The Meaning of Suffering in Drug Addiction and Recovery from the Perspective of Existentialism, Buddhism and the 12-Step Program

Self-Forgiveness and Gratitude in Recovery from Substance Use Disorders

Substance use is a multifaceted disorder of the whole person that is manifested on three levels: intrapersonal, interpersonal, and spiritual. Previous research has demonstrated that self-forgiveness and gratitude help build personal and social resources and reinforce the process of recovery from substance use disorders. The aims of the present narrative review article were to (a) explore self-forgiveness and gratitude as psychological mechanisms of behavioral change in recovery through the lens of positive criminology and recovery capital approach, (b) review the practice of self-forgiveness and gratitude in the Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) programs, and (c) present a conceptual model of self-forgiveness and gratitude in long-term recovery. Self-forgiveness and gratitude have been described as positive emotions and prosocial, empathy-based moral virtues that enhance well-being and health by reinforcing the establishment and maintenance of long-lasting positive relationships with self, others, and spirituality. This effect may occur through different levels and psychological mechanisms. This article contributes to the field by presenting the intrapersonal, interpersonal, and spiritual benefits associated with self-forgiveness and gratitude interventions that can initiate and sustain long-term recovery.

From Looking for Reason to Finding Meaning: A Spiritual Journey of Recovery From Sexual Trauma

The current study aims to describe a spiritual facet of recovery processes from sexual trauma, as manifested in the transformation from the frustration and despair of looking for reasons to the traumatic event(s) to the growth and prosperity of finding meaning. A phenomenological research was conducted, interviewing individuals with a variety of affiliations to spirituality and to trauma: female survivors who turned to spirituality as part of their recovery process (n = 17), spiritually oriented therapists who treat survivors (n = 10), and spiritual leaders and teachers who are often consulted by survivors and their close ones (n = 9). Participants were asked about the nature of perceived transformation of survivors' trauma, within the meaning context, and about the perceived relevance of such a spiritual meaning-making process to recovery. Findings suggests four stances in the process:(1) doubting, describing frustrations, denials, and struggles, (2) believing, describing the acceptance of the idea that there is spiritual meaning in the trauma, (3) knowing, describing calmness, comfort, trust, and sense of freedom, and (4) doing, describing carrying the message of spiritual recovery to other survivors. This study contributes to the growing body of literature on victimology and on spirituality. It adds to the research on the spiritual meaning-making process, on the role of spirituality in survivors' perceptions of victimization and recovery, and on the importance of spiritual meaning as a recovery capital. Additionally, it directs therapists to broaden their discussions with survivors on their beliefs and values. The study lays the foundation for a theory entitled Spiritual Victimology.

Meaning-Making among Drug Addicts during Drug Addiction Recovery from the Perspective of the Meaning-Making Model

(1) Background: This study aimed to explore the dynamics of meaning-making among drug addicts during drug addiction recovery by using a case study approach. The participants were five male recovering addicts, aged 26 to 49 years, who had been abstinent for 4 to 17 years; (2) Methods: Data collection consisted of in-depth interviews. Data were analyzed using the Adverse Childhood Experience (ACE) Questionnaire, Meaning in Life Questionnaire (MLQ), Beck’s Depression Inventory-II (BDI-II), and recovery stage criteria based on the Developmental Model of Recovery (DMR). (3) Results: The results showed that meaning making was an ongoing process before and during the use of drugs and recovery. Drug use was a coping strategy to overcome distress caused by ACE, which was perceived as a stressful event and brought up an implicit meaning of ACE. This initial meaning played an essential role in initiating the dynamics of the subsequent meaning-making process. A similar mechanism using non-constructive adaptation processes other negative impacts of drug use. They created more distress and developed false-positive beliefs, which resulted in continued drug use. Symptoms of depression occur during drug use, which drags the addict to the lowest point in life (hitting rock bottom), and addicts perceive it as a turning point for seeking treatment and attaining recovery. In complete recovery, reappraising the meaning of the stressors experienced throughout life makes new constructive meaning. Creating a constructive meaning of earliest traumatic experiences played an important role in preventing relapse and ensuring the success of recovery from drug addiction.

The Role of Acceptance and Change in Recovery from Substance Use Disorders

Long-term recovery (LTR) from substance use disorders (SUDs) has been described as a complex process. It has been proposed that psychological mechanisms can influence the resolution of problematic substance using behaviors and may explain how and why a recovery process works. The aims of this narrative review were to (a) examine acceptance and change as an underlying mechanism in LTR from SUDs; (b) examine the practice of acceptance and change in the Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) programs; and (c) present a conceptual model of self-acceptance and change in LTR from SUDs. Based on dialectical behavioral philosophy and mindfulness-based intervention, I posited that self-acceptance is an underlying mechanism that addresses the cyclical nature of shame, guilt, and SUDs; improves emotion dysregulation; psychological well-being; and activates a change process of recovery from SUDs. This article contributes to the field by presenting the opposing forces of acceptance versus change and their synthesis in promoting LTR from SUDs, and by discussing the practice of acceptance and change in the AA and NA programs.

From Enchantment to Disillusion: A Narrative Exploration of Cannabis Use Disorder Among Young Israeli Combat Veterans

Introduction: Substance use is common among military personnel and war veterans, especially combat veterans. Despite substantially high prevalence of cannabis use and Cannabis Use Disorder (CUD) consistently reported among veterans, little is known about psychological factors which may underlie CUD among this population. Methods: In this study, we used narrative analysis in order to interpret retrospective in-depth interviews of combat veterans (N = 12) who were released from mandatory military duty during the past 5 years and currently qualified for a diagnosis of CUD. Participants were recruited from a larger quantitative study were eligible for participation if they screened positive for a diagnosis of CUD according to the Cannabis Use Disorder Identification Test- Revised (CUDIT-R) questionnaire. CUD diagnosis was validated in-person using the cannabis section of the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5) interview protocol. All interviews were transcribed and coded using the content analysis procedure. Findings: Five main themes were extracted: (a) Traumatic events (b) Attitudes toward cannabis use (c) Combatant identity (d) The role of authority/father figures, and (e) Moral crisis. A meta-theme has been identified, "from enchantment to disillusion," representing a gradual psychological shift from a hopeful, highly motivated stance into the current state of mental rupture and moral injury, which are unsuccessfully compensated by excessive use of cannabis. Conclusions: This study shed light on the etiology of CUD among young combat veterans, highlighting the role of supposed self-medication for trauma and sense of betrayal.

The exploration of factors related to treatment retention in Narcotics Anonymous members: a qualitative study

Background

Elimination of psychological dependence to substance is more difficult than elimination of physical dependence, and needs to time, going through several stages, and internal care. The aim of this study was to exploring the factors related to treatment retention in Narcotics Anonymous members.

Methods

In a qualitative study and by individual interview, 12 recovered participants were interviewed. The participants were substance user, whom recovered for more than two years. The data were gathered by purposeful sampling and through recording and transcribing interviews. Data analysis were done by qualitative content analysis through three steps: conceptualization, interview and data analysis.

Results

After analyzing data, two main categories had emerged: “personal-psychological” and “social” factors. Personal-psychological" factors includes: self-knowledge, change of attitude, self-confidence, consistency in treatment, living in the moment and “social” factors include interaction with others, group of sympathizers, reformation of social and familial relationships, reclaiming the social position, supports received from others, and supports received from the generalized network.

Conclusion

Recovered individuals are in need to emotional supports and reclaiming their positions in the family and society play an important role in their treatment retention. Keeping the Substance users away from drugs is not the basic step of substance use treatment, but the necessary supports and special cares should be given to the Substance users after elimination of physical attachment, so that the psychological dependence can be eliminated as well.

Criminal Spin, Self-Control, and Desistance From Crime Among Juvenile Delinquents: Determinism Versus Free Will in a Qualitative Perspective

The current research is a qualitative examination of the relations between self-control and deterministic/non-deterministic perceptions of life events and the drifts into or desistance from a criminal spin among juvenile delinquents. Based on in-depth semi-structured interviews with 21 adolescents (11 active delinquents and 10 desisters), we found that both the intensification of criminal behavior and the desistance from criminal activity are gradual and connected to the reduction or acquisition, respectively, of self-control and the offenders' belief in their self-control. Criminal behavior and self-control were found to be associated with deterministic or non-deterministic perceptions of life events: the former combined with low self-control are associated with a delinquent lifestyle; the latter combined with high self-control promote the likelihood that young offenders will modify their behavior and desist from criminal behavior. The study may provide better understanding of the role of the criminal spin in the engagement or desistance from criminal behavior.

Factors influencing early withdrawal from a drug and alcohol treatment program and client perceptions of successful recovery and employment: a qualitative study

BACKGROUND

Substance use disorders are a major contributor to the economic and healthcare burden in Australia. Therapeutic communities (TCs) are utilised treatment methods globally, though low program completion rates continue to represent a major obstacle in effective and sustainable drug and alcohol treatment. The aim of this study was to explore reasons for early withdrawal from TC programs and perceptions of successful recovery. This study also aimed to explore how employment and volunteering related to early exit and perceptions of successful recovery.

METHODS

Semi-structured qualitative interviews were conducted with 13 ex-residents from a long-term TC program at a community-based rehab organisation in regional Australia.

RESULTS

Thematic analysis revealed a complex interplay of factors contributing to early TC withdrawal, and perceptions of successful recovery from a lived experience perspective and how this was shaped by employment and volunteering. Eleven themes were identified. Three relating to reasons for joining the program, which connected with ultimate withdrawal from the program: Pre-program existing relationships, pre-program employment situation and needing a 'circuit breaker' in their life. Three relating to reasons for early withdrawal: TC program characteristics, relationships during the program and planning future employment. Five relating to perceptions of successful recovery: Improved understanding of their addiction, reduced substance use, improved physical and psychological health, relationship success and employment success.

CONCLUSIONS

Reasons for leaving treatment early are multi-faceted and revolve around relationships, planning future employment and program characteristics. The influence that each plays on their decision to leave early is varied and determined by the value they assign it. Perceived success extends far beyond achieving and maintaining abstinence to encompass improved relationships, psychological and physical wellbeing, understanding of addiction and employment, studying or volunteering. Self-worth and feeling able to contribute to society through employment, study and volunteering were perceived to be essential elements of successful recovery. Clinicians, policy makers and program developers should use the extended definition of successful recovery from the ex-clients perspective when determining the clinical and economic effectiveness of TC programs.

Building Recovery Capital: The Role of "Hitting Bottom" in Desistance and Recovery from Substance Abuse and Crime

The aim of this article is to explore the role of "hitting bottom" as a motivation to initiate a recovery process and desistance from crime and substance use disorders (SUDs), and in building recovery capital (RC). Researchers and practitioners have long been interested in why and how offenders desist from crime. Desistance and recovery from crime and SUDs have also been linked to negative turning points, such as hitting bottom, which represents multidimensional suffering with physiological, familial, social, and criminal implications. The deleterious outcomes of SUDs cause individuals to lose their social and personal resources and hit bottom. According to the conservation of resources model, in the context of actual or potential loss of resources, individuals strive to maintain, protect, and build them. Thus, hitting bottom not only provides the initial motivation for change, but also drives individuals to build personal resources. The prospects for successful recovery are dependent upon the individual's personal and social resources, or RC. This article represents a first step in examining the role of hitting bottom in building RC in the process of long-term recovery. The conclusions may have theoretical as well as practical implications.

Stories of Hell and Healing: Internet Users' Construction of Benzodiazepine Distress and Withdrawal

Benzodiazepines are a group of drugs used mainly as sedatives, hypnotics, antiepileptics, and muscle relaxants. Consumption is recommended for 2 to 4 weeks only, due to fast onset of dependency and potentially distressing withdrawal symptoms. Few peer-review studies have drawn on the user experiences and language to appreciate firsthand experiences of benzodiazepine withdrawal or discontinuation syndrome. We looked extensively at patient stories of benzodiazepine withdrawal and recovery on Internet support sites and YouTube. Our analysis indicated that users employ rich metaphors to portray the psychologically disturbing and protracted nature of their suffering. We identified seven major themes: hell and isolation, anxiety and depression, alienation, physical distress, anger and remorse, waves and windows, and healing and renewal. By posting success stories, ex-users make known that "healing" can be a long, unpredictable process, but distress does lessen, and recovery can happen.

Positive Criminology and Rethinking the Response to Adolescent Addiction: Evidence on the Role of Social Support, Religiosity, and Service to Others

Adolescent addiction has emerged as a major public health problem. The greatest increase in alcohol and other drug use disorders can be found among youth. Concurrently, technological advances in policing coupled with aggressive prosecuting and sentencing practices have contributed to the growth of America's correctional system. The assertive response of policing, courts, and corrections, however, have not prevented the dramatic rise of adolescent addiction. Unfortunately, there is no national data tracking addicted youth in the criminal justice system to evaluate what works when it comes to youth with addiction. This article reviews justice system responses to adolescent offenders with addiction, and promising approaches engaging juveniles in programmatic components of Alcoholics Anonymous (AA). This study highlights the role of spirituality, service to others, and social support in maintaining sobriety, reducing arrests, and lowering recidivism for adolescents court-referred to treatment. Recommendations for improving the response to adolescent offenders with addiction are offered.

Smoking prevalence among monks in Thailand

Previous studies among Buddhist monks in Thailand have reported smoking rates to be as high as 55%. Because 95% of Thais are Buddhist, monks are highly influential in establishing normative behavioral patterns. As the first population-based study on smoking among Buddhist monks in Thailand, this study aims to determine the smoking prevalence in six regions of the country, and to examine smoking knowledge, risk perceptions, behaviors, and associated demographics among full-fledged and novice monks (n = 6,213). Results demonstrated that the overall prevalence for current smoking monks is 24.4% (95% confidence interval [24.453, 24.464]), with regional differences ranging from 14.6% (North) to 40.5% (East). Findings suggest that integrating prevention and cessation programming into religious courses may be one avenue for reaching many incoming monks. Further, involving monks in tobacco control education and setting a nonsmoking standard among them is vital to the success of reducing smoking rates among the general population in Thailand.