Assessment of spirituality and its relevance to addiction treatment

Nursing and Chaplain Partnership for Pain Management: A Survey of Nurses

PURPOSE

Pain is a universal experience for hospitalized patients, with physical, psychological, spiritual, and cognitive implications. As hospitals seek to identify nonpharmaceutical options for managing acute pain, the role of chaplains has been overlooked. The purpose of this study was to evaluate the perceptions of nurses regarding chaplain involvement in pain management.

METHODS

A survey was distributed to nurses to determine if they would request spiritual care services in various patient and family scenarios. Respondents were dichotomized into two groups based on self-report of whether they would contact a chaplain for patients with uncontrolled pain. Differences between groups were calculated using chi-square tests.

RESULTS

Of 45 nurse respondents, 27 (60%) reported they would not contact a chaplain for patients with uncontrolled pain. Nurses who would consult the chaplain for pain management did not differ from nurses who would not consult the chaplain in terms of their own religious identification, knowledge of patient religious documentation in the medical record, or past experience with chaplain services.

CONCLUSIONS

Study findings suggest that nurses' perceptions of chaplain involvement in pain management must be addressed prior to implementing a new hospital pain management protocol.

CLINICAL IMPLICATIONS

When developing and implementing new pain protocols based on holistic care of patients, hospitals should ensure that nursing staff are educated on when and how to incorporate chaplains as part of a holistic approach to managing acute pain.

Evidence-Based Assessment of Substance Use Disorder

The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.

Psychometric Evaluation of an Adapted Short-Form Spirituality Scale in a Sample of Predominantly White Adults in an Inpatient Substance Use Disorder Treatment Program

Spirituality is an important aspect of treatment and recovery for substance use disorders (SUDs), but ambiguities in measurement can make it difficult to incorporate as part of routine care. We evaluated the psychometric properties of an adapted short-form version of the Spirituality Scale (the Spirituality Scale-Short-Form; SS-SF) for use in SUD treatment settings. Participants were adult patients (N = 1,388; Mage = 41.23 years, SDage = 11.55; 68% male; 86% White) who entered a large, clinically mixed inpatient SUD treatment program. Factor analysis supported the two-dimensional structure, with factors representing Self-Discovery and Transcendent Connection. Tests of measurement invariance demonstrated that the scale was invariant across age and gender subgroups. The SS-SF exhibited convergent and concurrent validity via associations with participation in spiritual activities, hopefulness, life satisfaction, 12-step participation, and depressive symptoms. Finally, scores on the SS-SF were significantly higher at discharge compared to admission, demonstrating short-term sensitivity to change. These findings support use of the SS-SF as a concise, psychometrically sound measure of spirituality in the context of substance use treatment.

Association of Emotional Self-Regulation with Psychological Distress and Positive Functioning Dimensions in Brazilian University Students during the COVID-19 Pandemic

Emotional self-regulation is a relevant factor for human development capable of minimizing emotional difficulties in the face of adverse events, as was particularly useful during the COVID-19 pandemic. The present study aimed to evaluate emotional self-regulation in Brazilian health science university students and its relationship with positive psychology constructs (subjective well-being, hope, optimism, spirituality, self-compassion, and self-efficacy) and psychological distress (depression, anxiety, and stress). This was a prospective, cross-sectional, observational, analytic study of 1062 Brazilian undergraduate students with data collected using self-administered online questionnaires. Students in the first years of their undergraduate degree programs had significantly higher dysregulation scores than those in the final years. Multiple linear regression yielded a model that explained 71.8% of the variation in emotion dysregulation. The correlations of emotion dysregulation were significant and strong, scoring negatively with self-compassion, optimism, and subjective well-being and positively with psychological distress.

Positive Clinical Outcomes for Severe Reported Pain Using Robust Non-Addictive Home Electrotherapy-A Case-Series

The North American opioid epidemic has resulted in over 800,000 related premature overdose fatalities since 2000, with the United States leading the world in highest opioid deaths per capita. Despite increased federal funding in recent years, intended to address this crisis, opioid overdose mortality has continued to increase. Legally prescribed opioids also chronically induce a problematic reduction in affect. While an ideal analgesic has yet to be developed, some effective multimodal non-opioid pharmacological regimens for acute pain management are being more widely utilized. Some investigators have suggested that a safer and more scientifically sound approach might be to induce "dopamine homeostasis" through non-pharmacological approaches, since opioid use even for acute pain of short duration is now being strongly questioned. There is also increasing evidence suggesting that some more robust forms of electrotherapy could be applied as an effective adjunct to avoid the problems associated with opioids. This 4-patient case-series presents such an approach to treatment of severe pain. All 4 of these chiropractic treatment cases involved a component of knee osteoarthritis, in addition to other reported areas of pain. Each patient engaged in a home recovery strategy using H-Wave^® device stimulation (HWDS) to address residual extremity issues following treatment of spinal subluxation and other standard treatments. A simple statistical analysis was conducted to determine the change in pain scores (Visual Analogue Scale) of pre and post electrotherapy treatments, resulting in significant reductions in self-reported pain (p-value = 0.0002). Three of the four patients continued using the home therapy device long-term as determined by a post-analysis questionnaire. This small case-series demonstrated notably positive outcomes, suggesting consideration of home use of HWDS for safe, non-pharmacological and non-addictive treatment of severe pain.

Spirituality: A Key Component of the Salvation Army's Bridge Programme Model of Treatment in Aotearoa New Zealand

Spirituality is vital to The Salvation Army's Bridge model of treatment for alcohol and drug addiction. Spirituality is expressed through Recovery Church, prayer, spirituality lifters, the 12-step programme, and focuses on meaning and purpose. We recruited participants from several regional centers throughout Aotearoa New Zealand and evaluated spirituality using the WHOQol-SRPB and open-ended questions. Most participants held broad understandings of spirituality, only a minority equating it with religion. Participants who completed the Programme had statistically significant increases in spiritual wellbeing at end-of-treatment. These increases were maintained at a 3-month follow-up. Increases in spiritual wellbeing were associated with decreases in severity of alcohol and drug use.

Linguistic predictors from Facebook postings of substance use disorder treatment retention versus discontinuation

Background: Early indicators of who will remain in - or leave - treatment for substance use disorder (SUD) can drive targeted interventions to support long-term recovery.Objectives: To conduct a comprehensive study of linguistic markers of SUD treatment outcomes, the current study integrated features produced by machine learning models known to have social-psychology relevance.Methods: We extracted and analyzed linguistic features from participants' Facebook posts (N = 206, 39.32% female; 55,415 postings) over the two years before they entered a SUD treatment program. Exploratory features produced by both Linguistic Inquiry and Word Count (LIWC) and Latent Dirichlet Allocation (LDA) topic modeling and the features from theoretical domains of religiosity, affect, and temporal orientation via established AI-based linguistic models were utilized.Results: Patients who stayed in the SUD treatment for over 90 days used more words associated with religion, positive emotions, family, affiliations, and the present, and used more first-person singular pronouns (Cohen's d values: [-0.39, -0.57]). Patients who discontinued their treatment before 90 days discussed more diverse topics, focused on the past, and used more articles (Cohen's d values: [0.44, 0.57]). All ps < .05 with Benjamini-Hochberg False Discovery Rate correction.Conclusions: We confirmed the literature on protective and risk social-psychological factors linking to SUD treatment in language analysis, showing that Facebook language before treatment entry could be used to identify the markers of SUD treatment outcomes. This reflects the importance of taking these linguistic features and markers into consideration when designing and recommending SUD treatment plans.

Measures of religion and spirituality in dementia: An integrative review

Introduction

Literature on the association of religion and spirituality (R/S) and health is growing. However, it is unclear how R/S affects outcomes and is assessed in persons with dementia (PWDs). In this integrative review, we evaluate published R/S measures and synthesize R/S findings for PWDs.

Methods

We searched five databases (ATLA Religion, CINAHL, PsychInfo, PubMed, SocIndex) and identified 14 of 1043 studies for review. We assess the studies' information, quality, measures, and results.

Results

We identified 17 measures for R/S: six were adapted for use with PWDs and only two were validated for PWDs; most studies reported only measures' reliability, with Cronbach's alpha. The studies' findings support significant positive associations between R/S and cognitive function and negative associations between R/S and depression and behavioral expressions.

Discussion

The two validated scales indicated acceptable validity with overall good reliability. Nevertheless, diverse samples and rigorous study designs are needed to improve R/S measures and to examine associations over time for PWDs.

Highlights

Few scales for measuring religion and spirituality (R/S) have been validated in persons with dementia (PWD); additional testing is needed.Most R/S measures only reported scale reliability with Cronbach's alpha.Studies supported positive associations between R/S and health yet few studies exist. conducted.Only one spiritual intervention, spiritual reminiscence, was found for PWD.More rigorous R/S studies are needed to examine health outcomes in dementia.

Therapeutic community-oriented day treatment program for Korean women with alcohol use disorder: a non-randomized pilot feasibility trial

BACKGROUND

The prevalence of alcohol use disorder (AUD) among women in South Korea has been rising, causing public health problems. Yet women's treatment needs are mostly unmet in South Korea due to the lack of women-focused treatment programs. This study evaluated the feasibility, acceptability, and clinical outcomes of a therapeutic community (TC)-oriented day treatment program for Korean women with AUD on alcohol abstinence self-efficacy, forgiveness, and spirituality.

METHODS

The current study employed a quasi-experimental, non-equivalent control group design with a pretest and posttest. Participants were assigned to 6-month TC-oriented day treatment program (n = 19) or usual treatment (n = 21). Feasibility (treatment completion rate) and acceptability (overall program satisfaction) were assessed. Alcohol abstinence was measured as a clinical outcome at baseline, 3 months, and 6 months. Repeated measures using Alcohol Abstinence Self-Efficacy (AASE), Enright Forgiveness Inventory-Korea (EFI-K), and Spiritual Assessment Scale (SAS) were also obtained from both conditions at those three time points.

RESULTS

Fifteen participants (78.9%) in the intervention group successfully completed the program. The overall program satisfaction ratings were very high (4.9 ± 0.2). Continuous abstinence rates at 6 months were significantly higher in the treatment group (78.9%) than in the control group (9.5%). Results of the two-way repeated measures ANOVA indicated that statistically significant two-way (group × time) interaction effects were found for the intervention group on AASE, EFI-K, and SAS but not for the control group on any of the outcomes.

CONCLUSION

The current study demonstrated the feasibility and acceptability of implementing a TC-oriented intensive day treatment program to promote recovery in Korean women with AUD. This intervention merits further investigation as a potential strategy to help address alcohol abstinence self-efficacy, forgiveness and spirituality.

TRIAL REGISTRATION

KCT0006386 (Cris.nih.go.kr).

Relationships between prosocial factors and college student health

Objective This study examined relationships between prosocial factors including altruism, compassion, social connectedness, spirituality, and volunteerism and measures of health in college students. Participants: A total of N = 1,075 participants from four institutions across various regions of the U.S. were included. Methods: Participants were sent email invitation via student listserv to participate in a survey of health and prosocial factors that was open for one month. Results: Hierarchical linear regressions were completed to examine the influence of prosocial variables on perceptions of health and engagement in health behaviors. Social connectedness was a significant contributor to variance in all health measures, and the variables with the most variance explained were symptoms of depression (28.6%) and Health-Related Quality of Life (24.6%). Conclusions: Institutions should prioritize programing to enhance social connectedness and other prosocial behaviors because of the positive effect these factors can have on health and health behaviors.

Development of the Prostate Cancer Treatment Decision Framework: A Context-Specific Expansion of the Risk-as-Feelings Hypothesis

BACKGROUND

Over the past 2 decades, numerous decision-making interventions have been developed to guide the prostate cancer (PrCA) treatment choices of patients and families. These interventions are often supported by economic decision frameworks, which do not account for the role of emotions in treatment decisions. In some instances, emotion-driven decisions can override an individual's cognitive evaluation of a decision, leading to unfavorable outcomes such as decision regret.

OBJECTIVES

To produce a Prostate Cancer Treatment Decision Framework based on the Risk-as-Feelings Hypothesis.

METHODS

The authors reviewed seminal research in emotion and decision-making in an effort to create a context-specific decision framework.

RESULTS

Five variables, not germane to the Risk-as-Feelings Hypothesis, play prominent roles in PrCA decision-making including age, spirituality, family support, healthcare provider communication, and perception of treatment outcomes. While family support only affects decision outcomes by influencing emotion and cognitive evaluation of a PrCA decision, age, spirituality, and healthcare provider communication can have direct effects on an individual's perception of treatment outcomes.

CONCLUSIONS

The Prostate Cancer Treatment Decision Framework combines new variables with older models to explain the PrCA treatment decision-making process and elucidate relationships affecting treatment outcomes and survivors' perceptions of these outcomes. The core premise of this model can be applied to other high-risk health decisions.

IMPLICATIONS FOR PRACTICE

Healthcare providers have the greatest influence on PrCA treatment decision-making. Using a shared decision-making approach, providers should take into account a patient's personal characteristics and values, in addition to clinical presentation, to help patients with treatment decisions.

Spontaneous Spiritual Awakenings: Phenomenology, Altered States, Individual Differences, and Well-Being

Spontaneous Spiritual Awakenings (SSAs) are subjective experiences characterised by a sudden sense of direct contact, union, or complete nondual merging (experience of oneness) with a perceived ultimate reality, the universe, "God," or the divine. These profound transformative experiences have scarcely been researched, despite extensive anecdotal evidence suggesting their potential to catalyse drastic, long-term, and often positive shifts in perception, world-view, and well-being. The aims of this study were to investigate the phenomenological variances of these experiences, including the potential differences between SSAs and Spontaneous Kundalini Awakenings (SKAs), a subset of awakening experiences that the authors postulate may produce a higher likelihood of both physical and negative effects; to explore how these experiences compare to other altered states of consciousness (ASCs), including those mediated by certain psychedelic substances; and understand their impact on well-being. Personality trait absorption and temporal lobe lability (TLL) were assessed as predictors of Spontaneous Spiritual and Kundalini Awakenings (SSA/SKAs). A mixed within and between-participants self-report survey design was adopted. A total of 152 participants reporting their most powerful SSA/SKAs completed questionnaires measuring nondual, kundalini, and mystical experience, as well as depth of ASC, and trait absorption and TLL. Spontaneous Kundalini Awakenings were found to be significantly more physical, but not significantly more negative than SSAs, and overall, both sets of experiences were perceived to be overwhelmingly more positive than negative, even in cases where the experience was initially challenging. The phenomenological distribution of SSA/SKAs was similar to other measured ASCs although greater in magnitude, and appeared most similar in distribution and in magnitude to drug-induced ASCs, particularly classic psychedelics DMT and psilocybin. Temporal lobe lability and trait absorption were found to predict the SSA/SKA experience. The limitations and implications of these findings are discussed.

Health locus of control, spirituality and hope for healing in individuals with intestinal stoma

Objective To assess the health locus of control, spirituality and hope of cure in patients with intestinal stoma.

Methods This study was conducted at the Polo of Ostomized People in the city of Pouso Alegre, Minas Gerais. Participants were 52 patients with intestinal stoma. Three questionnaires were applied for data collection: a questionnaire on demographic and stoma-related data; the Scale for Health Locus of Control; the Herth Hope Scale, and the Self-rating Scale for Spirituality.

Results Most ostomized subjects were women aged over 61 years, married and retired. As to the stoma, in the majority of cases these operations were definitive and were carried out due to a diagnosis of neoplasia. Most ostomized subjects had a 20- to 40-mm diameter colostomy, 27 showed dermatitis as a complication, and 39 (75%) used a two-part device. The mean total score for the Scale for Health Locus of Control, the Herth Hope Scale, and the Self-rating Scale for Spirituality were 62.42, 38.27, and 23.67, respectively. Regarding the dimensions of the Scale for Health Locus of Control, the dimension “completeness of health” = 22.48, dimension “externality-powerful others” = 22.48, and dimension “health externality” = 19.48.

Conclusion Ostomized patients participating in the study believe they can control their health and that caregivers and individuals involved in their rehabilitation can contribute to their improvement. The cure or improvement has a divine influence through religious practices or beliefs.

Association of sociodemographic and clinical factors with spirituality and hope for cure of ostomized people

Objective To evaluate the sociodemographic and clinical factors related to patients with intestinal stoma and correlate them to the health locus of control, spirituality and hope for a cure.

Method This study was conducted at the Polo of Ostomized Patients of the city of Pouso Alegre, Minas Gerais. Participants were 52 patients with intestinal stoma. The scale for Health Locus of Control, the Herth Hope Scale, and the Self-rating Scale for Spirituality were used for data collection.

Results The patients were aged up to 50 years, with the following means: Herth Hope Scale: 17.53; Self-rating Scale for Spirituality: 19.33. With regard to marital status, single people had a mean of 21.00 for the Herth Hope Scale. Retired ostomized patients had a mean of 20.53 for the Herth Hope Scale, of 10.38 for the Self-rating Scale for Spirituality, and of Scale for Health Locus of Control, of 18.79. The patients whose cause of making the stoma was neoplasia attained a mean of 19.43 for the Self-rating Scale for Spirituality. Regarding the character of the stoma, the mean for the Herth Hope Scale was 18.40. In the ostomized individuals who lived with the stoma for less than four years the means for the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control were 17.39, 20.35, and 23.09, respectively. Patients who did not participate of an association or support had means for the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control of 19.08, 17.25, and 20.63 respectively.

Conclusion Ostomized patients believe they can control their health and that those involved in their care and rehabilitation can contribute to their improvement.

[Development and Validation of the New Version of Spirituality Assessment Scale]

PURPOSE

The purpose of this study was to develop a new version of Spirituality Assessment Scale (N-SAS) and verify its reliability and validity.

METHODS

The total of 59 preliminary items for the N-SAS were selected through a literature review, two rounds of experts' content validation, cognitive interviews, and pre-tests. Verification of its reliability and validity was divided into two phases. In Phase I, questionnaires were collected from 219 adults. Reliability was tested using Cronbach's alpha, validity with item analysis, and exploratory factor analysis. In Phase II, questionnaires developed based on the results of Phase I were collected from 225 adults. Reliability was tested using Cronbach's alpha, validity with confirmatory factor analysis, and criterion validity.

RESULTS

The final version of the N-SAS comprised two dimensions (vertical and horizontal), four domains (relationship with God; meaning of life and self-integration; self-transcendence; and relationship with others, neighborhoods, and nature), and 44 items were identified. Total Cronbach's α was .97; those of each subscale ranged from .79 to .98. N-SAS scores were positively correlated with the scores of Howden's Spiritual Assessment Scale (r=.81, p<.001).

CONCLUSION

Findings suggest that the N-SAS can be used to measure spirituality in adults. The use of N-SAS is expected to facilitate perceiving patient's spiritual needs and providing spiritual care.

Unna boot therapy impact on wellbeing, hope and spirituality in venous leg ulcer patients: a prospective clinical trial

Objective:

To assess the impact of Unna boot therapy on subjective wellbeing, hope and spirituality in patients with venous leg ulcers (VLU).

Method:

This was a prospective, descriptive, analytical, multicentre clinical trial conducted in a nursing care and education centre, an outpatient wound care clinic and a primary health care unit in Brazil. Adult patients with VLUs took part in the study. Patients with diabetic foot ulcers and mixed ulcers were excluded. A questionnaire assessing sociodemographic and religious characteristics of patients, the Subjective Wellbeing Scale, the Spirituality Self-Rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all patients.

Results:

A total of 60 patients (63.3% female; 86.7% aged ≥60 years) participated. Before Unna boot therapy, 65%, 66.7% and 65% of patients reported a score of one on positive affect, negative affect and life satisfaction, respectively, indicating poor subjective wellbeing. After one month of compression therapy, 66.7%, 50.0%, and 80.0% of patients reported a score of three for each element positive affect, negative affect and life satisfaction, respectively, showing a significant improvement in subjective wellbeing (p=0.029). A significant increase in total SSRS scores (p=0.017) was found between baseline (mean: 9.77) and one month of treatment (mean: 25.47), indicating a significant increase in a sense of spirituality. There was also a significant increase in total HHI values (p=0.009) between baseline (mean: 15.68) and one month of compression therapy (mean: 39.38), suggesting a significant increase in hope among patients.

Conclusion:

Patients with VLUs treated with Unna boot therapy in this study showed significant improvement in subjective wellbeing, spirituality and hope for cure.

Developing the Spirituality in Recovery Framework: The Function of Spirituality in 12-Step Substance Use Disorder Recovery

A large portion of substance use disorder recovery research has incorporated the study of mutual-aid 12-Step programs and faith-based programs. However, spirituality as a centerpiece of substance use disorder recovery, as an actionable or operationalized means of transformative change, is not well studied. As many individuals in recovery point to spirituality as the chief means by which they have overcome their substance use disorder, this represents a significant gap in the current literature. Though spirituality is difficult to operationalize and measure, several previous studies have examined aspects of the role of spirituality in the recovery process. This current article puts forth a theoretical framework in which leading articles involving spirituality in recovery are synthesized in order to inform a functional, theoretical model of change that can be utilized in future research design.

Association of Lower Spiritual Well-Being, Social Support, Self-Esteem, Subjective Well-Being, Optimism and Hope Scores With Mild Cognitive Impairment and Mild Dementia

Introduction: Positive psychology (PP) constructs contribute significantly to a better quality of life for people with various diseases. There are still few studies that have evaluated the evolution of these aspects during the progression of dementia. Objective: To compare the scores for self-esteem, life satisfaction, affect, spirituality, hope, optimism and perceived support network between elderly people with mild cognitive impairment (MCI), mild dementia and moderate dementia and control group. Methods: Cross-sectional study. The sample consisted of 66 healthy controls, 15 elderly people with MCI, 25 with mild dementia and 22 with moderate dementia matched by age, gender, and schooling. The instruments used were: Spirituality Self Rating Scale (SSRS), Rosenberg Self-Esteem Scale, Medical Outcomes Study's Social Support Scale, Life Satisfaction Scale (LSS), Positive and Negative Affect Schedule (PANAS), Revised Life Orientation Test (LOT-R), and Adult Dispositional Hope Scale (ADHS). Results: The scores for spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism, negative affect, and hope differed significantly between the groups (p < 0.05). The individuals with MCI and mild dementia had lower spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism and hope scores, and higher negative affect scores compared with the controls. The scores for PP constructs did not differ between the group of people with moderate dementia and the control group. Conclusion: Dementia was found to impact several PP constructs in the early stages of the disease. For individuals with greater cognitive impairment, anosognosia appears to suppress the disease's impact on these constructs.

High spirituality may be associated with right hemispheric lateralization in Korean adults living with epilepsy

PURPOSE

Although it is known that epilepsy and spirituality are related, spirituality in epilepsy has received relatively little clinical and scientific attention. Therefore, we investigated which epilepsy-related factors are associated with high spirituality in Korean adults living with epilepsy.

METHODS

This cross-sectional study was conducted in two university hospitals in Korea. Spirituality was assessed using the 6-item Spirituality Self-Rating Scale (SSRS). The participants were categorized into high and low spirituality groups according to the median SSRS score. The presumptive seizure onset zone was determined based on the clinical semiology, electroencephalography, and magnetic resonance imaging findings.

RESULTS

Of the 180 participants, 61.7% declared that they had a religious affiliation. The median SSRS score was 15 (interquartile range: 7, 22). The high spirituality subgroup consisted of 92 (51.1%) participants. In the univariate analyses, the high spirituality group was significantly associated with female sex (p<0.05), older age (p<0.01), longer epilepsy duration (p<0.05), polytherapy (p<0.05), complex partial seizure (p<0.05), levetiracetam or topiramate usage (p<0.05), and a right-lateralized seizure onset zone. The multiple logistic regression analysis identified right hemispheric lateralization as the only independent factor associated with high spirituality (odds ratio: 2.410, 95% confidence interval: 1.051-5.528, p<0.05).

CONCLUSIONS

High spirituality may be associated with right hemispheric lateralization but not with the temporal localization of the seizure onset zone in Korean adults with epilepsy.

Combining medically assisted treatment and Twelve-Step programming: a perspective and review

BACKGROUND

People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address this deficit, rehabilitative care for severe substance use disorders could be promoted through collaboration between practitioners of medically assisted treatment, employing medications, and Twelve-Step-oriented practitioners.

OBJECTIVE

To describe the limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders; and to assess how the two approaches can be employed together to improve clinical outcome.

METHOD

Empirical literature focusing on clinical and manpower issues is reviewed with regard (a) to limitations in available treatment options in ambulatory and residential addiction treatment facilities for persons with severe substance use disorders, (b) problems of long-term rehabilitation particular to opioid-dependent persons, associated with the limitations of pharmacologic approaches, (c) the relative effectiveness of biomedical and Twelve-Step approaches in the clinical context, and (d) the potential for enhanced use of these approaches, singly and in combination, to address perceived deficits.

RESULTS

The biomedical and Twelve-Step-oriented approaches are based on differing theoretical and empirically grounded models. Research-based opportunities are reviewed for improving addiction rehabilitation resources with enhanced collaboration between practitioners of these two potentially complementary practice models. This can involve medications for both acute and chronic treatment for substances for which such medications are available, and Twelve-Step-based support for abstinence and long-term rehabilitation. Clinical and Scientific Significance: Criteria for developing evidence-based approaches for combined treatment should be developed, and research for evidence-based treatment on this basis can be undertaken in order to develop improved clinical outcome.

Measures of spirituality for use in military contexts: a scoping review

Introduction: The purpose of this scoping review is to identify measures of spiritual fitness that can be used in a military context. Methods: Two independent reviewers applied post-hoc inclusion and exclusion criteria for the identification of relevant articles, reviews, and assessments. Each reviewer independently recorded criteria met using a jointly developed form, considering relevant spiritual fitness screening and assessment tools based on clinical experience. When two reviewers were in disagreement, a third blinded reviewer was used to create consensus. Results: 35 assessments with psychometric properties were identified that could be administered by military chaplains, health care professionals, or military personnel (through self-reporting) to evaluate spiritual fitness over time among those in the military service. The assessments were compiled into a table to isolate differing properties of each assessment, including target population, length/time to complete, measurement of affective, behavioural, and cognitive aspects of spiritual fitness, psychometric properties, and example questions. Discussion: There is now an opportunity to further identify and evaluate spiritual fitness screening and assessment tools that will appropriately and effectively determine the spiritual fitness and resilience of individuals serving in the military as well as their families.

Effects of religiosity and spirituality on the treatment response in patients with depressive disorders

BACKGROUND

Few studies have investigated the roles of religiosity and spirituality in predicting treatment response among psychiatric patients with depressive disorders.

METHODS

In total, 232 outpatients with depressive disorders completed measurements of psychological symptoms, religiosity, and spirituality at baseline. A response was defined as Clinical Global Impression-Improvement scale (CGI-I) score of 1 or 2 at the last visit during a 6-month treatment period. Univariate analyses and logistic regression analysis were used to identify predictors of treatment response.

RESULTS

In univariate analyses, treatment response was associated with marital status, longer treatment duration, less severe baseline symptoms, higher personal importance of religion, and higher spirituality. In logistic regression analysis, subjective important considerations for religion and spirituality were significantly related with treatment response after controlling for marital status, treatment duration, and baseline symptom severity. Of these variables, spirituality remained a significant predictor in the final model.

CONCLUSIONS

These findings suggest that higher spirituality may independently contribute to favorable treatment responses among depressed patients in addition to other demographic and clinical factors.

Culture, Personality, and Attitudes Toward Euthanasia

This article reports cultural differences in the relationship between personality characteristics and euthanasia attitudes using samples from Iran and the United States. Survey data from university students were analyzed using multivariate regression. Results indicate that while attitudes toward euthanasia are significantly more positive among the U.S. sample, there is significantly greater variation among the Iranian sample. Honesty-Humility and Openness to Experience are predictive factors in both samples, where Agreeableness is only significant among the Iranian group. Additionally, Chow tests of structural features of the multivariate models show significant differences between the two samples. We conclude by discussing implications of these results for understanding cultural similarities and differences in attitudes toward euthanasia, including the practical implications of this work for patient care in an increasingly globalized world.

Spirituality and desistance from substance use among reentering offenders

Prior research has indicated an inverse relationship between religion and criminal behavior; however, few studies have specifically examined the effect of spirituality on the desistance process among a contemporary and diverse sample of reentering drug-involved offenders. A comprehensive understanding of how spirituality is related to desistance from substance use can lead to more effective and evidence-based preventive and rehabilitative interventions. Using data from a longitudinal study of 920 diverse offenders returning to the community after a period of incarceration, the current study examines three distinct forms of substance use (alcohol, marijuana, and cocaine) to gauge the effect that spirituality plays in the desistance process. The findings suggest a relatively high importance of spirituality in terms of preventing substance use during reentry, particularly concerning the use of both alcohol and cocaine.

A qualitative study of methamphetamine users' perspectives on barriers and facilitators of drug abstinence

To better understand methamphetamine (MA) use patterns and the process of recovery, qualitative interviews were conducted with adult MA users (n = 20), comparing a sample that received substance abuse treatment with those who had not received treatment. Respondents provided detailed information on why and how they changed from use to abstinence and factors they considered to be barriers to abstinence. Audio recordings and transcripts were reviewed for common themes. Participants reported a range of mild/moderate to intensely destructive problems, including loss of important relationships and profound changes to who they felt they were at their core; e.g., "I didn't realize how dark and mean I was … I was like a different person." Initial abstinence was often facilitated by multiple external forces (e.g., drug testing, child custody issues, prison, relocation), but sustained abstinence was attributed to shifts in thinking and salient realizations about using. The treatment group reported using more and different resources to maintain their abstinence than the no-treatment group. Findings indicate individualized interventions and multiple, simultaneous approaches and resources were essential in reaching stable abstinence. Understanding long-term users' experiences with MA use, addiction, and abstinence can inform strategies for engaging and sustaining MA users in treatment and recovery.

The role of religion and spirituality in mental health

PURPOSE OF REVIEW

There has been increased interest in the relationship between religion and spirituality and mental health in recent years. This article reviews recent research into the capacity of religion and spirituality to benefit or harm the mental health of believers. We also examine the implications this may have for assessment and treatment in psychiatric settings.

RECENT FINDINGS

Studies indicate that religion and spirituality can promote mental health through positive religious coping, community and support, and positive beliefs. Research also shows that religion and spirituality can be damaging to mental health by means of negative religious coping, misunderstanding and miscommunication, and negative beliefs. Tools for the assessment of patients' spiritual needs have been studied, and incorporation of spiritual themes into treatment has shown some promise.

SUMMARY

Religion and spirituality have the ability to promote or damage mental health. This potential demands an increased awareness of religious matters by practitioners in the mental health field as well as ongoing attention in psychiatric research.

A preliminary 6-month prospective study examining self-reported religious preference, religiosity/spirituality, and retention at a Jewish residential treatment center for substance-related disorders

Although there is a substantial amount of research suggesting that higher levels of religiosity/spirituality (R/S) are associated with better treatment outcomes of substance-related disorders, no studies have explored this relationship at a faith-based residential treatment center. The objective of this prospective study is to explore the relationship between R/S, self-reported religious preference, and retention at a Jewish residential treatment center for substance-related disorders. Using the Daily Spiritual Experience Scale, R/S levels were assessed for 33 subjects at baseline, 1 month, 3 months, and 6 months. Results demonstrated a significant relationship between baseline R/S level and retention at 6 months, while R/S levels were unchanged during the course of treatment. Notably, no relationship was found between self-reported religious affiliation and retention. This study demonstrates that patients' R/S level, rather than religious affiliation, is a possible predictor for better outcome at faith-based residential centers for substance-related disorders.

Daily Spiritual Experiences and Adolescent Treatment Response

The purpose of this study is to explore changes in belief orientation during treatment and the impact of increased daily spiritual experiences (DSE) on adolescent treatment response. One-hundred ninety-five adolescents court-referred to a 2-month residential treatment program were assessed at intake and discharge. Forty percent of youth who entered treatment as agnostic or atheist identified themselves as spiritual or religious at discharge. Increased DSE was associated with greater likelihood of abstinence, increased prosocial behaviors, and reduced narcissistic behaviors. Results indicate a shift in DSE that improves youth self-care and care for others that may inform intervention approaches for adolescents with addiction.

Examining the relationship between ethnicity and the use of drug-related services: an ethnographic study of Nepali drug users in Hong Kong

A recent survey has shown that Nepali drug users in Hong Kong tend to have a low rate of usage of day-care and residential rehabilitation services, but a high rate of usage of methadone services. Little is known about the reasons behind such a pattern. Therefore, in this study, a 12-month ethnographic examination has been implemented in three sites, including a day-care center, residential rehabilitation center, and methadone clinic, to explore the experiences of 20 Nepali drug users in their use of drug-related services in Hong Kong and to examine the relationship between ethnicity and the use of drug-related services. The result shows that the reason for this pattern of service use is related to the approach of the services and the cultural perception of the service providers about the service users. The day-care and residential rehabilitation services emphasize an integrated approach, but the staff tend to overlook the heterogeneity of their clients, for example, the differences in caste and sex, and fail to provide suitable services to them, whereas the methadone service follows a biomedical model, which seldom addresses the social characteristics of the service users, which in turn minimizes the opportunity for misunderstandings between the staff and the clients. This research shows that ethnicity is a significant factor in drug treatment and that culture-specific treatment that takes into consideration the treatment approach and the heterogeneity of the clients is strongly needed.

Marital status and optimism score among breast cancer survivors

PURPOSE

There are an increasing number of breast cancer survivors, but their psychosocial and supportive care needs are not well-understood. Recent work has found marital status, social support, and optimism to be associated with quality of life, but little research has been conducted to understand how these factors relate to one another.

METHODS

Survey data from 722 breast cancer survivors were analyzed to estimate the association between marital status and optimism score, as measured using the Life Orientation Test-Revised. Linear regression was used to estimate the relationship of marital status and optimism, controlling for potential confounding variables and assessing effect modification.

RESULTS

The results showed that the association between marital status and optimism was modified by time since breast cancer diagnosis. Specifically, in those most recently diagnosed (within 5 years), married breast cancer survivors had a 1.50 higher mean optimism score than unmarried survivors (95 % confidence interval (CI) 0.37, 2.62; p = 0.009). The difference in optimism score by marital status was not present more than 5 years from breast cancer diagnosis.

CONCLUSIONS

Findings suggest that among breast cancer survivors within 5 years since diagnosis, those who are married have higher optimism scores than their unmarried counterparts; this association was not observed among longer-term breast cancer survivors. Future research should examine whether the difference in optimism score among this subgroup of breast cancer survivors is clinically relevant.

Personality factors and attitudes toward euthanasia in Iran: implications for end-of-life research and practice

This article reports on the relationship of personality and euthanasia attitudes. Results from a survey of 165 Iranian students showed that religiosity, honesty-humility, agreeableness, and extraversion were related to negative attitudes toward euthanasia, whereas openness was related to acceptance of euthanasia, with the unconventionality facet driving this relationship. Moreover, openness explained additional variance when added to a multivariate model containing religiosity and HEXACO factors. This study illustrates the possibility of accounting for variation beyond the traditional group level predictors of attitudes toward euthanasia and promoting future cross-cultural studies into personality and end-of-life issues and informing end-of-life conversations at the bedside.

Spiritual awakening predicts improved drinking outcomes in a Polish treatment sample

PURPOSE

This study examined concurrent and longitudinal associations between two dimensions of affiliation in Alcoholics Anonymous (AA)-attendance and spiritual awakening-and drinking outcomes among adult patients who were in treatment for alcohol dependence in Warsaw, Poland. In a study conducted at four addiction treatment centers, male and female patients (n = 118) with a DSM-IV diagnosis of alcohol dependence were assessed at baseline (Time 1 or T1), 1 month (T2), and 6-12 months postbaseline (T3) for AA meeting attendance, various aspects of AA affiliation, and alcohol use. Alcoholics Anonymous meeting attendance and alcohol consumption were measured using the Timeline Followback interview. Self-report of having had a spiritual awakening was measured using a modified version of the Alcoholics Anonymous Involvement Scale.

RESULTS

There were no cross-sectional or longitudinal associations between AA meeting attendance and improved drinking outcomes. In contrast, self-report of a spiritual awakening between T2 and T3 was significantly associated with abstinence (OR = 2.4, p < .05) and the absence of any heavy drinking (OR = 3.0, p < .05) at T3, even when demographic and clinical characteristics were statistically controlled.

CONCLUSIONS

Self-reports of spiritual awakening predicted improved drinking outcomes in a Polish treatment sample.

Spirituality in addictions treatment: wisdom to know…what it is

Spirituality has long been integrated into treatments for addiction. However, how spirituality differs from other related constructs and implications for recovery among nonspiritual persons remains a source of discussion. This article examines ways in which spirituality is delineated, identifies variables that might mediate the relations between spirituality and recovery from substance abuse disorders, describes distinctions between spiritual and nonspiritual facets of addictions treatment, and suggests means to assist in further clarification of this construct.

Spirituality, drugs, and alcohol: a philosophical analysis

Spirituality has long been associated with recovery from the socially constructed "addictive disease." Alcoholics Anonymous (AA) and its analogs have enjoyed widespread acceptance as a spiritual approach for achieving recovery. AA or its derivatives are the predominant approaches in treatment programs even though a wide array of evidence-based approaches are now promoted by governmental sources in the United States. This philosophical analysis contrasts the state of science about addictive disorders with the reliance on a spiritual approach that is heavily grounded in Christian theology. We present four problems that need consideration before accepting the applicability of 12-step spiritual practices as the backbone of addiction treatment or recovery.

"What do you mean by spirituality? Please draw me a picture!" Complementary faith-based addiction treatment in Switzerland from the client's perspective

This article reviews: (1) the relative importance of spirituality and religion in Switzerland and the United States, (2) the rationale for faith-based addiction intervention programs and the drawbacks of measurement approaches, and (3) results from a pilot study exploring the meaning of spirituality and religiosity from the consumer's perspective. Twenty-three patients entering the Swiss Südhang clinic in-patient alcohol user treatment program during the first five months in 2012 participated upon their admission in a video-taped drawing task, designed to provide their personal visualized definitions of the terms "spirituality" and "religiosity." Nine dimensions emerged pointing to a high complexity of the concepts.

Measuring spirituality and religiosity in clinical research: a systematic review of instruments available in the Portuguese language

CONTEXT AND OBJECTIVES

Despite numerous spirituality and/or religiosity (S/R) measurement tools for use in research worldwide, there is little information on S/R instruments in the Portuguese language. The aim of the present study was to map out the S/R scales available for research in the Portuguese language.

DESIGN AND SETTING

Systematic review of studies found in databases.

METHODS

A systematic review was conducted in three phases. Phases 1 and 2: articles in Portuguese, Spanish and English, published up to November 2011, dealing with the Portuguese translation and/or validation of S/R measurement tools for clinical research, were selected from six databases. Phase 3: the instruments were grouped according to authorship, cross-cultural adaptation, internal consistency, concurrent and discriminative validity and test-retest procedures.

RESULTS

Twenty instruments were found. Forty-five percent of these evaluated religiosity, 40% spirituality, 10% religious/spiritual coping and 5% S/R. Among these, 90% had been produced in (n = 3) or translated to (n = 15) Brazilian Portuguese and two (10%) solely to European Portuguese. Nevertheless, the majority of the instruments had not undergone in-depth psychometric analysis. Only 40% of the instruments presented concurrent validity, 45% discriminative validity and 15% a test-retest procedure. The characteristics of each instrument were analyzed separately, yielding advantages, disadvantages and psychometric properties.

CONCLUSION

Currently, 20 instruments for measuring S/R are available in the Portuguese language. Most have been translated (n = 15) or developed (n = 3) in Brazil and present good internal consistency. Nevertheless, few instruments have been assessed regarding all their psychometric qualities.

The recovery of religious and spiritual significance in American Psychiatry

This paper reviews a body of data that identifies underlying influences that have contributed to an evolving change in American Psychiatry toward a more positive and receptive stance toward religion and spirituality over the past three decades. This development, surprising in light of the remedicalization of psychiatry and its predominantly neuro-biological orientation, is attributed to five foundational ideas that have helped to leverage this change. These are significance of culture, creative power of ritual, psychic function of belief, neuro-biology of spirituality, and relevance of recovery narratives. The impact of these factors for psychiatric assessment and treatment is described, as well as the contribution of the Oskar Pfister legacy and award to the ongoing dialogue between religion and psychiatry. Adapted from the American Psychiatric Association's 2011 Oskar Pfister Lecture in Religion and Psychiatry.

Efficacy of different instruments for the identification of the nursing diagnosis spiritual distress

The study aims to identify the nursing diagnosis Spiritual distress in 120 patients with Chronic Renal Insufficiency, using different instruments, and to evaluate the effectiveness of these instruments in support of this identification. Data were collected separately by two nurses using a questionnaire containing sociodemographic information and the defining characteristics of Spiritual distress, as well as direct questioning to the patient regarding the presence of the diagnosis and the instruments: the Spirituality Rating Scale; Pinto and Pais-Ribeiro's Spirituality Scale; and the Spiritual Well-being Scale. The study found that 25.8% to 35.8% of the patients had the diagnosis. The diagnostic evaluation developed by the expert nurses presented no divergence between the two and obtained a perfect concordance coefficient (96.7%) with the opinion of the patient; this demonstrated substantial concordance with the Existential Well-being Sub-scale (83.3%) and with the Pinto e Pais-Ribeiro's Spirituality Scale (87.5%), which demonstrated their usefulness for diagnostic identification.