Soul Survivors — Spirituality and Religion in Addiction Recovery
By Dan Orzech
Social Work Today
Vol. 6 No. 2 P. 36

Recovery takes different directions. Whatever path is chosen, spirituality has helped many move away from destructive addictions to more peaceful destinations.

Ten years ago, Edward* was a successful businessman with a wife and four children. A regular at his family’s church, he considered himself a born-again Christian. But Edward was also having anonymous sex with men and going on periodic drinking binges.

In anguish about his behavior, but deeply in love with his wife, he worked up the courage to tell her what he was doing. Together they went to their minister, who conducted an exorcism that night. “They were trying to get rid of the evil spirits within me,” Edward says, “which included both being gay and being alcoholic.”

It didn’t work.

With the help of 12-step programs including Alcoholics Anonymous (AA) and Sexual Compulsives Anonymous, therapy to deal with his early sexual abuse, and a stint in rehab, Edward is now sober and no longer has anonymous sex. Divorced, he is living openly as a gay man and is more at peace with himself than ever before.

His spirituality, he believes, played an important part in his recovery. He tries to pray and write in a journal every day and goes to church regularly. But, he says, “I get more spirituality from the [12-step] rooms than I do from church.”

That is not unusual for people in recovery, according to Elizabeth Robinson, MSW, PhD, a researcher at the University of Michigan’s Addiction Research Center. “As a group,” she says, “men and women in recovery tend to be religiously alienated. Spirituality is very important to them, organized religion much less so.”

A Loaded Issue
For many clinicians and researchers, however, the role of spirituality and religion in helping people free themselves of alcoholism and other addictions is often a mystery.

As a result, it can be easily overlooked in therapy. The issue of God is “loaded,” says Abby Michaleski, LCADC, a licensed addictions counselor and rabbinical student in New Jersey. “Take a therapist who’s uncomfortable with it and a client—who’s already vulnerable—with no clue how to deal with it, and it just doesn’t get addressed.”

“Talking about spirituality and religion is like talking about sex,” says Robinson. “For many people, it’s private.”

The language alone can be a barrier. The world of religion uses terms such as grace and virtue that are not part of the everyday vocabulary of most social workers.

But the ideas the words are describing may be quite familiar. “The spiritual changes that happen in addiction recovery are actually reintroducing into people’s lives what religious traditions have considered virtues,” says Linda Mercadante, PhD, a minister and professor of theology at the Methodist Theological School in Ohio and author of Victims and Sinners: Spiritual Roots of Addiction and Recovery. That can include things such as honesty and taking responsibility for yourself, she says, as well as “forgiveness—including forgiving yourself, which is a big issue for people struggling with addictions—and reopening to community, because usually addiction is a very isolating experience.”

Praying More
Researchers have known for a long time that people who are more religious have a lower likelihood of developing alcohol-related problems—not to mention better health, greater marital stability, and lower levels of criminality.

Only in the last few years, however, have they begun looking closely at how spiritual and religious changes affect the recovery of people with alcohol and drug problems. A series of grants issued over the last five years by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Fetzer Institute, a Kalamazoo, MI-based foundation, have helped spur research in the area.

The early results emerging from this research show that for people in 12-step recovery programs, the more spiritual or religious they become, the more likely they are to stay sober.

Robinson has found, for example, in yet unpublished research funded by the NIAAA and Fetzer, that people in an alcohol treatment center who reported a growing number of daily spiritual experiences, or who become clearer about their purpose in life, were more likely to be free of heavy drinking after six months of recovery.

“People who go to 12-step groups like Alcoholics Anonymous or Narcotics Anonymous end up being more likely to identify themselves as spiritual,” says Sarah Zemore, PhD, a research scientist at the Alcohol Research Group of the University of California, Berkeley. “They’re thinking about God more, they’re praying more, meditating more, and that seems to have something to do with their getting sober.”

That’s a potentially significant finding, given the impact of alcohol problems on society. Nearly 14 million people in the United States—one in every 13 adults— abuse alcohol or are alcoholic, according to the NIAAA.

So far, however, the research has raised more questions than it’s answered. It’s not clear, for example, whether the spiritual changes are responsible for the sobriety, or whether people become more spiritual as they stop using drugs or alcohol.

Nor is it clear—since AA and other 12-step programs are spiritually focused approaches—whether the people undergoing these changes simply have a strong identification with the group and are the ones following the program, says Zemore.

Scared Away By Spirituality
Both Robinson and Zemore would like to study other approaches to recovery besides the 12-step model. “A lot of people get scared away from 12-step groups because they’re spiritual,” says Zemore. “There need to be alternatives for people who don’t want to attend these programs.”

Zemore would like to study nonspiritual approaches to recovery such as LifeRing, which aims, like 12-step groups, for complete abstinence from addictive substances or behaviors, but allows individuals to design their own tailor-made recovery programs. Unlike 12-step programs, LifeRing considers “higher powers” and other theological concepts as “redundant at best” to the recovery process.

LifeRing and other nonspiritual recovery groups such as Secular Organization for Sobriety, Women for Sobriety, Inc., or SMART Recovery, are all newer and far smaller than long-established 12-step programs. LifeRing, for example, has approximately 40 meetings each week in northern California and a few dozen elsewhere in the United States. AA, which was founded in 1935, has an estimated 52,000 meetings in the United States.

Some researchers are already studying paths to recovery that don’t follow the traditional 12-step model. Robinson’s current research includes subjects from Alcohol Management—formerly called DrinkWise—a moderated drinking program at the University of Michigan. And researchers such as Alan Marlatt, PhD, of the University of Washington, and Art Margolin, PhD, of Yale University—who calls his methodology 3-S, for Spiritual Self-Schema—are taking a different approach by teaching people to meditate as part of a recovery program.

While some people may be put off by the spiritual approach of 12-step groups, others are able to reframe it to meet their own needs.

Many people in recovery describe their “higher power” as the 12-step community, says Michaleski. That opens the door to people “who don’t believe in God, who aren’t going to go anywhere near God,” she says. “For many in recovery, the concept of a ‘higher power’ may mean ‘I’m not in charge.’ There may not be a connection with any type of religion, or any God, but they still have a sense of connection to something bigger than themselves.”

In the second step of AA, for example—immediately after admitting that they are powerless over alcohol in the first step—the alcoholic says he or she “came to believe that a power greater than ourselves could restore us to sanity.

“When you come into recovery,” explains Michaleski, “and you’re scared and overwhelmed and vulnerable, and you’ve been trying to handle this thing on your own, you learn to accept that you can’t do it by yourself. And the group is there to help you. So ‘a power greater than ourselves’ could be that the power of this program, or the people in these groups, or this therapist, might be able to help me.”

Similarly, the third step—“Made a decision to turn our will and our lives over to the care of God as we understood Him”—becomes a decision to accept that help.

That’s key, says Michaleski, because with addicts, “so much of it is about control. They’re saying, ‘I can control this. I can control myself. I’m fine. I don’t need anyone to help me.’”

The reluctance to trust others or accept help, she says, may come from the trauma or abuse that often underlies the addiction, and plays a part in the “spiritual bankruptcy that develops as the addictive disorder progresses.”

A Variety of Alternatives
Like Zemore, Robinson believes there must be various alternative treatment approaches that can serve different spiritual needs. “For some people, maybe the majority of people,” she says, “[spiritual issues] are really critical to their being able to stay sober. But there’s going to be a subset for whom that’s not an issue. It’s important for us to understand the variations in the religiousness and spirituality of different people’s recovery.”

The importance of that is reinforced by the stories in Anne Fletcher’s 2001 book, Sober for Good: New Solutions for Drinking Problems, which chronicles the paths to recovery of 222 men and women who had seriously abused alcohol. More than one half of the people profiled quit drinking without AA, some with the help of therapists, others on their own.

For a few, religion may hold the key to sobriety. Michaleski describes one woman she knows who has more than 20 years of sobriety from alcohol. “She spent six months or so in AA in the very beginning of her sobriety,” Michaleski says, “and has since been using the church as her primary healing method. She’s in long-term stable recovery, but she no longer attends AA.”

But that approach, Michaleski cautions, is probably not enough for most people diagnosed with alcohol or other chemical dependency. She has seen too many relapses among people who have relied primarily on the church to get well.

Therapy: A Critical Piece
AA alone is not enough for many people, says Michaleski—therapy is a “critical” piece of their recovery. “Many people join AA, never get into therapy, and stay sober,” she says, “but many others relapse. One of the reasons is that the underlying issues, the trauma issues, the family of origin issues—what the treatment field calls ‘second and late stage recovery’—need to be addressed.”

That is best done in therapy, says Michaleski—a fact that AA recognizes. The AA Big Book—the basic text of AA—”says that if you have other issues, you have to seek other help, which is the psychological piece,” she says. “AA doesn’t claim to be able to treat trauma, and many addicts are trauma survivors.”

But 12-step programs can also be a big help to people while doing in-depth work in therapy, Michaleski says. The 12-step programs provide strong support networks and help people develop relapse prevention skills. That’s essential when therapy touches on issues “that the addict avoided dealing with by using drugs or alcohol,” she says. “They need to know how to not pick up when the pain gets really great.”

The Varieties of Recovery Experience
As William James pointed out more than 100 years ago in The Varieties of Religious Experience, humans approach spirituality in myriad ways. That may apply to spirituality’s role in recovery as well. Just as different approaches to treatment may all work—NIAAA-funded studies on alcoholism in the 1990s showed that 12-step programs, cognitive-behavioral therapy, and motivational interviewing were all more or less equally effective in preventing relapse to heavy drinking—different approaches to spirituality in recovery may suit different people.

What is important, however, is that people receive treatment. “This is a powerful disorder,” says Michaleski. “Many people die of it, children are being abused, families are destroyed because of it.”

And despite the many open questions about spirituality and recovery, one thing is clear: 12-step programs are widely available, and they are helping many people. “There is a lot of evidence that 12-step groups works,” says Zemore, “and people should be encouraged to try them. And people who consider themselves atheist or agnostic benefit as much from them as people who consider themselves spiritual or religious.”
*fictional name

— Dan Orzech is a Philadelphia-based freelance writer, and editor of “Mindfulness Update,” a newsletter for mindfulness-based stress reduction practitioners.