Spirituality – steer away or steer towards?

We can no more do without spirituality than we can do without food, shelter or clothing – Bruce Lipton

Despite the fact that there are plenty of us about, we don’t have as much information as we would like on people in long term recovery. In one study[1], Mark Galanter and colleagues took the opportunity to interview physicians in long term abstinent recovery at a professional CPD meeting in the USA. All of them were members of Alcoholics Anonymous (AA). The researchers wanted to get a better understanding of the role of spirituality in AA membership and if/how the programme helps to stabilise abstinence. 

While most studies look at early outcomes after treatment episodes, the 144 doctors in this study had an average recovery time of 12 years. It was hoped that in studying them new insights would be revealed. 

In my recent blog about humanity in substance use disorder treatment I referenced a paper on spirituality in recovery. Spirituality is to do with meaning and purpose in life and it has been associated in other research with better outcomes for people recovering from alcohol and drug problems. 

Questions

The researchers had some questions they wanted to look at:

  • What differences in recovery status might there be between those physicians who entered AA in conjunction with referral by physicians’ health programs, and those who did not? 
  • What are some aspects of alcohol craving and affective status (such as depression) as concomitants of the recovery experience?
  • What role does spirituality play in the recovery process?

Demographics

The average age of the doctors was 58 with the majority (81%) being male. 86% were in employment. 46% had presented with a primary alcohol problem; 6% with a drug problem alone and 44% with a mixed alcohol and drug problem. Almost 60% had been in outpatient treatment for their dependence, but half of them had also been in residential settings.

Going to AA

77% had been referred by a professional and most were active in AA activities such as having a sponsor (82%); doing service (88%), having sponsored others (72%) and the average number of meetings attended a week was between two and three.

Spirituality

Most (60%) believed in God, but more than one in five believed in a ‘higher power’ only and just short of one in five believed in neither, further evidence that at least some atheists settle in AA. Four out of five respondents acknowledged having ‘a spiritual awakening’ which was associated with longer periods of abstinence and fewer cravings (half the craving of those who did not identify a spiritual awakening). Doctors were found to be relatively more spiritual and less religious than the general population and also to score higher than the norm on measures of anxiety and depression.

What does it mean?

The authors point out links between spirituality and recovery from previous studies:

“Measures of increased spirituality have been found to be associated with a positive outcome of participation in both abstinence and psychosocial outcomes of treatment.”

The authors conclude that the strong spiritual orientation in AA is distinct from ‘denominational commitment’, but ‘serves as a key element in the movement’s effectiveness’.

This study is interesting and useful, but it is highly focused on a professional group in a particular setting and involves a questionnaire administered at a point in time rather than following the doctors up over a period. Doctors are not necessarily the same as non-doctors of course. There are controversies around mandating attendance at a specific mutual aid group (even with a strong evidence base). It’s also interesting to wonder about the differences in belief systems between the US and the UK which is more secular, although many do differentiate religion from spirituality. Nevertheless, the findings are in line with other research and still have agency.

Given that ‘epiphanies are hard to manufacture’ and ‘spiritual awakenings’ can’t be ordered on the internet, what does this mean for those coming for help with substance use disorders? If we accept that spirituality has a part to play, ought we be actively addressing this in our interactions with clients? Should we be steering those we work with towards spirituality or encouraging them to talk in those terms? There can be problems problems with professional approaches on the subject, as the paper points out.

Attitudes toward AA among professionals in the substance use disorder field itself are variable, with treaters in the United States perhaps more positive than those in certain other international settings. One sample of American clinicians, for example, all referred at least some patients to Twelve‐Step groups, and most held a highly positive view of the fellowship’s utility. Research from elsewhere suggests a much lower referral rate and ambivalent attitudes to 12-step groups.

And other mutual aid?

A common theme for all mutual aid groups is positive social networking. There are other mutual aid groups around – SMART Recovery and LifeRing for instance, which do not emphasise spirituality per se. But if spirituality is framed in terms of finding meaning and purpose, the instillation of hope, and connection to things outside of oneself, could membership of those groups also contribute to ‘spiritual’ growth in an equivalent fashion or does AA’s spiritual core have the edge in this specific area? Does it matter what we call it?

Attitudes here are changing though as evidence accumulates. If ‘spiritual awakening’ is associated with a reduction in craving and helps those suffering from substance use disorders to remain networked with other recovering people in the long term, then perhaps addressing spirituality is indeed something all of us working with those seeking recovery, in all its forms, ought to be doing.

Continue the discussion @DocDavidM


[1] Galanter M, Dermatis H, Stanievich J, Santucci C. Physicians in long-term recovery who are members of alcoholics anonymous. Am J Addict. 2013 Jul-Aug;22(4):323-8. doi: 10.1111/j.1521-0391.2013.12051.x. PMID: 23795870.

Photocredit: https://www.istockphoto.com/portfolio/PeterSchreiber?mediatype=photography (under license)

This is an updated version of a previously published blog