ADDICTION IS A DISEASE CHARACTERIZED BY:

1
ADDICTION IS A DISEASE CHARACTERIZED BY

• Craving for the substance
• Impaired control over substance use
• Compulsive use
• Tolerance
• Withdrawal
• (Sawyer et al., 2003)

2
WHAT IS SPIRITUALITY?

• An individuals search for ultimate meaning in
  life.
• May be expressed through participation in a
  religion, but can be much broader than that
  encompassing family, naturalism, rationalism,
  humanism, and the arts. (Puchalski, 2003)

3
SPIRITUALITY RELATIVE TO RELIGION

• SPIRITUALITY RELIGION
• Unrelated to formal belief Formal
  beliefs/practices shared by
• system a group
• No defined roles Rituals and a form of
  governance
• Idiosyncratic Authority/leader (priest, rabbi,
  imam)
• Individual Social
• BOTH
• Sense of Transcendence
• Basis for defining purpose in life
• Extension of individuals coping resources
• Help provide meaning to suffering
• (Miller, 1998)

4
FOUR NOBLE TRUTHS

• TRUTH OF SUFFERING
• refers to the universal experience of suffering
  be it through aging, medical illness, emotional
  distress, dissatisfaction, or imperfection.
• CAUSE OF SUFFERING IS CRAVING
• craving and attachment develop for those objects
  associated with the alleviation of suffering.
• CESSATION OF SUFFERING
• is synonymous with Enlightenment or
  understanding.
• RIGHT UNDERSTANDING AND THE NOBLE EIGHTFOLD PATH
• achieving an end to suffering is possible for
  anyone who follows the path
• (Gowans, 2003)

5
SPIRITUAL SELF-SCHEMA (3-S) THERAPY FOR TREATMENT
OF ADDICTION

• Theoretical Bases
• integrates Buddhist philosophy and Cognitive
  Psychology Models
• Self Schema
• defined as a hierarchically organized system of
  knowledge and beliefs that underlie our intention
  and capacities (Singer Salovey, 1991)
• activates specific mental, verbal, and
  behavioral action sequences known as scripts and
  action plans
• scripts and action plans become automatic and
  foster continued substance use.
• Goal of 3-S Therapy
• To facilitate a shift in the clients habitual
  self-schema from addict to a spiritual
  self-schema that is consistent with abstinence
  and culminates in protection of self and others.
• (Avants Margolin, 2004)

6
ADDICT SELF SCHEMA

• Self-Attributions
• selfish, aggressive, evil, impulsive,
  irresponsible, unmerciful
• ?
• Discrepancy between actual self and desired self
• ?
• Negative affect precipitates substance use
• (Avants Margolin, 1995)

7
SPIRITUAL SELF-SCHEMA THERAPY

• The Noble Eightfold Path Trainings
• Mastery of the Mind
• Mastery of Morality
• Mastery of Wisdom
• (Avants Margolin, 2004)

8
OBJECTIVES OF TRAINING IN MASTERY OF THE MIND

• Become aware that auto pilot as governed by the
  addict self-schema causes harm in their daily
  lives.
• Apply specific strategies to develop the
  spiritual self-schema
• refocusing on their spiritual path when the
  addict self intrudes
• monitoring of automatic thoughts
• thought stopping
• self-affirmations
• visualization
• Apply Buddhist practices including
• Serenity meditation (anapanasati, in/out
  breathing)
• Mindfulness meditation
• (Avants Margolin, 2004)

9
OBJECTIVES OF TRAINING IN MASTERY OF MORALITY

• Achieve awareness of how the addict self-schema
  is associated with speech, action, and livelihood
  that causes harm to self and others.
• Develop scripts of compassion and empathy.
• Develop action plans for abstinence and risk
  prevention.
• (Avants Margolin, 2004)

10
OBJECTIVES OF TRAINING IN MASTERY OF WISDOM

• Aware that addict self is not the clients true
  nature
• Adopt 10 Buddhist paramis or values
  generosity, morality, renunciation, wisdom,
  effort, tolerance, truth, determination,
  loving-kindness, equanimity.
• Work on strengthening the application of those
  spiritual values during and between sessions,
  going to the gym.
• (Avants Margolin, 2004 Beitel et al., 2007)

11
THREE TIER SUPPORT SYSTEM AT 3-S THERAPY DISCHARGE

• Referral to a teacher/spiritual figure of the
  clients own choosing
• Continuation with spiritual lessons (Dhamma)
• Community or fellowship of like minded
  individuals (Sangha)
• (Beitel et al., 2007)

12
EVALUATION OF 3-S THERAPY

• Attendance at 3-S therapy sessions associated
  with
• ? use of intoxicants
• ? impulsivity
• ? spiritual practices (meditation and prayer)
• ? adoption of spiritual values
• (Margolin et al., 2007)

13
SPECIFIC ASPECTS OF SPIRITUALITY IMPACTED BY 3-S
THERAPY

• Feeling Gods presence
• Feeling touched by the beauty of creation
• Finding comfort and support in ones faith
• Feeling an increased sense of responsibility to
  relieve suffering in the world
• (Margolin et al., 2007, pg. 991)

14
CLIENT FEEDBACK ON 3-S THERAPY VS. STANDARD DRUG
COUNSELING

• More difficult to maintain attention during drug
  counseling
• Drug counseling was experienced as more like
  lecturing.
• Easier for them to stay engaged in 3-S because so
  varied
• Meditation was the most helpful
• (Margolin et al., 2006)

15
WORKING THE TWELVE STEPS OF ALCOHOLICS ANONYMOUS

• Admitting to powerlessness over alcohol, belief
  in a higher power and turning our will over to
  God as we understand him (steps 1,2,3).
• Making a moral inventory, admitting our wrongs to
  God and others (steps 4,5)
• Being ready and asking God to remove our
  character flaws (steps 6,7).
• Making a list of all persons harmed and making
  amends to them (steps 8,9,10).
• Contacting God through prayer and meditation
  (step 11).
• Having had a spiritual awakening as the result
  of working the above steps, carry message to
  alcoholics (step 12).
• (A.A. World Services)

16
AA SPIRITUAL EXPERIENCE

• ACTRESS PHYSICIAN
• Higher power at work Shift from feeling
  omnipotent
• led her to AA to surrender to a higher power
• Higher power also reflected Divine intervention
  at work
• in AA group members upon hitting bottom to give
• life plan and purpose
• Shedding pressures to be Feeling that he was not
  supposed
• perfect and experiencing to die but recover so
  he could
• renewed joy in life through help others
• connections with others

17
SPIRITUAL SELF-SCHEMA THERAPY ALCOHOLICS
ANONYMOUS
18
BELLEVUE SPIRITUALITY SUPPORT GROUP PROGRAM

• Theoretical Framework
• Positive Psychology (Seligman et al., 2001)
• Purpose
• To determine if patients would discuss how they
  can draw on their spiritual resources and
  strengths to enhance their recovery with support
  of hospital staff
• Format for the Meetings
• Semi-structured format applied during 1 hour
  meetings
• Lead In Questions
• Personal Do you consider yourself a spiritual
  person?
• Importance How is spirituality important in
  dealing with your illness?
• Community Are you a part of a spiritual or
  religious community?
• Utility Have you used spirituality to cope with
  your problems?
• Recovery Can spirituality play a part in your
  recovery?
• (Galanter et al., 2008)

19
BELLEVUE SPIRITUALITY GROUP EVALUATION MEANING OF
SPIRITUALITY

• Belief in a God/higher power
• Behavioral manifestations
• Prayer
• Recitation of religious or personal mantras
• Scripture reading
• Meditation
• Transformative experiences
• Revelations
• Miracles
• Rebirth
• Connection to others
• Physician-patient relationship
• Community members at large
• Active caring
• Compassion

20
BELLEVUE SPIRITUALITY GROUP EVALUATION FUNCTIONS
OF SPIRITUALITY

• Sources of inner strength/empowerment
• Reinforces optimism and equanimity in the face of
  stressful life events
• Source of hope
• Basis for treatment readiness

21
BELLEVUE SPIRITUALITY GROUP EVALUATION CLINICAL
ISSUES

• Spirituality and biomedicine are seen as
  compatible.
• Patients discussed how their belief in God and
  the power of prayer helped to bring them through
  the most difficult moments of their illnesses.
  In order to round out the discussion, the group
  leader asked what role people thought medical
  intervention also played for them, and a
  discussion ensued as people spoke in support of
  doctors care as well.
• (Galanter et al., in press)

22
BELLEVUE SPIRITUALITY GROUP EVALUATION CLINICAL
ISSUES

• Diversity in spiritual orientations is accepted.
• One patient said he was an atheist and did not
  think that religion had a place in a spirituality
  group. Another insisted that it was only through
  Jesus Christ that people are spiritual and can be
  saved. In dealing with this potential tension,
  the leader reminded people that within the
  spirituality group there is no right or wrong
  answer to peoples spiritual needs.
• (Galanter et al., in press)

23
VALUE OF AN INTERDISCIPLINARY APPROACH

• Combines and integrates multiple disciplines
  (i.e., chaplaincy, medicine, nursing, social
  work)
• Synergistic effect
• Enhances patient group cohesiveness
• Enhances quality of supervision for group
  facilitators

24
SUMMARY

• 3-S Therapy based on an integration of Buddhist
  philosophical principles and cognitive behavioral
  models has shown success in the treatment of
  addiction.
• The practice of meditation, the most highly
  regarded component of 3-S therapy, was viewed as
  transformative in that clients felt liberated
  from being enslaved to an addict lifestyle.
• Meditation techniques can strengthen spirituality
  as well as formal religious affiliation.

25
SUMMARY (continued)

• Across three different types of spirituality
  based approaches to addiction management, 3-S
  therapy, Alcoholics Anonymous, and our Bellevue
  spirituality group intervention, a number of
  themes arose in individuals characterization of
  their spiritual experiences during recovery
• Feeling the presence of God or a higher power.
• Experiencing hope for change associated with
  realizing that past actions do not determine
  future actions, rather, individuals are always
  free to choose well or poorly in their current
  situation.
• Feeling connected to others through common
  experience of suffering
• Caring for others in the form of not inflicting
  harm to themselves or others

26
SUMMARY (continued)

• RECOVERY THEMES
• Carrying the message to other individuals with
  addiction, as well as sharing their spiritual
  experiences as a means of helping others
• Experiencing new found joy in life and living in
  the moment
• Renewed comfort and support in ones faith
• The delivery of spiritually based interventions
  in health care settings by professional staff can
  be enhanced by an interdisciplinary approach (as
  opposed to a multidisciplinary approach)