Religion and Spirituality in Psychiatry

Spirituality and Substance Use Disorders 125what he had done, he watched in horroras the mother got out of the car to examinethe remains of her family. His dreamflashed forward, and he saw himself incourt, tortured by the agony of watchingthe mother sobbing. Then he saw himselfin prison, unable to handle the misery hehad imparted on this family. He awoke toreality just as he was losing consciousnessin his dream as a result of hanging fromthe ceiling of his jail cell.From the depths of despair, Jack woke upin a cold sweat and vowed to never drinkor use again. And ten years later, he continuesto keep that promise to himself.In this case study, the issue is not so much howto evoke change or spiritual growth, but ratherthat the clinician should be aware of the natureof such experiences and be prepared to help thepatients understand and integrate the experiencewithin their spiritual framework.Referring Out. Although we are encouragingthe inclusion of spirituality, it is also importantto note that there are times when referring thepatient to someone within a particular religioustradition is acceptable and even advisable.Consider the following example:Jon is a 52-year-old man seeking treatmentfor alcohol dependence. He wasdiagnosed with alcoholic cardiomyopathyand recently informed that the heartdamage and heart failure was irreversibleand that it is unlikely he will survive aheart transplant. During the intake session,Jon tells the therapist that he is adevout Catholic and that he has questionsabout whether or not he has lived a goodenough life to go to heaven and whetherGod will forgive him. The therapist realizesthat Jon is wanting specific answersrelated to a particular religious tradition,so arranges for Jon to meet with a priestonce a week.In this example, the therapist is aware thatthe patient is seeking theological rather thanpsychological questions regarding his religiousbackground and the nature of sin and salvation.For this within-faith intervention that the patientis seeking, the therapist is correct to refer thesequestions to a clergy member. It may be appropriatefor the practitioner to continue to see thepatient for substance abuse treatment in adjunctto seeing the priest for end-of-life questions, andthis should be discussed between patient andtherapist to determine the patient’s needs.7. CONCLUSIONTh e traditions of Alcoholics Anonymous emphasizethe vital importance of spiritual growthand transformation in recovery from substancedependence. Outside of the twelve-step modelof recovery, spirituality is receiving increasedattention, evidenced in both funded researchand etiological and treatment models of addiction.Clinicians and researchers continue to bechallenged by the complexity of defining whatspirituality is (and is not), the perspectives bywhich it is classified, and how to systematicallyintegrate it into addiction treatment. Theauthors have proposed one way of examining thedevelopment of addiction as related to spiritualdeficit and recovery from addiction as related tospiritual growth. Clinicians are encouraged toexplore, encourage, and support patients’ spiritualbackground and desire for spiritual growthand are offered suggestions for how to integratespirituality into the treatment of addictions.REFERENCES1. Cook CH. Addiction and spirituality . Addiction.2004 ; 99 : 539 –551.2. Mi l ler WR , Thoresen CE. Spirituality, health,and the discipline of psychology . Am Psychol .2004 ; 59 . 1 :54–55.3 . D a s s R , G or m a n P. How Can I Help: Storiesand Reflections on Service . New York : Alfred A.Knopf ; 1985.4. May G. Care of Mind/Care of Spirit . San Francisco :Harper Collins ; 1992 .5. AA World S er v ic es : Alcoholics Anonymous: TheStory of How Many Thousands of Men and Women