Eudaimonia and mindfulness as predictors of alcohol-dependence: a pilot study

Abstract

Both hedonia and eudaimonia contribute to well-being, but existing literature on alcohol-dependence concentrates on hedonic needs alone, leaving a research gap on the role of eudaimonia in alcohol-dependence. Theoretically, mindfulness promotes eudaimonia that presumably benefits individuals with alcohol-dependence, but the empirical literature on the same is scarce. Hence, the current pilot study intended to examine the association of eudaimonia and mindfulness with alcohol-dependence, and assess the feasibility of the main study. Study-I compared mindfulness and eudaimonia of individuals with (N = 154) and without (N = 160) alcohol-dependence. Its results called forth a study-II that explored the role of eudaimonia and mindfulness in predicting alcohol-dependence among the individuals undergoing treatment for alcohol-dependence (N = 110). The data were analyzed using the independent-sample t-test, Pearson correlation, and multiple linear regression. Study-I revealed the significant deficiency of mindfulness and eudaimonia among individuals with alcohol-dependence compared to those without alcohol-dependence. Study-II found that mindfulness and eudaimonia predicted alcohol-dependence and alcohol craving. Study result indicates the potential role of mindfulness and eudaimonia in the effective treatment of alcohol-dependence, through significant correlation among the variables. The study also highlights the feasibility and utility of the main study.

Keywords:

• mindfulness
• eudaimonia
• alcohol-dependence
• alcohol craving
• well-being

1. Introduction

In positive psychology, there are broadly two orientations or perspectives of well-being: i) hedonia that focuses on human behavior from a deficit or clinical perspective, prioritizing alleviation of pain and suffering; and ii) eudaimonia that explores positive human functioning by addressing the needs for meaning and purpose in life, excellence, growth and flourishing (Deci & Ryan, 2008; Huta & Ryan, 2010; Huta & Waterman, 2014). Applied positive psychology in recent years has been developing into a vast area within behavioral science that attempts to promote happy, meaningful, and purposeful life regardless of the presence or absence of human suffering. Within the discipline, hedonic well-being and related aspects received the most attention (Deci & Ryan, 2008), probably because of the clarity of the concept, ease of its operationalization, and comparatively effortless implications across various walks of life. But being a highly complex organism, human well-being does not necessarily result from hedonic satisfaction alone (Aknin et al., 2009; Kashdan & Breen, 2007; Park et al., 2020; R.T. Howell & Hill, 2009; Zeelenberg et al., 2020). Instead, well-being needs will extend to eudaimonia, that requires more than merely a pleasant, temporarily happy, and comfortable life (Baumeister et al., 2013; Hupkens et al., 2020; Pearce et al., 2020; Song et al., 2020).

Existing literature suggest that hedonia and eudaimonia tend to be correlated and it is significant to distinguish hedonia, eudaimonia, and general well-being for understanding their relationships better (Mise & Busseri, 2020). Further, the concept of “hedonic treadmill”—or the tendency to get adapted to hedonia and resultant requirement of continuous stimulation to maintain hedonic well-being—was reported in many studies (Diener et al., 2009; Keely, 2005), that highlight the need to focus on well-being measures other than hedonia. Hedonic adaptation can happen with both positive and negative life events, which will reduce the experience of pleasure and a purposeful living. Thus, it has a major role in low well-being and happiness (Lyubomirsky, 2011).

In excess, hedonia can also result in serious undesirable consequences, including addictive behaviors (Diener et al., 2009; Mise & Busseri, 2020). One such an addiction is alcohol-dependence, defined by International Classification of Diseases-11 (ICD-11) as “a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol . … despite harm or negative consequences. These experiences are often accompanied by a subjective sensation of urge or craving to use alcohol” (WHO, 2019). According to the report of the World Health Organization (WHO), one in every 20 death on the global level is caused by disorders related to alcohol use (WHO, 2018). Alcohol consumption and dependence often results from hedonic dysregulation (Koob, 2008) which can be managed through psychological interventions to regulate hedonic tendencies such as Mindfulness-Oriented Recovery Enhancement (MORE; Garland, 2016; E. Garland et al., 2012).

On the other hand the literature on the level of eudaimonia and well-being of individuals with alcohol-dependence is extremely scant, and therapeutic practices mainly focus on alcohol symptom reduction rather than the enhancement of well-being. As a result, the possibility of relapse is left open, if a major reason for hedonic indulgence that resulted in addiction is eudaimonic deficiencies.

Mindfulness is one of the popular psychological practices in the third wave psychotherapy that aid in bridging the gap between clinical symptom management or improvement of hedonia, and fulfillment of eudaimonic tendencies (Ivtzan & Lomas, 2016; Kabat-Zinn, 2013). Mindfulness is the state, process, and outcome of being aware of one’s perceptual reality, without any expectations or biases. The duration of mindfulness practice is positively correlated with several positive psychological aspects, including well-being (WHO, 2019). The mindfulness-to-meaning theory proposed by Garland et al. (WHO, 2018) advocates that, through a reappraisal of events to acknowledge the positive experiences associated with it, and gradual accumulation of positive affect, mindfulness promotes eudaimonia. Mindfulness enables positive reappraisal of negative or harmful events that would provide reassurance of eudaimonic meaning. It will also support the savoring of positive events that would intensify the corresponding pleasure, purpose, and happiness. Collectively, these reappraisals lead to enhanced eudaimonia (WHO, 2018). The relationship between eudaimonia and mindfulness is theoretically established, but the empirical literature on the level of mindfulness among individuals with alcohol-dependence and its association with eudaimonia is not widely explored.

Further, flourishing or the “experience of life going well, which is also a combination of feeling good and functioning effectively” (Huppert & So, 2013) is another concept closely related to well-being that is gaining popularity among studies on alcohol use disorders (Parker et al., 2021). Literature also denotes the need of assessing and promoting flourishing among individuals undertaking treatment for various substance use disorders including alcohol-dependence that will support sustainable recovery (Makin et al., 2021; Parker et al., 2018). Additionally, flourishing is generally seen as combination of both hedonia and eudaimonia (Huppert & So, 2013), that gives more reason for its inclusion in the current pilot investigation.

Thus, the current pilot investigation aimed to assess the level of eudaimonia among individuals diagnosed with alcohol-dependence; find the inter-correlation among mindfulness, eudaimonia, hedonia, well-being, flourishing, alcohol-dependence and alcohol craving; and identify the potential influence of eudaimonia on alcohol-dependence.

The current paper presents two studies—the first aimed at estimating the level of mindfulness and eudaimonia among individuals undergoing treatment for alcohol dependence in comparison with people who do not have a diagnosis of addictions. After finding the results, a second study was carried out that intended to assess the inter-correlation between mindfulness, eudaimonia, hedonia, well-being, flourishing, alcohol craving, and alcohol-dependence; and to estimate how eudaimonia and mindfulness predict alcohol-dependence.

2. Study I

2.1. Method

Individuals diagnosed with alcohol-dependence were recruited from two de-addiction centers in Kerala, India (N = 154) and assigned to group I. Purposive sampling was used to obtain responses from healthy adults with no addictions (N = 160) through an online survey who were assigned to group II. All participants were administered with assessments for mindfulness and eudaimonia. Table 1 shows the demographic characteristics of individuals with and without alcohol-dependence.

Table 1. Socio-demographic information of the individuals with (Group I) and without (Group II) alcohol-dependence

Demographics		Group I (N = 154) N%	Group II (N = 160) N%
Gender	Male	154 (100)	160 (100)
Education
	10^th or less	64 (42)	20 (13)
	12^th	78 (51)	36 (23)
	Graduation/Diploma	10 (6)	81 (50)
	Post Graduation	2 (1)	23 (14)
Marital status
	Unmarried	93 (60)	88 (55)
	Married	55 (36)	70 (44)
	Divorced	6 (4)	2 (1)
Place of residence
	Rural	89 (58)	48 (30)
	Semi-urban	46 (30)	102 (64)
	Urban	19 (12)	10 (6)
Income
	Below 10,000	11 (7)	15 (9)
	10,001–30,000	96 (62)	62(39)
	30,001–60,000	34 (22)	56 (35)
	60,001–1,00,000	13 (9)	27 (17)
Age group
	Below 30	47 (31))	75 (47)
	31–50	85 (55)	67 (42)
	51–70	22 (14)	18 (11)
Occupation
	Daily wages	90 (58)	87 (54)
	Private sector	31 (20)	21 (13)
	Self-employed	26 (17)	36 (23)
	Govt. sector	7 (5)	16 (10)

2.2. Inclusion criteria

Diagnosis of alcohol-dependence was the eligibility criteria for the group I and healthy adults who resided in Kerala were included in group II.

2.3. Exclusion criteria

Individuals with co-morbid diagnoses of addictions other than alcohol-dependence were excluded from the first group; and participants who had reported a current diagnosis or previous history of psychotic disorders were excluded from both groups.

2.4. Measures

2.4.1. Five-Facet Mindfulness Questionnaire (FFMQ)

short version: It is a brief 15-item version of the original 39-item FFMQ by Baer et al. (Parker et al., 2021) encompassing five facets of mindfulness—i) observing, ii) describing, iii) acting with awareness, iv) non-judging of inner experience, and v) non-reactivity to inner experience (Baer et al., 2012). Choi, 2015, Makin et al., 2021) had reported the internal consistency reliability of FFMQ-15 as >.70, whereas Gu et al. 2016 (Baer et al., 2006) had found adequate internal consistency (Cronbach’s alphas .64 to .83) and convergent validity of the 15-item FFMQ.

FFMQ record the respondents’ responses by a five-point scale of 1 to 5 where 1indicates “Never or very rarely true” and 5 indicates “Very often or always true”. It consists of items such as the following: “I pay attention to sensations, such as the wind in my hair or sun on my face”.

2.4.2. Questionnaire for Eudaimonic Well-Being (QEWB)

It assesses eudaimonia under six domains: i) self-discovery, ii) perceived development of one’s best potentials, iii) a sense of purpose and meaning in life, iv) intense involvement in activities, v) investment of significant effort, and vi) enjoyment of activities as personally expressive. The tool has adequate to high internal consistency, convergent validity, construct validity, and incremental validity (Waterman et al., 2010). Its Cronbach’s alpha were found to be .87 (Areepattamannil & Hashim, 2017), .83, and .85 (George et al., 2021) when applied among non-western populations.

QEWB has used a five-point Likert scale than ranged between 0 and 4, where 0 being “Strongly Disagree” and 4 being “Strongly Agree”. A sample item from the Questionnaire for Eudaimonic Well-Being: “I believe I know what I was meant to do in life.”

2.5. Data analysis

An independent sample t-test was conducted to determine if there was any significant difference between individuals with and without alcohol-dependence existed in terms of mindfulness and eudaimonia.

2.6. Ethical considerations

The study has received ethical clearance from the Department of Psychology, School of Social and Behavioral Sciences, Central University of Karnataka, Kalaburagi, India (Ethical clearance number: CUK/SDBD/Psy/EC-11/2019-20/11 Dated, 03–01-2020). Permissions were sought from the institutions from where the data were obtained, and informed consent was obtained from all the participants before initiation of the data collection.

2.7. Results

Group I–Individuals with alcohol-dependence

Group II–Individuals without alcohol-dependence

Table 2 shows the result of the independent sample t-test that indicates the significant difference between group I and group II on eudaimonia (t = 16.49, p < .001), and mindfulness (t = 17.62, p < .001).

Table 2. Mean, SD, and independent sample t-test of group I (N = 154) and group II on (N = 160) on Eudaimonia and Mindfulness

Variable	Group I		Group II		t	p
	Mean	SD	Mean	SD
Eudaimonia	31.3831	4.75	47.83	10.59	16.49	.000
Mindfulness	29.2857	5.75	45.06	10.44	17.62	.000

3. Study II

3.1. Method

In India, there are different kinds of de-addiction centers with varying treatment practices and duration. The prevalence of alcohol-dependence also varies with states within the country, as well as the amount and reasons for alcohol consumption. Thus, in order to keep the treatment as usual (TaU) uniform, 24 Integrated Rehabilitation Centre for Addicts (IRCAs) under the central government project to eradicate addictions, were chosen as the de-addiction centers from which the data will be collected. At IRCAs, a team of mental health professionals works together to administer pharmacological as well as psychological therapies for the temporarily rehabilitated individuals diagnosed with alcohol-dependence or alcohol-use disorder. Data were obtained consulting the concerned officials at each IRCA to identify individuals with alcohol-dependence. Dale View IRCA, Punalal, Thiruvananthapuram; Pratheeksha IRCA, Shanghumugham, Thiruvananthapuram; and TRADA IRCA, Manganam, Kottayam, had given permission for data collection. Each IRCA accommodates 15–30 in-patients at a time. All in-patients who had fulfilled the inclusion criteria and volunteered to participate within a month were interviewed in person; consent was sought; and was administered with the measures individually. From three IRCAs, 118 in-patients had participated in the study, out of which seven participants met exclusion criteria and one did not respond to all seven measures. Finally, scores of 110 participants were considered for final analysis. Table 3 shows the demographic features of the sample population.

Table 3. Socio-demographic information

Socio-demographics		(N = 110) %
Gender		Male
Education		110 (100)
	10^th or less	47 (43)
	12^th	47 (43)
	Graduation/Diploma	13 (12)
	Post Graduation	3 (2)
Marital status
	Unmarried	71 (64)
	Married	36 (33)
	Divorced	3 (3)
Place of residence
	Rural	66 (60)
	Semi-urban	28 (26)
	Urban	16 (14)
Income
	Below 10,000	4 (4)
	10,001–30,000	69 (63)
	30,001–60,000	32 (29)
	60,001–1,00,000	5 (4)
Age group
	Below 30	32 (29)
	31–50	69 (63)
	51–70	9 (8)
Occupation
	Daily wages	70 (64)
	Private sector	25 (23)
	Self-employed	11 (10)
Initiated age
	<15	4 (3)
	16–20	50 (45)
	21–25	54 (49)

3.2. Inclusion criteria

Diagnosis of alcohol-dependence; in-patients undergoing medication and psychotherapy/counseling for alcohol-dependence; and age between 23 and 70. The diagnoses were made by the clinical psychologists at the de-addiction centres according to ICD-11 criteria. Minimum age for study participation was decided as 23 because that is the legal drinking age in Kerala.

3.3. Exclusion criteria

History or present diagnosis of psychotic disorders as reported by self or according to the diagnoses from the de-addiction centre.

3.4. Measures

3.4.1. Five-Facet mindfulness questionnaire (FFMQ)

Same as study I

3.4.2. Questionnaire for eudaimonic well-being

Same as study I

3.4.3. Positive and negative affect scale (PANAS)

This 20-item tool measures positive affect and negative affect. Ten items of positive subscale is commonly used as a measure of hedonia (Kryza-Lacombe, 2016). The positive affect subscale has the Cronbach’s alpha of .86 to .90 and the test-retest correlations were .47 to .68 (Watson et al., 1988). A number of more recent studies have also confirmed the high reliability and validity of PANAS including that of Carvalho et al. 2013 (Waterman et al., 2010) and Crawford & Henry (Areepattamannil & Hashim, 2017). PANAS asks the respondents to “indicate the extent they have felt this way over the past week, for example, ‘Excited’.” The respondent should mark the intensity of the feeling in a five-point scale where 1 stands for “Very slightly or not at all” and 5 indicates “Extremely”.

3.4.4. P.G.I. general well-being measure

It is a 20-item tool that measures the general well-being of adults with reliability by Kuder Richardson formula-20, .98, and the test-retest reliability coefficient, .91 (George et al., 2021). It uses a 4-point scale from “not at all” to “all of the time” to assess the well-being of the individuals from four dimensions: physical, anxiety, mood, and self/others. Eg. “Interested in life a good bit of the time”. Cronbach’s alpha of the tools was found to be 0.87 (Karatzias et al., 2006, Verma and Verma, 1989).

3.4.5. Flourishing scale

Published by Diener et al. in 2010, it was used to assess flourishing. It is an eight-item scale with a seven-point Likert scale that ranges between “Strongly Agree” and “Strongly Disagree”, recording the responses from a positive perspective. The scale has good internal reliability (Diener et al., 2010). Fassih-Ramandi et al., 2020 (Watson et al., 1988) reported that the scale’s Cronbach’s alpha coefficient is .81 and the test-retest reliability, .82. A sample item from the scale is as follows: “I am competent and capable in the activities that are important to me”.

3.4.6. Penn alcohol craving scale (PACS)

This five-item scale assesses alcohol craving. It has excellent internal consistency, and adequate predictive validity, construct validity, and discriminant validity (Flannery et al., 1999). Kim et al. (Crawford & Henry, 2004) had reported that the scale has the Chronbach’s alpha of .91. A sample item in PACS is given here: “How often have you thought about drinking or about how good a drink would make you feel during this period?”.

3.4.7. The alcohol use disorders identification test (AUDIT)

It is a 10-item screening tool with a five-point scale, developed by WHO to assess alcohol consumption and associated problems, along with possible alcohol dependence (Babor et al., 2001). Allen et al., 1997 (Kryza-Lacombe, 2016) had reported the Cronbach’s alpha of AUDIT in .80s. A sample item from AUDIT: “How often during the last year have you had a feeling of guilt or remorse after drinking?”

3.5. Data analysis

Pearson correlation was used to find the inter-correlations of mindfulness, eudaimonia, hedonia, well-being, flourishing, alcohol craving, and alcohol-dependence. Multiple linear regression was carried out to determine the predictive value of mindfulness, eudaimonia, hedonia, well-being, and flourishing on both alcohol craving and alcohol dependence.

3.6. Ethical considerations

All procedures performed that involved human participants in accordance with the ethical standards of the institutional research committee of the Department of Psychology, School of Social and Behavioral Sciences, Central University of Karnataka, Kalaburagi, India (Ethical clearance number: CUK/SDBD/Psy/EC-11/2019-20/11 Dated, 03–01-2020). Permissions were sought from the institutions from where the data were obtained, and informed consent was received from all the participants prior to the administration of the assessment tools.

3.7. Results

Eudaimonia, mindfulness, well-being, flourishing, alcohol craving, and alcohol-dependence were tested for inter-correlation. The result of Pearson correlation shown in Table 4 indicates that, except the correlations of alcohol dependence with well-being and hedonia, all other variables have strong inter-correlation (p < .01). There was a significant positive correlation of eudaimonia with well-being (r = .69, p < .001), mindfulness (r = .80, p < .001), hedonia (r = .67, P < .001), and flourishing (r = .70, P < .001); and an inverse relationship of eudaimonia with alcohol craving (r = −.80, p = .000) and alcohol dependence (r = −.40, p = .000). The results also indicate a significant positive correlation of well-being with mindfulness (r = .65, P < .001), hedonia (r = .85, P < .001), and flourishing (r = .37, P < .001); and an inverse significant correlation of well-being with alcohol craving (r = −.57, P < .001), and insignificant correlation with alcohol dependence (r = −.03, p = .735). The Pearson correlation result shows a positive association of mindfulness with hedonia (r = .62, P < .001), and flourishing (r = .54, p = .006). It also indicates an inverse correlation of mindfulness with alcohol craving (r = −.68, P < .001), and alcohol dependence (r = .40, P < .001). Further, there was a positive association between hedonia and flourishing (r = .31, p = .001). Hedonia also had an inverse relationship with alcohol craving (r = −.57, P < .001). The result also shows a positive correlation between alcohol craving and alcohol-dependence (r = .47, P < .001), and a negative correlation between alcohol craving and flourishing (r = −.52, p = .016). Finally, there was an inverse correlation between alcohol-dependence and flourishing (r = −.48, P < .001).

Table 4. Inter-correlations of Mindfulness, Eudaimonia, Hedonia, Well-being, Flourishing, Alcohol Craving, and Alcohol Dependence (N = 110)

Variables	1	2	3	4	5	6	7
1. Eudaimonia	-
2. Well-being	.69**	-
3. Mindfulness	.80**	.65**	-
4. Hedonia	.67**	.85**	.62**	-
5.Alcohol Craving	−.80**	−.57**	−.68**	−.57**	-
6. Alcohol Dependence	−.40**	−.03	−.40**	.04	.47**	-
7. Flourishing	.70**	.38**	.54**	.31**	−.52**	−.48**	-

**p < .01(2tailed), *p < .05 (2tailed)

Results of the multiple linear regression shown in Table 5 indicates that there was a collective significant effect of mindfulness, eudaimonia, hedonia, well-being, and flourishing on alcohol craving (F = 38.50, p = 0.000, R² = .649). Mindfulness, eudaimonia, hedonia, and well-being collectively contributed to significant effect (F = 48.28, p = 0.000, R² = .648). The results also indicate a collective significant effect of mindfulness, eudaimonia, and hedonia (F = 64.83, P < .001, R² = .647). Further, the result point out the significant effect of mindfulness and eudaimonia jointly (F = 97.70, P < .001, R² = .646). Individually, mindfulness also had a significant effect on alcohol craving (F = 96.13, P < .001, R^{2 =} .471). Together, mindfulness, eudaimonia, hedonia, well-being, and flourishing predict 80.6% variability in alcohol craving.

Table 5. Regression Analysis: Mindfulness, Eudaimonia, Hedonia, Well-being, and Flourishing as predictors of Alcohol Craving

Variable	R	R^2	F	ΔR^2	ΔF	Std	t
Model 1
Mindfulness	.686	.471	96.13***	.471	96.136	−.686	9.80***
Model 2
Mindfulness	.804	.646	97.70***	.175	52.996	−.115	1.18
Eudaimonia						−.708	7.28***
Model 3
Mindfulness	.805	.647	64.83***	.001	.326	.104	1.04
Eudaimonia						−.686	6.55***
Hedonia						−.045	.57
Model 4
Mindfulness	.805	.648	48.28***	.001	.164	.109	1.08
Eudaimonia						−.693	6.51***
Hedonia						−.079	.68
Well-being						−.048	.40
Model 5
Mindfulness	.806	.649	38.50***	.001	.424	.110	1.08
Eudaimonia						−.742	5.67***
Hedonia						−.061	.50
Well-being						−.045	.37
Flourishing						.056	.65

* p < 0.05** p < 0.01; *** p < 0.0005

Table 6 shows results of the multiple linear regression that indicates a collective significant effect of mindfulness, eudaimonia, hedonia, well-being, and flourishing on alcohol-dependence (F = 15.63, p = 0.000, R² = .429). Mindfulness, eudaimonia, hedonia, and well-being also collectively contributed to significant effect (F = 17.74, p = 0.000, R² = .403). The results also indicate a collective significant effect of mindfulness, eudaimonia, and hedonia (F = 23.40, P < .001, R² = .398). Further, the result point out the significant effect of mindfulness and eudaimonia jointly (F = 11.77, p = 0.000, R² = .180). Individually, mindfulness also had a significant effect on alcohol-dependence (F = 20.58, p = 0.000, R² = .429).Together, mindfulness, eudaimonia, hedonia, well-being, and flourishing predicted 65.5% variability in alcohol dependence.

Table 6. Regression Analysis: Mindfulness, Eudaimonia, Hedonia, Well-being, and Flourishing as predictors of Alcohol-Dependence

Variable	R	R^2	F	ΔR^2	ΔF	Std β	t
Model 1
Mindfulness	.400	.160	20.58***	.160	20.588	−.400	2.80**
Model 2
Mindfulness	.425	.180	11.77***	.020	2.651	−.206	1.38
Eudaimonia						−.241	1.62
Model 3
Mindfulness	.631	.398	23.40***	.218	38.410	−.363	2.79**
Eudaimonia						−.549	4.01***
Hedonia						.645	6.19***
Model 4
Mindfulness	.635	.403	17.74***	.005	.871	−.379	2.88**
Eudaimonia						−.569	4.10***
Hedonia						.543	3.61***
Well-being						.145	.93
Model 5
Mindfulness	.655	.429	15.63***	.026	4.694	−.377	2.92**
Eudaimonia						−.360	2.15*
Hedonia						.464	3.04**
Well-being						.158	1.03
Flourishing						−.237	2.16**

* p < 0.05** p < 0.01; *** p < 0.0005

4. Discussion

Study I pointed out that there was a significant lack of eudaimonia among individuals with alcohol-dependence compared to those without alcohol-dependence, indicated by the significant mean difference between group I and II. This result supports the study by Torres & Tristan, 2014 (Diener et al., 2010) who had also found an inverse correlation between the use of alcohol and eudaimonia. Regarding mindfulness also, participants with alcohol-dependence had scored significantly lower compared to those without alcohol-dependence. This is similar to the existing literature where the inverse relationship of mindfulness with alcohol consumption and associated problems was found (Bodenlos et al., 2013). In another study, Shorey et al. 2014 (Flannery et al., 1999) have found that substance-abusers have lower mindfulness compared to healthy adults. The results indicate the possibility of eudaimonia and mindfulness being contributing factors to alcohol-dependence and its management.

It prompted the inception of study II that had explored the association of mindfulness, eudaimonia, and alcohol-dependence among individuals under rehabilitation undertaking treatment for alcohol-dependence. Study II had replicated the deficiency of mindfulness and eudaimonia among individuals with alcohol-dependence and also revealed the inter-correlation between eudaimonia, mindfulness, well-being, hedonia, flourishing, alcohol-dependence, and alcohol craving.

There is a significant association of eudaimonia with all other variables, which confirm the preliminary assumption of the potential role of mindfulness and eudaimonia on alcohol-dependence and alcohol craving. However, further empirical analyses are required to decide the nature and extent of these relationships.

Well-being consists of hedonic and eudaimonic well-being (Deci & Ryan, 2008), and an increase in well-being can be expected if either eudaimonia or hedonia improves. The current result affirms the positive correlation between eudaimonia and well-being. Mindfulness is found to have a significant positive correlation with eudaimonia, which supports the impact of mindfulness on eudaimonia advocated in the mindfulness-to-meaning theory (WHO, 2018). The present result is also in par with the study by Brown & Ryan, (Kim et al., 2008) where the association of mindfulness with several well-being variables was found. The current study has also replicated the positive correlation between eudaimonia and hedonia, reported previously (Huta, 2013; Turban & Yan, 2016). The broaden-and-build theory of positive emotions also advocates that the hedonic tendency of positive emotions gradually results in a broadened spectrum of experiences that promote personal, social, and psychological resources of eudaimonia (Fredrickson et al., 2004). If balanced, hedonia is not negative but getting too attached to hedonic stimuli results in suffering (Didonna, 2009). Higher mindfulness improves de-centering that allows enjoyment without being attached to the source of pleasure (Keesman et al., 2020), but because the individuals had also reported low mindfulness, it can be assumed that the hedonic indulgence was a resultant of unwarranted attachment with hedonic stimuli (alcohol).

Eudaimonia also has a significant inverse correlation with alcohol craving and alcohol-dependence that suggests the possibility of the reduction of the latter two if eudaimonia will be enhanced. Whether eudaimonic deficiency stands as an etiology for alcohol consumption, or excessive hedonic orientation suppress eudaimonic development, is a question that needs to be answered with future empirical studies.

General well-being is also positively associated with mindfulness, hedonia, and flourishing. The result indicates the positive potentials of mindfulness that enables the perceiver to reappraise the experiences to savor the pleasant sensations and imagery (Brown & Ryan, 2003), which is reminiscent of existing literature where a positive association between mindfulness and well-being is established (Huta, 2013). Considering that general well-being is a combination of hedonia and eudaimonia, a positive correlation between well-being and hedonia was the obvious expected outcome. At the same time, it needs to be mentioned that they are not the same but distinct (Turban & Yan, 2016). The current result signifies the association being intact even when the individuals experience low eudaimonia. Flourishing is also found to have a perceptible positive correlation with well-being as it is reported to be among other populations (Fredrickson et al., 2004; Kryza-Lacombe, 2016).

The current result also reports the inverse association of well-being with alcohol-dependence and alcohol craving. Although the direction of the relationship—or which variable influences the other—is not clear, the probability of enhanced well-being through reduced alcohol craving is apparent. There is also an inverse correlation between well-being and alcohol-dependence, but not at a significant level. The target population was individuals undergoing treatment for alcohol-dependence and the scores of alcohol-dependence reflect how they had been consuming alcohol and experiencing issues associated with it, prior to the initiation of treatment. The ongoing psycho-pharmaceutical treatments are supposed to be responsible for the better well-being of the individuals, reducing the correlation between wellbeing and alcohol-dependence.

Previous literature reported the positive association between mindfulness and different aspects of hedonia (Keesman et al., 2020; WHO, 2018), and study II confirmed the same. In addition, mindfulness showed a positive correlation with flourishing, suggesting that mindful appreciation of life events helps individuals to obtain a sense of flourishing. This is in line with a few previous studies (Akin & Akin, 2015; Malinowski, 2013). There is also an inverse correlation of mindfulness with alcohol craving and alcohol-dependence. This result corroborates previous studies that found the role of mindfulness in addictions and associated craving (Brewer et al., 2013). Sancho et al. (A.J. Howell & Buro, 2015) in a systematic review had also identified studies where mindfulness was found to have an inverse relation with alcohol-dependence and craving. Further, it is suggestive of the mindlessness of people who indulge in hedonic pleasures that might even be the cause of developing an addictive behavioral pattern. If the need for alcohol consumption is the reduction of pain, there are reasons to assume that they missed out on the opportunity to appreciate the positive experiences, being mindless of the life as it actually is.

Hedonia, assessed through the scale of positive affect, is associated with flourishing. If considered as an aspect of eudaimonia, flourishing will be correlated with hedonia, just like the correlation of flourishing with eudaimonia. Further, the literature suggests the association of hedonic components and flourishing (Diehl et al., 2011; Fredrickson & Losada, 2013). There is an inverse relation between hedonia and alcohol craving which might be due to the hedonic treadmill (Luhmann & Intelisano, 2018)—the never satiated need for pleasure due to continuous exposure of hedonic stimuli (alcohol). Alcohol use temporarily provides pleasure but it is also associated with negative consequences. These mixed experiences from alcohol might explain why there is no significant correlation between hedonia and alcohol-dependence. This result is in contrast with the study results of Szmigin et al. 2008 (Akin & Akin, 2015) who had found that alcohol use, specifically binge drinking, is a form of calculated hedonism. According to this study conducted in the UK, people consume alcohol deliberately to derive pleasure. Probable reasons for the failure of the current study finding no significant relationship between hedonia and alcohol-dependence are i) cultural differences contributing to the individual’s reasons for alcohol consumption, and ii) causal difference between alcohol-dependence and binge drinking where the latter might not result in dependence. Lindman et al. 2000 (Malinowski, 2013) support the differences across cultures regarding hedonic well-being due to alcohol consumption.

Alcohol craving has a positive correlation with alcohol-dependence. Alcohol craving co-occurs with alcohol-dependence and obviously, correlated. Alcohol craving and alcohol-dependence are found to have an inverse relationship with flourishing. It can be deducted that an intense urge to use alcohol and related consequences will act as a hindrance for the individual to flourish. This result bears a close resemblance to the study by McGaffin et al. 2015 (Brewer et al., 2013) where higher flourishing was found among individuals with the highest abstinence.

Results indicate the predictive value of mindfulness, eudaimonia, hedonia, well-being, and flourishing, on alcohol craving. Mindfulness alone contributes to 68.6% of the variance and along with eudaimonia mindfulness predicts 80.4% of the variance in alcohol craving. Hedonia, well-being, and flourishing also contribute to the total variance of alcohol craving, but only at a minute level. An increase in mindfulness and eudaimonia seem to be the highest contributing variables of decreased alcohol craving since individuals with higher mindfulness and eudaimonia reported the lowest urge to consume alcohol.

The prevalence of alcohol use in Kerala is between 33–50% and the prevalence of problem drinking is 12.8% (Rajeev et al., 2017). Bal, 2016, (Diehl et al., 2011) had reported alcohol-dependence among males in the Thiruvananthapuram district of Kerala as 38.41%. Hence, it is one of the biggest reasons for ill-health in the concerned region, that can be averted with a will. In the current study, mindfulness predicted 40% of the variance in alcohol-dependence, and mindfulness-based eudaimonic enhancement expectedly contributes to 42.5%. Hedonia being added to mindfulness and eudaimonia, the combination predicted 63.1% of the variance. One possible explanation for the greater involvement of hedonia here is that, as a disorder, alcohol-dependence is a manifestation of excessive hedonic indulgence, and apparently the affected individuals have higher hedonic tendencies (Didonna, 2009). Further studies shall explore the role of mindfulness and eudaimonia—whether they enhance hedonic satisfaction or reduce hedonic needs, both of which would yield the same result.

5. Limitations and suggestion for future studies

Although it serves the purpose of a pilot investigation, the small sample size is a major limitation of the current studies. Further replication studies with bigger sample size would yield clearer results with better predictive value. Further, there can be variables other than the ones considered in the exclusion criteria that might have influenced the results. Another shortcoming is the non-representation of females in the study. The entire population consisted of males and any possible gender differences and its contributions are not described. Since the study did not deliberately exclude participants from de-addiction centers based on gender, the reasons for the absence of females perceptibly calls for attention. Cultural and regional factors as well as the role of mediating and moderating factors shall also be explored that would benefit implications of the study, particularly development of interventions to enhance eudaimonia or well-being for individuals with alcohol-dependence. Finally, despite finding eudaimonic deficiency among individuals with alcohol-dependence, the current studies do not explain why, but being a pilot investigation, it urge the scientific community to explore the reasons of the significantly low eudaimonic well-being of individuals with addictive disorders.

6. Conclusion

At present, the treatments for alcohol-dependence prioritize addictive symptom management and reduction in relapse, instead of the quality of life of the individuals beyond the treatment period. Particularly if low well-being is the primary triggering factor of alcohol consumption, there is a high probability of relapse, and the cycle of treatment and relapse repeating, because alcohol use can be both a cause as well as an outcome of diminished well-being. If not well-maintained, deprived well-being shall precipitate relapse as a means of temporary relief. Even if people abstain, there is no guarantee for their productivity, happiness, contentment, and personal growth. Being behavioral scientists, it is the responsibility of psychologists to promote the well-being and flourishing of clinical as well as non-clinical populations. Thus in the context of alcohol-dependence treatment, it would be highly valuable to develop an intervention, considering the discrete needs of the population, to enhance their well-being, specifically eudaimonic well-being.

One of the major findings of the current study is that individuals with alcohol-dependence experience considerably lower mindfulness and eudaimonia, compared to those who do not have alcohol-dependence. The study also confirmed the correlation of eudaimonia and mindfulness with hedonia, well-being, flourishing, alcohol craving, and alcohol-dependence. Further, regression analyses suggest mindfulness and eudaimonia heavily contributing to the variance in alcohol craving and alcohol-dependence. These are indications of the possible utility of mindfulness-based eudaimonic enhancement as a facilitating intervention that would not only strengthen the ongoing treatment efficacy but also improve their well-being and flourishing.

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No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets associated with this paper are available from the corresponding author on reasonable request

Additional information

Funding

The authors have no funding to report.