The Personality of the Alcoholic through Seven Perspectives.

The different personalities of alcoholics are expressed in the way they manifest certain traits of their personality. In addition to knowing the general and common characteristics of alcoholics, it is even more important for clinical practice to know the differences between them, thus allowing a personalized approach to each patient, as a unique personality. The division of the personalities of alcoholics may be viewed through the prism of seven perspectives: the disease perspective, the dimensional perspective, the cognitive-anxiety perspective, the behavioral perspective, the spiritual/transcendent perspective, the narrative and the systemic perspective. Each of these perspectives more clearly represents part of the personality of the alcoholic; together they give a clearer picture of the problem and accordingly offer different treatment options.

Self-defining memories related to alcohol dependence and their integration in the construction of the self in a sample of abstinent alcoholics.

Using a self-defining memory task, this work studies the exact moment in which abstinent alcoholics perceived themselves as addicted. Phenomenological variables involved in the memory were obtained asking participants to evaluate their cognitions, perceptions and emotions associated with that self-defining memory. The sample consisted of 12 female and 31 male ex-alcoholics, with abstinence ranging from 6 months to 23 years. Mean age was 52.91 years. Our findings showed that awareness of the alcoholic self emerges in the context of uncontrolled consumption or an ultimatum from family members. This type of memory had a positive valence for most of the participants, regardless of the memory perspective (actor versus spectator). Those who remembered from an actor perspective, perceived the event as providing higher growth and personal learning. These results show the importance of exploring situations of uncontrolled consumption and family dynamics in the self-recognition of alcohol dependence. In addition, reinforcing an actor perspective compared to a spectator perspective might results in higher levels of personal enrichment, which may help maintain a patient's long-term recovery. These results support the use of autobiographical memory techniques to enhance awareness of the addicted self, and suggest the need to include these interventions in rehabilitation programmes.

Emotional Communication in Long-Term Abstained Alcoholics.

BACKGROUND: Alcoholism is associated with difficulties in perceiving emotions through nonverbal channels including prosody. The question whether these difficulties persist to long-term abstinence has, however, received little attention. METHODS: In a 2-part investigation, emotional prosody production was investigated in long-term abstained alcoholics and age- and education-matched healthy controls. First, participants were asked to produce semantically neutral sentences in different emotional tones of voice. Samples were then acoustically analyzed. Next, naïve listeners were asked to recognize the emotional intention of speakers from a randomly collected subset. Voice quality indicators were also assessed by the listeners. RESULTS: Findings revealed emotional prosody production differences between the 2 groups. Differences were particularly apparent when looking at pitch use. Alcoholics' mean and variability of pitch differed significantly from controls' use. The use of loudness was affected to a lesser extent. Crucially, naïve raters confirmed that the intended emotion was more difficult to recognize from exemplars produced by alcoholics. Differences between the 2 groups were also found with regard to voice quality. CONCLUSIONS: These results suggest that emotional communication difficulties can persist long after alcoholics have quit drinking.

P3 Component as a Potential Endophenotype for Control Inhibition in Offspring of Alcoholics.

AIMS: To assess inhibitory processes and the ongoing event-related potential (ERP) activity of offspring of alcoholics (OA) during a Go/No-Go task, with the purpose of characterizing possible psychophysiological endophenotypes for alcohol-dependent vulnerability. SHORT SUMMARY: EEG recordings and ERP measurements of young adults with positive and negative family history of alcoholism where obtained while they performed a Go/No-Go task to assess inhibitory processes. Offspring of alcoholics showed a different ERP pattern compared to the control group and exerted greater effort than the control group. METHODS: ERP measurements were obtained by electroencephalogram (EEG) recordings of 65 participants divided into two groups: one group of 30 subjects with positive family history of alcoholism and a control group of 35 subjects with negative family history of alcoholism. They performed a Go/No-Go task, where each individual was required to classify visual stimuli by colour (Go) and inhibit their response to a No-Go signal. RESULTS: OA have higher P3 amplitudes during the Go condition in all of the regions analysed and higher No-Go P3 amplitudes than control subjects in the frontal region. Unlike controls, OA have no differences between the P3 amplitudes across conditions. CONCLUSIONS: The absence of differences between the P3 Go and No-Go observed in the OA group can be interpreted as a possible alteration related with inhibition, in a way that they may need to recruit similar resources for inhibitory and classificational processes for both conditions. Therefore, the P3 component may be considered as a useful endophenotype and a vulnerability marker to develop addictive behaviour.

Elderly alcoholics compared to middle-aged alcoholics in outpatient treatment - 6-month follow-up.

PURPOSE: This study examined 6-month drinking outcomes of elderly patients compared with middle-aged patients in a clinical sample after initiation of outpatient treatment for alcoholism. MATERIALS AND METHODS: In a clinical prospective cohort study, 1398 consecutive patients from a municipality outpatient alcohol clinic were included. A total of 208 elderly patients aged from 60 to 82 years and 1190 middle-aged patients from 40 to 59 years participated in the study. The following psychosocial treatment interventions were offered: cognitive behavioral therapy, family therapy and supportive consultations. Using an 'intention-to-treat' method, primary outcomes included drinking outcomes (self-reported abstinence rates, drinking 3 drinks or less per day, and change in Addiction Severity Index [ASI] composite scores) during the 30 days prior to 6-month follow-up; secondary outcome was compliance to the recommended treatment. RESULTS: Compared to middle-aged, among elderly patients a higher proportion were females (33.5% vs. 42.8%) and had a lower family/social ASI-composite score (0.17 vs. 0.12) at baseline. Higher alcohol and family/social ASI-composite scores were inversely correlated with abstinence. Elderly patients had a higher chance for abstinence compared to middle-aged patients (Odds ratio 95% [confidence interval]) 1.40 (1.03-1.92). The proportion of elderly patients that drank 3 or less drinks per day was 17.8%, compared to 10.8% among middle-aged (p < .01). Finally, elderly patients obtained a higher compliance, which was similarly associated with abstinence (OR =2.46 (1.95-3.11)). DISCUSSION AND CONCLUSIONS: Elderly patients, who receive psychosocial outpatient treatment for alcoholism, have better 6-month outcomes within a range of drinking outcome measures compared to middle-aged patients.

Comparison of ego strength between aggressive and non-aggressive alcoholics: a cross-sectional study.

AIM: To determine the differences between aggressive and non-aggressive alcoholics in sociodemographic and clinical characteristics and ego strength. METHODS: This cross-sectional study included 111 aggressive and 123 non-aggressive male alcoholics aged between 25 and 60 years who were admitted to the Department for Alcoholism, University Psychiatric Hospital Vrapce, Zagreb, Croatia, from January to December 2016. All participants met the diagnostic criteria for alcohol dependence according to the Croatian Mini International Neuropsychiatric Interview (MINI), 4th revised edition of Diagnostic and Statistical Manual of Mental Disorders, and the International Classification of Diseases. Participants were clinically assessed by an experienced psychiatrist using a clinical interview, MINI, Questionnaire from the Brown-Goodwin Lifetime History of Aggression, and Ego Identity Scale (EIS) according to Erikson. A clinical psychologist performed cognitive function measurements. EIS scores were analyzed using one-way analysis of variance. RESULTS: In comparison with non-aggressive alcoholics, aggressive alcoholics were more often divorced, unemployed, hospitalized, and first treated for alcoholism at an earlier age (P<0.05 for all). They more frequently experienced depression (42.4% vs 19.4%, P=0.013) and attempted suicide (34.7% vs 6.2%, P=0.003), achieved a lower level of maturity at the second stage of psychosocial development related to shame and doubt (14.0±4.1 vs 17.4±3.7, P=0.013) and at the fourth stage related to inferiority (13.1±6.8 vs 18.1±9.3, P=0.011), and had lower total EIS score (75.8±20.4 vs 85.2±21.5, P<0.012) than non-aggressive alcoholics. CONCLUSION: Aggressive alcoholics had weaker ego-strength than non-aggressive alcoholics, experienced more depressive reactions and suicide attempts, and showed poorer psychosocial functioning. Oxford Centre for Evidence-based Medicine level of evidence: 3*.

Etiology of Teen Dating Violence among Adolescent Children of Alcoholics.

Family processes in early life have been implicated in adolescent involvement in teen dating violence, yet the developmental pathways through which this occurs are not well understood. In this study, etiological pathways from parental psychopathology and marital conflict in infancy to involvement in dating violence in late adolescence were examined in a sample of children at high-risk due to parental alcohol problems. Families (N = 227) recruited when the child was 12 months of age were assessed at 12-, 24-, 36-months, kindergarten, 6th, 8th, and 12th grades. Slightly more than half of the children were female (51%) and the majority were of European American descent (91%). Parental psychopathology in infancy was indirectly associated with teen dating violence in late adolescence via low maternal warmth and self-regulation in early childhood, externalizing behavior from kindergarten to early adolescence, and sibling problems in middle childhood. Marital conflict was also indirectly associated with teen dating violence via child externalizing behavior. Maternal warmth and sensitivity in early childhood emerged as an important protective factor and was associated with reduced marital conflict and increased child self-regulation in the preschool years as well as increased parental monitoring in middle childhood and early adolescence. Family processes occurring in the preschool years and in middle childhood appear to be critical periods for creating conditions that contribute to dating violence risk in late adolescence. These findings underscore the need for early intervention and prevention with at-risk families.

Salient cues improve prospective remembering in Korsakoff's syndrome.

OBJECTIVE: Korsakoff's syndrome is characterized by deficits in episodic memory and executive functions. Both cognitive functions are needed to remember to execute delayed intentions (prospective memory, PM), an ability that is crucial for independent living in everyday life. So far, PM has only been targeted by one study in Korsakoff's syndrome. This study explored the effects of executive control demands on PM to shed further light on a possible interdependence of memory and executive functions in Korsakoff's syndrome, METHOD: Twenty-five individuals with Korsakoff's syndrome and 23 chronic alcoholics (without amnesia) performed a categorization task into which a PM task was embedded that put either high or low demands on executive control processes (using low vs. high salient cues). RESULTS: Overall, Korsakoff patients had fewer PM hits than alcoholic controls. Across groups, participants had fewer PM hits when cues were low salient as compared to high salient. Korsakoff patients performed better on PM when highly salient cues were presented than cues of low salience, while there were no differential effects for alcoholic controls. CONCLUSIONS: While overall Korsakoff patients' showed a global PM deficit, the extent of this deficit was moderated by the executive control demands of the task applied. This indicated further support for an interrelation of executive functions and memory performance in Korsakoff. PRACTITIONER POINTS: Positive clinical implications of the work Prospective memory (PM) performance in Korsakoff's syndrome is related to executive control load. Increasing cues' salience improves PM performance in Korsakoff's syndrome. Salient visual aids may be used in everyday life to improve Korsakoff individuals' planning and organization skills. Cautions or limitations of the study Results were obtained in a structured laboratory setting and need to be replicated in a more naturalistic setting to assess their transferability to everyday life. Given the relatively small sample size, individual predictors of PM performance should be determined in larger samples.

Living with appending a scarlet letter: The lifelong suffering of children of alcoholics in South Korea.

Children of alcoholics (COAs) are those who have grown up with parental alcoholism. The purpose of this study was to understand the lives of Korean COAs within a Korean cultural context, influenced by Confucianism. Prior literature has extensively reported about the adverse life experiences of COAs related to their alcohol dependent parents. Indeed, most of these studies assume the U.S.- or Western-centric perspective. However, in order to provide culture-specific care, health professionals who provide care for diverse ethnic families have to understand the cultural influences on the families which have an ill family member. Data were collected from 20 Korean adult children through semi-structured interviews. All interviews were audio-recorded and fully transcribed. Thematic analysis was used for the data analysis. The lives of Korean COAs were described with four themes, namely: "Losing family," "Life with holding a bomb," "My life ruined," and "Being bound." CONCLUSION: In conclusion, the findings of this study demonstrated how cultural components could shape individual's life experiences in a family having an alcohol dependent family member. This study would be helpful for health professionals to deeply understand the alcoholic family members within a specific cultural background as well as to build a cultural-specific care-plans for them.

Impairments in learning by monetary rewards and alcohol-associated rewards in detoxified alcoholic patients.

BACKGROUND: Excessive alcohol consumption has been linked to structural and functional brain changes associated with cognitive, emotional, and behavioral impairments. It has been suggested that neural processing in the reward system is also affected by alcoholism. The present study aimed at further investigating reward-based associative learning and reversal learning in detoxified alcohol-dependent patients. METHODS: Twenty-one detoxified alcohol-dependent patients and 26 healthy control subjects participated in a probabilistic learning task using monetary and alcohol-associated rewards as feedback stimuli indicating correct responses. Performance during acquisition and reversal learning in the different feedback conditions was analyzed. RESULTS: Alcohol-dependent patients and healthy control subjects showed an increase in learning performance over learning blocks during acquisition, with learning performance being significantly lower in alcohol-dependent patients. After changing the contingencies, alcohol-dependent patients exhibited impaired reversal learning and showed, in contrast to healthy controls, different learning curves for different types of rewards with no increase in performance for high monetary and alcohol-associated feedback. CONCLUSIONS: The present findings provide evidence that dysfunctional processing in the reward system in alcohol-dependent patients leads to alterations in reward-based learning resulting in a generally reduced performance. In addition, the results suggest that alcohol-dependent patients are, in particular, more impaired in changing an established behavior originally reinforced by high rewards.

Social cognition deficits and associations with drinking history in alcoholic men and women.

BACKGROUND: Previous studies have demonstrated the presence of a social cognition factor as an element of general cognition in healthy control and clinical populations. Recently developed measures of social cognition include the social perception and faces subtests of the Wechsler Advanced Clinical Solutions (ACS) Social Cognition module. While these measures have been validated on various clinical samples, they have not been studied in alcoholics. Alcoholism has been associated with emotional abnormalities and diminished social cognitive functioning as well as neuropathology of brain areas underlying social processing abilities. We used the ACS Social Perception and Faces subtests to assess alcoholism-related impairments in social cognition. METHODS: Social cognitive functioning was assessed in 77 abstinent alcoholic individuals (37 women) and 59 nonalcoholic control participants (29 women), using measures of the ACS Social Cognition module and subtests of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) that contain a social cognition component (Picture Completion and Comprehension). Group and gender differences in ACS and WAIS-IV performance were assessed, as well as relationships between measures of alcoholism severity and social cognitive functioning. RESULTS: Alcoholics performed significantly worse than nonalcoholics on the ACS measures of Affect Naming and Faces Content. Alcoholic men were impaired relative to alcoholic women on Prosody Face Matching and Faces Content scores. Among alcoholics, longer durations of heavy drinking were associated with poorer performance on Affect Naming, and a greater number of daily drinks were associated with lower Prosody Face Matching performance. For alcoholic women, a longer duration of abstinence was associated with better performance on Affect Naming. CONCLUSIONS: Alcoholic men and women showed different patterns of associations between alcoholism indices and clinically validated social cognition assessments. These findings extend into the social cognition domain, previous literature demonstrating the presence of cognitive deficits in alcoholism, their association with alcoholism severity, and variability by gender. Moreover, because impairments in social cognition can persist despite extended abstinence, they have important implications for relapse prevention.

Impact of alcohol-related video sequences on functional MRI in abstinent alcoholics.

The object of this study was the identification of brain areas that were significantly more connected than other regions with a previously identified reference region, the posterior cingulate cortex, during the presentation of visual cues in alcoholics. Alcohol-related and neutral video sequences were presented to 30 alcoholics who had been abstinent for at least 4 days. Participants underwent a psychometric assessment before and after the presentation of the video sequences. Functional MRI data were acquired. Psychophysiological interaction analyses were carried out. Participants reported a significant increase in craving and arousal after the presentation of alcohol-related video sequences. The simple contrast alcohol versus neutral was found not to be significantly different in the present study. The brain regions that were found to correlate significantly more with the posterior cingulate cortex under the alcohol-related condition were the inferior parietal lobe, the medial temporal lobe, the inferior frontal gyrus, the postcentral gyrus, and the precuneus. The involvement of these regions in processes of memory, self-control, and self-reflection with a particular focus on alcohol dependence and craving will be discussed.

Addiction, drinking behavior, and driving under the influence.

Using a survey of drinkers (N = 1,634), we evaluated alternative explanations of heavy and binge drinking, driving under the influence (DUI), DUI arrests, speeding citations, and chargeable accidents. Explanations included socializing, short-term decision-making, unrealistic optimism, risk preferring behavior, and addiction. Most consistent relationships were between substance use and alcohol addiction and dependent variables for (1) binge drinking and (2) DUI episodes. Respondent characteristics (age, marital and employment status, race, etc.) had important roles for DUI arrests. Drinker-drivers and those arrested for DUI are partially overlapping groups with implications for treatment and policies detecting and incapacitating persons from drinking and driving.

Nucleus accumbens response to incentive stimuli anticipation in children of alcoholics: relationships with precursive behavioral risk and lifetime alcohol use.

Children of alcoholics (COAs) are at elevated risk to develop alcohol and other substance use disorders. The neurobiological underpinnings of this heightened vulnerability are presently not well understood. This study investigated whether, in humans, COAs have different functioning of the mesolimbic reward circuitry beyond previous substance use confounds and examined potential group differences in neural response in relation to alcohol use and behavioral risk. We studied 20 18- to 22-year-old COAs and 20 controls, developmentally well characterized for substance use and selected to match on sex, age, IQ, lifetime substance use and associated problems, and precursive (ages 12-14 years) externalizing behavioral risk. None met criteria for Diagnostic and Statistical Manual of Mental Disorders IV diagnosis. Neural responses to anticipation of reward and loss were assessed using functional magnetic resonance imaging during a monetary incentive delay task. Overall, COAs showed reduced ventral striatum activation during anticipation of monetary reward and loss compared with controls. However, additional analysis revealed that blunted nucleus accumbens (NAcc) response was only observed in COAs who have not demonstrated any problem drinking behavior. In addition, uniquely in COAs, NAcc activation was positively correlated with precursive externalizing risk, as well as current and lifetime alcohol consumption. These findings suggest a multilevel developmental process whereby lower precursive behavioral risk appears protective of later problem alcohol use in COAs, which is further associated with a blunted NAcc response to incentive anticipation, potentially reflecting a resilience mechanism. Moreover, the results suggest that a close association between motivational responses, alcohol consumption, and behavioral risk may underlie addiction vulnerability in COAs.

Increased receptor for advanced glycation end product expression in the human alcoholic prefrontal cortex is linked to adolescent drinking.

Adolescence is characterized behaviorally by increased impulsivity and risk-taking that declines in parallel with maturation of the prefrontal cortex and executive function. In the brain, the receptor for advanced glycation end products (RAGE) is critically involved in neurodevelopment and neuropathology. In humans, the risk of alcoholism is greatly increased in those who begin drinking between 13 and 15years of age, and adolescents binge drink more than any other age group. We have previously found that alcoholism is associated with increased expression of neuroimmune genes. This manuscript tested the hypothesis that adolescent binge drinking upregulates RAGE and Toll-like receptor (TLR) 4 as well as their endogenous agonist, high-mobility group box 1 (HMGB1). Immunohistochemistry, Western blot, and mRNA analyses found that RAGE expression was increased in the human post-mortem alcoholic orbitofrontal cortex (OFC). Further, an earlier age of drinking onset correlated with increased expression of RAGE, TLR4, and HMGB1. To determine if alcohol contributed to these changes, we used an adolescent binge ethanol model in rats (5.0g/kg, i.g., 2-day on/2-day off from postnatal day [P] 25 to P55) and assessed neuroimmune gene expression. We found an age-associated decline of RAGE expression from late adolescence (P56) to young adulthood (P80). Adolescent intermittent ethanol exposure did not alter RAGE expression at P56, but increased RAGE in the young adult PFC (P80). Adolescent intermittent ethanol exposure also increased TLR4 and HMGB1 expression at P56 that persisted into young adulthood (P80). Assessment of young adult frontal cortex mRNA (RT-PCR) found increased expression of proinflammatory cytokines, oxidases, and neuroimmune agonists at P80, 25days after ethanol treatment. Together, these human and animal data support the hypothesis that an early age of drinking onset upregulates RAGE/TLR4-HMGB1 and other neuroimmune genes that persist into young adulthood and could contribute to risk of alcoholism or other brain diseases associated with neuroinflammation.

Decoding of emotional components in complex communicative situations (irony) and its relation to empathic abilities in male chronic alcoholics: an issue for treatment.

BACKGROUND: Previous research has shown that deficits in the domain of emotions strongly characterize alcoholism. Patients diagnosed with alcoholism show impairments in emotional mimic recognition, as well as in the domain of emotional prosody. These data suggest that male alcoholics might suffer from a generalized emotional impairment associated with dysfunctions in empathy. Taken altogether, those deficits might influence alcoholics' relational domain and their performance in complex communicative situations such as ironic interactions. The present study investigates the ability of chronic male alcoholics to recognize the emotional component of ironic contexts and its relation to the comprehension of ironic meaning as a function of their empathic abilities. METHODS: Forty-four male subjects participated in a story comprehension task. They were asked to read stories with either an ironic or a nonironic ending. Participants were asked to fill in a questionnaire about communicative intentions and the emotional states of the stories' characters. Moreover, the correct comprehension of the ironic meaning was assessed through a self-reported questionnaire and related to the empathy quotient (EQ) which was measured in a preexperimental phase. RESULTS: Alcoholic subjects showed a lower EQ in comparison to healthy subjects and recognized significant fewer ironic endings. Social skills results were particularly impaired. The correlation between EQ and ironic endings recognition was significant. Moreover, alcoholics showed a tendency to attribute positive emotions to both ironic and nonironic contexts, showing an opposite pattern in comparison with control subjects who tended to associate negative emotions to ironic contexts. CONCLUSIONS: The present study indicates that emotional recognition deficits that have been previously observed in chronic alcoholics extend to complex interactive contexts. This deficit is associated with a more general impairment of empathy, especially in its social skill component. Clinical implications of the present results are discussed.

Craving Typology Questionnaire (CTQ): a scale for alcohol craving in normal controls and alcoholics.

INTRODUCTION: Craving is commonly thought to play a crucial role both in the transition from controlled drinking to alcohol dependence and in the mechanism underlying relapse. However there is no consensus on its definition, and on its correct assessment. Another significant hindrance is that craving is almost certainly a multi-faceted construct. To this respect a three pathway psychobiological model able to differentiate craving into a reward, relief, and obsessive component has been suggested. METHODS: CTQ was administered to 547 control subjects and to 100 alcohol dependent patients. The dimensional structure of the questionnaire, through the principal component analysis, the reliability and the threshold values were evaluated in both the control and clinical sample. RESULTS: The results showed and confirmed that the CTQ is composed of three dimensions. Cronbach's alpha coefficients suggest that the questionnaire is reliable. Alcohol-dependent subjects had a significantly higher mean score as compared to the normative sample in both Reward, Relief, Obsessive craving. Younger age correlated with higher scores on Reward craving (r=0.38; p<0.001) and males reported significantly higher scores than women on Reward craving (t=4.36; p<0.001). DISCUSSION: CTQ showed to be a reliable and valid questionnaire to distinguish a normative sample from pathological individuals. The average scores obtained represent the first normative data available for this questionnaire. Identifying a craving type may represent an important predicting or matching variable for anti-craving psychotropics. More research is needed with respect to CTQ's external validity, i.e. correlations with phenotypic, endophenotypic and genetic indicators of relief, reward and obsessive drinking.

The autobiography of addiction: autobiographical reasoning and psychological adjustment in abstinent alcoholics.

The narration of drinking experiences plays a central role in many alcohol rehabilitation programmes, yet few researchers have considered whether alcoholics' stories about such experiences relate to their psychological adjustment. Here we examine the extent to which drinking stories of abstinent alcoholics reflect autobiographical reasoning processes denoting self-change and self-stability, and whether these processes are associated with adjustment. Participants who revealed a positive self-change in their narratives about drinking demonstrated higher levels of self-esteem, authentic pride, and mental health compared to those who did not. In contrast, those who implied a sense of self-stability in their narratives demonstrated higher levels of hubristic pride and aggression, and poorer mental health. These results suggest that narrating positive self-change in the wake of substance abuse may underlie psychological adjustment, whereas establishing self-stability in these experiences may impede adjustment. More broadly, these findings underscore the importance of recognising the multi-dimensional nature of autobiographical reasoning.

Spirituality and the health professional.

The inclusion of spirituality in addictions recovery began with the 12-steps program of Alcoholics Anonymous. Cofounded by Bill Wilson, the 12-steps' spiritual orientation is based on Wilson's own recovery from alcoholism that was associated with a spiritual experience. His correspondence with Carl Jung, who verified the importance of Wilson's experience, empowered Wilson to make spirituality central to the 12 steps. Spirituality remains a source of misunderstanding between the scientific, empirically informed mental health community, and the 12-step recovery movement. This article offers an outline of spiritual development, based on neuroscience, which the professional can utilize in the spiritual aspect of a patient's recovery.

Catholic mass and its healing implications for the addicted person.

A convenience sample of 12 recovering alcoholics/addicts were interviewed, using open-ended interviews, during 2009 regarding their experience of Catholic Mass in relation to their recovery. Half of the participants had been raised Catholic, whereas the other half had converted. All have participated in Alcoholics Anonymous and lived in various areas in California. Data analysis used a phenomenological method allowing for use of the participant's own vocabulary. Implications and study limitations are noted, as well as suggestions for further research.