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Alcoholism Treatment Quarterly, 31:25–37, 2013

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ISSN: 0734-7324 print/1544-4538 online

DOI: 10.1080/07347324.2013.746625

Gender Differences in Spirituality in Personsin Alcohol and Drug Dependence Treatment

DONNA LEIGH BLISS, PhD and STACY S. EKMARKUniversity of Georgia, School of Social Work, Athens, Georgia USA

Although research has begun to broadly address gender differ-

ences in alcohol and drug dependence, there is a dearth of re-

search on gender differences in spirituality in this area, despite

the increased research emphasis on the role of spirituality in the

recovery process. This study addressed this gap by examining gen-

der differences in five dimensions of spirituality in persons in

diverse alcohol and drug dependence treatment settings. The hy-

pothesis that there would be gender differences in spirituality was

supported as women had higher levels of expression of cogni-

tive orientation toward spirituality compared to men. Implications

for alcohol and drug dependence treatment and research are

discussed.

KEYWORDS Spirituality, alcohol dependence, alcoholism, drug

dependence, addiction, gender, social work

Alcohol and drug dependence is a widespread problem in the United Statesthat profoundly affects millions of individuals, with far-reaching effects onsociety and the economy. In 2005, the number of people using illegal drugswas estimated to be 20 million, and the number of people who abusedalcohol was estimated to be between 16 million and 20 million (NationalCenter on Addiction and Substance Abuse at Columbia University, 2007).Furthermore, alcohol and drug dependence cost the nation an estimated$220 billion in 2005—more than cancer ($196 billion) and obesity ($133 bil-lion) (National Center on Addiction and Substance Abuse at Columbia Uni-versity, 2007).

Address correspondence to Donna Leigh Bliss, PhD, University of Georgia, School of

Social Work, 305 Tucker Hall, Athens, Georgia 30602. E-mail: dlbliss@uga.edu

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26 D. L. Bliss and S. S. Ekmark

Over the past few decades there has been a substantial increase inthe scope of research on alcohol and drug dependence as its etiology andmethods of improving treatment outcomes have been looked at more closely.One of the main criticisms of early research was that studies looked almostexclusively at entirely male samples, and hence treatment options weretailored toward men (Green, 2006) and were most often ill equipped to meetwomen’s divergent needs (Ashley, Marsden, & Brady, 2003). Recognition ofthis problem has led to an increase in research on gender differences inalcohol and drug dependence. A rapidly growing body of research nowindicates that alcohol and drug dependence among women and the issuesthat surround their dependence are different from those of men and may ne-cessitate a ‘‘specialized set of therapeutic interventions’’ (Ashley et al., 2003,p. 20). Because research shows that there are fundamental gender differencesin terms of alcohol and drug dependence, specialized gender-specific treat-ment programs have become increasingly common (Green, Polen, Lynch,Dickinson, & Bennett, 2004; Grella, 2008).

Research on gender differences in alcohol and drug dependence cantypically be grouped into two main categories: access to treatment andtreatment outcomes. Generally, research has found that women face greaterbarriers to accessing alcohol and drug dependence treatment than do men(Green, 2006; Tuchman, 2010). Not only do women face more impedimentsto treatment but research has shown that once women enter treatment, theydo so with more serious alcohol and drug problems and with more healthand social problems than do men (Marsh, Cao, & Shin, 2009). Research alsoindicates that ‘‘women who are addicted have a history of over-responsibilityin their families of origin and reportedly have experienced more disruptionin their families than their male counterparts’’ caused by entering alcoholand drug dependence treatment (Tuchman, 2010, p. 128). Additionally, thelack of available, affordable childcare options poses a practical barrier tomany women’s access to treatment as very few alcohol and drug dependencetreatment centers have childcare programs (Green, 2006).

There has been extensive research on the impact of alcohol and drugdependence on biology, social functioning, and psychology (Morgan, 2002);however, over the past two decades, the social work profession has high-lighted the need for examining spirituality as well, as part of a broader holisticapproach to assessing and treating alcohol and drug dependence. Socialwork, as well as other helping professions, has begun to include spiritualityas a component of person-in-environment assessment (Bliss, 2009). Further-more, the Joint Commission on Accreditation of Healthcare Organizations,the largest and most influential healthcare accrediting body in the UnitedStates, revised its standards in 2001 to require that spirituality be assessed ina variety of health care settings, including some types of behavioral healthcare organizations such as those that provide alcohol and drug dependenceservices (Hodge, 2006; Bliss, 2009).

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Gender Differences in Spirituality 27

Fortunately, there is a growing research base that highlights the roleof spirituality in improving treatment outcomes. In a literature review of 44empirical studies on various aspects of the relationship between spiritualityand alcohol and drug dependence, Bliss (2007) noted that 31 of these articlesexamined spiritual variables as components of the recovery process. Ingeneral, higher levels of spirituality were associated with improved treatmentoutcomes such as increased abstinence and improved life functioning. Al-though the vast majority of the studies that Bliss (2007) reviewed addressedthe 12-Step spirituality of Alcoholics Anonymous, it is important to notethat spirituality can be assessed in many other ways and along differentdimensions including meaning and purpose in life, relationship with God ora deity figure, personal values, locus of control, and spiritual well-being. Also,though spirituality was found to play an important role in recovery, it wasnot necessarily the only role as other factors were influential in promotingrecovery as well.

Despite the surge in research interest on spirituality and alcohol anddrug dependence in general, there has been a limited research focus ongender differences within this relationship (Bliss, 2007). Complicating thislack of research focus, the studies that are available regarding gender dif-ferences tend to focus more on discreet aspects of spirituality or examinedreligious practices as a proxy for spirituality. For example, in a review of theliterature one study that looked at spirituality in a treatment setting examinedthe affect of Qigong meditation on substance abuse treatment outcomes formen and women and found that female participants whose meditation wasof ‘‘acceptable quality’’ reported greater reductions in cravings, anxiety, andwithdrawal symptoms than did male participants whose meditation was of‘‘acceptable quality’’ (Chen, Comerford, Shinnick, & Ziedonis, 2010). An-other study evaluated the role of religiosity on the posttreatment abstinenceoutcomes of African American adults completing 3 months of substanceabuse treatment and found that women achieved significantly higher ratesof abstinence and were more likely to practice their religion posttreatmentthan the men in the sample (Stewart, Koeske, & Pringle, 2007). One studythat evaluated gender-specific patterns of drug use among active stimulantusers in rural Kentucky found that spirituality and/or religiosity may havemore ‘‘influence’’ on drug using behavior for rural male stimulant users thanfor females (Staton-Tindall et al., 2008).

The purpose of this study is to begin to address this gap in the researchliterature by examining gender differences in alcohol and drug dependencethrough the lens of spirituality that is diversely conceptualized. Given thebreadth of research that identified gender differences in various other aspectsof alcohol and drug dependence, this study tests the hypothesis that therewill be gender differences in spirituality, although the direction of thesedifferences are not predicted due to the limited research base on genderdifferences in spirituality to support such specificity.

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28 D. L. Bliss and S. S. Ekmark

METHOD

Research Design and Sample

A cross-sectional design was used for this study. Four programs located in theBaltimore, Maryland, and Washington, DC, metropolitan areas that offeredan array of services such as detoxification, inpatient, outpatient, methadonemaintenance, day treatment, and residential treatment agreed to participatein this study.

Convenience sampling was used to identify potential participants. In-clusion criteria for participants were men and nonpregnant women, age 18or older, currently in a substance abuse treatment program, had an alcoholuse disorder, and had fewer than 12 months of sobriety from alcohol usedisorders. Exclusion criteria were women or men in acute alcohol withdrawalor who were experiencing psychiatric symptoms that impaired their abilityto comprehend and/or respond to study questions. Potential participantswere prescreened by treatment staff to determine if they were eligible toparticipate in the study. This study was approved by the University of Mary-land Baltimore Institutional Review Board (IRB). All participants signed anIRB-approved informed consent form.

This study involved the author going onsite to these treatment centersand administering a survey in groups ranging from 5 to 20 clients (N D 180),which took about 30 minutes to complete. Clients received a $10 honorariumfor participating in the study.

Measure

Expressions of Spirituality Inventory–Revised. The Expressions of Spir-ituality Inventory–Revised (ESI-R) (MacDonald, 2000a) is a five-dimension(six items per dimension), 30-item self-administered measure of experiences,attitudes, beliefs, and lifestyle practices concerning spirituality. The ESI-R isscored using a 5-point Likert-type scale (0 D strongly disagree, 1 D disagree,2 D neutral, 3 D agree, 4 D strongly agree).

The five dimensions of the ESI-R are (1) cognitive orientation towardspirituality (pertains to the expressions of spirituality that are cognitive-perceptual in nature such as beliefs and attitudes), (2) experiential/pheno-menological dimension of spirituality (concerns experiential expressions ofspirituality such as spiritual, religious, mystical, peak, transcendental, andtranspersonal experiences), (3) existential well-being (spirituality as expressedthrough a sense of meaning and purpose in life), (4) paranormal beliefs(e.g., ESP, precognition, psychokinesis), and (5) religiousness (expression ofspirituality through religious means such as religious beliefs and practices).Each dimension is individually scored, with higher scores indicating higherdegrees of expression of the particular dimension (MacDonald, 2000a).

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Gender Differences in Spirituality 29

Although the ESI-R represents diverse expressions of spirituality ratherthan assessing a single construct of spirituality, given it is revised from theoriginal 98-item Expressions of Spirituality Inventory, which was derivedfrom a factor analysis of 11 existing measures of spirituality to determine ifthere was a stable factor structure that could be used to develop a modeland measure of spirituality (MacDonald, 2000b), the ESI-R does have a stablefactor structure of spirituality. MacDonald (2000a) stated the ESI-R had similarpsychometric properties and correlated with those of the 98-item version,which was reported to have interitem reliability, factorial validity, constructvalidity, and predictive validity.

RESULTS

Sample Demographic Characteristics

A sample of 180 women and men in various types of alcohol/other drugtreatment settings completed the surveys. The sample comprised slightlymore males than females. The mean age was 39.6 years (SD D 10.4). Slightlyless than two thirds identified themselves as African American, whereasslightly less than one third stated they were White. Slightly more than one halfstated their income for the previous year was less than $10,000. Mean yearsof education was 12.0 (SD D 2.12). Slightly more than one half reportedbeing single/never married, with slightly less than one third stating theywere separated/divorced. Outpatient treatment was the most common typeof alcohol/other drug program setting, followed by detox, and inpatient.The mean length of current sobriety was 71.97 days (SD D 77.98). Therewere no statistically significant gender differences in demographic variables,except for gender itself as there were significantly more males than femalesin the study (99 vs. 81). See Table 1 for additional information on sampledemographic characteristics.

Statistical Analysis

Given there were no statistically significant gender differences in the de-mographic variables and that only two categories of gender were used(men and women), it was not necessary to use ANOVA or analysis ofcovariance (ANCOVA) to test the research hypothesis as these statisticalanalyses are more suited when comparisons are made between more thantwo categories (ANOVA) and when covariates needed to be statisticallycontrolled for (ANCOVA) (Grimm & Yarnold, 2000). Therefore, t tests wereused as there were only two categories, and there were no statistically signif-icant differences between these categories in terms of salient demographicvariables.

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30 D. L. Bliss and S. S. Ekmark

TABLE 1 Sample Demographic Characteristics by Gender (N D 180)

Type

Malefrequency

(%)

Femalefrequency

(%) Significance

Gender 99 (55.0) 81 (45.0) **Race/ethnicity NS

African American 52 (28.8) 53 (29.4)White 32 (17.7) 24 (13.3)Hispanic 1 (.05) 1 (.05)Asian/Pacific Islander 1 (.05) 0 (.00)Other 8 (4.4) 3 (1.6)

Income previous year NSLess than $10,000 47 (26.1) 50 (27.7)10,000–19,999 15 (8.3) 12 (6.6)20,000–29,999 23 (12.7) 8 (4.4)30,000–39,999 6 (3.3) 5 (2.7)40,000–49,999 4 (2.2) 3 (1.6)50,000 or more 4 (2.2) 3 (1.6)

Marital status NSSingle/never married 48 (26.6) 43 (23.8)Separated/divorced 31 (17.2) 28 (15.5)Married 14 (7.7) 5 (2.7)Living with someone 3 (1.6) 4 (2.2)Widowed 3 (1.6) 1 (0.5)

Type of program NSOutpatient 34 (18.8) 20 (11.1)Detox 27 (15.0) 12 (6.6)Inpatient 24 (13.3) 11 (6.1)Women-specific 0 (0.0) 21 (11.6)Day support 4 (2.2) 10 (5.5)Halfway house 4 (2.2) 4 (2.2)Methadone maintenance 5 (2.7) 3 (1.6)Other 1 (0.5) 0 (0.0)

Type Mean (SD) Mean (SD) Significance

Years of education 11.84 (2.26) 12.27 (1.93) NSAge 38.63 (10.75) 40.78 (9.86) NSLength current sobriety in days 64.99 (74.52) 80.51 (81.65) NS

*p < .05, **p < .01.

There were statistically significant differences in gender in terms ofcognitive orientation toward spirituality (t D �2.56, df D 178, p D .011).Women had a mean score of 19.04 (SD D 4.92) and men had a mean scoreof 17.1 (SD D 4.8). There were no statistically significant gender differencesin religiousness (t D �1.52, df D 178, p D .129), paranormal beliefs (t D 1.38,df D 178, p D .169), experiential/phenomenological dimension of spirituality(t D �1.09, df D 178, p D .277), and in existential well-being (t D .369, df D

178, p D .713). See Table 2 for additional information on gender differencesin the five ESI-R dimensions of spirituality.

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Gender Differences in Spirituality 31

TABLE 2 Gender Differences in Five Expressions of Spirituality Inventory–Revised (ESI-R)Dimensions of Spirituality (N D 180)

Male Female

Dimension Mean SD Mean SD Significance

Cognitive orientation 17.2 4.8 19.04 4.9 .011Religiousness 17.6 4.9 18.7 4.5 .129Paranormal beliefs 8.7 4.4 7.8 4.2 .169Experiential/phenomenological 11.6 5.2 12.5 5.4 .277Existential well-being 11.5 4.9 11.2 5.7 .713

Note. Scores for each ESI-R dimension can range from 0 to 24, with higher scores indicating greater

expression of a particular dimension.

Internal Consistency Reliability and Intercorrelations

among ESI-R Dimensions

Cronbach’s alpha for the five dimensions of the ESI-R in this study was .67,which is slightly less than the ideal minimum of .70 (de Vaus, 2002). Asubsequent analysis of intercorrelations among the five dimensions of theESI-R indicated that cognitive orientation toward spirituality dimension andexperiential/phenomenological dimension of spirituality were significantlycorrelated with three other ESI-R dimensions. Existential well-being andreligiousness were significantly correlated with two other ESI-R dimensions,whereas paranormal beliefs was significantly correlated with one other ESI-Rdimension. See Table 3 for additional information on intercorrelations amongESI-R dimensions.

TABLE 3 Correlations among the Five Dimensions of the Expressions of Spirituality Inven-tory–Revised

Cognitiveorientation

Experiential/phenomenological

Existentialwell-being

Paranormalbeliefs Religiousness

Cognitive orientation PearsonCorrelation — .506 �.317 �.086 .794Significance (Sig.) — .001 .001 .252 .001Experiential/

phenomenologicalPearson

Correlation .506 — �.118 .285 .381Sig. .001 — .114 .001 .001Existential well-being PearsonCorrelation �.317 �.118 — .158 �.141Sig. .001 .114 — .035 .058Paranormal beliefs PearsonCorrelation �.086 .285 .158 — �.068Sig. .252 .001 .035 — .366Religiousness PearsonCorrelation .794 .381 �.141 �.068Sig. .001 .001 .058 .366 —

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32 D. L. Bliss and S. S. Ekmark

DISCUSSION

The hypothesis of this study was supported as gender differences in cognitiveorientation toward spirituality were found with women having higher levelsof expression compared to men. Although this finding is not unexpected inlight of the research literature on gender differences in various aspects ofalcohol and drug dependence, the paucity of research on gender differencesin spirituality in this population necessitates the need for a broader review ofgender differences in cognitive functioning and emotional expressiveness toassist in the interpretation of the study finding that women had higher levelsof expression of cognitive orientation toward spirituality compared to men.

Research on gender differences in aspects of cognitive functioning lendssupport for the validity of the finding that women had higher levels of expres-sions of spirituality that are cognitive-perceptual in nature such as spiritualbeliefs and attitudes compared to men. For example, gender differencesin cognitive processing have been closely analyzed in psychological andneuropsychological literature (e.g., Ardila, Rosselli, Matute, & Inozemtseva,2011; Hedges & Nowell, 1995; Kimura, 1999; Weiss, Kemmlera, Deisenham-merb, Fleischhackera, & Delazer, 2003). Cognitive processing, including corecognitive abilities such as verbal, visuospatial, and quantitative abilities, hasbeen shown to differ between males and females (Halpern et al., 2007). Ascited in Ardila et al., three major differences in cognitive abilities betweenmen and women have generally been reported ‘‘(a) higher verbal abilities,favoring women; (b) higher spatial abilities, favoring men; and (c) higherarithmetical abilities, also favoring men,’’ although differences in calculationabilities have, in some cases, been interpreted as a result of men’s strongerspatial abilities (Benbow, 1988; Geary, 1996); thus, the three differencesdescribed could be reduced to only two (Ardila et al., 2011, p. 984).

Similarly, the expression of these cognitive beliefs and attitudes is con-sistent with research that shows that women consistently report being moreemotionally expressive than men (Bronstein, Briones, Brooks, & Cowan,1996). For example, studies have found that women talk about emotionsmore than men and use more emotion words than men (Goldschmidt &Weller, 2000). Furthermore, in many studies women have self-reported ‘‘moreintense experience of emotions than men, more intense expression, andgreater comfort with and tendency to seek out emotional experiences’’ (Gross-man & Wood, 2003, p. 1010). Women have been shown to experience greateremotional intensity of positive and negative emotions, such as happiness andanger, respectively, as well as experiencing such intensity of emotion acrossthe life span from early childhood to adulthood (Aldrich & Tenenbaum,2006; Grossman & Wood, 1993). Furthermore, the hypothesis that emotionalexpression, recognition, and experiences may differ dramatically for malesand females is implicit in almost every theory of emotional development(Brody, 1985).

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Gender Differences in Spirituality 33

Finally, another plausible explanation for the finding that women ex-perience greater expression in cognitive orientation toward spirituality thanmen is that women differ from men in terms of religious expression (Miller &Stark, 2002). Research has shown that men and women throughout differentreligions ‘‘appear to construct their religious experiences and/or engagementin contrasting ways, men being more active, that is, oriented to action, andwomen more affective in their expression or understanding of their ownreligiousness’’ (Sullins, 2006, p. 847). The affective dimension of religiosity,which includes measures such as ‘‘frequency of prayer, the subjective experi-ence of comfort and strength in religion, or self-assessed intensity of religiousidentity,’’ consistently shows a greater difference between men and womenthan those measures that express the more active dimension of religion, suchas church attendance, membership, or volunteerism (Sullins, 2006, p. 847).

Implications for Alcohol and Drug Dependence

Treatment and Research

The findings from this study that women were more expressive of spiritualbeliefs and attitudes compared to men has important implications for alcoholand drug dependence treatment for women and men. For women, treatmentshould be structured to provide opportunities for women to learn how to usethe expression of their spiritual attitudes and beliefs in a manner that supportstheir recovery needs. Of particular importance is the need for treatmentproviders to help women translate these attitudes and beliefs into specificbehaviors and practices that promote recovery. Just as the specific treatmentneeds of women has led to the creation of gender-specific treatment pro-grams, mixed-gender treatment settings need to offer the flexibility in theprovision of treatment services to more effectively target how women canbetter utilize spirituality in their recovery efforts.

Fortunately, the increased research interest in spirituality has identifieda wide array of specific behaviors and practices that treatment providerscan offer to promote spiritual growth in women. For example, Canda andFurman (1999) provided a detailed discussion of spiritually sensitive practiceskills and techniques that practitioners can use ranging from creating aspiritual development time line and narrative to focused relaxing and guidedvisualization (p. 291). Hodge (2003) discussed how spiritual assessment toolsincluding spiritual histories, life maps, ecomaps, genograms, and ecogramscan be used to provide more effective client-centered services. Finally, inSpiritually Oriented Social Work Practice, Derezotes (2006) provided a prac-tical, theoretical framework for spiritually oriented social work practice thatcan be used to help facilitate spiritual development in traditional social workpopulations such as women.

At the same time, the fact that men were found to have lower expres-sions of spiritual beliefs and attitudes does not necessarily mean this is not an

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34 D. L. Bliss and S. S. Ekmark

important area to focus on in men’s recovery. Instead, societal expectationsof the gender role of men may inhibit this expression in a manner thatcan hinder their recovery efforts (Green et al., 2004; Grella, 2008). Ratherthan presume that spirituality is somehow of less importance to men in therecovery efforts, treatment providers would be well advised to more robustlyhelp men identify their spiritual beliefs and attitudes, and as with women,learn how to translate them into specific behaviors that promote recovery.

As with any research that explores new terrain, this study does havelimitations that suggest caution in the interpretation of the study findings.First, spirituality is a multidimensional construct that can be assessed in manyways. It is possible that other measures of aspects of spirituality may lead todifferent results. As such, the ESI-R should not be considered the definitivemeasure of spirituality, despite the comprehensive manner in which themeasure was developed from 11 other measures of spirituality. Second,despite the number of significant correlations among the various dimensionsof the ESI-R, when analyzed as a function of gender, only one of the fivedimensions of spirituality had statistically significant differences betweenmales and females. This does raise the possibility that the results of thisstudy were not necessarily clinically significant as it would be reasonableto presume that if one dimension of spirituality was significantly differentin terms of gender, the same might be true for other dimensions as wellgiven the number of significant intercorrelations. Third, the Cronbach’s alphaof .67 was less than the ideal minimum of .70 for exploratory research,which raises questions about the reliability of the ESI-R. However, someresearchers have questioned the utility of the coefficient alpha as an idealindicator of reliability and have suggested that other indicators of reliabilitymay be considered (DeVellis, 2012). Although this can be controversial tosome researchers given the wide use and acceptance of the Cronbach’s alphaas an indicator of reliability, such an alternative perspective does allow forthe tentative acceptance of the reliability of the ESI-R in this study despite itnot reaching the .70 threshold, while still calling for a cautious interpretationof the findings and the need for additional psychometric research on theESI-R.

Despite these limitations, this study highlighted an important, yet un-derexplored area that has implications for alcohol and drug dependencetreatment. As treatment providers continue to include spirituality as part of amore holistic framework for assessing and treating clients, providers will alsoneed to encourage clients to continue with their spiritual development afterdischarge. However, while many treatment providers support, and perhapsrequire participation in 12-Step groups such as Alcoholics Anonymous, whichhas an explicitly spiritual focus, it is important to note that given how broadlyspirituality can be conceptualized, the existence of other support groups thatcan also facilitate spiritual growth including secular recovery support groupssuch as SMART Recovery, Secular Organization for Sobriety, LifeRing, and

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Gender Differences in Spirituality 35

Secular Recovery, explicitly religious alternatives such as Celebrate Recov-ery, and gender-specific and secular recovery groups such as Women forSobriety.

Clearly, gender differences in diverse aspects of alcohol and drug depen-dence will continue to be an important area of research in the identificationof ways to differentially provide treatment services based on gender in thehope of improving treatment outcomes. As the role of spirituality in therecovery process continues to be an area of focus, further research is neededon examining gender differences using other measures of spirituality as theESI-R examined only five dimensions of spirituality. For example, in a reviewof the literature on the relationship between spirituality and alcohol anddrug dependence, Bliss (2007) found that spirituality is a multidimensionalconstruct that can be assessed in many ways and along different dimensionsincluding meaning and purpose in life, relationship with God or a deityfigure, personal values, locus of control, and spiritual well-being, to name buta few. Pursuing this line of research could pave the way for the developmentof more spirituality-based treatment interventions that could be differentiallytargeted toward women and men with the intention of improving treatmentoutcomes for those afflicted with alcohol and drug dependence problems.

REFERENCES

Aldrich, N. J., & Tenenbaum, H. R. (2006). Sadness, anger, and frustration: Genderedpatterns in early adolescents’ and their parents’ emotion talk. Sex Roles, 55, 775–785.

Ardila, A., Rosselli, M., Matute, E., & Inozemtseva, O. (2011). Gender differences incognitive development. Developmental Psychology, 47(4), 984–990.

Ashley, O. S., Marsden, M. E., & Brady, T. M. (2003). Effectiveness of substance abusetreatment programming for women: A review. American Journal of Drug and

Alcohol Abuse, 29, 19–53.Benbow, C. P. (1988). Sex differences in mathematical reasoning ability in intel-

lectually talented preadolescents: Their nature, effects, and possible causes.Behavioral and Brain Sciences, 11, 169–232.

Bliss, D. L. (2007). Empirical research on spirituality and alcoholism: A review of theliterature. Journal of Social Work Practice in the Addictions, 1, 5–25.

Bliss, D. L. (2009). Ethnic differences in spirituality in a sample of men and womenin diverse substance abuse treatment settings: Implications for practitioners.Journal of Ethnicity in Substance Abuse, 8, 413–430.

Brody, L. R. (1985). Gender differences in emotional development: A review oftheories and research. Journal of Personality, 53(2), 102–149.

Bronstein, P., Briones, M., Brooks, T., & Cowan, B. (1996). Gender and family factorsas predictors of late adolescent emotional expressiveness and adjustment: Alongitudinal study. Sex Roles, 34(11/12), 739–765.

Canda, E. R., & Furman, L. D. (1999). Spiritual diversity in social work practice: The

heart of helping. New York, NY: Free Press.

Dow

nloa

ded

by [

Uni

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f W

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ing

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rari

es]

at 1

7:43

18

Sept

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13

36 D. L. Bliss and S. S. Ekmark

Chen, K. W., Comerford, A., Shinnick, P, & Ziedonis, D. M. (2010). IntroducingQigong meditation into residential addiction treatment: A pilot study where gen-der makes a difference. Journal of Alternative and Complementary Medicine,

16, 875–882.Derezotes, D. S. (2006). Spiritually oriented social work practice. Boston, MA: Pear-

son.de Vaus, D. (2002). Analyzing social science data: 50 key problems in data analysis.

London, UK: Sage.DeVellis, R. F. (2012). Scale development: Theory and applications (3rd ed.). Thou-

sand Oaks, CA: Sage.Geary, D. C. (1996). Sexual selection and sex differences in mathematical abilities.

Behavioral and Brain Sciences, 19, 229–284.Goldschmidt, O., & Welter, L. (2000). ‘‘Talking emotions’’: Gender differences in a

variety of conversational contexts. Symbolic Interaction, 23(2), 117–134.Green, C. A. (2006). Gender and use of substance abuse treatment services. Alcohol

Research and Health, 29, 55–62.Green, C. A., Polen, M. R., Lynch, F. L., Dickinson, D. M., & Bennett, M. D. (2004).

Gender differences in outcomes in an HMO-based substance abuse treatmentprogram. Journal of Addictive Diseases, 23, 47–70.

Grella, C. E. (2008). From generic to gender-responsive treatment: Changes in so-cial policies, treatment services, and outcomes of women in substance abusetreatment. Journal of Psychoactive Drugs, 5, 327–343.

Grimm, L. G., & Yarnold, P. R. (2000). Introduction to multivariate statistics. In L. G.Grimm & P. R. Yarnold (Eds.), Reading and understanding more multivariate

statistics (pp. 3–21). Washington, DC: American Psychological Association.Grossman, M., & Wood, W. (1993). Sex differences in intensity of emotional experi-

ence: A social role interpretation. Journal of Personality and Social Psychology

65(5), 1010–1022.Halpern, D. F., Benbow, C. P., Geary, D. C., Gur, R. C., Hyde, J. S., & Gernsbacher,

M. A. (2007). The science of sex differences in science and mathematics. Psy-

chological Science in the Public Interest, 8(1), 1–51.Hedges, L. V., & Nowell, A. (1995). Sex differences in mental test scores, variability,

and numbers of high-scoring individuals. Science, 269, 41–45.Hodge, D. R. (2003). Spiritual assessment: Handbook for helping professionals. Bots-

ford, CT: North American Association of Christians in Social Work.Hodge, D. R. (2006). A template for spiritual assessment: A review of the JCAHO

requirements and guidelines for implementation. Social Work, 51, 317–326.Kimura, D. (1999). Sex and cognition. Cambridge, MA: MIT Press.MacDonald, D. A. (2000a). The Expressions of Spirituality Inventory: Test develop-

ment, validation and scoring information. Detroit, MI: Author.MacDonald, D. A. (2000b). Spirituality: Description, measurement, and relation

to the five factor model of personality. Journal of Personality, 68(1), 153–197.

Marsh, J. C., Cao, D., & Shin, H. C. (2009). Closing the need-service gap: Genderdifferences in matching services to client needs in comprehensive substanceabuse treatment. Social Work Research, 3, 183–192.

Miller, A. S., & Stark, R. (2002). Gender and religiousness: Can socialization expla-nations be saved? American Journal of Sociology, 107(6), 1399–1423.

Dow

nloa

ded

by [

Uni

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ity o

f W

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ing

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rari

es]

at 1

7:43

18

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13

Gender Differences in Spirituality 37

Morgan, O. J. (2002). Spirituality, alcohol and other drug problems. Alcoholism

Treatment Quarterly, 20, 61–82.National Center on Addiction and Substance Abuse at Columbia University. (2007).

Press releases. Retrieved from http://www.casacolumbia.org/templates/NewsRoom.aspx?articleidD617&zoneidD51

Staton-Tindall, M., Oser, C. B., Duvall, J. L., Havens, J. R., Webster J. M., Leukefeld,C. G., & Booth, B. M. (2008). Male and female stimulant use among ruralKentuckians: The contribution of spirituality and religiosity. Journal of Drug

Issues, 38, 863–882.Stewart, C., Koeske, G., & Pringle, J. L. (2007). Religiosity as a predictor of successful

post-treatment abstinence for African-American clients. Journal of Social Work

Practice in the Addictions, 7, 75–92.Sullins, D. P. (2006). Gender and religion: Deconstructing universality, constructing

complexity. American Journal of Sociology, 112(3), 838–880.Tuchman, E. (2010). Women and addiction: The importance of gender issues in

substance abuse research. Journal of Addictive Diseases, 29, 127–138.Weiss, E. M., Kemmlera, G., Deisenhammerb, E. A., Fleischhackera, W. W., & De-

lazer, M. (2003). Sex differences in cognitive functions. Personality and Indi-

vidual Differences, 35, 863–875.

Dow

nloa

ded

by [

Uni

vers

ity o

f W

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ing

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rari

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