Sobriety, spirituality linked for teens in treatment

Increased spirituality in teens undergoing substance abuse treatment is associated with greater likelihood of abstinence (as measured by toxicology screens), increased positive social behaviors, and reduced narcissism, according to a study by researchers from The University of Akron, Case Western Reserve University (CWRU) and Baylor University.

The study -- part of CWRU's "Project SOS" and "Helping Others Live Sober" research initiatives, two ongoing studies of adolescent addiction -- explored changes in daily spiritual experiences of 195 substance-dependent adolescents, ages 14-18, who were court-referred for treatment at New Directions, the largest adolescent residential treatment facility in Northeast Ohio.

New Directions provides a range of evidence-based therapies, including cognitive-behavioral therapy, motivational enhancement therapy, group therapies, and relapse prevention and aftercare. New Directions uses the 12-step recovery program of Alcoholics Anonymous, which does not require participants to hold any particular religious beliefs.

Researchers measured "daily spiritual experiences" independently of "religious beliefs and behaviors." Daily spiritual experiences are not bound to any particular religious tradition and include reported feelings of a divine presence, inner peace or harmony, and selflessness and benevolence toward others.

The researchers found that, on the "religious beliefs and behaviors" scale, adolescents reported a range of belief orientations at intake, including atheist, agnostic, unsure, non-denominational spiritual or denominational religious. The researchers also found that most of the adolescents, regardless of their religious background or denomination, reported having more daily spiritual experiences by the end of the two month treatment period.

The study, funded by the John Templeton Foundation, is the first to include detailed measures of both spirituality and religiosity as independent variables at baseline and over the course of treatment, while controlling for background characteristics and clinical severity, says Co-Investigator Dr. Matthew T. Lee, professor and chair of sociology at The University of Akron. Professor Lee also is vice president of the Institute for Research on Unlimited Love.

Participants, most of whom were marijuana dependent (92%) with comorbid alcohol dependence (60%), were interviewed within the first 10 days of treatment and two months later at treatment discharge. Outcomes assessed included urine toxicology screens, alcohol/drug craving symptoms, clinical characteristics, global psychosocial functioning, spiritual experiences and religious behaviors.

Co-Investigator Dr. Byron R. Johnson, director of the Institute for Studies of Religion and distinguished professor of the social sciences at Baylor, notes that "although about a third of the teens self-identified as agnostic or atheist at intake, two-thirds of whom claimed a spiritual identity at discharge, a most remarkable shift."

More important, these changes strongly predicted toxicology, narcissism and positive social behavior, Lee says.

"The key message is that changes in spiritual experiences are associated with better outcomes, including lower toxicology, reduced self-centeredness, and higher levels of helping others," Lee says.

The study, one of the few involving teens participating in Alcoholics Anonymous, "supports the AA theory of addiction -- which views self-centeredness as a root cause -- and suggests that this approach would be helpful in designing treatment options for adolescents," Johnson adds.

The adolescents' capacity to become more spiritual, and overcome self-centeredness, evidences the malleability of personality and belief orientation, Lee says.

"Contrary to the conventional wisdom," he says, "personality is not relatively fixed by late adolescence, and Axis II disorders such as narcissistic personality disorder can improve. What this means is that belief orientation, like personality more generally, is malleable. Just because an adolescent is not spiritual prior to participating in the treatment project, does not mean that they are incapable of becoming spiritual. Our results demonstrate that if they do become spiritual, they will tend to have much better outcomes."

Principal Investigator Dr. Maria Pagano, associate professor of psychiatry at CWRU's School of Medicine, suggests that "changes in spirituality during treatment may serve as the 'switch' that moves youth off of the track of substance dependency and onto the track of recovery and enhanced well-being, thereby countering harmful social trends like youth unemployment and decreased volunteering that have worked against addiction recovery."

"In other words," she adds, "change is possible and spiritual experience may be the key. Hopefully our results will encourage other researchers to further explore this thesis."

The results of the investigation were presented at the Annual Meetings of the American Sociological Association in New York City this past August and will be featured in the spring 2014 issue of Alcoholism Treatment Quarterly.