THE ROLE OF SPIRITUALITYIN ADDICTIONCarolyn FrancesJune 2008PC 6900
THE PSYCHOLOGY CONNECTION Psychology is generally defined as the study of the mind. However, the base word psyche originally meant soul. When practicing in the field of psychology we are treating more than the mind; we are dealing with the soul. Psychology does more than change environments and behavior; it changes people. It began as an existential exercise, delving and developing the soul of man, but today has become principally medically minded and neglects deeper issues of the soul. 2Psyche entering the garden. Artist unknown.http://students.ou.edu/Y/Erin.E.Young-1/Psyche_Entering_Cupids_Garden_CGFA.jpg
THE SPIRITUAL APPROACH “The Lord works from the inside out. The world works from the outside in. The world would take people out of the slums. Christ takes the slums out of people, and then they take themselves out of the slums. The world would mold men by changing their environment. Christ changes men, who then change their environment. The world would shape human behavior, but Christ can change human nature.” (Benson, 1985, emphasis added) 3
WHAT IS SPIRITUALITY Search for meaning Search for purpose Development of the person Connection to something greater than yourself A way of life “Miller (2003) notes that many factors point to spirituality as an antidote to addiction: as a preventative, a treatment, and a path to transformation.” (Waters & Shafer, 2005) 4
NATURE OF ADDICTION The early members of AA “believed that alcoholism and other addictions were a triple sickness of the body, mind, and soul.” (Morgan, 1999) “The chronic, progressive, and relapsing nature of addiction is a depressing and degrading process.” (Inaba & Cohen, 2004, p. 395) “… continued use leads to progressive physiological, emotional, social, relationship, family, and spiritual consequences that users find intolerable.” (Inaba & Cohen, 2004, p. 365) “Fortunately recovery is a spiritually uplifting and motivating process through which individuals gain a sense of purpose, community, and meaning for their lives.” (Inaba & Cohen, 2004, p. 395) 5
TREATING ADDICTION Treatment has two important aspects. First, the physical nature of addiction has to be battled – this may require medication to help with withdrawal, cravings, and general health. Then the psychosocial side must also be dealt with. Recovery is a restructuring of lifestyle and thoughts and behaviors. As addiction influenced every part of the person’s life, so recovery must also address every aspect of the whole person and their environment. In some ways, the addict needs to learn again how to live. “Without this they may have sobriety but they will not have 6 recovery.” (Inaba & Cohen, 2004, p. 398)
ASPECTS OF SPIRITUALITYIMPACTING ADDICTION Sense of hope and purpose Forgiveness Active lifestyle change Social support Builds self-reliance, self-esteem, problem solving, optimism, insight, decision making Devalue self-indulgence/sensation seeking (Multidimensional measurement of religiousness/Spirituality for use in health research, 2003) 7
CORRELATIONBetter outcomes and continuedabstinence correlate withactive practices such asattendance, prayer, scripturereading, and meditation(Miller, 1998; Magura, 2007;Galanter, 2006; Waters &Shafer, 2005; Brown et al.,2007)."We believe that the key tocontinued sobriety lies infacilitating daily spiritualbehaviors in the life of the Graph from Sterling, et al. (2007) usingrecovering individual" (Brown, Genia’s Spiritual Experience Index. Anotheret al., 1988, quoted in Morgan, area of significant change included the Daily1999, p. 18) Spiritual Experiences Scale. 8
12 STEP PROGRAMS “Believing they could do the impossible if it were Gods will, they set about to form a fellowship based on spiritual principles. Principles so universal and true that they could be applied by anyone who had even the smallest amount of willingness to believe in a benevolent God, leaving each free to define God as they best understood Him. ... Little did anyone realize that in that humble effort by a bunch of previously hopeless, derelict drunks was the beginning of the single most powerful program for overcoming self-destructive behaviors that has ever been introduced to the world. No efforts by medical science or modern psychology has ever duplicated their success.” (from “The Twelve Steps of Heart t’ Heart” pamphlet as quoted in Harrison, 2000, p. A-42, emphasis added) 9
THE 12 STEPS AND SPIRITUAL PRINCIPLESStep Principle1. We admitted we were powerless over Honestyalcohol – that our lives had becomeunmanageable.2. Came to believe that a Power greater Hopethan ourselves could restore us to sanity.3. Made a decision to turn our will and our Trust in Godlives over to the care of God as weunderstood Him.4. Made a searching and fearless moral Truthinventory of ourselves.5. Admitted to God, to ourselves, and to Confessionanother human being the exact nature ofour wrongs.6. Were entirely ready to have God remove Change of Heart 10all these defects of character.
THE 12 STEPS AND SPIRITUAL PRINCIPLESStep Principle7. Humbly asked Him to remove our Humilityshortcomings.8. Made a list of all persons we had Seeking Forgivenessharmed, and became willing to makeamends to them all.9. Made direct amends to such people Restitution andwherever possible, except when to do so Reconciliationwould injure them or others.10. Continued to take personal inventory Daily Accountabilityand when we were wrong promptlyadmitted it. 11
THE 12 STEPS AND SPIRITUAL PRINCIPLESStep Principle11. Sought through prayer and meditation Personal Revelationto improve our conscious contact with Godas we understood Him, praying only forknowledge of His will for us and the powerto carry that out.12. Having had a spiritual awakening as Servicethe result of these Steps, we tried to carrythis message to alcoholics, and to practicethese principles in all our affairs.From “Addiction Recovery Program: A Guide to Addiction Recoveryand Healing” 12
WHAT ABOUT OUTSIDE OF 12 STEPS? “Kubicek (1998) studied persons with six or more years in continuous recovery, half of whom were somehow involved in AA and half of whom were in "spontaneous remission," that is, recovery without any group support. ... Overall, Kubicek discovered thirteen elements that recovering persons described as important in their recovery. Importantly, five of these were overwhelmingly identified as essential for recovery success by both AA members and spontaneous remitters. In addition to social support, remembering negative consequences, renewed honesty in living, and having a desire for health, these persons described a spiritual component and "accepting help from a higher power" as essential to their recovery.” (Morgan, 1999, p. 17, emphasis added) 13
DRY OR SOBER Stephanie Brown found in her research (1985, 1988) that “While remaining dry focuses on continued abstinence from alcohol and other drugs as well as a fundamental movement away from dependency, "sobriety" entails achieving a kind of life-balance and expanded awareness, involving psychological, interpersonal, and spiritual exploration and change.” (Morgan, 1999, p. 14, emphasis added) “In ignoring the spiritual component to the addictive disorders, medical practitioners overlook the fact that the addictive disorders have physical, emotional, and spiritual components (Doweiko, 1996; Martin, 1990)” (Doweiko, 1999, p. 34) 14
WHAT KEEPS THERAPISTS AWAYFROM SPIRITUALITY Fears of imposing their own values on the client Fear that it is too personal to discuss Their own spiritual struggles Lack of training and knowledge View of spiritual as neurosis (Knox et al, 2005)* View that spirituality is replacing one compulsion for another (Inaba & Cohen, 2004)** Studies support the view that spirituality is a vehicle of psychological healing. (Knox et al, 2005) 15
WAYS TO ALLOW FOR SPIRITUALITY Knox, et al. (2005) report that clients indeed want to discuss spiritual matters and view spirituality as being important for healing and growth. Knox, et al. suggest that facilitating a discussion involves being receptive, creating a safe environment, listening for the sacred, and being self-aware of spirituality in their own lives. Their study also shows that allowing the client to begin the conversation about the spiritual is conducive to a positive experience, but the therapist must communicate openness to such a discussion. 16
WHAT CLIENTS FOUND HELPFUL referencing scriptural passages, teaching spiritual concepts, encouraging forgiveness, involving religious community resources, conducting assessments of client spirituality “Out-of-session religious interventions were considered more appropriate by clients than in- session religious interventions, but in-session interventions were rated as more helpful.”(Martinez, Smith, & Barlow, 2007, abstract) 17
THE NATURE OF CHANGE “"Something" happens to an addicts way of thinking, feeling, and acting in the world when she or he turns to recovery. The addict experiences a profound change. The change that occurs gives rise to new ways of thinking, feeling, and seeing the world as well as to alterations of life stance and lifestyle, that is, to cognitive, affective, and behavioral consequences. (Brown, 1985; King and Castelli, 1995) The recovering addict feels more comfortable with self, more connected and at home in the world, and more open to others. The recovering addict relates to others differently, becomes more honest, more engaged, more patient, humble, and grateful. The recovering addict is more mature, psychologically and emotionally, and is able to relate with others with humor, altruism, and hope (Chappel, 1992; Khantzian and Mack, 1989). Many addicts attribute these changes to the protection and intervention of a Higher Power. They have a sense of being cared for and caring.” (Morgan, 1999, p. 13-14) 18
REFERENCES Addiction recovery program: A guide to addiction recovery and healing. (2005). Salt Lake City, Utah: The Church of Jesus Christ of Latter-day Saints. Benson, E. T. (1985, November). Born of God. Ensign, 6-7. Brown, A. E., Pavlik, V. N., Shegog, R., Whitney, S. N., Friedman, L. C., Romero, C. et al. (2007, August). Association of spirituality and sobriety during a behavioral spirituality intervention for twelve step (TS) recovery. American Journal of Drug & Alcohol Abuse, 33(4), 611-617. Brown, H.P., Jr., Peterson, J.H., Jr. & Cunningham, O. (1988). An individualized behavioral approach to spiritual developmenty for the recovering alcoholic/addict. Alcoholism Treatment Quarterly, 5(1/2), 177-196. Brown, S. (1985). Treating the alcoholic: A developmental model of recovery. New York: John Wiley. Chappel, J.N. (1992). Effective use of Alcoholics Anonymous and Narcotics Anonymous in treating patients. Psychiatric Clinics of North America,16(1), 177-187. Doweiko, H. E. (1999). Substance use disorders as a symptom of a spiritual disease. In O. J. Morgan & M. Jordan (Eds.), Addiction and spirituality (pp. 33- 53). St Louis, MO: Chalice Press. Doweiko, H.E. (1996). Concepts of chemical dependency (3rd ed). Pacific Grove, Calif.: Brooks/Cole. 19
REFERENCES CONTINUED Inaba, D. S., & Cohen, W. E. (2004). Uppers, downers, all arounders, fifth edition. Ashland, OR: CNS Publications, Inc. Khantzian, E.J. and Mack, J.E. (1989). Alcoholics Anonymous and contemporary psychodynamic theory. In M. Galanter (Ed.), Recent Developments in Alcoholism, volume 7 (pp. 67-89). Plenum Press. King, E. & Castelli, J. (1995). Culture of recovery, culture of denial: Alcoholism among men and women religious. Washington, D.C.: Center for Applied Research in the Apostolate at Georgetown University [CARA]. Knox, S., Catlin, L., & Casper, M. (2005, July). Addressing religion and spirituality in psychotherapy: Clients perspectives. Psychotherapy Research, 15(3), 287-303. Kubicek, K. (1998). Self-defined attributes of success: A phenomenological study of long-term recovering alcoholics. Dissertation Abstracts International. [University Microfilms No.] Magura, S. (2007). The relationship between substance user treatment and 12- Step fellowships: Current knowledge and research questions. Substance Use & Misuse, 42(2-3), 343-360. 20 Martin, J.A. (1990). Blessed are the addicts. New York: HarperCollins.
REFERENCES CONTINUED Martinez, J.S., Smith, T.B., Barlow, S.H. (2007, October). Spiritual interventions in psychotherapy: Evaluations by highly religious clients. Journal of Clinical Psychology, 63(10), 943-960. Miller, W. R. (1998, July). Researching the spiritual dimensions of alcohol and other drug problems. Addiction, 93(7), 979-990. Miller, W. R. (2003). Spirituality, treatment, and recovery. In M. Galanter (Ed.), Recent developments in alcoholism. Volume 16: Research on alcoholism treatment: Methodology/psychosocial treatment, selected treatment topics, research priorities (pp. 391-404). New York: Kluwer Academic. Morgan, O. J. (1999). Addiction and spirituality in context. In O. J. Morgan & M. Jordan (Eds.), Addiction and spirituality (pp. 3-30). St Louis, MO: Chalice Press. Multidimensional measurement of religiousness/Spirituality for use in health research (Fetzer Institute/National Institute on Aging Working Group). Author. (2003). Sterling, R. C., Weinstein, S., Losardo, D., Raively, K., Hill, P., Petrone, A. et al. (2007, January). A retrospective case control study of alcohol relapse and spiritual growth. American Journal on Addictions, 16(1), 56-61. Waters, P., & Shafer, K. C. (2005, July). Spirituality in addiction treatment 21 and recovery, part 1. Southern Coast Beacon. Retrieved 26 May 2008, from www.scattc.org.