Sharon J. Turner

Health 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, denial, 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 12 state:

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.

12. Having 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.

Clearly a sense of life purpose increases with the practice of these two spiritual tenets in continued sobriety.

Without abstinence, full recovery would not be attainable. Additionally, AA is a fellowship and not always a treatment per se.

For the 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 behavioral, social, and denominational grounding. It is also doctrinal specific.

Religion involves a system of worship and a doctrine that is shared within its groupings.

Spirituality 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 life.

Spirituality 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.

Examining 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:

a)    Religion/Spirituality as a protective, discouraging device against alcoholism.

b)    The vulnerability factors in people who begin drinking/drug abuse.

c)    Are there aspects of religion which trigger alcoholism?

d)    The utilization of Spiritual practices in treatment recovery programs.

e)    The effectiveness of spiritually focused interventions.

f)      Investigation as to whether an addict's outlook on spirituality progresses.

g)    The effectiveness of clergy trained in therapy as opposed to non-clerics.

Spirituality 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, 1998).

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).

Alcoholics Anonymous World Services, Inc. 1987. If You are a Professional, A.A. Wants to Work With You. New York: Alcoholics Anonymous World Services.

Sandoz, c., The Spiritual experience in recovery: A closer look. Journal of Ministry in Addiction & Recovery 6 (2): 53-60, 1999.

Yarhouse, 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.
http://www.alcoholics.anonymous.org

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E-mail to Sharon J. Turner> moonpearl00@aol.com