Religion and Spirituality in Psychiatry

Spirituality and Substance Use Disorders 115and religion, including a discussion of how spiritualitycan be classified as an independent, dependent,moderating, or mediating variable. Finally,the authors highlight clinical implementations ofwhy, who, how, and when clinicians should discussspirituality with patients in addiction treatment.The empirical and theoretical findings areaugmented with case studies.2. DEFINING SPIRITUALITYThe topic of spirituality is receiving increasedattention in addiction research, evidenced bya steady escalation in publications and fundedresearch since 1980.(1) Within the research literature,however, there is lack of clarity in thedefinition of spirituality. It is often confused withreligion even though spirituality and religion aredistinct constructs.(2)In a review of the literature on addiction andspirituality, Cook examined 265 publications toidentify the definition of spirituality by differentauthors.(1) Cook found that only 12 percent ofthe papers explicitly defined the term spirituality ,32 percent offered a description of the concept ofspirituality, 12 percent defined a related concept(such as “the spiritually healthy person”), and 44percent of the papers left the term spiritualityundefined. Breaking the conceptual content of thedefinitions into component parts, Cook classifiedthe content of the various definitions into thirteenconceptual components.(1) Cook found thatthe four components that were encountered mostfrequently and were most central to the definitionof spirituality were transcendence, relatedness,core/force/soul, and meaning/purpose.(1) Onthe basis of Cook’s descriptive analyses, a workinghypothesis definition was proposed. Cook’sdefinition (1) highlights the main components ofhow spirituality is understood within the addictionliterature:Spirituality is a distinctive, potentially creativeand universal dimension of humanexperience arising both within the innersubjective awareness of individuals andwithin communities, social groups, andtraditions. It may be experienced as relationshipwith that which is intimately“inner,” immanent and personal, withinthe self and others, and/or as relationshipwith that which is wholly “other,” transcendentand beyond the self. It is experiencedas being of fundamental or ultimate importanceand is thus concerned with mattersof meaning and purpose in life, truth andvalues (pp. 548–549).3. THEORETICAL RATIONALE FOR THERELATIONSHIP BETWEEN SPIRITUALITYAND ADDICTION3.1. The Role of Spirituality in theDevelopment of AddictionThere is, in human nature, a desire to connectwith that which is beyond the self; that whichgives life meaning. Despite this yearning, individualsare distracted from spiritual seeking asthey are pulled toward the material world andoffered alternative ways to silence this spirituallonging. Ram Dass (3) wrote:It’s not difficult to recognize how deep arethe ways our mind has been conditionedto deal with unpleasant situations by resistingthem. Throughout our whole lives wehave been encouraged to do anything wecan to escape from rather than to exploreand investigate unpleasantness. … It’s notjust physical pain we try to avoid, but allkinds of unpleasant conditions: boredom,restlessness, self-doubt, anger, loneliness,loss, feelings of unworthiness. In our culturewe do all we can to push these experiencesaside, or keep them at a distance. Wechoose to be entertained. (1985, p. 79)Enticed by the temporary comfort that isoffered through the use of a substance, an individualbegins to see substance use as the shortcutto wellbeing. Gerald May (4) wrote, “If Godindeed creates us in love, of love, and for love,