We can no more do without spirituality than we can do without food, shelter or clothing – Bruce Lipton
Despite the fact that there are plenty of them about, we don’t have a lot of information on people in long term recovery. The researchers behind this study took the opportunity to interview doctors in long term recovery at a professional CPD meeting in the USA. All of them were members of AA and the study wanted to get a better understanding of the role of spirituality in AA members and how the programme helps to stabilise abstinence. Most studies look at early recovery after treatment episodes. The 144 doctors in this study had an average recovery time of 12 years and in studying them, it was hoped that new insights would be revealed.
Spirituality is to do with meaning and purpose in life and it has been associated with better outcomes for people recovering from alcohol and drug problems. We don’t know much about how spirituality impacts on craving and longer term sobriety.
The researchers had some questions they wanted to look at:
- What differences in recovery status might there be between those physicians who entered AA in conjunction with referral by physicians’ health programs, and those who did not?
- What are some aspects of alcohol craving and affective status (such as depression) as concomitants of the recovery experience?
- What role does spirituality play in the recovery process?
The average age of the doctors was 58 with the majority (81%) being male. 86% were in employment. 46% had presented with a primary alcohol problem; 6% with a drug problem alone and 44% with a mixed alcohol and drug problem. Almost 60% had been in outpatient treatment for their dependence, but half of them had also been in residential settings.
Going to AA
77% had been referred by a professional and most were active in AA activities such as having a sponsor (82%); doing service (88%), having sponsored others (72%) and the average number of meetings attended a week was between two and three.
Most (60%) believed in God, but more than one in five believed in a ‘higher power’ only and just short of one in five believed in neither, further evidence that some atheists at least settle in AA. Four out of five respondents acknowledged having ‘a spiritual awakening’ which was associated with longer periods of abstinence and fewer cravings (half the craving of those who did not identify a spiritual awakening). Doctors were found to be relatively more spiritual and less religious than the general population and also to score higher than the norm on measures of anxiety and depression. There was no difference in outcomes regardless of whether doctors had been referred to AA by a physicians’ health programme or not.
What does it mean?
The authors point out links between spirituality and recovery from previous studies:
“measures of increased spirituality have been found to be associated with a positive outcome of participation in both abstinence and psychosocial outcomes of treatment.”
The authors conclude that the strong spiritual orientation in AA is distinct from ‘denominational commitment’, but ‘serves as a key element in the movement’s effectiveness’.
This study is interesting and useful, but it is highly focused on a professional group in a particular setting and involves a questionnaire administered at a point in time rather than following the doctors up over a period. Doctors are likely to have higher recovery capital than the average client, but they do get different treatment and the bar is set high from the outset. Those considerations aside, this paper is in line with other research and still has agency.
Given that ‘epiphanies are hard to manufacture’ and spiritual awakenings can’t be ordered on the internet, what does this mean for those coming for help with addictions? If we accept that spirituality has a part to play, ought we be actively addressing this in our interactions with clients? The paper suggests their findings will make it easier though there are problems with professional approaches on the subject, as the paper points out:
‘Attitudes toward AA among professionals in the addiction field itself are variable, with treaters in the United States more positive than those in certain other international settings. One sample of American clinicians, for example, all referred at least some patients to Twelve‐Step groups, and most held a highly positive view of the fellowship’s utility. In two European surveys, however, one in England and one in Norway less than 10% of programs employed the Twelve‐Step model.’
What can doctors in long term recovery teach us?
Attitudes here are changing though as evidence accumulates. Doctors are actively referred (in some cases mandated) to attend mutual aid and as the evidence shows they have very good outcomes from treatment. Spirituality seems to play a role. If spiritual awakening is associated with a reduction in craving and helps those suffering from addictions to remain networked with other recovering people in the long term, then perhaps addressing spirituality is something all of us working with those seeking recovery ought to be doing. It looks like connecting people to Alcoholics, Cocaine and Narcotics Anonymous is something we need to get better at doing.
Galanter, M., Dermatis, H., Stanievich, J., & Santucci, C. (2013). Physicians in Long-Term Recovery Who Are Members of Alcoholics Anonymous The American Journal on Addictions, 22 (4), 323-328 DOI: 10.1111/j.1521-0391.2013.12051.x