Religiousness, Spirituality, and Addiction: An Evidence-Based Review

Definitions of Religiosity and Spirituality

Now the whole earth had one language and a common speech…let us go down and confuse their language so they will not understand each other…That is why it was called Babel—because there the Lord confused the language of the whole world. Genesis 11

The struggle of defining spirituality and religiosity makes it clear how far we have come from a universally understood language. Researchers and practitioners posit opinions on how to define these constructs; the diversity in meanings clearly echoes the confusion, disagreement, and lack of productivity described in the book of Genesis. Zinnbauer and Pargament have aptly called these terms the “definitional tower of Babel.” As Zinnbauer and Pargament wrote regarding those in the field who study spirituality and religion, “[We] can agree on one thing: we have never agreed about anything” (p. 4). There is little disagreement that spirituality and religion are constructs deserving of research and clinical attention, but because an important first step in researching a construct is how to operationalize and measure the construct, we begin in a tumultuous place.

Definitions of religion, and particularly spirituality, have changed and evolved over the years. Once representing a single construct, these constructs are now distinct and some would say even incompatible. Spirituality is increasingly defined in contrast to religion rather than as interchangeable terms. The definitions are marked by explicit and implicit philosophical and theological underpinnings and thus remain vulnerable to claims that the definitions are either too broad or too narrow. Koenig described religion as an expression that is institutional, formal, outward, doctrinal, authoritarian, and inhibiting, and spirituality as an expression that is individual, subjective, emotional, inward, unsystematic, and freeing. Pargament reported that religion is moving “from a broadband construct—one that includes both the institutional and the individual, and the good and the bad—to a narrowband institutional construct that restricts and inhibits human potential” (p. 3). Apparent in the polarization of these two constructs is an underlying message that is an exaltation of spirituality and a condemnation of religion.

It is common for scholars to begin manuscripts with caveats of the difficulty in defining these terms, discuss the divergent definitions, and then provide an entirely new definition altogether. Other researchers approach the complexity by simply avoiding a definition, instead asking questions such as “do you consider yourself spiritual?” or “how important is religion in your life?” Although results from questions such as these contribute to our understanding of the perceived importance of religiosity and spirituality and other variables, this approach is limited in terms of not furthering our understanding of how these terms are uniquely understood and defined by participants.

It is evident that defining these constructs is difficult; however, research evidence supports the usefulness of this pursuit because of the clear connection between spirituality and religion and mental health. In a recent review of longitudinal studies, increased spirituality and religion seem to consistently promote a longer, happier life. For individuals with mental or physical health problems, spirituality and religion enhance pain management, improve surgical outcomes, protect against depression, provide coping resources, and reduce the risk of suicide. Although religion and spirituality are relevant to many problems dealt with by practitioners and there is a consistent link between spirituality/religiousness and physical and psychological well-being, in few areas of mental health are these issues as central as addictive behaviors.

The Relationship Between Religiosity/Spirituality and Addiction

In some sense, addiction represents the antithesis of spirituality. For example, one of the four noble truths of Buddhism is “Suffering is caused by attachment,” and a central focus for followers of this tradition is to relinquish craving and clinging to things. Yet the centrality of attachment is readily apparent in the diagnosis of substance use disorders—part of the criteria for a substance use diagnosis is that a great deal of time is spent in activities necessary to obtain the substance. May describes the spiritual nature of addiction as “a deep-seated form of idolatry. The objects of our addictions become our false gods. These are what we worship, what we attend to, where we give our time and energy.” Attachment to a substance is a futile attempt to impose direction in one’s life, a direction that displaces one’s prior values, meaning structures, and goals. Instead, individuals become concerned with purposeful action toward their next drink or their next high. In Tillich’s terminology, the substance becomes the individual’s ultimate concern.

Spirituality is also central to the most influential model of recovery in the United States. The recovery program of Alcoholics Anonymous views addiction as a fundamentally spiritual problem and has promoted spirituality and religion as a central factor to recovery since 1935. In the words of Bill W., the co-founder of Alcoholics Anonymous, individuals with substance abuse problems “have been not only mentally and physically ill, [they] have been spiritually sick” (p. 34). The program of recovery is therefore based upon a model of prescribed spiritual practices.

In addition to the spiritual program of Alcoholics Anonymous and other 12-step programs, the literature is also quite clear that religious involvement is predictive of lower current and future rates of problem drinking. For instance, more than 80% of the nearly 100 studies on alcohol and religion reviewed by Koenig et al. reported a negative association between religiosity and problems with alcohol. It seems that individuals who are more active in a religion and for whom faith occupies a central place in their lives are less likely to develop dependence on a drug. Similarly, individuals entering treatment for alcohol/drug problems tend to have very low religious involvement and are often quite alienated from organized religion.

Religiosity/Spirituality and Addiction Research: An Overview

In a review of the literature on spirituality and addiction, Cook examined 265 publications in order to identify the definition of spirituality by different authors. Cook found that only 12% of the papers explicitly defined the term “spirituality,” 32% offered a description of the concept of spirituality, 12% defined a related concept (such as “the spiritually healthy person”), and in 44% of the papers the term “spirituality” was left undefined. Breaking the conceptual content of the definitions into component parts, Cook classified the content of the various definitions into 13 conceptual components. Cook found that the four components that were encountered most frequently and were most central to the definition of spirituality were transcendence, relatedness, core/force/soul, and meaning/purpose. On the basis of these components, Cook proposed the following definition:

Spirituality is a distinctive, potentially creative and universal dimension of human experience arising both within the inner subjective awareness of individuals and within communities, social groups, and traditions. It may be experienced as relationship with that which is intimately “inner,” immanent and personal, within the self and others, and/or as relationship with that which is wholly “other,” transcendent and beyond the self. It is experienced as being of fundamental or ultimate importance and is thus concerned with matters of meaning and purpose in life, truth and values (pp. 548–549).

One particular conundrum, evident in Cook’s definition and many other definitions of spirituality, is that scholars have begun to include aspects of mental health within the definition. If terms such as well-being and connectedness with others are considered part of the definition of spirituality, there is an inherent measurement problem when examining spirituality and religiousness in relation to positive mental health functioning. As Koenig stated, “Defining spirituality in this way assures that those who are ‘spiritual’ will be mentally healthy, and excludes those who are mentally ill from this desirable classification” (p. 351). In addition to this classification problem, there is also a concern in terms of measurement of treatment outcome. If a client shows improvement in mental health, we encounter the dilemma of whether this improvement is due to an increase in spirituality or religion or whether we are simply measuring improvement in quality of life.

Koenig’s concern is particularly relevant to how researchers understand addiction. Addiction involves a setting apart from oneself, others, and the world—a direct opposition to spirituality’s emphasis of oneness with all of humanity. There is therefore a clear confound as individuals with substance use problems begin to succeed in recovery—they begin to reconnect with humanity and realign their values and goals. The use of substances offers a way to “avoid being present to oneself” (p. 44). It is common for individuals with substance use problems to report that they feel disconnected from others, and as attachment to the substance increases there is a tendency to isolate from important relationships. In Alcoholics Anonymous, a common term is “terminal uniqueness,” describing a feeling of the alcoholic who feels an extreme uniqueness and alienation from his or her peers. Conversely, during recovery from substances, there is a tendency for individuals to attach to a Higher Power and reaffirm important relationships.

Readers interested in further exploring the definitions and distinctions of spirituality/religiousness are encouraged to access Geppert et al. These authors have compiled a priceless annotated bibliography of 1353 scholarly papers on spirituality/religiousness and addictions that are divided into 10 categories, ranging from the measurement of spirituality with attitudes about spirituality and substance use.