Psychology
chady5
Researchstudy.pdf
PEOPLE ATTENDING 12-STEP PROGRAMS AND EXPERIENCES OF
SPIRITUALITY: A QUALITATIVE INVESTIGATION
by
Anthony I. Chukwunta
LOUIS KAVAR, PhD, Faculty Mentor and Chair
MIKE DOOGAN, PhD, Committee Member
STEVEN WALLIS, PhD, Committee Member
Elizabeth Riley, PhD, Dean of Psychology
Harold Abel School of Psychology
A Dissertation Presented in Partial Fulfillment
Of the Requirements for the Degree
Doctor of Philosophy
Capella University
June 2018
ProQuest Number:
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© Anthony I. Chukwunta, 2018
Abstract
Some researchers have proposed that spirituality plays a role in alcohol or drug recovery, while
others have stressed the need for caution and recommended further research. To help elucidate
the connection between spirituality and alcohol or drug recovery the author used a generic
qualitative study design to investigate how people attending 12-step programs for recovery from
alcohol or drugs described their experiences of spirituality. After thematic analysis of the data
collected from the participants, five themes emerged: (a) feelings of peace and love, (b) higher
self-esteem, (c) feelings of joy and happiness, (d) feelings of being in the presence of a higher
power, and (e) becoming less judgmental. The results support the conclusion that spirituality
plays a role in recovery from alcohol or drug use.
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Dedication
I dedicate this dissertation to my late father Chief Anthony Chukwunta and my late sister
Mrs. Rita Ukamaka Agbu. Both were the winds beneath my wings in doing this PhD. My late
father motivated me to aim at getting my PhD. My late sister spurred me with her words of
wisdom and encouragement until her passing shortly before I completed this dissertation.
iv
Acknowledgments
My gratitude goes to God who gave me life and sustained me to complete this
dissertation. My thanks go to my faculty mentor and dissertation chair Dr. Louis Kavar. You are
a godsend. You guided me through this experience with patience, empathy, and deep
understanding. I would also like to extend my thanks to my committee members, Dr. Mike
Doogan and Dr. Steven Wallis, for their valuable insights and feedbacks. My special thanks go to
the participants who volunteered and shared their experience of spirituality. Your input led to the
completion of this study. To my family and friends, thank you so much for your patience and
understanding. I appreciate all the sacrifices each and every one of you made to support me
reaching my goal. To God be the glory!
v
Table of Contents
Acknowledgments.................................................................................................. iv
List of Tables ......................................................................................................... ix
CHAPTER 1. INTRODUCTION ........................................................................................1
Background of the Study .........................................................................................3
Need for the Study ...................................................................................................4
Purpose of the Study ................................................................................................5
Significance of the Study .........................................................................................6
Research Question ...................................................................................................6
Definition of Terms..................................................................................................7
Research Design.......................................................................................................8
Assumptions and Limitations ..................................................................................9
Methodological Assumptions ...........................................................................9
Theoretical Assumptions ................................................................................10
Topical Assumptions ......................................................................................11
Limitations ......................................................................................................11
Organization of the Remainder of the Study .........................................................11
CHAPTER 2. LITERATURE REVIEW ...........................................................................12
Methods of Searching ............................................................................................12
Theoretical Orientation for the Study ....................................................................13
Review of the Literature ........................................................................................15
What is Spirituality? .......................................................................................15
Psychology’s Understanding of Spirituality ...................................................22
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Spirituality and Recovery ...............................................................................25
A Brief History of 12-Step Recovery .............................................................35
The Current Status of the 12-Step Recovery Movement ................................38
Research on 12-Step Recovery .......................................................................40
Synthesis of the Research Findings .......................................................................46
Critique of Previous Research Methods ................................................................49
Summary ................................................................................................................49
CHAPTER 3. METHODOLOGY .....................................................................................51
Purpose of the Study ..............................................................................................51
Research Question .................................................................................................51
Research Design.....................................................................................................51
Target Population and Sample ...............................................................................53
Population .......................................................................................................53
Sample ............................................................................................................54
Procedures ..............................................................................................................55
Participant Selection .......................................................................................55
Protection of Participants ................................................................................56
Data Collection ...............................................................................................56
Data Analysis ..................................................................................................57
Instruments .............................................................................................................58
The Role of the Researcher .............................................................................58
Guiding Interview Questions ..........................................................................60
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Ethical Considerations ...........................................................................................60
Summary ................................................................................................................61
CHAPTER 4. PRESENTATION OF THE DATA............................................................63
The Study and the Researcher ................................................................................63
Description of the Sample ......................................................................................63
Research Methodology Applied to the Data Analysis ...........................................65
Presentation of Data and Results of the Analysis ..................................................66
Theme 1: Feelings of Peace and Love ............................................................68
Theme 2: Better Self-Esteem ..........................................................................70
Theme 3: Feelings of Joy and Happiness .......................................................70
Theme 4: Feelings of the Presence of a Higher Power ...................................72
Theme 5: Becoming Less Judgmental ............................................................76
Summary ................................................................................................................78
CHAPTER 5. DISCUSSION, IMPLICATIONS, RECOMMENDATIONS ....................81
Summary of the Results .........................................................................................81
Discussion of the Results .......................................................................................82
Conclusions Based on the Results .........................................................................82
Comparison of Findings with Theoretical Framework and Previous Literature ...83
Relationship of the Results to the 12-Step Program .......................................88
Relationship of the Results and Theoretical Orientation ................................89
Interpretation of the Findings.................................................................................90
Limitations .............................................................................................................91
viii
Implications for Practice ........................................................................................92
Recommendations for Further Research ................................................................92
Conclusion .............................................................................................................93
References ..........................................................................................................................95
STATEMENT OF ORIGINAL WORK ..........................................................................110
ix
List of Tables
Table 1. Participant Demographic Information ............................................................................ 64
1
CHAPTER 1. INTRODUCTION
There has been little agreement about the role spirituality plays in alcohol or drug
recovery, despite the fact that spirituality has been growing in popularity among alcohol or drug
users (W. R. Miller, 2009). The fundamental reason for this disagreement is that there has been
no consensus on the definition of spirituality (Memaryan, Rassouli, & Mehrabi, 2016).
For example, some investigators have considered spirituality to be a concept that is
measurable, while others disagree. Kapuscinski and Masters (2010) noted that there are many
spiritual measurement instruments, but the problem is that measurement affects construct validity
by overlapping with the construct of psychological well-being.
When it comes to external validity, Hammer, Cragun, and Hwang (2013) have shown that
culture can affect the way spirituality is interpreted. Recent studies have called for the
development of methodological approaches that allow spirituality to be measured in diverse
cultures. However, no such methodological approach has ever been used in a general setting, let
alone in a setting specializing in alcohol or drug use (de Jager Meezenbroek et al., 2012;
MacDonald et al., 2015). These diverse approaches have led many investigators to question that
a link even exists between spirituality and alcohol or drug recovery (MacDonald et al., 2015).
Memaryan et al. (2016) attribute the lack of consensus around a definition to cultural
differences, living environments, and differences in religious beliefs. The differences in the
definitions of spirituality have led many researchers to assume that spirituality cannot be used in
alcohol or drug recovery unless there is further clarification of its meaning (Memaryan et al.,
2016). This is because adopting one definition sparks criticism from researchers and practitioners
who favor other definitions (Moore, 2017).
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However, some researchers have posited a link between spirituality and alcohol or drug
recovery (Tuck & Anderson, 2014). These researchers based their findings on correlations
between spirituality and reduced alcohol or drug use, improved mental health, and improved
psychological well-being (Falb & Pargament, 2014; Rye, Wade, Fleri, & Kidwell, 2013).
Recovery is defined as a decrease in relapse and increase in self-efficacy (Buckingham,
Frings, & Albery, 2013). It is a process through which individuals, families, and communities
that suffer the disease of alcohol or drug problems use available resources to resolve their
problems (White, 2007). This process entails healing the wounds caused by alcohol or drugs,
developing a healthy lifestyle, and becoming productive in the society.
Spirituality has helped individuals with alcohol or drug problems to decrease use of
alcohol or drugs and is also the basis of recovery (Barton & Miller, 2015). Individuals who are
spiritual in their recovery journey enjoy better resiliency and better self-esteem than those who
are not spiritual (Barton & Miller, 2015). Individuals who are spiritual have been shown to cope
better when in recovery from alcohol or drug use (Gnanaprakash, 2013). Researchers who
propose a link between spirituality and alcohol or drug use recovery have suggested that
spirituality helps individuals with alcohol or drug use disorders overcome psychological
aggression, anxiety, depression, suicidal ideation, and feelings of alienation (Gnanaprakash,
2013).
Nevertheless, other researchers have continued to argue that the link between spirituality
and alcohol or drug use recovery is spurious. Those researchers have argued that more studies
are needed to properly understand any link between spirituality and alcohol or drug use recovery
(Hathaway, 2011). This dissertation is intended to help fill that gap in the literature by explaining
3
how people who attend 12-step programs for recovery from alcohol or drug use describe the
experiences of their spirituality.
In what follows, spirituality is defined as a personal connection with a higher power
(Kapuscinski & Masters, 2010). A higher power is a power that the individual believes to be
greater than themselves, which may be God or may accord with some other definition such as
wanting to be fully involved in one’s life (Mercadante, 2015).
Spirituality is the foundation of 12-step programs for members of Alcoholics Anonymous
(AA). Investigating how people who attend 12-step programs describe the experiences of their
spirituality could help to provide a clearer understanding of whether or not there is a link
between alcohol or drug use recovery and spirituality (Dermatis & Galanter, 2016).
Background of the Study
Recent studies have suggested the need for increased application of spiritual concepts to
the treatment of alcohol or drug use disorders (Dermatis & Galanter, 2016). When substances
consume an individual’s entire life, that individual experiences a disintegration of mind and body
(DiLorenzo, Johnson, & Bussey, 2001). Spirituality increases good living (Krause, 2007),
healthy lifestyles (Steger, Mann, Michels, & Copper, 2009), and reduces mortality (Boyle,
Barnes, Buchman, & Bennett, 2009; Krause, 2007).
Research has shown that Individuals who have spirituality enjoy a reduced risk of co-
occurring disorders (Boyle, Buchman, Barnes, & Bennett, 2010). Other studies have shown that
spirituality reduces the risk of mental disorders (Mascaro & Rosen, 2005; Owens, Steger,
Whitesell, & Herrerra, 2009). Individuals with spirituality have a reduced risk of suicidal
ideation, even when faced with depression (Heisel & Flett, 2004). In addition, individuals with
spirituality have been more likely to develop coping skills (Thompson, Coker, Krause, & Henry,
4
2003) and tended to do well in the workplace with occupational adjustment (Littman-Ovadia &
Steger, 2010). Individuals with spirituality have been considered more appealing in the social
domain (Stillman, Lambert, Fincham, & Baumeister, 2011). These studies have all suggested
that there is value in using spirituality in the treatment of alcohol or drug use disorders.
However, Hodge (2011) cautioned against using spirituality in the treatment of alcohol or
drug use disorders because the link between spirituality and alcohol or drug use recovery remains
unknown or is not fully understood. This lack of understanding has left a gap in the literature. To
bridge this gap in the literature, I studied how people attending a 12-step program for recovery
from alcohol or drugs described their experiences of spirituality.
Twelve-step programs such as AA, Substance and Alcohol Intervention Services for the
Deaf, Narcotics Anonymous World Services, All Addictions Anonymous, Big Book
Sponsorship, Cocaine Anonymous World Services, Crystal Meth Anonymous , Marijuana
Anonymous World Services, Nicotine Anonymous, Pills Anonymous, and Recoveries
Anonymous are rooted in spiritual principles and are associated with promoting recovery for
individuals with alcohol or drug use disorders (Majer, Payne, & Jason, 2015). I used a generic
research approach in an attempt to understand how individuals who were attending a 12-step
program for recovery from alcohol or drug use described their experiences of spirituality.
Need for the Study
As mentioned previously, the link between alcohol or drug use recovery and spirituality
is not well understood (Hodge, 2011), and has left a gap in the literature. Many addiction
treatment providers are unsure whether spirituality can be considered evidence based in the
treatment of alcohol or drug use disorder (W. R. Miller, 2009). Those in favor of using
spirituality have argued that people with spirituality, such as those with close relationships with a
5
higher power, enjoy better psychological well-being and lower rates of alcohol or drug use (Falb
& Pargament, 2014). In addition, individuals with a personal connection to a higher power found
that spirituality boosted recovery from alcohol or drug use (Koenig, 2000; Koenig & Larson
2001; Walker & Reimer, 2006). The application of spirituality to the treatment of alcohol or drug
use has also been linked to promotion of individual empathy and a positive way of life (Barton &
Miller, 2015). Spirituality has also been linked to helping individuals who suffer from alcohol or
drug addictions develop social skills and learn to live independently (Hardy, Zhang, Skalski,
Melling, & Brenton, 2014).
Nonetheless, researchers opposed to the application of spirituality to the treatment of
alcohol or drugs have argued that the connection between spirituality and alcohol or drug use
recovery is difficult to ascertain (Bryant-Davis et al., 2012; Hathaway, 2011). Researchers who
have found it difficult to link spirituality and alcohol or drug use recovery have suggested that
connecting the two can lead to psychosis (Mohr et al., 2011). Mohr et al. (2011) claimed that
spirituality can make individuals develop abnormal thinking and perceptions. The discord in
existing research suggests that a better understanding of the link between spirituality and alcohol
or drug use recovery is needed.
Purpose of the Study
Moore (2017) suggested that the link between spirituality and alcohol or drug use
recovery is very complex and that more studies are needed to fully understand the link. One way
to understand the link between alcohol or drug use recovery and spirituality is to explore how
people who are attending a 12-step program for recovery from alcohol or drug use describe their
experiences of spirituality because spirituality is the foundation of any 12-step program.
6
This study contributes to knowledge in the field of addiction psychology by attempting to
clarify whether spirituality contributes to alcohol or drug use recovery, and if so, how it
contributes. In addition, this study may help addiction psychologists feel more informed and
confident when considering the application of spirituality as part of their evidence-based
treatment.
Significance of the Study
There has been a rise in the use of 12-step programs in the treatment of alcohol or drug
use (Priester, Scherer, Steinfeldt, Jana-Masri, & Jashinksky, 2009). Despite this rise, some
addiction treatment providers have been unsure whether spirituality has any role in alcohol or
drug recovery and have avoided using it in treatment (W. R. Miller, 2009).
In this study I used a generic qualitative method to explore the link between spirituality
and alcohol or drug use recovery. Using a generic qualitative approach to address the research
question may create better understanding of where spirituality stands in alcohol or drug use
recovery, and the findings may suggest whether there is a need to enhance the training of
psychologists in spiritual competency for the treatment of alcohol or drug use disorders (Brown,
Tonigan, Pavlik, Kosten, & Volk, 2013; Schafer, Handal, Brawer, & Ubinger, 2011). A better
understanding of the link between spirituality and alcohol or drug use recovery could help lead to
better, happier, and healthier lives for millions of individuals who are currently suffering from
alcohol or drug use disorders.
Research Question
The research question was: “How do people attending a 12-step program for recovery
from alcohol or drugs use describe their experiences of spirituality?”
7
Definition of Terms
Alcohol or drugs (use): The American Society of Addiction Medicine (2015) described
alcohol or drug use as a chronic disease of brain reward, motivation, memory, and related
circuitry in which individuals continue to use alcohol or drugs despite negative consequences
resulting from continued use.
Higher power: This is a power believed to be greater than the individual’s power. A
power to which the individual is expected to turn his or her life (Mercadante, 2015). A higher
power is defined personally and subjectively: One individual may define it as God, another
individual may define it as wanting to be fully involved in one’s life (Mercadante, 2015).
Recovery: This is marked by a decrease in relapse and increase in self-efficacy
(Buckingham et al., 2013). Recovery is linked to reduced post-treatment relapse (Allsop,
Saunders, & Phillips, 2000; Gwaltney, Metrik, Kahler, & Shiffman, 2009). White (2007) referred
to recovery as a process through which individuals, families, and communities that suffer the
disease of alcohol or drug use can use available resources to solve their problems. This process
entails healing the wounds caused by alcohol or drugs, developing a healthy lifestyle, and
becoming productive in the society. Here, recovery described individuals who had remained
sober and for at least three years and were attending 12-step programs. Subbaraman and
Kaskutas (2012) suggested that after 3 years, individuals who are seeking treatment and have
enjoyed a network of support are more likely to benefit from a 12-step program than evidenced-
based approaches.
Spirituality: Spirituality is defined as a personal connection between an individual and the
individual’s higher power (Kapuscinski & Masters, 2010). This connection leads to spiritual
development. Spiritual development allows individuals to pursue positive aspects of life and
8
appreciate the beauty of creation (Kumar, 2015). Spirituality leads to people showing gratitude
and the acceptance of other people (Cohen, Gruber, & Keltner, 2010).
Twelve-step program: Twelve-step programs lead members to surrender to a higher
power. Surrendering to a higher power means that the individual admits to being powerless
against alcohol or drugs but is not fighting alcohol or drug use alone. Following a 12-step
program requires asking for help and following directions (Knack, 2013). Twelve-step programs
emerged as individuals in recovery continued to look beyond traditional alcohol or drug use
treatment. Individuals in recovery want to sustain long-term recovery from alcohol or drugs in
order to avoid relapse and maintain sobriety and abstinence (Society for Community Research
and Action, 2013).
Research Design
This research used a qualitative methodology. The focus of this research is how people
who are attending a 12-step program for recovery from alcohol or drugs describe their
experiences of spirituality. Qualitative methodology is a good choice for studying people’s
experiences and feelings or understanding people’s behaviors (Patton, 2002). In addition,
qualitative methodology is appropriate when an in-depth understanding of a phenomenon can
only be obtained by hearing from the individuals who have experienced the phenomenon
(Creswell, 2013).
The subject matter under study is purely subjective. I tried to understand the experience
of spirituality from the perspective of individuals who were attending 12-step programs for
recovery from alcohol or drugs (Ramlo, 2015). A qualitative methodology allowed me to gather
every individual’s description in detail. Using qualitative methodology for this study provided
9
me with the flexibility to explore the phenomenon under study while providing new information
that can assist in further studies (Kruth, 2015).
Specifically, this study utilized generic qualitative inquiry. Generic qualitative inquiry
investigates people’s subjective beliefs, opinions, attitudes, and reflections on their experiences
about a particular phenomenon in the outer world (Percy, Kostere, & Kostere, 2015). The
rationale for the choice of generic qualitative approach for this study was that I had
preknowledge and preunderstanding that spirituality contributed to individual recovery from
alcohol or drug use disorder (DeLucia, Bergman, Formoso, & Weinberg, 2015; Kaskutas et al.,
2014).
When a researcher has preknowledge and preunderstanding about a particular
phenomenon but wants to get a full detail understanding from the participants’ perspective, a
generic qualitative approach is the best one to use (Percy et al., 2015).
Assumptions and Limitations
The study rested on three different kinds of assumptions: methodological, theoretical, and
topical. The study also had several limitations, which I identified.
Methodological Assumptions
By adopting a qualitative methodology I assumed a philosophical approach that
emphasizes the use of interpretation and theory to derive results. A qualitative methodology
helps to understand people’s thoughts, feelings and subjective experiences (Creswell, 2013).
There were assumptions associated with each aspect of the research process, including the
research design, data collection, and data analysis.
Research design. The research design used in this study was a qualitative generic design.
Qualitative methodology relies on the data collected from the participants to discover a theory
10
(Fleming, Glass, Fujisaki, & Toner, 2010). I assumed that the use of a qualitative generic design
in this study would uncover what is not known or fully understood.
Data collection. The procedures for data collection were interviews (the interviews were
audiotaped), note taking in a diary, field notes, and personal experiences. Volunteers who met
the inclusion criteria were recruited (Creswell, 2013). I assumed that the interview questions the
volunteers answered would provide rich data for the study.
Data analysis. The data analyses were completed using a thematic procedure. The
analyses used in this study was of inductive analysis. I assumed that inductive analysis would
unify the individual experiences to form a core phenomenon.
Theoretical Assumptions
The theoretical assumption was that the study would bridge the gap in the literature and
erase doubts about whether there is link between spirituality and alcohol or drug use recovery
(Allen & Lo, 2010). Psychologists have considered spirituality to be an important part of the
human experience which promotes well-being (Heermann, Wiggins, & Rutter, 2007). Because of
this fact, I assumed that this study would enhance the training of psychologists in spiritual
competency. Many professionals have been uncomfortable exploring spirituality because of lack
of knowledge about spirituality (Brown et al., 2013; Sauders, Petrick, & Miller, 2014).
I considered my preunderstanding and preknowledge about spirituality and recovery and
how it can influence the study (Creswell, 2013). To manage these personal biases, I had to write
all my preunderstanding and preknowledge down in a personal journal and reflect on them. I
continued to reflect on my biases until all my views have all been addressed (Krishner,
Pozzoboni, & Jones, 2011).
11
Topical Assumptions
I assumed that individuals who use alcohol or drugs have suffered disintegration of mind
and body due to their alcohol or drug use. Furthermore, I assumed that participants in this study
had faced discrimination from family members and friends due to their alcohol or drug use. I
also assumed that participants placed their faith in a higher power to get sober. I assumed that
participants would answer the research questions honestly.
Limitations
This study was not without limitations. The first limitation is that I have no personal
experience of alcohol or drug use, which may have hindered my conceptualization of the study.
To overcome this barrier, I depended on reading literature about alcohol or drug use, taking
courses on addiction, and gaining work experience in the addiction field.
The second limitation of this study is that I had no prior experience conducting
qualitative research. However, I addressed this limitation by working with a mentor and doctoral
dissertation committee who were experts in qualitative research methodology.
Organization of the Remainder of the Study
Chapter 1 introduced the background of this study and the motivation for it. It also
introduced the study’s research question, design, defined the terms used, and addressed
assumptions and limitations of the study. Chapter 2 is a review of the literature on spirituality
and alcohol or drug use recovery as it relates to the research question. Chapter 3 describes the
methodology was used in the study. Chapter 4 presents the results of the study. Chapter 5
discusses the implications and recommendations of the study.
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CHAPTER 2. LITERATURE REVIEW
This study investigated the experiences of spirituality among people who attend 12-step
programs. This focus was chosen because existing research suggested a connection between
spirituality and alcohol or drug use recovery, although that connection is not fully understood
(Hodge, 2011). In this chapter, I review the aspects of this connection have and have not been
studied. Knowing what has been studied opens up other areas for further study (Bourzac, 2014).
In addition, I also review the literature on the approaches used to gather information for the
study.
Methods of Searching
To identify relevant literature, I used key terms that included spirituality, 12-step
recovery, spirituality and recovery, and generic qualitative approaches. I searched the following
databases: PsycINFO, PsycARTICLES, ProQuest Psychology Journals, Academic Search
Premier, and PsycBOOKS. I also gathered information from the World Health Organization,
Substance Abuse Mental Health Service Administration (SAMHSA), National Institute of Drug
Abuse, American Psychological Association, American Psychiatric Association, United Nations
Office on Drugs and Crime, Centers for Disease Control and Prevention, and American Society
of Addiction Medicine.
This literature review includes current research on spirituality. The section that describes
the current research on spirituality focuses on the definition of spirituality and psychology’s
understanding of spirituality. Also described in this literature review are 12-step programs and
recovery. The section about 12-step programs focuses on a brief history of 12-step programs, the
status of the 12-step recovery movement, and research on 12-step recovery.
13
Theoretical Orientation for the Study
The theoretical orientation for this study is Jung’s theory of personality integration. I
chose Jung’s theory because this study is about the integration of mind and body in alcohol or
drug recovery. Jung had personal experience with the effects of alcohol due to his own drinking
problems, which gave him more experience in treating patients with alcohol or drug-related
problems (Jung, 1963). He described the effect of his alcoholism as having no inside or outside,
because both inside and outside are affected (Addenbrooke, 2015). Here, Jung was referring to
the mind and body aspects of a person.
Some researchers have used mind and body in place of physical and spiritual (Sauders et
al., 2014). When an individual suffers the disease of alcohol or drug-related problem, both the
mind and body aspects of the person are completely affected in a negative way (Addenbrooke,
2015). The mind and body are disconnected (DeRobertis, 2016). Jung believed that an individual
involved with an alcohol problem is in need of spiritual and physical integration in order to get a
sense of wholeness (Jung, 1963). Jung and other depth psychologists believed that humans can
attain fulfillment through personality integration by connecting both the mind and body aspects
of person (DeRobertis, 2016).
When Jung was a psychiatrist in Zürich some of his patients had alcohol or drug-related
problems and he discovered that relapsing was common among those patients. Through his own
experiences, he told his patients that the only way to attain sobriety was to seek spiritual
awakening (Jung, 1963). His thinking has helped millions of alcoholics worldwide to pursue
recovery through an integrated approach as well as contributing to the development of self-help
groups (Drobin, 2014).
14
Jung introduced the notions of archetypes and mythology. According to Jung (1964),
archetypes are the reflections of a persons’ role that includes mother figure, father, old, wise, and
clown or joker. All human beings can relate to the archetypes because they capture universal
aspects of humanity; for example, the mother figure archetype has caring and compassionate
qualities (Jung, 1964). Myths have to do with the human mind as well as the embodiment of
human reality as a whole (Adamski, 2011). Myths reflect the relationship between humans and
reality, including the experiences humans have and the circumstances of those experiences as
they happen (Blocian, 2015). Myths are not archetypes, but myths do help to develop archetypal
meaning through story creation (Jung, 1964).
The unconscious, which Jung mentioned as an archetype, is the root of all experiences
(Jung, 1964). He categorized the notion of the unconscious as psychological rather than
philosophical with a metaphysical meaning (Hergenhahn, 2009). The collective unconscious is
where human experiences are deposited (Blocian, 2015). These human experiences help in the
formation of human personality (Adamski, 2011). Humans respond to their environment by
connecting to these experiences (Jung, 1964)
According to Jung (1964), myth is indispensable in the functioning of the collective
unconscious and the collective unconscious is the most powerful aspect of human personality,
because all experiences inherited from ancestors are deposited in the unconscious. These
inherited experiences are what Jung referred to as archetypes (Jung, 1964). Archetypes provide
people with a foundation of emotional experiences (Adamski, 2011). Jung noted that the human
mind is not blank at birth because it comes with experiences inherited from previous generations
15
and these human experiences play a major role in human development from childhood to
adulthood (Jung, 1964).
Naifeh (1995) believed that spiritual recovery from alcohol or drug use occurs at Jung’s
archetypal level, because humans lose control of using alcohol or drugs as a result of addiction to
alcohol or drugs. Proponents of self-help groups have admitted to being powerless when it comes
to fighting the disease of alcohol in order for recovery to take place (Naifeh, 1995). Twelve-step
programs help the individual to confront the shadow or that inner darkness, give up that aspect of
human selfishness as a result of the ego, and settle with the real self. By going through the 12
steps, an individual takes responsibility for his or her shadow and makes reparations for the
damages done during the alcohol or drug use (Addenbrooke, 2015). The 12 steps lead individuals
to seek a higher power to overcome the confusion that clouded their minds during the alcohol or
drug use (Addenbrooke, 2015).
Review of the Literature
What is Spirituality?
Spirituality is very important in the lives of many people despite the inconclusive nature
of its meaning. Spirituality involves beliefs and the meaning of events that are of value in life.
Garssen, Visser, and Meezenbroek (2015) agreed that despite the importance of spirituality the
lives of people, it is difficult to define because spirituality as a concept is subjective. Individuals’
perceptions of spirituality and experiences differ. According to Kavar (2012), many mental
health professionals have approached the definition of spirituality based on their own
experiences. Individual approaches to the definition of spirituality have resulted in the lack of a
general definition of spirituality. Many professionals, in an attempt to define spirituality, use
16
spirituality and religiosity interchangeably, thereby making it difficult to arrive at a general
consensus of the definition of spirituality (Memaryan et al., 2016).
There has also been no general consensus about whether spirituality and religiosity
should be used separately or interchangeably, particularly in terms of recovery from alcohol or
drug use disorders. Some researchers have seen spirituality and religiosity as two constructs with
different meanings, others have seen the two as having only one possible meaning (Del Rio &
White, 2012). Some researchers have assumed that spirituality subsumes religiosity, while others
claimed that religiosity promotes spirituality (Del Rio & White, 2012). One common factor is
that the two terms have often been used interchangeably. However, it is important to understand
the differences between the two in order to understand 12-step recovery (Del Rio & White,
2012).
To understand the differences between spirituality and religiosity, it is important to look
at what the literature has said about the two concepts. Many psychologists have used spirituality
and religiosity interchangeably because the two concepts overlap (Kapuscinski & Masters,
2010). Spiritual and religious traits are related but distinct aspects of human functioning
(Kapuscinski & Masters, 2010). The common themes that have emerged from individual
definitions of both spirituality and religiosity are references to a higher power or what is sacred
(Kapuscinski & Masters, 2010). Although spirituality and religiosity are connected, differences
have also be seen between their definitions (Kapuscinski & Masters, 2010). Kapuscinski and
Masters (2010) viewed spirituality from the perspective of Aristotelian hylomorphism—matter
and form. In this interpretation, the form is that aspect of a person that sustains life and makes
existence possible. In other words the form is spiritual and gives human beings existence (Del
17
Rio & White, 2012). Matter represents out of something a thing is made of or referred as
material cause. In human beings, the body is the matter (Kapusciniski & Masters, 2010).
Thomistic scholars saw Aristotelian hylomorphism as connected to the nature of the human soul.
According to Thomistic scholars, the soul is spiritual and the body is not spiritual (Del Rio &
White, 2012). From the Aristotelian point of view, spirituality is what makes humans to be
humans and religion is the element that promotes spirituality (Kapusciniski & Masters, 2010).
Spirituality has been seen as a search for the higher power that promotes individual
psychological well-being (Kapuscinski & Masters, 2010). This search for Higher Power is a
connection with the supernatural that surpasses religious affiliation; a striving for relevance and
searching for the ultimate meaning of life, even among individuals who do not believe in God
(Kumar, 2015).
In a quantitative study of adolescents between the ages of 16 and 19 from different
educational institutions in Mangalore and Kasaragod in India, Kumar (2015) showed strong
support for the theory that spirituality promotes individual psychological well-being. The first
instrument used in the study consisted of the Ryff Scales of Psychological Well-Being developed
by Ryff (1989). This instrument measures self-independence. Self-independence here refers to
self-autonomy, the ability to resist social pressure (Kumar, 2015). The Ryff Scales of
Psychological Well-Being also measure environmental mastery. Environmental mastery here
refers to ability to control external activities (Kumar, 2015). In addition, the instrument measures
personal growth, ability to relate with others, purpose in life, and self-acceptance (Kumar, 2015).
The second instrument used for this study was the Spirituality Scale (SS) developed by Delaney
(2003). This instrument has 23 items with 3 dimensions. The third instrument used for this study
18
was the Prosocial Tendencies Measure-revised developed by Carlo and Randall (2002). This
instrument measures prosocial behaviors (Kumar, 2015).
The sample consisted of 49 boys and 71 girls (Kumar, 2015). The study measured
psychological well-being in relation to spirituality, as well as prosocial behaviors. The study
found a strong connection between psychological well-being and spirituality, while prosocial
behavior differed significantly because of social and psychological changes that happen at this
stage of life (Kumar, 2015). The major limitation of this study was that the participants tended to
relate spirituality with religiosity and this resulted in the participants responding in different
ways (Kumar, 2015). Further studies with larger samples are needed and may help to generalize
the findings.
Religiosity is different from spirituality by its definition. Religiosity has been defined as
institutions and cultural norms designed to pursue spirituality (Pargament, Mahoney, Exline,
Jones, & Shafranske, 2013). Religiosity focuses on particular religious beliefs and practices. A
study by Singh (2014) with a total sample of 150 respondents from different courses at Banaras
Hindu University Varanasi (78 men and 72 women) strongly supported the perspective that
religiosity involves religious activities such as prayer, fasting, using holy water, meditation, and
attending pilgrimages, unlike spirituality that deals with personal connectedness with
transcendence or the higher power (Kapuscinski & Masters, 2010). The students completed
questionnaires that measured Cognitive Emotion Regulation, Life Satisfaction Scale, Positive
and Negative Affect Scale, and Oxford Happiness Questionnaires (Singh, 2014). All
questionnaires were completed in front of the researcher after class.
19
The data analysis suggested that students with high religiosity did more religious
activities such as prayer, fasting, using holy water, and meditation, which were the practices and
beliefs of their particular religious sect) compared to students with less religiosity but who still
showed a connection to the transcendence or the higher power (Singh, 2014). According to Singh
(2014), showing a connection to the transcendent or the higher power is a sign that those with
less religiosity have spirituality. The limitation found in this study was that the participants were
recruited in one university. Future study may consider recruiting participants in different
universities to create diversity and reduce bias. The study also suggested that religiosity is
different from spirituality. In addition, measurement of spirituality and religiosity are not the
same.
Some researchers have claimed that religiosity can be measured with a behavioral
approach (like the frequency of church attendance) and an attitudinal approach (like expression
of personal feelings). A study by Lewis (2002) analyzed the data of Lewis, Lanigan, Joseph, and
de Fockert (1977) on church attendance using the Francis Scale (Francis & Stubbs, 1987) and the
Depression-Happiness Scale (McGreal & Joseph, 1993). The sample of the original Lewis et al.,
(1977) study consisted of 154 full-time undergraduate students (68 men and 86 women) at the
University of Ulster in Coleraine, Northern Ireland whose ages ranged from 17 to 39. The results
suggested that there was no connection between religiosity and happiness when religion was
measured in terms of the frequency of church attendance and happiness was measured through
the Depression-Happiness Scale (Lewis, 2002).
Lewis (2002) recommended additional studies on the measurement of religiosity. The
limitation for this study was that the data used for the study was the data collected in the past and
20
events may have changed within the time gap. Future study is recommended to use current data
instead of data collected in the past. The study supported the idea that religiosity can be
measured separately from spirituality (Lewis, 2002).
Singh (2014) found that behavioral and attitudinal approaches are reflected in intrinsic
and extrinsic religious orientations. An extrinsic religious orientation involves religious practices
that are externally visible, such as prayers, symbols, religious material, religious languages, and
costumes. Intrinsic religious orientation includes norms and codes of conduct. On the intrinsic
level, individuals have been shown to view religion as a means to an end (Singh, 2014).
Saha (2014) adopted two methods, a literature review and a workshop with 10 to 14
people to promote religious development. Saha provided strong support for the hypothesis that
behavioral and attitudinal approaches are reflected in intrinsic and extrinsic religious
orientations. Questionnaires were administered to 375 adolescents using Allport and Ross’s
(1967) Intrinsic and Extrinsic Religiosity Scales, Templer’s (1970) Death Anxiety Scale,
Osarchuk and Tatz’s (1973) After Life Scale, and the Satisfaction with Life Scale (Diener,
Emmons, Larsen, & Griffin, 1986). The participants were 134 Protestants and 149 Catholics.
Saha’s analysis suggested that extrinsic and intrinsic religious levels were associated with
different concepts. Intrinsic religion was associated with low levels of anxiety and stress,
freedom from guilt, social events becoming more appealing, and reduced depression. Saha found
that the participants viewed extrinsic religious orientation as a means to an end; that is, their
beliefs were motivated by external factors. Saha found that the participants’ beliefs that were
motivated by external factors were associated with prejudice, narcissism, guilt, fear of death, and
aggression.
21
The limitation of Saha (2014) was that one method used in the study was a literature
review. The disadvantage of any study that bases its findings on a literature review is that flaws
in the reviewed literature affect the outcome of the study. However, Saha supported the idea that
religiosity can be measured separately from spirituality.
Li and Chow (2015) have seen religiosity as based on community, beliefs, and rituals.
Religiosity can determine the way an individual behaves based on his or her beliefs. Individuals’
behaviors are connected with their devotion to a particular religion or beliefs. When individuals
follow certain religious doctrines, their behaviors are influenced by the teachings of that religion.
Participating in church services has also been shown to influence individuals’ rationales for
embarking on prosocial behaviors (Li & Chow, 2015).
The differences in these definitions show that spirituality and religiosity cannot be the
same constructs. Spirituality is a personal relationship between a person and transcendence, but
religion embraces beliefs, traditions, rituals, and meanings (Del Rio & White, 2012).
Piedmont, Ciarrochi, Dy-Liacco, and Williams (2009) performed a structural analysis
with college students from Midwestern State University (324 women and 143 men aged 16 to
75). Spirituality was measured with the Spiritual Transcendence Scale, which consists of 23
items that includes three subscales (Piedmont et al., 2009). Religiosity was measured with the
Religious Involvement Scale, which consists of 12 items that assess religiosity (Piedmont et al.,
2009). Analysis of the data by Piedmont et al. suggested that spirituality and religiosity are not
interchangeable constructs.
Despite the differences, Parhami, Davtian, Collard, Lopez and Fong (2014).
22
have suggested that the two concepts have no definite definitions that capture their complexities.
These researchers suggested that to be as inclusive as possible, it is safer to use
religiosity/spirituality (Parhami et al., 2014).
However, the belief that spirituality is a personal connectedness with the transcendent is
aligned with 12-step practices, such as those of AA. Witkiewitz, McCallion, and Kirouac (2016)
conducted a literature review to evaluate the efficacy of spirituality in alcohol or drug recovery.
Witkiewitz et al. looked at qualitative studies of programs that have used spirituality to provide
support to individuals suffering from alcohol use disorders. They discovered that spirituality was
cited in the research literature on alcohol recovery more than 70 years ago. Their findings
suggested that the AA mechanism promotes spiritual growth. According to Witkiewitz et al., AA
members attain sobriety through spiritual growth. They found that religiosity and religious
affiliation are not enough to produce recovery from alcohol use disorders, but spirituality is
sufficient to produce recovery. The limitation of this study was that the result based its findings
on literature review and did not conduct its own study.
Some researchers (e.g., Kelly, Stout, & Magill, 2009; Tonigan, Rynes, & McCrady,
2013) have claimed that AA’s focus on spiritual experiences help individuals to grow and change
their perceptions of reality, world view, and understandings. These researchers have claimed that
this spiritual growth is responsible for individuals’ abstinence from drugs or alcohol.
Psychology’s Understanding of Spirituality
In the past few decades, the lack of an adequate theory on spirituality has created a
significant challenge for the psychology’s understanding of spirituality. In 1916, Leuba
described spirituality as a concept not related to the supernatural, but rather related to higher
23
reaches of mental life, such as mental activities that are related to the good, the beautiful, and the
true (Helminiak, 2008). However, Leuba’s definition of spirituality did not go far enough
because it is restricted to mental activities that are related to the good (Helminiak, 2008).
Next came Frankl (1962), who focused his perception of spirituality on what he called
noetic. Frankl describes noetic as inner knowledge of the human mind and a center for the
human phenomenon that can be described as spirituality. Frankl used the term noology to refer to
a state of mind or mental character and claimed that understanding of noology is more
anthropological than theological. Frankl proposed dimensions like somatic, psychic, and noetic,
which his logotherapy adopted as biological and psychological approaches to spirituality.
Later, Helminiak (1987, 1996a, 1996b, 1998) devised a comprehensive theory that
separated and interrelated theology, spirituality, and psychology. His theory sees spirituality as a
human phenomenon independent of theology and psychology, yet it remains open to theology
and psychology. Helminiak (2001) stated that spirituality can be viewed as an aspect of
psychology, different from religion and theology.
McIntosh (2015) buttressed Helminiak’s development of scientific spirituality.
Helminiak’s spirituality centered on inherent self-transcendence and it is an open-ended question
about all reality (Helminiak, 2001). His spirituality left both religions and nontheists to
extrapolate what spirituality means and triggered many psychologists to question the nontheist
spiritual account of the experience of transcendence (Helminiak, 2001).
The questions coming from psychologists necessitated a broadening of spirituality
beyond theism (Helminiak, 2001). To accommodate nontheist accounts of spirituality, Helminiak
expanded his thoughts and concluded that spirituality could be built on the normative process of
24
the functioning of the human mind (Helminiak, 2008). This conclusion that spirituality could be
built on the functioning of the human mind addressed the psychologists’ worries (Helminiak,
2008).
Helminiak (2001) believed that within the human mind, there is a self-transcending
dimension called the spirit, which is the basis of spirituality. The spirit motivates one to become
the best one can be. Openness to this inner spirit can result in experiences of inner
enlightenment. Srivastava and Raghoo (2013) supported this theory when they stated that the
mind is the true self and inherently clean from all impurities.
Many people have been becoming conscious that spirituality is a very important aspect of
their lives (Shafranske, 2016). Psychologists have come to understand this growing trend of
awareness of spirituality (Shafranske, 2016). The American Psychological Association has
recognized the importance of spirituality and religiosity in people’s lives and has included
religion and spirituality in the category of cultural and individual diversities as prerequisite for
psychology graduate degree accreditation (American Psychological Association, 2000).
Following suit, many social sciences have incorporated spirituality and religiosity in their formal
training (Russell & Yarhouse, 2006). A survey by Russell and Yarhouse (2006) showed that 90%
of predoctoral internship programs accredited by the American Psychological Association
address spirituality and religiosity during their doctoral internship supervision and only 9% did
not discuss spirituality and religiosity.
The growing trend in studying spirituality in psychology has been based on the
understanding that spirituality is part of human beings just as bodies and mental capacities are
part of the individual (Russell & Yarhouse, 2006). This understanding has been extended to
25
modern research in genetics and neurology, which have affirmed that spirituality is a part of
human makeup (Kavar, 2012).
Spirituality and Recovery
Previous studies have found that spirituality boosts an individual’s recovery from alcohol
or drug use disorders. DeLucia et al. (2015) focused on groups with long-term NA members to
identify the key factors that facilitated recovery. DeLucia et al. suggested that spirituality boosts
an individual’s recovery from alcohol or drug use disorders. The participants in the study
identified the key concepts that were critical to their recovery, such as responsibility and spiritual
awakening. The participants noted that the 12-steps were essential in connecting to a higher
power, which gave them a deep understanding of their spirituality. The 21 participants also
described fellowship as an essential element of their spirituality that boosted their recovery. The
limitation of this study was that the participants were selected from among 12-step program
members who had the same perspective about recovery, and so the sample was not truly
representative of the wider population of 12-step members (DeLucia et al., 2015).
Similarly, Kaskutas et al. (2014) strongly supported the idea that spirituality is an
important element of alcohol or drug recovery. This study used an Internet survey. The
participants were recruited from outreach extensions, recovery houses, electronic media, and
self-help groups. To be eligible to participate in the study, individuals were required to have had
a problem with alcohol or drugs in the past which they no longer had. Kaskutas et al. reported
that participants identified spirituality as one of the four key elements that boosted their
recovery. The limitation with this study was lack of clear definition of recovery, and lack of
26
inclusion and exclusion criteria. Future studies should consider defining clearly what recovery is
and using inclusion and exclusion criteria in the selection of participants.
DeLucia et al. (2015) and Kaskutas et al. (2014) both suggested that spirituality can be
instrumental in individual`s recovery from alcohol or drug use disorders.
People describe recovery in different ways. SAMHSA (2012) described recovery as a
way of supporting an individual to reach a goal such as wellness or improved living. SAMHSA
defined recovery in terms of providing individuals in need with evidence-based treatment and
recovery support. SAMHSA extended its definition of recovery to all populations and also added
that some individuals in recovery from alcohol or drug use pursue recovery through spirituality.
Flanagan and Briggs (2016) also supported the idea that some individuals in recovery
from alcohol or drugs pursue their recovery through spirituality. Flanagan and Briggs added that
when individuals in recovery from alcohol or drugs pursue their recovery through spirituality,
many issues are addressed, such as healing the wounds from alcohol or drug use and developing
a healthy life that is meaningful. This suggested that recovery is a continuous journey. Sustaining
this journey requires motivation, peer support, and social support (Flanagan & Briggs, 2016).
Timpson, Eckley, Sumnall, Pendlebury, and Hay (2016) reported that feelings of
acceptance and living responsibly are characteristics of recovery. Timpson et al. utilized a
qualitative interview with 32 participants drawn from six U.K. recovery communities and
discovered that recovery is not centered on the individual alone but extended to a wider
community and peer support. The findings of Timpson et al. suggested that the meaning of
recovery differed between those who are based in the community and those who are not. All had
27
consistent views about their own recovery and the individual benefits one can get from recovery,
and there was a general consensus that recovery is a continuous journey (Timpson et al., 2016).
The limitation of Timpson et al. (2016) study was that the discourse used did not fit the
recovery capital model that was used by participants. This is because participants described from
their individual perspective their understanding of recovery and benefits gained from recovery
(Timpson et al., 2016). To be able to measure and quantify recovery outcomes, participants need
to identify with the measures.
Ness, Borg, and Davidson (2014) conducted a small-scale review of the literature to
demonstrate that motivation is necessary for recovery because of the negative consequences
associated with alcohol or drug use disorders. They noted that some people with alcohol or drug
use disorders have experienced job loss, relationship problems, an inability to cope with daily
activities, and hospitalizations. Ness et al. found that peer support was important because it helps
the individual to overcome loneliness, have better understanding, feel loved and accepted, and
have supportive rather than condemnatory people around them. The authors noted that
individuals who use spirituality to recover from alcohol or drugs are in a better position to be
motivated and have a better family and peer support.
One of the limitations of Ness et al. (2014) was that the limited number of sources
included in the study may have affected the study’s internal and external validity. In addition, a
literature review relies on secondary data, and the original researchers may have omitted some
relevant topics pertaining to the authors’ research question.
Himelstein, Saul, and Garcia-Romeu (2015) stated that individuals utilize spirituality in
their recovery irrespective of their religious affiliation. The authors found that elements of
28
spirituality that individuals utilize in recovery included mindful meditation and prayer. Mindful
meditation has been widely studied and is credited as effective in the treatment of substance use
disorders (Himelstein et al., 2015).
Himelstein et al.’s (2015) study included a randomized controlled trial of 8 to 12 weeks.
Participants were given individual and group therapy. Participants who were placed in the
experimental group received formal mindfulness training and psychotherapy. According to
Himelstein et al., the mindfulness group reported an increase in self-esteem and a decrease in
relapses.
Bowen et al. (2014) evaluated the long-term efficacy of mindful spirituality in terms of
relapsing back into alcohol or drug use. This study was conducted between October 2009 and
July 2012 with a total of 286 eligible prospective participants who had successfully completed
the initial treatment for substance use disorders at any treatment facility. The prospective
participants were monitored for 12 months and were cleared medically. The participants were
randomly assigned to one of three groups for 8 weeks. The groups were mindful-based relapse
prevention (MBRP), treatment as usual for substance use (TAU), and relapse prevention (RP).
Bowen et al. compared the three groups, and the participants assigned to MBRP and RP
exhibited significantly lower risks of relapse for substance use and heavy drinking at the 6-month
follow up. At the 12-month follow up, the MBRP group reported more reductions in substance
use and decreases in heavy drinking compared to the RP and TAU groups. Bowen et al. seemed
to support the claim of Himelstein et al. (2015) that mindfulness can be effective in both adult
and adolescent populations. The effectiveness of mindfulness in increasing self-esteem and
29
decreasing in relapses that has been shown indicates that spirituality can play a vital role in
people`s recovery from alcohol or drug use irrespective of religious affiliation.
Spirituality may also play a major role in the holistic development of an individual
(Mueller, Plevak, & Rumans, 2001). Social sciences have adopted a positive approach in using
spirituality to address individual social problems, including substance use problems (Mueller et
al., 2001). Liliya and Deepali (2014) suggested that people who consider themselves as spiritual
usually experience more satisfaction and greater achievement in life than those who consider
themselves as non-spiritual. Liliya and Deepali claimed that people who consider themselves as
spiritual make use of their spiritual beliefs to cope better in life than those who consider
themselves as non-spiritual. Meanwhile, Mueller et al. (2001) claimed that spirituality can help
someone choose a better lifestyle by reducing alcohol or drug use and other addictive behaviors,
and Cotton et al. (2012) found that people with spirituality have more self-esteem, a stronger
self-identity, better psychosocial adjustment, and better establishment of interpersonal
relationships. These are all important elements in alcohol or drug use recovery (Cotton et al.,
2012).
Positive association is linked to spirituality and recovery. Positive association here means
individual well-being (Rye et al., 2013). Rye et al. (2013) supported the idea that people who
have spirituality and are in recovery are more likely to show positive association than individuals
who are in recovery without spirituality. Falb and Pargament (2014) used a survey to assess daily
experiences, including the level of individual alcohol or drug use, in relation to individuals’
connection with a higher power. The survey was completed by 3,966 participants and latent class
analysis (LCA) was used to determine the level of personal spirituality among the subgroups.
30
The result suggested that personal spirituality contributes to individual’s well-being and general
functioning (Falb & Pargament, 2014). The limitation of Falb and Pargament was that
individuals responding to a survey may not be sincere with the answers and as a result the survey
may not yield accurate results.
Harrington (2016) affirmed that when an individual’s well-being declines, spirituality
becomes a very important part of increasing the individual’s well-being. Such a decline can
cause an individual’s disconnection from reality (Harrington, 2016). According to Harrington,
for some individuals who are disconnected from reality, spirituality can help them to reconnect.
Cowlishaw, Niele, Teshuva, Browing, and Kendig (2013) noted that individuals who use
spirituality in recovery have positive life satisfaction, including self-esteem. Lee, Besthorn,
Bolin, and Jun (2012), in a study of 316 older adults in assisted living, found support for the link
between spirituality and positive life satisfaction. Their results showed that high stress was
associated with high levels of depression and low life satisfaction, and that spirituality and social
support were associated with low levels of depression and high levels of life satisfaction. The
limitation of this article was that the study used a purposive sampling method to recruit
participants, making it difficult to generalize the findings of the study (Lee et al., 2012). A future
study should use probability sampling to obtain a generalized finding.
Spirituality has been associated with forgiveness, gratitude, and empathy, especially
among individuals who use alcohol or drugs. Hardy et al. (2014) recruited 139 individuals aged
18–69 from four U.S. universities and asked them multiple questions about religious and
spiritual experiences. The survey was conducted via a website on a daily basis for 50 days, with
each day’s questions relating to the participants experiences that day, and measuring spiritual
31
experiences including empathy, gratitude, and forgiveness. In their analysis of the data, Hardy et
al. suggested that on the days when participants had more spiritual experiences, the participants
felt strong moral emotions like empathy, gratitude, and forgiveness. The limitations of the study
included the inability to measure moral behavior directly. The study measured only self-reported
moral emotions. Future studies are needed to measure actual moral behavior to clarify the
linkages that exist between spirituality, religiosity, and morality (Hardy et al, 2014). Despite
their study’s limitation, Hardy et al. indicated that individuals with spirituality are more likely to
show empathy, gratitude, and forgiveness than individuals without spirituality.
Easvaradoss and Rajan (2013) found that spirituality contributed to psychological well-
being of people who suffer from the diseases of alcohol or drug use disorders and other mental
health problems, as well as helping them to find meaning in their lives. Individuals with
substance use disorders and other mental health problems have used spirituality to discover the
essence of their existence. Easvaradoss and Rajan (2013) discussed the influence of positive
psychology on the general well-being of individuals and supported the idea that spirituality
improves the lives of individuals who suffer from alcohol or drug use disorders. Positive
psychology here means virtues that promote well-being (Easvaradoss & Rajan, 2013).
Easvaradoss and Rajan observed that spirituality is universal in nature, but that spiritual beliefs
differ and each culture has different beliefs regarding the supernatural, sacred, and divine nature.
Easvaradoss and Rajan described spirituality as a concept that does not come from material
reality (Faivre & Needleman, 1992).
Individuals recovering from alcohol or drugs use have used spirituality to discover the
essence of their being and to discover the meaning of their existence (Faivre & Needleman,
32
1992). Spirituality has helped individuals with alcohol or drug use disorders to seek a positive
sense of well-being, meaning, belonging, and purpose of their being (Easvaradoss & Rajan,
2013). The limitation of Easvaradoss and Rajan (2013) is that its findings are based on the
previous research. There is need to conduct further research instead of depending on the view of
past research. Easvaradoss and Rajan did claim that positive psychology is an old idea presented
in a new form and that it is one sided. Despite criticism of positive psychology, Gilbert (2008)
concluded that recognizing one’s spirituality is the most important aspect of care and recovery.
Gilbert (2008) claimed that, due to the role spirituality plays in recovery, there is a need for
mental health professionals to assess spiritual resources and links, both in hospitals and
communities, for individuals in recovery. This is because spirituality plays an important role in
reshaping individuals’ psychological well-being even when faced with stressful situations
(Gilbert, 2008).
Behaviors that promote spirituality are also more likely to promote feelings of peace,
hope, and inner discovery as well as the personal quest to connect to a higher power (Jankoswki
& Sandage, 2011). Jankoswki and Sandage (2011) recruited 211 master’s degree students from
Christian affiliated universities to participate in their study. Participants answered a self-report
survey of 15 items that measured four types of personal prayer: meditation, colloquial, ritual, and
petitionary, as well as adult attachment, hope, and the disposition to forgive. Jankoswki and
Sandage reported strong support for the idea that behaviors that promote spirituality promote
feelings of peace and hope and a search for transcendence. A limitation to Jankoswki and
Sandage’s study was that the participants were from one ethnicity and one Christian university.
Research from more diverse ethnic cultures is needed. Many religious cultures regard
33
forgiveness as a virtue, so a specific traditional study on forgiveness is needed. Despite the
limitations of their study, Jankoswki and Sandage showed that individuals who seek spirituality
are more likely to pursue peace, hope, love, and inner discovery.
Some researchers who have disavowed the link between spirituality and alcohol or drug
recovery instead have diagnosed spirituality as pathological (Pargament & Mahoney, 2002). This
disconnection between spirituality and recovery may be attributed to the difficulties associated
with studying phenomena that are subjective and hard to comprehend, such as spirituality
(Easvaradoss & Rajan, 2013).
A qualitative study conducted by Memaryan et al. (2016) provided support for the use of
spirituality in the treatment of alcohol or drug addiction. Memaryan et al. used purposive
sampling to select participants. They conducted semistructured face-to-face interviews with 17
Muslim participants (12 male, 5 female), with no other person in the room. The instrument used
to collect the data was the Consolidated criteria for Reporting Qualitative research (COREQ) 32-
item checklist. The interviews were audio recorded, transcribed, and analyzed. The findings of
Memaryan et al. suggested a lack of consensus on the concept of spirituality in the health care
sector and the authors suggested that it should not be used in the development of alcohol or drug
recovery programs (Memaryan et al., 2016). One of the limitations of the study is that the
Persian and Arabic resources consulted did not have English translations. In addition, studies
written in Persian and Arabic were not examined due to their unavailability in databases and lack
of English translation. Another limitation is that all the participants were Muslim; thus, the
results may not hold true for people from other religions (Memaryan et al., 2016). Future studies
are recommended so that the findings of the study can be generalized to people from other
34
religions. In addition, future studies should have larger samples that include people from other
religions.
Heinz et al. (2010) found that little is known about how spirituality could be used in the
formal treatment of alcohol or drug addiction due to the sensitivity of individual differences.
They used focus groups to conduct their study of 25 patients aged 20-53 in an outpatient
methadone-maintenance program in Baltimore, Maryland. The purpose of the study was to
examine the appropriateness of spirituality in alcohol or drug treatment.
The first instrument used by Heinz et al. (2010) was the Religion Problem Solving Scale
(RPSS; Pargament et al., 1988), which identifies how individuals use God in resolving their
problems. The second instrument was the Religious Background and Behavior Questionnaire
(RBBQ; Connors, Tonigan, & Miller, 1996). The RBBQ was used to measure religious
behaviors. The third instrument was the God Perception Questionnaire (GPQ; McGovern, 2003),
which was used to assess the perception of God as good or bad. The RPSS, RBBQ, and GPQ
were administered at the focus group sessions. Each focus group lasted approximately one hour.
Notes were taken and sessions were audiotaped. According to Heinz et al., many participants
reported that their alcohol or drug use created a hollow feeling in their inner experiences of
spirituality and coexisted awkwardly with their outer observance of spirituality. A major
limitation of this study was that it did not explore the cultural differences of the participants.
Future studies may consider taking into account the participants’ cultural differences. In addition,
the participants may have known each other, and their social responses may have created bias.
Heinz et al. recommended that future studies consider selecting participants from different
geographical zones.
35
A Brief History of 12-Step Recovery
The 12-step recovery movement emerged as individuals in recovery began to look
beyond traditional addiction treatments (Society for Community Research and Action, 2013).
Individuals in recovery wanted to sustain long-term recovery from alcohol or drug use to avoid
relapse and maintain sobriety and abstinence (Society for Community Research and Action,
2013). A 12-step recovery program leads members to surrender to a higher power. Surrendering
to a higher power means admitting to being powerless and not fighting alone (Knack, 2013).
Following a 12-step recovery program requires asking for help and following directions (Knack,
2013).
Twelve-step recovery was highly influenced by Carl Jung and William James, who had
similar backgrounds and shared similar interests (Jung, 1964). Both of their families were
religiously oriented (Jung, 1964). Jung and James believed that faith is very strong and can bring
healing (Bluhm, 2006). As a psychiatrist in Zürich, Jung told Rowland H. that the only way to
remain sober was to gain spiritual awakening (Bluhm, 2006). Rowland passed this message on to
Bill W. and Bob (Bluhm, 2006). Bill and Bob had problems with alcohol and both had exhausted
the treatment available at that time but continued to relapse (Drobin, 2014). Bill and Bob started
meeting on a regular basis and supporting one another (Drobin, 2014). Both understood the
shame felt by most alcoholics and the degree of fear many alcoholics have of public exposure
(Drobin, 2014). There was a high risk of social stigmatization among alcoholics, and to protect
their members’ interests, Bill and Bob insisted on strong confidentiality among members
(Drobin, 2014). Anonymity became one of the strongest features of AA (Drobin, 2014). Bill and
36
Bob achieved sobriety and the two started helping other alcoholic individuals using the 12-step
traditions. Here are the 12 steps:
1. We admitted we were powerless over alcohol—that our lives had become
unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we
understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our
wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to
them all.
9. Made direct amends to such people wherever possible, except when to do so would
injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as
we understood Him, praying only for knowledge of His will for us and the power to
carry that out.
37
12. Having had a spiritual awakening as the result of these steps, we tried to carry this
message to alcoholics, and to practice these principles in all our affairs (AA, 2001, p,
59).
In the 12-steps tradition, Steps 1, 2, and 3, connect the individual to a spiritual foundation
and Steps 4 to 12 are referred to as action steps (Drobin, 2014). In the first three steps,
individuals in recovery experience peace and tranquility (Spencer, 2014). The experience of
peace and tranquility is a consolation that helps them continue on the path of spirituality (Drobin,
2014).
Steps 4 to 9 manifest the purgative phase of a 12-step program (Drobin, 2014). The
purgative phase is very taxing. Recovering individuals see this phase as worrisome because
falling away from spiritual reality can trigger a relapse (Spencer, 2014). Relapsing due to doubts
about the individuals’ beliefs can cause bigger problems (Drobin, 2014). Recovering individuals
lose their consolation and peace during the phase of purgation. This phase is characterized by the
feeling that God is absent (Spencer, 2014). Many recovering individuals wonder about God’s
existence. In addition, misdiagnosis can happen at this phase. Mental health professionals may
misdiagnose the symptoms of this depressive mood as clinical depression (Drobin, 2014).
The purgative phase leads recovering individuals to the illuminative phase (Steps 10 and
11). In the illuminative phase, individuals experience less anger and anxiety (Dorbin, 2014).
Spencer (2014) described the illuminative phase as one of spiritual growth. Recovering
individuals begin to discover their true selves and find themselves doing well and living
authentically. The illuminative phase leads recovering individuals to the way of union (Spencer,
2014). The union phase is Step 12. The union phase represents the spiritual culmination of the
38
recovering individual. Recovering individuals experience feelings of closeness to God. The
experience of the union phase is ineffable (Drobin, 2014).
The Current Status of the 12-Step Recovery Movement
The 12-step recovery movement that started in the mid-1930s provided a spiritual
gateway to individuals struggling with alcohol or drugs. The movement is less than 100 years
old, but approximately two million people worldwide call themselves members (Alcoholic
Anonymous, 2016). The 12-step recovery movement utilized the traditional four paths to God:
understanding, devotion, service, and meditation (Hart & Ksir, 2013). These four paths have
appeared to be valid to 12-step participants regardless of religious affiliation. Because no specific
religious affiliation has formed the foundation of 12-step recovery, most mental health
professionals have integrated 12-step recovery with other evidence-based approaches to create a
method for individuals in recovery to incorporate spirituality in their recovery journey (Sandoz,
2014). Twelve step programs have remained relevant because many clinicians and recovering
individuals have continued to utilize 12-step program traditions in the treatment and pursuit of
recovery (Kart & Ksir, 2013).
In the past 20 years, 12-step organizations have gained entry to many treatment models
and become integrated with them. Many addiction treatment professionals have believed that
attaining abstinence requires constant support, and 12-step groups have provided that support
(Laudet, 2003). Meetings have been available and accessible to any person who wants to
participate in the 12-step program. Participation has been free (Laudet, 2003). Due to availability
and accessibility of meetings, clinicians have found it easy to make referrals for patients to attend
a 12-step program before and after other treatment (Laudet, 2003). According to the American
39
Psychiatric Association (1995), it is appropriate for clinicians to make referrals at any stage of
treatment, even when patients are still substance users. Recognizing the importance of 12-step
organizations in alcohol or drug recovery, many treatment organizations incorporated 12-step
programs into their model of treatment (Laudet, 2003).
Many addiction professionals have called for the inclusion of 12-step programs in
continuing education in the addiction field (American Psychiatric Association, 1995). This is
because the curriculum of continuing education in the addiction field centers more on
pharmacotherapies and pays less attention to psychosocial therapies (American Psychiatric
Association, 1995).
M. Miller (2015) called for psychosocial therapies to receive equal attention with
pharmacotherapies. Some addiction professionals have been concerned that biological
interventions are dominating the curriculum of addiction training both in graduate training and
internships (M. Miller, 2015). Some of these addiction professionals have called for the inclusion
of 12-step recovery programs in the curriculum (M. Miller, 2015). This is because 12-step
recovery has addressed the spiritual and psychological values of individuals that suffer from
alcohol or drug use disorders. Individuals attending 12-step program have discovered their
values and been able to connect with people around them (M. Miller, 2015). The federal
Substance Abuse and Mental Health Service Administration’s registry of evidence-based
programs and practices has included 12-step facilitation therapies and has promoted its use in
modern addiction treatment (M. Miller, 2015).
40
Research on 12-Step Recovery
There has been confusion in the literature when it comes to the description of 12-step
recovery. The literature has often treated self-help groups and 12-step programs interchangeably
(Freimuth, 2000). Freimuth (2000) strongly supported this confusion in the literature. Freimuth
differentiated self-help groups from addiction treatment programs based on 12-step principles
and stated that treatment programs based on 12-step principles are run by professionals in
inpatient and outpatient treatment facilities, whereas the self-help groups are run by members
who schedule meetings according to their needs. According to Freimuth, at the meetings,
members tell stories about their drinking history and how they stopped. The life stories of
members who attend 12-step programs appear to have the same outlook: Freimuth argued that
telling other members about one’s life story is therapeutic as well as a moral duty. A limitation
for Freimuth (2000) was that collaborative approach may not work best for everyone. This is
because individual problems differ and may not be addressed by collaborative approach. Future
studies may focus on how collaborative approach fits into individual needs.
Christensen and Elmeland (2015) strongly supported the claim that self-help groups
facilitate members’ recovery through sharing their stories. They used 42 qualitative semi-
structured interviews with individuals who were experienced heavy drinkers (31 self-changers
and 11 from AA). The 31 self-changers consisted of 9 women and 22 men; the AA group
consisted of 7 women and 4 men (Christensen & Elmeland, 2015). The study was conducted
from 2008 to 2011. The participants had not attended any alcohol or drug treatment programs in
inpatient or outpatient facilities. Interviews were conducted face to face and transcribed. Their
findings suggested that five of the self-changers drank sporadically, and one smoked cannabis
41
occasionally. No one in the AA group used alcohol or drugs any longer. The limitation of this
study was that the recruitment of participants was done through the media. Media recruitment
can lead to a certain bias (Christensen & Elmeland, 2015). In addition, volunteers may also have
hidden agenda. It is recommended that more studies be done using different approach in the
recruitment of participants that will yield less bias (Christensen & Elmeland, 2015).
Despite the confusion in the literature, Freimuth (2000) and Christensen and Elmeland
(2015) suggested that there is a difference between self-help groups and 12-step principles run by
professionals.
Twelve-step recovery promotes abstinence among people with substance use disorders.
Timko, Cronkite, McKellar, Zemore, and Moos (2013) conducted a study with 304 dually
diagnosed patients with mental health issues and substance use disorders who were outpatients of
the U.S. Department of Veterans Affairs (VA). Baseline information was taken along with
follow-up telephone calls at 6 months, 1 year, and 2 years. The baseline information included
self-report data, social anxiety symptoms, the utilization of mutual help groups (12-steps),
substance use, and psychiatric status. Social anxiety symptoms were measured using the Mini-
International Neuropsychiatric Interview Tracking Scale (Sheehan et al., 1998). Treatment and
participation in the mutual help groups were measured through self-reports. The Addiction
Severity Index (McLellan et al., 1992) was used to measure substance use and psychiatric status.
The follow ups were conducted through telephone calls. Timko et al. found that patients who
attended mutual support groups like AA and NA were more abstinent from substance use across
all follow-up calls than those who did not attend support groups. One limitation of the study by
Timko et al. was that all the patients were from the VA. The VA is federally funded and provides
42
superior treatment compared to the private sector (Timko et al., 2013). Another limitation was
that information about treatment utilization was not obtained from the individuals who attended
the mutual help groups; the authors recommend that this information be gathered in future
research.
Carrico et al. (2013) showed how 12-step recovery also helps participants to enjoy a high
level of social support and acceptance. Social support increases positive affect and can bring
about cognitive behavioral changes (Carrico et al., 2013). Carrico et al. examined how positive
affect can bring about a decrease in substance use. They studied 88 men who used
methamphetamine and had sex with men. Participants completed measures of positive and
negative affect, cognitive-behavioral change processes, social support, and individual self-reports
on substance use. Participants also provided urine samples for screening. Carrico’s results
suggested that positive affect is associated with specific social support, resulting in a decrease of
substance use. This study was limited in that it was cross-sectional and used a moderate sample
size. Further studies are needed with a larger sample size.
Twelve-step self-help groups are designed to help individuals with substance use
problems to reduce substance use. Many treatment centers encourage their clients to participate
in 12-step self-help programs during and after treatment because 12-step programs can lead to a
reduction in alcohol and drug use, especially when there is active involvement like having a
sponsor (Knack, 2013). Rynes and Tonigan (2012) studied how participation in 12-step programs
can help adults with alcohol and substance use disorders change. A total of 115 adults were
recruited from community AA groups and treatment facilities. The procedures for the study
included using breathalyzers to ensure that the participants’ blood alcohol concentration was not
43
higher than 0.05 prior to signing the consent forms. The participants completed 15 self-reported
questionnaires and provided urine samples for five drug screenings. Follow-up interviews were
conducted at 3, 6, and 9 months after intake. Rynes and Tonigan found that, having a sponsor in
a 12-step program increases participation and abstinence from alcohol or drug use. The limitation
was that the study measured sponsorship using different dichotomous variables, and so could not
identify the relationship between a sponsor and a client. Further research is needed on 12-step
recovery programs that captures the relationships between sponsors and clients.
Rynes and Tonigan’s (2012) results were supported by Kelly, Stout, Magill, Tonigan, and
Pagano (2011), who asserted that the primary task of a sponsor is to guide a new member to
attend meetings, read and walk through the 12 steps, pray, seek advice, and provide social
support for individuals’ abstinence and spiritual growth. Individuals with a high affiliation with
12-step recovery programs have been shown to be more likely to remain abstinent than those
with a low affiliation (Korcha, Polcin, & Bond, 2016). Individuals with a high affiliation with
12-step programs have been shown to be more likely to experience spiritual awakening and
change their behavior due to the message of hope and the lack of stigmatization from the 12-step
programs (Korcha et al., 2016). Individuals who have a low affiliation with a 12-step program
have been shown to be more likely to experience less spiritual awakening and more
stigmatization associated with alcohol or drug use outside of the 12-step program (Connor,
Haber, & Hall, 2016). The results of these studies indicated that participation in a 12-step
recovery program leads members to reduce substance use.
Twelve-step recovery programs are helpful in maintaining abstinence, especially when
their members do not have any other social support networks. Connor et al. (2016) conducted an
44
epidemiological survey and showed that half of patients with lifetime alcohol use disorders had
other mental health issues. Connor et al. recommended a general psychiatric evaluation in order
to meet the needs of these patients. They also recommended that patients need to be screened and
patients scoring 0-7 in the screening questions should be given basic alcohol education; patients
scoring 8-15 should be sensitized on how to reduce drinking; patients scoring 16-19 should be
given straightforward advice, brief counseling, and continued monitoring; and patients scoring
20-40 should be referred to an assessment specialist (Connor et al., 2016).
In terms of relapse prevention, Connor et al. (2016) found that a 12-step program was the
most widely used program for people with alcohol or drugs use problems. The limitation of this
study was that there are some medications that are yet to be approved to use for the treatment of
alcohol or drugs. It is recommended that more research into health services is needed to address
all forms of alcohol or drug use disorders (Connor et al., 2016).
Chen (2010) showed that 12-step recovery activities include physical, emotional, and
spiritual aspects. Chen conducted a study on physical, emotional, and spiritual transformation
with undergraduate students from the University of California, Berkeley, and found strong
support for the idea that that substance use can affect individuals physically, emotionally, and
spiritually. Chen had 63 participants answer a questionnaire about physical and emotional well-
being, and 84 participants answer a questionnaire about spiritual transformation. Chen found that
on the physical level, an individual gets addicted to substance use; on the emotional level, an
individual believes that substance use is a solution to problems; and on the spiritual level, an
individual experiences inner emptiness, which results in seeking external fulfillment with drugs.
The limitation in Chen’s study was that the focus was the 12-step program as a practical
45
approach to coping with stress associated with alcohol or drug use through spirituality. Twelve-
step programs have not worked for everybody (Laudet, 2003). Some participants attending 12-
step programs have considered the religious aspects of the program as an obstacle (Laudet,
2003).
Knack (2013) reviewed how the 12 steps can be integrated into psychotherapy and
suggested that the integration of the 12 steps into psychotherapy is possible. Knack reported that
psychotherapy and 12-step recovery have differences and similarities. The author provided three
ways by which 12-step recovery programs and psychotherapy can be integrated: (a) technical
eclecticism, where two or more different approaches are applied systematically; (b) relying on all
the common factors the two share together; and (c) theoretical integration, in which all the
differences are united (Knack, 2013). The limitation to this article was that 12-step program did
not work for everyone. Integrating psychotherapy and 12-step program could diminish the force
of treatment especially for those who believe that 12-step program is not working for them.
Despite the growth recorded by 12-step recovery programs in recent years, there are still
criticisms of the use of these programs in the treatment of alcohol or drug use disorders (Glaser,
2015). Some individuals think that 12-step recovery programs should not be used in the
treatment of alcohol or drugs. Glaser (2015) described how the program did not work for him
because he continued to relapse any time he got sober. He described AA as having unproven
efficacy. As a result of this unproven efficacy, there is no central uniformity in the program
(Glaser, 2015). Individuals who oppose using 12-step recovery programs in the treatment of
alcohol or drug use disorders have believed evidence-based treatment should be used instead
(O’Brien, 2015).
46
Glaser (2015) was supported by a study by O’Brien (2015). O’Brien measured the brain
activations of a group of alcohol and drug dependent patients using functional MRIs. The results
reported by O’Brien suggested that alcohol or drugs affect the circuits of the brain. If this is true
then treatment of alcohol or drug use disorders should focus on evidence that addresses the
changes in the brain circuits (O’Brien, 2015). The limitation of this study was that the focus was
only on the changes that occur in the brain, which overlooked the other physiological aspect of
addictions. It is recommended that future studies should focus on the physiological and
biological aspects of addictions.
Howland (2015) found that individuals who did not use a 12-step program in the
treatment of alcohol or drug use disorders rated 12-step programs as among the least effective
treatment methods. According to Howland, of 48 treatment methods that were rated, 12-step
programs were placed at 38th. This confirmed that not everybody accepted 12-step recovery
programs to be an effective way of addressing alcohol or drug use problems.
Synthesis of the Research Findings
Examination of the literature revealed the existence of polarization among researchers on
the use of spirituality in alcohol or drug use recovery. This polarization came about due to the
lack of a general consensus on the definition of spirituality. Some researchers have argued that it
is difficult to differentiate between spirituality and religiosity and that separating the two puts
restrictions on their meanings (Del Rio & White, 2012); these researchers have suggested that
the two terms should be used interchangeably. Other researchers have argued that spirituality and
religiosity are two different constructs and should never be used interchangeably; these
researchers have pointed out that differences can be seen in the definitions of the two constructs
(Kapusciniski & Masters, 2010).
47
Spirituality is different from religiosity by definition. Spirituality has often been seen as a
personal connectedness with a higher power (Kapuscinski & Masters, 2010). Connecting to a
higher power implies seeking something outside of the self (Kavar, 2015). Individuals have
pursued their spirituality through personal experiences. Religiosity has been to do with
institutions, rituals, and cultural norms. The focal point of religiosity has been on beliefs and
practices (Pargament et al., 2013). Individuals have pursued their religiosity through religious
affiliations and the practice of their religious teachings.
Aside from the differences in the definition of spirituality and religiosity, differences
were also seen in the way they have been measured by researchers. The measurements of the two
constructs are not the same, and different instruments are used. Religiosity has been measured
through behavioral and attitudinal approaches, but spirituality has been measured with the
Spiritual Transcendence Scale (Piedmont et al., 2009). These differences in the definitions and
measurements of spirituality and religiosity showed that the two constructs are not the same and
cannot be used interchangeably.
The literature suggested that spirituality has positive effects in alcohol or drug recovery
because, through spirituality, individuals with alcohol or drug problems gain deeper
understanding and acceptance of their problems (Nicholas & Hunt, 2011). Researchers who have
argued in favor of spirituality’s positive effect on alcohol or drug recovery have found evidence
that spirituality reduces alcohol or drug use and improves wellness (Dezutter et al., 2013; Hardy
et al., 2014). Researchers who have argued that spirituality is vital in alcohol or drug recovery
have found that people with alcohol or drug problems have used spirituality to find joy in their
daily activities (Wright & Stern, 2016).
48
Irrespective of religious affiliations, individuals recovering from alcohol or drug use
disorders have been able to utilize spirituality in their holistic development (Neff & MacMaster,
2005). The social sciences are very much aware of this individual holistic development and as a
result of this awareness, have adopted spirituality in addressing some social problems, including
substance use disorders (Cowlishaw et al., 2013). Individuals who have applied spirituality to
recover from their social problems have been shown to have more positive life satisfaction and
higher self-esteem than individuals without spirituality (Cowlishaw et al., 2013).
However, other researchers have cautioned against the use of spirituality in alcohol and
or drug use recovery because the relationship between spirituality and alcohol or drug use is very
complex and not as easy to apply as one may think (Hathaway, 2011). Researchers who have
subscribed to the complex nature of the link between spirituality and alcohol or drug use
disorders have suggested that spirituality can be punitive and judgmental toward people who
have alcohol or drug-related problems (Mohr et al., 2011). These researchers suggested that more
studies are needed before concluding that spirituality has a linkage between alcohol or drug
recovery.
The literature showed that spirituality is the foundation of the 12-step practices, providing
a connection between spirituality and 12-step programs (Witkiewitz et al., 2016). I presented
evidence that a majority of individuals attending 12-step programs connect to a higher power
through spiritual practices, have in-depth knowledge about spirituality in the recovery of alcohol
or drug-related problems, and are generally in a better position to address my study’s research
question.
49
Critique of Previous Research Methods
Many studies have supported a link between spirituality and alcohol or drug use recovery.
The studies that supported a link between spirituality and alcohol or drug use recovery reported
that spirituality reduced alcohol or drug use and helped individuals to remain abstinent (Good &
Willoughby, 2014; Hardy et al., 2014). The problem with some of the studies that supported the
connection between spirituality and alcohol or drug use recovery is that they did not differentiate
between spirituality and religiosity, thereby using the two terms interchangeably.
However, some studies have clarified spirituality and religiosity, suggesting that the two cannot
be used interchangeably because their definitions are not the same (Piedmont et al., 2009).
Despite the many studies that have supported the connection between spirituality and
alcohol or drug use recovery, other researchers have cautioned against using spirituality in the
treatment of alcohol or drug use disorders, such as Hathaway (2011). Researchers who supported
Hathaway’s view have suggested that it is not clear how spirituality is productive in the
treatment of alcohol or drug use disorders. Researchers who have opposed the use of spirituality
in the treatment of alcohol or drug use disorders have argued that the approach is unclear and
lacks scientific support (Hathaway, 2011). The argument of those who have not supported the
application of spirituality in the treatment of alcohol or drug use disorders has been based on the
poor understanding of the link between spirituality and alcohol or drug use (Hodge, 2011).
However, researchers who have claimed that spirituality improves psychological well-being have
found evidence for the link, advanced science, and opened up more areas for further research.
Summary
The literature review revealed many studies on spirituality, spirituality and recovery, and
12-step recovery. This revelation led to the discovery of the confusion associated with
50
spirituality and religiosity and why many psychologists have been using the two interchangeably.
Spirituality and religiosity are different constructs and the two cannot be combined because their
definitions are incompatible. The literature review also showed how psychologists understand
spirituality. The review identified studies that supported the connection between spirituality and
alcohol or drug use recovery, as well as studies that did not support this connection, and weighed
the evidence for and against the connection, settling in favor of the existence of the connection.
The review also described recent research on 12-step recovery. Lastly, the review identified
some ways that the psychological process of spirituality can help individuals recover from
alcohol or drug use disorders.
51
CHAPTER 3. METHODOLOGY
The literature review in Chapter 2 demonstrated the lack of consensus on whether
spirituality contributes to alcohol or drug recovery. To improve understanding of how people
attending 12-step programs for recovery from alcohol or drug use described their experiences of
spirituality, I adopted a generic qualitative research design. My aim in doing so was to explore
the link between spirituality and alcohol or drug recovery by letting the participants share their
experiences of spirituality related to recovery. I gathered data from participants, who had
experienced alcohol or drug use disorders and were attending 12-step programs. Interviews and
social interactions with the participants generated an understanding of how people attending 12-
step programs described their experiences of spirituality.
Purpose of the Study
Many health care providers are unsure how spirituality and alcohol or drug use recovery
are connected and consequently avoid the concept of spirituality in treatment (Hackney &
Sanders, 2003). The purpose of this study was to improve understanding of the connection
between spirituality and alcohol or drug use recovery. Such an understanding could help
researchers look critically at questions regarding how various aspects of spirituality, such as
theological beliefs, relate to alcohol or drug use recovery (Aldwin, Park, Jeong, & Nath, 2014).
Research Question
How do people attending 12-step programs for recovery from alcohol or drugs describe
their experiences of spirituality?
Research Design
Many factors contributed to the selection of a generic design for this study. This study
explored participants’ experiences of spirituality and alcohol or drug recovery, and the nature of
52
this study fit the generic research design. I used a generic design because other qualitative
approaches, such as ethnography, grounded theory, case studies, and phenomenology, did not fit
with this study. Ethnography investigates social groups, customs, beliefs, behaviors, practices
that deals with culture (Percy et al., 2015). Case studies investigate single cases using multiple
methods and different sources of data (Percy et al. 2015). Grounded theory explains existing
theory, and phenomenology investigates lived experience that deals with inner essence (Percy et
al. 2015). A generic research design can serve to investigate the participants’ experiences,
especially individual opinions, beliefs, and other subjective matters (Percy et al., 2015).
Percy et al. (2015) described generic research design as focused on gaining knowledge of
the outward, real world of experiences and reflections on the history of people’s lives. I chose a
generic design because he focused on the outward world experiences and reflections of the
participants to answer the research question.
Another reason for the choice of a generic design was the need to establish a link between
spirituality and alcohol or drug use recovery. The literature review revealed a lack of clarity on
whether such a link exists (Hackney & Sanders, 2003). Better understanding of participants’
experiences of spirituality while attending 12-step programs for alcohol or drug recovery,
obtained with a suitable exploratory research methodology, could clarify the existence of a link
between spirituality and alcohol or drug use recovery.
Generic qualitative research is intended to gain deeper understanding of the studied
phenomenon from the participants’ perspective as well as the meanings associated with their
experiences (Merriam, 2015). The distinctive feature of generic qualitative research is that the
key information emerges from the participants’ stories. Generic qualitative research captures
53
descriptions of the phenomenon studied through the participants’ stories and truth, and the
research problem (Lim, 2011). A researcher analyzes data and reports results in a systematic
manner.
The goal of using the generic qualitative research methodology in this study was to
capture individuals’ experiences of spirituality while attending 12-step programs and in recovery
from alcohol or drugs. A generic qualitative design was used to explore subjective opinions of
individuals attending 12-step programs for recovery from alcohol or drug use disorders. The
explanation of their experiences of spirituality could help researchers create a framework for
further research.
The aim of generic qualitative research is to understand the subject investigated from
individuals’ perspectives, so it focuses on individuals’ opinions, beliefs, attitudes, and
experiences (Percy et al., 2015). I tried as much as possible to eliminate all possible biases while
maintaining creativity through all the phases of data analysis (Creswell, 2013; Patton, 2002). To
do this, I reflected upon all possible biases and set them aside (Krishner et al., 2011). I
familiarized myself with the data collected from the participants by immersing myself in the data
from each individual (Percy et al., 2015). The data were analyzed by identifying patterns and
themes. The reoccurring themes were synthesized to understand how people attending 12-step
programs for alcohol or drug recovery described their experiences of spirituality.
Target Population and Sample
Population
The target population of this study were individuals attending 12-step meetings and in
recovery. Here, recovery described individuals who had remained sober and abstinent for at least
three years and were attending 12-step programs. Those attending these programs want to sustain
54
long-term recovery from addiction, avoid relapse, and maintain sobriety and abstinence (Society
for Community Research and Action, 2013).
Twelve-step programs lead members to surrender to a higher power, which means
admitting their own limitations and not attempting to proceed alone. To follow these programs
the individual must ask for help and follow directions (Knack, 2013). The participants in this
study were striving hard to maintain good relationships with family and friends, reintegrate into
their communities, and become productive members of society. Participants were drawn from an
AA group in Florida, where I had had no previous contact with the individuals. The inclusion
criteria for selecting participants were that they were 18 years and older, were attending a 12-step
program, had been in the program for 3 years, had completed the 12 steps at least one time with a
sponsor, had used alcohol or drugs in the past, had not relapsed for 3 years, were not receiving
any mental health treatment, had never been the researcher’s client, and considered themselves to
be spiritual people.
Sample
I utilized purposeful sampling to recruit the study participants. I screened the participants
with a set of screening questions. From the answers participants gave, I used my judgment to
select those who meet the inclusion criteria and thanked those who did not meet the inclusion
criteria for their willingness to participate in the study. This selection increased the credibility of
the study results. According to Patton (2002), selecting the participants with in-depth knowledge
of the phenomenon under study increases the credibility of the research. In qualitative
methodology, the findings could not be generalized to larger populations (Creswell, 2013) but
applied only to the specific population investigated. The sample size was 11 participants because
55
I reached data saturation, at which point no new theme emerged from the participants or the
information given by participants became redundant (Creswell, 2007). Members of the sample
were male and female, all 18 years or older, and from multiple ethnic backgrounds.
Procedures
Participant Selection
The study participants were selected as follows. First, after receiving Institutional Review
Board (IRB) approval, I visited meetings at two AA centers in Florida and brought a flyer. The
content of the flyer included my name, e-mail address, private phone number, and the criteria
participants had to meet in order to participate in the study. I had no previous contact with these
centers. When the speaker called for non-AA announcements, I raised my hand and read the
flyer. I left the flyer with the speaker.
Potential participants who responded to the announcement as contained in the flyer were
screened using the following screening tool:
1. Are you 18 years or older? Y/N
2. Are you attending a 12-step program? Y/N
3. Have you used alcohol and/or drugs in the past? Y/N
4. Have you been in a 12-step program for three years? Y/N
5. Have you completed 12-step program activities with your sponsor? Y/N
6. Have you relapsed in the past three years? Y/N
7. Are you being treated for any other mental health issues? Y/N
I explained to potential participants the purpose of the study and the voluntary nature of
participation. I notified them that they could leave the study at any time without any
56
consequences and that there was no financial cost to participate. Participants were informed that
the interviews would be conducted in a private study room at the public library.
I obtained the potential participants’ telephone numbers, e-mail addresses, and sent them
consent forms through e-mail or regular postal mail depending on their expressed preference. I
requested that the potential participants bring the consent forms to the interviews, along with any
questions that they had. Potential participants were also informed that the interviews would be
audiotaped and would last 1–2 hours. Before recruiting the participants, I obtained written
permission from the library manger to use the library rooms, following Creswell’s (2013)
guideline to seek permission to access a selected site.
Protection of Participants
The participants’ confidentiality was maintained by not using their names during data
collection and analysis. I redacted participants’ names so that even family members could not
identify them. Paper materials, tape recordings, and flash drives were locked in my personal
suitcase. All electronic materials were stored on my password-protected personal laptop to which
only I had access. Physical materials, such as the audio recordings, will be destroyed after seven
years. The paper materials will be shredded, and the tapes will be cut into pieces with scissors.
Data Collection
The procedure for data collection was face-to-face semi-structured interviews, commonly
used as a data source in qualitative research (Rihacek & Danelova, 2016). The face-to-face
interviews allowed the researcher to clarify any ambiguous issues and follow up on points when
necessary. According to Leedy and Ormrod (2013) semi-structured interviews help researcher to
make clarifications when face-to-face interviews are used in qualitative research.
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The interviews were audiotaped. The participants were given equal time of 1-2 hours to
talk about their experiences of spirituality. The six interview questions were open-ended and
nonjudgmental, as is appropriate for qualitative research (Creswell, 2013).
Before IRB approval, an expert in the field reviewed the interview questions, and the
interview questions were changed based on the expert’s feedback. All aspects of the interview
questions with potential to cause distress were modified. These questions allowed me the
flexibility to explore the study topic in depth while guiding the participants to discuss their
experiences of spirituality in recovery. In addition, the interview questions helped the
participants understand the problem I sought to solve.
After the interviews were conducted I transcribed the audio recordings and then started
data analysis.
Data Analysis
Data analysis was conducted according to the principles of generic qualitative research. I
followed the steps for analysis as described by Braun and Clarke (2006). I first familiarized
myself with all the individual data collected in the interview transcripts. Sentences connected to
the research question were highlighted.
I then reviewed the highlighted sentences and determined how relevant the highlighted
sentences were to the research question. All unrelated highlighted sentences were eliminated and
stored in a separate file. The remaining data were coded with serial numbers to keep track of
individual items. Related items were then clustered together to form patterns. I used my own
words to make these patterns meaningful. Yuknis (2014) stated that reoccurring themes in
qualitative methodology can be clustered together and the investigator should look for patterns.
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Next, I identified corresponding items that were specific to the patterns and used direct
quotes to elucidate those patterns. I clustered the patterns that looked similar and identified the
emerging themes. After analyzing all the data, the themes were arranged with supporting
patterns.
I then reanalyzed each participant’s data according to the themes and patterns. The
themes were synthesized together to form complete picture of the data regarding how people
who are attending 12-step programs describe their experiences of spirituality (Percy et al., 2015).
Instruments
The Role of the Researcher
In this study, I was the principal instrument, consistent with qualitative research
(Creswell, 2013; Patton, 2002). In addition, I used an Olympus Digital Voice Recorder to record
the interviews to help prevent losing or misinterpreting the information given by the participants.
I also took notes in his journal during the interviews to clarify what the participants said. As the
principal instrument in this study, I played an important role in determining its outcomes.
The credibility of the study depended on how well I played my role. In qualitative
studies, the credibility of the researcher contributes to the validity of the research (Creswell,
2007). In this study, my role included sample selection, data collection (conducting the
interviews), data analysis, and reporting of the results.
I ensured that the participants truly represented the population studied. I screened the
participants and selected only those who meet the inclusion criteria. Generally, to achieve good
results, I utilized the knowledge gained from courses, colloquia, and advice from my mentor.
Practices and knowledge acquired in courses increased my confidence to carry out this study.
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I was acutely aware of my strong family background on spirituality. I grew up believing
that with a deep connection to spirituality, nothing is impossible. I was also aware of the heavy
emphasis on spirituality in my educational background. To address these preconceptions, I made
them transparent by writing them down in my journal and reflecting on them until I felt that all
biases had been set aside (Krishner et al., 2011).
Furthermore, I reviewed the audiotapes and transcriptions to ensure accuracy. I went
through the recorded interviews to check if any area required further investigation. Because none
of the collected data needed clarification, and due to the vulnerability of the population, I did not
go back to the participants.
In the course of five years in my profession as a mental health and addiction counselor, I
have gained much experience, including familiarity with asking clients open-ended interview
questions. I took care that the research did not adhere to my previous knowledge regarding the
effect of spirituality in recovery, and I did not follow previous literature on spirituality while
collecting the data.
I maintained awareness of body language, follow up questions for clarifications, and
conversation timing to avoid impacting the outcome of the findings. I did not inhibit the
conversation of the participants, and I accepted the words of the participants without bias. I was
sensitive to the content provided by the participants and allowed participants to express
themselves without any interruption. I also used the participants’ words verbatim in the data
analysis thereby letting the participants guide the inquiry process, which enhanced the study’s
credibility (Patton, 2002).
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Guiding Interview Questions
The guiding interview questions were expected to answer the research question (“How do
people attending 12-step program for recovery from alcohol or drugs describe their experiences
of spirituality?”). The interview was semi-structured, and audiotaped. The duration of each
interview was 1 to 2 hours. The guiding interview questions were as follows:
1. How has your understanding of spirituality evolved while you have attended 12-step
meetings?
2. Can you tell me about specific times in your life you experienced spirituality?
3. How do you feel about yourself due to your awareness of spirituality since you started
attending 12-step meetings?
4. In what other areas do you feel that spirituality has helped you develop since you
started attending 12-step meetings?
5. How would you describe spirituality in your life today?
6. Is there anything related to spirituality I have not asked you about that you think is
important for me to know?
Ethical Considerations
I anticipated ethical challenges in this study, starting with recruitment of volunteers to
participate in the study. This ethical challenge was resolved by following Capella University’s
IRB process. The research topic and plan were submitted to the IRB for approval, and the IRB
screened them to ensure that the study would benefit humanity and that the research used no
unethical, misguided, or abusive behaviors (Morton, Proudfit, Calac, Portillo, & Lofton-
Fitzsimmons, 2013).
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The next ethical consideration addressed was informed consent. To ensure that the
participants confirmed their willingness, I gave them information about the study during the
screening process and allowed them to ask questions before signing the informed consent form.
The participants received information about the study’s purpose, benefits, and risks (Bhatt,
2015). Those selected for the study had the capability to decide for themselves whether to
continue to participate in the study and to understand that participation was purely voluntary.
Related to the ethical consideration of informed consent was the issue of confidentiality.
Protecting confidentiality made it possible to participate in the study without fear of disclosure of
personal identity (Adinoff, Conley, Taylor, & Chezem, 2013). The participants’ names were
redacted, and the information gathered from them was stored in a safe place. The audio
recordings were stored in my locked private suitcase, while electronic information was stored on
my private laptop protected by a password known only by me. In addition, the limits of
confidentiality were explained to the participants before they signed the informed consent form.
Throughout data collection, the relationship between the volunteers and myself remained
purely professional. Reporting of the study findings followed the guidelines for qualitative
research. All the findings and errors in the research and all the internal and external factors that
affected the study were reported (American Counseling Association, 2005).
Summary
A qualitative methodology was used to conduct this study, which was aimed at
understanding how people recovering from alcohol or drug use described their experiences of
spirituality. In the semi-structured interviews, open-ended questions allowed the researcher to
explore the participants’ understanding of their subjective experiences of spirituality and alcohol
or drug recovery. To strengthen the study’s credibility, I addressed my biases and made sure I set
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them all aside. The study involved human subjects, so ethical considerations from recruitment to
reporting the results were addressed. This study could contribute knowledge to the field of
psychology by improving understanding of the link between spirituality and alcohol or drug
recovery. The findings could help professionals in the substance-use field understand the role of
spirituality and give people recovering from alcohol or drug use a voice to share their
experiences of spirituality.
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CHAPTER 4. PRESENTATION OF THE DATA
The purpose of this study is to fill a gap in the literature about the link between
spirituality and alcohol or drug recovery, which is not fully known or well understood. I utilized
a generic qualitative approach, described in Chapter 3, to explore the spiritual experiences of
individuals who were attending a 12-step program and had deep knowledge of the role
spirituality played in their recovery.
Eleven members of the AA 12-step program were recruited from two AA centers in
Florida. In this chapter, I describe the study and the researcher, the sample, and the research
methodology as applied to the data analysis. I then present the data and an analysis of the results.
The Study and the Researcher
I was the principal instrument in this study, consonant with qualitative methodologies
(Creswell, 2007; Patton, 2002). I utilized my experiences as a therapist to help the participants to
feel relaxed and comfortable during the interview. The participants were able to share their
personal spiritual experiences, which resulted in rich data collection and in-depth knowledge
about the phenomenon under study. Throughout the period of this study, I was aware of my
biases and made them transparent by writing them down and reflecting on them. I used note
taking and memos during the interview.
Description of the Sample
Eleven volunteers who were currently attending a 12-step program participated in the
study. The volunteers were drawn from two AA meeting centers in Florida. They were screened
with a screening tool.
Through the screening, I identified the age of the volunteers, how long they had been in
the program, whether the volunteers had sponsors, and whether they had completed the 12-step
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activities with their sponsors. The volunteers were given consent forms by mail and instructed to
read the forms and bring them to the interview along with any questions they may have had.
Volunteers were told that the interview is going to be at the public library. The ages of the
volunteers ranged from 32 to 68 years old. The demographics of the participants are presented in
Table 1.
Table 1. Participants Demographic Information
Participants Gender Age Religion Employment
status
Ethnicity Years in
recovery
1 Female 60-70 Christian Full time White 20+years
2 Male 30-40 Christian Unemployed White 5 +years
3 Male 60-70 Christian Full time White 30+years
4 Male 50-60 Christian Full time White 5+years
5 Female 60-70 Nonreligious Full time White 30+years
6 Female 50-60 Christian Full time White 30+years
7 Female 50-60 Christian Full time Black 20+years
8 Female 50-60 Christian Unemployed White 30+years
9 Female 40-50 Christian Full time Black 15+years
10 Female 50-60 Christian Full time Black 20+years
11 Female 40-50 Christian Unemployed Black 15+years
Note. All participants were attending an Alcoholics Anonymous program.
Participant 1 had a college degree and is a mother. She had grown up in the community
and lived there her entire life. She defined spirituality as “that inner driving force that leads me to
pursue good.” Participant 2 had a high school diploma. Participant 3 also had a high school
diploma, a father and was self-employed.
Participant 4 had a high school diploma. He described spirituality as “having a friend in
my corner; someone who is ready to help me. It is like having someone to talk to all the time. It
is someone to rely upon when I’m feeling weak. I lean on him for strength.” Participant 5 is a
mother and had a graduate degree. She defined spirituality as “an energy that stays with me when
normal lifeness goes away” and said that normal lifeness goes away when daily activities are no
longer achieved due to alcohol or drug use. Participant 6 is a mother and had a bachelor’s degree.
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Participant 7 is a mother and had a high school diploma. She described spirituality as “a
pathway to a responsible life.” Participant 8 had not completed her high school education.
Participant 9 was a single mother.
Participant 10 is a mother. She had a high school diploma. She described her experience
with spirituality as “more of an inspirational development.” Participant 11 had a high school
diploma. She described spirituality by saying that “spirituality is a lifetime something, there is
never a time one can say that spirituality is enough.”
Research Methodology Applied to the Data Analysis
The methodology applied in this study for the data collection and analysis was a generic
qualitative approach. Braun & Clarke (2006) model thematic analysis was used during data
collection and analysis to address the research question. `
Eleven participants were recruited for the study and each met with me at the public
library for a face-to-face interview. All 11 participants met the inclusion criteria for the study.
After the interviews, I transcribed the audio recordings. To ensure accuracy, I went back
to the audio recordings and cross-checked them with the transcripts. Thematic analysis was used
to analyze the data. Throughout the data analysis process, I went through the data collected from
each participant, highlighting words, sentences, and phrases that were relevant to the research
question. I identified commonalities and dissimilarities from the data collected, highlights
emerged, which were considered as the initial codes. The common initial codes were clustered
together to form patterns. Similar patterns were clustered together to identify emerging themes.
Each theme was reviewed for accuracy and subsequently identified as the experiences of
spirituality of people attending 12-step program for recovery from alcohol or drugs use.
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Presentation of Data and Results of the Analysis
The underlying research question for this study was: How do people attending a 12-step
program for recovery from alcohol or drugs describe their experiences of spirituality? The data
collected from the 11 participants were organized separately. Thematic analysis was used for this
study, consonant with analyzing the qualitative data. Words, phrases, sentences, and quotes
relevant to the research question were extracted to form common patterns. Patterns were
combined and clustered to form themes. The themes were used to organize the information that
emerged from the individual participants and quotations from the individual participants were
used to support the themes.
The following are the themes that emerged based on the development of patterns from the
participants’ interviews: (a) feelings of peace and love, (b) better self-esteem, (c) feelings of joy
and happiness, (d) feeling the presence of a higher power, and (e) becoming less judgmental.
Theme 1: Feelings of Peace and Love
A feeling of peace and love was a theme that emerged from the participants’ responses.
All 11 participants responded that spirituality gave them peace of mind and a sense of love that
had eluded them because of alcohol or drug use. This theme was identified as the restoration of
physical, emotional, social, and psychological well-being among the participants. Through
feelings of peace and love, the participants believed that the love of a higher power and the love
of the people around them had impacted their lives and gave them peace of mind and body.
Participants 1, 2, 3, 4, 5, 6, and 11 reported that they had feelings of peace and love based on
their linkages with a higher power. Participants 6, 7, 8, 9, and 10 reported that they had feelings
of peace and love based on their well-being.
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Participant 1 reported that the “higher power is a correct and stronger sense of peace and
love. It carries no hangover. It works better.” Participant 1 further described the higher power as
“someone with unconditional love, who is ever-present and always there to hold my hand when
I’m crossing a bridge and shaking.” Participant 2 described his feelings of connecting to a higher
power: “It is like having a sense of peace, love, happiness, and unquantifiable joy within me.”
Participant 3 said, “That feeling of hopelessness, abandonment, and suicidal attempts
disappeared. There is inner peace, joy, and love within me.” Participant 4 shared that “all I can
tell you now is that my connection with God brought peace, love, and joy into my life.”
Participant 5 referred to her experience by saying, “To me, my experience of spirituality is that
sense of connectedness, oneness, compassion, and love.” Participant 5 further said that “the echo
gave me some sense of peace, some sense of acceptance, a sense of everything as it should.”
Participant 6 shared that “now my soul gets healthy when it connects to God. It helps me to live
in God’s way and practice in God’s way. That is when I have peace. God is the finite peace for
me. That is why I’m happy.” Participant 11 said, “I started feeling peace and love in my life. My
trust in the higher power increased.”
However, some participants based their feeling of peace and love based on their well-
being. Participant 6 said,
Waking up in the morning and not wanting to drink makes me experience peace in
nature. It is self-nurturing. That is how I feel peace. Nature is very peaceful. Mountains,
waters, etc. are calm. I need to calm the mind of alcohol. It is like a practice. I have really
enjoyed calmness, peace and love. I’m taking care of myself physically, eating well, and
spending time on meditation and working on disciplining myself in obedience.
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Participant 7 reported, “My life is filled with peace and love.” Participant 8 mentioned,
“Now, I cannot believe I have such a smile on my face. I can’t believe I would have the kind of
inner peace and love as I do now.” Participant 9 stated that “my spirituality has given me a sense
of peace and joy in my life.” Participant 10 reported, “I have more satisfaction, I have peace of
mind. I feel more comfortable talking to people. I feel more comfortable within myself.”
Participant 10 also said that “I enjoy absolute freedom and peace, and get love from my family
and friends.”
Theme 2: Better Self-Esteem
Better self-esteem emerged as a theme from the participants’ expressions of their feelings
about themselves while in the 12-step program for recovery from alcohol or drugs. Participants
1, 2, 3, 4, 6, 8, 9, 10, and 11 based their feelings of better self-esteem on loving their self. Prior to
attending the 12-step program, all participants reported feeling worthless, and having nothing to
contribute to the society. Participants 5, 6, 7, and 10 based their feelings of better self-esteem on
recognizing the value of the gifts God bestowed on them. Participants 6 and 10 based their
feelings of better self-esteem on both aspects (loving self and recognizing the gifts God bestowed
on them). Participant 1 described her feelings of better self-esteem this way:
I did not love myself when I was drinking, because alcohol disconnected me from the
realities of life. I was like an empty self. Getting sober reconnected me to the realities of
life. I started loving myself. By loving myself, it gave me a sense of better self-esteem; I
was able to love people around me.
Participant 2 reported:
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When I started coming to AA meetings, my life changed. I have a job; I take good care of
myself. I have a better life. I live a responsible life. I take care of my bills. I take care of
my family. . . . The way I treat myself is not the same. I love myself and treat myself
better.
Participant 3 stated, “My spirituality has helped me to have better self-esteem, peace, and
joy within me. I gave up selfishness and it made me to have confidence about myself.”
Participant 4 said, “Spirituality helped me to relax. It helps me to think positive about myself.”
Participant 6 described her feelings of better self-esteem as, “It is empowering. It is eccentric. I
got my crap together. It is a good feeling. When I have good feelings about myself, I develop a
better self-esteem.” Participant 9 shared, “Spirituality has made me become a more responsible
person than I was in the past. Spirituality gave me a better feeling about myself.” Participant 10
reported, “It gives me a better feeling and it gives me better self-esteem and makes me want to
go further and further. It makes me want to not go back to the slump.”
In addition, Participants 5, 6, 7, and 10 recognized the value of the gift of God in them.
Participant 5 described her feelings of better self-esteem as, “I can say I have more energy today
in my spiritual activities than in the past. My energy boosts the way I feel about myself. I feel
better and I thank God for the gift of this energy.” Participant 6 further described her feelings of
a better self-esteem as:
Self-esteem is feeling complete with what you’re doing. God gave me a sense of ability;
gave me the power to carry out my daily responsibilities. Carrying out daily
responsibilities has to do with self-esteem. I feel good about myself in a very realistic
humble way, not in an arrogant way. Self-esteem is a humble feeling.
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Participant 7 shared:
Well, I don’t feel as though I’m worthless. When I was drinking and using drugs, I
always felt stupid, fat, and ugly. I had different names for myself because I was not
having good feelings about myself. Sometimes call myself like tired and forgetful and
cranky. But I feel, I believe I have a true understanding that I am a child of God and that
God doesn’t create junk and I am worthy of not only His time for me and His source of
strength empowers me. I believe that my higher power actually died on the cross, was
brutalized and murdered—and He did that for me and so I put a lot of trust and faith in
that. And so my self-esteem is really solid these days.
Participant 10 described her feelings as:
When I got connected to a higher power, I started seeing things that I wanted to achieve
in life and I started making plans to achieve those things. It makes me better to know that
when I look at somebody who is an alcoholic, I see my picture in the past and knowing
that I’m different now. It gives me a better feeling and it gives me better self-esteem and
makes me want to go further and further. It makes me want to not go back to the slump.
Theme 3: Feelings of Joy and Happiness
A feeling of joy and happiness was another theme that emerged as the participants
described their feelings of well-being. This theme was identified as the participants’ inner and
outer feelings due to inspirations gotten from spirituality. An inner feeling of joy and happiness
existed internally within the person. An outer feeling of joy and happiness was expressed
externally by the person. Participants 1, 4, 5, 7, 8, 9, 10, and 11 based their feelings of joy and
happiness on positive changes that characterized their behaviors while in the 12-step program.
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Participants 2, 3, 4, 6, 7, and 8 based theirs on their involvement in doing good works.
Participants 4, 7, and 8 combined the two aspects (positive changes and involvement in doing
good works). Talking about positive changes, Participant 1 shared, “I was very motivated. My
happiness increased. My zeal to remain sober increased.” Participant 4 reported, “Today my life
has changed for good. This change just made me happier.” Participant 5 said, “Once I came back
to the normal world, it felt very beautiful. There is inner joy and happiness.” Participant 7 stated,
“Doing things in the right way and finding joy and satisfaction in the things I do is my
spirituality” and “I’m happy about the change spirituality has brought to my life.” Participant 8
shared, “My connection with my higher power and my spirituality has just changed and I don’t
have to worry about doing something wrong or hurting other people because I’m happy. I’m
living a happy, joyous life because of my spirituality.” Participant 9 reported, “My spirituality
has given me a sense of peace and joy in my life. I’m happier with my life today than in the
past.” Participant 10 described her feelings due to changes in her behavior:
It is like everlasting joy, joy that knows no boundaries. I don’t have to worry about
getting sick. I don’t have to worry about getting hangovers. I don’t have to worry about
getting into trouble with law enforcement agents. . . . My spirituality makes me healthier;
I am happy and live my life without any worry. I felt like I was carrying a heavy load and
the load was taken away from me. I’m out of trouble. It makes me happy and being
happy gives me that freedom. I don’t want to go back to the burden of alcohol in my life.
. . . Then it was a life of sadness, but now it is a life of joy and a life of finding meaning
in living. The two are not the same. I can say my spirituality has come a long way.
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Participant 11 reported, “After calling on him, I felt relieved. It is like the burden in my
heart was taken away. I experienced inner joy. I felt like the situation is under control. People
around me noticed that I was becoming more cheerful.” Participant 11 also said, “All I can tell
you is that staying connected to the higher power brings happiness.”
Some participants reported rediscovering their joy and happiness in their involvement in
doing good works. Participant 2 described his feelings about doing good works such as helping-
out to clean the meeting room after meetings as, “It is like having a sense of peace, love,
happiness, and unquantifiable joy within me.” Participant 3 shared, “My spirituality has helped
me to have good self-esteem, peace, and joy within me.” Participant 4 reported, “I used to be
very selfish, worried about money, trying to steal other people’s things; I’m not worried about
that any more. I go to work, make money to live well, and take responsibility for my family. That
makes me happy.” Participant 6 mentioned, “I’m comfortable right now. I’m happy today. I do a
gratitude list every night. I do self-inventory. Participant 7 said, “I’m a happy person today. I
have good friends and I’m happy with my friends and my friends are happy with me. I’m happy
with my family and my family is happy with me.” Participant 8 concluded, “When I got sober, I
felt happier and more fulfilled in life than when I was an alcoholic. Getting sober led me to do
more good things.”
Theme 4: Feelings of the Presence of a Higher Power
Feelings of the presence of a higher power emerged as a theme as participants discussed
the development of their spirituality in the 12-step program for recovery from alcohol or drugs.
The participants used “God” and “higher power” interchangeably. One participant used
“indefinable.”
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All participants expressed that getting involved in the 12-step activities led them to be
more involved in spiritual activities such as prayer, meditation, yoga, and retreats. Participation
in spiritual activities helped them feel the presence of the higher power in their lives. Some
participants reported that their feeling of the presence of the higher power came through positive
changes happening in their lives. On the other hand, some participants were able to feel the
presence of the higher power in their lives through making a connection with the higher power.
Participants 1, 2, 3, 4, 7, 8, 10, and 11 felt the presence of the higher power through
positive changes happening in their lives when they started attending the 12-step program.
Participants 2, 3, 4, 5, 6, 8, 9, and 10 felt the presence of the higher power in their lives by
making a connection with the higher power. Participants 2, 3, 4, 8, and 10 combined positive
changes and making a connection with the higher power. Participant 1 shared, “It is through
working the 12 steps and getting sober that I got the understanding that God is with me all the
time.” Participant 1 also said, “It is like being reassured that you know someone with a higher
power is constantly out there watching over you and guiding you. That is very comforting.”
Participant 2 described his feelings of the presence of the higher power as:
I started feeling his presence in all areas of my life. I feel like I have experienced a higher
power in AA. . . . When I had a problem in my former job I prayed, and the problem was
resolved. I believe that God is working in my life, I feel like my God is there directing me
on the things that I’m doing. I’m not doing anything by myself. It is like God is at my
side providing me all the powers that I need to do things.
Participant 3 reported, “When I started attending 12-step meetings that was the time I started
feeling the impact of spirituality. I started seeing God all around me.” Participant 4 stated, “God
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is good. Everything good comes from God. Whatever comes from God is spiritual.” Participant 7
said, “When I started attending 12-step meetings and experienced spiritual awakening, my higher
power took control of my life. My higher power brought me out from those mistakes. I was
cleansed.” Participant 8 described her feelings of the presence of a higher power as, “Every day I
pray to him and ask him to provide me with my daily bread and he does.” Participant 10 shared:
The higher power takes the craving for alcohol away. The higher power is inspirational.
He inspires me to do good things. He inspires me to stay sober. The higher power helps
me to be a better person and it makes me happy. He is my driving force. It is that higher
power that speaks to my mind that tells me that there is a better way.
Participant 11 described her feelings of the presence of a higher power in her life as:
When I have problems in my life, I call on the higher power. When I have challenges
about my family, I call on the higher power. When I get sick, I call on the higher power.
When I go to sleep, I call on the higher power for protection. In fact, I learned to put the
higher power first in my life.
Among the participants that identified their feelings of the presence of a higher power
through connection, Participant 2 reported, “I feel that it is my direct connection to a higher
power that led me to get sober.” Participant 3 mentioned, “It is when I started attending 12-step
meetings that I encountered spiritual awakening and became aware of the amount of power God
possesses over my life.” Participant 4 stated, “I rely on my connection with God. I know he loves
me and wants me to do well.” Participant 4 also added, “When I compare my life today and in
the past, I can tell you there is nothing like making a connection with God.” Participant 5
described her feelings of the presence of the indefinable as, “My connection to the indefinable
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made me feel that I’m not alone and also it enabled me to see myself in the sense that I’m unique
and insignificant.” Participant 5 further added:
My connection to the indefinable made me feel that I have to pass through this life and
that I’m not going to live in this life forever. My connection to this indefinable has made
me learn things that will help me to move on to whatever is next. My connection to the
indefinable has given me the sense not to take this world so seriously.
Participant 6 shared, “When I do yoga, I’m connected to the heavens and the universe. I always
say I’m grounded. When you’re grounded, you connect to God and the earth. That is really cool;
very cool for an alcoholic to connect to God and earth.” Participant 8 reported:
When I got connected with the higher power that was when I got sober from alcohol and
using drugs. Getting sober from alcohol and drugs ushered in the changes that occurred in
my life and I will forever be grateful for the changes that happened in my life.
Participant 9 said, “At this point, I understand that I needed the support of a higher power to deal
with my problem.” Participant 10 reported:
I said to myself, if they are connected to that power, I can be connected to that power and
that power can take me out of my junkedness. . . .when I got connected to a higher power,
I could think straight. It is like reasoning with a friend who is helping me to resolve
problems. By connecting to a higher power, there is that inner voice that tells me I need a
job. I need to do something better with my life. The voice tells me I can go back to
school. I can be anything I want to be. This is the push. This is what the higher power has
done to me since I got connected to him. He has brought the best out of me. He continues
to bring the best of me.
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Theme 5: Becoming Less Judgmental
Becoming less judgmental emerged as a theme as the participants described their
relationships with people around them. The participants reported improved relationships between
them and the people around them. The improvements were the results of their acceptance of
other people and by no longer criticizing or judging them. The participants identified becoming
less judgmental by acceptance of other people around them and having a better understanding of
the people around them.
Participants 1, 2, 4, 5, 6, 9, and 11 based their becoming less judgmental of the people
around them on developing the spirit of acceptance. Participants 2, 3, 7, 8, and 10 based their
becoming less judgmental on developing a better understanding of the people around them.
Participant 2 combined acceptance and a better understanding of the people around him to
identify his becoming less judgmental. On developing the spirit of acceptance, Participant 1
shared, “By loving myself, I was able to love the people around me and accept them the way
they are. I love them by not judging them.” Participant 2 mentioned, “I live a responsible life. I
have a job. I accept other people as they are. I don’t have to judge them or try to change them.”
Participant 4 described becoming less judgmental:
It has helped me to accept people in a way and not try to make people think my way. I
came to realize that He made people the way they are and not for me to change them. I
came to realize that I have to get along with them the way they are. This is the first thing
I learned at the 12-step meetings; not to judge other people, not to use derogatory
language with other people. To me, this is what makes people comfortable at 12-step
77
meetings, because other members are there to support one another and not to judge one
another.
Participant 5 reported, “Spirituality gave me humility to accept other people. At least I have to
accept that I can’t control other people.” Participant 6 stated, “Spirituality takes away selfishness,
and self-centeredness. I respect the other people around me. I don’t judge the people around me
as I used to do before.” Participant 9 shared, “I experienced spiritual transformation in every
other thing I do in life. The way I treat other people around me changed from bad to good. My
family responsibilities changed from bad to good.” Participant 11 described becoming less
judgmental as, “My life changed. I started liking the people around me. I stopped criticizing and
passing judgment on them.”
In addition to becoming less judgmental based on the acceptance of other people, some
participants based their becoming less judgmental on having a better understanding of the people
around them. Participant 2 said, “I learned at AA that I’m not perfect and nobody is perfect. I’m
not quick to judge or to point out someone’s fault as in blame. I learned that we are all human
and we are all vulnerable to mistakes.” Participant 3 reported, “My spirituality has helped me to
have more compassion and understanding of other people. I can feel other people’s struggles.”
Participant 7 stated, “My behavior completely changed. The way I treat the other people around
me changed.” Participant 8 shared, “I started being less judgmental about the people around me.
I started to understand that people make mistakes and no one is an angel. I started being a kind
and easygoing person.” Participant 10 concluded, “I also treat the people around me kindly. I
treat them with respect and dignity. I understand that people can make mistakes.”
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Summary
In this study, the information presented by the 11 participants addressed the research
question, “How do people attending a 12-step program for recovery from alcohol or drugs
describe their experiences of spirituality?” This study utilized 6 semi-structured interview
questions to address the research question. The participants were given the opportunity to share
their views on the 6 semi-structured interview questions. The transcripts of all participants were
reviewed thoroughly. From the responses given by the participants, patterns developed, and five
themes emerged from the analysis of the interviews. The participant’s quotations were used to
support the themes.
The results of the analysis uncovered the link that exist between spirituality and alcohol
or drug recovery. All the participants reported feelings of peace and love, better self-esteem,
feelings of joy and happiness, feeling the presence of a higher power in their lives, and becoming
less judgmental of the people around them. The participants reported these feelings and concepts
as things that had eluded them in the past due to alcohol or drug use. The participants described
their improved general well-being as a positive step toward living a meaningful life in society.
Chapter 5 will present a detailed discussion of the findings, implications, and recommendations.
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CHAPTER 5. DISCUSSION, IMPLICATIONS, RECOMMENDATIONS
In this chapter I discuss my findings and compare them to the current literature on
spirituality, recovery, and 12-step programs. I also discuss the limitations of the study,
recommendations for further research based on these limitations, and the conclusions reached.
Summary of the Results
The purpose and primary research question of this study was to understand how people
attending a 12-step program for recovery from alcohol or drugs described their experiences of
spirituality. Jung’s construct of personality integration and the archetypes provided theoretical
framework for this study (Jung, 1964).
A review of the existing literature made it clear that the link between spirituality and
recovery from alcohol or drugs is not well-known or fully understood (Hodge, 2011).
I used a generic qualitative design to gain information on how participants attending a 12-
step program for recovery from alcohol or drugs described their experiences of spirituality. The
method of data collection was open-ended, semi-structured face-to-face interviews. The
interviews were audiotaped and transcribed. Six interview questions helped to guide the
interviews and provide a collective answer to the research question.
I used thematic analysis to analyze the data collected from the 11 participants. After
reviewing the transcribed interviews, five prominent themes emerged: (a) feelings of peace and
love, (b) better self-esteem, (c) feelings of joy and happiness, (d) feeling the presence of a higher
power, and (e) becoming less judgmental. The participants’ experiences of spirituality during the
12-step program for recovery from alcohol or drugs are reflected in these five themes.
Participants’ experiences, as reflected in the themes, demonstrated the connection
between spirituality and recovery. The experiences described by participants suggest that
80
spirituality played a vital role in their recovery from alcohol or drugs. The result of this study
will go a long way to help addiction counselors and other field professionals to improve their
spiritual competency (Brown et al., 2013; Schafer et al., 2011). It is hoped that the result of this
study will help some of the millions of people who are suffering from alcohol or drug addiction
to live happier and healthier lives.
Discussion of the Results
This study reported how people who are attending a 12-step program for recovery from
alcohol or drugs describe their experiences of spirituality. The existing literature has called for
more research in order to understand the link that exists between spirituality and alcohol or drug
recovery (Hathaway, 2011). The information obtained from the 11 participants will help to fill
the gap in the research literature.
The five themes that emerged from the data analysis help address a gap in the literature
and contribute to growing the base of knowledge in psychology. The results of this study are in
line with the theoretical framework for this study and those of previous studies.
Conclusions Based on the Results
This study was meant to address the gap in the literature regarding spirituality and
alcohol or drug use recovery. The important findings in this study suggested that individuals
attending 12-step program for recovery from alcohol or drugs were able to rediscover their
spirituality lost as a result of alcohol or drug use. Through spirituality, individuals were able to
reintegrate their mind and body that had disintegrated as a result of alcohol or drug use.
Furthermore, through spirituality at the 12-step program, individuals were able to experience
improved emotional, psychological, and spiritual well-being.
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Prior research associated spirituality with reduced stress, anxiety, and depression;
becoming more appealing in the social domain; holistic development; increased feelings of
forgiveness, gratitude, and empathy; overcoming suicidal ideation; and overcoming feelings of
alienation. These concepts did not emerge as major themes in this study. The findings of this
study did not include these concepts even though they actually do overlap with the described
experiences of spirituality from individuals who are attending 12-step program for recovery from
alcohol or drugs.
Comparison of Findings with Theoretical Framework and Previous Literature
As previously discussed, some researchers have accepted the existence of a link between
spirituality and alcohol or drug recovery (Tuck & Anderson, 2014), while others have called for
more research to establish whether such a link exists (Hathaway, 2011). The reason more
research is needed is that this link is not well understood. The researchers that have accepted the
existence of such a link have based their claim on evidence that suggests that spirituality
contributes to reduced substance use and improves the psychological well-being of individuals in
recovery (Falb & Pargament, 2014; Rye et al., 2013). Prior research showed positive associations
between spirituality and reduced stress, anxiety, and depression; feelings of peace, love, joy, and
happiness; better self-esteem; becoming less judgmental; overcoming suicidal ideation;
connecting to a higher power; becoming more appealing socially; holistic development; feelings
of forgiveness, gratitude, and empathy; and overcoming feelings of alienation (Falb &
Pargament, 2014).
The findings of this study did not align with these earlier studies regarding reduced stress
and anxiety (Bennett & Shepherd, 2013; Gnanaprakash, 2013). None of the participants shared
an experience of reduced stress and anxiety. However, one of the participants discussed
82
encountering emotions, anxiety, and depression during the meetings while sober. The participant
attributed emotions, anxiety, and depression to withdrawal from using alcohol or drugs.
The finding of this study that spirituality can promote a feeling of peace and love support
the findings of Jankoswki and Sandage (2011). Drobin (2014) also found that through
spirituality, individuals in recovery from alcohol or drugs can experience an increased sense of
peace, love, and tranquility. Some of the participants in this study felt that they had a sense of
peace and love as a result of their connection to a higher power. Other participants felt that they
had a sense of peace and love because of their improved well-being. None of the participants
mentioned experiencing peace and love immediately upon attending the 12-step program.
Feelings of peace and love arose as the participants grew spiritually and made progress in the
program.
Many researchers have acknowledged that spirituality improves the self-esteem of
individuals who are in recovery from alcohol or drugs. Cotton et al. (2012), Cowlishaw et al.
(2013), and Lee et al. (2012) all claimed that people with spirituality seeking recovery from
alcohol or drug use show better self-esteem and stronger self-identity than those without
spirituality. All 11 participants in this study claimed improved self-esteem as a result of their
spirituality while they were in the 12-step program for recovery from alcohol or drugs. The
participants were able to improve their self-esteem based on increased love of self and
recognition of the gifts God had bestowed on them.
Becoming less judgmental was identified as a major theme, which supports Tuck and
Anderson (2014), who said that spirituality helps individuals in recovery from alcohol or drugs
adapt to a variety of tasks despite social disadvantages or the existence of negative conditions
83
like aggression, substance use, and emotional difficulties. Similarly, Ness et al. (2014) argued
that spirituality helps individuals in recovery who are attending a 12-step program become less
judgmental toward other members because acceptance rather than condemnation is an important
aspect of the recovery journey. All 11 participants in this study shared that they became less
judgmental of people around them due to improved relationships and a better understanding of
other people.
Reduced suicidal ideation did not emerge as a theme in this study. Only one participant
mentioned reduced hopelessness, abandonment, and suicidal ideation. L. Miller et al. (2012) and
Heisel and Flett (2004) reported that individual spirituality can reduce suicidal ideation, even
when faced with depression. Good and Willoughby (2014) found that individuals in recovery can
use spirituality to reduce suicidal ideation.
Wright and Stern (2016) and Liliya and Deepali (2014) found in their studies that
spirituality helps individuals in recovery from alcohol or drugs rediscover joy and happiness in
their daily activities, resulting in more life satisfaction and having greater achievements in life.
Feelings of joy and happiness emerged as a major theme in this study. All 11 participants
mentioned increased feelings of joy and happiness. Some of the participants identified their
feelings of joy and happiness through positive changes that occurred in their lives. Other
participants identified their feelings of joy and happiness through involvement in doing good
works.
DeLucia et al. (2015) described a connection to a higher power as an important tool that
provides individuals in recovery with a deep understanding of their spirituality. The authors
noted that connecting to a higher power helps individuals in recovery to be humble and become
84
more responsible. In addition, individuals in recovery are able to see who they are, accept that
there is a problem, and work on finding solutions to their problems. All 11 participants in the
current study described their connection with a higher power. Some participants used the terms
higher power and God interchangeably, while others used higher power to mean God. One
participant used the term indefinable.
The literature identified that individuals who use spirituality in their recovery from
alcohol or drugs are more appealing socially than those who do not (Stillman et al., 2011). The
findings of Littman-Ovadia and Steger (2010) supported the claim that spirituality helps
individuals in recovery from alcohol or drugs to be more appealing in the social domain and to
be more likely to experience improvement in the workplace.
Developing a healthy life that is meaningful as it relates to spirituality and recovery from
alcohol or drugs has been well researched. Flanagan and Briggs (2016) supported the idea that
spirituality can lead individuals in recovery to improve in many areas, including healing the
wounds from alcohol or drug use and developing a healthy life that is meaningful. Developing a
healthy life that is meaningful did not emerge as a major theme in this study. Only three
participants mentioned developing a healthy life. The three participants who specifically
mentioned this particular area referred to a good life as including taking care of themselves and
living responsibly.
Spirituality helps individuals in recovery from alcohol or drugs pursue holistic
development. This has led the social sciences to adopt spirituality in addressing social problems,
including alcohol or drug use (Mueller et al., 2001). Holistic development includes emotional,
physical, social, and spiritual potentials. Holistic development leads individuals to experience
85
more satisfaction and greater achievement in life (Liliya & Deepali, 2014). Holistic development
did not emerge as a major theme in this study. None of the 11 participants mentioned holistic
development. Participants 1, 4, 5, 7, 8, 9, 10, and 11 reported positive behavioral changes that
came about as a result of their spirituality while they attended the 12-step program. However,
these positive changes do not represent the holistic development of an individual.
Forgiveness, gratitude, and empathy are three kinds of moral emotion that boost an
individual’s recovery from alcohol or drugs. Forgiveness (Worthington, Berry, & Parrott, 2001),
empathy (Eisenberg, 2010), and gratitude (McCullough, Kilpatrick, Emmons, & Larson, 2001)
have been well researched and are all linked to spirituality and alcohol or drug recovery (Hardy
et al., 2014). Forgiveness, gratitude, and empathy did not emerge as a major theme in this study.
None of the 11 participants described forgiveness, gratitude, or empathy specifically. One
participant did use the word compassion, but never mentioned forgiveness or gratitude.
Bennett and Shepherd (2013) addressed the issue of how spirituality helps people in
recovery to overcome feelings of alienation. Their findings supported the claim that spirituality
provides individuals in recovery from alcohol or drugs with a high level of social support and
less alienation. Overcoming feelings of alienation did not emerge as a major theme in this study.
Only few participants described feelings of alienation. However, one participant mentioned
reduced feelings of alienation by having good relationships with family and friends.
Relationship of the Results to the 12-Step Program
Research on 12-step programs has been documented in the literature. A 12-step program
helps individuals in recovery to enjoy a high level of social support and acceptance, because
reduced stigmatization and total acceptance is part of the recovery process of individuals in 12-
86
step programs (Carrico et al., 2013). Individuals in 12-step programs want to be understood and
not judged. Connor et al. (2016) addressed the positive impact that a lack of stigmatization can
have on the behavioral changes of participants in 12-step programs. The findings of Carrico et al.
(2013) and Connor et al. (2016) are supported by the findings of this study regarding social
support in the 12-step program. All 11 participants reported enjoying a high level of social
support and acceptance and becoming less judgmental while attending the 12-step program.
Chen (2010) found that 12-step program recovery used a holistic approach in addressing
the problem of alcohol or drug use. Both mind and body aspects of individuals’ problems are
addressed in 12-step programs (Dermatis & Galanter, 2016). Addressing the mind and body are
very important in recovery because alcohol or drug use affects a person’s entire nature
(DiLorenzo et al., 2001). For the mind aspect, individuals in the 12-step recovery movement
utilize the traditional four paths to God: understanding, devotion, service, and meditation
(Sandoz, 2014). These traditional four paths lead individuals to spiritual awakening (Sandoz,
2014). The findings of DiLorenzo et al. (2001) and Sandoz (2014) are supported by the findings
of this study with regard to connecting to a higher power. All the participants shared that they
experienced connecting to a higher power.
Relationship of the Results and Theoretical Orientation
Jung’s (1964) construct of personality integration and the archetypes were discussed in
the literature review. Jung believed that recovery involves both the mind and the body because
both are affected by alcohol or drugs (Jung, 1964). To achieve a sense of wholeness and attain
fulfilment, the mind and body aspects of a person require integration (DeRobertis, 2016).
87
Jung centered integration of mind and body to achieve a whole on rediscovery of
selfhood. Jung approached self not from the point of view of modern identity but from
comprehensive experiences and putting all negative spiritual and psychological forces in balance
(Jung, 1964). This process involves a combination of the conscious and unconscious mind of a
person. Jung identified this process as individuation. According to Jung, individuation is
personality integration (Jung, 1964).
Construct of integration. The results of this study agree with Jung’s construct of
integration. The five themes that emerged from this study address the mind and body aspects of
the participants. The theme that addresses the mind aspect of the participants is their feeling of
the presence of a higher power. The themes that address the body include: (a) feelings of peace
and love, (b) better self-esteem, (c) feelings of joy and happiness, and (d) becoming less
judgmental. Jung claimed that individuals who suffer alcohol or drugs disorders disconnect from
the mind and body, and these five themes represent the process of integration of the mind, body,
and spirit to form a whole (Jung, 1963). It is this process of integration that makes an
individual’s quest to attain sobriety meaningful and purposeful (Kavar, 2012).
Archetypes and mythology. In addition to personality integration, Jung also discussed
archetypes and mythology. Jung stated that myths are not archetypes but rather help to develop
archetypes through story creation (Jung, 1964). Individuals use self-archetypes to rediscover
their true self. An archetype of self reintegrates other archetypes (Romila, 2017). Individuals
who attend 12-step programs are looking to rediscover their true self. Individuals use story
creation to develop archetypes. The stories are therapeutic as well as moral duty (Christensen &
Elmeland, 2014). The narrative of these stories involves sharing of experiences.
88
The themes that emerged from this study agree with Jung’s archetypal theory. The
themes represent feelings of happiness as opposed to sadness, comfort as opposed to discomfort,
peace as opposed to anarchy, love as opposed to hate, and feeling the presence of a higher power
as opposed to living in despair.
Interpretation of the Findings
This study investigated how people attending 12-step programs for alcohol or drug
recovery described their experiences of spirituality. The study is intended to help fill a gap in the
literature on the link between spirituality and alcohol or drug recovery. Hathaway (2011) and
Moore (2017) suggested that the use of spirituality in alcohol or drug treatment is not well
understood, revealing a need for more studies. Researchers who have maintained that the link is
not well understood have argued that this link is very complex and requires more clarification.
Participants in this study described their experiences of spirituality and identified key
outcomes from spirituality that influenced their feelings, attitude, and behavioral changes while
attending 12-step programs for recovery from alcohol or drug use. The participants reported that
attending these programs created an environment that facilitated the evolution of their spirituality
because these programs have a foundation in spirituality (Witkiewitz et al., 2016).
The participants were from different religious backgrounds, but they all shared the same
view on their experiences of their spirituality while in these programs. The participants
approached these programs as individuals but had shared goals and purposes.
The participants also shared the view that spirituality motivated them to engage in
meaningful activities, such as praying, meditating, doing yoga, going on retreats, volunteering to
help clean up after meetings, and reaching out and helping other people in need (Sandoz, 2014).
89
The participants saw this as a turning point because involvement in meaningful activities could
keep their minds focused on positive things.
The emotional, social, spiritual, and physical well-being the participants described as
resulting from their spirituality in these programs played a major role in their recovery journey.
The participants experienced feelings of peace, joy, love, and confidence, and they could
reconnect with family and friends after disconnection due to alcohol or drug use. Carrico et al.
(2013) suggested that people with a sense of spirituality attending 12-step programs have high
social support and acceptance. In this study, the participants described experiencing well-being
as a restoration of normalcy. In the 12-step program, the participants could experience a spiritual
awakening and gain a deep understanding of spirituality (DeLucia et al., 2015). The experiences
shared by the participants affirmed that spirituality contributed to their recovery from alcohol or
drug use.
Limitations
I conducted this study as a dissertation in partial fulfillment of the requirements for the
degree of Doctor of Philosophy. I had not conducted any research previously. As a novice in
qualitative research the information, insights, and data interpretation may be limited. An
experienced researcher might have gained greater depth in the findings. In addition, the
interviews were semi-structured. Non-structured interviews might have obtained more findings.
Only three men and eight women participated in the study. Having more women in the
study may have skewed the results. The races of the participants were not well distributed, either,
which may have also skewed the results. Additionally, the economic status and the educational
levels of the participants were not taken into consideration while conducting the study, and both
of these factors could have affected the results.
90
Implications for Practice
This study is important because the results suggest that there is a link between spirituality
and alcohol or drug recovery. Researchers like Hodge (2011) have argued that the link between
spirituality and alcohol or drug recovery is not well understood, and this attitude informs the
attitude of some addiction psychology professionals toward spirituality. The experiences of the
participants in this study have the potential to help show addiction psychology professionals the
vital role spirituality can play in alcohol or drug recovery.
The results of this study also suggest the value of spiritual competency training for
addiction professionals treating alcohol or drug use disorders (Brown et al. 2013; Schafer et al.,
2011).
Beyond the professional realm, the results of this study can help the public grasp the role
spirituality can play in alcohol or drug recovery and help some of millions of people with alcohol
or drug problems understand how spirituality can aid their recovery.
Recommendations for Further Research
These recommendations for future research are based on the current results. The
recruitment of participants for this study was done in only two centers in one community. For
further research, it is recommended that recruitment of participants span different regions,
cultures, and races.
Having more representation of one gender than the other may also have affected the
results of this study. Future research may consider conducting studies where the genders are
represented equally. Future research may also consider controlling for spiritual beliefs, economic
status, educational level, and age of the participants. Taking all these variables into consideration
would provide more areas of study that would be useful in the field of psychology.
91
Conclusion
The 11 participants in this study who were attending a 12-step program for recovery from
alcohol or drugs shared their experiences of spirituality. The rich in-depth information provided
by these participants helped fill the gap in the scientific literature regarding the connection
between spirituality and alcohol or drug recovery. The information provided by the 11
participants demonstrates that there is a deep connection between spirituality and alcohol or drug
recovery. It suggests that spirituality leads to feelings of peace and love, improved self-esteem,
feelings of joy and happiness, perception of the presence of a higher power, and becoming less
judgmental.
Participants reported losing their connection with a higher power due to alcohol or drug
use. A 12-step program for recovery from alcohol or drugs is deeply rooted in spirituality, and by
attending, these participants were able to reconnect with their spirituality.
The results of this study addressed the research question, “How do people attending a 12-
step program for recovery from alcohol or drugs describe their experiences of spirituality?” The
in-depth information given by the 11 participants from their own point of view were able to
address a gap in the literature. In addition, the findings in this study agreed with Jung’s construct
of personality integration, which is the theoretical orientation for this study. Individuals in a 12-
step program for recovery from alcohol or drugs were able to rediscover their spirituality as they
continued their recovery journey.
92
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STATEMENT OF ORIGINAL WORK
Academic Honesty Policy
Capella University’s Academic Honesty Policy (3.01.01) holds learners accountable for the
integrity of work they submit, which includes but is not limited to discussion postings,
assignments, comprehensive exams, and the dissertation or capstone project.
Established in the Policy are the expectations for original work, rationale for the policy,
definition of terms that pertain to academic honesty and original work, and disciplinary
consequences of academic dishonesty. Also stated in the Policy is the expectation that learners
will follow APA rules for citing another person’s ideas or works.
The following standards for original work and definition of plagiarism are discussed in the
Policy:
Learners are expected to be the sole authors of their work and to acknowledge the
authorship of others’ work through proper citation and reference. Use of another person’s
ideas, including another learner’s, without proper reference or citation constitutes
plagiarism and academic dishonesty and is prohibited conduct. (p. 1)
Plagiarism is one example of academic dishonesty. Plagiarism is presenting someone
else’s ideas or work as your own. Plagiarism also includes copying verbatim or
rephrasing ideas without properly acknowledging the source by author, date, and
publication medium. (p. 2)
Capella University’s Research Misconduct Policy (3.03.06) holds learners accountable for research
integrity. What constitutes research misconduct is discussed in the Policy:
Research misconduct includes but is not limited to falsification, fabrication, plagiarism,
misappropriation, or other practices that seriously deviate from those that are commonly
accepted within the academic community for proposing, conducting, or reviewing
research, or in reporting research results. (p. 1)
Learners failing to abide by these policies are subject to consequences, including but not limited to
dismissal or revocation of the degree.
108
Statement of Original Work and Signature
I have read, understood, and abided by Capella University’s Academic Honesty Policy (3.01.01)
and Research Misconduct Policy (3.03.06), including Policy Statements, Rationale, and
Definitions.
I attest that this dissertation or capstone project is my own work. Where I have used the ideas or
words of others, I have paraphrased, summarized, or used direct quotes following the guidelines
set forth in the APA Publication Manual.
Learner name
and date Anthony I Chukwunta 06/15/2018
