Spiritual Issues

Defining Spirituality

Those undertaking an extensive review of the literature on this topic may find the research difficult to decipher. Although the word spirituality has been used in the literature of the health and social sciences, the variations in how this word is defined and measured are highly problematic in making sense of the results.

The term spirituality generally refers to the human longing for a sense of meaning and fulfillment through morally satisfying relationships among individuals, families, communities, cultures, and religions. Although often viewed in a religious context, spirituality is not necessarily about being religious.

Spirituality is about responding to the deepest questions posed by an individual's existence with a whole heart. Religion refers to organized structures that center on particular beliefs, behaviors, rituals, ceremonies, and traditions.

During the past 5 years, several expert committees from the addiction and health fields have grappled with a scientific conception of spirituality. In 2003, William R. Miller summarized the findings of these committees into several working assumptions about spirituality:

• 1.
  Spirituality is not interchangeable with religion; it is one principal area of concern for religion, but religions also have other nonspiritual goals and purposes.
• 2.
  Spirituality is best understood as a characteristic of individuals. It includes the individual's "religion," or religiousness, but is not defined in relation to religion.
• 3.
  Spirituality is not a commodity that is present or absent, or one that is possessed in amount.
• 4.
  Spirituality is multidimensional and is best understood as comprised of multiple dimensions including behavior and practices, beliefs, motivations and values, and subjective experience.
• 5.
  Every person can be located somewhere within the multidimensional space of spirituality.

A recent review of the spirituality and substance abuse literature found a diversity of definitions and a lack of clarity in references to spiritual concepts. Christopher Cook's analysis, conducted in 2004, identified 13 conceptual components or dimensions within the definitions and descriptions of spirituality:

• 1.
  Relatedness—interpersonal relationships∗
• 2.
  Core/force/soul—the inner core, force, or soul of a person∗
• 3.
  Meaning/purpose—meaning and purpose in life∗
• 4.
  Transcendence—recognition of a transcendent dimension to life∗
• 5.
  Humanity—the distinctiveness of humanity
• 6.
  Authenticity/truth—authenticity and truth
• 7.
  Values—importance and worth
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• 8.
  Nonmateriality—opposition of the spiritual to the material
• 9.
  (Non)religiousness—opposition of spirituality to, or identity with, religion
• 10.
  Wholeness—holistic Wellness, wholeness, or health
• 11.
  S elf-knowledge—self-knowledge and self-actualization
• 12.
  Creativity—creativity of the human agent
• 13.
  Consciousness—consciousness and awareness

Items followed by an asterisk are the most frequently identified conceptual components of definitions and descriptions of spirituality.

These specific components provide an organizing framework for examining research and understanding the constructs that can be incorporated into spiritually focused treatment practices.

Research on Spirituality and Religion in Addiction Treatment

Research to date on addiction supports the notion that spirituality is an important topic to include in addiction treatment. Much of the research on this topic has been concentrated in a few areas. Principal among them are correlational studies examining relationships between substance use and religiosity in youth and adults, studies of Twelve-Step program involvement and Twelve Step-based interventions, and nonempirical commentaries. The research to date supports the notion that spirituality is an important topic to include in addiction treatment. For example, in a 2002 study of 237 recovering substance abusers, Dustin A. Pardini and colleagues found that higher levels of religious faith and spirituality predicted a more optimistic life orientation, greater perceived social support, higher resilience to stress, and lower levels of anxiety. Many large-scale studies have focused on the use of spiritual principles in Alcoholics Anonymous (AA), finding that substance abusers who practice the Twelve Steps are more likely to remain abstinent than those treated with other types of nonspiritual therapy, and individuals who reported a spiritual awakening as a result of their AA involvement were nearly 4 times more likely to be abstinent 3 years post treatment than individuals who reported never having had a spiritual awakening. In a large meta-analytic study conducted by the National Institute on Alcohol Abuse and Alcoholism in 1999, the Fetzer Institute found strong support for the protective nature of spirituality and religion (110 studies), of AA involvement (51 studies), and of spiritual/religious interventions (26 studies).

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