This article was downloaded by: [UQ Library]On: 18 November 2014, At: 14:39Publisher: Taylor & FrancisInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

American Journal of PastoralCounselingPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/wzaj20

An Empirical Exploration ofSpirituality and Religiousness inAddiction TreatmentChris Stewart PhD aa University of Pittsburgh, School of Social Work ,2010 Cathedral of Learning, Pittsburgh , PA , 15260 ,USAPublished online: 12 Jul 2012.

To cite this article: Chris Stewart PhD (2004) An Empirical Exploration of Spiritualityand Religiousness in Addiction Treatment, American Journal of Pastoral Counseling,7:4, 71-83, DOI: 10.1300/J062v07n04_05

To link to this article: http://dx.doi.org/10.1300/J062v07n04_05

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

An Empirical Exploration of Spiritualityand Religiousness in Addiction Treatment

Chris Stewart, PhD

ABSTRACT. There is relatively little known about the relationship be-tween spirituality and religiosity and substance abuse treatment. The lit-erature tends to be divided concerning the scope and nature of the role ofspirituality and religion in treatment for addictions. This study comparedthe clients of three different programs in a pretest-posttest design to de-termine if spirituality and religiosity changed significantly throughoutthe course of treatment. The results demonstrated little change in treat-ment though there were significant differences between the differenttreatment modalities. [Article copies available for a fee from The HaworthDocument Delivery Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.com> Website: <http://www.HaworthPress.com> © 2004 by TheHaworth Press, Inc. All rights reserved.]

KEYWORDS. Substance abuse, religiosity, spirituality, substance abusetreatment, spiritual change

INTRODUCTION

The relationship between religion and substance use is long and com-plex (Miller, 1998). Given the intricate connection of the two it is sur-prising that there is relatively little known about the role that spiritualityplays in the addiction process in general and, specifically, the treatment

Chris Stewart is Assistant Professor, University of Pittsburgh, School of SocialWork, 2010 Cathedral of Learning, Pittsburgh, PA 15260.

American Journal of Pastoral Counseling, Vol. 7(4) 2004Available online at http://www.haworthpress.com/web/AJPC

2004 by The Haworth Press, Inc. All rights reserved.doi:10.1300/J062v7n04_05 71

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

of addictions. The literature tends to report a general negative associa-tion between religiosity and substance use (Connors, Tonigan & Miller,1996; Cancellaro, Larson & Wilson, 1982; Koenig, George, Meador,Blazer & Ford, 1994; Miller, 1998). This relationship exists tenuously,however, as some studies have shown that there is little effect of reli-gion on positive substance use outcomes (Richard, Bell & Carlson,2000).

Recently several national institutes gathered experts to study the cur-rent state of knowledge and propose further study of the relationship be-tween alcoholism and spirituality. Some of the results of this conferencewere that religious or spiritual involvement predicts lower involvementwith most substances. Also, a conclusion was reached that there is goodevidence to support that participation in Alcoholics Anonymous is asso-ciated with reduced use, though there is less evidence to support thatthis treatment modality is more effective than other forms of treatment.Alcohol problems tend to be lower among people involved with alco-hol-proscriptive religions. The final conclusion was that spirituality, asa complex, multi-faceted phenomenon, should continue to be studied inrelation to addictions to begin to clarify this important relationship (Na-tional Institute on Alcohol Abuse and Alcoholism, National Institutesof Health, Fetzer Institute, 1999).

While religion has historically been the primary focus of scientific re-search, efforts are underway to try and capture the more difficult conceptof spirituality (Miller, 1998; National Institute on Alcohol Abuse and Al-coholism, National Institutes of Health, Fetzer Institute, 1999). Spiritual-ity is generally considered an individual set of beliefs and practices thatmay include religiosity whereas religion tends to refer to a social phe-nomenon (Miller, 1998). It has been proposed that it might be most accu-rate to conceptualize spirituality as a latent variable such as happiness orpersonality (Miller & Thoreson, 1998). An example of this approach isthe development of the Multidimensional Measurement of Religiousnessand Spirituality (MMRS) that attempts to capture an individual’s spiritu-ality in several related constructs (Fetzer Institute, 1999). Clearly there isevidence to suggest that spirituality is more complex than religiosity, butlittle is known about the constructs of spirituality and how they might re-late to religion and, further, the role of the multidimensional phenomenonto addiction treatment.

The nature of spirituality and religiosity in treatment is still under in-vestigation though some preliminary results report that programs utiliz-ing a religious focus tend to produce positive outcomes (Desmond &Maddux, 1981; Richard, Bell & Carlson, 2000). Similarly, investiga-

72 AMERICAN JOURNAL OF PASTORAL COUNSELING

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

tions have found that abstainers from alcohol used prayer significantlymore than those individuals who have relapsed (Johnsen, 1993; Walker,1997). These results support the notion that a critical component of12-step programs is of a spiritual nature. Indeed, some authors haveclaimed that a spiritual awakening is a direct result of embracing ahigher power, which leads directly to successful cessation from the useof substances (Green, Fullilove & Fullilove, 1998; Schaler, 1997). Thefoundational principle of the Alcoholics Anonymous program is thatuse of alcohol is incompatible with spirituality and the only hope for so-briety is to accept help by directing one’s life toward the higher power(Miller, 1998). Furthermore, some researchers have investigated possi-ble biological mechanisms of the spiritual role of addictions treatmentwith moderate success (O’Connell, 1999).

As with spirituality research in general, the results do not universallysupport the assumption that spirituality and religiosity are integral factorsin the treatment process. One study reported that while more religious cli-ents tended to espouse a more anti-alcohol attitude, there were no signifi-cant correlations in terms of successful outcomes. Also of note was theresult that the least religious clients were more likely to change their atti-tude concerning the harmful effects of alcohol during the course of treat-ment (Zucker, Austin, Fair & Branchey, 1987). There is, additionally,some evidence to support the notion that individuals participating in treat-ment may be less involved in religion than those without addiction prob-lems (National Institute on Alcohol Abuse and Alcoholism, NationalInstitutes of Health, Fetzer Institute, 1999; Cancellaro, Larson & Wilson,1982; Larson & Wilson, 1980; Miller, 1998). This finding could be sig-nificant in that a large portion of treatment in United States espouses theAlcoholics Anonymous model in treating addictions (Miller, 1997).

The role of spirituality and religiosity throughout the course of treat-ment is in need of further study. Currently there is little empirical evi-dence to support that spiritual change is a necessary part of treatment oroffers significantly better outcomes (Miller, 1998). It has been notedthat programs with spiritual foundations, such as A.A. and othertwelve-step programs, need to be tested to further determine the natureand scope of the contribution of spirituality and religiousness (Miller,1997).

In an effort to better understand the nature of spirituality and religionthrough the course of treatment, this project will seek to answer the fol-lowing questions: (1) Does the spirituality and religiousness of treat-ment clients change through the course of treatment? (2) Are there

Chris Stewart 73

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

differences in the spirituality and religiousness of clients attending dif-ferent types of programs, i.e., A.A.-based versus other types of pro-grams? (3) Do treatment clients attribute spirituality and religiousnessas a significant factor in their treatment? (4) Do specific demographiccharacteristics, such as treatment history or drug of choice, predict re-ligious or spiritual scores?

METHOD

Programs

This project surveyed the clients from three different types of treat-ment programs:

VA Treatment. The regional Veterans Administration Hospital offersa 30-day residential treatment program. This treatment follows the tra-ditional 12-step philosophy that includes frequent A.A. meetings.Group and individual therapies are offered in addition to medical care.A significant number of clients admitted are voluntary though a few in-voluntary clients do participate in treatment. Urine screens are utilizedto ensure compliance with treatment protocol.

Drug Court. The local mental health center provides outpatient treat-ment for those clients who are convicted of a first-time, felony drugcharge, thus all clients are involuntary. Clients are offered the choice oftreatment or facing a hearing with the possibility of harsher sentencing.The treatment option is further enhanced with the promise of the adjudi-cation of all charges upon completion. Drug screens are used to ensurethat clients are not using substances.

The treatment also follows the traditional 12-step philosophy with at-tendance of either A.A. or N.A. meetings required. Clients meet twice aweek for group meetings, with regular sessions with an individual coun-selor. The treatment lasts from one to one-and-a-half years with mostclients completing the program in 13 to 14 months. Clients participatein the program by passing through a series of four phases. Clients movethrough the phases by attending meetings and working on individual is-sues. Clients can also be demoted from a phase if they are caught usingsubstances or fail to attend the meetings. Though the treatment plan of-ten describes cohorts moving through phases together, this is the excep-tion rather than the rule as individuals move at their own pace, movingup and down the phases based on individual performances.

74 AMERICAN JOURNAL OF PASTORAL COUNSELING

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

Women’s Treatment. The local mental health center also offers 30-dayresidential treatment specifically for women. These women are referredfrom many sources, with both voluntary and involuntary clients seekingtreatment. This program loosely follows the 12-step philosophy and sug-gests, but does not require, any additional A.A. meetings. The programoffers group and individual therapy with a special focus on women’s is-sues.

Measurements

The spirituality and religiousness of the treatment clients were measuredusing the Multi-Dimensional Measurement of Religiousness/Spirituality(MMRS). This 88-item instrument was recently developed through theFetzer Institute in collaboration with the National Institutes of Health. Theinstrument measures spirituality and religiousness through the use of 12subscales. These scales include Daily Spiritual Experiences, Meaning, Be-liefs, Forgiveness, Private Religious Practices, Religious/Spiritual Coping,Organizational Religiousness, Values, and an Overall ranking. There isalso a section that surveys religious and spiritual history, denomination andthe amount of money contributed to religious causes. Many leading expertsin the areas of religion, spirituality and health developed this measure. Thepsychometrics suggest that this is an extremely reliable and valid instru-ment as all the sections report strong scores (Fetzer Institute, 1999).

Also, in an effort to measure religious orientation the Religious Ori-entation Scale (ROS) was used. This 26-item scale measures attitudestoward conventional religious beliefs. Low scores indicate a strongcommitment to orthodox belief and dogmatic and fundamentalist ten-dencies. Reliability is excellent with Cronbach’s Alpha scores of .91and .92 in psychometric tests (Hill & Hood, 1999). Validity has alsobeen rigorously established (Hill & Hood, 1999).

The Spiritual Well-Being Scale (SWB) was also used for comparisonpurposes with the MMRS. The SWB is one of the most widely used mea-sures in the literature and focuses on an individual’s religious well-beingand existential well-being. The overall reliability Cronbach’s alpha levelsranged from .89 to .94 indicating high reliability. The literature also sup-ports good validity though a ceiling effect can occur making it difficult todistinguish among individuals scoring high on the instrument (Hill &Hood, 1999). Because the sample was hypothesized to be of low spiritu-ality this issue was not considered to be a problem.

Chris Stewart 75

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

Additional questions were asked that surveyed clients’ perceptionsas to the importance of their religion and spirituality to their treatmentefforts. There were five questions in a 5-point Likert format that ratedspirituality and religion as important in treatment, from very importantto very unimportant. Test-retest reliability demonstrated .98 scores in apilot test.

Procedure

The VA clients were given the three measures of spirituality and reli-giosity at intake and again upon discharge. These clients completed themeasures individually or in small groups. The VA admitted clients on arotating basis that resulted in a continual admission and discharge cycle.Though this did result in different admission and discharge dates, therewas significant overlap of time and participation in group therapy topractically classify the clients as a cohort. Similarly, the women’s treat-ment group were surveyed together, as a cohort, upon admission andthen upon discharge and completion of the program approximately after30 days of treatment. The women completed the measurements during agroup therapy session.

The Drug Court clients followed a different procedure. Due to thelength of the program it was not possible to capture a cohort group asthey progressed through the various phases. It was decided that, insteadof a traditional pretest-posttest design, two collection points would beused with enough time between the points to allow significant move-ment through the phases. This was accomplished by surveying the cli-ents during the various group meetings and then repeating the procedurein 90 days. The clients also completed the measurements in a grouptherapy session. Completion of all measurements, for all treatment mo-dalities, was done on the premises of the sponsoring agency. Informedconsent was obtained from all participating clients.

Sample

There were 60 clients from the VA who participated in the study.Five were dropped from the analysis as they left treatment without com-pleting the program or the posttest. The ages of this group ranged from31- to 61-years-old. The largest age group (21%) was 47- to 53-years-old. These clients were mostly male (86%) and had a treatment history.While 15% of the sample had never received treatment, most reportedhaving treatment once (24%) or twice (23%). The majority of the sam-

76 AMERICAN JOURNAL OF PASTORAL COUNSELING

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

ple (55%) were African-American, with 44% reporting Caucasian; 35%of this group reported that religion or spirituality was important for suc-cessful treatment. The clients also reported (67%) that spirituality wasmore important for treatment than religion or religious participation.

The Drug Court program produced 65 clients who completed bothpretest and posttest measures. Three clients were dropped from analysisfor failing to complete a posttest measure with two of these individualssent to jail for failing to comply with treatment. The ages ranged from19- to 61-years-old. The largest percentage of the sample (40%) was un-der 30-years-old. The sample was heavily skewed in the gender cate-gory with 50 (77%) of the clients being male and only 15 (23%) beingfemale. The sample was also heavily weighted in the ethnicity category.African-Americans comprised 57% of the sample with Caucasian(35%) the next largest group. The majority of the clients in this program(65%) had never received previous treatment for addictions. The nextlargest category (21%) had been in treatment once with seven being thelargest number of treatment experiences.

Only 20 percent of the sample reported that spirituality or religionwas important in their treatment. In general, these clients reported(78%) that spirituality was more important to treatment than religion orreligious participation.

The women’s group consisted of 42 women. Three were removedfrom analysis for failing to complete a posttest. The ages ranged from21- to 49-years-old with fairly equal representation across all ages. Themean was 34-years-old. There was also fairly equal representation forethnicity with 44% African-American and 52% Caucasian. Treatmenthistory was balanced with 54% of the sample claiming to have receivedtreatment. Most of those women reporting previous treatment had re-ceived treatment once or twice. One woman reported having been intreatment 15 previous times.

This group felt that religion and spirituality were important for suc-cessful treatment (74%). These women also reported that participationin religion was necessary (51%) for treatment. Spirituality and religionwere often (56%) viewed as equally important elements in treatment.

RESULTS

In order to assess the change of spirituality and religiosity throughoutthe course of treatment, paired t-tests were used to measure change frompretest to posttest. The SWB, ROS and MMRS were analyzed for each

Chris Stewart 77

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

of the three different treatment programs. The two subscales for theSWB and nine dimensions of the MMRS, Daily Spiritual Experiences,Meaning, Beliefs, Forgiveness, Private Religious Practices, Reli-gious/Spiritual Coping, Organizational Religiousness, Values and theOverall ranking, were analyzed separately. In addition, two questionsthat measured the individuals’ perceptions of how religious and spiri-tual they considered themselves were analyzed as single items. TheVA clients did not significantly change on any of the 14 pairs. Theclosest factors approaching significance were Forgiveness (t (54) =1.895, p = .064) and the Social Well Being subscale of the SWB (t (54) =1.772, p = .082).

The Drug Court clients demonstrated even less significant results.None of the scales even approached significance. The Women’sTreatment group did have the Forgiveness scale demonstrate signifi-cance (t (38) = 2.45, p = .04). This effect disappeared, however, whena Bonferroni’s correction was used to control for the possibility offamily-wise error due to the large number of pairs being tested.

The next issue was to determine if there was any differentiation onthe scales between the different types of programs. An ANOVA wasrun with the 14 scales to determine if any differences were presentamong the treatment groups. Several overall models were significant.The question that measured the client’s perception of religiousnesswas significant overall (F (2, 310) = 7.88, p = .000), as was the ROSscore (F (2, 310) = 10.600, p = .000). The overall SWB scores weresignificant (F (2, 310) = 4.03, p = .019) along with the Religious SWBsubscale (F (2, 310) = 6.071, p = .003). The MMRS also had severalscales that proved significant. Private Religious practices (F (2, 310) =5.749, p = .004), Religious Values (F (2, 310) = 4.55, p = .012, Organi-zational Religiousness (F (2, 310) = 4.85, p = .009), Religious andSpiritual Coping (F (2, 310) = 4.93, p = .008), Spiritual Beliefs (F (2,310) = 4.22, p = .016), and Spiritual Meaning in Life (F (2, 310) =10.003, p = .000) were significant in differentiating the three treatmentgroups.

Tukey post hoc comparisons were performed to determine the sourceof the differences. The means and standard deviations of the significantscales are presented in Table 1. The perception of religiousness found amean difference (�.4241) to be significant in differentiating the VATreatment Group from the Drug Court clients. The overall SWB score,with a mean difference (�8.367), distinguished the Drug Court clientsfrom the Women’s Treatment group. The Drug Court was significantlydifferent from the other two groups on the RWB subscale with mean

78 AMERICAN JOURNAL OF PASTORAL COUNSELING

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

differences of (�5.079) for the Women’s Group and (�3.653) for theVA Treatment group. The ROS score also had the Drug Court with sig-nificant mean differences when compared to the VA (8.301) and theWomen’s Group (5.896).

The Drug Court clients were also significantly different from theother programs in analysis of the different MMRS subscales. The DrugCourt was different from the VA Treatment group with a mean differ-ence of (2.789) with Private Religious Practices, and also with the Reli-gious Values scale (.8652). Both the Women’s Group (�3.40) and theVA Treatment clients (�2.933) demonstrated significant mean differ-ences from the Drug court clients on the Organizational Religiousness

Chris Stewart 79

TABLE 1. Descriptive Statistics for ANOVA Post Hoc Tests

Variable Location Mean SDPerceived Religiousness Drug Court 2.66 .802

Women’s Group 2.56 .754VA 2.24 .782

SWB Drug Court 51.25 14.9Women’s Group 42.88 13.87

VA 46.00 17.07RWB(Subscale) Drug Court 24.13 8.72

Women’s Group 19.06 8.68VA 20.48 8.45

ROS Drug Court 70.19 12.17Women’s Group 64.29 11.86

VA 61.88 12.65Private Religious Practices Drug Court 16.65 6.36

Women’s Group 13.97 6.63VA 13.86 5.96

Religious Values Drug Court 7.81 1.98Women’s Group 7.54 2.46

VA 6.95 1.97Organizational Religiousness Drug Court 23.33 6.64

Women’s Group 26.73 7.91VA 26.27 1.97

Religious and Spiritual Coping Drug Court 19.67 5.58Women’s Group 18.33 6.11

VA 19.67 5.51Spiritual Meaning in Life Drug Court 74.14 13.78

Women’s Group 83.42 12.69VA 80.23 11.37

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

scale. The Women’s Treatment group was distinguished from the Drugcourt clients on both the Religious and Spiritual Coping scale (3.145)and the Spiritual Beliefs scale (1.61). Finally, the Drug Court demon-strated significant mean differences from both the VA (�6.69) and theWomen’s Group (�9.28) on the Spiritual Meaning in Life scale.

The last question was framed to discover if any demographic vari-ables were able to predict the religious or spirituality scale scores. Thiswas accomplished through a series of Linear Regression Models. Anal-yses were conducted with the sample divided by location, VA, DrugTreatment and Women’s Group, and together as a single sample. Thedependent variables were the scores of the religious and spiritualityscales. The independent variables were demographic variables that in-cluded ethnicity, age, gender, treatment history, drug of choice, treat-ment location, whether a client had reported that religion and spirit-uality were important for successful treatment, and whether a client hadreported that religion and spirituality were important in life. None ofthe models demonstrated significant results.

DISCUSSION AND IMPLICATIONS

The first issue of change during treatment received little support fromthese results. Two of the three programs utilize the 12-step principles thatclaim an integral spiritual component, yet no evidence to suggest a spiri-tual change was found (Green, Fullilove & Fullilove, 1998; Schaler,1997). Though no follow-up was conducted to determine the length oftime these clients remained abstinent and a significant number of themmay relapse, it was expected that some indication of change would occurduring the course of treatment. It is also interesting to note that theWomen’s Group, which did not closely follow the 12-step principles,also did not change during the course of treatment. These results suggestthat clients entering with strong beliefs and practices usually rely on theseprinciples to enhance successful treatment. Similarly, individuals withlower degrees of religiosity and spirituality still complete treatment butperhaps rely on other mechanisms and tend to ignore the spiritual compo-nent of treatment programs.

The second set of results concerns the differentiation of the differentmodalities. The Drug Court clients tended to be significantly less reli-gious, both in practices and beliefs, than either of the other locations.This group was less religiously conservative, had fewer private reli-gious practices and espoused fewer values influenced by religious be-

80 AMERICAN JOURNAL OF PASTORAL COUNSELING

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

liefs. Conversely, this group generally used spiritual ideals to help copewith stressful life situations. These results may be influenced by the factthat a majority of the clients in the Drug Court program had never re-ceived treatment for addictions. It is possible that as individuals receivenumerous treatment sessions they become more indoctrinated to thelanguage and are able to identify the importance of the spiritual compo-nent of treatment. It is also possible that the spiritual awakening occursnot during a single treatment episode but between episodes.

The most religious group was the Women’s Group. Though therewas no significant differentiation between the women and the clientsfrom the VA, the women tended to score higher on the religiosity vari-ables and lower on the spirituality variables than the VA clients. This issupported by the results from the questions measuring the importance ofreligion and spirituality to successful treatment. The Women’s Grouptended to report that religion and spirituality were identical constructs.This is in stark contrast to the other locations, comprised primarily ofmen, which felt that there was a definite difference between religion andspirituality and that spirituality was more important to treatment efforts.

The last issue to be considered was the prediction of religion and spiri-tuality scores by demographic characteristics. It is not terribly surprisingthat no characteristic or combination of characteristics was able to predictsuch scores. As with the prediction of individuals that will encounter is-sues with substance dependence, which is nearly impossible to accom-plish, it is not likely that an easy formula determining which individualsmight utilize spirituality or religion as important elements in addictiontreatment exists. This result supports the idea that spirituality and religionare complex constructs that may interact with many elements of the treat-ment forum.

The study results suggest that religion and spirituality are important fordifferent people at different places in their treatment history. Similarly,the modality seems to play a role in the effect of spirituality and religios-ity. Given the differences of those seeking treatment and the differencesamong modalities it is probably a good idea to assess clients to determinetheir level of spirituality and religiosity. Strong beliefs can be used as a re-source to increase the chance of successful treatment. Those clients withlow levels of these factors may be able to utilize other sources for supportand not become overly focused on concepts that contain little meaning.Consequently it may be able to provide a better match between client andprogram which can only improve treatment efficacy.

Chris Stewart 81

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

LIMITATIONS

Several limitations exist which require that the results be interpretedcautiously. The first concerns the sample. This was a treatment sampleof convenience. All participants in the analysis completed treatment andit is possible that those who do not complete treatment differ signifi-cantly and those analyzed do not accurately represent a larger treatmentpopulation.

It should also be noted that completion of treatment does not neces-sarily determine a successful outcome. It is possible that higher spiritu-ality and religiosity may differentiate those who relapse from those whomanage to remain sober. It does not, however, seem to be an element forsuccessful treatment completion.

Another possible limitation centers on the measurements. Thoughthe instruments used have good psychometric properties it is possiblethat there could be some measurement error. This is a complicated issueto empirically verify and not all the issues have been addressed. Thearea remains promising for research even with these limitations.

REFERENCES

Cancellaro, L., Larson, D. & Wilson, W. (1982). Religious Life of Narcotic Addicts.Southern Medical Journal, 75(10), 1166-1168.

Connors, G., Tonigan, J. & Miller, W. (1996). A Measure of Religious Background andBehavior for Use in Behavior Change Research. Psychology of Addictive Behav-iors, 10(2), 90-96.

Desmond, D. & Maddux, J. (1981). Religious Programs and Careers of Chronic HeroinUsers. American Journal of Drug and Alcohol Abuse, 8(1), 71-83.

Fetzer Institute (1999). Multidimensional Measurement of Religiousness/Spiritualityfor Use in Health Research: A Report of the Fetzer Institute/National Institute onAging Working Group. Kalamazoo, MI: Fetzer Institute.

Green, L., Fullilove, M. & Fullilove, R. (1998). Stories of Spiritual Awakenings, TheNature of Spirituality in Recovery. Journal of Substance Abuse Treatment, 15(4),325-331.

Johnsen, E. (1993). The Role of Spirituality in Recovery From Chemical Dependency.Journal of Addictions and Offender Counseling, 13, 58-61.

Koenig, H., George, L., Meador, K., Blazer, D. & Ford, S. (1994). Religious Practicesand Alcoholism in a Southern Adult Population. Hospital and Community Psychia-try, 45(3), 225-231.

Larson, D. & Wilson, W. (1980). Religious Life of Alcoholics. Southern Medical Jour-nal, 73(6), 723-727.

Miller, W. (1997). Spiritual Aspects of Addictions Treatment and Research.Mind/Body Medicine, 2(1), 37-43.

82 AMERICAN JOURNAL OF PASTORAL COUNSELING

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014

Miller, W. (1998). Researching the Spiritual Dimensions of Alcohol and Other DrugProblems. Addiction, 93(7), 979-990.

Miller, W. & Thoreson, C. (1998). Spirituality and Health. In: W. Miller (ed.), Inte-grating Spirituality in Treatment: Resources for Practitioners. Washington, D.C.:American Psychological Press.

National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health,Fetzer Institute, (1999). Conference Summary: Studying Spirituality and Alcohol.The Fetzer Institute, Kalamazoo, MI.

O’Connell, D. (1999). Spirituality’s Importance in Recovery Cannot Be Denied. Alco-holism & Drug Abuse Week, 11(47), 5.

Richard, A., Bell, D. & Carlson, J. (2000). Individual Religiosity, Moral Community,and Drug User Treatment. Journal for the Scientific Study of Religion, 39(2),240-246.

Schaler, J. (1997). Addiction Beliefs of Treatment Providers: Factors Explaining Vari-ance. Addiction Research, 4(4), 367-384.

Walker, S., Tonigan, J., Miller, W., Comer, S. & Kahlich, L. (1997). IntercessoryPrayer in the Treatment of Alcohol Abuse and Dependence: A Pilot Investigation.Alternative Therapies, 3, 79-86.

Zucker, D., Austin, F., Fair, A. & Branchey, L. (1987). Associations Between PatientReligiosity and Alcohol Attitudes and Knowledge in an Alcohol Treatment Pro-gram. The International Journal of the Addictions, 22(1), 47-53.

Chris Stewart 83

Dow

nloa

ded

by [

UQ

Lib

rary

] at

14:

39 1

8 N

ovem

ber

2014