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

Copyright Alcohol Medical Scholars Program 1

Spirituality in Substance Spirituality in Substance Abuse/Dependence TreatmentAbuse/Dependence Treatment

Marianne T. Guschwan, M.D.


Overview Overview

Definitions of spirituality and religionWhy 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


DefinitionsDefinitions

“Religio” – humanity’s bond with a greater being

“Spiritus” – breath or lifeReligious thinking: “An intellectual

endeavor out of the depths of reason….”


Why Spirituality Is ImportantWhy 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


Why Spirituality Is ImportantWhy Spirituality Is Important

Beliefs of our patients

Beliefs of medical professionals


Beliefs of Our PatientsBeliefs of Our Patients

Over 90% of Americans believe in God57% engage in daily prayer42% attended church in the last week


Beliefs of Our PatientsBeliefs 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)


Beliefs of Medical Beliefs of Medical ProfessionalsProfessionalsMost psychiatrists do not believe in

GodNurses 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


Religion and Spirituality in Religion and Spirituality in Substance Abuse TreatmentSubstance 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


Religion and Spirituality in Religion and Spirituality in Substance Abuse/Dependence Substance Abuse/Dependence TreatmentTreatment

“…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


First Three StepsFirst 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”


Steps 4 through 7Steps 4 through 7

Take a moral inventoryAdmit 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


Steps 8, 9 and 10Steps 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


Final Two StepsFinal 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”


Research involving SpiritualityResearch 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


Research Involving AAResearch 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


Research Involving AAResearch 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


Future ResearchFuture Research

Mechanisms unclearSuggested:

– Stress reduction– Cognitive behavioral effect– Affiliation– Group therapy

Futher research is necessary


SummarySummary

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


Documents

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