6103 Week 6 - Assignment: Treatment Approach

The Role of Spirituality in Helping African American Women with Histories of Trauma and Substance Abuse Heal and Recover

Joan Marie Blakey

There is increased interest in spirituality and the role it plays in helping in- dividuals with histories of trauma and addiction heal and recover. Using the Case Study method, the purpose of this study was to highlight the ways 26 African American women with histories of trauma and substance abuse used spirituality during the recovery process. Data analysis revealed components of a spiritual process that were used to facilitate healing and recovery. The first component, reclaiming spirituality, involved helping women reclaim and reconnect to their spirituality or spiritual practices that brought them solace and comfort. Finding meaning, the second component, consisted of helping the women find meaning and purpose for their lives. Trusting the process, the third component entailed building the women’s capacity to trust the process and to a lesser extent, surrender. Finally, active faith involved helping the women learn to rely on their faith in God rather than turning to drugs when obstacles and challenges arose. This study’s findings revealed that spirituality can be an ef- fective tool that promotes and facilitates recovery. Nonetheless, professionals need to recognize that not all women want to develop and nurture a spiritual life and that they must take their lead from them.

African american women have relied on Spirituality (e.g. individual’s belief, faith in, and personal relationship with God/higher power that transcends human limitations, restores them to well-being, and loves them unconditionally) to cope with unimaginable experiences such as slavery, racism, domestic violence, rape, as well as other forms of interpersonal trauma (i.e. childhood and adult victimization that causes significant psychological distress and functional impairment)

Social Work & Christianity, Vol. 43, No. 1 (2016), 40–59 Journal of the North American Association of Christians in Social Work

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(Brome, Owens, Allen, & Vevaina, 2000; Bryant-Davis, 2005; Potter, 2007; Stevens-Watkins, Sharma, Knighton, Oser, & Leukefeld, 2014). Spirituality is a significant part of many African American women’s daily lives. They derive a great deal of fulfillment and solace from their religious practices and faith in God (Ahrens, Abeling, Ahmad, & Hinman, 2009; Hooks, 2003; Stevens-Watkins et al., 2014; Yick, 2008).

Moreover, spirituality can counter the negative effects of oppression and trauma as well as contribute to positive mental health outcomes among African American women (Brome et al., 2000; Paranjape & Kaslow, 2010; Washington, Moxley, Garriot, & Weinberger, 2009; Watlington & Murphy, 2006). Studies have reported that spirituality is related to increased well- being, decreased levels of depression, anxiety, and post-traumatic stress disorder (PTSD) symptomology, longer periods of sobriety, and a more optimistic view of life (Ahrens et al., 2009 Avants, Warburton, & Margolin, 2001; Flynn, Joe, Broome, Simpson, & Brown, 2003; Gillum, Sullivan, & Bybee, 2006; Piedmont, 2004; Pardini, Plante, Sherman, & Stump, 2000; Paranjape & Kaslow, 2010; Piedmont, 2004; Watlington & Murphy, 2006).

Despite a growing body of literature documenting positive outcomes associated with spirituality, there is a need for more research that examines the ways trauma survivors in general use spirituality during the recovery process. Most studies have exclusively focused on intimate partner violence or sexual assault victims’ use of spirituality (Ahrens et al., 2009 Ai & Park, 2005). There also is a need to extend research in this area beyond white women or women as a whole and explore the use of spirituality by African American women with histories of trauma and substance abuse (Bryant- Davis, Ullman, Tsong, & Gobin, 2011; Curtis-Boles & Jenkins-Monroe, 2000; Drescher & Foy, 1995; Fallot, 2007; Fontana & Rosenheck, 2004; Fowler & Hill, 2004; Gillium, 2009; Stevens-Watkins et al., 2014).

Using the Case Study method, the purpose of this study was to un- derstand how 26 African American women with histories of trauma and substance abuse used spirituality during the treatment process. Given the high prevalence of trauma among African American women and the grow- ing recognition that spirituality is an important dimension of healing and recovery, it is critically important to understand more about spirituality as it relates to African American women (Brome et al., 2000).

Literature Review

prevalence of Trauma among African American Women

African American women experience disproportionately high rates of trauma as compared to their Caucasian counterparts (Hampton & Gillotta, 2006; Renison & Planty, 2003). Alim, Charney and Mellman (2006) reported that 65% of African Americans had exposure to trauma in their lifetime.

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African Americans who live in urban areas are at significantly higher risk of exposure to traumatic events resulting from community violence, racism, segregation, oppression/discrimination, and poverty (Alim et al., 2006; Davis, Ressler, Schwartz, Stephens, & Bradley, 2008). Moreover, rates of interper- sonal trauma among African American women are disproportionately high. Between 2001 and 2005, almost 50% of all victims of rape, sexual assaults, robberies and aggravated assaults were African American (Harrell, 2011). Nationally representative studies in the United States reported that African American women consistently reported higher rates of intimate partner violence than their white counterparts (West, 2004). Twenty five to 31% of African American women experience intimate partner violence (Gillum, 2009; Harrell, 2011). Among African American women ages 20–24, intimate partner violence was 29 per 1,000 victimizations for black women versus 20 per 1,000 victimizations for white women (Rennison, 2001). Finally, African American children have higher rates of child abuse and neglect as well as child fatalities than their white counterparts (United States Department of Health and Human Services, 2013). For example, Amodeo, Griffin, Fassler, Clay, & Ellis (2006) found that 34.1% of African American women versus 22.8% of white women had higher prevalence of childhood sexual abuse.

Commonly, African American women experience multiple forms of trauma (complex trauma) throughout their lives (Kubiak, 2005). Blakey and Hatcher (2013) reported that 73% of the African American women in their study experienced 5 to 12 traumatic events. Complex trauma refers to a combination of early and late-onset, multiple, and sometimes highly inva- sive traumatic events, usually of an ongoing, interpersonal nature (Lanktree & Briere, 2008). Complex trauma refers to the pervasive, severe, chronic, and hard-to-treat aspects of individuals who repeatedly have experienced multiple forms of prolonged trauma throughout their lives, usually starting in childhood (Cohen & Hien, 2006; Cottler, Nishith & Compton, 2001; Herman, 1992; Sacks, McKendrick & Banks, 2008).

Spirituality and Trauma Survivors

There are myriad ways that individuals cope with and manage symp- toms related to trauma (Fowler & Hill, 2004). Commonly, women turn to alcohol and illicit drugs to numb the pain associated with trauma and/or mental health symptoms such as PTSD, depression and anxiety (Sacks et al., 2008). Some women use self-harm or self-mutilation as a way to cope with trauma (Gladstone et al., 2004). Still other women cope with their traumatic histories by praying, meditating, worshipping God and other forms of spirituality (Bryant-Davis, 2005; Gillum, Sullivan, Bybee, 2006; Hooks, 2003; Stevens-Watkins et al., 2014; Potter, 2007; Yick, 2008).

The majority of studies focusing on spirituality and trauma have identified positive and negative ways in which spirituality has facilitated

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or hindered survivors’ healing and recovery (Ahrens et al, 2009; Bryant- Davis et al., 2011).

Positive Ways

Positive spiritual coping involves using spirituality and faith in a higher power to find meaning, solace, and support to manage and make sense of the things that have happened to them (Ahrens et al., 2009). Many studies have found that spirituality helps trauma survivors leave abusive relationships (Ahrens et al., 2009; Pargament, 1997; Potter, 2007). Spirituality offers an opportunity to open to the spiritual realm and in some cases caused them to have a spiritual awakening, offered them hope, and opened the possibility for growth (Adams, 1995; Ryan, 1998; Vis & Boynton, 2008). Spirituality has helped people transcend their pain by redefining the event as part of God’s plan, finding something beneficial in their experiences as well as turn- ing to the church or God for guidance and support (Fallot, 2007; Frankl, 1962; Marcus & Rosenberg, 1995; Pargament, Koenig, & Perez, 2000; Pot- ter, 2007). Moreover, spirituality has replaced trauma survivors’ emptiness and despair with hope, meaning, comfort, and direction (Frankl, 1962; Garbarino & Bedard, 1996; Lightsey, 2006; Marcus & Rosenberg, 1995; Pargament, 1997; Ryan, 1998). Finally, spirituality allowed many trauma survivors to put their lives into perspective, and catalyzed the process of post-traumatic growth (Potter, 2007; Ryan, 1998; Vis & Boynton, 2008).

Negative Ways

Negative spiritual coping involves individuals struggling with their faith in a God who allowed negative, hurtful, things to happen to them. These negative feelings towards God or spirituality have led them to de- nounce the existence of God and distance themselves from spiritual beliefs that once provided comfort (Ahrens et al., 2009; Pargament, Tarakeshwar, Ellison & Wulff, 2001). Trauma survivors who had negative feelings about spirituality felt distrustful, fearful, abandoned, and unprotected by God because they believe He allowed the abuse to occur by not preventing or stopping the traumatic event despite having the power to do so (Garbarino & Bedard, 1996; Herman, 1992; Lemoncelli & Carey, 1996; McCann & Pearlman, 1990; Ryan, 1998; Wilson & Moran, 1998). Some trauma survi- vors believed that God was punishing them and consequently had forsaken them in their time of need (Harris, Erbes, Engdahl, Olson, Winskowski, McMahill, 2008). Still other trauma survivors felt silenced by their religion or certain spiritual practices and/or blamed for the abuse instead of holding the perpetrator accountable (Taylor & Fontes, 1995; Wulff, 1991). These feelings were exacerbated in situations that included a religious/spiritual component or when religious figures perpetrated the trauma (Ryan, 1998).

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Gaps in the Literature

Spirituality is one of the few positive coping strategies used by trauma survivors that has been found to facilitate healing, so there is a need for more research examining the ways trauma survivors use spirituality during the recovery process. There also is a need to explore trauma and spirituality as it relates to African American women (Bryant-Davis et al., 2011; Curtis-Boles & Jenkins-Monroe, 2000; Drescher & Foy, 1995; Fallot, 2007; Fontana & Rosenheck, 2004; Fowler & Hill, 2004; Gillum, 2009; Stevens-Watkins et al, 2014). This study begins to address these important gaps in the literature.

method

This study uses the case study method that allows for an in-depth understanding of a contemporary phenomenon (e.g., African American women’s view of spirituality) within its real-life context (Creswell, 2013; Fisher & Ziviani, 2004; Padgett, 2008; Scholz & Tietje, 2002; Stake, 1995, 2006; Yin, 2009). Case studies enable the researcher to better understand a specific issue, problem or concern, and allow multiple facets of problem to be revealed and understood (Baxter & Jack, 2008; Creswell, 2013; Yin, 2009).

Sample

A maximum variation sample of 26 African American women with histories of substance-abuse women was recruited from a large, urban Midwestern city to participate in the study (Padgett, 2008). The goal of maximum variation sampling is to deliberately take full advantage of varia- tions that might be present in a sample population so that when patterns emerge, they are believed to highlight core experiences and shared aspects of the sample population (Patton, 2002).

The women’s ages ranged from 19 to 43 years (M=36 years old). The women had used alcohol and illicit drugs (e.g., marijuana, heroin, or crack cocaine) from 3 to 37 years. On average, the women had been using drugs and alcohol for 22 years. The youngest woman started using alcohol or illicit drugs at the age of 5 and the oldest started at 20. On average, the women started using drugs when they were 14. Women remained in treatment from 14–661 days (M=99 days). Finally, 19 of the 26 women (73%) had some kind of mental health diagnosis with depression, bi-polar disorder, and anxiety being the most common.

data Collection

Data collection methods employed in this study were interviews and document reviews. In-depth, semi-structured, open-ended interviews were

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conducted at the treatment center and lasted one to two hours. Interviews were digitally recorded and transcribed verbatim by a professional transcrip- tion service. Pseudonyms were used throughout the interviews to protect the anonymity of the substance abuse treatment agency and clients. The interview protocol explored general questions regarding each woman’s his- tory and experiences with substance abuse treatment and child protection, ways women coped with traumatic experiences, and the types of services that lead to recovery and healing. None of the interview questions asked specifically about the role of spirituality in these women’s lives. Nonetheless, spirituality was identified as an important part of all 26 women’s recovery.

In addition, I took notes on all of the pertinent information contained in each woman’s file, which included case notes written by substance abuse treatment professionals, biopsychosocial assessments, documents and reports involving the child welfare agency, psychological evaluations, and homework assignments completed by the women. The interviews, typed notes, and documents were uploaded into NVIVO 10, a qualitative software program that allows researchers to code and categorize narrative text, make connections between codes, and develop themes (Gibbs, 2002).

Participants received $25 for their participation in the study. All study protocols were approved by the university institutional review board that oversees research with human subjects. These protocols included a com- plete explanation of the study, consent forms, recruitment materials, and interview guides.

data Analysis

The first step in the analysis process is open-coding (allowing the codes to emerge from the data) the transcripts from in-depth interviews and information from the women’s files (Miles & Huberman, 1994; Padgett, 2008). This primarily involved reading the data multiple times and gener- ating a list of in vivo codes (codes that used the study participants’ words) and descriptive codes (Miles & Huberman, 1994). The case study analytic technique of looking within and between cases entails continuously re- turning to the interviews and repeatedly checking for disconfirming and corroborating evidence, as well as alternative explanations.

Multiple reviews of the codes generated themes. Thematic analyses involve searching for patterns that emerge from the data (Fereday & Muir- Cochrane, 2006). Yin (2009) refers to this process as pattern matching, a way of dissecting the data to understand “the patterns, the recurrences, the plausible whys” of individual instances, as well as the aggregation of instances (Miles & Huberman, 1994, p. 69). Pattern matching is the most desirable technique for case study analysis (Yin, 2009).

To enhance the rigor and credibility of the findings (Lincoln & Guba, 1985; Padgett, 2008), an audit trail through memos and field notes was

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created. Member checks (confirming the findings with the participants) during the data collection and analysis phases were also used as a cross- case analysis tool to confirm, challenge, and add complexity to the study findings (Lincoln & Guba, 1985; Padgett, 2008; Yin, 2009). Prolonged engagement (e.g. spending significant time in the field in order to under- stand the culture, setting or phenomenon) was another strategy I used to increase rigor (Padgett, 2008). I spent 14 months at the treatment center collecting data of the project. Finally, negative case analysis (e.g. giving equitable attention to divergent viewpoints) also was used as a strategy to increase rigor (Padgett, 2008).

Findings

Based on self-reports, clinician reports, and documents in the women’s files, all 26 women in this study (100%) experienced two or more traumatic or potentially traumatic events. Seven women (27%) experienced two to four traumatic or potentially traumatic events. Ten women (38%) experi- enced five to seven traumatic or potentially traumatic events. Nine women (35%) experienced eight to 12 traumatic or potentially traumatic events.

Of the traumatic events reported, 14 women (54%) reported being sexually abused as a child. Eight women (31%) indicated they were physi- cally abused as children. Ten women (38%) reported being raped as adults. Twenty-one women (81%) indicated that they had been or currently were involved in domestically violent relationships. Five women (19%) were forced to prostitute against their will. Finally, 13 women (50%) reported witnessing or experiencing some kind of violence (e.g., being kidnapped, tied up and severely beaten, witnessing close family members or friends being shot and killed) often associated with the drug trade.

With respect to potentially traumatic experiences, four women (15%) witnessed, as children, their mothers being beaten. Eleven women (42%) reported extreme emotional abuse as children. Seventeen women (65%) admitted to engaging in prostitution to obtain drugs or get money to pay their bills. Violence often was a part of these experiences. Eighteen women (69%) reported being neglected and abandoned, often because of paren- tal substance abuse. Seventeen women (65%) had a biological parent or parents who abused drugs. Thirteen women (50%) indicated that loss of children through their involvement with child protection was traumatic. Finally, four women reported being involved with the foster care system as children, and indicated that their involvement was traumatic. All four of them reported being abused in some way (e.g., sexual abuse, physical abuse, extreme neglect, and emotional abuse) while in foster care.

In terms of spirituality, data analysis revealed a spiritual process that 26 African American women with histories of trauma and substance abuse used four primary spiritually related strategies to facilitate healing and

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recovery: reclaiming spirituality, finding meaning, trusting the process, and active faith. A detailed explanation of each factor is described below.

Reclaiming Spirituality: “If it’s not alive, I am not alive”

Reclaiming spirituality involved restoring their relationship with God by returning to prayer/talking to God, meditation, reading their Bible, and for some, church attendance. In most cases, the women in this study re- stored their relationship with God/higher power upon entering treatment. Many of the women described how the traumatic experiences and substance abuse made them feel dead inside and corrupted them to the point that they stopped praying, going to church, reading their Bible, and meditating on God’s word. Reclaiming spirituality brought the women back to life. Kai is a 40-year-old woman who was physically abused and neglected as a child. As an adult, she was a victim of domestic violence, raped multiple times and witnessed many of her friends and family members killed. She stated:

When I was out there, my spirituality was corrupted…I got to get that relationship with Him you know that bond and you know to have that faith in Him to do for me what I can’t do for myself because I believe but somehow or another my faith is you know – my inner spirit…you know died when I was using. If it’s not alive, I’m not alive, you know?

Traumatic experiences often diminish or destroy any faith trauma survivors have in themselves, people, and relationships (Courtois & Ford, 2013). However, many of the women in this study trusted God and be- lieved that God loved them unconditionally and would never leave them. Vickie is a 26-year-old woman who was sexually abused by her father for many years until she was placed in foster care where she was neglected and abused. As an adult, she was a victim of domestic violence and often forced to prostitute to make money for her “boyfriend.” She described how reclaiming her spirituality renewed her faith and restored her sense of self:

Love is a powerful, powerful thing and it will pull you up from drowning. God loves us so much. God will be in your life even when you…walk away from him… I was like dis- connected from God spiritually and I had disconnected my soul not even knowing it. I was like dead, just rotten… But you know now the connection is hooked back up and I’m trying – I’m going to Him like and developing a relationship with Him and my relationship with Him is growing…I feel like I’m alive, resurrected. You know like being raised from the dead for real like I can see. I can breathe. I can grow. That’s all the things that a living thing does. You can’t do none of that when you on drugs, you’re dead.

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Many of women believed that they could not heal and recover without restoring their relationship with God. Lashaun is a 41-year-old woman who was a victim of domestic violence, witnessed several people killed, was kidnapped, tied to a bed, and forced to prostitute. She indicated that God was an important part of her recovery:

Since I been here, the main part of me staying sober is having a relationship with God. I know now that I cannot do it on my own. Prior to coming to treatment this time, I thought I could do it my own. I didn’t need no sponsor. I didn’t have to make meetings. But today I know I must make meetings. I must have a relationship with God.

Bailey, a 32-year-old woman with an extensive history of intimate partner violence confirmed Lashaun’s sentiments. She said:

Being in treatment opened my eyes to help me realize that I need to put God first and forget material things as well as let go of my relationship with Tony. I also realize that until I start putting God first nothing will go right in my life. I have to start working a spiritual program. I need to get into the word [my Bible] as well as the big book [Narcotics Anony- mous] if I am going to have any chance of getting better.

Reclaiming spirituality for women with histories of trauma and sub- stance abuse was the first step towards healing and recovery as it brought them back to life, helped restore their relationship with and faith in God, and move towards healing and recovery.

Finding meaning: “God has something for me to do”

The second way women used spirituality to heal and recover was finding meaning in the traumatic experiences they had been through in their lives. Experiences of trauma often challenge individuals’ core beliefs and raise questions about meaning and purpose of life (Ai & Park, 2005; Weaver, Flannelly, Garbarino, Figley, & Flannelly, 2003). The women believed that God saved them for a reason, part of which was to share their story so they could help other young women. Darla is a 43-year-old woman who was sexually and physically abused as a child. She had been raped multiple times. During the last rape, she was sodomized and left for dead. She also has an extensive history of being physically, verbally, and emotionally abused by romantic partners. She states:

I was always abused you know and I look at it in a spiritual aspect that God has always shown me and He has always brought me through…because my greatest fear was a fear

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of being alone. He always showed me…He was always there to let me know that a relationship with God is the best rela- tionship that you could ever have. He will never leave you. He would never hurt you…A lot of times I almost died by the hands of a man. But God showed me that it wasn’t time for me to go you know…I know that God has something for me to do. I saw my vision and I look at it as being me sharing my experiences with young women.

Kai also believed that despite being raped several times and witnessing people being killed, her life was spared for a reason. She states:

I was—man, on the road to a nervous breakdown or to flip out. God just kept me sane. He’s holding me for some reason. He got me. He has me. I know I’m in his hands. He’s carried me a long way. Through a whole lot of terrible situations, he done got me out of. I don’t know what I am supposed to do with it yet, but I know He has a purpose for all of this…I know to how to reach others and get on they level. I don’t know if that’s my calling from God but I be feeling that it is sometimes.

Finding meaning also involved women believing these traumatic ex- periences brought them closer to God and that God’s purpose for their lives was greater than their current situation. Edith is a 42-year-old woman who was sexually, physically, and emotionally abused and neglected as a child because her mom struggled with addiction all of her life. She was raped and involved in physically, verbally, and emotionally abusive relationships as an adult. She states:

All of these things that have happened to me help me to get closer to God. Cause I always say God I done did this and I don’t know what you got me here for but I know it ain’t using. I know He don’t got me on earth to use. I got too many talents and all that but I can’t get with it in the state of mind I’m in… I’m gonna try as hard as I can to stay motivated to do what I think God want me to do.

Finding meaning was the way many women made sense of the trau- matic things that happened to them. They believed that their lives had been spared so they could prevent others from experiencing the same things.

Trusting the process: “His will and not mine”

The third way women used spirituality to heal and recover was accept- ing that God knows best and while they did not always understand God’s

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ways, they believed there was a reason and trusted that God was going to work everything out. Tonia is a 34-year-old woman who was sexually abused and neglected as a child. She was raped while engaging in prostitution as an adult. She states:

I prayed constantly. Maybe she [my child protection worker] did have my best interests at heart but I didn’t feel that way. I truly have to depend on God and know that this is His will and not mine, and to trust…that God put these people in my life to help me.

Trusting the process also included the belief that God had blessings in store for them if they did their part. Vanessa, a 40-year-old woman who has been in a domestically violent relationship for years said:

I just need to ask God to reveal to me. Maybe it’s best for me to get my treatment without my kids this time…When I had them kids I wouldn’t take care of them kids. My focus really wasn’t on them kids. So maybe I just gotta look at that’s why God placed me back here to try to get it without my kids…I want to live the life that God intended for me... He keeps showing me. Everything I try to do prospers—everything. That’s just God saying see look what I got for you. Why won’t you stop playing, come here, come back you know…I want that. I want what God has for me.

Finally, trusting the process entailed believing that regardless of the out- come, they must do their best and have faith that God will do the rest. Edith said:

You know I’m like wondering why God did this. I can’t make out why I can’t be the one raising my kids. But I ain’t gonna question God about it. Believe that, I’m not gonna question Him not one time. I know that God has forgiven me, and He has a plan...I am just gonna have to wait to see how this un- folds and trust that God knows best… I’m still gonna do the best I can…I am gonna see what miracle is for me this time.

Trusting the process was the women’s attempt to surrender to a higher power. They accepted God knows best, that God has a plan even though they did not always know the plan, and if they did their part, everything would work in their favor.

Active Faith: “I ask him to show me the way”

The final way women used spirituality to heal and recover was ac- tive faith, which involved having confidence in God’s leading by pressing forward, persevering and persisting in spite of obstacle and challenges

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that arose. Kai, a 40-year-old woman with an extensive history of abuse shared her struggle:

God might not keep giving me chances to change my life… Everyone’s faith gets shaky sometime…But I turn to drugs instead of turning to God…I just tell myself God loves me and I ask Him to show me the way. Show me how to love me because I don’t even know… how to love me…And eventually I will …learn it.

Many of the women had an active desire to remain abstinent, were learning to rely on their faith in God rather than turning to drugs to man- age flashbacks and other effects of trauma, accepted God’s love and guid- ance, and actively strove to get better. Harriet, a 39-year-old woman with a history of childhood sexual and physical abuse and a victim of domestic violence and rape stated:

Using drugs made me numb and dull. When I stop using drugs, all these memories and flashbacks keep coming back. I don’t know what to do. I know God and I am working on trusting my higher power to help me.

Active faith did not mean that the women never had doubts about whether God was present in their lives. Rather, their previous experi- ences taught them to depend on God. Lisa is a 37-year-old woman who was physically, emotionally, and sexually abused as a child and adult. She witnessed the murder of two of her brothers by her “boyfriend” and cap- tor. She also has been raped repeatedly and left for dead on at least two separate occasions. She said:

Sometimes it doesn’t seem like God hears me. But I still keep praying. Because I have learned that even though it doesn’t seem like it, He is working things out…. I am grateful that God gave me another chance to live without the drugs and alcohol. Because I know God is not finished with me. I am a child of God and was created in His image. I am blessed to be loved and shown favor by God’s grace.

Active faith also involved the women’s strong convictions about God and a declaration that God served as their most powerful motivation to be drug free. Vickie, a 26-year-old victim of childhood sexual abuse said:

God done set it up, He done laid the ground work for me to have a good life and I want that you know. If I keep using drugs…I’m gonna die and He don’t want me to die…God made you. He been with you all your life. So He gonna fix it to where you ain’t gonna be able to take it, you gonna come

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back to Him…It’s all out of love so God will be like the most powerful influence in your life. He’s been the most powerful influence in my decision to want to be clean for real.

There were four primary ways African American women with histo- ries of trauma and substance abuse used spirituality to heal and recover. Once they were sober, they reclaimed or restored their spirituality. They also found meaning in the pain they experienced by hoping to help others from going through the same things. They believed that while God does not always reveal the plan, He has one and that they trusted it would be revealed in time. Finally, active faith represented the women’s commitment to spirituality and the ways in which they sought to nurture their spiritual- ity and make it a major part of their lives.

discussion

Substance abuse treatment is designed to open wounds, initiate the resolution of issues that have kept participants stuck in a cycle of addiction, and help them resolve and move beyond these issues (Beveridge & Cheung, 2004). While many substance abuse treatment modalities such as Alcoholics Anonymous are rooted in spiritual principles, clients’ use of spirituality is still a choice. Spirituality emerged among these African American women as a powerful force in their lives, even though none of the interview questions specifically asked about spirituality. During the course of an interview focused on women’s history and experiences with substance abuse treatment and child protection, each of the 26 women mentioned the powerful role that their rela- tionship with God played in moving their recovery forward. Despite the abuse, neglect, and mistreatment these women experienced, they perceived that their faith and belief in God remained a critical factor in their healing and recovery. They believed God was a benevolent being that saved their lives, kept them sane, made them feel alive, loved them unconditionally, and forgave them for any wrongdoing. Their connection to God gave their life purpose and mean- ing. Their spirituality enabled them to adapt, transform, and transcend various traumatic experiences while maintaining their faith in God.

In this study, the African American women only had positive views of spirituality. There are a couple of reasons that might explain this. First, 24 out of the 26 women indicated that they had been raised with spiri- tuality, a belief in God, and religion. They grew up praying, reading their Bible, and going to church. Many of them indicated that their mothers and other family members had been consistently praying for their healing and recovery. According to Curtis-Boles and Jenkins-Monroe (2000), “African Americans speak of ‘being raised’ in the church, which reflects not only church involvement from early childhood but also an important aspect of socialization that includes values transmission; positive modeling…and important lessons in managing life” (p.464). These women turned to their

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spirituality to help them cope with life’s difficulties because that is how they were raised. Second, the treatment center staff tended to have positive views of spirituality and believed that spirituality was a fundamental part of the recovery process. The staff reinforced the women’s spiritual beliefs as well as helped those women who had no spiritual foundation establish one.

While this paper identified some new themes such as reclaiming spiri- tuality and active faith, finding a sense of meaning and trusting the process has been confirmed by other studies (Mattis, 2002; Vis & Boynton, 2008). Alim, Feder, Graves, Wang, Weaver, Westphal et al., (2008) found that women’s sense of purpose promoted resilient outcomes and significantly aided the recovery process. Yick (2008) reported that spirituality helped trauma survivors find meaning and establish their life purpose. Principles such as trusting the process, surrendering to a Higher Power, accepting limitations, overcoming seemingly impossible obstacles, practicing grati- tude, changing thought patterns, and grieving losses are the cornerstone of any 12-step (i.e. Alcoholics Anonymous) program (Alcoholics Anony- mous World Services, 1976; Galanter, Dermatis, Bunt, Williams, Trujillo, & Steinke, 2007; Stoltzfus, 2007).

This study’s findings are important because they revealed components of a spiritual process that could help women with histories of trauma and substance abuse heal and recover. The first component involved the women reclaiming and reconnecting to their spirituality or spiritual practices that brought them solace and comfort. The second component consisted of helping the women find meaning and purpose for their lives. The third component entailed building the women’s capacity to trust the process and to a lesser extent surrender, which may be challenging as past experiences have reinforced trauma survivors distrustfulness (Courtois & Ford, 2013). The final component was active faith, which involved helping the women understand that spirituality, faith, and trusting in God are not always constant and that sometimes believers have periods of doubt and question whether God is still active in their lives. But it is important that they continue to rely on their faith in God.

Limitations of the Study

This study offers insight about spirituality among African American women with histories of trauma and substance abuse and the importance of acknowledging the significance of spirituality in the recovery process. However, several limitations should be considered. The first is that this study involved only one substance abuse treatment agency. The treatment center is located in a large, urban city in the Midwest. Moreover, it represents the “gold standard” of treatment facilities (i.e., gender-specific, comprehensive services that allows women to bring their children) in that it is the only publicly funded treatment center of its kind in the state. Therefore the

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findings may not be representative of women in another part of the state or country because the treatment context and approaches are often differ- ent. This particular agency did not have any policies regarding including religion/spirituality in treatment planning. Treatment professionals had complete discretion to include spiritual components they felt were most appropriate. This may not be true for other agencies, particularly those that are faith-based. Further, the study findings only included African American women. Women from other racial groups and ethnicities may have differ- ent experiences or see spirituality differently than the African American women in this study. Moreover, all participants were Christian. The findings are presented from this vantage point. Individuals from other faiths would likely have a different experience. Finally, I did not ask in-depth questions about the women’s spirituality. While this can be seen as a strength in that many women discussed their faith and spirituality as part of the recovery process, asking in-depth questions specifically about the women’s use of spirituality may have yielded different results.

Implications for practice

Inclusion of spirituality in trauma and substance abuse treatment pro- grams may serve to greatly benefit women as spirituality plays a vital role in post-traumatic processing (Gillum et al., 2006; Vis & Boynton, 2008). For African American women specifically, it may serve to increase their social support network and connection to other people and God which may give them added emotional and practical support they need to cope with the abuse they have experienced or provide them with courage to end an abusive, unhealthy relationship (Bryant-Davis et al., 2011; Curtis-Boles & Jenkins-Monroe, 2000; DiLorenzo, Johnson, & Bussey, 2001; Gillum et al., 2006; Lewis, Hankin, Reynolds, & Ogedegbe, 2007; Mattis, 2000, 2002). Spirituality also is an important source of strength, which aids many African American people in times of distress and is often seen as an important part of their identity (Curtis-Boles & Jenkins-Monroe, 2000; Mattis, 2000, 2002).

In terms of treatment, it is beneficial for helping professionals to understand that clients may have spiritual beliefs and that these views may influence their recovery in positive and negative ways (Beveridge and Cheung, 2004). Although, none of the women had negative views of spirituality, other studies have found that negative views are not uncommon and can affect women’s recovery from trauma and substance abuse (Ahrens et al., 2009; Garbarino & Bedard, 1996; Harris et al., 2008; Herman, 1992; Lemoncelli & Carey, 1996; McCann & Pearlman, 1990; Pargament et al., 2001; Ryan, 1998; Taylor & Fontes, 1995; Wilson & Moran, 1998; Wulff, 1991). Professionals also need to recognize that not all women want to develop and nurture a spiritual life. Professionals have to be careful to avoid proselytizing or promoting any particular belief systems. Instead

55

they must leave this decision completely up to the individual and take their lead from the women.

Helping professionals who work with severely traumatized clients need to be comfortable working with and talking with individuals who raise existential and spiritual issues (Shaw, Joseph, & Linley, 2005). It is important that substance abuse treatment programs include spirituality as part of the programming offered to women. This can include daily prayer and meditation, making available a quiet room for prayer or reflection, hold- ing church service onsite, allowing the women to attend church services offsite, and providing the women access to clergy or religious figures of their choice (Gillum et al., 2006). Again, individuals should not be penalized if they choose not to participate in these kinds of activities.

Spirituality can be an effective tool that aids women in recovering from trauma and substance abuse (Brome et al., 2000). Incorporating spirituality in the treatment process can restore women’s faith and trust (things that are often eroded by trauma) in a higher power (Miller & Guidry, 2001) as well as promote and sustain healing and recovery. v

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Joan Marie Blakey, Ph.D., Assistant Professor, University of Wisconsin- Milwaukee, Helen Bader School of Social Welfare, 2400 Hartford Avenue, Enderis Hall, Room 1177, Milwaukee, WI 53211 Phone: (414) 229-3998. Email: [email protected].

Keywords: spirituality, substance abuse treatment, African American women, trauma, case study

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