The Role of Spirituality in Medical Care and Clinical Practice - Essay Example

CHAPTER I Introduction The role of spirituality in medical care and clinical practice is recognized as an important tool for healing. The World Health Organization reports, ‘Patients and physicians have begun to realize the value of elements such as faith, hope, and compassion in the healing process’ (BMA, 2002). Despite its religious connotation, spirituality is more closely connected with peoples essential humanity, says Peter Gilbert (Breathing Space, 2006). Spirituality unites the inner self with the universe. Studies have confirmed definite relations between spirituality and physical and mental health conditions (BMA). An alcoholic falls under the category of mental care. Based on spirituality, the Alcoholics Anonymous (AA) has designed a twelve-step program for the recovery of alcoholics. This research paper will examine how spirituality contributes to their recovery. The second purpose of this study is to look at which qualities gives more satisfaction to the individual during the twelve-step program of AA. (I am not too sure if I have understood the second point clearly). The study would also determine qualities of the members who grow spiritually during recovery. Definitions of the terms spirituality, alcoholic, alcoholism, abuse, sobriety, addiction, abstinence, recovery, and dependence would help in the research work. Before going into the definitions, it is important to understand the far-reaching effects that alcohol has on human life. Alcoholics Anonymous Alcoholics Anonymous is an alcoholism-treatment organization founded in 1935. Ever since, it has been treating millions. By 1995 it had 2 million members worldwide (Gleick E, 1995). Alcoholism was a closely held secret and carried a harsh social stigma. Alcoholics Anonymous brings such people together and helps them to recover and remove this stigma. James Houck had begun drinking at age 5. At a meeting at the local YMCA of the Oxford Group, Houck was drawn to the group’s teachings, which were based on the four principles – honesty, purity, unselfishness, and love (August M, 2004). Having recovered fully, Houck made it his mission to spread the spiritual aspects of Oxford Group’s teachings amongst the new generation of recovering alcoholics, especially within AA. It is on these principles of life that the 12-step program of AA has been formulated. Alcoholics Anonymous can be a solution for alcoholism, drug addiction and other addictions. A study done by Vaillant (1983) and Vaillant and Milofsky (1992) found that self-help groups in the form of AA involvement was more useful than clinical treatment provided in maintaining abstinence. This is an important study because AA estimates that there are 100,700 groups worldwide with 51,700 groups in the United States of America. If one program can impact so many individuals there must be some important variables that could be used for other people with addictions or major life altering problems. In addition, self help groups play a major role in the United States. “The treatment provider community must become attuned to the idea of spirituality as an important component of successful skills and resources available both to the patient and provider…” (Jarusiewicz, 108). Significance of the problem Alcohol claims 100,000 deaths a year. Of the 10% of alcoholics who attempt to quit each year, only 1 in 10 of those succeed (Carry, 1999). Several authors have noted the effectiveness of A.A. (Brown, 1985; May, 1988; Vaillant, 1995). Sheeren (1987) believes that “Alcoholics anonymous is a fellowship accepted worldwide as the primary and most successful therapy for the recovering alcoholic” (p.104). As resources for longer-term inpatient treatment of alcoholism diminish (Lowinson et al., 1997), and treatment shifts to an intensive out-patient modality, it becomes increasingly important that clinicians provide effective and efficient care. Due to the fact that long-term inpatient treatment of alcoholism is diminishing and more individuals are turning to A.A., an effective and efficient way for clinicians to act is to become more aware of A.A., more aware of the contributing factors, and the beliefs about spirituality that A.A. holds. The quantity of recovery is important, but so is quality, which is why quality of life survey will be included. Definitions: Spirituality is “that which enables the growth of positive and creative values in the human being” (Booth, 1984. p. 141). Spirituality is a rather broad concept. Booth’s definition is effective in conveying the shift that occurs for many recovering alcoholics from an obsession with drinking. They are able to relate troubles to a positive outlook, which fosters personal growth; they express gratitude for recovery, and a willingness to be of service to others. The A.A. literature also stresses that this higher power need not have any religious connotation (Alcoholics Anonymous, 1976). Nevertheless, “mental health professionals are often skeptical about the relevance of the spiritual approach to treatment effectiveness” (Peteet, 1993, p.263). Alcoholic: The recognition that one is an alcoholic may or may not involve the physical dimension of alcoholism as an addiction, such as tolerance, withdrawal, etc. Within the context of the present research, however, the alcoholic can be characterized as a person for whom the use of alcohol consistently disrupts or prevents the conduct of activities and relationships which are necessary for the health and well-being of the alcoholic. The alcoholic is often the last person to recognize that this has occurred, due to the phenomenon of denial. It has often been said that an alcoholic is a person who keeps on doing the same thing expecting different results (young, 2005). Alcoholism: One of the difficulties in attempting to define alcoholism is that it affects people in so many different ways, in such varying amounts, with varying frequency of use. The medical definition of alcoholism cited below as a disease notes its physical dimensions, such as progression. However, for the purposes of the present research, a definition offered by many recovering people reflects the aspect of self-diagnosis that is unique to alcoholism, and is deemed necessary by many of these same individuals for the process of recovery to begin. It could be stated that one knows one has alcoholism when one can no longer predict the consequences of one’s actions when drinking. Alcoholism as a Disease: In defining the disease concept of alcoholism, Jokicki Tekamine, M.D., has said I see chemical dependency as a disease like any other. It has a beginning, middle, and an end. It has a diagnosis and a prognosis. It has symptoms; it can be replicate; it is chronic; it progresses over time; patients can relapse; there’s the withdrawal phenomenon; and if it is not treated, it ends in death. That’s a disease. (Cary, 1999, p.xviii) The question of whether or not alcoholism is, in fact, a disease has been debated for many years (Vaillant, 1995). Alcohol Abuse: The DSM-IV has defined substance abuse (and, interchangeably, alcohol abuse) as “A maladaptive pattern of substance use leading to clinically significant impairment or distress…” (APA, 1994, p.182). Alcohol Dependence: The DSM-IV has stated that substance dependence (in which they include alcohol dependence) is “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior” (APA, 1994, p.176). Addiction: Within the context of the present research, addiction can be defined as a mental compulsion and preoccupation with drinking, coupled with physiological dependence on alcohol. Abstinence: For the purpose of the present research, abstinence can be defined as the total cessation of alcohol consumption, on a 24-hour-a-day basis. Sobriety: In contrast to the mere absence of alcohol consumption, which characterizes abstinence, sobriety involves the conscious pursuit and maintenance of a lifestyle, which incorporates those elements which the recovering person has found to be facilitative of personal growth and a reasonable degree of contentment. Recovery in Sobriety: “The alcoholism recovery process is one of construction and reconstruction of a person’s fundamental identity and resultant view of the world” (Brown, 1985, p.55). “The focus is on daily growing by making free choices to evolve into the person we were meant to be” (Lawton, 1985, p.57). These two quotes represent the process of recovery as one, which allows an unobstructed view of a person’s true identity. Relapse: A relapse occurs when an alcoholic returns to drinking after some period of abstinence. Surrender: “Surrender is an emotional step in which the Ego, at least for the time being, acknowledges that it is no longer supreme…For the alcoholic, surrender is marked by the admission of being powerless over alcohol (Tiebout, 1954, p.618). Tiebout acknowledges that a person is not merely an alcoholic, but that his or her resources alone are insufficient to recover from alcoholism. Abstinence versus Sobriety: Abstinence is abstaining from something for a period of time. Sobriety is a life free of drinking. This is a word often misused by recovering alcoholics, and a focus that therapists could help their clients maintain - the end goal of life without drinking. Powerlessness and Unmanageability: Associated with the experience of surrender are several attendant terms which may represent the recovery concepts that meet with the most resistant among both the general public and the therapeutic community. The two terms ‘powerlessness’ and ‘unmanageability’ are considered to be of critical importance as to be highlighted in the first step of alcoholics anonymous. Purpose of Research What makes it a success? It has been observed that people attending Alcoholics Anonymous become sober; their personality transforms and their daily lives become better and more productive. “Individuals who at one time appeared totally unraveled, self-absorbed, and preoccupied with obtaining and using alcohol and/or drugs, with abstinence and recovery, suddenly appear more whole, and begin to show concern for the care of others as much as themselves” (Green, Fullilove, M, & Fullilove. R, 1998). How is it that a program designed to help people stop drinking also assists individuals to mature and improve their overall self? What are the steps that the program follows, and what are the aspects of their traditions that makes Alcoholics Anonymous successful? One factor worth examining is the element and contribution of spirituality. Role of therapist-patient relationship A contributing factor to antipathy which exists between A.A. and many therapists may be the role of spirituality in recovery (Humphreys, 1993; Kurtz, 1985). Many A.A. members will state that spirituality is one of the main factors that helps them stay sober and active in the program. This disagreement that occurs between the program of Alcoholics Anonymous and therapists could be lessened if it was clearly stated that spirituality is a main factor in the recovery from alcoholism. Another benefit from finding the importance of spirituality is relaying the relevance of spirituality to newcomers who often question and misinterpret the definition of spirituality. Having a better and more in depth understanding of what role spirituality plays in the treatment of alcoholism, will help guide and improve therapist-patient relationship. (need to find cite for this – cite could be the example of Houck on page 2) Dual diagnosis is another situation where it is important for an alcoholic to be active and participating in A.A. and seek concurrent treatments with a therapist. If clients feel that the program of alcoholics anonymous is beneficial to them, and a therapist is not familiar or supportive with the treatment program, a client may feel that the therapist is not empathetic or understanding of his/her problem. This could lead the client to a pre-mature drop out of therapy. For these two powerful entities to best work together with a mutual goal in providing or locating a treatment for the individual, clinicians must fully understand and accept the terms found in A.A (surrender, unmanageability, powerlessness, etc). These terms relate to practicing recovery with spirituality. Identifying changes in the alcoholic Recovering alcoholics who are looking at the changes in their quality of life is another factor worth examining. Many people who walk in to the doors of A.A. are desperate; many of them have lost their jobs, family members, or friends. If each of the steps in A.A is supposed to lead individuals to a spiritual awakening, then it can be proved that spirituality is a contributing factor for success among alcoholics that can bring changes or improvement to the participants’ quality of life. Comparisons One hypothesis is that people who have more involvement in A.A will have a higher level of spirituality as measured by the GAATOR. A second hypothesis is that the quality of life for recovering alcoholics will change as they continue the twelve-step program using the quality of life index survey. A third hypothesis is that if the level of spirituality increases over the six-month period there will be a higher increase in quality of life. A comparison that will be examined is the difference in the level of involvement in Alcoholic Anonymous measured by the level of involvement scale and level of spirituality measured by the GAATOR 2.1 a member of the twelve step program has reached. Another comparison that will be made is looking at if the quality of life measured by the Quality of Life Inventory changes for people who have been in the program for six months. The third comparison will determine if the members’ spirituality level goes up as their quality of life improves using the same tools listed above. The twelve-step program of Alcoholics Anonymous It is a cultural taboo concerning admitting personal powerlessness and acknowledging the need for help (Kohn 1984; Peteet, 1993). This is the first and essential step towards entering the spiritual realm, admitting that their lives are unmanageable and asking for help from a higher power. Key factors that have contributed to individuals in staying sober or remaining abstinent are key words used in the book of Alcoholics Anonymous. Therapists must support that spirituality is an important factor. Otherwise, how can the therapist help their clients with the processing in A.A. steps that encourage and support long term sobriety. Looking at each one of the steps it is observed that the final goal leads to spiritual awakening. Step One “We admitted we were powerless over alcohol – that our lives had become unmanageable.”               The guiding principle for this step is “Acceptance.”  It is one thing to admit that one is an alcoholic but it is quite a different concept to concede to one’s innermost self that he is an alcoholic.  This is the first vital step for recovery. Step Two “Came to believe that a Power greater than ourselves could restore us to sanity.” The principle is “Faith”, a belief in something that is unseen.  This is a difficult idea for the newcomer to grasp after they have worked so hard to control their lives only to discover that this does not work and then to ask them to have faith in something they most likely have never known.  Faith is hard where there is such a high fear of the unknown.  Step Three “Made a decision to turn our will and our lives over to the care of God as we understand Him.”             Surrender and trust is the vital principle here.  It has been said that our will is our thinking and it is therefore our thinking that we are turning over to a higher power.  What is interesting however, is that we do not really get to know exactly what our thinking has been until the fourth step work has been done. Step Four “Mad a searching and fearless moral inventory of ourselves.” “Honesty” is indispensable.  Without a level of brutal honesty, it is difficult to discover the truth of one’s thinking and the motives that are behind the thoughts. Step 5 “Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.”             This step takes a lot of “Courage”, as one knows what he has done in the past and it is believed that God knows too.  However, to tell another person for the first time all of our shortcomings can cause a lot of fear.  It is said that courage is not the absence of fear rather it is walking through the fear with courage. Step Six “Were entirely ready to have God remove all these defects of character.”             “Willingness” is a key to this step since we must be ready to let go of a lot of ideas and actions.  These may have at one time been crucial for our survival but they are no longer needed, since whatever was causing the need for survival has been removed from one’s life. Step Seven “Humbly asked Him to remove our shortcomings.”             This requires a level of “Humility” that must be present to have a change in attitude, which permits us to move out of ourselves toward God. Step Eight “Made a list of all persons we had harmed, and became willing to make amends to them all.”             This is a list of people taken from our list that was made during the fourth step, when we were getting ready to approach these individuals asking for “Forgiveness” for our past mistakes. Step Nine “Made direct amends to such people wherever possible, except when to do so would injure them or others.” “Freedom” from the past takes place at this step when we approach those that we have harmed and ask how we can best right the wrongs we have caused. Step Ten “Continued to take personal inventory and when we were wrong promptly admitted it.”             This is one of three key steps in moving forward in a new life and requires “Perseverance.”  This step keeps the slate as clean as possible at all times. Step Eleven “Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.”             “Patience” is the watchword here as it takes time and practice to get comfortable with practices that might be new for an alcoholic. Step Twelve “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.”            “Charity and Love” are important to give the hope that another alcoholic cannot achieve sobriety and love someone else until they can learn to love themselves. This research will review the steps to see how spirituality is incorporated. At the same time, it will also look at other factors that A.A. implies and incorporates in treatment, which is often misunderstood. Read More