This document discusses the role of spirituality in addiction treatment and recovery. It argues that addiction affects the body, mind and soul, so treatment must address spiritual well-being. Twelve-step programs incorporate spiritual principles like honesty, hope and forgiveness. Studies show better recovery outcomes for those engaged in daily spiritual practices like prayer. While some therapists avoid spirituality due to concerns over imposing values, clients find spiritual discussions and references helpful when facilitated properly. True recovery involves profound personal changes attributed to a higher power by many recovering addicts.

1. THE ROLE OF SPIRITUALITY
IN ADDICTION
Carolyn Frances
June 2008
PC 6900

2. 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.
2
Psyche entering the garden. Artist unknown.
http://students.ou.edu/Y/Erin.E.Young-1/Psyche_Entering_Cupids_Garden_CGFA.jpg

3. 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

4. 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

5. 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

6. 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)

7. ASPECTS OF SPIRITUALITY
IMPACTING 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

8. CORRELATION
Better outcomes and continued
abstinence correlate with
active practices such as
attendance, prayer, scripture
reading, and meditation
(Miller, 1998; Magura, 2007;
Galanter, 2006; Waters &
Shafer, 2005; Brown et al.,
2007).
"We believe that the key to
continued sobriety lies in
facilitating daily spiritual
behaviors in the life of the
Graph from Sterling, et al. (2007) using
recovering individual" (Brown, Genia’s Spiritual Experience Index. Another
et al., 1988, quoted in Morgan, area of significant change included the Daily
1999, p. 18) Spiritual Experiences Scale.
8

9. 12 STEP PROGRAMS
“Believing they could do the impossible if it were
God's 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

10. THE 12 STEPS AND SPIRITUAL PRINCIPLES
Step Principle
1. We admitted we were powerless over Honesty
alcohol – that our lives had become
unmanageable.
2. Came to believe that a Power greater Hope
than ourselves could restore us to sanity.
3. Made a decision to turn our will and our Trust in God
lives over to the care of God as we
understood Him.
4. Made a searching and fearless moral Truth
inventory of ourselves.
5. Admitted to God, to ourselves, and to Confession
another human being the exact nature of
our wrongs.
6. Were entirely ready to have God remove Change of Heart 10
all these defects of character.

11. THE 12 STEPS AND SPIRITUAL PRINCIPLES
Step Principle
7. Humbly asked Him to remove our Humility
shortcomings.
8. Made a list of all persons we had Seeking Forgiveness
harmed, and became willing to make
amends to them all.
9. Made direct amends to such people Restitution and
wherever possible, except when to do so Reconciliation
would injure them or others.
10. Continued to take personal inventory Daily Accountability
and when we were wrong promptly
admitted it.
11

12. THE 12 STEPS AND SPIRITUAL PRINCIPLES
Step Principle
11. Sought through prayer and meditation Personal Revelation
to improve our conscious contact with God
as we understood Him, praying only for
knowledge of His will for us and the power
to carry that out.
12. Having had a spiritual awakening as Service
the result of these Steps, we tried to carry
this message to alcoholics, and to practice
these principles in all our affairs.
From “Addiction Recovery Program: A Guide to Addiction Recovery
and Healing”
12

13. 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

14. 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

15. WHAT KEEPS THERAPISTS AWAY
FROM 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

16. 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

17. 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

18. THE NATURE OF CHANGE
“"Something" happens to an addict's 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

19. 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

20. 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.

21. 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.