Spiritual Care: The Missing Piece in Addiction Treatment?

spiritual care the missing part of addiction treatment

Do spiritual care professionals belong in addiction treatment? If so, then how? This article poses these questions to a group of spiritual care professionals from across the country who have formed a national organization called Spiritual Care Addiction Treatment Professionals (SCATP). The responses of these qualified spiritual care leaders present a firsthand look at the evolving face of addiction treatment; the historical role of spiritual care in a clinical environment; and modernized approaches for integrating spiritual care more effectively in addiction treatment and best practices moving forward. The article also summarizes the important role that spiritual care provides in addiction treatment from the perspective of those struggling with addictions.

Historical Role of Spiritual Care in Addiction Treatment

Spirituality has been a cornerstone in addiction recovery for the past 80 years. However that foundation has been challenged, shaken and even eliminated by some modern recovery programs. The roots of many addiction treatment programs are found in the original 12-Step program, Alcoholics Anonymous (AA). It is commonly observed that AA’s roots include the Oxford Christian Fellowship Group, which placed an emphasis on spiritual principals including testimony, mentorship, and restitution. The 12-Step foundation of these treatment programs often led to the work of priests, pastors, rabbis and other religious professionals. In addition, at one time a premium was placed on counselors who had a “spiritual awakening” and could pass on their experience, strength and hope (and beliefs) to those under their care. According to Rev. Jack Abel, Senior Director of Spiritual Care at Caron Treatment Centers, “our own center and other early offerings including Hazelden and Hiwatch have in their history noted priests who played a central role.” He adds that “the fourth step and its similarity to confession was often part of what created the bridge between recovery and a religious or spiritual care professional.” This has since evolved into other spiritual practices being used, such as the Serenity Prayer, times for silent reflection, Yoga and forms of Mindfulness Meditation.

Rev. Eyglo Bjarnadottir, Spiritual Care counselor at the Hazelden Betty Ford Foundation, echoes the same message. “Hazelden historically has had a strong commitment to providing patients with individualized spiritual care during their treatment. This commitment is rooted in the understanding of Substance Use Disorder being an illness of body, mind and spirit. We provide the time and the attention needed in treatment to listen, assess, and provide guidance for the spiritual healing process to begin. No matter the spiritual background – agnostic, atheist, or a believer in God based on their own understanding, the importance of the spirit for recovery is honored by deep listening and recognition, followed by guidance and support, leading to actions that promote change.” It is important to note that other professions and disciplines, including neuroscience, are beginning to understand Carl Jung’s formula: “Spiritus contra Spiritum.” (1)

Spiritual Care in Treatment…”Two Thumbs Up”

The question then seems to be: How can an evidence-based addiction treatment facility incorporate such spiritual practices into its program in an effective and appropriate way without violating a client’s freedom of religion and spiritual beliefs? One answer to that question is to utilize trained professionals in the field of spiritual care and counseling so those matters can be addressed in sensitive and appropriate ways.
Rev. Meridith Graham, Chaplain at Rosecrance Health Network in Chicago, Illinois noted that “with the influence of 12- Step recovery programs, spirituality continues to demonstrate a positive impact on long-term sobriety. Without question, those in recovery have communicated that spirituality provides essential ingredients for a life in recovery, including a sense of purpose for one’s life, an inner connection with a Higher Power that offers peace, and moral guidelines that provide accountability to oneself and others.”
In a client survey facilitated at Rosecrance, clients’ comments overwhelmingly supported spiritual care services as an essential component of addiction treatment; and for their lives beyond treatment. Common client responses were similar to these:

Conrad A.—“I’m not religious, so strictly religious teachings fall on deaf ears, but I gleaned the spiritual lessons from all of our sessions. I loved spirituality. Thank you!”
Kyle V.—“Made me definitely set spiritual goals and start to love myself!”
Michael M.—“It helped me pinpoint some parts of myself that I’ve been out of touch with.”
Wendy—“The class she [Rev. Graham] leads was awakening in a lot of ways. I loved it.”

These comments and many others like them point out that spirituality opens a new dimension for clients to understand their addiction, and thus understand themselves in a positive way which is proven to be great motivation for long-term recovery.

Dr. Leta Herrington, Chaplain at the CeDar Treatment Center in Denver, CO. shared the immediate response of fellow staff members when they were informed that there was going to be a reduction of opportunities for their clients to meet with the Spiritual Care staff due to other staffing responsibilities. All the reactions echoed the reply from Patti Pade, MD, CeDAR’s Addictions Medicine Director, who wrote: “In all my years of monitoring health professionals one thing was certain – – without a strong spiritual connection, there was little chance of a sustained or robust recovery. I, for one, would recommend that increased staffing for the spiritual staff be a priority.” CeDar’s Medical Director, Laura Martin, MD added: “What a huge bummer- I’ve seen incredible growth based on these sessions.”

Thus the “missing piece” of spirituality in addiction treatment by trained and qualified spiritual care professionals is a dilemma for treatment centers. The current focus of modern treatment is moving towards more clinical, psychological and medical therapy models. Along with that, many treatment centers see trained spiritual care providers as an unnecessary expense they cannot afford to include in their staffing priorities. So, what is lost when spirituality is no longer seen as a priority in a well-rounded and effective addiction treatment program? Many programs are facing these difficult challenges.

Modernized Science Supports Spiritual Care Services

Today, a rift is often present between the language found in the “AA Big Book” and what is taught in a more clinical, medical and evidence-based models for treatment. At the same time, research and experience have recognized spirituality as a key ingredient in the changing landscape of effective health care. Numerous behavioral and neurological studies have demonstrated that positive changes in mood and brain function are produced when patients utilize various spiritual activities. This now is considered an important part of general medical care as well as treatment for addictions. In fact, a Harvard Medical School affiliated study stated: “That in 2007 alone, healthcare providers advised more than 6 million Americans to use meditation and related mind-body therapies.” And that “Mindfulness-based approaches may effectively replace medications for some patients.” (2)

Rev. James “Wolf” Yoxall, Spiritual/Wellness Director at Pavillon Treatment Center in North Carolina made reference to the importance of having trained Spiritual Care Professionals in helping the clients find their way into new thinking on their spiritual beliefs. Wolf stated: “One of the most challenging aspects of the work is sitting in a room of 25 patients each coming from a different or non-existent belief system, and having to help the group find common ground that works for them.” Quoting from the AA Big Book:

In that case, you may be suffering from an illness which only a spiritual experience will conquer, (Chapter 4, pg. 44). (3)

Not everyone has a “Burning Bush” spiritual experience so it is important to help patients understand their own connection to their spirituality in their daily recovery and for those that do have one, it is important that someone with an understanding of these experiences be available to help patients put it into perspective. One patient wrote regarding this: “Thank you so much for helping me. The rituals that you had me do were so thoughtful and profound. I felt so safe and free of being able to let go of pain I had carried with me for over 30 years. I now feel I can walk a path of recovery and spirituality, because now I feel whole again.

Spirituality Helps to Address the “Root” of the Problem

According to Dr. Bill Starr, Chaplain at the Sundown M Ranch in Selah, Washington, spirituality helps clients address many of the most common set-ups for relapse such as stress, anger, resentment, self-pity and grief. He writes: “We have found that offering a spiritual alternative to using alcohol and other drugs when facing a wide variety of life’s challenges gives our clients a sense of hope and confidence that they have healthy options.” He went on to write: “The key is to help each client find something they can turn to that will assist them in facing those challenges, and practice it often enough for it to establish a new ‘default setting’ in their brains. Prayer, Mindfulness Meditation, spiritual reading and other spiritual practices can replace drugs as the ‘go to’ response for many clients in times of crisis, as effective recovery tools.”

Rev. Dan Thompson, Director of Spiritual Care in Northern Michigan’s Harbor Hall Treatment Centers agrees and emphasizes the need to treat the whole person: The Spiritual, Physical, Mental, Emotional and Social. “Spirituality” is taught and explored from the indwelling thought of the collective mind and the personal search for purpose and self-worth. Clinicians and Spiritual Care Professionals share diverse training while effectively collaborating as they support clients who explore the mind-body-spirit path. According to AA literature:

To those who have made progress in A.A., it amounts to a clear recognition of what and who we really are, followed by a sincere attempt to become what we could be, (12 & 12, pg. 58). (4)

Chris, a recent graduate, was not expecting addiction treatment to include “spirituality” alongside physical and mental care. At his graduation he wrote to his Spiritual Director, “By dealing with my innermost thoughts, feelings, beliefs and resentments I have come to the inner peace I have been looking for. Relief at last! I no longer have to live behind the mask. I finally like what I see in the mirror and cannot wait to see what the rest of this journey has in store for me.”

Next Phase of Addiction Treatment: Spiritual Care Leaders and Clinicians…Partners in Recovery

If spirituality is an important ingredient in effective addiction treatment, then how it is presented and represented is also an important factor in offering responsible spiritual care. So far there are no national standards for certification of spiritual care professionals, but perhaps that will need to be initiated in order to assure that credible and responsible spiritual care will be offered in our treatment centers. To accommodate such credentials, educational programs will need to be created to train and prepare those who seek to work in the profession of spiritual care. Few options are available at this time, however some are emerging. For instance, just this past summer CeDAR began a full-time Chaplain Resident program. Their goals include:

Developing a model for training and developing professional chaplains in the context of addiction and recovery that can be used in other centers around the country
Developing more chaplains skilled in the particular application of their profession to the addiction and recovery field who can take those skills into other recovery centers and communities.

Clearly there is a growing need to keep the important contributions of spirituality in the mix. We need to make sure this is done in a way which fits the demands and needs for responsible treatment for our clients who come from a wide variety of backgrounds. There is a growing debate over what such a treatment model might look like, if it is offered at all. Hopefully trained spiritual clinicians like those who make up SCATP can bring their expertise and insight to the table and help set the course for this aspect of addiction treatment in America.

Join in the discussion at the next Evolution of Addiction Treatment Conference coming up in Los Angeles this coming February. Representatives from the SCATP Steering Committee will be present to explore this important topic, and ways that addiction treatment providers can incorporate meaningful and responsible spiritual support to the multi-dimensional treatment of Substance Use Disorders.

1. “Alcohol in Latin is ‘spiritus,’ and you use the same word for the highest religious experience, as well as for the most depraving poison. The helpful formula therefore is: ‘spiritus contra spiritum.’” Correspondence from Carl G. Jung, to Bill W., dated January 30, 1961, reproduced in the A.A. Grapevine Archives, http://silkworth.net/gravevine/bwtocgjung.html (Jan. 1963).
2. Rufus, Anneli (2012 Nov/Dec). Zen Medication: Can Meditation Heal Us? Spirituality and Health. http://Spiritualityhealth.com/articles/zen-medication-can-meditation-heal-us.
3. Alcoholics Anonymous, 4th Edition, Alcoholics Anonymous World Services, Inc., 2001, pg. 44.
4. Twelve Steps and Twelve Traditions, Alcoholics Anonymous World Services, Inc., 1997, pg. 58.

Bill Star bio Dan Thompson bio eyglo Bjarnadottir bio