This study explored the relationship between an individual's level of faith and spirituality and addiction recovery success. Participants were 20 relapsing. Alcoholics and addicts are famous for their issues with denial. The relationship between recovery and spirituality is often defined by the sense of chaos. influence on the course of addiction and recovery. The purpose of spirituality as a subjective experience, a relationship (with self and/or with . and relapse.
One participant rated himself 0, but his stories and comments during the focus-group session vividly indicated a strong belief in God and an active prayer life, so it seems likely that his questionnaire response was an error. His scores on the questionnaires were otherwise similar to those of the other participants.
The RBBQ scores suggest that all participants had a strong belief in God, and that they were more likely to engage in internal activities such as praying or thinking about God than they were to engage in external activities such as attending religious services or reading religious writings. Questions and discussion points addressed during groups often prompted highly personal and emotional responses, coupled with suggestions for implementation of a spiritually based group. Five themes and several sub-themes emerged from analyses of recordings of the focus-group sessions.
Participants reported substantial religious background One commonality among participants was exposure to religious and spiritual practices early in life. A majority endorsed a history of regular church attendance in childhood, and several had been educated at religious schools. Other participants linked their early religious experiences to punitive or coercive parental enforcement: During active addiction, spirituality suffered in complex ways 3.
Participants recognized a conflict between abusing drugs and adhering to the organized practices of their religions Many participants reported that they still prayed and attended church services during periods of active addiction.
These participants summarized their experience of spirituality, while they were in active addiction, as having been largely a bankrupt attempt at manipulation. In recovery, they found it difficult to define how they could still be a spiritual and ethical people despite this history. Some reported feeling that spirituality had helped assuage negative feelings i. How wrong is that? But going to church started me in the right direction—it was still meaning something to me.
I died twice on the operating table…. For most participants it seemed that placing faith in a higher power lessened the perceived overwhelming personal burden of the challenges of recovery.
However, some expressed anger and frustration towards God for having been subjected to challenging obstacles in the initial stages of recovery e. Participants generally endorsed the idea of a spirituality group in clinic 3. Participants reported negative experiences with NA as a source of spiritual support Participants stated that while the spiritually oriented philosophy of step programs was appealing, their own experiences of step meetings had left them with mostly negative impressions.
Methadone Anonymous was founded to address this issue, but participants stated that they found Methadone Anonymous programs rare and difficult to locate.
I would attend a spirituality group before I would attend a step meeting…. Participants reported isolation from churches, due to self-perceived outsider status Several participants reported feeling alienated by religious institutions because of their perceptions that fellow members often passed moral judgment.
Other concerns that dissuaded participants from attending church were fears of not having the proper attire or not knowing the prayers and rituals during services. Some participants were dissuaded from using church-based resources including support groups for addicts due to perceived lack of confidentiality. Participants had specific but varied suggestions for implementation of a spirituality group in clinic Participants generally expressed strong support for implementation of a spiritually oriented group in the clinic.
Several stipulations were suggested. It was emphasized that participation in such a group had to be voluntary, so that individuals who do not feel comfortable discussing spirituality would be able to waive their right to attend.
Discussion We conducted an exploratory study using both quantitative and qualitative tools to examine the role of spirituality in recovery and to determine the appropriateness of providing a spiritual program in an inner-city drug treatment program.
Our main finding—that there was considerable support among participants for integrating a voluntary spiritual program into substance-abuse treatment—complements a similar finding in a prior focus-group study Arnold et al. In that study, all participants were HIV-positive, and for many of them, the prospect of AIDS had increased their tendency toward spirituality.
In our sample, only one participant of 25 who took part in the focus groups tested HIV-positive at intake, but, as mentioned in section 3. Unlike the prior study, ours specifically explored the relationship between drug use and spirituality during periods of active addiction. Before discussing our findings, we should note that drug use and spirituality are not antithetical; under some circumstances, drug use may be entheogenic, inducing or facilitating spiritual experiences a property not limited to the classes of drugs traditionally used in religious rites, and sometimes seen with stimulants such as amphetamine Siegel, However, we did not expect to find such effects associated with the compulsive use of heroin or cocaine, and no participants reported such effects.
For most participants, addiction seemed to hollow their inner experiences of spirituality and to coexist awkwardly, if at all, with their outward observances of religious rituals. The tension is illustrated in an anecdote shared outside of group by one of our participants: Perhaps for that reason, participants conveyed the need for a spiritual resource that would serve as an addition or an alternative to traditional church services and step meetings.
This resource would incorporate elements from both, while introducing new aspects specifically tailored to individuals faced with the arduous challenges associated with substance abuse recovery. Future research and clinical experimentation will be required in order to determine the format of a group that would be both practical and helpful in a substance-abuse clinic.
For example, participants repeatedly stressed that the group should be nonsectarian, but they seemed to envision this largely within a Christian framework though one participant did mention Islam. Among the advantages of such an approach is that it is free of negative associations for most adherents of the major Western monotheistic religions. On the other hand, the use of an unfamiliar form of spirituality could confer some disadvantages; for example, it may not harness the fervor that many individuals bring to their familiar faiths.
In addition, the structured, psychoeducational nature of the Spiritual Self-Schema approach does not resemble what was suggested by participants in this project.
Some limitations in the current study should be noted. The most serious limitation is that participants were self-selected; the 26 out of 79 eligible clinic patients who agreed to attend a focus group may have been the ones most likely to support incorporating spirituality into drug treatment.
On the RBBQ, all participants in the current study except one who gave contradictory responses indicated that they were strongly religious 3 or 4 on a scale of 0—4. Some earlier data from our clinic may put this into perspective. In addition, all were Protestant or Catholic. Other limitations include the fact that some participants knew each other from interactions in the clinic, which may have prompted a bias towards more socially acceptable responses to discussion topics.
Several participants reported either past or present involvement in a step program as one of the focus groups drew to the close, participants decided to recite the Serenity Prayer ; it is likely that some of the language used was influenced by the step philosophy. It should also be noted that the results of studies like this one may be more applicable in the US than in other countries.
Survey data have consistently shown that the general population of the US is among the more religious in the world.
The Role of Spirituality In Addiction Recovery | Holistic Treatment
Even so, spiritually based interventions have been well received in other countries. As mentioned briefly in the Introduction, we did not attempt to explore cultural differences such as those associated with race and ethnicity.
In a prior study of patients in our clinic, we found that African-American patients rated themselves higher on a spirituality questionnaire than European-American patients, and we found a complex pattern of racial differences in correlations between spirituality and amount of ongoing heroin and cocaine use Heinz et al.
We cannot draw any conclusions about race from our data, but we would like to suggest a framework for future studies.
In considering race in the context of an in-clinic spirituality group, at least two possibilities should be considered: First, spirituality groups in clinic may have promise. Specifically, they might be a place where spirituality is freed from other elements of step philosophy that are sometimes considered, at least in principle, to be counterproductive for African-Americans and other historically disempowered groups such elements include professions of powerlessness, and an individual-centered rather than structural or politicized attribution of problems; Saulnier, Prior qualitative research suggests that African-American attendees may have complex, partly alienated relationships with step programs Durant, ; Saulnier, We know of no findings to suggest that outcomes of step attendance differ by race.
Even so, the perception of step meetings as white, middle-class enclaves remains, and clinic-centered spirituality groups may therefore be attended by members of minority groups who otherwise would not attend self-help meetings. Second, spirituality groups in clinic may entail risk. While the authors report that the intervention as a whole was well received, it is easy to imagine how such attempts at cultural tailoring could backfire if attempted by clinicians with insufficient understanding of what they are doing.
Such concerns notwithstanding, the Joint Commission on Accreditation of Healthcare Organizations has mandated assessment of cultural background and spiritual orientation for outpatients entering substance-abuse treatment JCAHO, There appear to be no accompanying recommendations regarding the subsequent use of the information.
We hope that our findings, combined with those of future qualitative studies with more diverse samples, will build a foundation from which spiritually informed interventions in substance-abuse-treatment settings can be further developed and systematically evaluated. Footnotes Statement from all the authors: When this paper was in manuscript form, some readers apparently wondered whether its motivations included religious advocacy. Therefore, we would like to clarify that we hold a broad range of personal viewpoints on spirituality and religion, including for some of us a strong commitment to secularism.
Contributor Information Adrienne J. Clark, Battelle, Baltimore, MD. Nineteen clients declined to answer the spirituality questions. Subject demographics, pre-intervention drugs of choice, treatment modality, and the amount of relapse on each specific drug in DATOS Our final sample was Treatment modalities were short-term inpatient Table 1 rank-orders, the number of clients who reported relapse on specific drugs during treatment.
The concentration we found meant that the combined relapse index we used might mask any differential effects on the less frequently abused drugs, and results should not be generalized to all drugs without careful consideration of each alone.
The Reliability of the self-report substance abuse among this population A review of the DATOS literature suggests that these self-report data are quite reliable as only 8. The small positive result is crucial since the results are dependent on self-report data. The central hypothesis stated that clients with high spirituality would self-report significantly less drug relapse involving all drugs found in Table 1 combined, when compared to clients with low spirituality.
The hypothesis was tested across five different ordinal measures of spirituality: Each selected spirituality measure is consistent with Durkheim's conclusions that all human cultures have spirituality that provides an essential function. Functionally, it reinforces culturally specific expected behaviors and values that produce social bonds and interaction with others resulting in inhibition of deviance, such as drug abuse.
A focus-group study on spirituality and substance-abuse treatment
Theoretically, it follows that each of the five DATOS spirituality measures should be highly associated with remission. High spirituality in each measure is an indirect gauge of strong bonds to others with similar beliefs promoting conformity instead of deviance.
It also follows that some measures such may produce more social bonds and less relapse than others. For example, as attending religious services would present more opportunities for social bonds than watching religious programs since the former must involve social interaction while this may or may not occur viewing a television program. Secondary hypotheses Table 1 shows that, the distribution of relapse is heavily skewed toward a few drugs.
Thus, we tested whether the relationship between spirituality and relapse held for each drug for which there existed sufficient relapse numbers individually. Each spirituality measure contains 4 or 5 categories. We reasoned that since significant clinical differences may be masked by the combined index we separated the psychostimulants into cocaine and crack to provide independent data.
The dependent variable in these secondary analyzes was month remission or relapse from any drug that more than 50 clients had used to relapse. It is noteworthy that the SPSS package that we utilized provides for regression results as well. The regression results are found in each table under the chi-square statistics and consistently match the level of significance we found using chi-square and we corrected for type one errors as well.
Results The results of the main hypothesis are presented in Tables 2 to Each table Tables 246810 uses a different measure of spirituality that can be associated with the creation of social bonds, norms, and values that lower deviance from the norm, in this case, addiction see Figure 1. Table 12 presents the results for more frequently abused drugs individually.
The outcome variable of relapse or remission in each subtype includes relapse to all drug abuse or remission during the previous year. The percentage who reported no drug abuse or alcoholic intoxication during the year after treatment entry; is broken down by no or very high spirituality. We found an increase in remission from all drugs combined when spirituality is very high as opposed to absent.
In order to be identified as in remission in Tables 2 to 11 and Figure 1a subject had to indicate that during the previous year, he or she had not used any drugs.
It also included narcotics, opiates, methadone, Dilaudid, downers or depressants, sedatives, barbiturates, benzodiazepines, tranquilizers, methamphetamines, inhalants, or other illegal drugs. Participants who were the highest in terms of spiritually consistently had higher remission rates than those without spirituality; they were also better than those with average-spirituality.
The subjects who were the lowest in terms of spirituality had the highest relapse rates. With regard to religious beliefs see Tables 2 and 3 for those subjects who had the lowest belief, remission from all drugs of abuse during the past year was In contrast to those subjects who had the highest belief remission from all abusable drugs during the past year was Tables 4 and 5 show that participants who attended religious services more than once a week had remission rates The bottom row of Table 12 compares all drugs combined on each of the five measures of spirituality.
It shows that those attending religious meetings most frequently produced the largest reduction in relapse Attending religious meetings is the only one of the five measures that directly quantifies the social interaction and social bonds that Durkheim deemed to be so important for controlling deviance. However, the differences in remission as a function of spirituality were still statistically significant at the 0.
A few clients had relapsed on the latter three drugs. The results were not significant for eight drugs. The question of why relapse from methamphetamines, PCP, LSD, hallucinogens, inhalants, amphetamines, methadone, or Dilaudid, were not statistically significant remains unanswered.
It could be that the number of relapses on those drugs was insufficient inferential testing, or there may be no relationship with these drugs. We suspect the former rather than the latter since relapse on these eight drugs only averaged However, Table 12produced other important findings including the fact that the association varies among drugs, but no result was more intriguing than the observation involving crack and cocaine.
Both were significant at the 0. Specifically, subjects with high spirituality produced There were six exceptions that were not significantly associated at even 0. As sated above the regression analysis consistently match the level of significance.
Limitations, Strengths and Suggestions Design The greatest limitation of all correlational studies is that they never can eliminate all rival explanations for the results. This study deign is insufficient to test for causation. However, correlational studies such as this often to lead to such trials.
Validity and reliability Although we have no problems with the wording of the federal questions on spirituality, this field could be strengthened by measuring the correlation between them and alternative questions found in validated psychometric instruments and sociological surveys that might better tap into why such a strong association exists. This might lead to further support or rival explanations.
Statistics It would be interesting to build measures that were true ratio scales instead of ordinal and test them against these questions to see if interval scales or at least dichotomous nominal ones could be created that would allow more sophisticated analyses above ordinal level measures.
Clinical ramifications If a causative underlying mechanism was as simple as Durkheim and Cohen suggested social bonds to social institutions, there is a rich literature on how to use such knowledge in the addiction counseling literature.
Motivational Interviewing followed by Cognitive Behavioral Therapy, Rational Emotive Therapy and others touch on building bridges and support that are different forms of social bonds.
Importantly, each of the five measures that we evaluated significantly correlated with each other, and as such we treated them separately.
The Role of Spirituality In Addiction Recovery
Since each is very significant standing alone, we decided not to combine the five measures into one unit. The reason for this decision is that the combination of measures would mask the individual-measures, and the individual measures have implications for clinicians. For example, encouraging clients who believe to participate each week in their faith may lower relapse significantly.
A limitation of this study may have to do with the assumption that attendance at a religious activity encompasses social interaction. However, most sociologists would argue that symbolic interaction the dominant theoretical framework in sociology today would state that people construct their behaviors on the basis of their interpretation of others actions.
People then adjust their constructed behaviors to be consistent with those that would receive the approval of others.
Thus, a person who attends a religious service out of a desire to do so on a regular basis, need not speak to anyone there.
They will, however, still interact non-verbally in a conversation of symbols via expressions on the face and body. Interaction can be, for example, verbal or symbolic including simple gestures, eye contact, smiles, hand movement, which have powerful effects on how participants interpret the meaning of what they observe. In addition, we would like to point out that relapse in the literature is associated with the type of program, time-in treatment, and the severity of addiction as important variables.
However, we did not attempt to control for them in this posthoc study. However, that does not bring our results into question.
It would create an impossible standard for scientists-namely the scientist must control for every independent variable that affects the outcome variable, a standard that no scientist could ever meet.
The limitation is that our design is a correlational study that is not capable of proving whether the results are "causative. The literature notes significant differences in outcomes based on types of programs, length of time in treatment, and preadmission severity, but as Hubbard et al. While we did not address the role of family or others in our posthoc analysis we propose that support for spirituality should be considered as a useful tool in treating addiction by creating social bonds as well as any other practices that do so such as sponsors and family members who promote normative behavior.
Briefly, according to structural functionalism, social norms cluster into social roles that also clusters into role-sets that in turn cluster into five major institutions that each have critical roles in maintaining the survival of every human culture.
Thus, according to Durkheim accepting spiritual norms will increase the probability of resisting deviance and as such possibly drug abuse relapse. Moreover, Sutherland  added "differential association theory," that says; the time spent with people we are "intimate" with will greatly influence conformity or deviance based on their belief systems. Finally, Travis Hirschi  found that social bonds "attachment" were the best predictors of conformity or deviance in over teenagers.
The five selected measures: Table 2 - 11 show that participants who attended religious services more than once a week had remission rates It is noteworthy that the strength of the association in Table 4 is stronger than that in Table 2.
We hypothesize that this could be due to the increase in support from participating with other people in religious services in addition to religious beliefs. In short, the presence of two bonds not one. When we evaluated different drugs of abuse, some interesting results became obvious see Table