Religion and Spirituality in Psychiatry

9 Spirituality and Substance Use DisordersALYSSA A. FORCEHIMES AND J. SCOTT TONIGANSUMMARYSpiritual values and meanings are importantdeterminants and regulators of behavior, and atreatment model that recognizes this componentoffers a more integrated view of how to best treataddiction. The authors of this chapter approachthe interface of spirituality and addiction fromthe premise that individuals possess a fundamentaldesire for meaning and purpose – componentscentral to spirituality – and that the difficulty infulfilling these needs sometimes results in destructivemethods of coping, including the problematicuse of substances. The authors propose a modelof how spirituality is involved in the developmentand recovery of addiction. We then reviewrelevant research literature and current methodologicalquestions that consider spirituality as anindependent, dependent, moderating, or mediatingvariable. Finally, clinical and practical implementationswill be discussed and augmented withcase studies.1. INTRODUCTIONConceptions of spirituality and addiction areintimately tied together in the United States.Twelve-step programs, founded on the doctrineand prescribed spiritual practices of AlcoholicsAnonymous (AA), are the dominant models forrecovery from addiction. Therefore, it is hard tospeak about addiction without speaking aboutspirituality.Spirituality is also addiction’s Tower of Babel.There is little consensus among both professionalsand laypersons as to what spirituality is, how itrelates to religion, how it should be measured, howit relates to recovery from substance use disorders,where it belongs in formal treatment, and howrelevant it is for recovery. Strong opinions havebeen voiced both for and against the inclusion ofspirituality in addiction treatment. Some arguethat it is one of the most important resources bywhich people achieve and maintain sobriety, whileothers argue that including spirituality within formaltreatment or mandating patients to twelvestepprograms is unconstitutional and challengesthe separation of church and state. Overall, then,spirituality has been a significant source of conflictwithin the treatment of substance use disorders,and consequently, clinicians fall along thespectrum in deciding to either emphasize or avoiddiscussing this subject with patients.Th is is an evidence-based chapter intended tohelp guide clinical practice. The authors beginwith a definition of spirituality. We then proposea model for understanding the role of spiritualityin the development and recovery from addictionas one way practitioners might understand thisinterface. We present the roots of the long-standinginterface between spirituality and addictionas stemming from the twelve-step model, rootedin spiritual practice and beliefs. Included in theoverview of the twelve-step model is a discussionof the frequency and magnitude of spiritualtransformations that are often experienced byindividuals during the process of recovery fromaddiction. We also present studies that haveattempted to move outside of the twelve-stepmodel and systematically incorporate spiritualdisciplines as an intervention for addiction. Wethen engage the reader in some of the currentdebates concerning the interface of spirituality114