Spirituality in Addictions Treatment: Wisdom to Know…What It Is

Abstract

Spirituality has long been integrated into treatments for addiction. However, how spirituality differs from other related constructs and implications for recovery among nonspiritual persons remains a source of discussion. This article examines ways in which spirituality is delineated, identifies variables that might mediate the relations between spirituality and recovery from substance abuse disorders, describes distinctions between spiritual and nonspiritual facets of addictions treatment, and suggests means to assist in further clarification of this construct.

Keywords:

• addiction treatment
• spirituality
• treatment
• mind–body
• substance misuse
• recovery
• mediators

Notes

4 The reader is reminded that the medicalizing and pathologizing of a range of human behaviors and adaptations and associated diagnoses of types of psychoactive substance use and selected users is relatively recent and is a consensus-based taxonomy which is not always empirically informed. Editor's note. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th ed.; American Psychiatric Association: Washington, DC, 1994.

5 The reader is asked to consider that with the advent of artificial science and its theoretical underpinnings (chaos, complexity, and uncertainty theories), it is now posited that much of human behavior is complex, dynamic, multidimensional, level/phase structured, nonlinear, law-driven, and bounded (culture, time, place, age, gender, ethnicity, etc.). Being a believer or nonbeliever in a higher power—however, this concept is defined and delineated—would be such a behavior/process. This is not a semantic issue. Distinguishing between one's religion, religiosity and spirituality, and its posited association with an abstinent lifestyle can be affected by dimensionalizing each of these three phenomena. There are two important issues to consider and which are derived from this: (1) Using linear models/tools to study nonlinear processes/phenomena can and does result in misleading conclusions and can, therefore, also result in inappropriate interventions; (2) the concepts prediction and control have different meanings and dimensions than they do in the more traditional linear "cause and effect" paradigms. (Buscema, M. (1998), Artificial Neural Networks, Substance Use & Misuse, 33(1–3). Editor's note.

6 The term “recovery” can be viewed as a binary process, recovered or not recovered, whatever the criteria being used; as well as in a manner consensualized by the 12-step movement of an ongoing process, a day at a time, which is achievable but is never fully achieved. These are not simply semantic distinctions. The reader is referred to the work of the General Semanticists (The symbol is NOT the thing symbolized, the map is NOT the territory. The word is NOT the thing. S. I. Hayakawa) as well as to Osgood's thesis of the semantic differential, in which context influences meaning. Editor's note.

7 The reader is referred to Hills's criteria for causation which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. (Hill, A. B. (1965). The environment and disease: Associations or causation? Proceedings of the Royal Society of Medicine 58: 295–300). Editor's note.

8 This refers to the DSM-IV diagnostic category.

9 There are numerous specific measures of spirituality, and this goes beyond the scope of this paper (see Chuengsatiansup, 2003; Egbert, Mickley & Coeling, 2004; Koenig, 2008; Sussman, Nezami, & Mishra, 1997, for more examples).

10 The Oxford Group was an organization founded in 1931 by Frank Buchman, an American Lutheran Christian minister and missionary, derived from Christian tenets but not a religion, guided by four “absolutes” (honesty, purity, unselfishness, and love), and spiritual principles of confession, surrender, restitution, and doing God's Will (Bufe, 1991).

11 Treatment can be briefly and usefully defined as a unique, planned, goal-directed, temporally structured, multidimensional change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual –help-based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which aren't also used with nonsubstance users. Whether or not a treatment technique is indicated or contraindicated, and its selection underpinnings (theory-based, empirically-based, principle of faith-based, tradition-based, etc.) continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) and well-being treatment-driven models, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success, as well as failure. Treatment is implemented in a range of environments; ambulatory as well as within institutions which can include controlled environments. Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models: (1) the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive; (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active; and (3) the "informed model" in which the patient makes the decision(s). Substance users, who represent a heterogeneous group of people and patterns of use, continue to be treated in "specialized" programs which are distanced from the mainstream of the treatment of nonusers—”NORMED TREATMENT OF NORMED DISEASES”—all-too-often manifest imparity in availability and delivery of needed services, utilize policies which are stakeholder -driven and not evidence-based and may be ethically insensitive. Editor's note.