The following article is the continuation of a two part article on the importance of Spirituality in long term recovery which was in our June issue. For those who want to read part one, go to www.thesoberworld.com
Several other studies have suggested that 12-step attendance helps promote long-term abstinence for many people (Warfield & Goldstein, 1996; Bradley, 1988; and, Gorski & Miller, 1986). In 2003 Laudet, et al, found that attendance at meetings was successful in the short term (Laudet, Magura, Cleland, Vogel, & Knight, 2003). However, a deeper look at the study showed that it was very hard to get members to continue their attendance once they had established sobriety. While this study does not specifically discuss spirituality as a major factor, 12-Step programs are rooted in spiritual awakenings, as stated earlier. The finding suggest that while members establish their sobriety, their length of attendance has more to do with the severity of the problems or consequences they suffered at the hands of their drinking or drug use. Laudet’s study leads one to believe that a member’s level of desperation has a greater effect on long term attendance. However, the study fails to establish what happens to ones sobriety after attendance drops off.
Laudet, et al, followed this study the following year by studying Double Trouble in Recovery, a fellowship adapted from 12-Step programs aimed at those who were dual-diagnosed, with substance abuse issues and a psychiatric illness (Laudet, Magura, Cleland, & Vogel, 2004). The study confirmed that attendance at 12-Step meetings is a strong factor associated with abstinence. Specifically, Laudet stated that not only is attendance a factor, but because alcoholism and drug addiction are chronic diseases attendance is most beneficial when it is ongoing. His research showed that drop off in attendance was often followed with relapse (Laudet, et al, 2004). However, once again, spirituality was not specifically mentioned as 12-Step programs were viewed in their entirety, as opposed to a discussion about what parts of 12-Step programs had the greatest effect.
A 2005 study by Leigh, et al, found a significant relationship between spirituality and the use of both alcohol and tobacco (Leigh, Bowen, & Marlatt, 2005). Their research found that those with higher scores relative to spirituality were likely to engage in fewer harmful behaviors such as alcohol and substance abuse. This finding would support those in the recovery community who believe that addiction issues are rooted in a lack of spirituality, again suggesting future research to be necessary. Further, Leigh’s study found the connection of spirituality and recovery to be consistent with 12-Step philosophy that spirituality leads to recovery. The study also suggested that there may be a relationship between introversion and binge-drinking, perhaps causing future research to point in that direction also.
Many other studies have also found a significant relationship between spirituality and recovery from substance abuse. In a rather large study entitled Substance Abuse; Religious Faith and Spirituality May Aid Recovery conducted in 2000, it was found that higher levels of religious faith and spirituality were associated with several positive mental health outcomes. Further, higher faith and spirituality was associated with increased ability to cope, greater resilience to stress, an optimistic approach to life, and lower levels of anxiety, all issues that a newly sober person must learn to deal with appropriately if they are to stay sober. It was suggested by the study that these attributes may lead to better results for substance abuse sufferers (Pardini & Plante, 2000). Other studies have suggested that spirituality as method of attaining sobriety has reached the point that its success has caused changes in the counseling field, regarding substance abuse (Steiker and Pape, 2008). The study cites a fascination with spirituality, retreats, college courses, discussion groups and a substantial increase in the sales of books and journals regarding spirituality as a phenomenon. Further, as suggested by Pardini and Plante above, Steiker and Pape found that those successful in recovery showed a higher level of prayer and meditation, which ultimately led them to increased health and a decrease in substance use. The authors claim spirituality as a “preventative antidote” to later relapse (Steiker & Pape, 2008). Pardini and Plante, among other researchers, contend that this is an area that should be further researched, hopefully leading to a more collaborative effort between members of religious organization and professionals in the medical and mental health fields (Korinek, 2007; Pardini & Plante, 2000; and, Morell, 1996).
A 2007 study, entitled “Promoting Spirituality in Families with Alcoholism”, stated that spirituality provides a vital resource for healing and recovery from substance abuse. The article states that meditation is a spirituality-enhancing behavior that promotes an individual to be still and listen, inaction that is often not tolerated in today’s world (Korinek, 2007). Furthermore, he cites several researchers (Anderson, 1999; Walsh, 1999, and Martin & Booth, 1999) who illustrate that many of the original practices of Alcoholics Anonymous such as prayer and meditation, confessions and forgiveness, service to others, and other community-enhancing behaviors lead to a more communal mentality and an enhanced ability to cope and recover from substance abuse. Korinek goes on to quote the National Institute for Healthcare Research, which stated that there is strong evidence that spiritual involvement predicts less use of and fewer problems with alcohol, tobacco, and illicit drugs. Finally, the writer makes the argument that in the face of the positive effect of spirituality on alcoholism, adding spirituality as a component of treatment has been slow, even for some of its easiest aspects. He cites meditation as an easy component to add to treatment that would enhance spirituality with little or no cost or effort (Korinek, 2007).
In a focus group conducted over a two year period Heinz, et al, produced a pilot study that attempted to look at twenty-five substance abuse out-patients and their attitudes and beliefs about spirituality, substance use, and recovery. Specifically, they aimed to find participants’ outlook on the relationship between spirituality and recovery and whether spiritual components could be integrated into a standard treatment setting without creating concerns about individual differences and beliefs. A focus-group methodology was used in hopes of gaining a unique perspective and insight into opportunities and concerns with spirituality’s inclusion (Heinz, Disnes, Epstein, Glezen, Clark, and Preston, 2010). Heinz also found, among other things, that addiction and spirituality have a hard time co-existing. When actively using, participants felt that their level of spirituality was lessened and their spiritual experiences hollowed. Further, they felt isolated from churches due to their self- perception of being an outsider.
Conversely, when attempting to abstain participants felt that spirituality rose, giving them strength and peace. Further, they felt that during early sobriety spirituality provided something for them to reach for, and more importantly, hope. Many participants felt that hope was essential to recovery. Finally, they felt that spirituality and a faith in a higher power provided lessened the overwhelming personal burden of recovery (Heinz, et al, 2010).
Finally, participants felt that spirituality as part of a treatment setting was a positive step forward. This was in contrast to their feeling that Narcotics Anonymous provided regarding spirituality. Participants felt that while in concept NA’s promotion of spirituality was positive, in practice there were problems such as hypocrisy, lack of acceptance by the group, and a general dislike of the format. These concerns would have to be addressed if spirituality were to become a part of a treatment center environment.
The connection between spirituality and abstinence from addiction has been well documented in recent years through studies and journal articles (Heinz, et al, 2010; White, Montgomery, Wampler, and Fischer, 2009; and, Mason, Deane, Kelly, and Crowe, 2009). Interest in the connection has also spurred many dissertations and theses to be recently written on the subject.
In nearly every case the link has been made that a subject’s spirituality is a major factor in their “program” of sobriety if they are going to achieve long-term sobriety/recovery. A sample review of the more recent ones is provided below. The level of importance of spirituality, among other factors, was discussed in a 2007 dissertation entitled, “The Perceived Attributes of Abstinence by Addicts in Long-Term Recovery (Prince, 2007). Prince found that nine different themes existed in those who achieved long-term recovery/sobriety. The themes were spirituality, family support, social support, formal or informal treatment, significant life changing events, knowing one’s limits, volunteer/service work, recreational activities, and education. Many of the themes were also identified as being important in short-term recovery, implying that it is vitally important for those in recovery to maintain daily routines in how they stay sober. Prince’s study was conducted in a qualitative fashion in order to find commonalities among the different subject. Subsequently, eight subjects were used for the interviews.
Of the nine themes that emerged only one, significant life-changing events, was identified by all eight subjects. Family and social support were identified by seven subjects. This was followed by spirituality, among others, that was identified by six subjects. Clearly, Prince found spirituality to be an important factor. An argument can be made even from the limited information provided that spirituality plays a role in many of the other themes also. For example, treatment center programs often have a spirituality aspect to their programs, in addition to social support, volunteer/service work, and significant life changing events having some subtle spiritual components. Additionally, it would appear that Prince’s study would follow the thoughts of 12-step recovery, although this was only touched on in this dissertation.
A 2009 thesis, entitled “Religiosity, Spirituality, and Substance Abuse” explored the relationship between lifetime crack cocaine use, lifetime injection drug use, drinking problems, and illegal substance relative and the effects of religiosity and spirituality (Allen, 2009).
Allen’s research found that the effect of spirituality on substance abuse was significantly higher as the seriousness of the kind of abuse increased. For example, he found that spirituality did not have as great an effect on drinking problems as it did crack cocaine or intravenous drug use. Interestingly, because alcohol use is legal and accepted, Allen finds problem drinking to be less dangerous than the drug use mentioned above. Statistics belie this finding. A 2004 study looking at deaths due to “indulgence” cited statistics provided by in the Journal of the American Medical Association showing that alcohol abuse kills five times as many people annually as all illicit drugs combined (Mokdad, et.al, 2004).
Another interesting part of Allen’s research showed that religiosity and spirituality were seen as particularly helpful when combined with 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous. Allen attributed this higher level of success to the social support aspect that 12-step programs foster, creating a sense of mutual encouragement and accountability in a spiritual environment (Allen, 2009). Furthermore, he states that 12-step programs may have some success due to their ability to suppress individualism, an example of this being the 3rd of the 12 steps which encourages participants to turn their will and their lives over to the care of God as they understand him (Alcoholics Anonymous, 1939).
A 2010 dissertation entitled “Factors Contributing to Long-Term Sobriety Following Treatment for Drug and Alcohol Abuse” attempted to identify all the positive factors associated with someone achieving two years of abstinence following treatment (Jacobson, 2010).
Jacobson’s qualitative study included fifteen participants, all of whom agreed that 12-step programs were their main strategy in staying clean and sober. As stated earlier, Alcoholics Anonymous and Narcotics Anonymous are spiritual programs in nature and promoted a spiritual awakening as the ultimate conclusion. Further, it was stated that being abstinent was not enough, one must attain a level of serenity and “work the 12 steps” to be truly sober. Finally, 60% stated that the ideal program would include medically supervised detox, in-depth therapy, and a spiritual component as the main aspects of treatment.
One of the few quantitative study dissertations completed on the subject of alcohol and/or drug abuse relative to spirituality was entitled Alcoholism: Spirituality and Personal Dynamics (Streukens, 2009). Streukens’ dissertation attempted to explore and compare the relationship of spiritual and personality dynamics with three groups of recovery alcoholics. The groups were divided by length of sobriety; the first with less than one year, the second with one to three years, and the third with more than three years.
Streukens’ study found that those in early recovery were also early in their spiritual journey, showing less spirituality than those in mid-term recovery. Streukens suggest that it is in mid-term recovery that one’s spirituality peaks. His findings suggest further that as one advances in their recovery years they become complacent in regards to their spiritual growth and health. Finally, Streukens feels that incorporating spirituality activities into ones program of recovery at different, specific times may foster improved potential outcomes.
Streukens’ study is interesting and seems to agree with commonly shared beliefs and concerns in 12-step meeting rooms. That is, it has long been thought that someone in early recovery will have a much greater chance at sobriety if they have reached a level of despair that forces them to follow any suggestion, even one that may go against their core beliefs, such as a belief in a higher power (Streukens, 2009). As their life improves through their first year they often come to believe that spirituality and a higher power is the reason their life has changed for the better. In Streukens’ mid-term recovery stage the subject will raise his spirituality accordingly. However, as Streukens suggests, there often comes a time when the recovering person becomes complacent towards their spiritual needs. Streukens suggest this occurs at three years. Those in 12-step programs may differ with when it happens, but they definitely agree that it is a problem that has to be overcome, or it leads to relapse. 12-steppers believe this phenomenon occurs between five and ten years, somewhat later than Streukens. It has been often thought that one in recovery for as long as five years has allowed several factors to return to his life during this time. Most notably, it is felt that one’s ego, and all its negative characteristics, comes back. Additionally, the problems faced by a newly recovered person, such as legal, marital, employment, financial, and such have usually been overcome in the first several years of sobriety. This leads to another version of this phenomenon known in Alcoholics Anonymous as “letting the things that AA gave you take you away from AA”. An interesting follow-up to this study would be to look at why the complacency happens, a closer look at when it happens, how to recognize it is occurring, and what can be done about it.
The review of literature and studies regarding the links between spirituality and recovery to addiction shows a consistently high priority put on spirituality as a major factor in one’s recovery. While it is clearly not the only factor in someone staying sober, it certainly is one of the factors that many journal articles and dissertations on methods of recovery address in some form. Additionally, 12-step programs and treatment centers have shown for many years that spirituality is one of the key ingredients in one staying sober (Steiker & Pape, 2008; Leigh, Bowen, & Marlatt, 2005; and, Pardini & Plante, 2000). The real question is how much spirituality is required? How “spiritual” are treatment centers willing to go with their curriculum? Will the person struggling with alcoholism and addiction submit themselves to large doses of spirituality? Further research is needed and adjustments in curricula need to be made. While wholesale changes are not realistic, treatment centers that are truly interested in recovery rates should take a long, hard look at what works for long-term sober people and make adjustments. Perhaps small at first, but over time the changes may need to be radical to have an significant effect on recovery rates.
Tony Foster is the Director of Therapy at the Beachcomber Outpatient Services treatment center located in Boynton Beach, Florida.