Many think of addiction as not only a physical, emotional, and psychiatric disease, but also as a spiritual one. This being the case, addiction treatment requires a spiritual component. What that spiritual component is and how to incorporate it into treatment remain challenging questions for clinicians to consider—ones that generate the strongest disagreements among treatment professionals.
The dictionary definition of spirituality consists of “the spirit or the soul as distinguished from the body” or of something related to religion or religious beliefs. An inability to define spirituality minus its religious connotation is prevalent among the general population, and may creep into the attempt to instill a spiritual component into chemical dependency treatment. Spirituality is entirely possible with or without a belief in a supreme being.
During substance abuse treatment, spirituality should be kept clearly distinct from religion and religious interpretation. In the context of adolescent treatment and recovery, spirituality is associated with a profound personality change and the forming of an inner peace and strength. It is also highly personal and specific to the individual. One of the most profound revelations from the Alcoholics Anonymous (AA) model and the 12-Step movement, which both espouse the invocation of a higher power, is the observation that religion itself is not enough to overcome addiction.
In the AA philosophy the definition of a higher power is left to the individual. This higher power can range from a Judeo-Christian view of God to nature or even to the collective wisdom of the AA group. From this context, spirituality becomes a bridge to something beyond oneself. It is a way of connecting to and achieving a sense of association with a universe larger than one's personal existence.
Adolescence is a time of looking forward and looking backward—a transitional phase fraught with issues of personal identity and the establishment of a value system. It is often marked by experimentation and defiance against authority, which often result in the dismissal or complete rejection of spiritual concepts at a time not conducive to facilitating a spiritual awareness. A large number of substance-abusing adolescents enter treatment with distorted views of spirituality. These can be embodied in statements such as: “There is no such thing as spirituality,” “Prove there is a God or higher power,” or, “I can depend only on me, and I don't need anyone or anything else.”
Hazelden Publishing's The Dual Disorders Recovery Book reminds us of two important prerequisites for spirituality: (1) that we realize our own humanity and (2) that we realize our dependence upon others. The former condition leads to the latter. Typically, adolescents feel omnipotent and invincible. Therefore, if spirituality emphasizes giving up oneself and surrendering, it may clash with the adolescent's view that he/she is self- sufficient and unaccountable to others.
Spirituality cannot be taught in didactic fashion. It is largely an experiential, non-logical process of association and emulation. The first exposure tends to come through the example of other recovering persons, either recovering staff members or members of self-help groups attending to adolescents during treatment. Recovering individuals who have achieved a spiritual awakening or spiritual state appear to have a sense of calm, peace, and fullness that contrasts with the gloom and doom many adolescents feel during treatment. This sense of serenity may induce curiosity in those who have never shared such an experience.
However, example and knowledge alone are not enough to bring about a transformation necessary for recovery. As adolescents settle into the treatment program, they are required to act in accordance with principles such as honesty and integrity. This enforced accommodation promotes, and to an extent requires, behaviors compatible with a type of personality change noted in the AA literature. Often the substance-abusing adolescent acts on the basis of external direction rather than out of an understanding of his/her behavior's spiritual or philosophical implications. At this point it is important to remember a principle of therapy: that adolescents must have opportunities to practice whatever new behaviors treatment providers are attempting to encourage. That is why inpatient chemical dependency treatment makes sense. In a safe, structured setting, adolescents are able to practice honesty and integrity, such as by telling the truth when asked about situations on the unit or about their behavior relative to others.
In encouraging adolescents to take ownership of their recovery, they also must be encouraged to take responsibility for their past. It is important that adolescents be able to tell their own stories their own way and that counselors be present with them. There is a saying in AA circles: “Honesty gets you sober—honesty about what you've done and whom you've hurt—and responsibility keeps you sober.”
Here are some basic principles and strategies for integrating spirituality into substance abuse treatment for adolescents:
Remember that adolescents initially may not be receptive to hearing about the spiritual component of AA or NA treatment, because of what is going on with them at the moment.
Some adolescents already might have specific spiritual beliefs from childhood religious upbringing. In this case, their beliefs must be honored, while they can be offered an alternative way of viewing spirituality.
Regardless of the adolescent's willingness or unwillingness to explore spirituality as it pertains to AA or NA, staff must be supportive and remain there for the client.
Because of adolescent developmental issues related to receptive and expressive language, it is necessary to define standard terms used in AA and NA, including “spirituality,” “powerlessness,” and “higher power.”
Adolescents need to feel safe before they will be receptive to new terms and concepts.
Adolescents need to know they are valued and respected, whether or not they accept the AA/NA definitions of spirituality.
It is important for clinicians not to become discouraged, because spirituality for substance-abusing adolescents is a journey and not an event.
It is important to provide adolescents in treatment with role models of young people who have incorporated spiritual concepts into their treatment/recovery. A word of caution: Do not allow one adolescent to preach to another.
Incorporate sober fun activities into the recovery program.
Integrating spirituality into treatment for chemically dependent adolescents can be challenging. However, from a clinical, social, emotional, and recovery standpoint, the rewards definitely outweigh the challenges. Spirituality is important in recovery and in our own lives as clinicians, parents, and friends. While the adolescent in treatment may or may not hold beliefs that match those of his/her treatment provider, we must continue to use the best treatment practices and instill hope that the adolescent will experience his/her own spiritual awakening.Fred J. Dyer, PhD, CADC, is a trainer and consultant specializing in substance abuse, violence prevention, and adolescent and family issues. His clients include social service agencies, school districts, and probation offices. He spoke on treatment of adolescent co-occurring disorders at the SECAD 2005 conference this past December