Alexandre B. Laudet

1
THE ROLE OF SPIRITUALITY, FAITH AND LIFE MEANING
IN THE ADDICTION RECOVERY PROCESS

• Alexandre B. Laudet
• Center for the Study of Addiction and
  RecoveryNational Development and Research
  Institutes, Inc.
• William L. White
• Chestnut Health Systems/Lighthouse Institute
•  
• 28th Congress of the World Federation for Mental
  Health - Sept. 2005
• Funded by NIDA Grant R01 DA14409 by the Peter
  McManus Charitable Trust
• Correspondence laudet_at_ndri.org

2
BACKGROUND

• Many recovering substance users report quitting
  drugs because they wanted a better life.
• The road of recovery is perceived as the path to
  a better life
• It is a challenging and stressful path for most
  cravings, temptations to use, dealing with
  wreckage of the past, establishing a drug-free
  life (friends, employment), facing stigma and
  discrimination, self-esteem issues etc.
• There has been little research among persons in
  recovery in spite of the numbers involved, and
  most research has focused on substance use
  outcomes.

3
BACKGROUND THE RECOVERY PROCESS

•      

• Addiction conceptualized as a chronic disorder
• Recovery from a chronic disorder is a process
  that
• Unfolds over time and
• May occur in a succession of stages
• Most addiction research has used relatively
  short-term follow-ups (lt2 yrs)
• As a result, we know more about recovery
  initiation than about later stages - recovery
  maintenance and consolidation
• Likelihood of sustained recovery increases as a
  function of recovery length
• However, risk of relapse remains a reality well
  into stable recovery (3 yrs)
• Costs of return to active addiction are many and
  they are high
• Need to identify factors that promote recovery
  maintenance over the course of the process (i.e.,
  at different stages)
• Factors associated with recovery initiation and
  maintenance may differ

4
QUALITY OF LIFE and STRESS RESEARCH IN THE
ADDICTION FIELD

• The few studies on quality of life and stress
  conducted in the addiction field have typically
  recruited active users and/or HIV participants
• STRESS Findings from the few studies available
  suggest that stress levels are very high among
  active users.
• Stress is also frequently cited as a relapse
  trigger
• QUALITY OF LIFE (QOL) among active users is poor
  - as low or lower as that of patients with other
  serious chronic disorders and health conditions
  e.g., lung disease and diabetes
• Addiction treatment clients QOL significantly
  lower than that of individuals interviewed one
  week prior to cardiac surgery
• We know very little about quality of life and
  stress levels in the recovery community or as as
  a function of recovery stage

5
WHY STUDY QUALITY OF LIFE IN THE RECOVERY
COMMUNITY?

• Addicts improve when their relationships to
  work, family, and other aspects of their
  environment improve (Peele (1985)
• That is to say, quality of life is critical to
  the recovery process
• Overall, it is critical
• To identify factors that influence (enhance
  and/or threaten) QOL among recovering persons and
  buffer stress and
• To examine the role of these factors over the
  course of the recovery process

6
SPIRITUALITY, RELIGIOSITY and MEANING

• Religiosity has specific behavioral, social,
  doctrinal, and denominational characteristics
  because it involves a system of worship and
  doctrine that is shared within a group.
• Spirituality is concerned with the transcendent,
  addressing ultimate questions about lifes
  meaning, with the assumption that there is more
  to life than what we see or fully understand. ()
  While religions aim to foster and nourish the
  spiritual lifeand spirituality is often a
  salient aspect of religious participationit is
  possible to adopt the outward forms of religious
  worship and doctrine without having a strong
  relationship to the transcendent. (p. 2)
• The will to meaning- constructing meaning from
  lifes events,- is an essential human
  characteristic and an inherent part of the
  spiritual pursuit meaning provides context that
  is essential to understand and successfully cope
  with lifes difficulties

7
SPIRITUALITY, RELIGIOSITY, MEANING and HEALTH
OUTCOMES

• Scientific literature strongly supports the
  notion that spirituality and religiousness can
  enhance health and QOL.
• A large body of research has investigated the
  role of religiosity and spirituality in dealing
  with stressful situations
• In addition to enhancing QOL and to offering
  resiliency in stressful situations, spirituality
  and religiosity have also been studied in
  association with substance use behavior.
• A fairly large body of evidence shows an inverse
  relationship between involvement in religion
  (e.g., attending services, considering religious
  beliefs important) and likelihood of substance
  use across life stages

8
SPIRITUALITY, RELIGIOSITY, MEANING and ADDICTION
RECOVERY

• If religious and spiritual involvement can act as
  a protective factor, it should come as no
  surprise that it could act as a means of ridding
  oneself of an addiction
• Well-designed studies using quantitative methods
  have also documented the importance of
  spirituality to attaining and maintaining
  recovery
• A handful of long-term studies documented the
  association between increased involvement in
  religion and remission among alcoholic
  individuals.
• Evidence that among recovering individuals,
  higher levels of religious faith and spirituality
  are associated with cognitive processes
  previously linked to more positive health
  outcomes including more optimistic life
  orientation, higher resilience to stress, lower
  levels of anxiety, and positive effective coping
  skills
• Recovering persons often report that religion
  and/or spirituality are critical factors in the
  recovery process

9
STUDY OBJECTIVES and ANALYTIC PLAN

• This study addresses two primary research
  questions
• What are the roles of spirituality, faith and
  life meaning (SFLM) as a prospective predictor of
  sustained addiction recovery, quality of life and
  stress? and
• Is the contribution of SFLM to subsequent
  outcomes similar or different across recovery
  stages?
• Analytic Plan
• Multiple regression analyses with baseline level
  of outcome domain entered in Step One and
  spirituality, faith and life meaning entered in
  Step Two
• Separate regressions conducted for each of the
  three outcome domains
• For each outcome domain, separate regressions
  conducted for the total sample and for each of
  the four baseline recovery stages

10
THE PATHWAYS PROJECT 

• A five year NIH-funded investigation of factors
  associated with stable recovery over time ongoing
  in New York City
• Naturalistic prospective design Data collected 4
  times at yearly intervals
• Eligibility criteria are (1) self-reported
  abstinence of one month or longer and (2) not
  currently in residential treatment.
• Voluntary participation based on informed consent
• Semi-structured interviews lasting
  approximatively 2 hours
• Participants receive 30 for baseline interview,
  with increased stipends for follow-ups
• A baseline cohort of 354 persons in recovery from
  one month to 10 years
• 317 one-year follow-up interviews conducted, 89
  of those remaining alive (4 deceased)

11
PATHWAYS STUDY SAMPLESUMMARY

• Primarily members of inner-city ethnic,
  underserved minorities
• Long severe history of (primarily) crack and/or
  heroin use
• Almost all are polysubstance users
• Self-identified as in recovery from one month
  to 10 years
• 31 HepC and 24 HIV
• Almost all have used formal addiction treatment
  services and 12-step fellowships

12
SUBSTANCE USE PROBLEM SUBSTANCES
Primarily crack/cocaine and heroin poly-substance
users
13
SUBSTANCE USE LENGTH, SEVERITY CURRENT STATUS

•  
•  
• GENERALLY LONG SEVERE HISTORY OF POLYSUBSTANCE
  USE
• Years regular use of alcohol Mean 17.4 St. Dev
  10.6
• Years regular use of drugs Mean 18.7 St. Dev
  12.0
• Dependence Severityb Mean 11.6 St. Dev 2.4
• Time since last used (median) .
• Alcohol (median) 14 months (range .1
  to 528)
• Illicit drugs (median) 14 months (range
  1 to 231)
• b Sheehan DV Lecrubier Y (2002) Mini
  International Neuropsychiatric Interview.
  University of South Florida Tampa. Possible
  Score range 0 to 14. Primary substance only
•  

14
SUSTAINED RECOVERY _at_ F1 Total sample
15
BASELINE RECOVERY STAGES
16
SUSTAINED ABSTINENT RECOVERY AT F1 AS A FUNCTION
OF BASELINE RECOVERY STAGE
17
Why is it important to identify determinants of
stress and of QOL?

• QUALITY OF LIFE AND STRESS AS PREDICTORS OF
  SUSTAINED RECOVERY

18
Quality of life and Stress as Predictors of
sustained recovery _at_ F1 Multiple regression
findings

• Total gt 6 mos 6 - 18 mos. 18 - 36 m 3 yrs
• N 312 N 87 N 82 N 63 N 80
•   
• Length of recovery .26 .31 .26 .11 .21
• Stress .03 .23 .00 .02 .16
• Quality of life .17 .11 .14 .02 .09
• F 12.02 4.3 2.9 .21 1.2
• R2  11 14 10 1 5
• QOL SIGNIFICANT PREDICTOR OF
  RECOVERY FOR TOTAL SAMPLE
• STRESS SIGNIFICANT PREDICTOR OF
  SUSTAINED F1 RECOVERY AMONG INDIVIDUALS IN EARLY
  RECOVERY (when risk of relapse is highest)
• plt.05 plt.01 plt.001  p lt.1
  trend
•  
•  
•  

19
SFLM as prospective predictor of

• F1 recovery, quality of life, and stress

20
Baseline SFLM as Predictor of sustained recovery
_at_ F1

• Total gt 6 mos 6 - 18 mos. 18 - 36 m 3 yrs
• N 312 N 87 N 82 N 63 N 80
•  
• Step One
• BSLN recovery length .28 .29 .28 .10 .16
• F 26.5 7.5 6.9 .61 3.1
• R2  8 8 8 1 3
•  
• Step Two SFLM
• Spirituality .10 -.01 .07 .16 .01
• Religiosity .12 .35 .06 .16 -.24
• Life meaning .06 -.25 .26 .01 .35
• F 11.7 3.3 3.7 1.2 2.5
• R2  13 14 16 8 12
•  
• plt.05 plt.01 plt.001  p lt.1
  trend
•  

21
Baseline SFLM as Predictor of Quality of life _at_
F1

• Total gt 6 mos 6 - 18 mos. 18 - 36 m 3 yrs
• N 312 N 87 N 82 N 63 N 80
•  
• Step One
• Baseline QOL .33 .25 .25 .21 .39
• F 36.4 5.7 5.3 2.7 13.4
• R2 11 6 6 4 15
•  
•  
• Step Two SFLM
• Spirituality .24 .03 .32 .31 .29
• Religiosity .11 .11 .11 -.03. .12
• Life meaning .03 .09 -.21 .10 .01
• F 15.1 2.3 2.4 3.1 6.0
• R2  17 10 11 17 25
•  
• plt.05 plt.01 plt.001  p lt.1
  trend
•  

22
Baseline SFLM as Predictor of stress _at_ F1

• Total gt 6 mos 6 - 18 mos. 18 - 36 m 3 yrs
• N 312 N 87 N 82 N 63 N 80
•  
• Step One
• Baseline Stress .36 .26 .19 .54 .36
• F 44.58 6.27 2.8 24.69 11.57
• R2  13 7 3 28 13
•  
• Step Two SFLM
• Spirituality -.24 -.09 -.41 -.22 -.36
• Religiosity .03 -.01 .00 .03 .19
• Life meaning .01 .02 .23 -.04 -.13
• F 15.7 1.7 2.2 7.5 7.4
• R2   17 7 10 34 29
• plt.05 plt.01 plt.001  p lt.1
  trend
•  

23
CONCLUSIONS

• Overall, baseline levels of spirituality, faith
  and life meaning were significant predictors of
  outcomes one year later in a subset of analyses
• This is particularly true for the subgroup of
  persons in stable (3yr) at baseline.
• Meaning predicted sustained recovery in Grp 4
• Spirituality predicted higher quality of life and
  lower stress _at_ F1
• Greater baseline levels of religiosity were
  prospectively associated with poorer recovery and
  stress outcomes
• The role of SRLM seems to increase as recovery
  progresses (especially the role of spirituality
  on quality of life)

24
IMPLICATIONS

• This study is among the first to use a
  prospective quantitative design to assess
  separately the role of spirituality, religiosity
  and meaning in addiction recovery over time
• Data are consistent with previous reports and
  extend current knowledge to the role of SRLM at
  successive stages of the recovery process
• This area of inquiry is in its infancy. Research
  is needed on
• The processes underlying the role of SRLM on
  outcomes
• How recovering persons define and experience
  SRLM and
• The path to meaning/purpose over time - as
  meaning may be a useful ingredient of recovery
  capital that could be available to individuals
  who choose not to embrace spirituality/religiosity