Spirituality during alcoholism treatment and continuous abstinence for one year

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.

The Effect of Baseline Patterns of Spiritual Coping, Forgiveness, and Gratitude on the Completion of an Alcohol Addiction Treatment Program

The purpose of this study was to identify distinct profiles of persons beginning alcohol addiction therapy with similar baseline configurations of spiritual coping, forgiveness, and gratitude. The associations between latent profile membership and the completion of therapy were also examined. The sample was composed of 358 alcohol-dependent persons receiving an outpatient treatment program. The Spiritual Coping Questionnaire, the Forgiveness Scale, and the Gratitude Questionnaire were used to assess the baseline levels of spirituality-related variables. Using latent profile analysis, five profiles were identified: (1) both moderately positive and negative dimensions of spirituality (33.2%), (2) moderately positive dimensions of spirituality (21.0%), (3) predominantly negative dimensions of spirituality (20.2%), (4) mixed dimensions of spirituality with the lowest positive religious coping (14.0%), and (5) highly positive dimensions of spirituality (11.6%). Notably, the latent profiles differed in terms of the treatment completion rates. The results suggest the need to carry out a multidimensional assessment of spiritual functioning of persons beginning alcohol addiction therapy to provide treatment that is adjusted to patients' spiritual potential and deficits.

Factors associated with women achieving and maintaining abstinence from alcohol: a rapid evidence assessment

Purpose

The purpose of this paper is to review the literature on the factors related to women’s ability to achieve and maintain abstinence from alcohol.

Design/methodology/approach

A rapid evidence assessment was carried out in four stages: definitions and research questions were agreed, search and selection were completed, data were extracted, quality of studies was assessed, and findings were synthesised and presented.

Findings

Medline, PsycINFO, CINAHL and ASSIA were searched for cohort studies published in English during January 2000–February 2015. Expanded search terms for Women, Alcohol and Abstinence, and Cohort were used to identify relevant studies for inclusion, resulting in 1,040 records. Of these, 32 manuscripts from 31 studies were eligible for inclusion in the review. Alcohol-related factors such as increased quantity and frequency of alcohol consumption were related to lower likelihood of achieving and maintaining abstinence; treatment factors such as type of treatment and number of treatment episodes were related to higher and lower likelihood; demographic factors such as financial problems and poor housing status were related to lower likelihood; and psychological factors such as craving, other drug use and comorbid health problems were linked to lower likelihood.

Originality/value

To the authors’ knowledge, this is the first time the factors related to the specific outcome of abstinence in women have been synthesised. Many of the factors found are also known to contribute to vulnerability for developing alcohol problems. The review revealed the paucity of studies with female only samples, or where results for women were reported separately.

Cessation and reduction in alcohol consumption and misuse after psychedelic use

BACKGROUND

Meta-analysis of randomized studies using lysergic acid diethylamide (LSD) for alcohol use disorder (AUD) showed large, significant effects for LSD efficacy compared to control conditions. Clinical studies suggest potential anti-addiction effects of LSD and mechanistically-related classic psychedelics for alcohol and other substance use disorders.

AIMS

To supplement clinical studies, reports of psychedelic use in naturalistic settings can provide further data regarding potential effects of psychedelics on alcohol use.

METHODS

An anonymous online survey of individuals with prior AUD reporting cessation or reduction in alcohol use following psychedelic use in non-clinical settings.

RESULTS

343 respondents, mostly White (89%), males (78%), in the USA (60%) completed the survey. Participants reported seven years of problematic alcohol use on average before the psychedelic experience to which they attributed reduced alcohol consumption, with 72% meeting retrospective criteria for severe AUD. Most reported taking a moderate or high dose of LSD (38%) or psilocybin (36%), followed by significant reduction in alcohol consumption. After the psychedelic experience 83% no longer met AUD criteria. Participants rated their psychedelic experience as highly meaningful and insightful, with 28% endorsing psychedelic-associated changes in life priorities or values as facilitating reduced alcohol misuse. Greater psychedelic dose, insight, mystical-type effects, and personal meaning of experiences were associated with a greater reduction in alcohol consumption, controlling for prior alcohol consumption and related distress.

CONCLUSIONS

Although results cannot demonstrate causality, they suggest that naturalistic psychedelic use may lead to cessation or reduction in problematic alcohol use, supporting further investigation of psychedelic-assisted treatment for AUD.

The role of spirituality in alcohol abstinence self-efficacy amongst alcoholics anonymous members

Purpose

Previous research indicates that Alcoholics Anonymous (AA) can play an effective role in alcohol use disorder recovery (Kelly, Stout, Magill, Tonigan and Pagano, 2011). Acceptance of a “Higher Power” and experiencing a “spiritual awakening” are essential components of AA recovery programme (Alcoholics Anonymous World Service, 2014). The purpose of this paper is to identify if there are high associations in levels of spirituality and alcohol abstinence self-efficacy (AASE) measures amongst AA members.

Design/methodology/approach

Self-reported measures were collected from members of AA of their spiritual and religious beliefs and their everyday experiences of alcohol abstinence. Demographic information of participant’s ethnical background, age and length of AA membership was also obtained.

Findings

The analysis revealed high levels of spirituality amongst participants with a mean of 70.14 (2dp). There was no difference in participant high or low spiritual beliefs and their attitude towards alcohol abstinence. The frequency measures of spiritual activities showed that 73.7 per cent of participants engage in private spiritual or religious activities more than once a week.

Originality/value

Overall the study supports previously conduced researches in the field of spirituality and AASE amongst AA members when considering other variables associated with sustained sobriety. The implications of the results of this study are discussed and suggestions have been made for further investigation.

Spirituality and mental health status among Northern Plain tribes

Spirituality measures often show positive associations with preferred mental health outcomes in the general population; however, research among American Indians (AIs) is limited. We examined the relationships of mental health status and two measures of spirituality - the Midlife Development Inventory (MIDI) and a tribal cultural spirituality measure - in Northern Plains AIs, aged 15-54 (n = 1636). While the MIDI was unassociated with mental health status, the tribal cultural spirituality measure showed a significant relationship with better mental health status. Mental health conditions disproportionately affect AIs. Understanding protective factors such as cultural spirituality that can mitigate mental health disorders is critical to reducing these health disparities.

Cultural adaptation, psychometric properties, and outcomes of the Native American Spirituality Scale

Spirituality is central to many Native Americans (NAs) and has been associated with recovery from substance use disorders (SUDs). However, no published questionnaire uniquely taps tribal-specific spiritual beliefs and practices. This hinders efforts to integrate traditional NA spirituality into SUD treatment and track spiritual outcomes. As part of a randomized controlled trial examining SUD treatment for NAs, we adapted the Daily Spiritual Experience Scale (DSES) in collaboration with members of a Southwest tribe to create the Native American Spirituality Scale (NASS) and measured changes in the NASS over the course of treatment. The 83 participants (70% male) were from a single Southwest tribe and seeking SUD treatment. They completed the NASS at baseline, 4, 8, and 12 months. Exploratory factor analysis of the NASS was conducted and its temporal invariance, construct validity, and longitudinal changes in the factor and item scores were examined. The NASS yielded a 2-factor structure that was largely invariant across time. Factor 1 reflected behavioral practices, while Factor 2 reflected more global beliefs. Both factors significantly increased across 12 months, albeit at different assessment points. At baseline, Factor 1 was negatively related to substance use and positively associated with measures of tribal identification while Factor 2 was unrelated to these measures. Given the importance of tribal spirituality to many NAs, the development of this psychometrically sound measure is a key precursor and complement to the incorporation of tribal spirituality into treatment, as well as research on mechanisms of change for SUD treatment among NAs and assessment of NA spirituality in relation to other aspects of health.

Sex Differences in Spiritual Coping, Forgiveness, and Gratitude Before and After a Basic Alcohol Addiction Treatment Program

The aim of the study was to examine the sex differences in the initial level of spiritual coping, forgiveness, and gratitude and changes occurring in these areas during a basic alcohol addiction treatment program. The study involved 112 persons, including 56 women and 56 men, who started and completed a basic alcohol addiction treatment program at day care units of 11 treatment centers. Two measurements were taken: one in the first week of the treatment, and one in the last week (5th-7th week after baseline). The Spiritual Coping Questionnaire, the Forgiveness Scale, and Gratitude Questionnaire were used. When starting the therapy, women had a higher level of negative spiritual coping (p = .024) and a lower level of forgiveness of others (p = .041) than men. During the therapy, positive changes in spiritual coping occurred in both sex groups, although in the case of women they involved improvements in more domains and they were stronger. The increase in the level of moral values (except for self-forgiveness) was noted solely in women. The study reveals the need to take sex differences into consideration when introducing spiritual elements into the therapy.

The relationship between spirituality and aggression in a sample of men in residential substance use treatment

There is a robust literature documenting that aggression perpetration is increased among individuals in treatment for substance use. Although aggression decreases with successful substance use treatment, a substantial number of patients continue to engage in aggression following treatment. Thus, continued research is needed on potential protective factors for aggression that could be enhanced during substance use treatment. The current study examined the relationship between spirituality and aggression among men in residential treatment for substance use (N = 398), as many substance use treatment programs employ spirituality-based interventions. Findings demonstrated that spirituality was negatively associated with attitudinal, physical, and verbal aggression, as well as a composite aggression score. Moreover, spirituality remained negatively associated with aggression after controlling for age, alcohol use and problems, and drug use and problems. These findings provide preliminary evidence for the association between spirituality and aggression among men in treatment for substance use. Continued research is needed in this area, particularly longitudinal and treatment outcome research.

General and religious coping predict drinking outcomes for alcohol dependent adults in treatment

BACKGROUND

Religiosity is associated with improved treatment outcomes among adults with alcohol dependence; however, it is unknown whether religious coping predicts drinking outcomes above and beyond the effects of coping in general, and whether gender differences exist.

METHODS

We assessed 116 alcohol-dependent adults (53% women; mean age = 37, SD = 8.6) for use of religious coping, general coping, and alcohol use within 2 weeks of entering outpatient treatment, and again 6 months after treatment.

RESULTS

Religious coping at 6 months predicted fewer heavy alcohol use days and fewer drinks per day. This relationship was no longer significant after controlling for general coping at 6 months.

CONCLUSIONS

The relationship between the use of religious coping strategies and drinking outcomes is not independent of general coping. Coping skills training that includes religious coping skills, as one of several coping methods, may be useful for a subset of adults early in recovery.

SCIENTIFIC SIGNIFICANCE

This novel, prospective study assessed the relationship between religious coping strategies, general coping, and treatment outcomes for alcohol-dependent adults in treatment with results suggesting that the use of religious coping as one of several coping methods may be useful for a subset of adults early in recovery.

Dispositional mindfulness, spirituality, and substance use in predicting depressive symptoms in a treatment-seeking sample

OBJECTIVE

It is imperative that research identifies factors related to depression among individuals in substance use treatment, as depression is associated with substance use relapse. Dispositional mindfulness and spirituality may bear an important role in the relationship between depression and substance use.

METHOD

Using preexisting patient medical records (N = 105), the current study investigated dispositional mindfulness and spirituality in relation to depressive symptom clusters (affective, cognitive, and physiological) among men in residential substance use treatment. The mean age of the sample was 41.03 (standard deviation = 10.75).

RESULTS

Findings demonstrated that dispositional mindfulness and spirituality were negatively associated with depressive symptoms. After controlling for age, alcohol use, and drug use, dispositional mindfulness remained negatively associated with all of the depression clusters. Spirituality only remained associated with the cognitive depression cluster.

CONCLUSION

Mindfulness-based interventions may hold promise as an effective intervention for reducing substance use and concurrent depressive symptoms.

Relationship of spirituality or religion to recovery from substance abuse: a systematic review

Spirituality and religion are frequently acknowledged as significant contributors to individuals' recovery from substance use disorders. This review focuses on the role that spirituality or religion plays in substance abuse treatment outcomes. Our search of three databases-PubMed, CINAHL, and Psych Info-turned up 29 eligible studies for review. We group our findings according to whether the study's focus was on alcohol only or alcohol and other drug use. The most common treatment outcome was abstinence followed by treatment retention, alcohol or drug use severity, and discharge status. For most studies, we found evidence suggesting at least some support for a beneficial relationship between spirituality or religion and recovery from substance use disorders. Our review addresses the strengths and limitations of these studies.

Multiple dimensions of spirituality in recovery: a lagged mediational analysis of Alcoholics Anonymous' principal theoretical mechanism of behavior change

Alcoholics Anonymous (AA) states that recovery is possible through spiritual experiences and spiritual awakenings. Research examining spirituality as a mediator of AA's effect on drinking has been mixed. It is unknown whether such findings are due to variations in the operationalization of key constructs, such as AA and spirituality. To answer these questions, the authors used a longitudinal model to test 2 dimensions of AA as focal predictors and 6 dimensions of spirituality as possible mediators of AA's association with drinking. Data from the first 18 months of a 3-year longitudinal study of 364 alcohol-dependent individuals were analyzed. Structural equation modeling was used to replicate the analyses of Kelly et al. (Alcohol Clin Exp Res. 2011;35:454-463) and to compare AA attendance and AA involvement as focal predictors. Multiple regression analyses were used to determine which spirituality dimensions changed as the result of AA participation. A trimmed, data-driven model was employed to test multiple mediation paths simultaneously. The findings of the Kelly et al. study were replicated. AA involvement was a stronger predictor of drinking outcomes than AA attendance. AA involvement predicted increases in private religious practices, daily spiritual experiences, and forgiveness of others. However, only private religious practices mediated the relationship between AA and drinking.

Six-month changes in spirituality and religiousness in alcoholics predict drinking outcomes at nine months

OBJECTIVE

Although spiritual change is hypothesized to contribute to recovery from alcohol dependence, few studies have used prospective data to investigate this hypothesis. Prior studies have also been limited to treatment-seeking and Alcoholics Anonymous (AA) samples. This study included alcohol-dependent individuals, both in treatment and not, to investigate the effect of spiritual and religious (SR) change on subsequent drinking outcomes, independent of AA involvement.

METHOD

Alcoholics (N = 364) were recruited for a panel study from two abstinence-based treatment centers, a moderation drinking program, and untreated individuals from the local community. Quantitative measures of SR change between baseline and 6 months were used to predict 9-month drinking outcomes, controlling for baseline drinking and AA involvement.

RESULTS

Significant 6-month changes in 8 of 12 SR measures were found, which included private SR practices, beliefs, daily spiritual experiences, three measures of forgiveness, negative religious coping, and purpose in life. Increases in private SR practices and forgiveness of self were the strongest predictors of improvements in drinking outcomes. Changes in daily spiritual experiences, purpose in life, a general measure of forgiveness, and negative religious coping also predicted favorable drinking outcomes.

CONCLUSIONS

SR change predicted good drinking outcomes in alcoholics, even when controlling for AA involvement. SR variables, broadly defined, deserve attention in fostering change even among those who do not affiliate with AA or religious institutions. Last, future research should include SR variables, particularly various types of forgiveness, given the strong effects found for forgiveness of self.

Spirituality, Religiousness, and Alcoholism Treatment Outcomes: A Comparison between Black and White Participants

This study addresses an unexplained finding in the alcoholism treatment field: despite the health and socioeconomic disparities that exist between blacks and whites at intake, blacks and whites achieve equivalent treatment outcomes. Using Project MATCH data, this study explores religiousness and spirituality as strengths in the African American community that may account in part for equivalent outcomes. Using binary logistic regression, this study found that as purpose in life increased, blacks were more likely to achieve sobriety than whites. This study provides evidence that purpose in life is a cultural strength and an advantage among blacks in achieving sobriety.