1. Copyright Alcohol Medical Scholars Program1 Spirituality in Substance Abuse/Dependence Treatment Marianne T. Guschwan, M.D.

2. Copyright Alcohol Medical Scholars Program2 Overview Definitions of spirituality and religion Why Spirituality is Important –Relationship to Health –Beliefs of Patients –Beliefs of Medical Professionals Spirituality’s Relationship to the Treatment of Substance Use Disorders Research in AA and Spirituality

3. Copyright Alcohol Medical Scholars Program3 Definitions “Religio” – humanity’s bond with a greater being “Spiritus” – breath or life Religious thinking: “An intellectual endeavor out of the depths of reason….”

4. Copyright Alcohol Medical Scholars Program4 Why Spirituality Is Important Involvement with spirituality/religion predicts improved quality of life and survival rates of patients with advanced malignancies Association between religious commitment and lower blood pressure

5. Copyright Alcohol Medical Scholars Program5 Why Spirituality Is Important Beliefs of our patients Beliefs of medical professionals

6. Copyright Alcohol Medical Scholars Program6 Beliefs of Our Patients Over 90% of Americans believe in God 57% engage in daily prayer 42% attended church in the last week

7. Copyright Alcohol Medical Scholars Program7 Beliefs of Our Patients 80% believed that religious faith can aid in recovery from illness 63% agreed that doctors should talk to them about spiritual issues (McNichol, 1996)

8. Copyright Alcohol Medical Scholars Program8 Beliefs of Medical Professionals Most psychiatrists do not believe in God Nurses and medical students in one survey ranked spirituality as a low consideration of patients treated on a dual diagnosis unit However, the patients ranked spirituality and belief in God as most important to their recovery

9. Copyright Alcohol Medical Scholars Program9 Religion and Spirituality in Substance Abuse Treatment “Religions have been far from silent on the use of psychoactive drugs….” Judeo-Christian sacraments involving wine Native American, Polynesian and African religions have used hallucinogens and other substances to enhance spiritual transcendence Judeo-Christian Bible denounces drunkeness Islam strictly prohibits the use of alcohol and drugs

10. Copyright Alcohol Medical Scholars Program10 Religion and Spirituality in Substance Abuse/Dependence Treatment “…and spirituality has long been emphasized as an important factor in recovery from addiction.” Alcoholics Anonymous (AA) derived from a Christian Fellowship in 1935 12 Steps

11. Copyright Alcohol Medical Scholars Program11 First Three Steps Admit powerlessness over alcohol Belief in a “power greater than ourselves” Turn will over to the care of God “as we understood Him”

12. Copyright Alcohol Medical Scholars Program12 Steps 4 through 7 Take a moral inventory Admit to God, to ourselves, and to another human being the exact nature of our wrongs Ready to have God remove all these defects of character Ask Him to remove our shortcomings

13. Copyright Alcohol Medical Scholars Program13 Steps 8, 9 and 10 Made a list of all persons harmed and became willing to make amends to them all Made direct amends wherever possible Ongoing personal inventory and promptly admitted when we were wrong

14. Copyright Alcohol Medical Scholars Program14 Final Two Steps Through prayer and meditation improve our conscious contact with God, ‘as we understood Him’ “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs”

15. Copyright Alcohol Medical Scholars Program15 Research involving Spirituality Religious/spiritual involvement predicts less use of and fewer problems with alcohol, tobacco and illicit drugs Mechanisms are poorly understood –Principles avoidance –Social support for abstinence –Involvement in activities that are incompatible with use –Prosocial values

16. Copyright Alcohol Medical Scholars Program16 Research Involving AA Modest correlation found between improved drinking behavior and: –having a sponsor –engaging in twelfth step work –leading a meeting –increasing participation compared to a prior involvement

17. Copyright Alcohol Medical Scholars Program17 Research Involving AA Involvement with AA is associated with better outcomes after professional treatment Project Match compared Twelve-Step Facilitation Therapy (TFT) with CBT and MET TFT group did at least as well and did better on measures of complete abstinence

18. Copyright Alcohol Medical Scholars Program18 Future Research Mechanisms unclear Suggested: –Stress reduction –Cognitive behavioral effect –Affiliation –Group therapy Futher research is necessary

19. Copyright Alcohol Medical Scholars Program19 Summary Spirituality and religion have an important role in medicine, especially in the addiction field Spirituality and religion play an important role in the lives and health of patients Clinicians may have biases regarding spiritual issues Current research findings Further research is needed

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