If you help addicts and alcoholics recover for a living, you live in two worlds. There is the world of substance abuse and treatment that you read about in the newspapers, hear of at professional conferences, and see promoted at the top levels of policy and administration. This is the realm where addiction is a brain disease, where the cause is genetic and neurochemical, and where hope lies in a prescription. Then there is the humble place, ground level, where you work. Here, you encourage people to accept their problem, to reach out for help, to review their past and to hope for a future. And for many if not most of your clients, recovery will involve a personal transformation that is spiritual in nature. Those who reject this path should be helped in other ways.

Most of the 11,000 treatment programs in the country introduce their clients to some form of spirituality, usually based on the 12-Step program of Alcoholics Anony-mous or Narcotics Anonymous (Roman & Blum, 1997). A growing number of programs offer alternative spiritualities — such as yoga, Islam, Native American religions, or Christianity — blending these practices with the 12-Step approach. Some refer clients to secular support groups, such
as Women for Sobriety or Secular Organizations for Sobriety, which may still encourage members to develop spiritually or to follow their own religion.

Publicly, professionals often downplay the spiritual roots of recovery, as if they are embarrassed by this seemingly non-scientific, old-fashioned notion. But take heart and be bold; spiritual interventions are quintessentially evidence-based. Second, these also appeal to many members of disadvantaged or minority groups, which satisfies the demand for cultural competence and diversity. Third, spiritual interventions are low-cost during treatment, and self-sustaining and community-based after treatment. It’s the perfect aftercare. Finally, recovery offers the oldest and most established form of a faith-based solution, one that should be studied for lessons by proponents of faith-based services.

Spirituality, that connection with some transcendent reality, truth, or meaning, can exist outside religion — and religion may contain a range of spiritual methods. Spirituality does not require belief in a God, but beliefs alone do not constitute spirituality. What is necessary is for those beliefs to lead to values through personal verification, for one’s philosophy of life to be “vitalized by emotion” (Sapir, 1949).

The founders of AA began with the premise, based on their experience, that the solution is spiritual and so too is the malady, at least in part. If impaired spirituality and addiction go hand-in-hand, which comes first may never be fully established. For those addicted to illegal substances, however, drugs become a counterfeit God. Rather than escaping, alcoholics are seeking — usually God, serenity, or a spiritual life — a point made by Carl Jung, Bill Wilson, and other thinkers, as well as by the 200 alcoholics and addicts I interviewed for my book, The Soul of Recovery: Uncovering the Spiritual Dimension in the Treatment of Addictions (Oxford University Press, 2002). Many spoke of trying to fill a “God-sized hole” with drugs or alcohol. In response, spirituality allows life without alcohol — one supplants the other. As Carl Jung wrote in a 1961 letter to Bill Wilson, the formula is “spiritus contra spiritum.”

Faith’s utility for the addict
Generally, AA participation seems to improve the chances of recovery. Based on a 50-year study of 660 men, George E. Vaillant, a psychiatrist at Harvard Medical School, found that of the men who achieved three or more years of sobriety, 40 percent did so through AA. Indeed, Vaillant reported in The Natural History of Alcoholism Revisited, that more recovered alcoholics began abstinence at AA than in treatment.

A 1998 review of studies by William R. Miller of the University of New Mexico found that spiritual or religious involvement reduces the risk of substance abuse and that increased involvement appears to correlate with recovery. “One drives out the other,” Miller wrote, echoing Jung. Further, Miller found that substance abusers who practice the 12 Steps are more likely to remain abstinent than those treated with two other types of non-spiritual therapy (Miller, 1998).

Two major reviews of the research by blue-ribbon panels support some of the claims made in the area. One, by 20 scientists and directed by Miller in 1996 for the private National Institute for Healthcare Research, found “good evidence” that involvement with AA is associated with better outcomes in outpatient care and that meditation-based interventions are associated with reduced substance abuse and problems and “reasonable evidence” that AA involvement is associated with better outcomes after inpatient care. The other review, sponsored by the National Institute on Alcoholism and Alcohol Abuse and the Fetzer Institute, found “strong support” for the protective nature of spirituality and religion (110 studies); of AA involvement (51 studies); and of spiritual/religious interventions (26 studies) (NIAAA, 1999).

Project MATCH, an eight-year, $27 million federally funded effort, studied alcoholic patients in three types of outpatient care — 12 Step-facilitation, cognitive behavioral therapy, and motivational enhancement therapy. The study found comparable results with all three groups: 35 percent were abstinent a year later. But large segments of each group attended AA, underscoring its role in successful recovery (Bower, 1997). In a three-year study of 722 subjects, Lee A. Kaskutas of the Alcohol Research Group found that both secular and religious participants in AA, at follow-up, reported a doubled rate of spiritual awakening (Kaskutas, 1999).

A disease of the person or brain?
Today, many officials and policy-makers intone that addiction is a brain disease based on decades of scientific study. Acting on this, they promote the message that our best hope lies in finding the errant gene or neurochemical. As therapy, the disease concept is doomed to fail, asserts Jerome D. Frank and Julia Frank in their classic book, Persuasion and Healing, since it implies the person suffers from impersonal forces such as bad genes, and absolves the patient of responsibility leaving him/her to follow doctor’s orders. The AA approach is more effective since it uses the idea of illness to relieve feelings of guilt while also making “the alcoholic responsible for the consequences of his or her drinking and for following the steps to recovery, which involves moral acts such as making amends to others and helping other alcoholics” (Frank & Frank, 1993).

It is hard to understand skepticism toward spiritual interventions since they are so practical. The alcoholic in need is encouraged to try what has worked for others and see if it helps him/her. After all, people generally adhere to a set of beliefs and practices that work for them. As Emile Durkheim, the French sociologist, observed of religion or spirituality, “Its true function is to make us act and to help us live” (Durkheim, 1912).

In terms of utility, spiritual methods are akin to cognitive behavioral therapy, which encourages thoughts and ideas that work. “Cognitive restructuring helps a client control emotions, and, ultimately, behaviors, by convincing the client that certain ideas are irrational and by teaching more rational, less defeating ideas” (Steigerwald & Stone, 1999). One hears similar talk from recovered alcoholics or addicts, who routinely say that they now “have a thinking problem, not a drinking problem.”

“The (AA) slogans and steps should be put into behavioral cognitive terms so that practitioners can see we’re not about burning incense and waving crosses,” said Patricia Owen, Hazelden’s research director. “We may be talking about the same thing, but in different language.”

Cultural competence
Spirituality often works well with women and members of various ethnic and racial minorities. While some critics say the entire notion of a “higher power” is patriarchal and demeaning to women, many on the ground level of recovery see it as a means to self-sufficiency and dignity. Among the women Florence Wright sees at The Women’s Treatment Center in Chicago, powerlessness does not mean weak, she told me. “We talk about regaining a sense of power as well as control over their lives.”

A network of mutual-aid groups for women stressing positive thinking and behavior modification has spread widely since being founded in 1975. Women for Sobriety (WFS) was formed by Dr. Jean Kirkpatrick, who discovered that the primary admission in Alcoholics Anonymous, “that we were powerless over alcohol,” encouraged dangerous dependencies among women. But Lee A. Kaskutas of the Alcohol Research Group found that many WFS members saw little conflict with the tenets of AA, and used both groups according to their individual needs. For women, writes Kearny, spirituality “may take the form of participation in traditional religious rituals, exploration of woman-focused religious movements, or development of personal spiritual rituals and practices.”

Programs run by and for Native Americans also have embraced traditional spiritualities to help clients who are not well served by mainstream treatment, which is part of a broader movement in Native American health services. “We really believe in living with nature, which includes the spiritual and healing ceremonies,” said Roslyn Curtis, director of health services for the Navajo Nation. “One of the things we’re teaching is to go back to families and the old ways.”

At Desert Visions, a 24-bed treatment center on the Gila River reservation that treats chemically dependent Indian youths from 41 tribes in four states, youths attend sweat lodges, which director Theda Starr likes for the physical effects. “It detoxes the kids like that,” she told me with a crisp snap of her fingers, “and gets all the poisons out.” Each youth also researches his or her own tribe, attends weekly talking circles, and camps out at a sacred site in the nearby mountains of the Tohono D’odham Nation. Families usually consent, given the flexible approach. “We don’t foist any one particular culture on them,” Starr said. Other programs use talking circles, prayer wheels, tobacco offerings, purifications, and drumming circles.

This is not to say that traditional methods come naturally to clients. Many live far from their homelands and often know little about their tribal culture or traditions. “Indian people aren’t all into tradition the way most professional people think they are,” said Paul Rock Kretch, a counselor in Phoenix. “Most are ghetto people.” To help patients bridge the gap with mainstream AA-style treatment, Kretch and other Native counselors use a version of the 12 Steps rewritten with reference to a Great Spirit rather than a “higher power.” It acknowledges the need for purification, as well as prayer and meditation, and emphasizes the importance of family and tribe.

Within Indian culture, adaptations may be welcome. “Until just recently, the women used to sing behind the men, who were drumming,” said Donna Isham of Minnesota’s Department of Human Services. “Now they sit right at the drum.”

Science and the spirit
The hostility or discomfort with the spiritual or human element of addiction and recovery manifests itself in a lack of research, at least up until the past decade. Studies on every other aspect of addiction — neurochemistry, biology, and pharmacology — cram the scientific and medical journals. Medical professionals who are preparing to work with substance abusers can pass through their education hearing little on the topic, though this too is changing. The same is true for those at the microscope. As Miller stated, “Diversity training of psychological and medical researchers typically includes no serious consideration of spiritual and religious issues, despite the presence of a large volume of studies showing positive relationships between religious involvement and health” (Miller, 1998).

The message filters down to counselors. The index in a major textbook for the substance abuse field lists three citations for “spirituality,” one related to AA and two for “drug use as catalysts for...” (Lowinson, 1997). The National Institute on Alcohol Abuse and Alcoholism’s 10th Special Report to the U.S. Congress on Alcohol and Health acknowledges that 12-Step programs predominate in U.S. treatment and that their effectiveness has been confirmed by research (NIAAA, 2000). But this is said in one page out of 492 pages, as if to indicate that, well, a spiritual approach is interesting, but let’s get back to neurochemistry. Similarly, NIDA’s booklet, “Principles of Drug Addiction Treatment: A Research-based Guide,” devotes a brief paragraph to 12-Step programs as an adjunct to treatment (NIDA, 1999).

Even at programs, administrators often describe their regimens as entirely medical and psychological even when a copy of the 12 Steps hangs on the wall or patients meet daily for morning meditation. But clients and counselors beg to differ. The Delaware Valley Clinical Trials Network surveyed staff at 50 programs in three states and found that 83 percent agreed with the statement, “Spirituality should be emphasized more” (NSATTC Bulletin, 2000). In a 1998 survey, Daytop Village, an old-line therapeutic community, found that 81 percent of 700 clients agreed that “your relationship with God helps you in your treatment” and 89 percent agreed that, “having a relationship with God is important to being clean and happy.” Other research has found that even though spirituality improves outcomes, most patients say it was neglected during their stay in treatment (Royce, 1995).

Outcomes: measuring spirituality
Many do acknowledge, unabashedly, the crucial role of spirituality. Why? Because it serves to change people, and change is the core of recovery. “You show me a chronic medical disorder, any one, and I’ll show you the need for behavioral change if the treatment is to work,” said Thomas McClellan. “Every study that looks at this finds that participation in the self-help groups is quite consistent with maintained change.”

Spirituality deserves scrutiny because in the substance abuse field, the results are concrete: a person recovers or not. The 12-Step philosophy concentrates on a solution and avoids naming causes other than to suggest alcoholism stems from a spiritual deficit. “If you don’t have a spiritual awakening, you won’t have a sober lifestyle as I see sober,” said Peter Hayden, the no-nonsense director of Turning Point, which serves about 2,000 predominantly black clients in Minneapolis. “You may be dry or not drinking, but without spirituality you will not be living with elements you need,” such as love, dignity, and responsibility.

The spirituality of recovery
Most people know of AA, NA, or other addiction recovery groups as self-help. To outsiders, self-help seems to eliminate the isolation of the alcoholic, offering a sympathetic group of peers who can listen, advise, console, and support. But to members, it offers all that and much more. Primarily, these groups help members grow toward, achieve, as well as sustain a spiritual awakening — one that will keep them sober.

In essence, the 12-Step approach gives newcomers a mandate that can, paradoxically, be fulfilled flexibly: Find a power outside of yourself, anyway you want. Faith is also necessary in a secular course of therapy. “A therapeutic program must be convincing to the sufferer — that is, rhetorically persuasive — whether or not it is scientifically or universally true” (Frank & Frank, 1993).

At the very least, human assent is required, an almost gentle, invisible decision that defines human freedom. As the psychologist and author Victor Frankl realized during his time in the Nazi concentration camps, even in the most restricted circumstances, humans remain free to choose their attitude toward their situation. Acceptance, not to be confused with approval, is the first step in any personal development. “At bottom, the whole concern of both morality and religion is with the manner of our acceptance of the universe,” William James observed.

The spirituality found in treatment and recovery is, above all, adaptable. It is a big tent with room for many. In the wider world, many religions have converted AA concepts to their own purposes, or members have used it in tandem with denominational beliefs.

A network of groups called Jewish Alcoholics, Chemically Dependent Persons, and Significant Others has spread and adapted the 12-Step method. Christians have done the same through an array of denominational support groups.

In his book, Millati Islami (The Path of Peace): Islamic Treatment for Addiction, Zaid Imani reconciles the 12 Steps to that religion and the Qu’ran. There is the Sufi Order Recovery Support Group, and many recovered substance abusers find solace in Buddhism.

Despite these different interpretations and various uses of its concepts, AA consistently helps people abstain during treatment and beyond. Many studies focus on the high dropout rate in 12–Step fellowships, up to 90 percent during the first 90 days. Don McIntire took a deeper look at AA membership surveys and eliminated non-alcoholics and those who drop out during an introductory period of 90 days. Reduced to this core of alcoholics who are intent on finding help — AA’s target audience — McIntire found that 55 percent were sober after one year, and 50 percent after five years (McIntire, 2000).

Changing religion and society
The recovery movement, with its lack of doctrine and dogma and its healthy tension between the individual and the group, has enabled many people to acknowledge their ideas about a deity and spirituality. Addiction treatment and recovery demonstrate that we can discuss spirituality, with its reference to values, character, and transcendence, in neutral language. Medicine and public policy increasingly ask people to take more responsibility for their health and behavior, and the addiction field has long helped people to assume that responsibility with the help of a spiritual life.

Spirituality, practiced in thousands of ways and either by individuals or through groups, can provide the long-term help needed to persist in a new life. This is not to argue that society should stop treating addicts, but managed care and other changes have whittled down what’s available. Today, many patients are referred directly to support groups, which have reported a surge in such newcomers. In a way, the situation returns the recovery movement to its roots, that of the last resort for those not helped elsewhere. Even in the best scenario, treatment invariably ends. Support groups can be there, down the block, for the long term. There or elsewhere, spirituality can be developed for a lifetime.

The power of these support groups — autonomous, disparate, and informal — cannot be overestimated. Recovery groups can fill some of the void left as other sources of help have floundered or evaporated. The spirituality of recovery has real consequences: sobriety, purpose, productivity, and life.

So it is odd that as our society incorporates spirituality into mainstream healthcare and taps the power of faith in other social services, many in substance abuse policy, research, and even treatment seem intent on ignoring what has worked for millions of recovered substance abusers.

Christopher D. Ringwald wrote The Soul of Recovery: Uncovering the Spiritual Dimension in the Treatment of Addictions (Oxford, 2002) and is an editor and presenter on related topics at Advocates for Human Potential in Albany, NY. He can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or 518-729-1262.

References
Bower, Bruce, “Heavy Drinkers Of All Stripes May Get Comparable Help From A Variety Of Therapies,” Science News, Jan. 25, 1997.
Durkheim, Emile. The Elementary Forms of Religious Life. (1912/1995). Trans. and intro. Karen E. Fields. Free Press: New York, New York.
Frank, Jerome D. and Julia Frank. (1993). Persuasion and Healing: A Comparative Study of Psychotherapy. Johns Hopkins: Baltimore, MD.
James, William. (1902). The Varieties of Religious Experience. Random House: New York, New York.
Kaskutas, Lee. (1999). “The Role of Religion, Spirituality, and AA Involvement in Sustained Sobriety.” In NIAAA and Fetzer.
Lowinson, Joyce H., et al., eds. (1997). Substance Abuse: A Comprehensive Textbook, Third Edition. Williams & Wilkins: Baltimore, MD.
McIntire, Don. “How Well Does AA Work? An Analyses of Published AA Surveys (1968-1996) and Related Analyses/Comments.” Alcoholism Treatment Quarterly 18(4), 2000: 1-18.
Miller, William R. “Researching the Spiritual Dimensions of Alcohol and Other Drug Problems.” Addiction 93 (July 1998): 979-990.
NIAAA. (2000). 10th Special Report to the U.S. Congress on Alcohol and Health. NIH: Bethesda, MD.
NIAAA and the Fetzer Institute. (February, 1999). Conference Summary: Studying Spirituality and Alcohol. NIAAA: Bethesda, MD.
NIDA. (October, 1999). “Principles of Drug Addiction Treatment.” NIH Publication 99-4180.
NSATTC Bulletin. (October 2000). “Clinician Beliefs About Addictions and Treatment.” Bulletin of the Northeastern States Addiction Technology Transfer Center.
Roman, Paul & Terry Blum. (1997). National Treatment Center Study Six and 12 Month Followup Summary Report. Institute for Behavioral Research, Athens, GA.
Royce, James. (1995). “The Effects of Alcoholism and Recovery on Spirituality.” In Spirituality and Chemical Dependency, ed. Robert J. Kus, 19-37. Harrington: Binghamton, NY.
Sapir, Edward. (1949). Culture, Language and Personality: Selected Essays, edited by David G. Mandelbaum. University of California Press: Berkeley, CA.
Steigerwald, Fran and David Stone. (June, 1999). “Cognitive Restructuring and the 12-Step Program of Alcoholics Anonymous.” Journal of Substance Abuse Treatment 16: 321-329.
Vaillant, George. (1995). The Natural History of Alcoholism Revisited. Harvard: Cambridge, Mass.

This article is published in Counselor, The Magazine for Addiction Professionals, June 2003, v.4, n.3, pp. 32-37.

---

Comments

Add New Search RSS

Write comment
Name:
Email:	do not notifynotify
Title:
UBBCode:	-color-aquablackbluefuchsiagraygreenlimemaroonnavyolivepurpleredsilvertealwhiteyellow -size-tinysmallmediumlargehuge
	Please input the anti-spam code that you can read in the image.

Powered by !JoomlaComment 3.25

3.25 Copyright (C) 2007 Alain Georgette / Copyright (C) 2006 Frantisek Hliva. All rights reserved."