Gratitude is mutual between social work faculty member Amy Krentzman and community partner Jennifer Diederich, who are collaborating to support people in recovery from substance use disorders.Gratitude is mutual between social work faculty member Amy Krentzman and community partner Jennifer Diederich, who are collaborating to support people in recovery from substance use disorders.

The gratitude factor

New findings on what works in addiction recovery programs from an innovative social work scholar

Giving thanks is a common practice that spans cultures and has been a hallmark of religious practice for millennia.

“Gratitude begins in our hearts and then dovetails into behavior,” writes best-selling author Anne Lamott in her book Help, Thanks, Wow: The Three Essential Prayers.

Gratitude is also part of many addiction treatment and recovery programs. Alcoholics Anonymous, for example, recommends expressing “genuine gratitude for blessings received” as part of step 10 of its 12 steps. And people in recovery are often asked by their sponsors to write 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 rather than illness that emerged in the 1990s. But in 2012, no studies had yet explored gratitude practices in recovery programs.

Social work researcher Amy Krentzman was surprised when she discovered the gap. She had been studying addiction recovery for more than 10 years with a particular focus on positive psychology, since the study of successful addiction recovery is strengths-based by definition.

“Gratitude is a naturally occurring emotion among people in recovery,” says Krentzman. “On the menu of positive-psychology interventions, gratitude practices seemed to hold the most potential.”

Krentzman designed an experiment to study a popular intervention from positive psychology called the Three Good Things exercise and assembled a team to carry it out.

The study took place in early 2013 in a Midwestern community where the 23 participants were enrolled in an outpatient program to treat their alcohol use disorder. All were adults, nearly equal numbers of men and women; 80 percent were European American.

Each person began with a face-to-face intake assessment. Then, every day for 14 days they received email invitations to answer a survey with six questions. 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.

ThreeGoodThings

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.

The results showed that the Three Good Things exercise had an impact on mood—it decreased negative mood and increased feelings of calm and ease, factors known to support and reinforce recovery.

Meanwhile, the control group did not experience similar effects.

“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.’”

But those effects lasted only as long as the practice continued—there was no lingering after-effect.

Krentzman’s team had completed the first formal study of gratitude in alcoholism treatment. The Journal of Positive Psychology published the results in 2015. A new grant will soon allow Krentzman to build on the study, examining the function of gratitude in a journaling practice among people in recovery in rural communities.

And something unexpected emerged in the Three Good Things follow-up interviews. Participants mentioned that completing a questionnaire about their emotions—the Positive and Negative Affect Schedule, or PANAS for short—was helpful to their recovery.

Krentzman dug back into the data. She 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 their mood increased.

It was an important finding because mood plays such a significant role in models that explain the motivation to drink. It was the first study that suggested that the PANAS questionnaire might have therapeutic properties for people with addictions. The secondary study was published in the journal Qualitative Health Research the same year.

A focus on wellness

An estimated 20 million people in the United States, or about 8.4 percent of the population, have had an active substance use disorder in the past year. Alcohol abuse is by far the most prevalent. Only 10 percent of people who meet the criteria for addiction enter treatment, says Krentzman. But with and without treatment, many recover from addictive disorders. And those who do, keep recovering, every day, many for the rest of their lives.

Krentzman arrived in 2013 as an assistant professor in the School of Social Work. Her Three Good Things study had been completed, and analysis had begun.

“Minnesota is a wonderful place to be doing this kind of research,” she says. “There’s a great community of people who care deeply about recovery issues.”

A resource on recovery

Across the hall from Amy Krentzman on the St. Paul campus is the Minnesota Center for Chemical and Mental Health, founded in 2013 in the School of Social Work with funding from the State of Minnesota. It’s an avenue for lifelong learning, helping the public and professionals keep up with the explosion of research and treatment methods related to treatment and recovery from substance use disorders, mental illness, and co-occuring disorders. Krentzman is among those who have collaborated with the center on training, continuing education, and research. Learn more at mncamh.umn.edu.

Krentzman exudes a calm intensity and positive spirit. In a classroom in Peters Hall or making a presentation to a community organization, she speaks thoughtfully, listens intently, and smiles often. Her habits are those of a skilled and seasoned social worker, honed over years of conversations and serving others.

Her path to Minnesota, home of pioneering addiction treatment programs, covered long years of social work service, teaching, and a master of social work degree in New York. After her doctorate at Case Western Reserve University in Ohio, Krentzman spent four years of postdoctoral work at the University of Michigan in Ann Arbor.

John Kelly, associate professor of psychiatry in addiction medicine at Harvard Medical School, first met Krentzman in Michigan. He recognizes her as one of a cadre of individuals that focuses on positive aspects of recovery and what works.

“She’s done some fabulous work on gratitude and spirituality, which has been talked about but not really studied in our field,” says Kelly. “We’ve tended to focus on the pathology and deficits. She’s ultra rigorous, a top-notch scientist, with a lot of creativity, in a valuable and interesting area. She is demonstrating that you can be a serious scientist and focus on positive emotion and gratitude.

“As one of the leaders in the field, she has really zoomed in on the particular emotions of gratitude and hope,” he adds, “and, no pun intended, for that I am really grateful!”

Communication OARS

In the School of Social Work, Krentzman’s teaching assignment includes a core class for MSW students.

Because social workers must listen and respond appropriately to their clients, communication is a foundational skill. Krentzman teaches the acronym from Motivational Interviewing, “OARS,” to help students remember the key types of optimal conversational responses: Open-ended questions. Affirmations. Reflections. Summaries.

But the impact of OARS and other skills wasn’t limited to social-work settings. Krentzman’s students began reporting that their new skills were changing their lives outside of class—with girlfriends and boyfriends, parents and siblings, friends and coworkers.

On the last day of Krentzman’s classes, she often asks her students to write a word in response to the cue, “There is only one word for what we had together.” Then they take a photo. This class gave Krentzman an oar for OARS, signed with their names—it now hangs in her office.
On the last day of Krentzman’s classes, she often asks her students to write a word in response to the cue, “There is only one word for what we had together”—Krentzman chose “Fire” inspired by the quote, “Education is not the filling of a pail but the lighting of a fire.” This class presented Krentzman an oar for OARS, signed with their names—which now hangs in her office.

That gave Krentzman an idea: Could these skills help people in recovery, too?

She contacted Union Gospel Mission in St. Paul, and they opened their doors. Krentzman teamed up with the mission’s clinical social worker, Janet Westlund, and then designed a five-week communication skills class in winter 2016 and an assessment to measure its impact.

Nineteen men ages 20 to 55, all with chronic addiction histories but sober at the time, were recruited into the study. They were randomly assigned to either take the class on Tuesday afternoons or complete a weekly packet of questionnaires.

When the class was done, those who’d received the packets were offered the opportunity to take the class. All but one of them did.

Krentzman presented the preliminary results to the Union Gospel Mission leadership and staff this fall. She opened with thanks to everyone for hosting her and her study. She wanted to share not only her research findings but also the clinical and demographic data she collected in the course of the study that may be most valuable to the program.

The randomized pilot study showed there was value in the approach, results that can be used to pursue funding for a larger study. The staff was enthusiastic.

“Data is very important to our future,” says Dr. Charles P. Morgan, executive director of Union Gospel Mission Twin Cities.

The gift of a bigger picture

Jennifer Sevlie Diederich has data—a lot of it.

Ten years ago, she founded Come Straight Home, a quality sober living house for women coming out of addiction treatment programs. At one point it grew to five houses. Nearly 700 women have been served.

“What I have is purpose, passion, and intent for providing the best possible, quality ethical living for women coming out of treatment,” says Diederich, who has walked that path herself.

Two years ago, Diederich and Krentzman had coffee with one of Diederich’s house managers and a colleague of Krentzman’s—Lana Yarosh, U assistant professor of computer science and engineering, who investigates technology as a medium for peer support in addiction recovery communities.

“When Jennifer mentioned that she had a box with eight years of intake forms documenting length of stay and reason for leaving, I was excited,” Krentzman remembers. “And she has a background in nursing—she is meticulous and collected detailed information on things like meds.”

“I keep really good records—for me,” says Diederich with a laugh, “but it took a month to figure out my mess. Amy was able to walk me through the process.”

Amy Krenztman, right, and Jennifer Sevlie Diederich in the kitchen at Come Straight Home.
Amy Krentzman, right, and Jennifer Sevlie Diederich in the kitchen at Come Straight Home.

For the next few months, Krentzman and three of her graduate research assistants came to Diederich’s home office and carefully went through all her records, alphabetizing, de-identifying, and extracting data to enter into a database.

“This is a unique data set that could tell us so many things,” Krentzman explains, “like how many days is optimal for living in a sober house before transitioning out? What are some differences between those who relapse and those who don’t? Differences such as psychiatric diagnoses, age, and so on. And what’s the nature of change in sober-living demographics over time—for example, age and addiction severity?

“What we find should help anyone who’s running a sober-living house and those who are recommending sober living after treatment,” she continues. “It will advance our understanding of success rates and optimal lengths of stay, which can generate recommendations for treatment providers and families.”

Diederich was impressed by the process.

“Amy showed up with an agenda that was clear and concise,” she says. “She was methodical. She amazed me in her ability to follow rules of confidentiality. She kept saying, ‘I am so happy you kept such good information!’ If somebody moved out and I didn’t write down the date, she was able to find out from the billing. Who could do this? Rarely have I seen someone as respectful, conscientious, and accommodating.

“I can’t wait until it’s over and Amy can sit down and tell me what she’s found: These are the women coming to you; these are their presenting problems.”

The gratitude is mutual.

“Jennifer opened her home to us and entrusted us with her records,” says Krentzman. “It’s a joy to work in partnership with her. We are pushing for the same goals. She is devoted to helping women achieve lasting recovery, and I will do my best with the data we’ve gathered to support her and others in helping women get well.”

Yes, Krentzman has a gratitude practice, too. Every morning with a cup of tea, she writes her own list of Three Good Things.

Learn more about Amy Krentzman and the School of Social Work.

Addiction 101: Myths and Misconceptions

Amy Krentzman presented a free webinar on this topic offered through the U of M Alumni Association on Tuesday, February 28, 12-1 p.m. central time. Issues included criteria for diagnosis, recommended treatment approaches, and the nature of addiction recovery. Get more information about UMAA webinars at umnalumni.org/intranet/virtual#webinars.

Story by Gayla Marty | Photos by Dawn Villella except as indicated | Winter 2017