Rehabilitative Services

Journal of Addictions & Offender Counseling • April 2016 • Volume 37 35

© 2016 by the American Counseling Association. All rights reserved.

Received 05/06/15 Revised 07/24/15

Accepted 07/27/15 DOI: 10.1002/jaoc.12014

Self-Efficacy Among Adults in Substance Abuse Treatment: The Role of Religious Coping

Amanda L. Giordano, Elizabeth A. Prosek, Sahar Loseu, Cynthia M. Bevly, Julia Stamman, Citlali E. Molina, Molly M. Callahan, and Richard-Michael Calzada

In substance abuse treatment, general self-efficacy and religiousness are factors that may support positive outcomes. The authors surveyed clients receiving substance abuse treatment (N = 121) and found that religious coping predicted general self-efficacy scores. Clinical implications are discussed.

Keywords: substance abuse, general self-efficacy, religious coping

Bandura (1977) defined self-efficacy as the belief that “one can successfully execute the behavior required to produce the outcomes” (p. 193). According to Bandura (1999), one’s belief that he or she can successfully reach a desired outcome is necessary to initiate action and to persist in light of adversity or challenges. Researchers have found that the construct of self-efficacy relates to many behaviors such as exercise (Luszczynska, Gibbons, Piko, & Tekozel, 2004), oral self-care (Schwarzer, Antoniuk, & Gholami, 2015), and persistence in college (Liao, Edlin, & Ferdenzi, 2014). With particular relevance to the current study, previous researchers have also found associations between self- efficacy and substance abuse (Connors, Tonigan, & Miller, 2001; Coon, Pena, & Illich, 1998; Kuusisto, Knuuttila, & Saarnio, 2011); generally, higher levels of self-efficacy in specific domains, such as alcohol abstinence, corresponded to lower levels of substance abuse and better substance abuse treatment out- comes. In addition to empirical research, previous authors have supported the relationship between self-efficacy and substance abuse with theoretical propositions: Bandura (1997) noted that an increase in self-efficacy will likely lead to sobriety among problem drinkers. With regard to relapse, Bandura (1999) purported that those with high self-efficacy may conceptualize a brief return to substance use as a slip, rather than failure, and recommit to sobriety. Therefore, self-efficacy is an important construct in the exploration of substance abuse treatment and sustained abstinence from drugs and alcohol.

Amanda L. Giordano, Elizabeth A. Prosek, Sahar Loseu, Cynthia M. Bevly, Julia Stamman, Citlali E. Molina, Molly M. Callahan, and Richard-Michael Calzada, Department of Counseling and Higher Education, University of North Texas. Correspondence concerning this article should be addressed to Amanda L. Giordano, Counseling Program, Department of Counseling and Higher Education, University of North Texas, College of Education, 1155 Union Circle #310829, Denton, TX 76203 (e-mail: amanda.giordano@unt.edu).

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Currently, there are two distinct ways to measure self-efficacy: behavior- specific or general. With regard to substance abuse, numerous researchers have studied behavior-specific self-efficacy, particularly related to absti- nence and refusal behaviors, and have demonstrated a strong relationship between self-efficacy and treatment outcomes (Greenfield, Venner, Kelly, Slaymaker, & Bryan, 2012; Kadden & Litt, 2011). For example, in a study of clients in residential treatment for substance use disorders, Ilgen, McKellar, and Tiet (2005) found abstinence self-efficacy to be the strongest predictor of sustaining abstinence for 1 year posttreatment. Abstinence self-efficacy referred to participants’ belief that they will remain completely abstinent 1 year after discharge from the program. In addition, findings from Project MATCH, the multisite, national research project, revealed abstinence self- efficacy, as measured by the Alcohol Abstinence Self-Efficacy scale (AASE; DiClemente, Carbonari, Montgomery, & Hughes, 1994), as a predictor of days abstinent among adults in outpatient and aftercare treatment for substance abuse (Connors et al., 2001).

Although behavior-specific self-efficacy is recommended by Bandura (1997), several researchers have investigated general self-efficacy, encom- passing an individual’s global sense of competence to address stressful or adverse situations (Luszczynska, Scholz, & Schwarzer, 2005; Schwarzer & Jerusalem, 1995). Researchers posited that self-efficacy is a homogeneous construct (Schwarzer, Mueller, & Greenglass, 1999). Supporters of global self-efficacy have recommended that researchers consider studying general self-efficacy when interested in multiple obstacles or stressors in various domains (Luszczynska et al., 2005). Given the multitude of stressors and barriers faced by those in recovery from substance abuse, such as damaged relationships, financial stress or strain, health issues, and guilt or shame stemming from past experiences, general self-efficacy seems appropriate. A sense of efficacy regarding the ability to refuse or abstain from substances may be too narrow and, in fact, may not be the precipitator of relapse. Indeed, Bandura (1997) suggested that “problem drinkers are driven to heavy drinking more by a low sense of efficacy to manage aversive emo- tional states” (p. 359). Therefore, higher levels of general self-efficacy may allow a recovering individual to address a variety of stressors and therefore reduce the need to cope with substances.

Previous researchers have investigated the relationship between general self-efficacy and substance abuse, finding support for an inverse relationship. Specifically, among adult men, Mittag and Schwarzer (1993) determined that those with low general self-efficacy had higher alcohol consumption than those with high general self-efficacy. Among individuals with HIV, Corless et al. (2012) found those with low general self-efficacy engaged in higher levels of substance abuse. In addition, Hassel, Nordfjærn, and Hagen (2013) described a significant, inverse relationship between general self-efficacy and illicit drug use as well as alcohol use. Moreover, Nordfjærn, Hole, and Rundmo (2010) reported that psychological distress, the strongest predictor

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of substance abuse, was significantly and inversely related to general self- efficacy. Therefore, given the established relationship between general self-efficacy and substance use, it seems imperative to better understand predictors of general self-efficacy among substance abusing clients. One potential predictor is religiousness and individual variables pertaining to religious identity.

Religiousness, Spirituality, and Self-Efficacy

Over the past few decades, the construct of spirituality has emerged as distinct from religion. Rather than polar opposites, however, religion and spirituality frequently are integrated constructs (Pargament, 1997). Spirituality, which often is conceptualized as one’s personal experience of beliefs, values, and transcendence, may exist with or without religion, which often refers to institutionalized practices and communal traditions (Pargament, 1997; Zinnbauer et al., 1997). Although differences exist be- tween the constructs of spirituality and religion, significant overlap and integration also exist; therefore, researchers on these topics often explore elements of both phenomena.

Previous researchers have provided support for the associations between religious/spiritual elements and various types of self-efficacy. For example, in a sample of 144 undergraduate students, Duffy and Blustein (2005) determined that intrinsic religiousness, defined by internally motivated reasons for one’s religiousness, and spiritual awareness, defined by one’s awareness of God and the nature of one’s connection to God, significantly predicted career decision self-efficacy. In a study of African American youth and young adults, researchers found that substance refusal efficacy positively correlated with public and private religiosity (Nasim, Utsey, Corona, & Belgrave, 2006). In addition, refusal efficacy, or one’s confidence in the ability to refrain from using substances in stressful situations, medi- ated the relationship between private religiosity (i.e., personal beliefs and an individual’s values pertaining to a Higher Power) and several forms of substance use (Nasim et al., 2006). Researchers have also determined that religiousness is related to general self-efficacy. Holt, Roth, Clark, and Debnam (2014) found that among a sample of African American adults, those with higher levels of religious beliefs (i.e., private participation in religious behaviors and personal religious beliefs) had higher levels of general self-efficacy. Therefore, previous researchers have suggested that religiousness correlates with self-efficacy, as measured in various ways.

One aspect of religiousness warranting further examination with regard to self-efficacy is religious coping. Pargament, Smith, Koenig, and Perez (1998) suggested that when faced with negative life circumstances, religion can be used as a positive coping strategy (perceiving God as benevolent and a source of support) or a negative coping strategy (perceiving God as puni- tive and punishing). Although related, positive religious coping (PRC) and

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negative religious coping (NRC) are distinct dimensions of the multifaceted construct of religious coping (Pargament et al., 1998). Previous researchers have found small, positive correlations between PRC and NRC; however, the low correlations (i.e., r = .17 and r = .18) and discriminant validity confirmed that they are unique constructs, rather than opposing ends of a continuum, which individuals may use simultaneously (Pargament et al., 1998). Indeed, Pargament et al. (1998) stated that rather than using only one religious coping method at a time, individuals use religious coping “in combination with each other” (p. 720) when faced with negative life events. Both PRC and NRC may be associated with the construct of self- efficacy. For example, higher levels of PRC were found to associate with higher levels of psychological growth resulting from a stressor (Pargament et al., 1998). In addition, in a qualitative study of female intimate partner violence survivors, researchers identified a theme of self-efficacy emerging from the use of spiritual coping mechanisms including “experiencing God as a lifeline for survival” (Drumm et al., 2014, p. 389). This finding supports the notion that PRC may predict self-efficacy. With regard to NRC, Smither and Walker (2015) found that core self-evaluation (a construct including generalized self-efficacy among other factors) stood in a significant negative association with the perception that God is punitive. Therefore, both PRC and NRC may be significant predictors of general self-efficacy.

Purpose of the Current Study

Given the extant research findings on general self-efficacy as a positive fac- tor in substance abuse treatment and recovery, as well as the relationship between self-efficacy and religious elements, we developed the present study to determine the predictive validity of religious coping on general self-efficacy. Specifically, we sought to address the following research question: Do levels of PRC and NRC significantly explain the variance of general self-efficacy among a sample of adults in outpatient substance abuse treatment? In view of previous findings, we hypothesized that both PRC and NRC would significantly and uniquely explain the variance of general self-efficacy, with PRC predicting more general self-efficacy and NRC predicting less.

Method

Procedure

After receiving institutional review board approval, we identified potential substance abuse treatment centers to serve as the sampling population for the study. We used convenience sampling methods and selected substance abuse counseling groups based on size, level of treatment, and time of day to provide a greater chance for adequate sample distribution. Inclusion cri- teria for selection included that treatment centers (a) were nonfaith based,

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(b) used intensive outpatient programs, (c) and provided group counseling for adult clients. We administered 127 paper surveys to group members in 13 separate outpatient groups within three treatment centers. Participants who completed the survey received a $5 gift card to a local restaurant. We collected 125 completed survey packets, with a response rate of 98.4%. We removed four surveys because of missing data, particularly in regard to age, because we could not verify the participants met the inclusion criteria of age 18 years. Therefore, 121 participants formed the final sample.

Participants

Participants included adults in outpatient substance abuse treatment centers in a southwestern region of the United States. Two inclusion criteria for the study included a minimum age of 18 years and current involvement with outpatient substance abuse treatment. Participant groups were equal among those mandated to treatment (47.9%, n = 58) versus those volun- tarily receiving treatment (47.9%, n = 58), with five individuals choosing not to provide this information. The mean age of the participants was 35.04 years old (SD = 11.60). With regard to gender, 45.5% (n = 55) of par- ticipants identified as women, 53.7% (n = 65) identified as men, and one participant (0.8%) identified as transgender. Racial/ethnic identification was as follows: 1.7% (n = 2) Asian/Pacific Islander, 29.8% (n = 36) Black/ African American, 20.7% (n = 25) Latino/Hispanic, 1.7% (n = 2) multiracial, 2.5% (n = 3) Native American, 43.0% (n = 52) White, and 0.8% (n = 1) other. Participants reported sexual orientation: 7.4% (n = 9) of participants identi- fied as bisexual, 6.6% (n = 8) identified as gay, 85.1% (n = 103) identified as heterosexual, and one participant (0.8%) did not report sexual orientation. With regard to religious affiliations, participants selected from a list of 10 potential options in which 0.8% (n = 1) identified as Buddhist, 9.9% (n = 12) identified as Christian Catholic, 57.0% (n = 69) identified as Christian Protestant, 2.5% (n = 3) identified as practicing New Age spirituality, 6.6% (n = 8) identified as no religious affiliation, 19.8% (n = 24) identified as spiritual but not religious, and 3.3% (n = 4) identified as other. Some per- centages may not total 100 because of rounding.

Measures

Brief Religious Coping Scale. The Brief Religious Coping Scale (RCOPE; Pargament, Feuille, & Burdzy, 2011; Pargament et al., 1998) is composed of 14 items assessing religious coping. More specifically, the Brief RCOPE contains two subscales, one that measures PRC and one that measures NRC in response to life stressors. The subscales are measured on a 4-point Likert-type scale, ranging from 1 (not at all) to 4 (a great deal). An example of a PRC scale item is, “Sought God’s love and care,” and an example of an NRC scale item is, “Questioned God’s love for me” (Pargament et al., 1998). Because the scale specifically refers to a Deity, it is conceptualized as a religious coping scale; however, because many individuals express

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their spirituality through religion (Pargament, 1997), it may also represent spiritual coping for some participants. In previous research, Giordano et al. (2015) used the Brief RCOPE and attained a Cronbach’s alpha level of .92 for the PRC scale and .81 for the NRC scale, providing evidence of strong internal consistency. With regard to validity, Pargament et al. (2011) reviewed current literature and determined that PRC scores related to spiritual health and psychological well-being whereas NRC scores related to poor psychological functioning. In the current study, scores on the PRC subscale had a Cronbach’s alpha level of .93; scores on the NRC subscale had a Cronbach’s alpha level of .87. These subscale scores demonstrated strong reliability evidence above the minimum standard level of .70 for social science research (Heppner & Heppner, 2004).

General Self-Efficacy Scale. We used the General Self-Efficacy Scale (GSE; Schwarzer & Jerusalem, 1995) in this study to measure self-efficacy. The original GSE scale was constructed in German and has since been trans- lated to over 28 languages (Luszczynska et al., 2005). Respondents rated the 10 items on a 4-point Likert-type scale ranging from 1 (not at all true) to 4 (exactly true). Example items include “I can always manage to solve difficult problems if I try hard enough” and “I can remain calm when fac- ing difficulties because I can rely on my coping abilities.” The GSE score is obtained by calculating the sum of all item scores, with 10 representing the lowest score and 40 representing the highest. Scores on the GSE scale demonstrated strong evidence for internal consistency (Cronbach’s α = .86) in a meta-analysis (Scholz, Doña, Sud, & Schwarzer, 2002). The test–retest reliability based on a 2-year interval ranged from .47 for men to .63 for women (Schwarzer & Jerusalem, 1995). In addition, researchers supported the scale’s validity with positive correlations between GSE and self-esteem, optimism, and internal control (Schwarzer & Jerusalem, 1995). Scores on the GSE scale indicated strong reliability evidence (α = .81) in the current study.

Data Analysis

Before data analysis, we used the G*Power software program to calculate the necessary sample size (Faul, Erdfelder, Buchner, & Lang, 2009). We chose to specify a medium effect size for a priori analyses on account of previous findings on related constructs (Hassel et al., 2013). Our study required 68 participants with a moderate effect size (f 2 = .15), a power of .80, an alpha level of .05, and two tested predictors. Because this study was part of a larger research project, we sought to collect data from 125 adults in substance abuse treatment to perform all necessary analyses and account for incomplete surveys. Upon initial examination of the data, we assessed whether or not the data met the assumptions of multivariate analyses. A correlation matrix revealed modest correlations between study variables. Thus, multicollinearity was not a concern. The data met assumptions of independence and linearity. In addition, all skewness and kurtosis coef- ficients were within the range of plus or minus one, with the exception

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of NRC, which was slightly skewed (1.10). Upon visual inspection of the scatterplot of standardized predicted and residual values, we determined that the data met the assumption of homoscedasticity and, therefore, we proceeded with the multiple regression analysis. We used a multiple re- gression analysis to assess the unique contribution of each predictor (PRC and NRC) on GSE. Because PRC and NRC are distinct yet connected (Par- gament et al., 1998), a multiple regression allowed for the examination of the predicted change in GSE resulting from each form of religious coping while holding the other constant.

Results

The means and standard deviations of study variables were as follows: GSE (M = 30.31, SD = 4.57), PRC (M = 21.45, SD = 5.96), and NRC (M = 12.06, SD = 5.31). To address the research question examining the amount of variance in general self-efficacy scores accounted for by PRC and NRC, we used a simultaneous multiple regression. PRC and NRC scores served as the independent variables, and general self-efficacy scores served as the dependent variable. The results of the regression analysis were significant, R2 = .07, adjusted R2 = .06, F(2, 118) = 4.61, p = .01, accounting for 7.2% of the variance. According to Cohen (1992), this effect size falls between small (.02) and medium (.15). Examination of standardized beta coefficients revealed both PRC, B = .18, β = .24, t = 2.61, p = .01, 95% CI [.04, .32], and NRC, B = –.16, β = –.18, t = –2.02, p < .05, 95% CI [–.31, –.00], uniquely accounted for variance explained. The direction of the beta values, which were con- firmed by the correlation coefficients, indicated that higher levels of PRC and lower levels of NRC significantly predicted general self-efficacy scores among adults in outpatient substance abuse treatment, thereby supporting our hypothesis.

Discussion

Beyond the established associations between GSE and lowered substance use (Corless et al., 2012; Hassel et al., 2013; Mittag & Schwarzer, 1993), GSE relates to other desirable outcomes such as quality of life (Ponizovsky et al., 2010), active coping and positive reframing (Luszczynska et al., 2005), and proactive attitudes (Albion, Fernie, & Burton, 2005). In light of the potential benefits associated with GSE, it is important to identify predictors of GSE. Such findings might inform substance abuse treatment practices. In the current study, we sought to determine the amount of variance of GSE explained by PRC and NRC among adults in outpatient substance abuse treatment. Religious elements have long been recognized as protective fac- tors against substance abuse (Desmond, Ulmer, & Bader, 2013; Fletcher & Kumar, 2014; Mason, Schmidt, & Mennis, 2012; Stoltzfus & Farkas, 2012), yet they also may relate to self-efficacy. Indeed, our findings indicated that,

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after accounting for interrelationships among the predictor variables, the regression model (containing both PRC and NRC) significantly predicted GSE. Specifically, PRC uniquely predicted higher levels of GSE whereas NRC uniquely predicted lower levels, which supported our hypothesis. Religious coping explained slightly more than 7% of the variance in GSE, a small to moderate effect size.

These findings were similar to those attained by previous researchers who found associations between aspects of religiousness and self-efficacy (Duffy & Blustein, 2005; Holt et al., 2014). Our study served to expand these findings by supporting the relationship between religious elements and self-efficacy among clients with substance use disorders. In addition, our results confirmed the distinct effects of PRC and NRC on self-efficacy. Previous researchers supported the notion that spiritual coping responses and PRC are linked to self-efficacy and psychological growth (Drumm et al., 2014; Pargament et al., 1998). In the same way, PRC predicted general self-efficacy in our regression model. One possible explanation for this find- ing is that those with a secure connection to the Divine feel more capable to execute tasks successfully with the support of a Higher Power. Furthermore, previous researchers have linked punitive perceptions of God (related to NRC) to lower self-evaluation, including generalized self-efficacy (Smither & Walker, 2015). Similarly, the results of our regression model supported the negative association between NRC and GSE. The utilization of NRC may decrease self-efficacy by causing individuals to question their ability to be successful if the Divine is “punishing” or working against them. Thus, an individual’s perception of God and function of religiousness during nega- tive life circumstances may serve to empower or paralyze the individual in his or her quest to be successful in a variety of tasks.

Implications for Counselors

These findings have several implications for clinicians working in substance abuse treatment settings, such as emphasizing the importance of assessment for religious/spiritual elements of clients’ identities. Rather than relying on demographic items on an intake form, more thorough assessment is needed to understand how clients use religiousness, particularly when faced with challenging circumstances. Pargament (1997) defined religion as “a search for significance in ways related to the sacred” (p. 32) and em- phasized that clients can use religion as a way to positively or negatively cope with challenges. For clients who identify interest or experience in such matters, an exploration of their religious belief system—or absence of religious belief system—may be useful at both intake and throughout the counseling process.

This focus on assessment is supported by the spiritual competencies crafted by the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC; Cashwell & Watts, 2010). Competency 10 states that counselors

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work to “understand a client’s spiritual and/or religious perspective by gathering information from the client and/or other sources” (Cashwell & Watts, 2010, p. 5). A comprehensive understanding of the client’s religious perspective, when applicable, can assist in building rapport, constructing accurate client conceptualizations, determining interventions, and forming appropriate treatment goals. Therefore, it may behoove counselors work- ing with an addictions population to examine both the nature of a client’s religiousness and whether clients use religious elements in response to difficulties. Counselors may use formal measures such as the Brief RCOPE (Pargament et al., 1998), Quest Scale (Batson & Schoenrade, 1991), or Daily Spiritual Experience Scale (Underwood & Teresi, 2002) to assess religious/ spiritual elements. In addition, counselors can invite clients to construct spiritual life maps (Hodge, 2005), in which clients depict significant events on their spiritual journeys. Finally, counselors can use informal assessment strategies throughout the counseling process by reflecting, exploring, and assisting clients in their understanding of their religious/spiritual values and identities.

Another implication is the importance of supporting clients’ use of PRC, given our findings that PRC was related to higher levels of GSE, whereas NRC was related to lower levels of GSE. Pargament et al. (1998) stated that PRC results from a secure connection with God and consists of coping strategies, such as seeking spiritual support, collaboration, and benevolent reappraisals of God. NRC, conversely, results from a tenuous connection with God, spiritual struggle, and punishing reappraisals of God (Pargament et al., 1998). One way to support clients’ use of PRC may be through an attachment theory framework. Researchers have linked God images and God concepts to childhood and adult attachment styles (Dickie et al., 1997; Noffke & Hall, 2007). Moriarty, Hoffman, and Grimes (2006) posited that counselors can assist in changing attachment styles and related God images by (a) creating a secure bond between counselor and client; (b) responding in new, healthy ways to client transference; and (c) identifying maladaptive attachment styles to increase client awareness of relational patterns. In this way, clients can model attachment styles after the therapeutic alliance and extend these patterns to other relationships (Moriarty et al., 2006). By aiding in the formation of secure attachment styles, counselors may help clients assess and reconstruct their religious attachment to foster PRC.

Another means to support clients’ use of PRC may involve referrals to 12-step support groups, such as Alcoholics Anonymous (AA). The AA fel- lowship does not affiliate with any religious denomination but does identify as a spiritual program. For clients who are open to the spiritual nature of 12-step programs, AA may offer a helpful, adjunct resource for their recovery process. Through the steps and traditions of AA, members come to rely on a Higher Power and find support through a secure connection with the Divine. The third step of the 12 steps of AA describes surrendering to “the care of God as we understood Him” (Alcoholics Anonymous World

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Services Inc., 2001, p. 59), emphasizing that the God of their understanding is a supportive, caring resource, rather than a punitive, condemning judge, thus fostering PRC rather than NRC. In addition, the Big Book of AA states,

The central fact of our lives today is the absolute certainty that our Creator has entered into our hearts and lives in a way which is indeed miraculous. He has commenced to accomplish those things for which we could never do by ourselves. (p. 25)

This description of the nature of the Divine may augment PRC levels by creating secure, rather than tenuous, connections with a Higher Power. In- deed, many members of AA have described experiencing a gradual spiritual awakening, after which they reported a decreased use of substances; more commitment to AA, religion, and AA service; and less depression (Galanter, Dermatis, & Sampson, 2014). For clients who express an interest in the AA model, attending 12-step meetings and working the program may be helpful in developing spiritual and religious coping strategies that serve to support them through negative life events, thus fostering a greater sense of PRC. Clients involved in AA may choose to discuss with their counselors their experiences in meetings, work on the 12 steps, and spiritual awakening. Counselors should be familiar with 12-step programs and the ASERVIC spiritual competencies to provide a safe, accepting environment for clients to explore their spiritual process.

Limitations and Future Research

Although the current study provides important information regarding the relationships between religious coping and general self-efficacy among clients in substance abuse treatment, several limitations exist. First, our sample came from one geographic location in the southwestern United States, which could have a unique religious tone that may not generalize to other regions. The majority of the sample identified as Christian Protestant, thus the findings may not represent samples from areas with more diverse religious affiliations. Also, we used convenience-sampling methods and, therefore, the benefits of random sampling are not applicable. Furthermore, we provided incentives for survey completion, which may have influenced some group members’ participation. In addition, our statistical analysis was correlational in nature; causality cannot be assumed. Moreover, although the demographic questionnaire included items assessing the number of times in treatment and the number of days since current treatment experi- ence began, responses to these items were largely incomplete or answered incorrectly and, therefore, were not included in the statistical analysis.

The results of this study prompt further research in this area, including the examination of additional predictors of GSE among clients in addiction counseling. The current regression model left a large portion of GSE unex- plained, suggesting that other predictor variables exist. These predictors may be different elements of religion/spirituality (e.g., faith community

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support, sense of purpose and meaning in life, intrinsic religiousness, self- worth resulting from connection with a Deity) or variables not associated with religion/spirituality. Future researchers may seek to examine the impact of additional religious/spiritual elements, as well as nonreligious/ spiritual variables, to better understand general self-efficacy among clients in substance abuse treatment. In addition, research investigating the rela- tionship between GSE and relapse at various intervals posttreatment would be beneficial. Moreover, the counseling field would benefit from research investigating the impact of AA involvement and attachment interventions on PRC and NRC scores. Empirical studies identifying aspects of substance abuse treatment that serve to significantly increase PRC while reducing NRC would assist clinicians in planning and implementing treatment protocols with this population.

Conclusion

Previous researchers have established support for the notion that general self- efficacy corresponds to positive outcomes with regard to substance abuse (Cor- less et al., 2012; Hassel et al., 2013; Mittag & Schwarzer, 1993). Religiousness is a potential predictor of general self-efficacy; however, religiousness can be mea- sured in various ways. We considered a specific understanding of religiousness by investigating clients’ PRC and NRC. In our sample of outpatient substance abuse treatment clients, PRC correlated to higher levels of general self-efficacy whereas NRC correlated to lower levels. To foster positive treatment outcomes, counselors are encouraged to explore religious coping behaviors and perceptions among their clients who value a religious belief system.

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