Sanctuary for the Abused
Friday, March 09, 2007
By William White, MA & Alexandre Laudet, PhD
On the surface, the trends would seem to be contradictory: a surging science-to-practice movement and rising interest in the role of spirituality in addiction, treatment and recovery. A growing number of researchers (including the authors) are responding to these confluent trends by using scientific methods to operationally define spirituality and measure its influence on the course of addiction and recovery. The purpose of this article is to highlight some of this research and explore the implications of research findings to the practice of addiction counseling.
The lack of a consensual definition of spirituality in the addictions field (Cook, 2004) has resulted in both theistic (belief in God) and non-theistic (inner strength, moral values) interpretations of spirituality (Kaskutas, Turk, Bond & Weisner, 2003; Arnold, Avants, Margolin & Marcotte, 2002). In its broadest meaning, spirituality can be defined by how it is experienced (a heightened state of perception, awareness, performance or being) and by what it does to and for the individual (informs, heals, empowers, connects, centers or liberates) (White, 1992) Clients describe spirituality as a subjective experience, a relationship (with self and/or with resources beyond the self), a core quality of character and a style of living (Miller, 2003; Corrington, 1989). Spiritual experiences are distinguished from other experiences by their acute clarity and authenticity, their intensity (transcending ordinary experience) and their catalytic power. The term spirituality includes but has evolved beyond its religious moorings to convey experiences that bring a heightened sense of meaning and purpose in one’s life.
In order to conduct scientific studies on spirituality and addiction recovery, scientists have been forced to operationally define spirituality and develop instruments that can measure changes in the degree of one’s spiritual orientation over time. These instruments include the Spirituality Self-Assessment Scale, the Spiritual Well-Being Scale, the Spiritual Belief Scale, the Brief Multidimensional Measure of Religiousness/Spirituality and also the Religious Background and Behavior Scale used in Project MATCH (Gorsuch & Miller, 1999). These instruments measure such dimensions as belief in a higher power, daily rituals of meditation/prayer, life purpose and goals, balance and wholeness, personal values (e.g., honesty, humility, compassion, forgiveness, tolerance), and personal relationships.
Scientists are using these definitions and instruments to answer several key questions about spirituality and addiction.
• Does a spiritual void in one’s life heighten vulnerability for the development of a substance use disorder?
• Do self-defined spiritual experiences play a role in recovery initiation and, if so, what are the active ingredients within and measurable effects of such experiences?
• Does spirituality play a role in recovery maintenance and, if so, are these dimensions different than those that influence recovery initiation?
• What is the relationship between spirituality and religiosity as they interact over the course of addiction and recovery?
• Does a focus on spirituality within recovery mutual aid societies and the professional treatment of substance use disorders enhance long-term recovery outcomes?
Spirituality, recovery, history
The questions now being raised about spirituality by scientists are not new. The potential role of spiritual experiences in the resolution of alcohol problems was a central theme in early Native American cultural and religious revitalization movements and within the late 18th century writings of Dr. Benjamin Rush. When members of the Washingtonians described transformational experiences that did not include references to God, they were charged with the heresy of humanism. Debates raged through the 1840s over the relative merits of religious, spiritual and secular recovery experiences. It is among the lay alcoholism psychotherapists of the early twentieth century that we first see theology consciously transformed into therapy (in the work of Courtenay Baylor) and the later secularization of this approach into one emphasizing psychological technique (in the work of Richard Peabody). One of the innovations of Alcoholics Anonymous, which followed on the heels of the lay therapy movement, was to emancipate spirituality from its explicitly religious roots by charting a course between explicitly religious and secular pathways of recovery (White, 1998; White & Kurtz, 2005).
The beginnings of modern addiction counseling were marked by an emphasis on the role of spirituality in recovery. This interest in religious and spiritual influences on recovery faded in the wake of new biopsychological models of intervention, but is increasing once again. No, the questions being asked about spirituality and recovery are not new, but this is the first time in history rigorous scientific methods are being employed to answer them. This column has recently explored religious and secular styles of recovery. Now, we focus our attention on what we are learning about spirituality and recovery.
Spirituality and addiction recovery: the science
While research on spirituality, addiction and recovery is in its infancy, there are some consistent findings to date. First, we know that individuals with higher degrees of religiosity and spirituality are less likely to consume alcohol and other drugs and to consume less of such substances when they do use them. Conversely, studies are confirming that people with lower levels of spirituality, meaning and purpose in their lives are at increased risk for substance use disorders (Miller, 1998). Some investigators have conceptualized excessive alcohol and drug use as self-treatment for existential pain (Ventegodt, Merrick, & Andersen, 2003). Second, there is growing evidence that spirituality can serve as an antidote for substance use disorders. The most consistent finding is that clients with higher scores on measures of spirituality are more likely to be abstinent following treatment than those with lower scores (Waters and Shafer, 2005; Miller, 1998; Avants, Warburton & Margolin, 2001; Jarusiewicz, 2000). The influence of spirituality on recovery is independent of religiosity. For example, degree of religiosity at treatment admission does not predict or only modestly predicts positive treatment outcomes, but self-reports of having had a “spiritual awakening” through involvement with A.A. are highly predictive of recovery three years following treatment admission (Kaskutas, Turk, Bond & Weisner, 2003; Project MATCH Research Group, 1997). Another finding of note is that previous religiousness or spirituality is not a prerequisite to gaining the benefits of a spiritual orientation during the stages of recovery initiation and maintenance (Christo & Franey, 1995).
Clients in treatment speak of spirituality in terms of a turning point in their lives, protection and support from a higher power, guidance of an inner voice, life meaning, gratitude and service work with others seeking recovery (Arnold et al, 2002). The depth of this spirituality rises with length of recovery (Jarusiewicz, 2000) and produces a wide range of benefits. A spiritual orientation to recovery is associated with a higher quality of life, life contentment, optimism, social support and lower levels of stress and conflict (Corrington, 1989; Pardini, Plante, Sherman & Stump, 2000). Most clients in treatment recognize the benefits of spirituality to their long-term recovery (McDowell, Galanter, Goldfarb & Lifshutz, 1996) and support the availability of spiritual components of treatment (Arnold, et al, 2002).
The authors’ studies in New York City confirm many of these findings. We are conducting a NIDA-funded five-year prospective study of 354 previously heroin- and cocaine-dependent individuals self-identified as in recovery from one month to 10+ years. Our interviews with these individuals confirm that spirituality reduces the risk of relapse by serving as a protective buffer against the stress of early recovery (Laudet & White, 2005) and that a spiritual orientation toward recovery increases as recovery progresses (Laudet, Morgen & White, in press). When other factors are controlled (e.g., problem severity, drug choice, gender, ethnicity, etc.), higher spirituality at our first interviews predicts sustained recovery at the follow-up interviews.
Spirituality, life meaning and addiction counseling
So what does all this mean for the addictions counselor? These studies confirm that spirituality can be a catalyst of recovery initiation, a protective shield in early recovery and an increasingly significant dimension of long-term recovery maintenance. As such, spirituality is a valid area to explore in the assessment and service planning processes. Clients’ understandings of spirituality exhibit significant shifts in how spirituality is defined and utilized over the course of recovery. Addiction counselors would be well advised to support each client’s unique, stage-dependent interpretation of spirituality (with or without belief in a higher power) and to approach spirituality within the larger framework of life meaning and purpose.
The role of spirituality in recovery initiation requires that we remain open to the power of sudden, transformative change. Many clients talk about a “turning point” in their lives in spiritual terms. Such experiences often occur in the context of near death experiences (from overdoses, suicide attempts, violent victimization), HIV/AIDS, addiction-related deaths of close friends and incarcerations. Addiction counselors can play an important role in enhancing the enduring influence of such experiences.
The evolving role of spirituality in long-term recovery dramatically underscores that recovery is much more than the removal of alcohol and other drugs from an otherwise unchanged life. Early recovery is marked by the stressors of disengaging from alcohol and other drugs and cleaning up the debris of one’s addiction. The successful resolution of these tasks is often followed by existential panic: “I’m sober. Now what do I do?” (Chapman, 1991; White, 1996). Moving through this crisis involves a transformational journey marked by major changes in character, values, identity, interpersonal relationships and lifestyle. Spirituality is a potential sense-making framework through which these transitions can be planned and retrospectively understood via story reconstruction. Addiction counselors can play an important role as a guide in this process and help each client construct a recovery-enhancing narrative of his or her life.
Acknowledgment: Support for preparation of this article was provided by the National Institute on Drug Abuse (Grant R01DA14409). The opinions expressed here are those of the authors and do not necessarily reflect the official policies of the National Institute on Drug Abuse.
William White (firstname.lastname@example.org) is a Senior Research Consultant at Chestnut Health Systems and author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America.
Alexandre Laudet (email@example.com) is the Director of the Center for the Study of Addictions Recovery at the National Development and Research Institutes, Inc. in New York City.