Forgiveness and Alcohol Problems: A Review of the Literature and a Call for Intervention-Based Research

Abstract

Despite empirical associations with many health-related outcomes and its fundamental place in Alcoholics Anonymous, the scientific study of forgiveness in addiction and recovery has only recently begun. Evidence derives from naturalistic studies and, when used, a short follow-up interval. It is time to expand the empirical study of the salutary forgiveness–alcohol association to include intervention-based research with sufficient follow-up intervals. Understanding the basic and nuanced effect of forgiveness among people with alcohol and other drug problems, though not a panacea, will inform the development of more refined and efficient treatment strategies for individuals struggling with alcoholism and addiction.

KEYWORDS:

• Forgiveness
• alcohol and other drug problems
• intervention

Notes

¹Generally speaking, the term indirect effect can be defined as the relationship between two variables (X and Y) based on another variable (Z), such that Z influences the nature of the relationship between X and Y. For example, basic moderation is defined as X and Y are associated in the context of Z₁, but not Z₂, whereas basic mediation is defined as X and Y are associated through Z, such that X is associated with Z, which in turn is associated with Y (Hayes, 2009). Furthermore, mediation analyses can produce three mediation-based effects (see also Preacher & Hayes, 2004, 2008a): (1) full mediation where an initial direct association between X and Y subsequently fully operates through Z, (2), partial mediation where an initial direct association between X and Y remains yet also operates through Z, and (3) indirect only where X and Y are associated, but only through Z; an initial direct X to Y association is not observed.

²A listing of the 55 references produced by this search, which was not limited by date constraints, is available from the first author. The 17 studies considered explicitly focused on the forgiveness–alcohol association are indicated by an asterisk in the reference section.

³That is, a more consistent and/or relatively stronger effect (e.g., partial r, β).

^aTreatment entry and 6-month follow-up.

^bCross-sectional data only.

^cTreatment entry, 6-month follow-up, and 9-month follow-up.

✓ = statistically significant salutary association/difference observed

^dRelatively larger partial r.

^eUsing the same measurement scale, relatively largest odds ratio among all participants.

^fUsing the same measurement scale, relatively largest odds ratio among past-year congregants.

^gDeleterious relationship observed but concluded to be anomalous.

^hAmong adolescents in a primary care setting; not necessarily with alcohol problems.

^aTreatment entry and 6-month follow-up.

^bCross-sectional data only.

^cPretest, posttest, and 4-month follow-up.

✓ = statistically significant salutary association/difference observed.

^dRelatively larger partial r.

^ee.g., 8/9 = significant salutary associations observed in eight of nine subscales.

^fRelatively larger β.

^gDeleterious relationship observed, interpreted to be due to unique features of the sample.

^aTreatment entry and 6-month follow-up.

^bCross-sectional data only.

^cThe relationship between forgiveness and the outcome variable operates through MH and/or SS, or SU.

^dForgiveness of self associated with AUDIT Total, but only in the context of shame.

^eSubsequently including forgiveness of others changes interrelationships among multiple variables (direct, indirect, and total effects).

^fNonclinical sample of college students; not necessarily with alcohol problems.

✓ = statistically significant salutary association/difference observed.

⁴Alternatively, geographic (urban vs. rural) and demographic (gender, age, education) differences, for example, may account for all or part of this discrepancy between the parallel series of studies (see Webb & Brewer, 2010a). See also Hirsch (2006).

⁵A model of alcohol-related outcomes influencing health-related functioning may also be useful to consider but is outside the scope of this article. Given the economic burden of alcohol, $185 billion in the United States alone in 1998 (Harwood, 2000), indeed its worldwide yearly toll of 2.5 million deaths (World Health Organization, 2011), we have chosen to concentrate on alcohol as a focal outcome in its own right (see also, Babor et al., 2010).