Abstract
Although spirituality has long been considered to be a protective factor in the treatment of substance use disorders, little has been done to operationalize the various dimensions of spirituality in clinical settings. The aim of this paper was to propose a framework – the three-legged stool – to act as a structure for spiritual interventions. The “stool” consists of three “legs”: creativity (creative arts and play therapy techniques), service (helping others), and solitude (contemplative prayer and meditation). The components of the framework are explained and support for the inclusion of each leg is offered.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Alcoholics Anonymous World Services. (2001). Alcoholics Anonymous: The story of how many thousands of men and women have recovered from alcoholism (4th ed.). New York: Author.
Alterman, A. I., Koppenhaver, J. M., Mullholand, E., Ladden, L. J., & Baaime, M. J. (2004). Pilot trial of effectiveness of mindfulness meditation for substance abuse patients. Journal of Substance Use, 9(6), 259–268.
Amatruda, K. (2003). Somatic consciousness in adult sand-play therapy. In C. E. Schaefer (Ed.), Play therapy with adults (pp. 233–270). Hoboken, NJ: Wiley.
Armstrong, K. (1993). A history of God: The 4,000-year quest of Judaism, Christianity and Islam. New York: Ballantine Books.
Arnold, R. M., Avants, S. K., Margolin, A., & Marcotte, D. (2002). Patients’ attitudes concerning the inclusion of spirituality into addiction treatment. Journal of Substance Abuse Treatment, 23, 319–326.
Avrahami, E. (2003). Cognitive behavioral approach in psychodrama: Discussion and example from addiction treatment. The Arts in Psychotherapy, 30(4), 209–216.
Benson, P., & Spilka, B. (1973). God image as a function of self-esteem and locus of control. Journal for the Scientific Study of Religion, 12(3), 297–310.
Bernie, K., Speca, M., & Carlson, L. E. (2010). Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress and Health, 26, 359–371.
Bernstein, J. W. (2012). Commentary on a paper by Danielle Knafo. Psychoanalytic Dialogues, 22, 72–75.
Bowen, S., Witkiewitz, K., Dilworth, T., Chawla, N., Simpson, T., Ostafin, B., et al. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20(3), 343–347.
Briere, J. (2015). Pain and suffering: A synthesis of Buddhist and western approaches to trauma. In V. M. Follette, J. Briere, D. Rozelle, J. W. Hopper, & D. I. Rome (Eds.), Mindfulness-oriented interventions for trauma: Integrating contemplative practices (pp. 11–30). New York: Guilford Press.
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237.
Canda, E. R., & Furman, L. D. (2010). Spiritual diversity in social work practice. New York: Oxford University Press.
Chen, G. (2006). Social support, spiritual program, and addiction recovery. International Journal of Offender Therapy and Comparative Criminology, 50, 306–323.
Claus, R. E., & Kindleberger, L. R. (2002). Engaging substance abusers after centralized assessment: Predictors of treatment entry and drop out. Journal of Psychiatric Drugs, 34(1), 25–31.
Cook, C. C. H. (2004). Addiction and spirituality. Addiction, 99, 539–551.
Cranford, J. A., Nolen-Hoeksema, S., & Zucker, R. A. (2011). Alcohol involvement as a function of co-occurring alcohol use disorders and major depressive episode: Evidence from the National Epidemiologic Survey on alcohol and related disorders. Drug and Alcohol Dependence, 117, 145–151.
Cropley, A. (2006). Creativity: A social approach. Roeper Review, 28(3), 125–130.
Daaleman, T. P., & Frey, B. B. (2004). The spiritual index of well-being: A new index for quality-of-life research. Annals of Family Medicine, 2, 499–503.
Damianakis, T. (2001). Postmodernism, spirituality, and the creative writing process: Implications for social work practice. Families in Society: The Journal of Contemporary Human Services, 82(1), 23–34.
Dermatis, H., & Galanter, M. (2015, February). The role of twelve-step-related spirituality in addiction recovery. Journal of Religion and Health, 21, (no pagination).
Diaz, N., Horton, E. G., Green, D., McIlveen, J., Weiner, M., & Mullaney, D. (2011). Relationship between spirituality and depressive symptoms among individuals who abuse substances. Counseling and Values, 56(1), 43–56.
Diaz, N., Horton, E. G., & Malloy, T. (2014). Attachment style, spirituality, and depressive symptoms among individuals in substance abuse treatment. Journal of Social Service Research, 40(3), 313–324.
Diaz, N., Horton, E. G., McIlveen, J., Weiner, M., & Williams, L. B. (2011). Spirituality, religiosity and depressive symptoms among inpatient substance abusers. Journal of Religion and Spirituality in Social Work: Social Thought, 30(1), 71–87.
Edwards, C. G. (2000). Creative writing as a spiritual practice: Two paths. In M. E. Miller & S. R. Cook-Greuter (Eds.), Creativity, spirituality, and transcendence: Paths to integrity and wisdom in the mature self (pp. 3–23). Stamford, CT: Ablex Publishing Corp.
Feen-Calligan, H. (2007). The use of art therapy in detoxification from chemical addiction. The Canadian Art Therapy Association Journal, 20(1), 16–28.
Finney, J. R., & Malony, H. N. (1985). An empirical study of contemplative prayer as an adjunct to psychotherapy. Journal of Psychology and Theology, 13(4), 284–291.
Frey, B. B., Daaleman, T. P., & Peyton, V. (2005). Measuring a dimension of spirituality for health research: Validity of the spirituality index of well being. Research on Aging, 27(5), 556–577.
Galanter, M., Dermatis, H., Bunt, G., Williams, C., Trujillo, M., & Steinke, P. (2007). Assessment of spirituality and its relevance to addiction treatment. Journal of Substance Abuse Treatment, 33, 257–263.
Hall, T. W., & Edwards, K. J. (1996). The initial development and factor analysis of the spiritual assessment inventory. Journal of Psychology and Theology, 24(3), 233–246.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.
Hodge, D. R., & McGrew, C. C. (2005). Clarifying the distinctions between spirituality and religion. Social Work and Christianity, 32(1), 1–21.
Humphreys, K. (2004). Circles of recovery: Self-help organizations for addictions. Cambridge, UK: Cambridge University Press.
Jankowski, B., & Sandage, S. J. (2011). Meditative prayer, hope, adult attachment, and forgiveness: A proposed model. Psychology of Religion and Spirituality, 3(2), 115–131.
Jarusiewics, B. (2000). Spirituality and addiction: Relationship to recovery. Alcoholism Treatment Quarterly, 18, 99–110.
Johnson, L. (1990). Creative therapies in the treatment of addictions: The art of transforming shame. Arts in Psychotherapy, 17, 299–308.
Juhnke, G. A., Watts, R. E., Guerra, N. S., & Hsieh, P. (2009). Using prayer as an intervention with clients who are substance abusing and addicted and who self-identify personal faith in God and prayer as recovery resources. Journal of Addictions and Offender Counseling, 30(1), 16–23.
Julliard, K. (1995). Increasing chemically dependent patients’ beliefs in step one through expressive therapy. American Journal of Art Therapy, 33, 110–119.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.
Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S., & Pagano, M. E. (2011). Spirituality in recovery: A lagged meditational analysis of Alcoholics Anonymous’ principal theoretical mechanism of behavioral change. Alcoholism: Clinical and Experimental Research, 35, 454–463.
Larson, D. B., & Larson, S. S. (1994). The forgotten factor in physical and mental health: What does the research show? Rockville, MD: National Institute for Healthcare Research.
Larson, D. B., Sherill, K. A., & Lyons, J. S. (1994). Neglect and misuse of the “R word”: Systematic reviews of religious measures in health, mental health and aging research. In J. S. Levin (Ed.), Religion and health: Theoretical foundations and methodological frontiers. Thousand Oaks, CA: Sage Publications.
Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (2002). Dialectical behavior therapy for patients with borderline personality disorder and drug dependence. American Journal on Addiction, 8(4), 279–292.
Longabaugh, R., Donovan, D. M., Karno, M. P., McCrady, B. S., Morgenstern, J., & Tonigan, J. S. (2005). Active ingredients: How and why evidence-based alcohol behavioral treatment interventions work. Alcoholism: Clinical and Experimental Research, 29, 235–247.
Lyons, G., Deane, F., Caputi, P., & Kelly, P. (2011). Spirituality and the treatment of substance abuse disorders: An exploration of forgiveness, resentment and purpose in life. Addiction Research and Theory, 19(5), 459–469.
Lyons, G., Deane, F., & Kelly, P. (2010). Forgiveness and purpose in life as spiritual mechanisms of recovery from substance abuse disorders. Addiction Research and Theory, 18(5), 528–543.
Magura, S., Knight, E. L., Vogel, H. S., Mahmood, D., Laudet, A. B., & Rosenblum, A. (2003). Mediators of effectiveness in dual focus self-help groups. American Journal of Drug and Alcohol Abuse, 29, 301–322.
Magyari, T. (2015). Teaching mindfulness-based stress reduction and mindfulness to women with complex trauma. In V. M. Follette, J. Briere, D. Rozelle, J. W. Hopper, & D. I. Rome (Eds.), Mindfulness-oriented interventions for trauma: Integrating contemplative practices (pp. 140–156). New York: Guilford Press.
Maltby, J., Lewis, C. A., & Day, L. (2008). Prayer and subjective well-being: The application of a cognitive-behavioural framework. Mental Health, Religion, and Culture, 11, 119–129.
Marlatt, G. A. (2002). Buddhist philosophy and the treatment of addictive behavior. Cognitive and Behavioral Practice, 9, 44–50.
Marlatt, G. A., & Chawla, N. (2007). Meditation and alcohol use. Southern Medical Journal, 100(4), 451–453.
Maslow, A. (1968). Towards a psychology of being. New York: Van Nostrand.
Matto, H. (2002). Integrating art therapy methodology in brief inpatient substance abuse treatment for adults. Journal of Social Work Practice in the Addictions, 2(2), 69–83.
McDargh, J. (1986). God, mother, and me: An object relational perspective on religious material. Pastoral Psychology, 34(4), 251–263.
McDowell, D., Galanter, M., Goldfarb, L., & Lifschutz, H. (1996). Spirituality and the treatment of the dually diagnosed: An investigation of patient and staff attitudes. Journal of Addictive Diseases, 15(2), 55–68.
McLellan, A. T., Luborsky, L., Woody, G. E., O’Brien, C. P., & Druley, K. A. (1983). Predicting response to alcohol and drug abuse treatment: Role of psychiatric severity. Archives of General Psychiatry, 40, 620–625.
Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and implications of a mindfulness-meditation stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17(3), 192–200.
Miller, W., & Bogenschutz, M. (2008). Spirituality and addiction. Southern Medical Journal, 100(4), 433–436.
Monakes, S., Garza, Y., Wiesner, V., & Watts, R. E. (2011). Implementing Adlerian sand tray therapy with adult male substance abuse offenders: A phenomenological inquiry. Journal of Addictions and Offender Counseling, 31(2), 94–107.
National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Available at https://www.socialworkers.org/pubs/code/default.asp
Niebuhr, R., & Brown, R. M. (1987). The essential Reinhold Niebuhr: Selected essays and addresses. New Haven, CT: Yale University Press.
Oreskovic, A., & Bodor, D. (2010). Addiction and art. Alcoholism, 46(1), 9–13.
Owen, P. L., Slaymaker, V., Tonigan, J. S., McCrady, B. S., Epstein, E. E., Kaskutas, L. A., et al. (2003). Participation in Alcoholics Anonymous: Intended and unintended change mechanisms. Alcoholism: Clinical and Experimental Research, 27, 524–532.
Pagano, M. E., Friend, K. B., Tonigan, A. S., Scott, J., & Stout, R. L. (2004). Helping other alcoholics in Alcoholics Anonymous and drinking outcomes: Findings from Project MATCH. Journal of Studies on Alcohol, 65(6), 766–773.
Pagano, M. E., Zemore, S. E., Onder, C. C., & Stout, R. L. (2009). Predictors of initial AA-related helping: Findings from Project MATCH. Journal of Studies on Alcohol, 70, 117–125.
Paloutzian, R. F., & Ellison, C. W. (1982). Loneliness, spiritual well-being and quality of life. In L. A. Paplau & D. Perlman (Eds.), Loneliness: A sourcebook of current theory, research, and therapy (pp. 224–237). New York: Wiley Interscience.
Piderman, K. M., Schneekloth, T. D., Pankratz, V. S., Stevens, S. R., & Altschuler, S. I. (2008). Spirituality during alcoholism treatment and continuous abstinence for one year. Journal of Studies on Alcohol, 68, 282–290.
Piedmont, R. L. (1999). Does spirituality represent the sixth factor of personality? Spiritual transcendence and the five-factor model. Journal of Personality, 67(6), 985–1013.
Piliavin, J. A., & Siegl, E. (2007). Health benefits of volunteering in the Wisconsin Longitudinal Study. Journal of Health and Social Behavior, 48, 450–464.
Polcin, D. L., & Zemore, S. (2004). Psychiatric severity and spirituality, helping, and participation in Alcoholics Anonymous during recovery. American Journal of Drug and Alcohol Abuse, 30, 577–592.
Ramseur, C., & Wiener, D. (2003). Rehearsals for growth applied to substance abuse growth. In D. Wiener & L. Oxford (Eds.), Action therapy with families and groups: Using creative arts improvisation in clinical practice (pp. 107–134). Washington, DC: American Psychological Association.
Reiland, J. D. (1990). A preliminary study of dance/movement therapy with field-dependent alcoholic women. The Arts in Psychotherapy, 17, 349–353.
Robinson, E. A. R., Cranford, J. A., Webb, J. R., & Brower, K. J. (2007). Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample. Journal of Studies on Alcohol, 68, 282–290.
Robinson, E. A. R., Krentzman, A. R., Webb, J. R., & Brower, K. J. (2011). Six-month changes in spirituality and religiousness in alcoholics predict drinking outcomes at nine months. Journal of Studies on Alcohol, 72, 660–668.
Schaefer, C. E. (2003). Play therapy with adults. Hoboken, NJ: Wiley.
Seidlitz, L., Abernathy, A. D., Duberstein, P. R., Evinger, J. S., Chang, T. H., & Lewis, B. (2002). Development of the spiritual transcendence index. Journal of the Scientific Study of Religion, 41, 439–453.
Sher, M. E., & Straughan, H. H. (2005). Volunteerism, social work, and the church: A historic overview and look into the future. Social Work and Christianity, 32(2), 97–115.
Siegel, D. (2012). A pocket guide to interpersonal neurobiology: An integrated handbook of the mind. New York: Norton & Co..
Somov, P. (2008). A psychodrama group for substance use relapse training. The Arts in Psychotherapy, 35(2), 151–161.
Sterling, R. C., Weinstein, S., Losardo, D., Raively, K., Hill, P., Petrone, A., et al. (2007). A retrospective case control study of alcohol relapse and spiritual growth. American Journal of Addictions, 16, 56–61.
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.
Tonigan, J. S. (2007). Spirituality and Alcoholics Anonymous. Southern Medical Journal, 100(4), 437–440.
Treadwell, T., Kumar, V. K., & Wright, J. (2010). Integrating cognitive behavioral with psychodramatic theory and techniques. In S. S. Fehr (Ed.), Interventions in group therapy (Revised ed., pp. 395–401). New York: Routledge/Taylor Francis.
Weisner, C., Matzger, H., & Kaskutas, L. (2003). How important is treatment? One-year outcomes of treated and untreated alcoholic dependent individuals. Addiction, 98(7), 901–911.
White, W. L., & Whiters, D. (2005). Faith-based recovery: Its historical roots. Counselor Magazine for Addiction Professionals, 6(5), 58–62.
Witbrodt, J., & Kaskutas, L. A. (2005). Does diagnosis matter? Differential effects of 12-step participation and social networks on abstinence. American Journal of Drug and Alcohol Abuse, 31, 685–707.
Zemore, S. E. (2007a). A role for spiritual change in the benefits of 12-step involvement. Alcoholism: Clinical and Experimental Research, 31(10 Suppl), 76s–79s.
Zemore, S. E. (2007b). Helping as healing among recovering alcoholics. Southern Medical Journal, 100(4), 447–450.
Zemore, S. E., Kaskutas, L. A., & Ammon, L. N. (2004). In 12-step groups, helping helps the helper. Addiction, 99(8), 1015–1023.
Zemore, S. E., & Kaskutas, L. A. (2004). Helping, spirituality and Alcoholics Anonymous in recovery. Journal for Studies on Alcohol, 65, 383–391.
Zemore, S. E., & Pagano, M. E. (2008). Kickbacks from helping others: Health and recovery. In M. Galanter & L. A. Kaskutas (Eds.), Research on Alcoholics Anonymous and spirituality in addictions recovery (Vol. 18, pp. 141–166). New York: Springer Science + Business Media.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Gail Horton, E., Luna, N. (2018). A Framework for Addressing Spirituality in the Treatment of Substance Use Disorders: The Three-Legged Stool. In: MacMillan, T., Sisselman-Borgia, A. (eds) New Directions in Treatment, Education, and Outreach for Mental Health and Addiction. Advances in Mental Health and Addiction. Springer, Cham. https://doi.org/10.1007/978-3-319-72778-3_13
Download citation
DOI: https://doi.org/10.1007/978-3-319-72778-3_13
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-72777-6
Online ISBN: 978-3-319-72778-3
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)