Reconciling spirituality and recovery
By Steven Diogo
In Twelve Step circles, it is widely held that spirituality is the key to recovery. But for many seeking to break the bonds of addiction, talk of spiritual matters is not a key but a barrier that threatens to block the passage to a sober life.
Despite what is presented as a wide view of spirituality in Twelve Step programs—with a focus on developing one’s own concept of a higher power—many still chafe at any mention of God, higher power or any entity that is not grounded in the physical plane. For these people, it is insufficient to draw distinctions between spirituality and religion or to substitute higher power for God. To put it in Big Book terms, they do not believe, nor are they willing to believe, that there is a power greater than themselves that is capable of solving their problems.
And yet many of these people recover. Some find ways to filter out the spiritual components. Others find support in secular alternatives. How this challenge is addressed by the newcomer and the group, sponsor or counselor is critical to success in recovery, says John Howard Prin, a recovery counselor, educator and author of three books on recovery. In his practice, Prin integrates several approaches: Twelve Step philosophy, Stage-II Recovery, cognitive behavioral therapy and positive psychology. What connects all of these approaches, Prin says, is a focus on finding purpose.
“To have a happy life, you not only have to have positive emotions that come from things like sex and eating good food,” Prin says, “but you also need to have a purpose that is authentic to you, which you are acting out for the benefit of others. Another way to put that is to serve something that is larger than you. This shifts the focus off the self and gets the recovering addict focused on the needs of others.”
Joseph Shrand emphasizes the importance of feeling valued. An instructor in psychiatry at Harvard Medical School and medical director of the CASTLE program for addicted teens at High Point Treatment Center in Brockton, Mass., Shrand says his focus is on implementing strategies that help teens recognize and support their own value and respect the value of those around them.
The theory behind this approach, called theory of mind, refers to the ability to recognize one’s mental states—beliefs, intents, desires—and to understand that others have beliefs, desires and intentions that are different from one's own. From a neurochemical perspective, theory of mind is based on the fact that the human brain is hardwired to seek and build connectedness with other people. It is this connectedness, Shrand says, that allows the addicted brain to move from the alienation of substance abuse to the joy of living as a valued member of society.
“Human beings have a natural interest in attaching to other human beings,” Shrand says. “If you think of this from an evolutionary viewpoint, this is incredibly important. When we were evolving as a species, we were not the strongest animal or the fastest animal. We were at enormous risk of being breakfast for some other creature. So we evolved this ability to form social networks.”
Shrand explains that if we see ourselves as valued, we are much less likely to worry about whether we have a place in the group or are in danger of being cast out and, from an evolutionary viewpoint, becoming lunch.
From an Alcoholics Anonymous (AA) perspective, this mirrors the action of Steps 4 through 9, which are designed to clear away shame and resentment and help the individual recognize his or her worth or value. Further, the Twelve Step focus on helping others reinforces this sense of value, says Prin.
By understanding the neurochemistry involved in addiction and recovery and by implementing cognitive-behavioral therapies to encourage thoughts, feelings, beliefs and actions that support the shift to proper neurochemical function, Shrand says scientists can see the recovery process—maybe even the spiritual experience—at work.
The God Hormone
Modern neuroscience has shown that all addiction is grounded in the effect of addictive substances on the neurotransmitter dopamine, a chemical in the brain that controls the sense of immediate pleasure. Biting into a good steak or having an orgasm triggers a release of dopamine. So do alcohol, cocaine, heroin, nicotine and all other addictive substances, only at much higher degrees.
But it is a different neurotransmitter, called oxytocin, which triggers the sense of lasting pleasure that we call joy, well-being, contentment and connectedness. Oxytocin—sometimes called the cuddle hormone—is released during experiences of extreme connection, such as breast feeding or directly following an orgasm, but also by people in the midst of an intense religious experience, Shrand says. Dopamine acts primarily in the limbic system, the most ancient part of the human brain and the seat of impulse and memory.
Oxytocin activates components in the prefrontal cortex, the most advanced part of the brain and the realm of higher order thinking such as decision making and predicting consequences. It is also the part of the brain that analyzes other people’s reactions to us. In the addiction process, the long-lasting pleasure derived from oxytocin gets shortcircuited by the massive amounts of dopamine flooding the brain.
The brain learns to depend on dopamine, and it rewards behavior that seeks immediate pleasure rather than long-term happiness. Because the dopamine reward system was extremely important for early humans in learning what to eat and how to survive and reproduce, the brain literally reverts to a less-evolved state of existence. At a neurochemical level, the recovery process involves rebalancing the effects of dopamine and oxytocin back to their proper roles.
So from a scientific standpoint, the spiritual experience involved in recovery could be rephrased as a movement from dopamine to oxytocin or a journey from the limbic system to the prefrontal cortex. Besides being the cuddle hormone, oxytocin could be viewed as the God hormone, the chemical seat of attachment and connectedness not just to other people but also to a larger purpose and the universe.
But does the process need to be cast in spiritual terms? Or can this sense of connectedness—even the action of prayer and meditation—be viewed in non-spiritual terms? There are many who believe they can. Among them are adherents to secular alternatives to Twelve Step programs. Groups such as SMART Recovery, Secular Organizations for Sobriety and LifeRing were founded by recovering individuals who could not accept the spirituality, particularly the references to God, in Twelve Step programs.
Besides talk of God or any higher power, these groups share a common disdain for the concept of powerlessness. Secular sobriety movements view recovery as self-empowerment and view as harmful the promotion of powerlessness and dependence upon any type of higher power to fix the addict’s problem.
In an essay on the LifeRing website, Candice Shelby, associate professor of philosophy at the University of Colorado Denver, says addicts are not powerless in the sense promoted by the Twelve Steps. As a result of AA’s view of powerlessness, Shelby writes, “addicts are left feeling that they can do nothing about their condition but put themselves in the hands of others, real or imagined. This has resulted in a not-better-than-chance rate of success in treatment on most professional counts.”
Shelby argues that addicts are powerless over the effects of addictive drugs while they are high and during the period of physical withdrawal. Beyond that, she argues, what appears to be powerlessness is in fact a misunderstanding of the power of emotional versus intellectual thought.
“The very shape of our world is affected by emotional value (or meaning) inherent in those substances, which, at least in the beginning, make us feel so very good,” Shelby writes. “Places, people and things are seen as opportunities or obstacles to satisfaction, even if we refuse to acknowledge them in that light. Arguments and reasons have no power over emotion, which operates at a deeper level in our brains than does the higher reason of which we are so proud. … Recognizing the unconscious influence that emotion has in shaping their world, as well as in planning and executing their actions, can help addicts make sense out of ways of acting which would otherwise seem crazy, senseless and/or uncontrollable.”
Once this process is accomplished, Shelby argues, power is restored to the addict with no need to appeal to a higher power.
Integrating Science and Spirituality
In its simplest terms, recovery is healing. To the psychotherapist, recovery consists of the reordering of disordered beliefs, emotions and attitudes that allow the addict to participate in balanced relationships.
To the neuroscientist, it is a realignment of neurotransmitters that have been thrown out of whack by substance abuse. And to many in recovery, it is the existence of and faith in a higher power. Reconciling the spiritual aspect of recovery with the scientific may have more to do with the recovering individual’s purview rather than striking upon universal truths.
“Spirituality is part of people’s psyche, even for those who consider themselves non-religious or even non-spiritual,” says Craig S. Cashwell, a professor in the Department of Counseling and Educational Development at the University of North Carolina at Greensboro and the author of the book Integrating Spirituality and Religion into Counseling. “They could be angry at religion or centered in religion or completely apathetic toward religion, but it is part of who they are, so it has to inform how we work with them.”
Cashwell says counselors, sponsors and sober friends need to focus on working with the recovering person’s existing sense of spirituality rather than trying to teach him or her any sort of spirituality. “The conversation has to unfold in a very supporting, accepting, non-judging way,” he says.
Sherry Gaba, a licensed psychotherapist and recovery coach on VH1’s Celebrity Rehab with Dr. Drew and the author of The Law of Sobriety: Attracting Positive Energy for a Powerful Recovery, says the challenge is to meet addicts where they are and to not shame them because they are struggling with their spirituality. “We need to focus on helping them figure out what being spiritual means to them,” Gaba says.
“Use whatever it is they define as spiritual as a place to start, a sacred space to begin unleashing their spirituality. Help them create thoughts that will attract positive outcomes in their life. The wisdom is there if they take the time to listen to it.”