Recovery on higher ground: Spirituality in the treatment of substance abuse

• Maintaining professional boundaries is critical when dealing with religious and spiritual aspects of the patient’s life and thinking. Keep in mind issues of transference and the authoritative influence of the psychiatrist. The patient should understand the difference between services offered by a mental health professional and those given by a spiritual counselor or member of the clergy. Spiritual and religious issues, such as addressing concerns over guilt and sin and a relationship with God, should be referred to an appropriate clergyperson.

• Spiritual interventions introduced into the therapeutic process always should derive from the patient’s perspective and value system; they should not be imposed from an external source.

• Referral to AA often will help alcohol-dependent patients. The heart of AA’s philosophy is that addiction should be seen as a spiritual problem and that genuine recovery requires a profound spiritual awakening (Box 2). AA, as well as interventions inspired by it (eg, NA), are based on peer support, are readily available, and free. Although there is a dearth of controlled research demonstrating the efficacy of AA compared with other interventions, many recovering alcoholics credit these 12-step programs with their having maintained sobriety and adopting a positive lifestyle.

Recent research has identified specific components of AA participation that seem to be helpful.²⁶ These include activities that are spiritual in nature and other generally active components of substance abuse care. Patient preference should be respected when encouraging AA involvement. For patients who are uncomfortable with AA—especially with its emphasis on spirituality—alternative peer support groups are available, such as SMART Recovery.^27,28 If the patient adopts AA’s philosophy, it might be helpful for you to employ the language of AA and its constructs when talking with him (her).

Useful strategies on how therapists can encourage AA participation and integrate mutual help groups into treatment planning are described by Nowinski.²⁵ Some AA members believe that use of medication is antithetical to the recovery process, but this is not the position of AA²⁹; using FDA-approved medications, such as naltrexone and acamprosate, is evidence-based and often should be a part of the treatment regimen for alcohol dependence.

Bottom Line

Awareness of, and sensitivity to, the religious and spiritual characteristics of patients with substance use disorder can enhance clinical rapport, inform development of individualized treatment plans, and suggest strategies, such as professional consultation, that might increase the prospects for successful treatment.

Related Resources

• Galanter M. The concept of spirituality in relation to addiction recovery and general psychiatry. Recent Dev Alcohol. 2008;18:125-140.
• Monod S, Brennan M, Rochat E, et al. Instruments measuring spirituality in clinical research: a systematic review. J Gen Intern Med. 2011;26(11):1345-1357.

Drug Brand Names

Acamprosate • Campral

Naltrexone • ReVia, Vivitrol

Disclosure

The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

Featured Audio
John P. Allen, PhD, MPA, discusses whether spirituality plays a different role in treating substance use disorder than it might in treating other psychiatric illnesses. Dr. Allen works at the Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, Division of Addictions Research and Treatment, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.