& Spirituality in Alcoholism Assessment
genuine interest concerning the impact of the existing relationship
of the physical, mental, emotional, social and spiritual
facets of our lives is evolving and penetrating many disciplines.
Physicians as well as other medical scientists have not
acknowledged the roles of religion and spirituality in the
well-being construct. Research is sorely lacking in the
possible benefits, advantages, and phenomena of employing
religion and spirituality in treatment and recovery from
alcoholism and substance abuse addictions.
by Sharon J. TURNER
outcomes cannot be left solely to conventional organic
medicine, and the reliability
of a patient's conduct. It is my belief that to truly
foster the most realistic and honest solutions towards
the efficacy of spirituality in treatment, programs would
have to assume a brave stance in spirituality being the
core of any enduring recovery.
What have we to discourage this concept?
Fundamental steps needed for recovery are inner reflection
and love of self. Can anyone actually prove that meditation
and prayer cannot enfold the addict and help facillitate
religious and spiritual commitment recovery? It can act
as a great discipline in the lifestyle of a recovering
addict. It is quiet, can be done in a number of settings
and situations, and is private. The challenge is to bring
someone with no religious foundation to this threshold
of acceptance. It is uncanny how drinking is encouraged
and accepted, but spirituality may provoke caution.
In this millennium, I would hope to see a sector designed
to stimulate and provide research on the influence of
spirituality, the prevention of alcoholic abuse, and the
maintenance of long-term recovery from alcohol dependence.
A number of disciplines - researchers, theologians/clergy,
health practitioners and treatment professionals would
need to examine spirituality and alcoholism from a multi-disciplinary
perspective. The methodological concepts should be a collaborative
effort between such groups in order to recognize the cross-references,
old and new that would emerge.
Alcoholism is a disease that dominates an individual and
displaces many concerns and responsibilities. We know
that there are genetic and environmental risk factors
that support alcoholism. Religion and spirituality exist
in both the internal and external environment of one's
being. This is a potent consideration in treatment. Spirituality
is not only present in specific religious traditions,
but can be related to attitudes about life's meaning and
purpose. Spirituality promotes a value that people see
in themselves and others. Such an outlook is crucial as
a coping mechanism, and motivating positive behavior.
Research has typically found less alcohol abuse among
people who see themselves as religious than among less
religious people. Spiritual/religious involvement acts
as an important protective factor against alcohol/drug
abuse. Many addicts who fall prey to alcoholism are found
to have a low level of religious involvement, and spiritual
engagement is heavily correlated with recovery (Miller,
1998). We know that the history of alcohol use is intertwined
with religion. Most religious traditions have defined
beliefs about the use of alcohol. There are usually specific
practices regarding the consumption of alcohol.
There are current existing therapies for alcoholism that
rest on a spiritual basis (Sandoz, 1999). Alcoholics Anonymous
(AA) is a worldwide organization that advocates a spiritual
approach in recovery. It is not an advocate of any specific
religious influence although its basic premise has a Christian
sense, in the use of the word God. AA as a social movement stands as the most powerful existing and
enduring of its type. AA bases the role of spirituality
as a mechanism for change. AA has developed an oral tradition
for alcoholics showing them that change will come about
through practice, and not just ideas. It is this confirmation
in fellowship with other addicts that nourishes and supports
their vulnerabilities. This is an enduring mutual self-help
group that demonstrates exactly what religion is - the
foundation of what may not be seen - but what is known
in a shared united belief. Alcoholism is associated with
tremendous suffering, psychological mal-adoption,
and physical and emotional debilitation. Most of this
suffering is rooted in core problems that rule out proper
self-care and self-governance. AA is successful because
it acts as a simple yet sophisticated group psychology
that can effectively define and reach these core psychological
issues. The honesty and openness of AA illustrates how
alcoholics may be similar in their vulnerability, but
unique in their treatment process. Having to speak out
and say, "I am an alcoholic" is a declaration
that opens the heavy gate to recovery. Religion rests
on the premise that you have to come to it in order to be free. While AA is non-scientific,
it and other 12 Step programs have evolved in a set of
attitudes, beliefs and behaviors that clearly facilitate
change in the addict. AA also fosters a healthy dependence
in the alcoholic. In religious and spiritual practices,
a person offers oneself in simple belief and trust. It
must also be noted that spirituality is said to live within
you. An addict may develop spirituality by looking inward,
in order to recognize his/her breadth and potential. Treatment
professionals know of the need for continuing support,
tolerance, and nurturing of the alcoholic.
Within the AA construct of its 12 Steps, Steps 11 and
11. Sought through prayer and meditation to improve our
conscious contact with God as we understand Him, pray
only for knowledge of His will for us and the power to
carry that out.
had a spiritual awakening as the result of these steps,
we tried to carry this message to alcoholics and to practice
these principles in all our affairs.
a sense of life purpose increases with the practice of
these two spiritual tenets in continued sobriety.
abstinence, full recovery would not be attainable. Additionally,
AA is a fellowship and not always a treatment per se.
most part, religion and spirituality are seen as indistinguishable.
I feel that it is safer to say that the two bodies are
distinct, but intertwined. Religion has specific
social, and denominational grounding. It is also doctrinal
involves a system of worship and a doctrine that is shared
within its groupings.
can be viewed as more transcendent, and promotes compassion
toward others. In this age, spirituality has made us question
what more there is to life, other than what we place certain
high values on. Religion actually works to foster a spiritual
is a relevant aspect of religious participation. It is
apparent then that religion and spirituality can be complex
and multi-dimensional. There are different domains of
each that that are relevant in health and health outcomes.
The domains I refer to would be values, beliefs, forgiveness,
coping, commitment, and daily spiritual experience.
these characterizations of religion and spirituality is
a starting point for investigation
on alcoholism treatment in these domains. The research
focus would have to be on specific aspects of religion
and spirituality that are relevant to treatment.
Appropriate topics for investigation might be:
Religion/Spirituality as a protective,
discouraging device against alcoholism.
The vulnerability factors in people who
begin drinking/drug abuse.
Are there aspects of religion which trigger
The utilization of Spiritual practices
in treatment recovery programs.
The effectiveness of spiritually focused
as to whether an addict's outlook on spirituality progresses.
The effectiveness of clergy trained in
therapy as opposed to non-clerics.
is now receiving greater attention in medical literature,
especially in the family
practice journals. There is a new instrument called the
Spiritual Involvement and Beliefs Scale, which has been
widely designed to be widely applicable across religious
traditions, to access actions as well as beliefs, to address
key components not assessed in other available measures,
and to be easily administered and scored. This instrument
is a questionnaire of 26 items that was administered to
50 family practice patients and 33 family practice educators.
Instrument reliability and validity are very good, with
high internal consistency (Hatch, Burg, Naberhaus, Hellmich,
Alcoholics Anonymous has developed an oral tradition for
teaching people to alter their relation to their own desires
and their freedom, teaching that this is done through
oral declaration and steadfast practice. The same tools
that have built this organization exemplify an ethical
worldview. AA supports the disease model of alcoholism
while remaining a spiritual program. AA stands on a significant
terrain that is not considered by the medical community.
In maintaining their practices, AA has combined the experience
of total transformation, characteristic of a religious
conversion. The slogans of AA are in actuality mental
techniques for dealing with the challenges of daily life,
whether addicted or not. It is my feeling that treatment
professionals can become more effective and relevant when
they understand that many patients hold religious values.
More awareness of this
sector in their lives may aid the clinician's efforts
in providing more accurate assessments and treatment plans
(Yarhouse, VanOrman, 1999).
Anonymous World Services, Inc. 1987. If You are a Professional,
A.A. Wants to Work With You. New York: Alcoholics
Anonymous World Services.
R.L., Burg, M.A., Naberhaus, D.S., Hellmich, L.K. The spiritual
involvement and beliefs scale: Development and testing of
a new instrument. Journal of Family Practice 46 (6)
Hartigan, Francis. Bill W: A Biography of Alcoholics Anonymous
Co-founder Bill Wilson, 1st ed., New York: Thomas Dunne
Books/St.Martin's Press, 2000.
Jelinek, E. Alcoholism and the Book of Proverbs: A look
at alcoholism as shown in Proverbs 23: 29-35. Journal of
Ministry in Addiction & Recovery 5 (2): 65-74, 1998.
W.R. Researching the spiritual dimensions of alcohol and
other drug problems. Addiction 93 (7): 979-990.
c., The Spiritual experience in recovery: A closer look.
Journal of Ministry in Addiction & Recovery
6 (2): 53-60, 1999.
M.A., VanOrman, B.T., When psychologists work with religious
clients: Applications of the general principles of ethical
conduct. Professional Psychology: Research and Practice
30(6): 557-562, 1999.
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E-mail to Sharon J. Turner> firstname.lastname@example.org