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Jul 2015 by PCI College

Spirituality and Meaning in Addiction and Recovery by Eoin Stephens

Eoin Stephens, President of PCI College discusses the importance of meaning and spirituality in the treatment of addiction.

Addiction is an area of mental health and therapeutic endeavour where there has always been a strong emphasis on the issue of what can or can’t give real meaning to life. The Twelve-Step programme of Alcoholics Anonymous started this trend (inspired indirectly by Carl Jung, according to the story) by emphasising the necessity of a “spiritual awakening” as part of the recovery process, and conceptualising alcohol as a false “higher power” in the alcoholic’s life - promising meaning, but actually draining it away. This view had an enormous influence on the addiction counselling field right through the second half of the twentieth century, and the Twelve Steps became a core part of addiction counselling (sometimes the whole of it).

 

The first three steps, and the last, are probably the most relevant for our topic here:

 

1. We admitted we were powerless over alcohol - that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him. …

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

 

12-Step approaches are still influential, but have partly given way to newer, more psychologically-influenced therapy approaches, especially CBT and Motivational Interviewing. Mindfulnessbased approaches are also having an increased influence in the field. Are issues of meaning as important as ever in working Spirituality and Meaning in Addiction and Recovery Eoin Stephens with addiction problems? Does it make any difference whether we are dealing with a substance addiction such as alcoholism or a behavioural addiction such as sex addiction? These and other questions will be explored in my conference seminar on June 20th.

 

One of the main things to emphasise is that the general function of any kind of addictive object, whether an alcoholic drink, a bet, or a pornographic video, is the same - to provide the promise of a pleasurable emotional shift. Addictive objects tend to be some form of Supernormal Stimuli, promising quick, uncomplicated, reliable feelings of a various kinds: comfort, excitement, escape, confidence, etc. This emotional function becomes the meaning of the addictive object for the addicted person, in two ways. First, the object is strongly associated with these feelings. Association is a large part of what we mean by “meaning” - when we say that home means comfort and security to us, we mean that these things are very strongly associated together in our minds (through a process of experiential learning). Second, as tolerance develops, the anticipation of the “consumption” of the addictive object becomes a more powerful motivator than the actual “use” - this means that the addiction is more to the idea of porn, heroin, chocolate, etc, than it is to the thing itself.  The meaning of the substance or behaviour becomes, therefore, increasingly compelling yet increasingly false. This kind of view of addiction, increasingly supported by research in Evolutionary, Cognitive and Neuro-Psychology, meshes quite well with the AA view described above.

 

Cognitive Behavioural Therapy adds to this general perspective a more specific “Functional Analysis”, where the therapist helps Eoin Stephens College President 5 Summer 2015 and challenges the client to explore the individual meanings/ purposes/functions the addictive object has or had for them. This focus on individual, “idiosyncratic” meanings is much more central to CBT than many people are aware, and this aspect of the approach is often emphasised by Beck.  At its deepest, it can lead to a detailed Case Formulation, helping both client and therapist to gain an appropriately complex understanding of the client’s unique cognitive/emotional/behavioural world, and the experiential learning process through which it came into existence. This can, amongst other things, help clients to see the role that an addictive substance/behaviour played in their life as understandable and meaningful, even though it was ultimately destructive.

 

Carnes, amongst others, has applied the CBT model to the problem of addiction, especially in the area of sex addiction. He sees addiction, like Beck does, as a repetitive cyclical process, which he summarises as Preoccupation, Ritualisation, Acting Out, and Despair (and thence back to Preoccupation).  The Ritual stage is the most interesting for our purpose here, as it emphasises the individual, rigid, “sacred” rituals which an addict uses during the build-up to each episode of addictive use. These rituals (and the instruments necessary to carry them out e.g. a syringe, a barstool, a racing paper, a smartphone) become just as strongly associated with the anticipated emotional rewards of the ultimate addictive object as the object itself does. Therefore, as described above in relation to the objects of addiction, the rituals and their paraphernalia become imbued with an enormous amount of meaning for the addict. They become what psychology calls “salient”, i.e. they stand out from the rest of the addict’s environment; addicts would often describe them as having an aura almost of magic, of holiness, of sacredness, of spiritual significance. Perhaps the highly structured nature of 12- step meetings provides an alternative, healthier, set of significant rituals for some recovering addicts?

 

The Motivational Interviewing approach to addiction problems reminds us, amongst other things, that motivation for recovery (and away from addiction) should never be taken for granted.  Although recovery, being healthier by definition, is of course the rational option, the motivation of the active addict (or of someone in early recovery) is much more ambivalent. Human beings are motivated by things and activities that hold meaning and value for them at the particular time in question; addictive objects and rituals may be imbued with the “halo effect” described above for quite a long time, while the rewards of recovery (stability, respectability, intimacy, etc.) may seem distant and unreal rather than genuinely meaningful. Reconnection with core values has long been an emphasis of many therapeutic approaches, and MI is no exception – real motivation comes from real, felt, passion about “things that matter” to us as individuals, that hold meaning and significance (perhaps even some kind of “higher” significance, if they are to motivate us for a large part of our life).

 

In the end, though, meaning, passion, motivation and connection can only be felt “in the moment” (even supposedly abstract motivations such as justice are often associated with strong emotions, and motivations as seemingly rarefied as curiosity have been linked with the so-called “epistemic emotions” i.e. emotions associated with the pleasures of knowing and understanding).  Mindfulness, or learning to be “in the now”, is a technique originally associated with spiritual approaches such as Buddhism, but is now incorporated into many therapeutic approaches for addiction as well as for other problems, such as Mindfulness-Based Cognitive Therapy, Acceptance & Commitment Therapy, and Dialectical Behaviour Therapy.  It is seen as a key technique for teaching clients how to stay more connected with the present moment, thereby helping those struggling for recovery to reap the rewards of the simple pleasures of daily life – something everyone could benefit from, but which the recovering addict, perhaps, cannot afford to do without… As they say in AA, “One day at a time”

Eoin Stephens, MIACP, MACI (June 2015)
PCI College President

 

 

Bibliography:

Alcoholics Anonymous (1976) Alcoholics Anonymous. New York: A.A. World Services.

Barrett, D. (2010) Supernormal Stimuli: How Primal Urges Overran Their Evolutionary Purpose.W.W. Norton.

Beck, A.T., Wright, F.D., Newman, C.F. & Liese, B.S. (1993) Cognitive Therapy of Substance Abuse. New York: Guilford Press.

Carnes, P. J. (2001) Facing the Shadow: Starting Sexual & Relationship Recovery. Wickenburg, AZ: Gentle Path Press

Hayes, S.C. & Levin, M. (2012) Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions.

Context Press.

Kouimtsidis, C. et al (2007) Cognitive Behavioural Therapy in the Treatment of Addiction. Chichester: Wiley.

Kurtz, E. (1991) Not God: A History of Alcoholics Anonymous. Hazelden.

Miller, W. & Rollnick, S. (2012) Motivational Interviewing, 3rd Edition: Helping People Change. New York: Guilford.

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