beyond academic / research grounded understanding what works for whom and under what circumstances. In this context, recovery from a substance use condition may be best considered as a process of transmission embedded within community. People in recovery help each other to recover by sharing knowledge, skills and resources with each other through the initiation stages of recovery and beyond into long term, stable recovery.
Gratitude can counter common challenges that occur in the addiction process. Addiction has long been associated with self-centeredness. It increases as loss of control becomes more frequent in the battle to satiate a bottomless well of want that can only fleetingly be filled with every increasing consequence. Remorse, regret, and pain increase as addiction removes the things a person values in their life as addiction runs its course. Degraded health, increased isolation and deteriorated capacity to function as all is sacrificed to gain temporary relief from the pain and the loss. The most vicious of destructive cycles.
To rebalance life in recovery, thankfulness as a concept predated our current concept of gratitude, but is related. The Oxford Group was an early 20th century recovery group that helped influence the structure of Alcoholics Anonymous emphasized “thankfulness” as part of moral re-armament. It was founded by Frank Buchman as a transnational Christian movement that sought moral and spiritual renewal through what it called “personal work.”
Thankfulness as part of moral rearmament was linked to confession, amends, and service. Such work entailed the transformation of individuals to revitalize society, emphasizing moral inventory, confession, restitution, guidance, and evangelistic sharing. It helped move people out of the isolation of addiction back into society. There are intersections between such transformative work and gratitude. Many of these concepts can be recognized in the very foundations of 12 step mutual aid processes.
From its inception, Alcoholics Anonymous embraced a process of spiritual renewal to rise out of the moral and spiritual bankruptcy of addiction. It owed a lot to the conceptual framework of the Oxford Group. Thankfulness was reframed as gratitude. When we think of November as Gratitude Month, this is the origin. There is a General Service Office of AA Box 459 newsletter from the Fall of 2000 that describes the first official recognition of an A.A. Gratitude Week, specifically designed to coincide with Thanksgiving week in the U.S. in 1956. During that era, they had Gratitude Dinners. The practice of gratitude as part of a recovery process was something they understood experientially, even if the science behind it simply did not exist yet.
A full examination of the role of gratitude in the range of mutual self-help programs that exist is beyond the scope of this writing, yet there were consistent themes across a range of mutual aid methods. In Celebrate Recovery, it is woven into the concepts as an antidote to pride, resentment, and control while being part of the relational glue to strengthen connections and the redemptive experience. In the White Bison Wellbriety program, thankfulness is woven into the medicine wheel facets of humility, spiritual awareness and the gifts of healing and of forgiving the unforgivable. While SMART recovery does not have a focus on either thankfulness or gratitude, exercises such as five positives a day, five good things that happened today, five things you did well, or five pieces of progress, strengths, or evidence that life is improving offer a close corollary. These suggest common ground in programs developed by indigenous recovery communities from a variety of diverse perspectives, cultures and orientations.
Gratitude in the Initiation Stages of Recovery
The examination of gratitude as part of the addiction recovery process has not received broad examination, but there have been some studies. “Gratitude, Abstinence, and Alcohol Use Disorders: Report of a Preliminary Finding” published in 2017 found that for individuals with alcohol use disorders who were abstinent, the association of gratitude with future abstinence was positive. In the initial stages of recovery, individuals can often face intense negative emotions such as shame, guilt, anger, and hopelessness. Resumption of substance use is the temporary antidote that can mask the pain in the short term even as it magnifies it progressively. It also suggests that trying to get people who are still drinking to practice gratitude may be counterproductive. This may mean that interventional strategies using gratitude as a tool requires thoughtful and nuanced applications. This is not new information to many in the recovery community who understand that gratitude is not typically a good tool for those who are still using.
Recent metanalysis of gratitude as an intervention strategy found it to be an effective therapeutic complement:
- Shift in Focus: Gratitude practices, such as journaling, encourage a shift in mindset from focusing on what is lacking to appreciating what is present can aid early recovery stabilization. This process can help restructure cognitive patterns and train the brain to be more attuned to positivity and buffer against resumed use.
- Counteracting Negative Thoughts: Gratitude can serve as a “competing response” to negative mental habits like rumination and worry which are characteristic of addiction. By focusing on appreciation, the brain may reduce its tendency to dwell on frustrations and negative emotions, such as resentment and envy and support recovery by focusing energy and emotion more constructively.
- Neural Repair: Neuroscientific studies show that gratitude activates brain regions responsible for emotional regulation, reward, and decision-making, such as the medial prefrontal cortex. This practice may also reduce activity in the amygdala, the brain’s fear center, contributing to a calmer state and lower stress levels. This is in part how recovery and practices of gratitude can actually repair the brain and increase the likelihood of sustained recovery.
Gratitude in Recovery Maintenance
As individuals move through maintenance and into stable recovery, the role of gratitude can evolve and deepen. Over time, it can increase empathy and self-awareness, which augments personal recovery and supports the expansion of prosocial connections and civic engagement. People in recovery are civically engaged at significantly higher rates than the general public:
- Reinforcing Sobriety: Gratitude is an evidenced based healing strategy. Participants in studies reported that gratitude practices helped them explicitly link good things happening in their lives to their sobriety, which reinforces the commitment to abstinence. In that same 2017 study linked above, the author found that among individuals who are already abstinent, higher levels of gratitude are positively associated with future abstinence.
- Building Resilience: Research is finding that gratitude fosters emotional resilience, enabling individuals to better handle setbacks, stress, and cravings, seeing challenges as opportunities for growth rather than failures. This is similar to what Dr Angela Duckworth found in her work on measuring grit. Grit can be defined as a human quality of perseverance to pursue long term goals despite adversity and setbacks. Dr. Duckworth views gratitude as a quality of “gritty” or resilient people. Grit as a trait is not static, it can be measured and acquired through effort.
- Strengthening Relationships: Addiction often damages social bonds. Gratitude moves people beyond an exaggerated focus on self to develop an increased sense of value in more robust human bonds. Expressing gratitude to friends, family, and support groups helps repair and strengthen these vital connections, building a strong support system that is crucial for sustained recovery.
- Improved Mental and Physical Health: Gratitude supports a healthier life. Ongoing gratitude practice is linked to lower levels of stress, anxiety, and depression. It improves physical health outcomes like better sleep, reduced inflammation and lower blood pressure, which support overall well-being and a healthier lifestyle post-addiction in sustained long term recovery.
The practice of gratitude evolved out of the experiential knowledge of people generations ago who understood that addiction was more than a physical or psychological condition, but one that sapped the soul. They knew that addiction eroded the spiritual facets of the human condition and that recovery was more than the physical restoration of health. They first conceived thankfulness and gratitude as vital recovery tools to address these challenges. In that time, there was no research showing that gratitude can improve physical health. There was no understanding in the past of the capacity of the brain to heal through gratitude practices; they did not need the literature to show them what they could see with their own eyes. It was then passed down generationally within these communities.
As an addiction treatment practitioner a generation ago, I had a managed care insurance entity reject the work I was doing with people to practice gratitude because it was not viewed at the time as evidence based. It is increasingly and rightfully viewed as evidence based. We will most likely find more evidence over the course of time on how to use gratitude as a tool to help people gain and sustain recovery in more nuanced ways. We should embrace such efforts even as we remind our care systems about the value of practice-based evidence, which typically precedes academic literature.
Gratitude fosters the practice of humility. We should also practice humility as a professional field in respect to how we know what we know and support insights and strategies gained through experiential learning across our history. Valuing the myriads of groups who have figured out what works in respect to initiating and sustaining recovery. All those who read this must know that addiction, the spectrum of substance use conditions and the continuum of healing from these highly complex conditions is in many ways still in its infancy. Institutional humility is grounded in the knowledge that we know that we understand so very little about what we are dealing with even as our evidence-based increases incrementally. This would mean that future recovery research makes intentional space for what William White has defined as four primary arenas of knowledge or “ways of knowing.” Experiential Knowledge, Common / Public Knowledge including folklore or myth, Professional / Clinical Knowledge, Scientific Knowledge.
Validating all the ways of knowing on a field level would be a field level expression of gratitude for what lay people and indigenous recovery communities have learned about effective resolution and resilience in overcoming addiction and becoming better versions of ourselves as a result.
Sources
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