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THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT 1 THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT: AN ARTICLE REVIEW Karen Sopchak School of Behavioral Science, Liberty University Author Note Karen Sopchak I have no known conflict of interest to disclose. Correspondence concerning this article should be addressed to Karen Sopchak Email: Ksopchak@liberty.edu

THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT 2 THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT: AN ARTICLE REVIEW Summary The article Using Prayer as an Intervention with Clients Who Are Substance Abusing and Addicted and Who Self-Identify Personal Faith in God and Prayer as Recovery Resources maintains that spirituality, faith, and prayer are essential tools when counseling addicts and alcoholics. The authors explain that a plethora of recent evidence supports this hypothesis. However, this is not a new concept to the members in the rooms of Alcoholics Anonymous and Narcotics Anonymous. In 1937, a hospital administrator wrote, “ When my head doctor, Silkworth, began to tell me of the idea of helping drunks by spirituality, I thought it was crackpot stuff, but I have changed my mind. One day, this bunch of ex-drunks of yours will fill Madison Square Garden.” (W, 1953) In the article, Juhnke et al. (2009) describe a method for integrating faith and prayer into counseling sessions with addicts and alcoholics who identify as spiritual. By developing a four- question assessment tool, the researchers determined whether clients would be interested in utilizing faith and prayer within their sessions. If a respondent answers yes to the assessment inquiries, the counselor may discuss the four methods in which prayer could be used in therapy. In 2009, the Council for Accreditation of Counseling and Other Related Education Programs (CACREP) required students to understand the role of spirituality and faith within the programs used for addictions (Junke et al., 2009). Even the ACA code of ethics notes that a client’s religious beliefs should not be discriminated against and should be considered in their care (Junke et al., 2009). The four methods the researchers incorporated in therapy were praying to identify treatment goals, praying at the start of a session, praying for the client during the session, and ending the session with prayer.

THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT 3 Most 12-step meetings begin with the preamble and the AA acceptance prayer. At the closing of the meetings, many home groups end with either the Lord’s prayer or the Serenity prayer. Just as Galanter et al. (2016) found that AA member’s prayer was associated with a relative reduction in self-reported craving and increased attention in managing emotions, Junke et al. 2009, found that participants who used prayer in their counseling sessions found it helpful and made therapy more productive. Members of the 12-step groups are not required to recite these prayers, just as the researchers caution that prayer is not appropriate for all clients and should only be used when clinically appropriate (Junke et al., 2009). There is no inherent contradiction within the research by Junke et al. 2009. However, it is essential to note that different individuals have varying interpretations and experiences with prayer in counseling and 12-step settings. Some clients and members may adhere strictly to the principle of belief in a higher power, while others may interpret or apply it differently. Additionally, external factors of differing perspectives among recovering addicts and alcoholics may lead to contrasting viewpoints and practices. Overall, the principle of spirituality and self-defined higher power remains central to 12-step groups and clinical practices for persons in recovery. Interaction As a recovering heroin addict of over ten years, this article sparked my interest. I attended both AA and NA meetings at the beginning of my recovery; however, I stopped attending after my two-year celebration. The concept of these groups is to encourage the addict or alcoholic to interact with positive role models, achieve abstinence, encourage self-efficacy and coping skills, and help prevent relapse. Sadly, the majority of meetings I attended lacked many of

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THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT 4 the core concepts of recovery and achieving abstinence. I have found that my newly regained faith, family, education, and self-awareness have been the key to long-term sobriety. Spirituality and faith, although touched on frequently in the literature and step-work, were never considered religious. The idea of a Higher Power in 12-step meetings is any power greater than oneself. For many, this is the Christian God. For others, it is nature, the connection with other addicts; even a doorknob could be someone’s higher power. The word “God” to many in recovery is a paradox. He is mentioned in the serenity prayer and four of the twelve steps. Nevertheless, unlike traditional dogmas, the 12-step program allows the members to define their concept of a higher power. The recovering addict or alcoholic is expected to follow their belief of a higher power, just as long as they respect their concept. For centuries, alcoholism and addiction were viewed as a moral problem, a lack of willpower and control. The 1930s brought about the acceptance of hospitalization and humane treatment of the addict/alcoholic rather than the demonizing mentality. In 1956, The American Medical Association noted that alcoholism was officially considered a disease (İşbilen & Mehmedoğlu, 2022). The Disease Concept of Alcoholism was published in 1960 by E.M. Jellinek, leading to the acceptance of the disease classification, and the addiction began to be explained physiologically (İşbilen & Mehmedoğlu, 2022). A medical classification was a massive win for the medical community, yet many cases showed that medical treatment alone was insufficient. Numerous treatment models, group therapy, cognitive behavioral therapy, self- help groups, and therapeutic communities began to emerge in order to help the addict and alcoholic continue their sobriety. Interestingly enough, as early as 1906, Dr. Elwood Worcester formed the Emmanuel Movement, a multidisciplinary treatment concept that addressed medical, psychological, and

THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT 5 religious treatment for addicts and alcoholics (İşbilen & Mehmedoğlu, 2022). This was the first time in America that alcoholics received both inpatient and outpatient treatment, combining the three schools of thought. Unfortunately, the paradigm dissolved when the founders of the movement retired. The doctors and psychologists that followed could not find the benefit of combining the three concepts until Bill W, one of the founders of AA, made spirituality viable in the treatment of alcoholics (İşbilen & Mehmedoğlu, 2022). One of the most quoted phrases in the AA literature is “faith without works is dead” (W & Anonymous, 1976 pp. 16, 30, 31 88, 76). In James 2:26, the bible writes, “For as the body without the spirit is dead, so faith without works is dead also ( The Holy Bible , 2002). Junke et al. 2009 argue that when half of the 12 steps mention God, it is clear that spirituality is a central theme in recovery. An addict who incorporates faith into their recovery must work for their recovery; they must abide by the concept that “faith without works is dead” (W & Anonymous, 1976, p. 16). By addressing prayer and faith in both 12-step work and personal therapy, the addict incorporates their beliefs in both settings. In the final article I read for this assignment, Grim and Grim (2019) found that 73% of addiction treatment programs use a spiritual-based model, nearly 130,000 congregation-based substance abuse programs are founded in the US, and 84% of scientific studies show that faith is a positive factor in addiction prevention. These statistics, coupled with the research by Junke et al. 2009, make it easy to conclude that incorporating faith and prayer into substance abuse prevention is an effective tool to combat relapse.

THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT 6 Application One of the best ways to incorporate spirituality and prayer in recovery is when the addict or alcoholic is experiencing cravings. Cravings are often described as an intense desire to use substances (Månsson et al., 2022). Although the concept of cravings lacks a verified definition, the concept is included in diagnostic tools such as the WHO’s International Classification of Diseases and the DSM-5 (Månsson et al., 2022). Relapse prevention and tackling cravings are essential for an addict or alcoholic to maintain sobriety. A person’s higher power and spirituality are critical tools that a counselor or sponsor can implement when an addict is struggling. In this scenario, Mark is a thirty-four-year-old veteran suffering from PTSD and severe opiate use. He has tried abstinence numerous times, including three stints in a rehabilitation center, but cannot maintain sobriety. Mark has willingly decided to try one-on-one therapy as well as the 90-90 meeting protocol. The first question I would ask Mark is if he believed in a power greater than himself and what this power meant to him personally. According to Junke et al. 2009, Clients want to pray when they believe that God exists and that he is invested in their recovery. If Mark believes in God or any form of spiritual being, I would ask if he would be open to including prayer in our sessions. Since Mark has had many failed attempts, I would ask if anyone has attempted prayer and spirituality in his recovery before. If he has, I will further inquire into how it was implemented and whether he felt any success. If he has not, I would ask if he would like to start with prayer, asking for understanding, trust, openness, and communication. This particular client suffers from a dual diagnosis, so, I would also want to make certain that he is open to utilizing prayer and spirituality for both his PTSD and addiction. The article by Junke et al. 2009, writes that a list of options should be provided. Since Mark is open to utilizing

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THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT 7 prayer, I would also ask if we might pray about his cravings at the end of the session. Incorporating versus such as 1 Peter 5:9. This verse tells us, Resist, firm in your faith, knowing that the same kinds of suffering are being experienced by your brotherhood throughout the world ( The Holy Bible , 2002). Ephesians 6:10-11 would be a fitting verse as well, “Finally, be strong in the Lord and in the strength of his might. Put on the whole armor of God, that you may be able to stand against the schemes of the devil” ( The Holy Bible , 2002). Whether he believes in God as I understand him or not, praying to his higher power gives him spiritual armor against cravings and temptations. Allowing the client to maintain control over prayer is vital (Junke et al., 2009). One thing that I would highlight with this client and others is that just because prayer was used in a particular session, it does not mean that it must be utilized in every session. Occasionally, clients who have used prayer in a particular session may choose to eliminate it from reoccurring sessions, and they should be applauded for their truthfulness (Junke et al., 2009). Lastly, I would ask Mark at his next appointment how he felt about praying and if he noticed any difference after leaving the appointment. Mark and all addicts and alcoholics need to utilize every tool in their arsenal to maintain sobriety. Unlike other psychological disorders, addiction can, and often will, result in death. People suffering from an obsession with substances often feel alone, angry, guilty, confused, and hopeless. As a counselor, it is my job to help them heal from their obsession and to pinpoint the underlying causes of their addiction. By utilizing prayer in these sessions, I am not only there for the client, but God, faith, and understanding also assist.

THE ROLE OF SPIRITUALITY AND PRAYER IN ADDICTION TREATMENT 8 References Galanter, M., Josipovic, Z., Dermatis, H., Weber, J., & Millard, M. A. (2016). An initial fMRI study on neural correlates of prayer in members of Alcoholics Anonymous. The American Journal of Drug and Alcohol Abuse , 43 (1), 44–54. https://doi.org/10.3109/00952990.2016.1141912 Grim, B. J., & Grim, M. E. (2019). Belief, behavior, and belonging: How faith is indispensable in preventing and recovering from substance abuse. Journal of Religion and Health , 58 (5), 1713–1750. https://doi.org/10.1007/s10943-019-00876-w İşbilen, N., & Mehmedoğlu, A. U. (2022). Spirituality-Based Addiction Counseling Model Proposal: Theory and Practice. SPIRITUAL PSYCHOLOGY and COUNSELING , 7 (1), 75–105. https://doi.org/10.37898/spc.2022.7.1.167 Juhnke, G. A., Watts, R. E., Guerra, N. S., & Hsieh, P. (2009). Using Prayer as an Intervention With Clients Who Are Substance Abusing and Addicted and Who Self-Identify Personal Faith in God and Prayer as Recovery Resources. Journal of Addictions & Offender Counseling , 30 (1), 16–23. https://doi.org/10.1002/j.2161-1874.2009.tb00053.x Månsson, J., Ekendahl, M., Karlsson, P., & Heimdahl Vepsä, K. (2022). Atmospheres of craving: a relational understanding of the desire to use drugs. Drugs: Education, Prevention and Policy , 1–9. https://doi.org/10.1080/09687637.2022.2142092 The Holy Bible . (2002). American Bible Society. W, B. (1953). Twelve Steps and Twelve Traditions . Google Scholar. W, B., & Anonymous, A. (1976). Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism. Alcoholics Anonymous World Services.

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