Addiction & Spirituality

1. Addiction & Spirituality Jennifer M. Paulsen Ferris State University

2. Spiritual interest • As a new nurse, my goal and desire is to focus my career on becoming an emergency room nurse or psychiatric nurse. In either of these areas, I will encounter patients struggling with addiction.

3. Addiction to substances is considered a medical disease, characterized by the continued use of substances despite significant substance-related problems (American Psychiatric Association, 1994 p. 175). Spirituality has continually been considered an important piece of addiction recovery. One of the few areas of health care where spiritually is more common than not is the treatment of alcohol and drug abuse (Barnum, 2003, p.11).

4. C.G. Jung believed (Bauer, 1982 as cited in Barnum 2003) that “alcohol” in Latin is spiritus, and you use the same word for the highest religious experience as well as the most depraving poison” (p.11). Jung also believed (Bauer, 1982 as cited in Barnum 2003) that “ alcohol was the equivalent, on a low level, of spiritual thirst for wholeness; it represented the search for union with God” (p.11).

5. Relevant terms Religious Problem Solving Scale (RPPS) Comprises three subscales that identify how individuals assign responsibility to themselves or God in resolving a problem. Religious Background and Behavior Questionnaire (RBBQ) A brief measure of current and past religious practices and behaviors. God Perception Questionnaire (GPQ) Assesses perception of God as kind or wrathful Focus group A form of qualitative research in which a group of people are asked about their perceptions, opinions, beliefs and attitudes.

6. Research Question Does spirituality help in addiction recovery?

7. Literature Review • Study # 1 Subjects were recruited from a 28 week clinical outpatient treatment program from the National Institute on Drug Abuse (NIDA). Five focus group sessions were held to examine personal beliefs about the role of spirituality in addiction recovery and its appropriateness in formal treatment. The three assessment instruments used included the RPPS, RBBQ and GPQ. They were administered upon arrival. The group also discussed how they viewed spirituality during active addiction. Confidentiality was emphasized on questionnaire. • 26 participants ages 20-53 16 males, 10 females • Methadone-maintained 18 Protestant, 4 Catholic, 4 no religion stated 17 high school diploma, 4 some college, 5 no high school diploma Heinz et al (2010)

8. Study #1 Results The RPSS subscales suggested that participants most often endorsed a partnership with God in resolving conflict. The RBBQ scores suggest that all participants had a strong belief in a God. They were more likely to engage in prayer and thoughts of God than attending religious services or reading religious writings. The GPQ scores indicates that the participants strongly disagreed that God was not punishing, avenging, and wrathful. They strongly agreed that God was loving kind, and forgiving. Heinz et al. (2010)

9. Study #1 Conclusion Overall the focus-group thoughts and opinions regarding spirituality and religion were very positive. Suggestions for a spiritually based clinic group were offered and may have great promise especially with methadone treated addicts. It is apparent that spirituality has a strong force in addiction recovery. Nearly all of the participates believed that a voluntary spiritual discussion group in formal treatment would be preferred over current alternatives such as a 12 step program. Some participants had a negative experience with 12-step programs because the 12 steps require that participants are clean from all addictive substances, except nicotine and caffeine. Methadone Anonymous (MA) has been founded and addresses this problem but, Participants have found MA rare and hard to find. Limitations of study included that all subjects identified themselves as strongly spiritual. Other limitations may include that most of the subjects knew each other and this fact may have influenced the verbal discussions. Heinz et al. (2010)

10. Study # 2 • 60 subjects at an inpatient public hospital for treatment of severe addiction were offered • 12 private sessions with a professional spiritual director. Half of the participants were assigned to • the experimental group and had treatment as usual (TAU) along with the 12 sessions of spiritual • guidance (SG). The sessions explored 12 spiritual disciplines described by author • Richard Foster . These included acceptance, celebration, fasting, gratitude, guidance, meditation, • prayer, reconciliation, reflection, service to others, solitude and worship. The book was given to • all participants. Follow up sessions were planned at 4,8 and 12 months after baseline assessment with spiritual director. • 36 women, 24 men • 50% Hispanic, 35% Caucasian, 12% Native American • Detoxified adults 18 or older, excluded people intended to start methadone • Average inpatient stay at time of study was 25 days • Participants that planned on residing within 60 miles for 1 year • Miller, Forcehimes, O’Leary, LaNoue (2008)

11. Study # 2 Results and conclusion Of the 30 patients assigned to SG 3 did not attend any sessions, 5 attended only 1 session, 5 attended 2. The remaining 17 patients were considered “treated” for purpose of analysis. Of all possible follow up sessions 86% were completed at 4 months, 83% at 8 months and 82% at 12 months. The treated SG group showed an unexpected increase in anxiety and depression. The reduction of alcohol and other drugs were not significantly different in the SG group than in the TAU group. The particular study was not promising. SG had no effect on spirituality or substance abuse outcomes at any of the follow up sessions. Limitations of study may include the absence of time spent using Spiritual interventions on their own and lack of attendance at the meetings. Miller, Forcehimes, O’Leary, LaNoue (2008)

12. Study # 3 • 24 clients in a outpatient drug treatment center participated in two focus groups. • The groups were tape recorded and the information was transcribed. During the • sessions the participants told stories of the experiences and changes that have • taken place in their lives due to addiction. The stories were analyzed to determine • if there was a link to the concept of a higher power and their recovery. The storytelling • is a key component in the 12-step programs in which the participants were active in. • 16 men, 8 women • 20 African Americans, 4 Hispanics • Participants were those in the early stages of recovery and those with significant • time clean. • Green, Thompson, Fullilove (1998)

13. Study # 3 Results and conclusion: The spiritual discussions that both groups were involved with clearly showed a higher power as their guidance. It was a very large part of their recovery process. Participants noted that they would not be abstinent without faith. A new member to sobriety voiced his disbelief in a higher power . Some of the members were troubled by his confession but agreed to feeling that way before entering treatment. Both groups agreed that the program and people in it were fundamental to their recovery, but believing and forming a relationship with a higher power regardless of who or what the higher power was has kept them clean. It is clear that a relationship and faith in a higher power has provided meaning and spiritual guidance for this group of individuals. Their individual stories and spiritual awareness began in a 12-step program. Limitations could include the small sample size. Also, most of the participants were long time members of NA and AA programs. Green, Thompson, Fullilove (1998)

14. Implications for practice • Address patients spiritual and religious needs • Refer patient to treatment center if an acute care setting • Refer patient to support groups • Listen with a nonjudgmental presence • Encourage patient to express themselves • Addiction screening if patient in the ER • Assess for suicide or spiritual distress

15. conclusion Substance abuse has detrimental effects on millions of individuals and families. Spirituality is often overlooked in the acute care treatment of substance abuse and formal clinical settings. Despite awareness of its importance , little research has been done to describe the ways in which spirituality contributes to the recovery process (Green, 1998). The 12- step programs such as AA and NA are the most widely known and used programs. The final study emphasizes the success of the programs spiritual approach on substance abuse. As a nurse pursuing her career in the ER or a mental health facility I plan to continue research on the benefits of spirituality and addiction. I hope one day to utilize the power of spirituality to help individuals at the beginning of their complex journey.

16. References Heinz, A. J., Disney, E. R., Epstein, D. H., Glezen, L. A., Clark, P. I., & Preston, K. L. (2010). A focus-group study on spirituality and substance-abuse treatment [Electronic version]. , 134-153. doi:10.3109/10826080903035130 Barnum, B. S. (2010). Spirituality in nursing: From traditional to new age (2nd ed., pp. 11-13). New York: Springer Publishing Company. Miller, W. R., Forcehimes, A., O'Leary, M. J., & LaNoue, M. D. (2008). Spiritual direction in addiction treatment: Two clinical trials. Journal of substance abuse treatment, 35, 434-442. Lesley, G. L., Fullilove, M. T., & Fullilove, R. E. (1998). Stories of spiritual awakening: The nature of spirituality in recovery.Journal of substance abuse treatment, 15(4), 325-331.