Addressing Substance Abuse in the UK

CHAPTER ONE

Introduction

Substance abuse is a major problem not only in the United Kingdom (UK) but also the whole world. All over the world governments are grappling with drug-related deaths and other negative consequences of substance abuse (Heinz et al, 2010). Although prevention measures addresses the root causes of substance abuse, it is equally important to adopt treatment and recovery initiatives to help people who are already dealing with addiction. In this regard, rehabilitation plays an important role in helping addicted individuals stop compulsive drug seeking and abuse. In most cases drug addiction manifests itself as chronic disorder that requires long-term treatment with multiple interventions and regular monitoring (Powell, Shahabi, and Thoresen, 2003; Piedmont, 2003). As a result there are a number of evidence-based approaches to treatment of substance abuse problems in people. In particular, drug treatments takes the form of behavioural therapy, medications, or a combination of the two. According to the National Drug Treatment Monitoring System (NDTMS) report, there were 268,390 adults in contact with drug and alcohol services in 2017-2018, a reduction of 4 percent from the previous year in England. While the number of people entering treatment in 2017-2018 in the non-opiate and alcohol group was largely the same as the preceding year, the number of people being treated for crack cocaine increases by 18 percent in a similar period (Piedmont, 2003). The report further show that there was an estimated 589,101 adults with alcohol dependency in need of specialist treatment in the period of 2016-2017. Interestingly, the report shows that there has been a significant decline in prevalence of alcohol dependency for the last 5 years leading to 2018. In contrast, it is only one in five of alcohol dependent people in need of treatment that receive it. In essence, the fall in alcohol dependency numbers does not correspond to the provision of treatment services to those who need it. In the 2017-2018 period, a total of 121,332 individuals exited the drug and alcohol treatment system at 48 percent, a drop of 1 percent from the previous year (Heinz et al, 2010). More disturbingly, opiate clients were found to have the lowest rate of successful exits compared to non-opiate and alcohol dependent clients.

Aims

To find out the role of spirituality and Christian faith in substance misuse rehabilitation

Objectives

To carry out the study efficiently, the aim has been divided into specific objectives as shown below:

To find out the role of spirituality and Christian faith in substance misuse rehabilitation

To find out the impacts of the use of spirituality and Christian faith in substance misuse rehabilitation

To find out if spirituality and Christian faith only could assist in substance misuse rehabilitation without the use of other medical treatment methods

Research Questions

The research seeks to answer the following questions:

What is the place of spirituality and Christian faith in substance misuse rehabilitation?

Are spirituality and Christian faith the only effective ways in substance misuse rehabilitation?

Rationale of the Study

Rationale of the Study

Although there are other forms of treatment for substance misuse, spirituality has been proven to be an equally effective remedy for the problem either as sole treatment or a combination. A number of people recovering from substance misuse have frequently cited spirituality as helpful influence through the process (Heinz et al, 2010). However, little is known of the impact of spirituality and Christian faith in substance abuse recovery process. In fact, spirituality has not yet been fully recognised as a formal treatment for substance abuse problems. It follows that there is need to conduct further research in the area to realise the full potential of spirituality and Christian faith in habitation process. Despite the dearth of research in this area, there are studies that have linked spirituality to recovery and improvement in treatment outcome (Powell, Shahabi, and Thoresen, 2003; Piedmont, 2003). In some of the studies, the recovering addicts reported that spirituality was a pillar for their recovery efforts especially when they were facing changes and threatened with a relapse. Further, the Alcoholic Anonymous (AA) and Narcotic Anonymous (NA) programs are strongly associated with the use of spirituality and Christianity to facilitate recovery in addicts but there is no concrete evidence as to the effectiveness of these methods (Heinz et al, 2010). The specific problem is that most studies have examined the link between spirituality and recovery of drug addicts but not the actual impacts of the use of the phenomena in substance misuse in rehabilitation. Therefore, a knowledge gap exists as to what is the impact of spirituality and Christian faith as a method of treating substance misuse. Some publications have reported that spiritual wellbeing is associated with better adherence to treatment regiments but they have not gone as far as to examine how spirituality impacts treatment of addictions (Bukhart, Schmidt, and Hogan 2011; Burkhart, Solari-Twadell, and Haas, 2008). It follows that there is need for further research in this specific area to improve treatment options for substance misuse.

Chapter Summary

Chapter one of the study will cover a general introduction of the research highlighting its background, purpose, rationale, and justification. It further outlines and dissects the study into the specifics including the objectives, aims and the research questions. Chapter two will cover the literature review that will delve into various scholarly writings on the research topic. This chapter will critically look at the works of different authors and evaluate their relevance and contribution to the research topic. Chapter three will be about the methodology which relates to the nature of methods of study adopted in this paper. Chapter four will concern the analysis and discussion of data collected in the preceding. Finally, chapter five will conclude the paper giving appropriate recommendations.

CHAPTER TWO

Literature Review

Spirituality and Christian faith in context

Burnett (2014) defines spirituality as ‘n openness to God, nature or the universe where one can experience harmony, with truth, feelings of love…..enlightenment with as sense of meaning and purpose in life, an individual’s connection with God or the Transcendent. On the other hand the Christian faith is the belief in Jesus Christ based on the teachings of the Bible and Christianity as a religion. Both spirituality and the Christian faith intersect at some point with regard to the element of belief and faith in God or a higher or Supreme Being. Koenig (2011, 2018) in his evidence-based studies has shown that there is positive impact of faith on health and well-being of patients generally. Schoenthaler et al. (2018) demonstrates the positive impact of faith based approaches to treatment of hypertension in blacks, in his study. Other studies have also suggested that inner, spiritual aspects of healing are common in the philosophies of Taoism, Buddhism, and traditional Chinese medicine. Therefore, an integrated model of body-mind-spirit is effective in inspiring significant improvements in patients. Although the above studies may be too general, they provide a foundation for the examination whether the same applies to substance misuse rehabilitation. According to Grim and Grim (2019) spirituality is important in both the prevention and recovery from substance misuse. The authors highlights that not only are young adults involved in religion less likely to engage in substance abuse but also addicts in spiritual programs have lower risk of relapse. In particular, their study point to the effectiveness of the 12-step fellowship programme pioneered by the AA. The authors further acknowledge that faith-based organisations in the United States (US) have played a major role in combating substance abuse by running recovery programs at the congregational level, an approach that involves the addict, his family and the community in the recovery process. In essence, the use of spirituality in the recovery process of addicts is more effective than some of the federal government and state strategies. As a result, the US Department of Health and Health Services (USDHHS) has recognised the role of faith-based organisations and formed partnerships with them to fight substance misuse problem through the US Department of Health and Human Services’ Centre for Faith-Based and Neighbourhood Partnerships (US Department of Health and Human Services, 2018). Hence, the authors’ maintain that spirituality is essential in recovery programmes because of its ability to go beyond the norms in other methods of rehabilitation. Interestingly, Grim and Grim note that despite the existing evidence based research on effectiveness of spirituality in the recovery process, the USDHHS has not taken any steps to provide for a central directory for the tracking and coordination of faith based initiatives and their effectiveness.

Spirituality as a form of treatment falls under the behavioural type of treatment as opposed to medication. As a result, an addict who is vaguely spiritual may not be an indication of behaviour change. Jang and Franzen (2013) suggest that spirituality requires concrete beliefs, behaviours and a sense of belonging or meaning that will propel a change of outcomes. In this regard, the study acknowledges that the AA has all the above elements reduced into writing in its Big Book. Some of the set of beliefs required of members in the Big Book include cessation of drinking, a home group and belonging. Bray (2009), conducted a study in New Zealand involving mental health professionals who used spirituality in treating addiction and trauma patients. The author concludes that spirituality plays a significant role in developing well-being and psychological growth, promoting positive health outcomes, and integrating trauma. He recognised that even though mental health professionals work in an environment based on the medical model, there is opportunity to explore and use spirituality to help trauma and addiction patients. Wilkinson and Velten (2016) recognise at the outset that there is indeed a gap in in the literature regarding the use of faith based approaches in recovery from substance misuse. Their study concerns a programme run by a small faith-based substance abuse counselling group found in south Texas known as Pecan Hill. Accordingly, they claim that interviews conducted indicated that the methods used at Pecan Hill were successful and the use of Christianity in the process offered a clearer spiritual view that inspired hope in the participants. Interestingly, the study dismisses other faith-based programmes like AA for its vagueness and failure to direct its members to a specific spiritual being. Specifically, the study identifies the spiral model of stages of change as an element that is largely responsible for its success. Another study suggests that incorporating underlying spirituality in therapy may improve substance misuse treatment practices (Hendrickson, 2013). Hendrickson analyses the use of Religious Problem-Solving Scale (RPS) in uncovering of underlying religious beliefs of African Americans and Hispanics in the US for substance abuse addiction. In the end, the author suggests that religious beliefs could lead to easier treatment or impede the recovery process of some patients of substance abuse. In another study, the authors admit that there is there is dearth of research regarding the link between spirituality and recovery from substance use disorders. As a result they examine the above relationship by exploring the use of Spirituality, Forgiveness and Purpose (SFP) model of recovery as used by the Australian Salvation Army Rehabilitation Centre. They suggest that spirituality has a positive impact in the recovery process of addicts of substance misuse in light of the SFP model that facilitates a greater purpose and engagement in life. Further, they explain that the model exhibits spiritual belief concept that is based on self-forgiveness and perceptions of being forgiven that aid addicts in the recovery process and in effecting change to their lives. Beraldo et al. (2019) suggest that spiritually-based approaches have positive impacts in managing substance use disorders like aggressiveness in recovering addicts. Using AA as an example of a spiritual-based approached to treating alcoholism the authors suggest further that it is more beneficial for minorities like African-Americans, Latinos and Native-Americans. The authors particularly explore the use of spirituality to treat substance misuse in rural areas, where they claim it is more successful compared to urban areas.

Substance misuse in context

The misuse of substances, as well as the dependence on substances is notably not a new phenomenon. This is because there are various stories of humans who seek to alter, or rather change their moods and feelings throughout history. In accordance with the recent statistics, it is evident that approximately 24million individuals across the globe, roughly 1 in about 10 individuals who are over 12 years old depend on alcohol, as well as other drugs. Moreover, statistics also indicate that illicit drug usage in the UK has been on a higher increase rate over the years, and in figures, this was about 8.3 per cent in the year 2002, and it rose to about 9.4 per cent in the year 2013. It is worth noting that there are other indicators, which show the rise in the rate of demand for drugs, as well as the usage of those drugs (Beraldo et al., 2019). Clearly, from the year 1991 to 2011, the prescriptions written, and meant for opiate pain treatments in the UK doubled from 75 to 150 million, and the Mexican Heroin production (whereby, the UK is the largest consumer) increased from 9metric tons in the year 2005 to 50metric tons in the year 2009. Notably, the rate of devastation, as well as the impact of drug misuse and addiction is considered to be too much prominent in the present society, thus, qualifying it to be regarded as epidemic, as it is a major issue that has been calling upon debates, and even campaigns (Bray, 2019). The number of young people that are dying due to opiate overdose daily is staggering and clearly, this has captured the attention of the UK. A major concern regarding this increasing threating to the society is that amongst the 24 million that are addicted to substances such as alcohol, and other drugs, only about 11 per cent of them receive treatment. However, lack of treatment also poses as an issue that is being addressed at the national level and by many partner organizations (Burkhart et al., 2011). This paper is primarily focusing or rather, it is designed to address the treatment aspect for addictive disorders, which have proven to be significant in the recovery process of individuals who are addicted and as such, the role of spirituality is being brought under scrutiny. There are many theories, which relate to addicting that have been expounded upon by many scholars and as such, significant knowledge has been provided than in the past. However, the aspect of spirituality and its impact on addiction disorders and its related treatments remain somehow vague and also abstract, yet it is fertile for exploration, as well as examination. According to Burkhart et al. (2008), human psychological suffering, and also difficulties associated with tolerating suffering, emotional, as well as behavioural dysregulations pose at the heart of various addictive disorders and as such, no treatment is noted to be complete without the exercise of empathy and understanding of whatever addictive drugs do to a person, in order to make the addictive substances or even behaviours to be compelling. Addictive drugs often relieve human suffering and pains. As such, if an attempt is being made to provide effective treatment for various addictive disorders, then there must be an understanding of pains, as well as suffering and the manner of relieving them, for the purpose of treating addictive disorders without having to use drugs (Burkhart et al., 2008). In this regard, the impact of spirituality and Christian faith play a key component on that level of understanding, which needs to be included in treatment.

Overall, it is significant taking into account, the fact that people who are in pain or distress; whether physical, emotional, or even spiritual often look for relief from their varied discomforts through using various substances such as alcohol or even other drugs in alleviating their pain. However much these drugs are capable of numbing pain, they also have the capability of destroying relationships, and making people to isolate from others, thus, ending up addicted and lonely in their pain (Burnett, 2014). Addiction is derived from the word addicere, which is a Latin word that means having no voice or surrendering of an individual to a master. Clearly, recovery from addiction is considered to be a process of re-connecting and also taking oneself back and finding self-voice. One significant way of achieving this is through connecting to a power that is much higher, to community, family and also to mutual support groups. By connecting to various support groups, it is evident that those that seek recovery do find the strength, power, as well as the hope they need in continuing their recovery journey. Clearly, this is considered to be far from a new concept, or rather, practice, although many people have been doing it in history, during the times of sorrow, and joy (Grim & Grim, 2016). Humans do associate with others by use of a source of strength that is beyond that which they naturally possess, often referred to as spirit. In accordance with the provisions of Hodge, it is worth noting that spirituality of Christian faith is nurtured in the community. In this regard, he describes spirituality as oneness with others and this ought to spring from a common goal, hope, as well as shared memory. He stresses that it is through one another that many people find their self-worth through locating themselves within a given community of their fellow humans (Burnett, 2014). Traditionally, spirituality should be conveyed through telling stories that have been in existence and this still poses as a form of healing, especially for many individuals, and especially within various mutual support groups.

Relationship between spirituality and Christian faith and substance misuse rehabilitation

Various studies that are concerned with spirituality and its related value in the recovery process from substances misuse purpose to provide a range of perspectives, as well as definitions. However, there are many scholars who second the opinion that spirituality is an abstract and also a personal phenomenon that involves an awareness of the other, and this involves some form of meaning, as well as the connectedness with the holy, which transcends to reality (Heinz et al., 2010). Various studies do attempt to differential the notion of spirituality from Christian faith through describing the latter as beliefs and practices, which follow a given doctrine that has been set forth, whereas spirituality is thought of to be along the lines of something that is beyond self, to connect with. Spirituality and Christian faith are two concepts, which provide perspective, meaning, as well as life purpose, and this is a total restoration of whatever addiction or rather substance misuse would take away, thus, making an individual to exercise significant growth, and have the ability to be their true selves. Various scholars have been able to discover that spirituality and Christian faith are central to an individual’s care, well-being, as well as growth, which are in line with their essence of humanness. Notably, spirituality and Christian faith should not be described as a thing or even a feeling (Hendrickson, 2013). Rather, it should be described as an awareness, or paying attention to, and being present to whatever is taking place around us and also in us. Various scholars such as Koenig (2011) have studied the manner in which individuals find various meanings by telling stories, and handling everything with a focused mind that helps them see what they are part of, which is apart from any other thing in life. Other scholars have also studied the manner in which people use their stories in conveying their experiences through opening their heart, as well as minds to experience various things, which are not describable. Generally, it should be noted that regardless of the specifics revolving around the definition, literature reveals that spirituality involves people attempting to make significant sense of various life situations, thereby, aiming at providing meaning or even purpose (Hendrickson, 2013). The concepts relating to “beyond and between” have been connected to addiction and they imply that spirituality aids individuals in moving beyond self-bondage, towards a connection between oneself and others, which is found to be significant and fundamental. Such kind of research underscores the value that community presents and thus, denotes that being with others is significant, especially where individuals find acceptance. However, it is evident that other scholars have over the years discredited spirituality and its related impacts as they perceive it to be vague, abstract, and also difficult to measure and prove (Hendrickson, 2013). Regardless of whether there is lack of consensus regarding the spirituality definition, it is evident that there exists no dispute onto its prevalence, as well as importance in terms of recoveries from substance misuse. Many scholars have researched on the role that spirituality plays, especially in the 12-step recovery programs and even prior to when those programs were founded. Alcoholic Anonymous (AA) makes it clear that individuals that suffer from substance misuse could derive acceptance amongst others and thus, begin to confront the dark side (Koenig, 2018). In this regard, scholars presume that the highest spirituality levels emerge only when faced with an honest confrontation with the evil that exists in oneself. Literature also suggests that the only hope that those who misuse substances have is majorly spiritual experience. The impact that spirituality plays towards aiding the “sick-souled” in finding their way back onto a grounding or rather, connection with other meaningful relations, as well as the community is abundant in the existing literature throughout the entire history. However, it is worth noting that the impact of spirituality, whilst relating it to recovery from addiction was noted to largely become known with the prominence of the 12-step or even the mutual support groups such as AA (Lyons et al., 2011). Although the spirituality that was discovered in AA was open to personal interpretation, it was and is still considered to be the driving force that aids substance misusers to recover. In this regard, this kind of spirituality poses as a set of beliefs that holds ground against various emerging mainstream beliefs that relate to medicine, psychiatry and other conditions, which focus primarily of the causatives of addiction. Significant to note, the science-based approach purposed to replace the concept of addiction from being a spiritual sickness to a medical disease model, which guides human understanding, as well as treatment (Schoenthaler et al., 2018).

Although spirituality and various scientific schools of thoughts have been perceived as opposing forces towards recovery, and especially granted the non-professionalism of the AA, versus doctors and scientists who are medically trained. It is worth noting that integrating both approaches gives a significant understanding that aids in recovery from addiction. Moreover, according to research, three quarter of those that are under recovery often report that they are using spiritual practices (Schoenthaler et al., 2018). However, it is evident that much of such research focus on evidence-based practices, and as such, a little attention has been paid to the aspects of recovery related to spirituality. Owing to the fact that lack of studies focus on the value of spirituality in recovery from substance misuse, this is noted to be due to multiple interpretations of the aspect of spirituality, as it is vagary and involve intangibility. Clearly, this trend appears to be dynamic, and it is evident that more studies are focusing on the value, as well as impact of spirituality in the literature. As per the provisions of the literature, there is a significant emphasis on the integration of spirituality in treatment for sick individuals and those addicted to substances. A focus on the history, it is worth noting that the 12-step groups (AA) of the aspects of spiritual recovery highlight that exercising some kind of spiritual awakening that result from practicing the steps. This allows addicts to be able to reconnect with other individuals in the community in in their interpersonal relationships, thereby, providing significant meaning to their lives (U.S. Department of Health & Human Services (HHS) (2018). Within the context of the Jung’s framework of high spirituality, it relates to the requirement for low need for substances in life management, and as such, low spirituality influences the requirement or rather, need for substances. Significantly, the findings of this research supports previous findings regarding the value that is associated with spirituality, it cited that 95 per cent of those that were in a treatment environment volunteered to participate wanted to learn and even talk about spirituality as an aspect that many claimed they lacked, for them to feely whole once again (Wilkinson & Velten, 2013). Clearly, others have as well noted that spirituality is a key construct in addiction treatment and many addicts often make it clear that when their spiritual relationship, as well as connectedness to the world is closed, then their recovery process is significantly reconnected. Moreover, in the study conducted regarding the Native American Culture with regards to substance misuse, a report was made, which stresses that rehabilitation requires the healing of the spirit, body, as well as the mind within a larger community (Koenig, 2011).

CHAPTER THREE

Introduction

This chapter purposes to rise above the provided theory to provide a significant methodological approach by which data was collected. In doing this, there ought to be a link between the theoretical concepts and the research problem, in line with measurable notions. Notably, the subject displayed in this chapter will be concerned with the approaches that were used in the research and this will include the research techniques, as well as the methodologies in the collection of data. This chapter will significantly compare and contrast various studies, as its primary focus will be to conduct a secondary research.

Methods used in deriving the articles

In an attempt to search for the articles for this study, the researcher searched three databases, which included PubMed, PsychInfo, and CINAHL. Considering PubMed, and PsychInfo, it should be noted that these electronic databases aided in deriving significant and relevant information, which related to spirituality and substance misuse rehabilitation. Moreover, it is evident that they have more than a million references for most of the international journals. Most importantly, is the fact that these electronic databases often receive frequent information updates. Needless to forget is that the databases also cover extensive subjects, which relate to the subject at hand and records have it that they entail indexes, which contain substance misuse rehabilitation headings, and provide a significant criterion useful in the search for standardized terms (Heaton, 2004). On the other hand, it is evident that CINAHL contains a significantly unique content. It contains pre-viewed journals, and smart tools, which assist in the tracking, and the analysis of various other researches that are useful in the psychology field, social sciences, as well as health sciences. Based on the opinion that various researches have already been regarded as interdisciplinary, it is clear that CINAHL make is possible for researchers to get relevant, as well as obtainable researchers that are analytical and critical. Overall, it is worth noting that the database has abstracts, psychological web pages, and even peer-reviewed journals (Trzesniewski et al., 2011).

Criteria for inclusion and exclusion

Inclusion criteria

The inclusion criteria primarily focused on articles that had significant relevancy, credibility, as well as coherence of arguments as they were presented by various authors. Moreover, the selection also focused on articles that had extensive content, and as such, their abstracts and even titles had to be reviewed. Most significantly, the journal articles, which were included had to focus primarily on the subject of the impact of spirituality and Christian faith on substance misuse rehabilitation. In this regard, this study only included journals that were published in a span of 20 years, and that is not more than 20 years ago (not earlier than 2000). Essentially, the study also included articles that were communicated only in the English language. Other inclusion factors included studies, whose articles had randomized control trials, cross-sectional studies, and even quasi-experimental. In this regard, it should be notes that the studies that were included had to significantly purpose on evaluating the impact of spirituality and Christian faith on substance misuse rehabilitation by focusing either on qualitative or even quantitative methodology. In addition, the study also included articles that supported the fact that spirituality and Christian faith are important components in substance misuse rehabilitation. Finally, this study also included studies that had the intervention of the AA support program and the non-AA support program.

Exclusion criteria

Of great importance to note firstly is that this study excluded studies, which were published long time ago, and that is more than 20 years ago. Moreover, it should be noted that there was also an exclusion of studies, which did not have their primary research data. Other studies that were also excluded are those that were not in line with the subject of discussion, and in this case, it is evident that they failed in focusing on spirituality and Christian faith and its relevance towards substance misuse rehabilitation. Needless to forget, the exclusion also was directed to studies that were not communicated in the English language, and also excluded studies that had a broad intervention, wherefore, other than spirituality and Christian faith, they focused on other treatment measures for the rehabilitation of addicts.

CHAPTER FOUR

Results and Discussion

Introduction

Whilst putting into consideration the provisions of the previous chapter, it is evident that this chapter aims at providing the findings that were derived from the selected journal articles that were included in the study. This will aid in answering the research question, meeting the objectives of the study and ultimately, the aim of the study. Thereafter, this chapter will provide the discussion for the findings.

Search results

Significantly, the systematic search on the electronic databases produced 450 records. It is significant to take note of the fact that this initial search was carried out with an aim of providing significant source documents, which were based on various systematic reviews and as it had been anticipated, it is worth noting that the search produced hits, that were relevant for this study. Whilst refining the produced results, 150 articles were significantly eliminated, or rather, excluded because of duplication and as such, the researcher was only left with 300 articles, which then had to be screened. Significantly, some databases enables the articles to be taken to excel whilst others failed to allow direct export. In this regard, the process of screening was carried out simultaneously. As such, there was the exclusion of 175 articles, based on the opinion that they failed to have primary researches as this purposed to be a mandatory factor for inclusion. The remaining articles were then 25. They were then taken for significant and critical assessment for their content, in a bid to ascertaining whether they were eligible for inclusion fully. As such, 18 articles were excluded because it was discovered that their full contexts failed in providing a detailed discussion on spirituality and Christian faith on substance misuse rehabilitation. At the end, only 7 articles were obtained for this study, and this is as presented in the flow chart below:

AA/12-Step Programs

In 4 studies, substance misuse rehabilitation was researched in the context of A/12-step programs and these included Zemore, 2007; Hendricks et al., 2003; Murray et al., 2003; as well as Kaskutas et al., 2003. In this regard, it is worth noting that the substance misuse outcomes included the sobriety length, specifically the abstinence for any time length. Murray et al. (2003) also significantly expounded on the consequences that are associated with alcoholic drinking. Overall, it is worth noting that the findings that were derived from these studies were mixed, wherefore positive significant relationships, were also observed between spirituality and abstinence. Zemore et al. (2007) noted that although the religious baseline that was measured via a religious background and Behaviour scale (RBB) failed in predicting a 30 day sobriety as at 12 months, spirituality and Christian faith scores did. In this regard, he noted that spiritual change purposed to function, as a significant partial median whilst putting into a consideration, the relationship that existed between the 12-step involvement and the 30 day sobriety. Significant to note, is that spiritual awakening was as well assessed by Kaskutas et al. (2003), who purposed to interview 587 interviewees at a given treatment entry. These scholars discovered that spiritual awakening was somehow associated with abstinence in the third year, as compared to the participants who did not report spiritual awakening. Moreover, it was evident that the participants who reported spiritual awakening also reported continuous abstinence. In this regard, the religious beliefs at the baseline did not in any way associate with abstinence. However, when measured as a single item in the RBB scale, it is worth noting that religion was classified individuals as being atheists, spiritual, agnostic or even “unsure.” Three of the studies found out a concept in gender difference. In Hendricks and his colleague’s study, they purposed to compare the views of 35 married couples (comprising of an alcoholic husband and the spouse), the spirituality of the husband was not in any way significantly associated with his sobriety length. However, the general spirituality of the wife was significantly and in a positive way, related to her report, regarding the sobriety of the husband.. In the investigation conducted by Murray et al., it was discovered that spiritual importance purposes to significantly correlate with a significant locus of control, especially for women but this can only be approached with a statistical significance for men. Notably, for the total group, it is evident that the locus of control was not in any way related to sobriety. However, various multivariate analyses were not carried out and as such, gender impacts could not be significantly determined. In a similar way, in bivariate analyses, it is evident that spiritual openness, as well as religious practice were noted to be significantly only for men but were not in any way related to the multivariate analyses. Overall, these investigations significantly acknowledged that gender is a possible moderator for various relationships between abstinence and spirituality.

Non-AA/12-Step Programs

Three studies were carried out outside the AA/12-step programs context. Of the three, just one was solely focusing on individuals with alcohol abuse. The three studies included Krentzman et al., 2010; Stewart et al., 2008; and Chu & Sung, 2009. It is significant to note that these studies focused on varied treatment outcomes, wherefore, the most common outcome that was investigated was abstinence, followed in by the retention time or time of treatment, discharge status and the efficacy of abstinence. Moreover, it should be noted that the findings were mixed, especially for the alcohol-only, than for the poly-substance group.

Alcohol Only

In the alcohol only groups, spirituality and Christian faith was significantly related to sobriety. However, the relationship depended on the manner in which such concepts were measured. In the study conducted by Stewart et al. (2008), participants that had reported ‘regular practise of self-faith’ were more likely to achieve the aspect of abstinence in a period of three months. However, spirituality as it is often measured by the adapted Intrinsic Religion Motivation Scale, it stresses that it does not relate to sobriety. As measured by the RBB, spirituality questionnaire was associated with a small but rather, significant increase in the rate of continuous sobriety in a period of 6 months as provided by the investigation of Krentzman et al.’s (2010). Similarly, public spiritual practices, as well as the existential well-being are related to continuous abstinence for a period of one years, whereas private spiritual practices, religious well-being, and even intrinsic religiosity are not (Chu & Sung, 2009). Based on the study conducted by Krentzman et al. it is significant to note that spirituality is as well associated with sobriety at approximately 15months. However, this was not associated with the outcome derived in the study of Stewart et al. Spirituality has significantly been operationalized by Krentzman et al., in line with the purpose in Life (PIL) scale, whilst Stewart utilized the 13 item spiritual support sub-scale provided for the spiritual experience index. Notably, the purpose in life scale does not mention God nor any other higher power. Significant to note, Stewart et al. also purposed to include this measure, yet failed to operationalize it to be of spirituality and thus, discovered that it was not significantly related to the aspect of abstinence at a period of 3 months. Stewart et al. made an observation that the statistical importance of regular practice of spirituality applied to women, yet had a significant impact for men. Krentzman et al, based on their secondary analysis that was concerned with project match data, they noted that race is a significant moderator, especially for spirituality. In this regard, for each unit that increased above the purpose in Life scale, blacks were noted to be 4.4 per cent more likely as compared to whites, to be sober within a period of 15 months. Generally, these studies noted that individuals that have a lower spirituality, which was matched with a less spiritual program were most likely to be terminated from treatment at a premature time. Moreover, regarding the abstinence efficacy, it is worth noting that individuals that were not spiritual at the time of admission were provided with spiritual oriented kind of treatment, and as such, they did not have a poor treatment outcome. However, those who were considered to be less spiritual and as such, significantly matched did not have low scores in terms of abstinence efficacy. The findings were noted to be similar for the desire of the participants to drink.

Polysubstance

Analysis of the findings made it clear that in order to have a typical program for drug treatment, the spirituality of an individual does not significantly correlate with the critical retention, which is defined to be 90 days. Findings also reveal that spiritual beliefs do not predict less drug use upon controlling before jail terms. Instead, the major predictor is whether the victim is still in treatment, wherefore, those who are still in treatment have less drug use as compared to those in prison or in the community. Amongst the studies that suggested partial support, it is worth noting that two included significant treatment outcomes, which targeted drug use severity, rather than just total abstinence (Stwart, 2008). Spirituality at intake is noted not to relate to substance misuse at 6 months upon discharge. However, the results presented varied, based on the primary substance problem of an individual. Among those who use crack cocaine, it is worth noting that increasing the attendance in church from a baseline level to follow-up was associated with less reports being made regarding drug use. Amongst individuals who alcohol was their major problem, it is evident that increasing the attendance in church and increasing of the 12-step program attendance posed as significant predictors for reducing alcohol usage. Notably, there was no major predictor for drugs such as marijuana. Stewart et al. (2008) utilized significant sub-scales and as such, separately analysed two significant questions, based on the scales. Clearly, the questions purposed to ask the participants whether they were religious or spiritual individuals and he noted that different sub-scales related to different kind of treatment outcomes. In this regard, for drug use severity, it is worth noting that the ‘meaning’ and even the ‘religious as well as spiritual coping’ sub-scales were noted to be significant. Moreover, the treatment history was noted to be significant and purposed to significantly interact with the ‘meaning’ subscale, wherefore the participants without any form of previous treatment history had great changes in terms of their spirituality scores (Stwart, 2008).

Discussion

The primary purpose of this literature review was to provide an exploration of the impacts of spirituality and Christian faith to the recovery process associated with substance misuse. In the 7 studies that have been reviewed, it is worth noting that the most common form of treatment was noted to be abstinence, and this is particularly when alcohol is put into consideration. Significantly, abstinence could be a measure of a sobriety length or even abstinence for a given period of time. Overall, it should be noted that regardless of the manner in which abstinence was measured, there purposed to be a mix of both supportive and non-supportive findings. Nevertheless, it is certain that evidence suggests some support for a significant relationship between spirituality and Christian faith and recovery from substance misuse (Stwart, 2008). Owing to the fact that there is no commonly accepted definitions of spirituality and religion, it is worth noting that differentiating between the two terms has posed an ongoing concern, especially in this study area. As it had been previously stated, this review clearly separated spirituality as a sense of belonging to a given realm of experience or even a belief, whereas religiousness purposes to incorporate a formal approach towards faith whilst emphasizing on faith practices (Bray, 2019). Notably, the current review was not able to compare spirituality and religion, owing to the different approaches used in operationalizing and undifferentiating the combination of spirituality and religion in one single study. Notably, the studies that utilized the AA or rather, the 12-step programs as a sample method or even a recovery program significantly identified spirituality to be a positive influence on recovery from substance misuse. Participants in such kind of programs attended meetings in varied places in different times of the day to once in 7 days. In the studies presented, it is evident that accounting for the meeting attendance frequency was not feasible, owing to the nature of the participation of individuals in AA (Burnett, 2014). Additionally, considering a universally comprehensible spiritual basis for these kind of programs, it is a major concern that these kinds of programs are significantly connected by a self-selection bias. As such, it is hard determining whether the observed relationships were, owing to the structure of the given program or the growth in spirituality of the participants. The characteristics of the participants are significant in the analysis. However, gender or even race are often not described. In an instance where either of these kind of variables have been examined, spirituality then purposes to influence on the outcome of the treatment, and this at times varies as a result (Chu and Sung, 2009). Significant to note is that in most of the examined studies, treatment participants were noted to be middle-aged. Adults who are aged 18-25years have high rates of dependence on substance and abuse amongst all the adult age groups. Unfortunately, it is evident that this age group was presented poorly in the studies. The measurement tools used in the studies were reliable and also valid. Some studies that were carried out, conducted secondary analyses such as the study of Zemore (2007) who purposed to use the data that had been used from previous trials. In line with this, is also the study of Chu and Sung (2009) that utilized data from DATOS study. Clearly, their utilization in previously collected data significantly restricted their analysis depth. Additionally, many of the 7 studies incorporated just a measure, item and even a subscale. Utilization of multiple spirituality measures showed a partially supportive connection between spirituality and the outcome of treatments and this illustrates the complexity of this kind of relationship. Furthermore, in most of the studies, spirituality was examined just at a baseline. In the studies that used a single measurements as a data point, it is evident that it was difficult assessing the effect of spirituality growth over the course of even after the recovery program. Some studies’ measures were not regarded as significant. However in spirituality over time was noted to be significant. One of the inclusion criteria in this study was that the study had to examine substance misuse. AA studies significantly focused on the abuse of alcohol whilst other studies focused on many other substances and this had an inclusion, yet not limited to cocaine, pain medications, and even heroin. Notably, marijuana was noted to be seldom identified in the review studies as a particular substance being misused, yet it is commonly abused substance in the US. Consequently, there was no results that provided significant insight into the impact of spirituality and Christian faith on the marijuana, yet it is a commonly abused substance.

CHAPTER FIVE

Conclusion

This systematic review provides the impact of spirituality on substance misuse and this has primarily focused on adolescents and adults. Research indicates and suggests that nurses in all healthcare aspects should be aware of various characteristics associated with substance misuse and the existing link between the conditions and spirituality and Christian faith as a significant adjunct to treatment. Notably, spiritual well-being is presently being associated with better adherence to various regimens of treatment. Initial nursing assessments do include psychosocial questions regarding substance misuse, as well as religious preference. Including the impact of spirituality in the life of an individual may as well be useful in the creation of a ‘plan of care’ for an individual. Holistic healthcare providers and nurses have over the time considered various aspects of a patient and this includes the presence or the absence of the aspect of spirituality in their life. However, it is evident that the ability of defining spirituality poses a difficulty. Further research, based on the agreement and standardization of the different definitions associated with spiritual assessment, as well as inclusion of this research study in terms of nursing education are noted to be necessary. Notably, long-term sobriety from substance misuse poses as a lifelong process. Significantly, there are numerous factors, which contribute to failure and even success. DATOS, having been funded by the National Institute on Drug Abuse, significantly included spiritual support, as well as religion as motivating factors towards recovery. In a similar way, the success of AA also is in support of this opinion. Healthcare practitioners working in all healthcare aspects ought to recognize this connection and as such, incorporate it into all days’ practices. Overall, although there are other forms of treatment for substance misuse, spirituality has been proven to be an equally effective remedy for the problem either as sole treatment or a combination. A number of people recovering from substance misuse have frequently cited spirituality as helpful influence through the process. However, little is known of the impact of spirituality and Christian faith in substance abuse recovery process. In fact, spirituality has not yet been fully recognised as a formal treatment for substance abuse problems. It follows that there is need to conduct further research in the area to realise the full potential of spirituality and Christian faith in habitation process.

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