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

Effectiveness of a spiritual adaptation of cognitive behavioural therapy in improving resilience, self-esteem and spirituality among clients with opioid use disorder: A quasi-experimental study

WHAT IS KNOWN ON THE SUBJECT?: Opioid use disorder (OUD) is a prevalent problem among Egyptian youth, and achieving recovery and abstinence is challenging. Cognitive behavioural therapy (CBT), a well-known approach, can be particularly beneficial when it addresses psychological aspects such as resilience and self-esteem. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Our research is recognized as a trailblazer in integrating a spiritual adaptation of CBT with spiritual elements for treating patients with OUD in the Egyptian context. This innovative approach marks a significant advancement in the field. The study found a statistically significant increase in the mean scores of resilience, self-esteem, and spirituality (p < .001 each) following the spiritual adaptation of CBT sessions compared to the control group. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings can guide psychiatrists and nurses in providing more comprehensive and effective care to patients with OUD by incorporating a spiritual adaptation of CBT with spiritual components into treatment plans.

ABSTRACT

INTRODUCTION: Opioid use disorder (OUD) is a prevalent problem among Egyptian youth, and achieving recovery and abstinence is challenging. Cognitive behavioural therapy (CBT), a well-known approach, can be particularly beneficial when it addresses psychological aspects such as resilience, self-esteem and spirituality.

AIM

This study aimed to evaluate the effectiveness of a spiritual adaptation of CBT in enhancing these factors among clients with OUD.

METHODS

A quasi-experimental study with a control group was conducted using a pretest-posttest design. The study included 49 clients with OUD and 46 clients in the control group. The Rosenberg Self-Esteem Scale-Modified Arabic Version, Daily Spiritual Experience Scale, and the Connor-Davidson Resilience Scale were used as measurement tools. CBT was delivered in 60-min group sessions. After 3 months, the questionnaires were re-administered to evaluate the effectiveness of a spiritual adaptation of CBT sessions.

RESULTS

The study found a statistically significant increase in the mean scores of resilience, self-esteem and spirituality (p < .001 each) following a spiritual adaptation of CBT sessions compared to the control group.

DISCUSSION

A spiritual adaptation of CBT effectively enhanced resilience, self-esteem and spirituality in clients with OUD.

IMPLICATIONS FOR PRACTICE

Understanding the effectiveness of a spiritual adaptation of CBT in enhancing resilience, self-esteem and spirituality can enable psychiatrists and nurses to provide more comprehensive and effective care to patients with OUD.

Beyond the 12 steps: Integrating chaplaincy services into Veteran Affairs substance use specialty care

Background: Interprofessional training is increasing in focus within medical education. Although substance use treatment has long been interprofessional in nature, chaplaincy has been relatively absent in outpatient settings. Since 2013, the Veterans Health Administration has supported an Interprofessional Advanced Fellowship in Addiction Treatment (IAFAT), with 7 sites nationally recruiting across multiple health care disciplines. In the fall of 2017, Veteran Affairs Connecticut Healthcare System (VACHS) became the first such fellowship to expand its recruitment to include chaplain fellows. We seek to share rationale for recruiting chaplains, current curriculum and curricular needs, and the potential roles of chaplains in outpatient addiction treatment. Methods: Collaborating with the office of chaplaincy education, we describe the process of chaplain recruitment, incorporation into a new treatment setting, and supervision, and we report on the feasibility of this innovative training initiative. Results: During the first year, the chaplain fellow has developed and maintained a new clinical service in an outpatient substance use disorder (SUD) specialty care setting, delivering over 150 hours of group and individual treatment to veterans. He has provided 12 presentations to staff on the role of a chaplain and other related topics, as well as written an article on the topic of addiction for a clergy audience. Anecdotally, staff satisfaction has been high, and the current chaplain is helping to recruit for his replacement. Limitations: As a feasibility pilot project, there is no outcome and very limited quantitative data. Conclusions: Chaplain fellows can be successfully incorporated into outpatient SUD clinics with a noticeable degree of fellow, staff, and patient satisfaction.

Raja yoga meditation and medication-assisted treatment for relapse prevention: A pilot study

The continued need for advancement in evidence-based SUD treatment, as well as increases in treatment expense and decline in support from insurance providers, suggest that brief, innovative, and affordable treatments are needed. Meditation, spirituality, and adherence to medication-assisted treatments have all been shown to support abstinence. The current trial assessed effects of spiritually-based meditation, versus relaxation or standard treatment, on substance abstinence and psychological distress and dysfunction in a partially buprenorphine-supported (41.5%) treatment sample. Participants (N = 40) were recruited from an intensive outpatient treatment program, in which three treatment locations acted as separate experimental conditions. Abstinence was measured through urinalyses at baseline and weekly thereafter for the duration of the intervention. Psychological distress and dysfunction were assessed with a Likert-scaled questionnaire measuring symptoms typically associated with SUD. Co-varying for buprenorphine use, participants in the Meditation condition had better odds of remaining abstinent than participants in the Treatment-as-Usual (TAU) and Relaxation conditions. There were no significant differences in substance abstinence between the Relaxation and TAU conditions. Further, co-varying out baseline there were no significant differences at post-course in psychological distress and dysfunction between the three conditions. Results from this pilot trial suggest that this spiritually-informed approach may offer additive support to individuals in SUD treatment, as an aid to the meditative aspect of the 12 steps, or a non-12-step alternative spiritual supplement to standard SUD treatment.

What Do You Say Before You Relapse? How Language Use in a Peer-to-peer Online Discussion Forum Predicts Risky Drinking among Those in Recovery

Increasingly, individuals with alcohol use disorder (AUD) seek and provide support for relapse prevention in text-based online environments such as discussion forums. This paper investigates whether language use within a peer-to-peer discussion forum can predict future relapse among individuals treated for AUD. A total of 104 AUD sufferers who had completed residential treatment participated in a mobile phone-based relapse-prevention program, where they communicated via an online forum over the course of a year. We extracted patterns of language use on the forum within the first four months on study using Linguistic Inquiry and Word Count (LIWC), a dictionary-based text analysis program. Participants reported their incidence of risky drinking via a survey at 4, 8, and 12 months. A logistic regression model was built to predict the likelihood that individuals would engage in risky drinking within a year based on their language use, while controlling for baseline characteristics and rates of utilizing the mobile system. Results show that all baseline characteristics and system use factors explained just 13% of the variance in relapse, whereas a small number of linguistic cues, including swearing and cognitive mechanism words, accounted for an additional 32% of the total 45% of variance in relapse explained by the model. Effective models for predicting relapse are needed. Messages exchanged on AUD forums could provide an unobtrusive and cost-effective window into the future health outcomes of AUD sufferers, and their psychological underpinnings. As online communication expands, models that leverage user-submitted text toward predicting relapse will be increasingly scalable and actionable.

Spiritual Well-Being and Associated Factors with Relapse in Opioid Addicts

INTRODUCTION

Opioid dependence relapse is a complex and multidimensional problem, and lack of spiritual well-being is a major concern in opioid addicts.

AIM

This study was conducted to determine spiritual well-being and factors associated with relapse among opioid addicts.

MATERIALS AND METHODS

This cross-sectional study was conducted from April 2015 to September 2015. According to purposive sampling, 312 eligible addicted patients were enrolled in the study. The patients had at least an attempt of detoxification in the past six months and referred to an outpatient detoxification clinic in Shahrekord (Southwest, Iran). They completed Paloutzian and Ellison's Spiritual Well-being Scale. A researcher-developed questionnaire consisting of demographic characteristics and 20 questions about associated factors with relapse was administered. Data were analysed by version 16.0 (SPSS Inc.,Chicago, IL) using one-way ANOVA, Pearson's correlation test, chi-square, Friedman test, and student's t-test.

RESULTS

The most important factors associated with opioid dependence relapse consist of relation with an addict friend, unemployment, living expenses, family conflicts, and somatic pain. In the present study, 157 patients had never experienced relapse while the mean of relapse in the rest participants was (3.25±1.53) times. Furthermore, the addicted patients with relapse had significantly lower scores of spiritual well-being and its subscales compared with non-relapse patients (p<0.001).

CONCLUSION

The findings of the present study indicate the necessity of paying attention to spiritual well-being, family and economical, personal, and occupational factors as crucial factors in opiate addiction relapse.

Substance misuse prevention: addressing anhedonia

Anhedonia refers to the inability of experiencing pleasure in positive life events. It has been conceptualized as a stable yet malleable characteristic and is associated with hypoactivity in the mesolimbic and mesocortical dopaminergic systems. Very recently, it has been posited as an etiologic factor associated with drug addiction onset, escalation, and relapse. Prevention programming could be developed to counteract the harmful impact of anhedonia, so as to minimize its impact on drug misuse. Remedial efforts are those that either (1) permit the individual to tolerate low levels of pleasure without resorting to drug misuse or other maladaptive behaviors that may unhealthily besot pleasure (for example, through normalization, structuring time, or meditation) or (2) counteract anhedonia by enhancing ones capability to experience pleasure (for example, behavioral activation, positive psychology, pharmacotherapy, or pursuit of positive addictions). School-based activities could be developed that can be completed by individuals, small workgroups, or the whole classroom. The concept of anhedonia is described in this chapter, and possible prevention strategies that might be utilized in schools as well as other contexts are discussed.