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Alexandre B. Laudet

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THE ROLE OF SPIRITUALITY, FAITH AND LIFE MEANING IN THE ADDICTION RECOVERY PROCESS ... Meaning predicted sustained recovery in Grp 4 ... – PowerPoint PPT presentation

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Title: 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
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