A Review of the LiteratureChristina Bender

Argosy University

Unlike diabetes, addiction has no clearly defined cause

Review of the literature which examines the relationship between spirituality and maintenance of abstinence from substance abuse

Future research is necessary to differentiate the distinction between spirituality and religious practices and to determine specific effective components of spirituality

98.4 percent increase in Emergency Room visits from 2004 to 2009 involving misuse of pharmaceuticals (Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, December 28, 2010)

Effective treatment modalities not as clearly defined

Addiction is a complex phenomena affecting the body, mind and spirit (DiLorenzo, Johnson & Bussey, 2001)

Most treatment approaches include a spiritual component

9 of the 10 articles reviewed (Avants, Marcotte, Arnold, & Margolin, 2003; Boeving, 2010; Chen, 2010; DiLorenzo et al., 2001; Douglas, Jimenez, Lin, & Frisman, 2008; Heinz, Epstein, & Preston, 2007; Kendler, Liu, Gardner, & McCullough, 2003; Koenig, 2009; Saunders, Lucas, & Kuras, 2007) deemed spirituality necessary to recovery.

Effectiveness demonstrated by the current model of treatment, facilitated 12-step recovery including a spiritual component.

“The act of surrender sets in motion a conversion experience, which involves a self-change including reorganization of one's identity and meaning in life” (Chen, 2010, p. 363)

Saunders et al. (2007) correlated alcohol misuse with spiritual and religious discrepancies

The spiritual conversion coupled with spiritual discord associated with addiction may explain the necessity of addressing the spiritual in recovery

Weaknesses:◦ Lack of specificity◦ Difficulty obtaining accurate information from addicts

Small sample sizes◦ 34 (Avants et al., 2003)

◦ <100 (Boeving, 2010)

Non-random samples◦ Problem and controls non-random (Sanders et al., 2007)

Specialized populations◦ Current inner city opiate & cocaine users (Avants et al.,

2003)

◦ Off-shore treatment facility participants (Boeving, 2010)

◦ Homeless mothers (Douglas et al., 2008)

◦ Inner city individuals (Heinz, 2007)

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Ethnocentric Populations◦ White men and women born in Virginia (Kendler et

al, 2003)

◦ African Americans (Heinz et al, 2007)

◦ African Americans compared to non-African Americans (Douglas et al, 2007)

Potential Secondary Gains◦ $25 for completion of a larger battery of

questionnaires (Avants, et al., 2003)

◦ Being allowed to keep their children in their homes (DiLorenzo et al., 2001).

Kendler et al. (2003)◦ Decreased risk of substance misuse associated with

increased religious involvement

Koenig (2009)◦ Review of the literature which found religious

involvement related to less psychiatric illness and less substance abuse

◦ Raised possibility of religious behavioral guidelines serving to decrease substance abuse

◦ Added when those who belong to religious traditions who practice abstinence begin using substances, the “use can become severe and recalcitrant” (p. 289).

No clear distinction between religion and spirituality was made in either of these two studies.

Avants et al. (2003)◦ HIV risk behavior inversely associated with

spirituality◦ Found positive assumptions about the world such

as people are basically good associated with increased spirituality

◦ Found positive assumptions pertaining to the ability to control outcomes through good personal behavior associated with increased spirituality

◦ Professed importance of spirituality evidenced necessity of inclusion of spirituality in recovery plan

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Boeving (2010)◦ Suggests shamanistic spiritual systems be

considered instead of current models of treatment he defines as “medical” and/or “crypto-Christian” (p. 93)

◦ Cites Peele et al. (2000) when he suggests clinical and anecdotal evidence supports no more than a 5% long-term recovery rate using standard 12-step formats

◦ Contends inclusion of Shamanistic spiritual practices incorporating spiritual, physical (detoxification) and family relationships are necessary to increase long-term recovery rates

Contends neither religion nor spirituality are requirements for successful recovery

Reports rational emotive behavior therapy can be equally effective for religious/spiritual clients and non-religious/non-spiritual clients

Contends rational emotive behavior therapy advocates self-acceptance similar to most major religions, but does so without a spiritual component

Douglas et al. (2008)◦ Found African Americans reported higher spiritual

well being indicating increased relative importance of spirituality in their lives

◦ Longitudinal study over 15 months which examined homeless mothers (88 African American & 101 non-African American)

Heinz et al. (2007)◦ Found a positive correlation between professed

spiritual and religious importance and recovery rates in the African Americans examined

Vast majority of the studies (9 of 10) conclude spirituality is a necessary component

Dissent is provided by Ellis (2000) who also provided the only breakdown of the effective components◦ He reports the following similarities between rational

emotive behavior therapy and the foundations of many religious philosophies: “unconditional self-acceptance, high frustration tolerance, unconditional acceptance of others, [and] the desire rather than the need for achievement and approval” (p. 29)

Necessary to determine the effective components of spirituality for clients unwilling to embrace spirituality

Focus on what makes the spiritual component effective by isolating each variable independently and determining alternatives for those resistant to spiritual practices

Avants, S. K., Marcotte, D., Arnold, R., & Margolin, A. (2003). Spiritual beliefs, world assumptions, and HIV risk behavior among heroin and cocaine users. Psychology of Addictive Behaviors, 17(2), 159-162. doi:10.1037/0893-164X.17.2.159

Boeving, N. G. (2010). Sneaking God (back) through the back door of science: A call for a comparative addictionology. Pastoral Psychology, 59(1), 93-107. doi:10.1007/s11089-009-0217-7

Chen, G. (2010). The meaning of suffering in drug addiction and recovery from the perspective of existentialism, buddhism and the 12-step program. Journal of Psychoactive Drugs, 42(3), 363-75. Retrieved from http://search.proquest.com/docview/759967077?accountid=34899

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DiLorenzo, P., Johnson, R., & Bussey, M. (2001). The role of spirituality in the recovery process. Child Welfare, 80(2), 257-73. Retrieved from http://search.proquest.com/docview/213804524?accountid=34899

Douglas, A. N., Jimenez, S., Lin, H., & Frisman, L. K. (2008). Ethnic differences in the effects of spiritual well-being on long-term psychological and behavioral outcomes within a sample of homeless women. Cultural Diversity and Ethnic Minority Psychology, 14(4), 344-352. doi:10.1037/1099-9809.14.4.344

Ellis, A. (2000). Can rational emotive behavior therapy (REBT) be effectively used with people who have devout beliefs in God and religion? Professional Psychology: Research and Practice, 31(1), 29-33. doi:10.1037/0735-7028.31.1.29

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Heinz, A., Epstein, D., & Preston, K. (2007). Spiritual/Religious experiences and in-treatment outcome in an inner-city program for heroin and cocaine dependence[dagger]. Journal of Psychoactive Drugs, 39(1), 41-9. Retrieved from http://search.proquest.com/docview/207971362?accountid=34899

Kendler, K., Liu, Z., Gardner, C., & McCullough, M. (2003). Dimensions of religiosity ad their relationship to lifetime psychiatric and substance use disorders. The American Journal of Psychiatry, 160(3), 496-503. Retrieved from http://search.proquest.com/docview/220482381?accountid=34899

Koenig, H. G.,MD. (2009). Research on religion, spirituality, and mental health: A review. Canadian Journal of Psychiatry, 54(5), 283-91. Retrieved from http://search.proquest.com/docview/222845928?accountid=34899

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Saunders, S. M., Lucas, V., & Kuras, L. (2007). Measuring the discrepancy between current and ideal spiritual and religious functioning in problem drinkers. Psychology of Addictive Behaviors, 21(3), 404-408. doi:10.1037/0893-164X.21.3.404

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (December 28, 2010). The DAWN Report: Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, MD.