By Austine Duru
The complex problem of opioid addiction and abuse in the United States has become a crisis more troubling than previously imagined. In 2011, the Centers for Disease Control and Prevention reported the use of illegal drugs such as heroin and recreational use of prescription painkillers such as oxycodone have risen to epidemic proportions and are worsening. The Substance Abuse and Mental Health Services Administration estimates that there are 4.3 million non-medical opioid users in the U.S. This has drawn the attention of elected officials, celebrities, and community activists.
Healthcare organizations are also grappling with this problem, which they have inadvertently helped create due to increased dispensing of powerful and highly addictive opioid painkillers. For most people, spirituality and religious coping are ways to begin to grapple with opioid addiction. Professional chaplains are considered critical in helping address the challenges. Unfortunately, little research exists on the specific ways that chaplains and spiritual care providers help address the problem. Also, research conclusions about the role of spirituality, faith, and religious coping in recovery from opioid addiction are mixed. However, there are a few substantive research articles on this topic.
A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction. In this work, Karen Dugosh and her colleagues systematically reviewed 30 prior and recent publications based on empirical research on the best psychosocial interventions to use, along with approved medications, to combat opioid addiction. This is based on the widely studied “contingency management” and “cognitive behavioral therapy” models that have been used in conjunction with methadone treatment for opioid addiction. The findings from articles published between 2008 and 2014 suggest that psychosocial interventions such as counseling, spirituality, 12-step programs, cognitive behavioral therapy, etc., can be significant parts of comprehensive, recovery-oriented treatment. Fourteen of the 27 studies reviewed were related to methadone treatment, and eight of these 14 showed that participants benefitted significantly from psychosocial interventions, specifically resulting in less illicit drug use and increased program attendance. This is one of the strongest predictors of long-term success in addiction recovery. The literature review also points to significant gaps in the research regarding psychosocial interventions in conjunction with medications. More research is needed to help drive best practices.
A focus-group study on spirituality and substance-abuse treatment. In this 2010 study, Adrienne J. Heinz, Elizabeth R. Disney, David H. Epstein, Louise A. Glezen, Pamela Clark, and Kenzie L. Preston explored the role of spirituality in recovery to determine the appropriateness of spiritual intervention in an inner-city drug treatment program. The authors used both quantitative and qualitative tools to determine whether spirituality could be incorporated into formal treatment while acknowledging unique differences and needs. The authors conducted focus groups with 25 methadone-maintained outpatients to examine beliefs about the role of spirituality in recovery and its appropriateness in formal treatment. The groups also discussed the relationship between spirituality and behavior during active addiction. The analyses suggest that spirituality and religious practices can help recovery from active addiction. Many participants supported integrating a voluntary spiritual program into substance-abuse treatment. One limitation of the study was that all participants identified as strongly spiritual. Of note, “participants conveyed the need for a spiritual resource that would serve as an addition or an alternative to traditional church services and 12-step meetings. This resource would incorporate elements from both, while introducing new aspects specifically tailored to individuals faced with the arduous challenges associated with substance abuse recovery” (Heinz, Disney, Epstein, Glezen, Clark and Preston, 2010). This study has implications for outpatient chaplaincy services. It also points to the need for further research to determine the structure and nature of a spirituality group that would be both practical and beneficial in an outpatient substance-abuse clinic.
The Role of Spirituality in Treating Substance Use Disorders. James DiReda and Jude Gonsalvez investigated the interconnections of mind, body, and spirit in recovery from substance dependence, given that pain and suffering are often the root causes of addictive behaviors, and the resulting effects include isolation, alienation, shame, rejection, and emotional trauma. They were particularly curious about the role of spirituality in addressing the pain and suffering associated with substance abuse. The authors surveyed 50 women and men diagnosed with substance use disorders who participated in a 30-day residential treatment program. The results led to several important conclusions: 1.) Study participants defined and attributed meaning to spirituality in four categories 2.) Ninety percent of those surveyed believe in the value for spirituality and its meaning for them, and 81% were able to articulate how their spirituality has helped them in their recovery process. 3.) Ninety-four percent expressed the desire for a spiritual focus in their treatment program.
In a recent study titled Changes in Religious Coping and Relapse to Drug Use Among Opioid-Dependent Patients Following Inpatient Detoxification, Eve S. Puffer, Linda M. Skalski, and Christina S. Meade examined the relationship among religious coping, opioid use, and participation in the 12-step program. They believed that it is important to identify psychosocial factors associated with poor outcomes and high relapse rates among people struggling to overcome opioid dependence. The authors surveyed 45 participants receiving inpatient opioid detoxification at baseline and follow-up. Positive religious coping might be protective, while negative religious coping might be a barrier to treatment. “Positive religious coping at baseline was associated with history of 12-step participation after controlling for years of substance use (OR = 2.33, p= .01). That is, individuals with higher religious coping were more likely to have ever been to meetings. Furthermore, increased positive religious coping was associated with frequency of 12-step participation at follow-up (β= .42, p= .03). Negative religious coping was unrelated to 12-step participation” (Puffer, Skalski and Meade, 2013). The study concludes that positive religious coping could help in opioid recovery, while negative religious coping could be a barrier to recovery.
Substance Abuse Counselors’ Recovery Status and Self-Schemas: Preliminary Implications for Empirically Supported Treatment Implementation by Elizabeth M. Nielson is an attempt to “better understand the relationship between substance abuse counselors’ personal recovery status, self-schemas, and willingness to use empirically supported treatments for substance use disorders” (Nielson, 2016). In the study, 12 practicing substance abuse counselors address the enduring misperceptions that addiction counselors with personal history of addiction tend to be more competent than their non-recovering counterparts. The findings suggest that within the study sample, “recovering counselors tended to see those who suffer from addiction as qualitatively different from those who do not, and hence themselves as similar to their patients, while non-recovering counselors tended to see patients as experiencing a specific variety of the same basic human struggles everyone experiences, and hence also felt able to relate to their patients’ struggles” (Nielson, 2016). This finding suggests that counselors’ recovery status and corresponding self-schemas might be related to counselor willingness to learn and practice specific treatments. This research has implications for chaplains working in healthcare, substance abuse, or addiction recovery centers.
Austine Duru, BCC, is the regional director of mission, ethics, and pastoral care at SSM Health in Madison, WI.