Trait-based recovery enhances engagement and reduces anxiety and depression symptoms

Abstract

The Trait-Based Model of Recovery is a strengths-focused intervention designed to enhance personality traits and reduce mental health symptoms, such as anxiety and depression, among individuals recovering from addiction. This study evaluated the model’s effectiveness using a quasi-experimental pre-post design across diverse settings, including residential and outpatient programs in Kentucky and a pretrial diversion program in Albuquerque, New Mexico, highlighting its broad applicability and generalizability. Participants (N = 139) exhibited substantial reductions in depression (71.5%) and anxiety (58.5%), alongside significant improvements in nine of ten targeted traits, notably resilience and self-awareness. Retention was considerably higher in the intervention group (97.1%) compared to the comparison group’s substantial attrition (15.5% retained). Empathy slightly declined post-intervention, indicating an area for further refinement. The findings support the Trait-Based Model of Recovery as a holistic and strengths-focused framework capable of effectively addressing addiction and co-occurring mental health disorders. By enhancing traits and addressing their potential negative expressions, this approach provides meaningful therapeutic value across diverse recovery contexts. Future research should explore the long-term sustainability of outcomes and identify targeted strategies to enhance traits such as empathy, further optimizing this innovative recovery approach.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-06384-0.

Introduction

Addiction treatment has significantly evolved over the past century. Early interventions, including lobotomies and electroshock therapy, were common in the early 20th century¹, but have since been replaced by more compassionate, evidence-based methods. The establishment of Alcoholics Anonymous (AA) in 1935 introduced the 12-step model, which remains influential and has supported millions in achieving sobriety and rebuilding their lives.

Contemporary treatments now incorporate empirically supported psychotherapies, such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), which emphasize cognitive reframing, emotional regulation, and management of co-occurring mental health conditions². While CBT and DBT have demonstrated efficacy for many individuals, these structured cognitive and behaviorally intensive modalities may be less effective or accessible for certain groups, including young adults (ages 18–25) who may require less rigid or more personally engaging interventions, or individuals who lack resources for DBT’s intensive training requirements³. Similarly, Alcoholics Anonymous (AA), although broadly successful, may be less appealing or effective for those uncomfortable with its spiritual framework or who prefer individualized psychotherapeutic approaches⁴. These recognized limitations underscore the value of exploring tailored, strengths-focused interventions such as the Trait-Based Model, particularly for populations who may not optimally respond to traditional approaches.

Substance use disorders (SUD) remain a global public health challenge, with treatment increasingly mandated through judicial mechanisms, notably drug courts and correctional rehabilitation programs^5,6. However, recent shifts toward viewing addiction as a public health rather than exclusively criminal issue emphasize the urgency for strengths-based, accessible recovery models that effectively engage diverse populations, including justice-involved individuals⁶.

Within positive psychology, strengths-based recovery frameworks have gained attention⁷. Positive psychology interventions (PPIs), such as the G-CHIME model⁸ and recovery capital frameworks^9,10, highlight the value of leveraging individual strengths and resources in the recovery process. Nonetheless, explicit integration and empirical validation of trait-focused models specifically tailored to addiction recovery remain relatively unexplored. This study directly addresses this gap by empirically evaluating a comprehensive, explicitly trait-focused model designed for addiction recovery.

Traditional recovery models, including the 12-step framework, often employ a “deficiency model,” emphasizing powerlessness, character defects, and the necessity for external intervention. While beneficial for many, this emphasis can inadvertently reinforce feelings of shame, stigma, and helplessness¹¹, potentially impeding recovery by exacerbating negative self-perceptions and internal fragmentation.

By contrast, emerging literature highlights the advantages of strengths-based approaches focused on fostering positive self-perception, resilience, self-worth, and motivation. Principles from positive psychology suggest that interventions which build upon inherent strengths empower individuals toward sustainable recovery. Improved self-esteem and self-efficacy have been correlated with reduced relapse rates and enhanced treatment adherence^12,13.

While influential recovery models have significantly contributed to the mental health recovery literature, their explicit exclusion of substance use disorders emphasizes the need for distinct frameworks tailored explicitly for addiction recovery. Models addressing the unique recovery processes for SUD, including relapse prevention, self-stigma reduction, and targeted trait enhancement, remain underdeveloped.

Additionally, anxiety and depression frequently co-occur with substance use disorders, complicating recovery. These mental health issues serve as both drivers and consequences of addiction, perpetuating emotional distress and substance use cycles¹³. Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) frequently co-occur, complicating recovery due to shared neurological, genetic, and environmental risk factors, underscoring the need for integrated treatments addressing both disorders simultaneously¹⁴. Effective interventions must simultaneously address these co-occurring disorders alongside addiction to enhance overall outcomes. Emotional intelligence, self-awareness, and resilience have been identified as critical traits in mitigating relapse risk and promoting long-term recovery success¹⁵.

The Trait-Based Model of Recovery responds to these identified gaps by utilizing a strengths-focused, empirically grounded framework that prioritizes the cultivation of core personality traits such as resilience, self-awareness, and emotional intelligence. Unlike approaches that conceptualize resilience solely as a dynamic skill fluctuating across contexts¹⁶, the Trait-Based Model views resilience within a stable constellation of inherent traits including authenticity and emotional intelligence, thereby providing durable internal resources for sustained recovery.

Prior research¹⁷ has revealed notable parallels between traits commonly exhibited by individuals in recovery and those identified in effective leaders, including determination, authenticity, and adaptability. These insights underpin the Trait-Based Model’s emphasis on enhancing positive self-perception, effectively addressing co-occurring mental health conditions, and fostering personal empowerment.

Furthermore, enhanced self-perception and emotional resilience have been shown to mitigate internalized stigma, supporting healthier coping mechanisms and sustained recovery outcomes^18,19. Specifically, self-awareness and emotional intelligence are associated with lower self-stigma, improved self-acceptance, and reduced vulnerability to relapse^19,20.

This study explicitly evaluates the effectiveness of the Trait-Based Model of Recovery in enhancing measurable personality traits—such as authenticity, resilience, and emotional intelligence—and assesses its impact on reducing anxiety and depression compared to traditional recovery interventions. By providing empirical validation for this trait-focused approach, this research aims to establish its efficacy, generalizability, and potential for significantly improving addiction recovery outcomes across diverse populations and settings.

While strengths-based recovery approaches within positive psychology have gained attention, there remains a notable gap regarding explicitly trait-focused interventions specifically tailored to addiction recovery. Existing positive psychology and recovery capital models often address general dynamic capacities—such as resilience and hope—but do not systematically focus on stable personality traits such as authenticity, emotional intelligence, and self-awareness. This explicit trait orientation represents a significant theoretical and practical gap. Addressing this gap is critical, as trait-focused interventions possess cross-cutting potential to more effectively address co-occurring mental health disorders prevalent among individuals with substance use disorders (SUD), offering a more holistic and sustainable pathway for recovery.

Literature review

Personality-focused approaches in addiction recovery

Evidence-based psychotherapeutic approaches, including Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT), have significantly advanced addiction treatment by promoting emotional regulation, enhancing motivation, and facilitating behavioral change. Nevertheless, these modalities exhibit notable limitations in addiction contexts. Specifically, MI can become less effective when severe ambivalence persists, commonly seen in early recovery stages²¹. CBT, though effective for cognitive restructuring, may inadequately address deeper emotional and interpersonal complexities characteristic of chronic substance use²². DBT, despite its robust efficacy and inclusion of mindfulness strategies, typically requires extensive training and resource-intensive supervision, thereby limiting widespread accessibility³. These constraints underscore the necessity for scalable interventions that simultaneously promote enduring emotional stability, interpersonal growth, and broad accessibility.

While strengths-based recovery approaches have gained prominence, most research primarily emphasizes general dynamic capacities—such as resilience, hope, and motivation—within broad positive psychology frameworks^8,23 and recovery capital models^9,10. These frameworks often conceptualize traits like resilience as context-dependent, fluctuating capacities rather than stable, enduring resources¹⁶. In contrast, the Trait-Based Model explicitly differentiates itself by systematically targeting stable, measurable personality traits—including authenticity, emotional intelligence, self-awareness, and creativity¹⁷-conceptualizing them as enduring internal resources crucial for sustained long-term recovery.

Emergence and potential of the trait-based model

The Trait-Based Model of Recovery represents an innovative, strengths-focused intervention explicitly designed to cultivate stable personality traits integral to sustained addiction recovery. This model reframes inherent traits such as resilience, emotional intelligence, self-awareness, and authenticity as internal resources rather than deficits, thus promoting enhanced self-perception, emotional stability, and empowerment¹⁷. By emphasizing self-awareness and resilience, the model actively addresses and mitigates self-stigma, enhancing participant engagement and fostering sustainable recovery outcomes^3,18. Unlike deficit-focused models, such as the 12-step framework—which emphasizes powerlessness and character defects—the Trait-Based approach prioritizes strengths, reducing shame, enhancing self-efficacy, and improving retention rates^3,11. Research confirms that increased self-awareness and resilience significantly reduce internalized stigma, further enhancing sustainability of recovery and adherence to treatment plans¹⁸.

Cross-cutting potential of the trait-based model

The holistic framework of the Trait-Based Model emphasizes cultivating traits such as resilience, emotional intelligence, self-awareness, and creativity. Unlike conventional addiction treatment models, this approach leverages inherent strengths to facilitate personal growth, improved self-perception, and emotional stability, offering potential applicability beyond addiction to various mental health conditions.

For individuals experiencing anxiety disorders, enhancing emotional intelligence and self-awareness equips them to identify and regulate emotional triggers, thus reducing anxiety frequency and severity. Resilience further facilitates effective coping and recovery from stressors, contributing significantly to emotional regulation improvements²⁴.

This trait-focused model also aligns well with therapeutic objectives for individuals diagnosed with personality disorders, notably borderline personality disorder (BPD), characterized by emotional dysregulation and interpersonal difficulties. Developing emotional intelligence and self-awareness within this population can enhance interpersonal functioning and reduce impulsivity, offering a practical alternative to the resource-intensive demands of DBT³.

Moreover, the model’s emphasis on creativity and authenticity addresses central depressive symptoms, such as stagnation, diminished purpose, and loss of meaning. Creativity fosters adaptive problem-solving and innovative thinking, while authenticity promotes alignment between personal values and actions, contributing significantly to overall emotional well-being and life satisfaction²³. Emphasizing resilience and self-awareness additionally reduces self-stigma, thereby increasing engagement and long-term treatment adherence.

The Trait-Based Model also holds considerable promise for individuals with attention deficit hyperactivity disorder (ADHD), who typically face challenges with impulsivity, self-regulation, and sustained attention. Cultivating self-awareness and emotional intelligence aids these individuals in recognizing attention patterns and managing impulsivity more effectively. Additionally, emphasizing resilience can enhance persistence and improve overall executive functioning, mitigating symptom severity²⁵.

Ultimately, the Trait-Based Model’s strength and broad applicability arise from its comprehensive focus on empowerment and personal growth through targeted trait development. Its capability to foster core personality traits positions it as a versatile and promising intervention, beneficial for addressing addiction recovery as well as diverse mental health conditions and broader behavioral challenges.

Objective

This study primarily aims to evaluate the effectiveness of the Trait-Based Model of Recovery across four critical domains relevant to addiction recovery: anxiety, depression, targeted trait improvement, and engagement (retention rates). These domains were selected due to their interconnected roles in fostering sustainable, holistic recovery. Anxiety and depression frequently co-occur with substance use disorders, serving both as contributors to addiction and as significant obstacles to sustained recovery⁴. Addressing these co-occurring emotional conditions is essential for promoting emotional stability, resilience, and comprehensive recovery success.

Additionally, the Trait-Based Model explicitly emphasizes cultivating stable personality traits, including resilience, emotional intelligence, authenticity, creativity, and self-awareness. Influential mental health recovery models²³ typically exclude substance use disorders, underscoring the necessity of trait-focused frameworks specifically tailored to addiction recovery contexts.

Hypotheses

The present study tests the following hypotheses:

1. Trait Improvement: Participants in the Trait-Based intervention will demonstrate significant enhancements in targeted personality traits (resilience, emotional intelligence, self-awareness, authenticity, and creativity), fostering adaptive emotional regulation, improved interpersonal effectiveness, and sustained personal growth.

2. Reduction in Anxiety and Depression: Participants will experience measurable reductions in anxiety and depression symptoms, thereby improving emotional stability and overall psychological well-being.

3. Increased Engagement and Retention: Due to its strengths-based and empowering approach, the Trait-Based Model will yield higher participant engagement levels, as evidenced by increased retention rates throughout the treatment duration.

This study aims to provide a comprehensive evaluation of the Trait-Based Model’s effectiveness across these interconnected domains. While enhanced self-perception is an anticipated theoretical outcome of strengths-based interventions, this research explicitly measures tangible outcomes—such as trait improvements, reductions in anxiety and depression, and increased engagement—to significantly expand the empirical foundation supporting strengths-based, trait-focused addiction recovery interventions.

Methods

Study design

This study employed a quasi-experimental, pre-post design using a mixed-methods approach to evaluate the effectiveness of the Trait-Based Model of Recovery compared to standard addiction treatment programs. Participants included clients enrolled in residential, outpatient, or justice-involved addiction treatment programs located in Kentucky and New Mexico. Daily treatment schedules and therapeutic conditions across these contexts were consistent, with the primary difference being participation in either the Trait-Based Model or standard addiction curricula during a designated daily time block.

All participants began the Trait-Based intervention concurrently with their admission to treatment programs. Specifically, participants enrolled in residential or intensive outpatient care initiated the structured Trait-Based Model curriculum within their first week of admission. Individuals who had been enrolled in treatment prior to the initiation of the intervention were not included in this study, thus ensuring consistency in exposure to the Trait-Based Model and mitigating variability related to prior treatment exposure.

Treatment programs selected for this study included residential, intensive outpatient, and pretrial diversion programs in central Kentucky and Albuquerque, New Mexico, based on their existing implementation or commitment to adopting the Trait-Based Model. Programs were purposively selected to represent diverse clinical settings and geographic areas, thus enhancing the ecological validity and generalizability of findings. Programs excluded were those not yet implementing or not willing to implement the Trait-Based Model within the study timeframe, or programs that served populations significantly different in clinical severity or treatment modality, potentially limiting comparability.

Participants in the Trait-Based intervention group attended structured group sessions from 8:00 to 10:00 am, five days per week. Each session featured one of 40 lessons from the comprehensive Trait-Based Model curriculum, including a 20–30-minute educational video, structured group discussions, interactive activities, reflective assignments, journaling exercises, and group processing facilitated by trained peer support specialists or clinicians.

The comparison group participated concurrently in widely established, evidence-based addiction treatment curricula—“Living in Balance” and the “Matrix Model”—during this same time block. These curricula were chosen due to their broad adoption and empirical validation, providing a meaningful and practical benchmark for evaluating the Trait-Based Model’s effectiveness.

Due to ethical and logistical constraints in real-world treatment settings, random assignment was impractical. Instead, participants were selected quasi-randomly with assistance from peer support specialists, ensuring ethical fairness and minimizing potential bias or disruptions within the treatment environment.

Anxiety and depression were assessed using validated instruments (Generalized Anxiety Disorder-7 [GAD-7] and Patient Health Questionnaire-9 [PHQ-9]). Personality traits were measured using the Trait and Hero of Recovery Archetype Assessment, a newly developed instrument with preliminary internal consistency previously established through a separate pilot study involving 364 individuals from similar treatment settings. Engagement was measured via retention rates obtained from administrative records at 60- and 90-days post-admission.

All procedures adhered strictly to ethical guidelines, with IRB approval provided by Campbellsville University, ensuring confidentiality, informed consent, and participant safety throughout the study.

Participants

Participants included 139 adults receiving addiction treatment in residential or intensive outpatient programs who were assigned to the Trait-Based Model of Recovery intervention group. The majority were enrolled at a primary residential treatment facility located in central Kentucky, with additional participants from residential or intensive outpatient treatment programs in New Mexico, where the Trait-Based Model had also been implemented. The inclusion of multiple treatment sites enhanced geographic diversity and supported the generalizability of findings. Participant ages ranged from 19 to 61 years, with a gender composition of approximately 60% male and 40% female. Participants primarily presented with moderate-to-severe substance use disorders characterized by polysubstance use and prolonged histories of addiction.

A separate comparison group (N = 425) consisted exclusively of participants from the primary residential treatment center in central Kentucky who participated concurrently in standard, evidence-based treatment curricula (“Living in Balance” and “Matrix Model”). Participants in both groups shared similar demographic characteristics and severity profiles upon admission. Due to logistical and administrative constraints at the primary treatment site, participants in the comparison group did not complete additional standardized assessments (GAD-7, PHQ-9, Trait Assessment), and therefore this group was utilized exclusively to evaluate retention and engagement outcomes.

Inclusion criteria for the Trait-Based intervention group were intentionally broad to ensure ecological validity and applicability to typical addiction treatment populations, and included: (a) age of 18 years or older, (b) diagnosis of moderate-to-severe substance use disorder upon admission, (c) active enrollment in residential or intensive outpatient care at the start of the study, and (d) cognitive capacity to engage meaningfully in assessments and structured intervention activities. Exclusion criteria included acute psychosis, severe cognitive impairment, active withdrawal symptoms severe enough to preclude meaningful participation, or inability to consistently engage in assessments or intervention activities.

Participants were selected quasi-randomly by peer support specialists within each treatment facility to minimize disruptions in therapeutic group dynamics, ensure fairness in assignment, and reduce biases or perceptions of preferential treatment. This method preserved ethical standards while supporting practical and realistic implementation within clinical settings.

Intervention

The intervention evaluated in this study was the Trait-Based Model of Recovery, a structured, interactive curriculum explicitly designed to cultivate and strengthen ten personality traits crucial for sustained recovery: resilience, creativity, gratitude, self-awareness, tenacity, determination, empathy, appreciation, motivation, emotional intelligence, and authenticity. This comprehensive curriculum comprised 40 lessons systematically organized into eight distinct thematic modules delivered over eight weeks.

Participants attended structured group sessions five days per week (Monday–Friday) for two hours each day (8:00–10:00 am). Each session included a 20- to 30-minute educational video specifically developed for the Trait-Based Model, introducing the session’s key concepts, illustrating practical applications of targeted traits, and demonstrating their relevance to addiction recovery. Following each video, trained peer support specialists or clinicians facilitated structured group discussions, reflective exercises, role-playing scenarios, and interactive activities explicitly designed to enhance participants’ self-awareness, interpersonal effectiveness, emotional regulation, and personal empowerment.

Central to the Trait-Based Model is an emotional development framework called the Tree of Traits, a conceptual and visual tool designed to help individuals achieve and maintain internal balance by understanding, assessing, and intentionally developing their inherent traits. Participants learned to utilize the Tree of Traits to recognize when their traits were expressed in balanced, constructive ways (light expressions) versus imbalanced, maladaptive ways (shadow expressions). Practical exercises guided participants through processes of reflecting upon and adjusting their trait expressions, empowering them to self-assess and restore emotional equilibrium throughout their recovery journey.

A key therapeutic benefit of the Tree of Traits is its capacity to mitigate shame and stigma associated with past behaviors. Through the framework, participants come to understand previous negative behaviors as manifestations of substance use disorder influencing their inherent traits toward maladaptive or “shadow” expressions. This reframing helps reduce unnecessary shame and alleviates feelings of unworthiness, facilitating improved self-perception, self-compassion, and motivation for sustained recovery.

The Trait-Based Model integrates evidence-based strategies derived from positive psychology, strengths-based recovery approaches, cognitive-behavioral principles, mindfulness practices, and transformational leadership theories, adapted explicitly for recovery contexts. Facilitators received mandatory training (approximately five hours) covering detailed curriculum content, group facilitation skills, trauma-informed care, and techniques to maximize participant engagement and fidelity to the intervention.

This curriculum has previously been piloted and successfully implemented across various residential and intensive outpatient treatment contexts, demonstrating strong participant engagement and retention rates. Participant guidebooks accompanied each lesson, offering structured journaling prompts, reflection questions, goal-setting exercises, and practical applications of trait-based concepts between sessions.

Treatment protocols and curriculum

All participants in both the Trait-Based Model intervention group and the comparison group received comparable addiction treatment protocols, including individualized counseling, case management, psychoeducation, relapse prevention, and structured therapeutic activities standard in residential and intensive outpatient programs.

The primary distinction between groups was the curriculum used during a structured daily group session from 8:00 to 10:00 am, five days per week. The intervention group participated in the interactive Trait-Based Model of Recovery curriculum, consisting of 40 structured lessons that included educational videos, group discussions, reflective assignments, and interactive activities facilitated by trained peer support specialists or clinicians.

In contrast, the comparison group engaged concurrently in widely adopted, evidence-based curricula delivered within the same scheduled timeframe. This parallel structure helped control for external treatment variables and isolate the unique effects of the Trait-Based Model intervention, thereby strengthening the validity and reliability of observed outcomes.

Comparison group

The comparison group (N = 425) consisted of adults enrolled concurrently at the primary residential treatment center in central Kentucky, participating in standard, evidence-based addiction treatment curricula: the “Living in Balance” and “Matrix Model.” Participants in the comparison group followed a similar daily schedule as the intervention group, attending structured treatment sessions five days per week during the same two-hour morning block (8:00–10:00 am). The comparison group was assessed using engagement metrics (retention rates) obtained from administrative records at the same intervals as the intervention group (baseline, 60-day, and 90-day intervals). Mental health and trait assessments (GAD-7, PHQ-9, Trait and Hero of Recovery Archetype Assessment) were administered solely to the Trait-Based intervention group, as the primary aim was to evaluate the intervention’s specific impact on these variables rather than compare mental health outcomes directly between groups.

These widely adopted curricula were selected because of their empirical validation, established effectiveness, and broad usage in addiction treatment settings, thereby providing an appropriate real-world benchmark for evaluating the relative effectiveness of the Trait-Based Model. Due to logistical and administrative constraints at the primary treatment site, participants in the comparison group did not complete additional standardized assessments (GAD-7, PHQ-9, Trait Assessment), and therefore this group was utilized exclusively to evaluate retention and engagement outcomes.

The comparison facility was chosen based on geographic proximity, demographic comparability, and similar treatment structures (both residential and intensive outpatient programs). However, the absence of random assignment raises the possibility of systematic differences between groups that were not explicitly measured, limiting causal interpretations.

Measures

Anxiety

Generalized anxiety Disorder-7 (GAD-7; Spitzer et al., 2006)

The GAD-7 is a validated, widely-used self-report measure assessing generalized anxiety symptoms. It consists of seven items, each rated on a scale from 0 (not at all) to 3 (nearly every day), with higher scores indicating greater anxiety severity. Previous validation studies have shown excellent internal consistency (Cronbach’s α = 0.92) and strong construct validity. The GAD-7 was administered at baseline (within one week of admission) and again post-intervention.

Depression

Patient health Questionnaire-9 (PHQ-9; Kroenke et al., 2001)

The PHQ-9 is a validated nine-item self-report measure assessing depressive symptom severity. Items are rated on a scale from 0 (not at all) to 3 (nearly every day), with higher scores indicating increased severity of depressive symptoms. It demonstrates strong psychometric properties, including high internal consistency (Cronbach’s α = 0.89) and established validity for monitoring depressive symptoms (27). The PHQ-9 was administered concurrently with the GAD-7 at baseline and post-intervention.

Trait improvement

Trait and Hero of recovery archetype assessment

The Trait and Hero of Recovery Archetype Assessment is a newly developed self-report instrument assessing ten personality traits integral to the Trait-Based Model: resilience, creativity, gratitude, self-awareness, tenacity, determination, empathy, appreciation, motivation, emotional intelligence, and authenticity. The assessment consists of a 50-item Likert-scale questionnaire, with each trait measured by five positively phrased statements. Participants rate each item on a 5-point scale ranging from 1 (“Strongly Disagree”) to 5 (“Strongly Agree”). Scores for each trait are calculated by summing responses to the corresponding items, with higher scores indicating higher trait levels.

Prior to the current study, the assessment underwent preliminary validation in a pilot study involving 364 adults from similar residential addiction treatment settings, demonstrating acceptable internal consistency (Cronbach’s alpha ranging from 0.640 to 0.731 across traits, see Table 1). While these preliminary reliability scores suggest initial internal consistency, additional psychometric evaluation is ongoing, particularly to establish construct validity through factor analyses and further studies across diverse populations.

Table 1.

Cronbach’s alpha scores for trait and Hero of recovery archetype Assessment.

Trait	Cronbach’s α
Resilience	0.689
Creativity	0.707
Gratitude	0.698
Self-awareness	0.724
Tenacity	0.671
Determination	0.724
Empathy	0.684
Appreciation	0.731
Motivational	0.697
Emotional Intelligence	0.640
Authenticity	0.703

Internal consistency was assessed with a pilot sample (N = 364).

These internal consistency values indicate preliminary reliability, though further psychometric validation is warranted. The assessment was administered pre- and post-intervention.

Engagement (retention rates)

Engagement was operationalized as the retention rate calculated from treatment center administrative records. Specifically, retention was defined as the percentage of participants remaining actively engaged in treatment at 60 and 90 days after initial admission. Retention percentages were calculated by dividing the number of participants still enrolled at these intervals by the original number of participants starting treatment in each group (Trait-Based Model: N = 139; comparison group: N = 425). This method provided an objective measure of participant engagement and retention throughout the treatment period.

Data collection and analysis

Data collection occurred at two distinct time points: baseline (within one week of participants’ initial admission into treatment) and post-intervention (immediately following program completion or at the point of early discharge, approximately 90 days after admission). At both time points, participants completed standardized assessments measuring anxiety (Generalized Anxiety Disorder-7;²⁶), depression (Patient Health Questionnaire-9;²⁷), and core personality traits (Trait and Hero of Recovery Archetype Assessment). Engagement was measured using retention data obtained directly from administrative records provided by the treatment facility, calculated as the percentage of participants remaining enrolled in treatment at 60- and 90-days post-admission.

Quantitative analyses were conducted using paired-sample t-tests to evaluate pre- and post-intervention differences in anxiety, depression, and personality traits within the intervention group. Cohen’s d effect sizes were computed to determine the practical and clinical significance of observed changes. Retention data were analyzed descriptively, comparing percentages of participants retained at 60 and 90 days between the Trait-Based intervention group and the comparison group. All statistical analyses were performed using SPSS statistical software.

Qualitative data comprised structured facilitator observations recorded during the Trait-Based Model sessions. These observations documented participant engagement, session dynamics, responsiveness to trait-focused activities, and the implementation fidelity of the intervention. Qualitative data were analyzed through thematic content analysis, identifying recurring themes related to engagement and providing context and depth to the quantitative findings.

Confidentiality and data security

All collected data were stored securely using HIPAA-compliant methods to ensure confidentiality and anonymity. Identifiable information was accessible exclusively to authorized research personnel and utilized solely for research purposes.

Minimizing risks and providing support

Participants were informed of potential risks associated with study participation, including emotional discomfort related to self-reflection on past substance use or emotional experiences, psychological distress potentially arising from intensive self-assessment or interpersonal activities, and minimal risk associated with confidentiality breaches (though carefully mitigated by secure, HIPAA-compliant data handling protocols). The Trait-Based intervention was specifically designed to minimize these psychological and emotional risks by fostering personal growth within a structured, strengths-focused environment. Participants had immediate access to professional counseling and emotional support services throughout the study period to promptly address any emotional or psychological distress that might arise.

Equity and accessibility

Active measures were taken to ensure equitable access to participation, with no exclusions or barriers based on gender, race, ethnicity, socioeconomic status, or other demographic factors.

Consideration of vulnerable populations

Recognizing the inherent vulnerability of the addiction recovery population, heightened precautions were implemented to safeguard participants’ emotional and psychological well-being. Ongoing monitoring for signs of distress and immediate availability of supplementary support services were integral to the study design. The complete dataset, including detailed assessment protocols, supplementary analyses, and raw data supporting the findings, is publicly available as a supplementary file at https://zenodo.org/records/14624888.

Results

Participant characteristics

Participants in the Trait-Based intervention group (N = 139) were adults with a mean age of 38 years, representative of residential and intensive outpatient treatment populations within central Kentucky and New Mexico. The gender distribution was approximately 60% male and 40% female. Baseline anxiety scores (GAD-7: M = 11.20, SD = 1.32) and depression scores (PHQ-9: M = 12.65, SD = 1.73) indicated moderate-to-severe symptom severity upon admission. The comparison group (N = 425) showed similar demographic characteristics and baseline symptom severity, establishing equivalency between the two groups. Participant flow, enrollment, and retention details are illustrated in Fig. 1.

Fig. 1.

Participant flowchart for trait-based model and comparison group. Intervention participants typically completed the 40-lesson Trait-Based Model within approximately 12 weeks. Comparison group retention assessed at the 90-day interval post-admission.

Trait improvements (Intervention Group)

Participants demonstrated statistically significant improvements in nine of the ten assessed traits (Table 2). Paired-sample t-tests revealed meaningful increases from pre- to post-intervention for all measured traits except Empathy, which slightly but significantly decreased (t(138) = − 17.391, p < .001).

These results underscore the Trait-Based Model’s effectiveness in strengthening personality traits central to recovery, leadership, and personal growth (Fig. 2).

Fig. 2.

Pre- and post-intervention trait scores and percentage improvements following the trait-based model of recovery. Mean scores before and after participation in the Trait-Based Model, highlighting percentage improvements. Empathy showed a minor reduction post-intervention, suggesting an area for future curriculum adjustment.

Mental health outcomes (Intervention Group)

Participants experienced substantial reductions in anxiety and depression symptoms post-intervention:

• Depression (PHQ-9): Mean scores reduced from 12.65 to 3.6 (t(19) = 5.248, p < 0.001), a 71.5% reduction.

• Anxiety (GAD-7): Mean scores decreased from 11.2 to 4.65 (t(19) = 4.748, p < 0.001), a 58.5% reduction.

These findings clearly indicate the Trait-Based Model’s efficacy in alleviating mental health symptoms critical to sustained recovery (Fig. 3).

Fig. 3.

Reduction in anxiety and depression after trait-based intervention. Anxiety and depression mean scores pre- and post-intervention, demonstrating significant improvements.

Program retention rates

Retention rates were assessed by calculating the percentage of participants who remained actively enrolled and engaged in treatment at the 90-day interval post-admission. Both intervention and comparison groups followed similar treatment protocols, including individualized counseling, psychoeducation, case management, relapse prevention, and therapeutic activities.

The critical difference between groups was the structured group curriculum from 8:00–10:00 am daily. The intervention group completed the structured 40-lesson Trait-Based Model of Recovery curriculum, typically over a 12-week (90-day) period. Out of 139 participants, 135 (97.1%) remained enrolled and either completed or were near completion at the 90-day mark, demonstrating notably high program retention and engagement.

In contrast, participants in the comparison group, engaged in evidence-based curricula (“Living in Balance” or “The Matrix Model”) during the same daily time slot, experienced significantly higher attrition. Of the initial 425 participants, only 110 (25.9%) remained enrolled at 60 days, decreasing further to 66 (15.5%) at 90 days.

High retention rates are crucial for treatment providers, as extended engagement and successful completion significantly enhance the likelihood of sustained recovery and positive long-term outcomes^4,28. The observed retention difference between groups suggests higher engagement among participants in the Trait-Based Model, although causal interpretations should be made cautiously due to potential pre-treatment differences and programmatic variability (See Fig. 4 for a comparative visual representation of retention rates across both groups.)

Fig. 4.

Program completion rates for the trait-based model program vs. traditional treatment programs. This figure compares participant retention rates at intake, 60 days, and 90 days. Both groups received identical treatment protocols except for the structured morning curriculum (Trait-Based vs. traditional curricula: “Living in Balance,” “The Matrix Model”). The Trait-Based Model (yellow) achieved substantially higher retention (97.8% at 60 days, 97.1% at 90 days) compared to the traditional treatment group (orange; 25.9% at 60 days, 15.5% at 90 days). High retention significantly predicts successful recovery outcomes^4,28.

Facilitator observations

Facilitator reports provided additional evidence of the program’s impact, noting marked increases in participants’ optimism, engagement, and motivation. Facilitators frequently observed enhanced interpersonal dynamics within groups, improved communication skills among participants, and a heightened sense of accountability and enthusiasm for recovery activities. Participants often expressed increased self-confidence and exhibited noticeable shifts toward proactive behaviors, aligning with the quantitative findings of reduced anxiety and depression.

Leadership potential

Participants’ increased scores on traits such as Creativity, Determination, and Authenticity positively correlated with self-assessed leadership potential, as evidenced by participant endorsements of statements like “I believe I have what it takes to be a good leader.” These findings highlight the program’s capacity to foster traits applicable beyond recovery, enhancing professional and community-oriented leadership skills.

Trait variability

Although significant improvements were observed in most traits, individual results varied based on participant-specific factors such as initial trait levels, external support networks, and engagement levels. This variability underscores the necessity for ongoing assessment and personalized interventions tailored to individual needs within recovery programs.

Empathy

The observed slight decline in empathy post-intervention warrants targeted programmatic refinement. Future iterations of the Trait-Based curriculum should incorporate additional activities and exercises explicitly designed to strengthen empathy skills, potentially improving interpersonal outcomes and overall recovery quality.

Summary of results

The present study demonstrated that the Trait-Based Model of Recovery significantly reduces anxiety and depression while fostering substantial improvements in essential personality traits such as resilience, self-awareness, tenacity, and creativity. The model’s exceptional participant retention rates (97.1% completion at 90 days) highlight its practical value, attractiveness, and feasibility compared to traditional treatment approaches. Qualitative facilitator observations strongly corroborate quantitative results, emphasizing participant gains in optimism, motivation, and proactive engagement. Despite overall positive outcomes, the slight decline observed in empathy scores provides a meaningful direction for further curriculum enhancement. Collectively, these findings robustly support the Trait-Based Model’s efficacy and underscore its potential to facilitate sustained recovery, personal growth, and leadership development across diverse treatment settings and populations.

Interpretation of results

The results provide robust evidence for the efficacy of the Trait-Based Model of Recovery in fostering mental health improvements and personal growth among individuals in recovery. Substantial reductions in depression (71.5%) and anxiety (58.5%) demonstrate the model’s effectiveness in managing co-occurring conditions commonly associated with addiction recovery. While similar mental health symptom reductions were observed in the control group, the Trait-Based Model uniquely facilitated significant improvements in nine out of ten measured traits, including resilience, self-awareness, and motivational attributes.

The significantly higher retention rate of 97.1% compared to 15.5% in the control group highlights the model’s effectiveness in fostering participant engagement. Longer engagement directly correlates with positive recovery outcomes^4,29. The emphasis on personal growth and trait enhancement likely contributed to participants’ sustained commitment, distinguishing this model from traditional approaches.

Facilitator observations complemented quantitative findings, noting marked increases in participants’ optimism, motivation, and engagement. The slight decline observed in empathy scores post-intervention was unexpected and warrants attention. Enhanced self-awareness and assertiveness might initially challenge interpersonal sensitivities, temporarily reducing perceived empathy. Future implementations could integrate targeted empathy-enhancing activities, such as role-playing exercises and perspective-taking discussions.

Results align with and extend prior research¹⁸ emphasizing the overlap between traits in effective leaders and individuals in recovery. This underscores the model’s comprehensive approach in providing sustainable pathways to personal growth and recovery.

Cross-cutting implications

The Trait-Based Model demonstrates significant potential beyond addiction recovery, benefiting broader mental health populations. For example, resilience can facilitate quicker recovery from setbacks in anxiety disorders. Enhancing emotional intelligence can improve conflict resolution and stress management, significantly benefiting individuals with borderline personality disorder, often challenged by emotional dysregulation. Moreover, by enhancing self-perception, the model addresses self-stigma, a known barrier to treatment engagement across conditions.

Novel contribution

Unlike traditional deficit-focused models, the Trait-Based Model distinctly prioritizes cultivating inherent strengths. By emphasizing traits like resilience, emotional intelligence, and self-awareness, this model addresses psychological healing comprehensively, empowering participants toward sustainable recovery and personal empowerment.

Comparison to existing literature

This study builds upon existing research on strengths-based interventions in addiction recovery, adding unique contributions to the broader field. Traditional modalities, such as Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT), primarily focus on addressing deficits or managing maladaptive behaviors. While these interventions have proven effective, they often do not explicitly prioritize strengths development. The Trait-Based Model complements these traditional methods by explicitly leveraging inherent traits, aligning closely with recovery-oriented frameworks²³. Furthermore, this approach aligns well with studies involving the Five-Factor Model (FFM), which identifies personality traits as key predictors of recovery success²⁹. However, unlike FFM research that primarily identifies relevant traits, the Trait-Based Model actively provides strategies and structured approaches to develop and enhance these traits, bridging an important gap in current treatment literature.

Strengths

Strengths of this study include the use of validated assessment instruments (e.g., GAD-7 and PHQ-9), ensuring reliable measurement of mental health outcomes, a longitudinal design allowing for tracking of participant progress over time, and the inclusion of a diverse participant sample, enhancing the generalizability of findings across various demographic and treatment contexts.

Limitations

This study has several limitations that should be acknowledged. First, due to the quasi-experimental design, causal interpretations must be made with caution. The lack of random assignment means observed improvements can only be interpreted as associations rather than definitive causal effects. Second, due to logistical and administrative constraints at the primary treatment site, the comparison group utilized internally developed single-item scales rather than standardized instruments (PHQ-9, GAD-7, Trait and Hero of Recovery Archetype Assessment). Although these internal measures indicated general improvements in mental health, differences in measurement structure and validity precluded direct comparisons with intervention group outcomes. Thus, the comparison group primarily served to evaluate differences in retention and engagement. Third, reliance on self-reported data introduces potential bias, though facilitator observations provide some mitigation. Lastly, the observed slight decline in empathy scores post-intervention highlights a specific area for targeted programmatic refinement. Future randomized controlled trials are essential to firmly establish causality and further validate these promising results.

Implications for practice

The findings underscore the value of integrating trait-focused interventions within addiction recovery programs. By addressing mental health symptoms and simultaneously fostering personal strengths and traits such as resilience, self-awareness, emotional intelligence, and creativity, the Trait-Based Model provides a comprehensive and empowering framework for sustainable recovery. Practitioners may utilize this strengths-based approach either independently or in combination with established treatment modalities like Cognitive Behavioral Therapy (CBT) or Motivational Interviewing (MI) to deliver more holistic care.

Moreover, the significant improvement in retention rates highlights the model’s practicality in clinical settings, suggesting that programs emphasizing personal growth, self-awareness, and leadership development can substantially enhance participant engagement and long-term outcomes. Given the broad applicability of traits like resilience and emotional intelligence across diverse mental health contexts, practitioners might also consider adopting or adapting trait-focused interventions beyond addiction recovery, potentially benefiting clients struggling with co-occurring disorders, chronic stress, anxiety, or depressive disorders.

Implications for research

Future research should investigate the Trait-Based Model’s long-term efficacy by examining whether observed improvements in mental health symptoms and key personality traits persist beyond initial program completion. Conducting longitudinal follow-up assessments at 6-month and 12-month intervals would provide valuable insights into sustained recovery outcomes. Additionally, subsequent studies could benefit from randomized controlled trials (RCTs) utilizing standardized measurement tools across intervention and comparison groups, strengthening causal inferences and enhancing methodological rigor.

Given the variability observed in trait development outcomes among individuals, further investigation into moderating factors—such as baseline trait levels, demographic characteristics, external support systems, or facilitator approaches—could inform tailored, individualized interventions. The slight decline observed in empathy also warrants additional attention, suggesting a need for targeted curricular refinements or adjunctive activities aimed at enhancing empathy development. Exploring how such refinements affect overall outcomes could significantly improve the Trait-Based Model’s comprehensive efficacy and adaptability across varied populations and treatment settings.

Conclusion

This study provides strong evidence supporting the effectiveness of the Trait-Based Model of Recovery as a comprehensive and strengths-focused approach to addiction treatment. Participants demonstrated significant reductions in anxiety and depression symptoms and notable improvements across multiple essential personality traits, including resilience, self-awareness, tenacity, and creativity. Remarkably high retention rates (97.1%) further underscore the model’s practicality and appeal compared to traditional recovery programs, highlighting its potential to meaningfully enhance client engagement and long-term treatment outcomes.

By fostering personal growth and leadership development, the Trait-Based Model not only addresses immediate recovery needs but also equips individuals with enduring skills essential for sustained recovery, improved mental health, and overall life satisfaction. While additional refinements—particularly regarding empathy development—are warranted, the current findings affirm the value and adaptability of trait-focused interventions in diverse clinical and community settings. Future research should continue exploring the model’s longitudinal impacts and extend its application to broader mental health contexts, maximizing its potential as a transformative tool for both recovery and holistic personal development.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

Authorship ContributionsJason Roop wrote the main manuscript text. prepared Tables 1, and 2; Figs. 1, 2, 3 and 4. and conducted the statistical analysis. Dr. Roop designed the study and supervised the project, as well as reviewed the manuscript and approved the final version for submission.

Table 2.

Pre- and post-intervention trait scores and statistical results (N = 139).

Trait	Pre-Mean (SD)	Post-Mean (SD)	% Change	t(138)	p-value	Cronbach’s α
Resilience	71.82 (21.80)	77.68 (20.78)	+ 8.16%	44.073	< 0.001	0.689
Creativity	64.54 (22.71)	69.58 (22.69)	+ 7.81%	36.163	< 0.001	0.707
Self-Awareness	77.87 (19.49)	82.42 (19.27)	+ 5.84%	50.435	< 0.001	0.724
Appreciation	71.01 (19.52)	72.02 (18.44)	+ 1.42%	46.054	< 0.001	0.731
Motivational	66.07 (22.70)	70.55 (21.90)	+ 6.78%	37.150	< 0.001	0.697
Tenacity	63.91 (22.29)	70.56 (21.87)	+ 10.41%	37.183	< 0.001	0.671
Determination	67.81 (21.97)	70.34 (20.49)	+ 3.73%	41.890	< 0.001	0.724
Authenticity	68.52 (21.28)	71.74 (19.80)	+ 4.70%	42.791	< 0.001	0.703
Emotional Intelligence	62.30 (20.77)	64.71 (19.88)	+ 3.87%	36.184	< 0.001	0.640
Empathy (No Improvement)	65.32 (23.27)	63.22 (21.84)	–3.22%	–17.391	< 0.001	0.684

SD = Standard Deviation; All paired-sample t-tests significant at p < .001. Empathy scores slightly decreased post-intervention, suggesting a need for targeted curriculum refinement.

Data availability

The datasets generated and analyzed during the current study are publicly available in the Zenodo repository at https://zenodo.org/records/14624888. All assessments, statistical analyses, and study protocols were conducted in accordance with ethical guidelines and standards.

Declarations

Competing interests

The authors declare no competing interests.

Ethical approval

All study procedures adhered strictly to ethical guidelines and standards established by the Institutional Review Board (IRB) of Campbellsville University, which provided formal ethical approval before commencement.

Informed consent

Participants received comprehensive information regarding the study’s purpose, procedures, potential risks, and benefits. Written informed consent was obtained from each participant prior to enrollment, with explicit assurance of their right to voluntarily withdraw from the study at any time without penalty.