The Role of Twelve-Step-Related Spirituality in Addiction Recovery

This paper reviews empirical studies conducted on the role of spirituality and religiosity (S/R) characteristics in 12-step recovery among program members followed up after substance abuse treatment and those assessed independent of formal treatment. Aspects of spiritual functioning that change in relation to program participation and those S/R characteristics that were found to mediate the association between program involvement and drinking-related outcomes are discussed. In addition, a review is provided of 12-step program studies investigating S/R-related predictors of clinical outcomes relevant to risk of relapse among members in long-term recovery. To further examine the role of S/R characteristics in recovery, a study was conducted on long-term AA members to assess the relationship of S/R characteristics and AA program involvement to craving for alcohol and emotional distress after controlling for relevant demographic variables. Feeling God’s presence daily, believing in a higher power as a universal spirit, and serving as an AA sponsor were all predictive of positive outcomes.     

Recovery From Alcohol or Drug Abuse: The Relationship Between Identity Styles and Recovery Behaviors

The purpose of this study was to explore the relationship between identity styles and recovery from substance abuse. Consistent findings have established a relationship between identity diffusion and substance misuse, but no research has explored the influence of identity styles on recovery processes. Participants (N = 252) from treatment and recovery- based facilities and groups using a 12-step recovery model were assessed with the Identity Style Inventory (White, Wampler, & Winn, 1998) and self-report measures of pretreatment addiction, length of continuous abstinence, quality of recovery, and recovery progress. Those with a diffuse/avoidant style had shorter lengths of continuous abstinence, fewer recovery-oriented behaviors, lower quality of recovery, and less recovery progress than those with an information style, suggesting an important relationship between identity styles and the process of recovery from substance abuse.     

Integrated treatment of co-occurring mental illness and addiction: clinical intervention, program, and system perspectives

Individuals with mental illness and addiction comprise at least half of the patients in most mental health treatment systems. This combination results in increased risk for frequent psychiatric relapses, poor medication compliance, violence, suicide, legal problems, and high utilization of the emergency room or inpatient services. Traditional mental health and addiction treatments have not adequately addressed these co-occurring disorders due to clinical interventions, programs, and system flaws that have not addressed the individual's needs. Integrated treatment requires both an understanding of mental illness and addiction and the means to integrate and modify the traditional treatment approaches in both the mental health and addiction treatment fields. There is strong evidence to support the efficacy and effectiveness of integrated treatment in this population. All mental health clinicians should become experienced and skilled in the core psychotherapy approaches to treating substance use disorders, including motivational enhancement therapy, relapse prevention (cognitive-behavioral therapy), and 12-step facilitation. In addition, integrated treatment includes integrating medications for both addiction and mental illness with the behavioral therapies and other psychosocial interventions. This article reviews the clinical intervention, program, and system components of integrated treatment and specific clinical interventions for this population.     

Bill W. Goes to Hollywood: The Rise and Fall of Recovering Addiction Experts

Although historians of addiction have long debated whether an oral culture of "sharing" or "Big Book"-based reading practices are foundational to 12-step recovery culture, the role other types of media have played in the development of contemporary recovery discourse has remained largely unexplored. This essay compares the production, reception and formal elements of the films The Lost Weekend and Smash Up in relation to the popularization of the disease concept of alcoholism. Through an analysis of archival sources, addiction narratives, and nascent alcoholism research, this paper argues that, by emphasizing the importance of popular representations of alcoholics above scientific inquiry, early recovering "experts" successfully promulgated the disease concept of alcoholism, but the testimonials of later recovering alcoholics became relegated to the sphere of popular culture.     

Addictions and the Quest to Control the Object

Most patients come into psychoanalytic treatment engaged in some form of repetitive, destructive behavior that is an externalization or projection of their internal struggles. One form of this object relational acting-out is the addictions, be they to alcohol, gambling, drugs, sex, procrastination, or other variations. The patient's experience is a "must do-can't stop" one that leaves them both desperate and relieved. Patients come to us wanting help in refraining from these addictive patterns. Sometimes, they are attending a 12-step program or are in a day treatment recovery program but need additional assistance in remaining free from their addictive behaviors. Others seek out psychoanalytic treatment while still involved in their addiction, but wish to stop the behavior and build a more positive plan for their lives. This paper examines the deeper object relational issues that lie behind the addictive process. The transference is often colored by acting-out, by sadomasochistic dynamics, by projective identification, and by fantasies of persecution and loss. Case material is used to explore these specific problems as well as the patient's general difficulties with paranoid-schizoid and depressive functioning.     

Alcoholism, drug abuse, and the homeless.

Credible estimates of the prevalence of alcohol and drug abuse suggest that alcohol abuse affects 30% to 40% and drug abuse 10% to 15% of homeless persons. A review of policies that address substance abuse among the homeless finds that interventions alternate between control and rehabilitation. However, the unique needs of a changing homeless population require an integration of alcoholism and drug abuse recovery services with programs for women, adolescents, and the mentally ill. Alcohol- and drug-free housing is essential to support and maintain recovery. Psychology can contribute in the development of effective programs for homeless individuals struggling with addiction and alcoholism.     

Addiction,the addict,and career: Considerations for the employment counselor

Employment counselors have been resistant to working with persons in recovery from addiction except under the strictest of criteria. This article examines the relationship between this resistance and the concepts of addiction and addict. Following this is an examination of substance abuse recovery and practical suggestions on incorporating recovery knowledge into career counseling. The goals of the article are twofold: (a) to present a framework that highlights the necessity of employment counseling for the recovery process from substance misuse and (b) to affirm that many employment counselors have the skills needed to assist clients who have been labeled as addicts.     

Addiction as an attachment disorder: implications for group therapy

This article presents a perspective on addiction that not only substantiates why group therapy is the treatment of choice for addiction, but also integrates diverse perspectives from 12-step abstinence-based models, self psychology, and attachment theory into a complementary integrative formula. Attachment theory, self psychology, and affect regulation theory characterize addiction as an attachment disorder induced by a person's misguided attempt at self-repair because of deficits in psychic structure. Vulnerability of the self is the consequence of developmental failures and early environmental deprivation leading to ineffective attachment styles. Substance abuse, as a reparative attempt, only exacerbates that condition because of physical dependence and further deterioration of existing physiological and psychological structures. Prolonged stress on existing structures leads to exaggerated difficulty in the regulation of affect, which leads to inadequate modulation of appropriate behavior and self-care and increased character pathology.     

"Do social networks explain 12-step sponsorship effects? A prospective lagged mediation analysis": Correction to Rynes and Tonigan (2011)

Reports an error in "Do social networks explain 12-step sponsorship effects? A prospective lagged mediation analysis" by Kristina N. Rynes and J. Scott Tonigan (Psychology of Addictive Behaviors, Advanced Online Publication, Sep 5, 2011, np). There is an error in the last paragraph of the Participants section. It was reported that 14.8% of the sample were Asian, however, 14.8% of the participants were American Indian or Alaskan Native and no participants were Asian. (The following abstract of the original article appeared in record 2011-20052-001.) Sponsorship is a basic and important part of the 12-step approach to recovery from substance abuse (Alcoholics Anonymous, 2005) and research has shown that having a sponsor is associated with increased involvement in 12-step programs and improved outcomes (Bond, Kaskutas, & Weisner, 2003; Tonigan & Rice, 2010). However, little is known about how sponsorship improves outcomes. Given research demonstrating bivariate associations between sponsorship and social support for abstinence (Majer, Jason, Ferrari, Venable, & Olson, 2002), we hypothesized that the association between having a sponsor and increased abstinence outcomes would be explained by increases in one's abstinence-based social network. Prospective fully lagged mediational analyses did not support this hypothesis and these results ran counter to findings of five previous studies (cf. Groh, Jason, & Keys, 2008). A review of these studies showed that researchers often used cross-sectional or partially lagged methods to test mediation and the mediational effect of the social network was small in magnitude. Results suggest that the prospective association between sponsorship and abstinence is not explained by increases in the abstinence-based social network and demonstrate the need for future studies to use rigorous and time-lagged methods to test social support for abstinence as a mediator of the effects of 12-step involvement. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Addiction Recovery: 12-Step Programs and Cognitive-Behavioral Psychology

This article provides the helping professional with an overview of treatment issues referred to as spiritual by those recovering from alcohol and drug addictions through 12-step programs like that of Alcoholics Anonymous. Conflicts between academically trained helping professionals and researchers, and those advocating spiritually oriented treatment programs are reviewed. Spiritual aspects of recovery may be foreign constructs for the academically trained helping professional. The goal of this article is to discuss these spiritual constructs in terms of cognitive-behavioral psychology, a knowledge base common to most professionally trained helpers.     

Integrating group psychotherapy and 12-step work: a collaborative approach

Group therapists can expect to treat an increasing number of patients who are active in a 12-step program or other addiction-related self-help groups. The value of simultaneous participation in these two modalities has been recognized; 12-step work supports abstinence necessary for the focus on emotional growth in psychotherapy. However, mere simultaneous participation in the two modalities fails to incorporate the benefits of a collaborative relationship where both modalities are used to support both abstinence and emotional growth. The conjoint approach to group and individual treatment is used to (a) argue for the possibility of a collaborative relationship between psychotherapy and a patient's 12-step work, (b) understand the benefits and challenges to collaboration, and (c) provide guidelines for how to work collaboratively with a 12-step program. Illustrations are provided of typical issues raised by this type of collaborative relationship.     

Use of Film in Undergraduate Human Services: Understanding the Addiction and Recovery Process

ABSTRACT

Steady growth of the addiction field requires human service education programs to prepare competent professionals who can successfully engage in addiction practice. Competency in addiction practice requires human service students to develop an objective understanding of the relapse prevention and recovery process. Though research supports the use of media tools in the classroom, its use in developing addiction intervention competencies in human service students is unknown. The authors present an exploration of the film 28 Days as an addiction recovery teaching tool and discuss students’ understanding of recovery and relapse prevention. Implications for addiction and human service education are also presented.     

累积生态风险与青少年网络成瘾:心理需要满足和积极结果预期的中介作用

青少年网络成瘾与个体所处的生态背景密切相关。目前已有不少研究探讨家庭、学校、同伴背景中单个或少数风险因素对青少年网络成瘾的影响,但少有研究关注多个背景中生态风险因素的累积对青少年网络成瘾的影响及其心理机制。本研究基于累积风险模型和动机心理学理论,考察累积生态风险对青少年网络成瘾的影响及基本心理需要满足(个体在现实生活中需要被满足的情况)和积极结果预期(个体对网络使用诱因大小的判断)在其中的并行和/或链式中介作用。被试为5所中学的998名青少年。结构方程模型分析表明:(1)在控制了人口学变量后,累积生态风险对青少年网络成瘾具有显著的正向预测作用(呈"负加速模式")。(2)累积生态风险通过显著降低基本心理需要满足(表现出"梯度效应"),进而促进青少年网络成瘾。(3)累积生态风险通过显著提升积极结果预期(呈"负加速模式"),进而促进青少年网络成瘾。(4)累积生态风险对青少年网络成瘾的影响被基本心理需要满足和积极结果预期两条并行路径完全中介。上述结果表明,累积生态风险对青少年网络成瘾具有重要影响,且这种影响是通过需要和诱因两种动机力量一"推"一"拉"的合力来实现。     

The Impact of Relationship Education on the Couple Relationship: A Grounded Theory of Intentionality and Awareness

Research on relationship education (RE) programs generally shows their effectiveness, but it is important to understand what the mechanisms of change are, how they occur within programs, and what participants experience. The purpose of this study was to explore couples' perceptions of the key components of their experience as participants of a Prep-based RE program. Research questions included: How do couples describe their experience of taking an 8-hour relationship education class? What elements had the biggest impact on their relationship? How has their relationship changed as a result of participation? Interview data from 39 married and cohabitating couples who participated in RE were analyzed using grounded theory methods. Six categories emerged from the analytic process, resulting in a model that provided explanatory detail of a typical RE program experience and its impact on the participants. These categories were: intentionality and awareness, context, relationship, workshop, impact (of RE), and couple interview. Couples described these categories as developing in a relatively chronological order, with Intentionality and Awareness being a central category that cut across the process and helped explain the impact of the program on the couple relationship. Implications for research, program development, and program facilitators providing RE are discussed.     

Spirituality and Confidence to Resist Substance Use Among Celebrate Recovery Participants

Since self-efficacy is a positive predictor of substance use treatment outcome, we investigated whether it is associated with spirituality within a religious 12-step program. This was a cross-sectional survey (N = 91) of 10 different Celebrate Recovery sites held at community churches. The mean spirituality score for those with high confidence was significantly greater than those with low confidence. Spirituality associated with greater confidence to resist substance use (OR = 1.09, 95% CI 1.02–1.17, P < 0.05). So every unit increase of measured spirituality increased the odds of being above the median in self-efficacy by 9%. We conclude that spirituality may be an important explanatory variable in outcomes of a faith-based 12-step recovery program.     

On a new argument for the existence of God

Conclusions The conclusion of Shutte's argument that the Christian God exists does not follow from his premises without additional dubious premises. Furthermore, the first premise of the argument, namely that human persons depend on other persons to develop as persons is an empirical premise that cries out for empirical support that Shutte fails to supply. Alternative schemes of personal development are available but he does not show that they are mistaken. Moreover, Shutte's scheme generates a puzzle about how personal development is ever possible. Finally, the theory of human nature underlying his argument is unsupported. On the other hand, the substitution of more sinister theories of human nature in his scheme would result in the conclusion that the first cause of personal development is a being with some attributes that conflict with the attributes of the Christian God and would involve a complete revamping of his theory of personal growth.     

Spirituality: The Key to Recovery From Alcoholism

The authors suggest that a condition of “negative spirituality” underlies and sustains alcoholism, and perhaps all addictions, and that a secure recovery is not possible unless a “spiritual awakening,” such as is envisioned by Alcoholics Anonymous (AA), is achieved. A broadly applicable conceptual model of spirituality is inferred from the AA 12-step rehabilitation program.     

Relatio as Modus Essendi : The Origins of Henry of Ghent's Definition of Relation

The context in which medieval theologians discuss 'relation' is nearly always a trinitarian one. They have to solve an awkward problem: to explain how in God the persons are identical with the divine essence, yet different among themselves. In this paper I want to argue that Henry of Ghent's interest in the nature of the Trinity acted as an impetus towards the development of his theory of the nature of relations. In this context the accounts of Thomas Aquinas and Giles of Rome will be considered as important for understand18 ing Henry's account. Henry's positive account of relations stems from Avicenna. For Henry, a relation is not an aliquid but has two modes of being, both as an accident and as a relative. Henry's attempt to think the nature of relation leads to him developing a relational ontology.     

Translation of the 12-step alcoholic anonymous from English language to Yoruba language and its application within the Yoruba culture among patients with alcohol use disorder in Nigeria

ABSTRACT

The aims of this study were to translate the English version of the 12-step alcoholic anonymous (AA) to the Yoruba version and to compare among patients with alcohol use disorders (AUDs), which version would be associated with a higher participation in AA. After an initial translation of the English version of the AA to Yoruba version, 200 participants with AUDs were randomised into either group, matched by age and gender and enrolled in the 12-step programme for six months. Compared to the Yoruba group, the proportion of participants retained in treatment in the English AA group was significantly lower between baseline and at six months, OR?=?.45, 95% CI (.26–.83). The Yoruba 12-step AA has the potential of mitigating the language barrier the English version poses to individuals with limited ability in the English language because participants felt more connected with God.     

Adoption of community-based cardiac rehabilitation programs and physical activity following phase III cardiac rehabilitation in Scotland: A prospective and predictive study

Little is known about levels of physical activity and attendance at phase IV community-based Cardiac Rehabilitation (CR) programs following completion of exercise-focussed, hospital-based phase III CR. This study aims to test, compare and combine the predictive utility of the Common-Sense Self-Regulation Model (CS-SRM) and the extended Theory of Planned Behaviour (TPB) with action planning for two rehabilitation behaviours: physical activity and phase IV CR attendance. Individuals diagnosed with coronary heart disease (n = 103) completed baseline measures of illness perceptions, intentions, perceived behavioural control (PBC), action planning and past physical activity in the last week of a phase III CR program, and 95 participants completed follow-up measures of physical activity and attended phase IV CR (objectively confirmed) 2 months later. Only one predictor (PBC/cyclical timeline) significantly predicted levels and change of physical activity. While illness perceptions were not predictive of phase IV CR attendance, the extended TPB model showed good predictive power with action planning and intention as the most powerful predictors. Amongst participants who planned when and where to attend phase IV CR at the end of phase III rehabilitation, 65.9% subsequently attended a phase IV CR program compared to only 18.5% of those who had not made a plan. This study adds to our understanding of cardiac rehabilitation behaviour after completion of health service delivered programs. Comparing theoretical models and rehabilitation behaviours contributes to the development of behaviour theory.