Religion and Spirituality in Psychiatry

Spirituality and Substance Use Disorders 121and increase personal spiritual practices duringfollow-up, which, in turn, would affect substanceuse outcomes. In both trials, however, contraryto prediction, spiritual guidance had no effect onspiritual practices or substance use outcomes atany follow-up point.5.2. Spirituality as a Dependent VariableRobinson, Cranford, Webb, and Brower (39)reported significant six-month changes in spiritualand religious practices, daily spiritual experiencesand forgiveness, positive religious coping,and purpose in life among their sample of substanceabusers attending AA. Likewise, in ProjectMATCH, for example, 27.6 percent (n = 108) ofthe outpatient clients who attended AA during thetwelve weeks of treatment (N = 391) also reportedhaving had a spiritual awakening as a result oftheir AA attendance. In the aftercare sample, 569clients reported attending some AA during treatmentof which 29.3 percent (n = 167) reporteda spiritual awakening in connection with AAattendance. (37) Strong evidence, across diversemeasures of religiousness and spirituality, documentsspiritual increases among AA members.5.3. Spirituality as a Moderator VariableA number of studies have investigated whetherindividual spiritual/religious beliefs and practicespredispose a person to use spiritual-basedinterventions and, if so, whether they receivedifferential and improved benefit by attendingsuch programs. Schermer and colleagues, (40)for example, reported that self-reported atheistswere significantly less likely to attend AA relativeto self-reported agnostics, spiritual, and religiouspersons. Interestingly, however, atheists who didattend AA reported equal benefit as religious andspiritual alcoholics. Likewise, Connors et al.(37)theorized that more spiritual/religious alcoholicswould fare better when they received twelve-stepfacilitation therapy relative to cognitive behavioralor motivational enhancement therapy.Here, they reasoned that enhanced comfort withthe therapeutic orientation of the spiritual-basedtwelve-step therapy would produce improvedoutcomes. Contrary to predictions, neither compliancewith therapy nor drinking outcomes differedfor matched and mismatched alcoholics.More recently, Kelly et al.(41) reported that spiritualand religious beliefs of a sample of 160 adolescentinpatient substance abusers was unrelatedto frequency of AA meeting attendance over aneight-year follow-up.5.4. Spirituality as a Mediator VariableIt is possible that spirituality influences thecausal pathway through a reduction of behavioralrisks brought about by the promotion of ahealthier lifestyle.(42) Spiritual disciplines, particularlythose offering complex beliefs abouthuman relationships, ethics, and life and death,are directly relevant to health, and spiritual feelingsand thoughts might enhance coping skills.For instance, Krause (43) found that spiritualbeliefs and practices were associated with higherself-esteem and feelings of self-worth, particularlyamong older adults. Ellison (44) reported asimilar finding, indicating that individuals witha strong faith report feeling happier and moresatisfied with their lives. Idler et al.(45) reported“spiritual interpretations of difficult circumstancesmay have the power to bring individualsto a state of peace of acceptance of a situation thatcannot be altered and give them the ability to livewith it” (p. 333).Research support has also been found forphysiological mechanisms that are alteredthrough spiritual practices. Benson (46) foundthat certain spiritual practices (that is, prayer andmeditation) elicited a “relaxation response,” anintegrated physiological reaction in oppositionto the “stress response.” This response resulted ina lowering of individuals’ blood pressure, heartrate, and changes in brain wave activity.Another possible mechanism is a social functionthat is altered through spiritual practices.Perhaps spirituality operates through an expansionof one’s social support network by providinga sense of friendship and emotional support, suchas that provided in a setting such as Alcoholics