Much research on treatment of substance use disorders (SUDs) focuses on reducing symptoms like depression and cravings. However, a growing body of literature examines the role of grit, gratitude, happiness, and other positive psychological constructs, including optimism.
Dispositional optimism—the forward‐thinking expectation that good things will happen—has been associated with enhanced psychological well‐being across various health domains.
Now, researchers at McLean Hospital have conducted the first study of optimism among individuals entering short‐term inpatient SUD treatment. They determined that optimism scores can be quite low in that patient population, and in The American Journal on Addictions, they suggest that treatment planning may benefit from efforts to build up or bolster a sense of optimism.
The authors are Scott E. Provost, MM, MSW, research associate in the Department of Psychiatry at Harvard Medical School, Roger D. Weiss, MD, chief of McLean’s Division of Alcohol, Drugs, and Addiction and director of the Alcohol, Drug, and Addiction Clinical Research Program, and colleagues.
Methods
Between June 2017 and July 2018, the researchers enrolled 355 adult inpatients who were asked to complete a 20- to 30‐minute battery of questionnaires on tablet devices. The main variable of interest was the optimism subscale of the Life Orientation Test-Revised.
Other self-report measures were:
- The Demographic and Smoking Questionnaire
- The Brief Addiction Monitor
- The Craving Scale
- The Overall Anxiety Severity and Impairment Scale (OASIS)
- An opioid overdose questionnaire created by the research group
Characteristics of the Cohort
342 participants completed the Life Orientation Test-Revised and were included in the analyses. The mean age of the cohort was 39 (range, 18–71), 59% were male, 43% were employed full-time, 22% were married or cohabiting, and 76% had at least some college education.
The most common primary SUDs were alcohol use disorder (60%) and opioid use disorder (26%). 56% of patients reported current cigarette use, and only 44% rated their physical health as good or better.
Optimism Scores
The cohort’s mean optimism score, 11.7, was lower than in any report reviewed for this study, including research on other SUD populations and individuals with other mental health problems.
Optimism and Other Variables
In multivariable analyses, the variables significantly associated with optimism were the following (P<0.001):
- College education—associated with higher optimism scores (β, 0.186)
- Higher anxiety severity scores on OASIS—associated with lower optimism scores (β, −0.406)
- Higher recovery protection factor scores on the Brief Addiction Monitor (which includes four items: confidence in the ability to remain abstinent, days in attendance at mutual‐help meetings, belief in religion or spirituality supporting recovery, and satisfaction with progress toward achieving recovery goals)—associated with higher optimism scores (β, 0.179)
Interpreting the Findings
This population’s markedly low optimism level may be a state attribute, at least in part, reflecting life‐changing transitions when the future is uncertain. Alternatively, low optimism might be a marker of a fixed trait that’s a risk factor for the onset and maintenance of SUDs.
Assessing optimism at entry into inpatient treatment for SUDs may be clinically useful. That time is a high‐risk phase during a SUD, and previous research suggests a low level of optimism contributes to self‐doubt and lower confidence, feelings of powerlessness to make behavioral changes, disengagement from treatment, and increased risk of leaving inpatient treatment.
In addition, an optimistic outlook could be encouraged by clinicians for individuals in the pre-contemplation stage of change to instill hope and nurture motivation and be continued in post‐inpatient follow‐up treatment.
This study also emphasizes the importance of balancing the need to assess symptoms in individuals with SUDs against the need to recognize the strengths of recovery protection factors.
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