Few components of drug and alcohol treatment are more misunderstood than spirituality and addiction recovery.
As such, spirituality and addiction recovery can often be a tangled web that to those outside of the process seems cult-like, and to those just starting out seems confusing. But it doesn’t have to be, according to Howard Bowlin, a sober alcoholic and the spiritual adviser at Cornerstone of Recovery, an East Tennessee-based drug and alcohol treatment center. A spiritual component to the addiction recovery process, much less having a “spiritual adviser” on staff at a drug and alcohol rehab, may seem overtly religious – but in reality, it’s in line with the majority of medical facilities around the world.
“Why do trauma hospitals, why do cancer centers, why do mental health facilities have pastoral care departments and chaplains on staff? Because they do,” Bowlin says. “That is a component that much of the medical world has seen has value in the healing of patients. It’s not something we just made up. Virtually all hospitals have a pastoral care department and have chaplains on staff. Nobody is forced in any hospital to accept the care of a chaplain in their treatment, but they are available.
“They may make rounds, stick their heads in a patient’s room and ask if that patient has a minute to chat, but if that person says, ‘I want nothing to do with you,’ it doesn’t get forced on anybody. But if they want, that chaplain will sit and chat, or even say a prayer with them. It’s just a recognized part of medical care and has been for ages.”
The origins of chaplaincy
Chaplaincy, according to Father David O’Malley [2], dates back to 337 A.D., when a Roman soldier sliced his cloak in half to give part of it to a beggar on the streets of Rome. That night, he dreamed of Christ wearing half of the cloak and admonishing bystanders who gave the beggar nothing; according to legend, Martin dedicated his post-military life to working with the poor and would eventually be canonized as St. Martin of Tours, whose Catholic feast day is Nov. 11.
According to O’Malley, Martin’s cloak became a holy relic, carried into battle and used for the swearing of oaths. “The cloak was called a cappella – a cape,” O’Malley writes. “It was kept in a tent or in a building that came to be called a cappella, or chapel. The person assigned to look after this sacred relic was called the capellano or chaplain. The chaplain would control access to the sacred symbol and organise prayers and ceremonies for the community to celebrate the spirituality it signified. These were the first people to be called chaplains.”
The tradition of chaplains began first in the military but soon spread to other institutions, including health care. In contemporary American culture, according to the Association of Professional Chaplains (APC) [3], the chaplaincy movement began with the Rev. Russell Dicks, then chaplain at Wesley Memorial Hospital in Chicago, and Dr. Richard Cabot, the two of whom co-authored the 1936 work “The Art of Ministering to the Sick.” A 1940 national survey revealed that only 18 general hospitals had full-time chaplains, but over the next decade, the American Protestant Hospital Association made great strides to adopt standards of certification and encourage clinical pastoral education.
“At about the same time hospital chaplains began conversing, another group of chaplains employed in psychiatric hospitals was organized at the May, 1948 meeting of the American Psychiatric Association,” according to the APC, and “In just over a half century, chaplaincy has become a highly recognized and respected profession. Chaplaincy associations, which were initially established to create a sense of identity and accountability, have grown into well-organized professional groups that command the respect of professionals in all fields.”
At Cornerstone of Recovery, Bowlin’s official title is Spiritual Liaison, and he serves in a number of roles. As a military veteran who enlisted in the United States Marine Corps in 1966 and served for 20 years before retiring as a master gunnery sergeant and later finding his calling as an Episcopal priest (now retired), he oversees veterans groups for former members of the military who come to Cornerstone seeking drug and alcohol treatment. And he works as part of the clinical team to help patients work through the spiritual component of the recovery process.
Bowlin’s clerical background, however, belies his own rocky initial relationship with spirituality.
“I got sober in 1980, when there weren’t a lot of treatment centers available, so I did it the old-fashioned way – through (a 12 Step program),” he says. “And when I started going, I wanted nothing to do with the God thing. In fact, I almost didn’t go to my first 12 Step meeting because it was held in a church. A lot of that was ignorance – one of the guys who went told me not to worry about it, because the group just rented a room in the building – but I had a real problem with the God aspect.”
Sobriety and addiction recovery: Rooted in tradition
It’s a common reaction – even Bill Wilson, the co-founder of Alcoholics Anonymous, recoiled when confronted with spirituality as a component of sobriety: “When my head doctor, Silkworth, began to tell me of the idea of helping drunks by spirituality I thought it was crackpot stuff,” Bill writes in the A.A. book Twelve Steps and Twelve Traditions [4].
In 1934, a year before A.A. was officially established, Wilson still wasn’t convinced that a spiritual component could play a role in sobriety. By that point, he was still drinking and desperate to quit, but a visit by an old friend, Ebby Thatcher, aroused his curiosity. Like himself, Thatcher had been a raging alcoholic, but during that visit, he refused a drink:
“Disappointed but curious, I wondered what had got into the fellow. He wasn’t himself. ‘Come, what’s all this about?’ I queried. He looked straight at me. Simply, but smilingly, he said, ‘I’ve got religion.’
“I was aghast. So that was it – last summer an alcoholic crackpot; now, I suspected, a little cracked about religion.” [5] However, the change in his friend, as well as Thatcher’s declaration that would become a familiar refrain in later years in A.A. circles – that God had done for him what he could not do for himself – led to a dawning realization on Wilson’s part:
“His human will had failed. Doctors had pronounced him incurable. Society was about to lock him up. Like myself, he had admitted complete defeat. Then he had, in effect, been raised from the dead, suddenly taken from the scrap heap to a level of life better than the best he had ever known! Had this power originated in him? Obviously it had not. There had been no more power in him than there was in me at that minute; and this was none at all.”
The tipping point, Wilson continues in Alcoholics Anonymous – known as “The Big Book” in sobriety parlance – came when he pushed back against the idea that God might be that particular power: “I didn’t like the idea. I could go for such conceptions as Creative Intelligence, Universal Mind or Spirit of Nature but I resisted the thought of a Czar of the Heavens, however loving his sway might be. I have since talked with scores of men who felt the same way.
“My friend suggested what then seemed a novel idea. He said, ‘Why don’t you choose your own conception of God?’ That statement hit me hard. It melted the icy intellectual mountain in whose shadow I had lived and shivered many years. I stood in the sunlight at last.”
It was one of these groups that noted psychoanalyst Carl Jung directed a Rhode Island native, Rowland Hazard, after “Jung determined that Rowland’s case was medically hopeless, and that he could only find relief through a vital spiritual experience.” [7] Through his work with the Oxford Group, Hazard visited Thatcher, who in turn embraced its spiritual solution and carried a similar message to Wilson. While it might seem odd that Jung, the founder of analytical psychology, might prescribe a spiritual experience as a means of restoration from alcoholism, “it is consistent with Jung’s background and interest,” according to Charles Fox, writing a 2019 story for the publication The Week [8]: “Jung’s father and several uncles were clergymen, while his mother reported having ‘second sight’ and said she was visited by spirits at night. After Jung earned his MD in 1902 and joined the psychiatric hospital of the University of Zürich, he treated many difficult patients with alcohol-related problems – about 13 percent of all admissions, he said.”
The evolution of ‘spiritual, not religious’
Although Wilson would eventually break away from The Oxford Group to form A.A. as a separate organization, he took with him many of the principles to give A.A. a framework rooted in spirituality. It’s important to note that one of the reasons Wilson and other A.A. pioneers decided to part ways with The Oxford Group is because “they were aggressively evangelical,” Wilson wrote [9]. “They sought to re-vitalize the Christian message in such a way as to ‘change the world.’ Most of us alcoholics had been subjected to pressure of evangelism and we never liked it. The object of saving the world – when it was still very much in doubt if we could save ourselves – seemed better left to other people.”
Still, the Christian underpinnings of A.A. were already in place, and to outside observers, those nuances were difficult to distinguish. It’s easy, then, to understand why such direct parallels can be drawn from the spirituality of 12 Step recovery to the religious overtones of its earliest incarnations. But, as Dr. Ernest Kurtz, author of the book Not God: A History of Alcoholics Anonymous points out, the religious underpinnings didn’t turn A.A.’s earliest adherents into Christian fundamentalists: In many cases, it simply helped realign their spiritual compasses.
“As the language of the 1930s-composed A.A. ‘Big Book’ attests, most of the earliest members had been conventional but not very deep Christian believers and had, like Wilson himself, fallen away from membership and practice,” Kurtz says in a 2014 interview [10]. “The stories in the first edition of Alcoholics Anonymous confirm this, offering a picture of individuals raised in religious backgrounds who had fallen away from religious practice. But essential to their recovery, according to their stories, was a discovery of some personal power greater than themselves. This discovery of the reality of some kind of ‘Higher Power,’ some kind of beyond was, for most, the key to their newfound sobriety.”
However, Kurtz adds that at the same time, that spiritual experience led the organization’s early pioneers to “the acceptance that they did not have all the answers, even about ‘the spiritual.'” The spiritual principle of humility was key, Kurtz points out, in preventing members from holding any sort hierarchical positions of spirituality or from standing in judgment over newcomers who may come to the fellowship seeking sobriety but stand in the same skeptical spot that Wilson once found himself:
Skepticism, however, is a natural outgrowth of the general mistrust that many suffering addicts and alcoholics have. In fact, Bowlin says, it’s rare that patients he works with are outright atheist. Agnostics aren’t uncommon – men and women who believe “maybe there is, maybe there isn’t; I don’t know or, in some cases, I don’t care,” he says. But most of his work is with those who individuals who struggle with the idea of spirituality. And what he often finds, he adds, is that they can’t differentiate between spirituality and religion.
“When somebody gets referred to me by their respective treatment team because they are ‘struggling’ with spirituality, we’ll chit-chat a bit when they come into the room, and when I ask them how they’re doing spiritually, they will start by talking about their religious experiences,” he says. “So they immediately go there, even though they’ve been told since the day they walked in the door that for many people, it’s two separate things. Now, I think that’s very common here in the South – we’re in the Bible Belt, and many of our patients have had a religious component to their upbringing.
“For some of them, that’s really ingrained in them, even if they say they haven’t been to church in years. They’ll still talk about how they were saved when they were younger, how they went to Vacation Bible School and all of that, and even though it’s interesting information for background purposes, it doesn’t have anything to do with spirituality.”
And then, Bowlin adds, there is a group of individuals whose issues include childhood trauma – some of it, on occasion, inflicted in a religious setting or by individuals associated with their particular houses of worship.
“Now, they are adults, long separated from those communities, but they hear the word ‘God,’ and the trauma is right back,” Bowlin says. “It takes a lot of steady work for them to come to a different, healing understanding of a power greater than themselves.”
Spirituality and addiction recovery: A self-defined path
Understanding that spirituality is different from religion has been written about extensively in philosophical circles, but Adam Brady, writing for the website of author and alternative medicine advocate Deepak Chopra [11], puts it this way: Religion “is a personal set or institutionalized system of religious attitudes, beliefs, and practices; the service and worship of God or the supernatural,” often “based upon the lives, teachings, and beliefs of a historical or archetypal figure (e.g., Christ, Buddha, Moses, Krishna, Muhammad).”
Spirituality, on the other hand, is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred,” most often – but not always – based on the teachings of the founders of various religions.
The difference isn’t always clear, even to those who seek recovery with a strong religious background already in place.
“The hardest group I’ve ever worked with are people who actually fit a classic definition of fundamentalist – who believe their way is the only one way, and they’re so rigid that they don’t want to look at anything else,” Bowlin says. “They come from a religious background, maybe they were saved when they were 13, and they say, ‘I just don’t get this Higher Power thing.’
“And I’ll say to them, ‘What do you mean by that?’ They usually say something like, ‘Well, I hear people talking about a Higher Power, but I believe in God. What am I supposed to do?’ And I usually tell them, ‘You’re done.’ That’s their Higher Power. It doesn’t have to be any more complicated than that. ‘God as we understood Him’ means exactly what it says.”
As Kurtz points out, however, the growth of A.A. from its earlier neo-Christian origins parallels its spread to areas of the world in which Christians are the minority. By the same token, the emergence of minorities as vibrant, vocal and valid voices in all areas of life has deepened the complexities of what spirituality means, Kurtz writes [10]: “Over time, many more and different people have found sobriety in Alcoholics Anonymous – women, individuals from the LGBT community, African Americans, Hispanics, members of various ethnic groups, the partially employed and the newly unemployed, the surprisingly young and the ever older – and even beyond these artificial groupings, of course, each individual’s spirituality is the unique product of that person’s whole life.”
More importantly, the cultural experiences and backgrounds of individuals who seek a relationship between spirituality and addiction recovery often temper the way in that relationship is nurtured. In fact, as researchers William White and Alexandre Laudet point out [12], some sort of spiritual enlightenment is often crucial to the recovery process, or at least the understanding that it involves so much more than simple abstinence: “Early recovery is marked by the stressors of disengaging from alcohol and other drugs and cleaning up the debris of one’s addiction. The successful resolution of these tasks is often followed by existential panic: ‘I’m sober. Now what do I do?’ Moving through this crisis involves a transformational journey marked by major changes in character, values, identity, interpersonal relationships and lifestyle. Spirituality is a potential sense-making framework through which these transitions can be planned and retrospectively understood via story reconstruction.”
Spirituality and addiction recovery: What the research says
However, the Western idea that the realms of science and medicine must remain separate from those of faith and spirituality persist, and overcoming the general consensus, even among the health care community, that spirituality plays no therapeutic part in addiction recovery is difficult. It is not an association without scientific merit, however.
A 2017 study of more than two decades of research, published in the journal Addiction [13], was revelatory: “The religious overtones of AA continue to raise skepticism and concern in the popular media and scientific arena. Evidence now exists, however, demonstrating AA is an effective clinical and public health ally that aids addiction recovery through its ability to mobilize therapeutic mechanisms similar to those mobilized in formal treatment, but is able to do this for free over the long-term in the communities in which people live. To superficially dismiss AA as a potentially effective addiction recovery support option on the grounds that it is ‘religious’ and therefore unscientific, is inconsistent with the body of rigorous research accumulated during the past 25 years.”
Some of that research includes:
- A 2010 study of enrollees in an outpatient program [14], published in the journal Substance Use and Misuse, found that “nearly all participants agreed that integration of a voluntary spiritual discussion group into formal treatment would be preferable to currently available alternatives.”
- A paper by researchers William White and Alexandre Laudet, published in a 2006 edition of the journal Counselor Magazine [12], revealed that “there is growing evidence that spirituality can serve as an antidote for substance use disorders. The most consistent finding is that clients with higher scores on measures of spirituality are more likely to be abstinent following treatment than those with lower scores.”
- A 2000 study published in the Journal of Substance Abuse Treatment [15] revealed that “among recovering individuals, higher levels of religious faith and spirituality were associated with a more optimistic life orientation, greater perceived social support, higher resilience to stress, and lower levels of anxiety.”
- A 2013 study published in the journal Substance Use and Misuse [16] found that “changes in spiritual practices are associated with an increased abstinence from alcohol consumption among 12-step affiliates,” and that “changes in the practice of prayer and meditation … did account for increased abstinence and reduced drinking intensity.”
It’s important to note, of course, that even with the various subsets of recovery groups, there are different schools of thought when it comes to spirituality and addiction recovery, as a 2014 article in the Rhode Island Medical Journal points out [17]: “Rational Recovery argues that AA’s spirituality component should be excluded from the recovery program where the antithetical view of Celebrate Recovery movement, led by Rick Warren, author of The Purpose Driven Life, rallies for a faith-based approach and cautions against a watered-down or vague definition of the Christian God.”
Bowlin, however, has a way of cutting through the chatter of the whole addiction vs. spirituality debate:
“Don’t overcomplicate it and don’t make it more difficult than it is, because it’s really quite simple,” he says. “I like to use the analogy of a lamp when I’m doing a spirituality lecture. If a lamp is in the corner, no matter what you do, you can’t make the lamp come on until it’s plugged into a power source. It doesn’t matter to the bulb whether the power is hydro-electric, atomic, solar, wind turbine, gas-fired, coal-fired. It just needs power. The light cannot turn itself on.
“So if the problem is powerlessness – which is basically Step One – then the solution is to get some power, which is Step Two. And Step Three is just to plug it in. To me, it’s that simple.”
Re-establishing a connection to self, others and the Other
So how do spirituality and addiction recovery work? It’s all about connection, Bowlin says – but that connection is threefold.
“When we’re talking about spirituality in recovery, it has to do with a profound disconnection in three areas: one’s own self; with others; and the third is whatever you want to call it – God, the big picture, whatever you believe that we live in and are connected to and has some sort of influence in our lives,” he says. “When I’m talking about disconnection from self, it’s a loss of meaning, of purpose, of a sense of value as a human being. In addiction, we love that. With others, it could be, but it’s not limited to, family – people we once had a close relationship to in which it was mutually nurturing and all that good stuff. Again, as the disease progresses, it erodes, and in some cases, it’s totally broken.
“And the third area, I just call it the ‘other.’ It can be God; it can be nature; it can be visible or invisible or whatever is out there that nurtures us in some way so that when we lose contact with it, our lives and our spirit, if you will are diminished.”
Those who come to drug and alcohol treatment, or to the rooms of recovery, often feel that disconnect in profound ways, even if they don’t know how to articulate it. For some, as Bowlin pointed out, it’s a frayed connection to the spiritual nourishment they received through religion. For others, it’s the sense that something, some crucial component, is missing in their lives.
“These are the people who are what I call blank slates – they had no religious component to their upbringings whatsoever,” Bowlin says. “They’re not hostile to the idea, but they have no vocabulary, no experience on which to hang any sort of spiritual principles or concept of the words God or Higher Power – but if they’re willing to keep an open mind, they’re often the easiest to work with.”
Nurturing spirituality in addiction recovery doesn’t mean holding worship services in a treatment center, or reading the Bible in a non-religious 12 Step meeting. (It should be pointed out, in fact, that in the vast majority of 12 Step fellowships, the only readings allowed are those from that particular program’s approved literature.) Prayers that include the word “God” are often used to open or close meetings, and most A.A. groups close with The Lord’s Prayer, a familiar refrain in Christianity.
However, as it pertains to drug and alcohol treatment, spirituality is essentially the process of “becoming,” Bowlin says – emerging from the isolated, self-centered shell of addiction and into the light of a shared experience that’s positive, nurturing and emotionally rewarding.
“And we do that in a myriad number of ways – individual therapy, group therapy, family therapy, educational classes, for example,” he says. “It’s even done in activity therapy and fitness therapy, or at lunch, when they begin to take better care of themselves by eating a proper meal. It’s all about enriching their personal worth, value, meaning and purpose through a number of different ways.”
And the change is a palpable one that transforms individuals who come to rehab beaten and broken into individuals who have hope that their futures aren’t the forlorn and desperate dark lands they once imagined them to be while under the influence of drugs and alcohol.
“I can almost tell by walking through the parking lot how long someone has been in treatment by saying something like, ‘Wow, did you notice the flowers this morning? They’re beautiful,'” Bowlin says. “Early on, they’ll say, ‘What flowers?’ – even as they’re walking right by them. But as they start to reawaken to the world around them, they’ll notice those things and say, ‘Yeah, they’re really beautiful today.’
“Those are spiritual issues, and much of my work at Cornerstone is to help people to reconnect and get back in relationships in all those areas. If they’re willing, we have something to work with, and we tell everyone that even the Big Book says, if you can find another way that works for you, then knock yourself out.
“If what you’re doing is a valid path for you, then I’m all for it. But this is what we do.”