Religion and Spirituality in Psychiatry

Spirituality and Substance Use Disorders 123between-faith interventions. It is also importantfor providers to be aware of referral sources andknowledgeable of local religious or spiritual leadersfor consultation or referral purposes.Given the lack of empirical data on the effectivenessof addiction counselors delivering spiritualguidance, it is important to consider howmuch expertise and knowledge the patient isseeking and or expecting from the practitioner.Practitioners must consider the possibility that aspiritual intervention may require the practitionerto be in more of an expert role and that providersneed to have a sufficient level of expertisein the area of spirituality before addressing thisissue with patients.6.3. How to Raise the Issue of SpiritualityThe question of how to raise the issue of spiritualitywith patients is a primary difficulty for practitionersand patients in addiction treatment. Somepatients may not frame their dilemma as a spiritualone, others may have grown up without a spiritualvocabulary, and others may bear still-painful scarsof exposure to toxic religion. Whatever the reason,many patients who wish to discuss spiritual issuesmay not know where to begin. Similarly, manyproviders struggle with how to raise this issue duringassessment and treatment.Open questions are a good place to start, becausethese questions challenge patients to reflect and toexplore. Answering an open question requires notonly content, but also some processing and organizationof information. The provider thereforelearns not only facts, but also something of howthe person organizes meaning. These questionsare appropriate during the clinical interview partof an assessment or during an intake or followupsession as the provider begins to piece together thepatient’s narrative. Some examples of open questionsto begin exploration of this area are■■■What is your view of spirituality?To what/whom are you most committed inlife?How do you understand the relationshipbetween spirituality and addiction?■■How do you understand your purpose in life?What would you like to be different in yourspiritual life a year from now?6.4. When to Raise the Issueof SpiritualityAside from mutual-help recovery programs, formaltreatment programs rooted in a twelve-stepmodel and specific treatments linking patientswith twelve-step programs (for example, TwelveStep Facilitation), there is not an empiricallybased systematic approach for integrating spiritualityin treatment. Therefore, there is littleresearch regarding the timing of when a discussionof spirituality should be initiated or whenspiritual growth should be encouraged.Th e severity of the patient’s substance usedisorder may play a role in determining themost appropriate time to begin a discussion ofspiritual issues. Findings from two recent clinicaltrials of a spiritual intervention delivered inan inpatient addiction treatment setting (Miller,Forcehimes, et al., in press) suggest that introducingspiritual exploration too early in treatmentmay be counterproductive. According toMaslow’s (52) theory, people tend to fulfill needsin the hierarchical order of survival, safety, loveand belongingness, esteem, self-actualization,and finally spiritual or transcendence needs.Perhaps, for individuals who are early in therecovery process, other needs are prioritizedabove spiritual ones, and the timing was notappropriate to attempt to facilitate spiritualgrowth. Severely substance-dependent individualsseeking treatment are often unemployed,lacking adequate social networks, strugglingwith housing and financial stressors, experiencingsignificant relationship conflicts, and oftenhaving complicated concurrent medical issuessecondary to their substance use disorder.For these reasons, the authors suggested thatpatients’ basic needs of safety, love, and survivalwere of greater necessity than working towardspiritual growth and that the intervention mighthave been better suited to aftercare.