Spirituality in Addiction Recovery: A Narrative Review.

In the area of addiction, Canada has been in a public health crisis since 2016. Addiction takes a toll on an individual's self-worth and identity. In this narrative literature review, the distinct nature of spirituality was addressed. Next, individualized conceptualizations of spirituality were outlined. Subsequently, the importance of fellowship in addiction recovery was detailed. Next, the significance of being of service was presented. Meaningful and authentic spirituality were discussed in the context of recovery identity. Lastly, spirituality as a personal journey is described. A narrative literature review of 70 manuscripts published between 1999 and 2021 was undertaken to determine multiple approaches to treating addiction recovery in the context of spiritual development. An understanding of spirituality can inform counsellors regarding spiritual development in addiction recovery. Implications for counselling include a roadmap to support clients developing an individualized spiritual connection and operating as a functional system.

The Role of Acceptance and Change in Recovery from Substance Use Disorders.

Long-term recovery (LTR) from substance use disorders (SUDs) has been described as a complex process. It has been proposed that psychological mechanisms can influence the resolution of problematic substance using behaviors and may explain how and why a recovery process works. The aims of this narrative review were to (a) examine acceptance and change as an underlying mechanism in LTR from SUDs; (b) examine the practice of acceptance and change in the Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) programs; and (c) present a conceptual model of self-acceptance and change in LTR from SUDs. Based on dialectical behavioral philosophy and mindfulness-based intervention, I posited that self-acceptance is an underlying mechanism that addresses the cyclical nature of shame, guilt, and SUDs; improves emotion dysregulation; psychological well-being; and activates a change process of recovery from SUDs. This article contributes to the field by presenting the opposing forces of acceptance versus change and their synthesis in promoting LTR from SUDs, and by discussing the practice of acceptance and change in the AA and NA programs.

The role of spirituality in addiction medicine: a position statement from the spirituality interest group of the international society of addiction medicine.

Spirituality is a construct that is reflected in a diversity of strongly felt personal commitments in different cultural and national groups. For persons with substance use disorders (SUDs), it can serve as a component of the recovery capital available to them. This position statement reviews empirical research that can shed light on psychological, social, and biological aspects of this construct. On this basis, the Spirituality Interest Group of the International Society of Addiction Medicine (ISAM) makes recommendations for how this construct can be incorporated into research and clinical care.

Spiritual Principles of Alcoholics Anonymous.

Alcoholics Anonymous is, according to the Program's basic documents, a spiritual program - especially regarding Steps 2-3, 5-7, and 11-12. This paper reviews the history of the Program with emphasis on its spiritual background, as well as on the roots of the spiritual side of the program, and showing the spiritual accents in the Big Book of Alcoholics Anonymous. The paper also considers the Christian background of the movement and, more broadly, explores the connection of AA founders William (Bill) Wilson and Dr. Robert (Bob) Smith with several Catholic people, such as Edward (Ed) Dowling, SJ, and John C. Ford, SJ, and indicates some points of contact between the Program and Ignatian spirituality. The paper illustrates the pioneering role of the Alcoholics Anonymous program in integrating spirituality into the process of recovery from and treatment of addictions, an integration that just recently has been embraced by modern psychotherapy and psychiatry. The paper shows the theoretical and spiritual underpinnings of the Program in the religious context. The paper illustrates the orientation of the Program in assisting addicts to integrate into their recovery their own spirituality, a clearer image of God, and personal spiritual and religious progress.

An empirical study on the construct of "God" in the Twelve Step process.

Background: The term God, included in 5 of the 12 Steps of Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), self-designated spiritual fellowships, has not been studied empirically relative to members' experiences. A greater understanding of this can be clinically useful and can shed light on the 12 Step process of recovery. Objectives: To determine how NA members understand the 12-step concept "God as we understood Him" and the relationship between their understanding of God and the intensity of their craving and depressive symptoms." Methods: 450 (59% male) NA members completed a survey related to their experiences relative to their relationship with "God." The relationship among these variables and comparisons to the general population was analyzed. Craving and depressive symptoms were assessed by self-report. Results: 98% of the NA participants believe in God explicitly or some other higher power (vs 89% of a probability sample of the US population), 67% believe that God determines what happens to them some or all of the time (vs 48%), 78% (vs 28%) report hearing God talking to them "in their mind"; and 37% report that God talks to them "out loud." Acceptance of 12 Step God-related variables inversely predicted a significant portion of the variance of scores on craving (7.5%) and depression (13.5%). Conclusions: Respondents' understanding of God in NA varied considerably and was predictive of their depressive symptoms and craving intensity. These findings can serve as a basis for research into mechanisms underlying NA/AA recovery experiences and can also aid clinicians in how to employ these programs.

ALCOHOLICS ANONYMOUS "SPIRITUALITY" AND LONG-TERM SOBRIETY MAINTENANCE AS A TOPIC FOR INTERDISCIPLINARY STUDY.

The foundational literature of Alcoholics Anonymous provides a good example of how ideas from different intellectual paradigms can be woven together to enhance understanding of addiction and recovery. A detailed hypothesis about how the 12 steps of Alcoholics Anonymous work as a program of emotion management is presented. The hypothesis assigns a central role to a secular interpretation of spirituality, consistent with naturalism. Clinical research which appears to indicate that spirituality is not the chief mechanism of recovery in Alcoholics Anonymous is critiqued. Interdisciplinary research is required, if the extent and nature of the efficacy of AA's 12 steps are to be understood.

Overlapping Mechanisms of Recovery Between Professional Psychotherapies and Alcoholics Anonymous.

BACKGROUND: Much research over the past 25 years has focused on elucidating the mechanisms by which Alcoholics Anonymous (AA) affects behavioral change in its participants. In addition to research on the spiritual mechanisms for which AA is best known in the popular conception, research on mechanisms of recovery (MOR) has predominantly supported social, cognitive, and affective mechanisms that are also present in many professional psychotherapies. AIM: This paper compares and contrasts the theorized MOR of AA with those found in several common professional psychotherapies to illustrate analogous elements. METHODS: Literature review, summary, and synthesis of studies examining the MOR of both AA and common psychotherapies including analytic/dynamic therapies, cognitive-behavioral therapies, and acceptance and mindfulness-based therapies. RESULTS: There exists a significant overlap in theorized MOR of AA and mainstream, professional psychotherapies. Mechanisms with the greatest overlap include those mobilizing stress and coping theory, behavioral choice theory, and social learning theory, while mechanisms more unique to AA compared to professional psychotherapies mobilize social control theory to a greater degree. CONCLUSIONS: In caring for patients with addiction, practicing clinicians will find it useful to be aware of overlapping analogous elements found in the AA program and professional psychotherapies and how they can complement one another.

Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse.

This study reviews the voluminous empirical evidence on faith's contribution to preventing people from falling victim to substance abuse and helping them recover from it. We find that 73% of addiction treatment programs in the USA include a spirituality-based element, as embodied in the 12-step programs and fellowships initially popularized by Alcoholics Anonymous, the vast majority of which emphasize reliance on God or a Higher Power to stay sober. We introduce and flesh out a typology of faith-based substance abuse treatment facilities, recovery programs, and support groups. This typology provides important background as we then move on to make an economic valuation of nearly 130,000 congregation-based substance abuse recovery support programs in the USA. We find that these faith-based volunteer support groups contribute up to $316.6 billion in savings to the US economy every year at no cost to tax payers. While negative experiences with religion (e.g., clergy sex abuse and other horrendous examples) have been a contributory factor to substance abuse among some victims, given that more than 84% of scientific studies show that faith is a positive factor in addiction prevention or recovery and a risk in less than 2% of the studies reviewed, we conclude that the value of faith-oriented approaches to substance abuse prevention and recovery is indisputable. And, by extension, we also conclude that the decline in religious affiliation in the USA is not only a concern for religious organizations but constitutes a national health concern.

Twelve-Step Programs and Spiritual Support at the End of Life.

Experts estimate that over 25 million Americans are in recovery from addiction to alcohol and other drugs. Many will be confronted with a serious progressive illness necessitating palliative care or hospice services. In current literature, substance use disorder has mostly been examined in relation to appropriate symptom assessment and management, opioid risk screening, and controlled substance prescribing practices. However, as hospice and palliative care (HPC) clinicians strive to provide whole person care for the seriously ill, awareness and facilitation of healthy psychosocial-spiritual coping strategies for recovering addicts should enhance such care. One of the more common support mechanisms to support recovery is the 12-step program, based on Alcoholics Anonymous. Twelve-step programs have been shown to provide effective coping strategies, not only to help facilitate ongoing abstinence but also to support other psychosocial-spiritual crises. The HPC providers may help to serve those living with addiction disorders better by assessing not only patient histories of substance use/abuse and other addictive behaviors but by facilitating their ongoing support recovery efforts. Here, we use 2 HPC cases to illustrate the value of 12-step recovery programs in patient support and provide recommendations for enhancing such healthy coping in HPC clinical settings.

Stressful events, spirituality, and alcohol consumption in participants of the 12-Step AA Program. / Eventos estresantes, espiritualidad y consumo de alcohol en participantes del programa de 12 pasos de AA.

This work sought to determine the association between stressful events, spirituality, program participation and alcohol consumption in participants of the AA 12-step program. The study used a descriptive correlation and predictive method. The population was comprised by members from AA, Mexico. A simple random sampling by clusters was performed, the sample consisted of 72 AA participants with 95% CI. The Spiritual Perspective Scale and the Social Readjustment Rating Scale were used. Stressful events are negatively and significantly related to alcohol consumption (rs = -0.316, p = 0.007), this indicates that the higher the number of stressors, the lower the number of days without alcohol consumption; participation in the program was positively and significantly related to alcohol consumption (rs = 0.776, p = 0.001), which indicates that greater years of participation means greater number of days without alcohol consumption. Spirituality showed no significant relationship (p > 0.05), there is also a significant effect of participation in the program and age on alcohol consumption (R2 = 65.2%, p = 0.001). Participation in the AA program is related to and has an effect on the number of days without alcohol consumption.

El objetivo es determinar la asociación entre los eventos estresantes, la espiritualidad, la participación en el programa y el consumo de alcohol en participantes del programa de 12 pasos de AA. Método descriptivo correlacional y predictivo. La población fueron integrantes de AA, México. Se realizó un muestreo aleatorio simple por conglomerados, la muestra estuvo conformada por 72 participantes de AA con un nivel de confianza del 95%. Se utilizó la Escala de Perspectiva Espiritual y la Escala de Clasificación de Reajuste Social. Los eventos estresantes se relacionan de manera negativa y significativa con el consumo de alcohol (rs = -.316, p = .007), esto indica que mayor índice de eventos estresantes menor es la cantidad de días sin consumo de alcohol, la participación en el programa se relaciona positiva y significativamente con el consumo de alcohol (rs = .776, p = .001), esto señala que mayor años de participación mayor es la cantidad de días sin consumo de alcohol, la espiritualidad no mostró relación significativa (p > .05), además existe efecto significativo de la participación en el programa y la edad sobre el consumo de alcohol (R2 = 65.2%, p = .001). La participación en el programa de AA se relaciona y tiene efecto sobre a cantidad de días sin consumo de alcohol.

Eventos estresantes, espiritualidad y consumo de alcohol en participantes del programa de 12 pasos de AA / Stressful events, spirituality, and alcohol consumption in participants of the 12-Step AA Program

Resumen El objetivo es determinar la asociación entre los eventos estresantes, la espiritualidad, la participación en el programa y el consumo de alcohol en participantes del programa de 12 pasos de AA. Método descriptivo correlacional y predictivo. La población fueron integrantes de AA, México. Se realizó un muestreo aleatorio simple por conglomerados, la muestra estuvo conformada por 72 participantes de AA con un nivel de confianza del 95%. Se utilizó la Escala de Perspectiva Espiritual y la Escala de Clasificación de Reajuste Social. Los eventos estresantes se relacionan de manera negativa y significativa con el consumo de alcohol (rs = -.316, p = .007), esto indica que mayor índice de eventos estresantes menor es la cantidad de días sin consumo de alcohol, la participación en el programa se relaciona positiva y significativamente con el consumo de alcohol (rs = .776, p = .001), esto señala que mayor años de participación mayor es la cantidad de días sin consumo de alcohol, la espiritualidad no mostró relación significativa (p > .05), además existe efecto significativo de la participación en el programa y la edad sobre el consumo de alcohol (R2 = 65.2%, p = .001). La participación en el programa de AA se relaciona y tiene efecto sobre a cantidad de días sin consumo de alcohol.

Abstract This work sought to determine the association between stressful events, spirituality, program participation and alcohol consumption in participants of the AA 12-step program. The study used a descriptive correlation and predictive method. The population was comprised by members from AA, Mexico. A simple random sampling by clusters was performed, the sample consisted of 72 AA participants with 95% CI. The Spiritual Perspective Scale and the Social Readjustment Rating Scale were used. Stressful events are negatively and significantly related to alcohol consumption (rs = −0.316, p = 0.007), this indicates that the higher the number of stressors, the lower the number of days without alcohol consumption; participation in the program was positively and significantly related to alcohol consumption (rs = 0.776, p = 0.001), which indicates that greater years of participation means greater number of days without alcohol consumption. Spirituality showed no significant relationship (p > 0.05), there is also a significant effect of participation in the program and age on alcohol consumption (R2 = 65.2%, p = 0.001). Participation in the AA program is related to and has an effect on the number of days without alcohol consumption.

Spirituality, Religiosity and Addiction Recovery: Current Perspectives.

Substance use disorders are an important public health problem with a multifactorial etiology and limited effective treatment options. Within this context, spirituality-based approaches may provide interesting and useful options in managing substance use disorders. This kind of intervention can have positive effects in alleviating some core symptoms associated with substance use, such as aggressiveness. Improvement in cessation rates for alcohol, cocaine and opioid use disorders have also been described in some clinical studies. However, spirituality may not play a beneficial role in some subgroups, such as among individuals with crack cocaine and cannabis use disorders. A widely available intervention for alcohol use disorders is Alcoholics Anonymous (AA), which can be seen as a spirituality-based intervention. Spirituality also seems to be especially beneficial for minorities such as Latinos, African-Americans and Native-Americans. Moreover, spiritual-based interventions are also helpful alternatives in many rural environments where conventional healthcare for substance use disorders may not be easily available. However, spiritual-based interventions may be considered as a possible adjunctive therapeutic option to conventional treatments. There is a need for prospective studies outside U.S., especially where spiritual-based approaches are available. It may be difficult to carry out randomized controlled trials because of the nature of the spiritual/ religious dimensions. However, prospective studies that evaluate mediation effect of spirituality and religiosity on recovery would be helpful. Qualitative studies combined with quantitative design offer excellent options to evaluate the recovery process, especially among special populations.

Associations of Spiritual Well-being, Attitude toward Death and Quality of Life among Alcoholics Anonymous / 정신간호학회지

PURPOSE: The aim of the study was to investigate associations of spiritual well-being, attitude toward death, and quality of life among Alcoholics Anonymous (AA). METHODS: This study was cross-sectional and descriptive in design. The data was collected from August to September 2018 with 133 AA members drawn from two provinces of South Korea. The data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA with Turkey tests, Pearson's correlation coefficients, and hierarchical multiple linear regression analyses using SPSS/WIN 20.0 program. RESULTS: The existential spiritual well-being (β=.52, p<.001), attitude toward death (β=.24, p<.001), dual diagnosis (β=−.17, p=.003), occupation (β=.12, p=.035) of the participants were significant factors, which explained 63.7% of the variance of quality of life. CONCLUSION: The study findings highlight the need to develop psychological nursing strategies to enhance the spiritual well-being and improve a positive attitude toward death based on the job and dual diagnosis among AA members to improve their better quality of life.

Factores Asociados al No Consumo de Alcohol en Personas Dependientes en Recuperación / Factors Associated with Not Drinking Alcoholic Beverages in Dependent Individuals on Recovery / Fatores Associados ao Não Consumo de Álcool em Pessoas Dependentes em Recuperação

Objective. This work sought to determine the association between personal factors and not drinking alcoholic beverages in alcohol-dependent individuals on recovery process. Methods. This was a cross-sectional quantitative study. The sample was comprised by 119 adult belonging to 50 Alcoholics Anonymous groups in Saltillo, Coahuila (Mexico). The sampling was simple random, by conglomerates (AA groups). To gather the information, a Personal Data Card was used along with a history on alcohol consumption and the instruments Scale on Social Readjustment Classification, Spiritual Perspective Scale, Schwartz Values Survey, and the Alcohol Use Disorders Identification Test (AUDIT). Results. The time without alcohol consumption was related positively with age (r=0.59) and spirituality (r=0.29) and negatively with stressful events (r=-0.31). The Multiple Linear Regression Model explained 32.5% of the variance, with age being the variable remaining in the model and which affected not drinking alcoholic beverages. Conclusion. Values and spirituality favor not drinking alcoholic beverages in individuals in the process of recovering from the dependence, while exposure to stressful events increases vulnerability to alcohol consumption. (AU)

Objetivo. Determinar la asociación entre los factores personales y el no consumo de alcohol en personas dependientes en proceso de recuperación. Métodos. Estudio cuantitativo, de corte transversal. La población estuvo conformada por 119 adultos pertenecientes a los 50 grupos de Alcohólicos Anónimos de Saltillo, Coahuila (México). El muestreo fue aleatorio simple, por conglomerados (grupos AA). Para la recolección de la información se utilizó una Cédula de Datos Personales e Historial de Consumo de Alcohol y los instrumentos Escala de Clasificación de Reajuste Social, Escala de Perspectiva Espiritual, Cuestionario de Valores Schwarts y Cuestionario de Identificación de los Trastornos debidos al Consumo Alcohol (AUDIT). Resultados. El tiempo sin consumo de alcohol se relacionó en forma positiva con la edad (r=0.59) y con la espiritualidad (r=0.29) y en forma negativa con los eventos estresantes (r=-0.31). El Modelo de Regresión Lineal Múltiple explicó el 32.5% de la varianza, siendo la edad la variable que se mantuvo en el modelo y tuvo efecto sobre el no consumo de alcohol. Conclusión. Los valores y la espiritualidad favorecen el no consumo de alcohol en las personas en proceso de recuperación de su dependencia, mientras que la exposición a eventos estresantes aumenta la vulnerabilidad al consumo. (AU)

Objetivo. Determinar a associação entre os fatores pessoais e o não consumo de álcool em pessoas dependentes de álcool em processo de recuperação. Métodos. Estudo quantitativo, de corte transversal. A amostra esteve conformada por 119 adultos pertencentes aos 50 grupos de Alcoólicos Anônimos de Saltillo, Coahuila (México). A amostragem foi aleatória simples, por conglomerados (grupos AA). Para a recolecção da informação se utilizou uma Cédula de Dados Pessoais e Historial de Consumo de Álcool e os instrumentos Escala de Classificação de Reajuste Social, Escala de Perspectiva Espiritual, Questionário de Valores Schwarts e Questionário de Identificação dos Transtornos devidos ao Consumo Álcool (AUDIT). Resultados. O tempo sem consumo de álcool se relacionou em forma positiva com a idade (r=0.59) e com a espiritualidade (r=0.29) e em forma negativa com os eventos estressantes (r=-0.31). O Modelo de Regressão Lineal Múltiplo explicou 32.5% da variação, sendo a idade a variável que se manteve no modelo e teve efeito sobre o não consumo de álcool. Conclusão. Os valores e a espiritualidade favorecem o não consumo de álcool nas pessoas em processo de recuperação da dependência, enquanto que a exposição a eventos estressantes aumenta a vulnerabilidade ao consumo. (AU)

Factors Associated with Not Drinking Alcoholic Beverages in Dependent Individuals on Recovery.

OBJECTIVES: This work sought to determine the association between personal factors and not drinking alcoholic beverages in alcohol-dependent individuals on recovery process. METHODS: This was a cross-sectional quantitative study. The sample was comprised by 119 adult belonging to 50 Alcoholics Anonymous groups in Saltillo, Coahuila (Mexico). The sampling was simple random, by conglomerates (AA groups). To gather the information, a Personal Data Card was used along with a history on alcohol consumption and the instruments Scale on Social Readjustment Classification, Spiritual Perspective Scale, Schwartz Values Survey, and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: The time without alcohol consumption was related positively with age (r=0.59) and spirituality (r=0.29) and negatively with stressful events (r=-0.31). The Multiple Linear Regression Model explained 32.5% of the variance, with age being the variable remaining in the model and which affected not drinking alcoholic beverages. CONCLUSIONS: Values and spirituality favor not drinking alcoholic beverages in individuals in the process of recovering from the dependence, while exposure to stressful events increases vulnerability to alcohol consumption.

Perspectiva espiritualidad en integrantes de alcohólicos anónimos: estudio piloto / Perspective spirituality in members of alcoholics anonymous: pilot study

La espiritualidad es un concepto que se ha relacionado de manera positiva con la salud física y mental de las personas y se ha observado que juega un papel importante en el manejo y recuperación del abuso de sustancias como el alcohol. El objetivo principal de este estudio fue determinar la perspectiva espiritual de los integrantes de AA (Alcohólicos anónimos). El diseño fue cuantitativo, descriptivo de corte transversal. La población estuvo conformada por integrantes de AA de 3 municipios suburbanos de Nuevo León, México. Se realizó un muestreo no probabilístico, la muestra estuvo conformada por 35 adultos pertenecientes a los grupos de AA, se utilizó la Escala de Perspectiva Espiritual (SPS). Los resultados muestran que el promedio del índice de espiritualidad en los participantes fue de 66.33 (DE = 17.23), el promedio de prácticas espirituales fue de 59.64 (DE = 25.11) y el de creencias espirituales fue de 70.70 (DE = 16.60). Se concluye que los integrantes de AA tienen un nivel alto de espiritualidad total, en prácticas espirituales y en creencias espirituales (AU)

Spirituality is a concept that has been linked positively with physical and mental health of people and has been found to play an important role in the management and recovery of substance abuse like alcohol. The main objective of this study was to determine the spiritual perspective of the members of AA. The design was quantitative, descriptive cross-sectional. The population consisted of members of AA 3 suburban municipalities of Nuevo Leon, Mexico. A non-probability sampling was performed, the sample consisted of 35 adults from AA groups, Spiritual Perspective Scale (SPS) was used. The results show that the average rate of spirituality in the participants was 66.33 (SD = 17.23), the average spiritual practices was 59.64 (SD = 25.11) and spiritual belief was 70.70 (SD = 16.60). It is concluded that AA members have a high level of total spirituality, spiritual practices and spiritual beliefs (AU)