In the mid-1980s, alcohol and drug addiction treatment centers were almost exclusively twelve step oriented, and psychiatry had little or nothing to do with twelve-step recovery. This was easily seen at conferences, such SECAD in the early 1990s. We had to be very careful with selection of speakers and topics so as not to offend or detract from the integrity of twelve-step treatment. Much has changed since those days. Now, co-occurring disorders (addiction and mental illness) programs are the norm, not the exception.
These patients have two diagnoses: one psychiatric and the other substance related. Now, through research, we talk much more in terms of addiction as a disease of the brain, using PET scans to demonstrate the destructive nature of methamphetamines and other drugs. A recent article by Dr. Marc Galanter, “Evidence-Based Medicine and spirituality,” which appeared in The American Journal of Psychiatry, noted an association between serotonergic activity and inclination toward spirituality. This is important since the neurotransmitter serotonin plays such a vital role both in mood disorders, such as major depression, and in addiction.
The success of twelve-step meetings has raised some important questions for contemporary psychiatry. A Project MATCH study done on twelve-step meetings showed that scores on spirituality in recovering alcoholics at three years were predictive of positive outcomes at ten years. Of patients who attended twelve-step meetings, those who reported a spiritual awakening were three times more likely to be abstinent three years later than those who did not. In this latter group, greater religiosity had no effect on outcome.
In dealing with spirituality, the subject of religion is always close at hand. In a pilot study in the Journal of Religion and Health, definitions and evaluations of religion and spirituality were explored. Content analysis of definitions reveals religion as objective, external, and ritual or organizational practices that one performs in a group setting and that guide one’s behavior.
Spirituality is defined as internal, subjective, and divine experience or direct relationship with God. Spirituality is acquiring more and more attention in the medical field as we try to fill the gaps that have existed for so long in treating the whole patient. Attention to spirituality is now a prerequisite by the Joint Commission on Accreditation of Healthcare Organizations. It has to be included in a psychiatric assessment. It is also a subject of much debate in the training of nurses in intensive care areas.