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The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 57

Guest Blogger and long-time Council friend, Bob W. presents Part 57 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In the evolution of these Notes, we have attempted to look at the afflictions of addiction and alcoholism both in the rampant untreated state and in the long, maybe lifelong process of recovery.  We have seen these journeys from a deeply mythic perspective, all aspects of them having stark parallels to the thousands of stories of heroes that attend the human experience.

In recent times, I have begun to see our journeys as coming in stages. First, we stop drinking or using. We deal with the pain, the minute by minute, hour by hour, day by day agonies of living without the substance or behaviors we used to medicate and escape.  Slowly, slowly, we begin to feel better and, in time, time itself seems to move along without those daily tremors of abstinence and deprivation.  Soon then we begin a second stage…that of working with a sponsor over the steps, one by one, embracing a Higher Power in personal terms and climbing the staircase of the Spirit, coming to understand our disease and its pitfalls in deeper and deeper terms.  We commit ourselves to service is small ways, supporting the Fellowship in daily chores and working with others.

In a few months or years, we move to a third stage, life in a container, a network of like women and men with whom we can live and be sustained with increasing ease and comfort.  As addicts and alcoholics, we are always at risk, but, in time, staying close to that Community, relapse becomes less and less of an option.  We begin to see the true meaning of the idea of a Sunshine of the Spirit. We begin to feel the overwhelming sense of gratitude for our Higher Power and the Fellowship that engulfs us.

Beyond this, I am beginning to see the idea of a fourth stage, maybe another dimension, a fourth dimension.  Committing ourselves to service first and foremost, eschewing any recognition, or even any third party knowledge, of such service other than our Higher Power, we become a rock upon which the power of the Fellowship is seamlessly resting.

We become a bit like Dante in the final stages of Paradiso.  Earlier in this trilogy, Dante had to trudge through the horrors of the Inferno with all the characterizations of the missteps of mankind. Then he moved into and through Purgatorio where is detailed the struggles to redeem oneself of the travesties of bad behavior. Much of Dante’s larger story here is reminiscent of our own journeys and our progress towards committed sobriety. But then Dante finally ascends into heaven, Paradiso, where he ultimately comes face to face with God.  As outlined in earlier Notes, the scene is captivating with God represented as a magical essence of pure love.

It has come to me that there are those of us to whom we all look for leadership and inspiration who have been cloaked with just such a spiritual mantle. Said another way, there are women and men among us in whose presence we all feel especially blessed…women and men who have become a near manifestation, deep within in our mind and hearts, of the power of a higher being.  What a joy it is to live in a community of such lightness and splendor!

What would alcohol sales look like if excessive and problem drinkers drank in moderation?

alcohol sales

The following article was recently published on the research page of the Recovery Research Institute website. It reports a novel new study focusing on the alcohol industry’s public support of moderate drinking amidst speculation that a large portion of alcohol industry profits come from alcohol sales to excessive drinkers and individuals with drinking problems. The research explored what percentage of alcohol sales are accounted for by heavy drinkers, and what the alcohol industry stands to lose financially if everyone drank in moderation (within government health guidelines).

WHAT PROBLEM DOES THIS STUDY ADDRESS?

The alcohol industry has long faced a difficult public relations dilemma. Though many individuals enjoy using alcohol with little or no consequence, for many others, alcohol causes significant emotional, physical, and interpersonal harm. At a population level, alcohol use has a prodigious, adverse social and economic impact. In order to mitigate the perception that the alcohol industry is profiting from suffering, and at times because of government pressure, in many countries major alcohol producers have voluntarily funded public awareness campaigns about the harms of excessive alcohol use. Critics, however, have argued that such voluntary measures are doomed to fail because they involve companies engaging in activities and policies aimed at reducing the harmful behaviors on which their profitability depends. In essence, these companies have a major conflict of interest. 

The alcohol industries in England and the United States have often played down the extent to which profits are driven by excessive use of their products, in spite of evidence from several countries that alcohol consumption is concentrated within a minority of heavier drinkers. The present study explored whether such findings are also true for England. Specifically, the authors asked: 1) What proportion of alcohol sales revenue is accounted for by people drinking more than government recommended guidelines for low-risk drinking (in the UK no more than 14 standard drinks per week, where a standard drink is equal to 7.9g of pure alcohol. This is considerably less than in the U.S. where a standard drink is equal to14g of pure alcohol – almost twice as much). 2) How does financial dependence on heavy drinkers vary between different sectors of the alcohol industry? 3) How would alcohol sales revenue be affected if everyone’s consumption fell to within guideline levels? 

This research has implications not just for public health policy, but for the millions of these heavy drinkers with alcohol use disorder in England, and countries like the United States.

HOW WAS THIS STUDY CONDUCTED?

This paper uses data from the UK Office for National Statistics’ Living Costs and Food Survey and the National Health Service’s Digital Health Survey for England. The Living Costs and Food Survey is distributed to households on a continuous basis throughout the year and asks each individual aged 16 years and over to keep a detailed diary of their daily expenditure over a 2-week period. For alcohol, the survey provides transaction-level data on beverage type (e.g., beer, cider, wine, spirits), price paid, and volume of product purchased. The survey also asks where the alcohol was purchased; either in a hotel, restaurant, or bar (known in the UK as on-trade sales), or from an alcohol retailer like a liquor store (referred to in the UK as off-trade sales). The authors pooled data from the 2013 and 2014 iterations of the survey, comprising a total of 9,975 households. 

The Health Survey for England is a large, nationally-representative survey of 16,872 individuals (2013 and 2014 pooled) which records self-reported ‘typical’ consumption by beverage type. Coverage of total alcohol purchases relative to estimates from more robust national accounts and sales data is approximately 60% (compared to 40% for the Living Costs and Food Survey), suggesting people markedly under-report their alcohol use. 

Drinking groups were defined according to UK government guidelines. ‘Moderate’ drinking is consumption below or equal to 14 standard drinks per week for both sexes, with a standard drink in the UK equaling 7.9g or 10ml of pure alcohol. ‘Heavy’ drinking refers to consumption above this level. Within the ‘heavy drinking’ category, the authors further distinguished ‘hazardous’ (15–35 units for women, 15–50 for men) from ‘harmful’ (36+ for women, 51+ for men) drinking, based on government guidelines.

WHAT DID THIS STUDY FIND?

The authors found that on the whole, the bulk of alcohol sales in England in 2013/14 were to individuals drinking excessively. An estimated 77% of alcohol was sold to drinkers consuming above guideline levels: 30% to harmful drinkers and 48% to hazardous drinkers. Further, alcohol consumed in excess of the guideline levels (i.e., those drinking 14 or more standard UK drinks per week) accounted for 44% of all sales.

Moderate drinkers (i.e., those drinking 14 or fewer UK standard drinks per week), who represented an estimated 59% of the population, were estimated to consume only 23% of all alcohol and accounted for only 32% of all revenue (Figure 1). The 21% of the population who were hazardous drinkers consumed an estimated 48% of all alcohol and accounted for an estimated 45% of all revenue. A relatively small group of harmful drinkers, comprising 4% of the total population, consumed almost a third (30%) of all alcohol sold in England, and accounted for nearly a quarter (23%) of all alcohol sales revenue.

Figure 1. Source: Bhattacharya et al., 2018.

Figure 1. Volume and value of alcohol sales by consumption level in England, 2013/14. The first column represents the makeup of the entire English population by drinking behaviors. The second column shows what percent of alcohol consumed in England was accounted for by each category of drinker. The third column shows the percentage of alcohol revenue accounted for by each category of drinker. As illustrated in this figure, in spite of making up only 25% of the population, hazardous and harmful drinkers accounted for 78% of alcohol consumption and 68% of alcohol revenue. 

In terms of differences between on-trade (i.e., in a hotel, restaurant or bar) and off-trade (alcohol retailors), 81% of off-trade revenue was estimated to come from those drinking above guideline levels (Figure 2). The corresponding amount was substantially lower (60%) for on-trade sales, although heavy drinkers also still accounted for the majority of sales revenue, highlighting the fact that hazardous and harmful drinkers accounted for the majority of both retail and bar/restaurant sales.

Figure 2. Source: Bhattacharya et al., 2018.

Figure 2. Proportion of revenue from harmful, hazardous and moderate drinkers by beverage types and retailer in England in 2013/14. On-trade refers to hotel, restaurant, or bar sales; off-trade refers to alcohol retailors. 77% of beer expenditure was estimated to come from drinkers consuming above guideline levels, compared to 70% for cider, 66% for wine and 50% for spirits. Hazardous and harmful drinkers accounted for the majority of on-trade and off-trade alcohol sales. 

The authors also report that should alcohol consumption be reduced to low-risk levels suggested by the UK government (i.e., 14 or less standard drinks per person, per week), the alcohol industry would stand to lose 38% of their current revenue (Figure 3). In absolute terms, this implies that the industry’s market value would fall by £13 billion (approximately US$17 billion).

Figure 3. Source: Bhattacharya et al., 2018.

Figure 3. Predicted percentage decline in alcohol revenue in England if alcohol consumption were to fall to government guideline levels for low-risk drinking (i.e., 14 or less standard drinks per person per week). Percentage declines in revenue are broken down by point of sale (on-trade versus off-trade), and alcohol category (beer, wine, etc.), as well as point of sale type crossed with alcohol category (in box, bottom right of figure). Altogether, the alcohol industry in England would stand to lose 38% of its revenue if everyone drank in accordance with government guideline levels for low-risk drinking.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Findings indicate the alcohol industry in England derives a large portion of its profit from excessive and/or problem drinkers. Given the consistency of this finding with similar research in Australia and Brazil, it seems likely that such a study conducted in the United States would find similar results. These findings raise serious questions about the conflicts of interest arising when an industry reliant on hazardous and harmful drinking is allowed to self-regulate and manages its public image with largely ineffective ‘safe drinking’ mantras (e.g., “Drink responsibly”). These findings also reinforce the need for strong alcohol sales policy, which has been shown to have real impact on problem drinking. Moreover, in so far as they suggest that a financially successful alcohol industry of its current size and form depends upon harmful drinking, the UK government’s economic support for alcohol producers, for example through tax cuts and trade negotiations, appear more problematic. These findings may also have relevance for ongoing debates about whether to restrict alcohol sales to state monopolies or open them up to commercial enterprises.

LIMITATIONS

  1. The authors’ analysis is taken from self-reported survey data, which tends to underestimate alcohol consumption. Their approach assumes implicitly that all sections of the population under-report their drinking in the same proportion. If anything, this probably underestimates the alcohol industry’s full reliance upon the heaviest drinkers, who are less likely to be represented in surveys.
  2. The analyses do not distinguish between specific companies. The degree to which any individual company benefits from sales to heavy drinkers is therefore unclear.

BOTTOM LINE

  • For individuals and families seeking recoveryHarmful and hazardous drinkers drive the bulk of English alcohol sales; a finding observed in other countries and presumed to be the same in other Western countries like the Unites States.
  • For treatment professionals and treatment systemsHarmful and hazardous drinkers drive the bulk of alcohol sales in England, and presumably other Western countries as well. Allowing the alcohol industry to design and self-monitor its own public health messaging regarding harmful/hazardous drinking represents a major conflict of interest. An industry that is financially reliant on harmful/hazardous drinking is unlikely to implement measures sufficient to curb problematic alcohol use.
  • For scientists: Harmful and hazardous drinkers drive the bulk of alcohol sales in England. The questions addressed by this research need to also be asked in the United States. Further, more research on the extent to which the alcohol industry has, in the past, mitigated volume declines by raising prices and selling more premium products would provide an indication of how sustainable such a strategy is likely to be in the long term. A further possible extension would be to explore the tax revenue generated by the government from excise duty on harmful drinkers, and the extent to which that tax revenue helps address some of the consequences of alcohol use disorder (e.g., funding publicly available treatment and recovery support services).
  • For policy makersAlcohol use and alcohol use disorder cost Western economies hundreds of billions of dollars annually and cause tremendous personal and societal harm. The alcohol industry profits directly from this problem. The alcohol industry’s conflicts of interest highlighted in this paper should be considered when creating and enforcing alcohol policy.

CITATIONS

Battacharya, A., Angus, C., Pryce, R., Holmes, J., Brennan, A., & Meier, P. S. (2018). How dependent is the alcohol industry on heavy drinking in England? Addiction, 113(12), 2225-2232. doi: 10.1111/add.14386

The Council on Recovery is the leader in providing a wide range of prevention and education resources aimed reducing alcohol use, especially among adolescents and young adults. We also offer therapeutic counseling and an intensive outpatient treatment program (IOP) for those affected by alcoholism. For more information, please call 713-942-4100 or contact us online.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 56

Guest Blogger and long-time Council friend, Bob W. presents Part 56 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In the commercial world that is the core of the economic society in which we all live and work, the experience of bankruptcy, along with the economic impacts of death and divorce, is one of the horrors that some of us have to experience.  We can define bankruptcy as insolvency, a condition in which the financial equity in one’s organizational structure or life system has been entirely exhausted and the ability of cash flows to service all sorts of debt obligations is nil; it is an experience that horrifies us and the commercial worlds in which we all live.   There is a set of laws called the Bankruptcy Code (the “Code”), formerly known as Title 11 of the U.S. Code of laws and regulations which governs precisely how the process of bankruptcy is meant to work to allow individuals, corporations and other organizations to resolve the conflict presented by their debt obligations and, then, to be rehabilitated.

I have had some experience in this world and it strikes me how it resonates so powerfully with the experience of addiction, the descent into its worst nightmares and the process to recover and build a sober life.  I have come to believe that life in our economic world is replete with people that span the full range of experiences, from those for whom success and wealth seem to come with consummate ease, to those who just can’t keep it together and are always on the edge of, or deep in the throes of insolvency.  It is much like the range of experiences of all humanity with addictive substances and behaviors. Many of those at the dark end of the economic cycles are increasingly caught in the web of insolvency as a result of a spendthrift and wholly irresponsible patterns of life.  They seem powerless over the experience of living beyond their means and their life increasingly becomes unmanageable.

The process of recovery for such people is also much like that for the alcoholic and addict, working with consultants, therapists, family and friends to discover a new way of living and managing daily affairs.  There are many parallels in the descent into bankruptcy and the process to recover to a sound and responsible way of living.

I have a good friend who has worked in this world most of her life, helping debtors to migrate through the myriad of processes that the Code provides.  I was at a meeting with her one day, where a number of distressed debtors – individuals, couples and small companies – sat in a large room ringed with small alcove offices.  The small offices were occupied by officials of the Court system and the meeting, called a Chapter 13 meeting in Texas, was to allow for the Court system and the debtors to come to terms with the precise nature of the debtors’ insolvency and develop a procedure for its resolution to be presented to and approved by the Bankruptcy Courts themselves.  As different debtors were called to a particular office my friend went with them, as their counsel, to explain and arrange each of their processes of resolution.  As I sat there observing, I was struck by the fear and anxiety on the faces of the debtors and the ease and comfort of my friend’s manner in working with them to a resolution. She was an “angel of mercy” moving about the room, very much like the presence that recovering alcoholics who serve as sponsors have in a room full of distraught and anxious newcomers of AA and its sister12 step programs.  Both are wonderful experiences to witness, the newbie alcoholic starting to work the steps with a sponsor and the bankrupt beginning the processes of financial rehabilitation with her/his counsel, both nurturing recovery with a presence of deeply committed service.

Bipartisan Legislation Introduced to Require Warning Labels on Addictive Prescription Opioids & Mandate Education for Opioid Prescribers

In a rare bipartisan effort, Senators Edward J. Markey (D-Mass.) and Mike Braun (R-Ind.) introduced two bills last week aimed at combating the opioid epidemic. The first first piece of legislation is called Lessening Addiction By Enhancing Labeling (LABEL) Opioids Act. The bill calls for labeling prescription opioid bottles with a consistent, clear, and concise warnings that opioids may cause dependence, addiction, or overdose.

The second bill, entitled the Safe Prescribing of Controlled Substances Act, requires any prescriber of opioid medication to undergo mandatory education on safe prescribing practices. Specifically, it mandates that all prescribers, who are applying for a federal license to prescribe controlled substances, must complete mandatory education to help encourage responsible prescribing practices.

Nearly 50 percent of opioid dependence originates with prescribed opioid painkillers. The two pieces of legislation seek to make sure patients and prescribers understand the dangers and full impact those prescriptions may have on the life of a patient.

Specifically, the LABEL Opioids Act would require the Food and Drug Administration (FDA) to issue regulations providing for a warning label to be affixed directly to the opioid prescription bottle handed to the patient by the pharmacist. Utah, Arizona, and Hawaii have passed state laws requiring labeling of prescription opioids, and legislation has been introduced in several other states. Last year, Canada issued regulations to require opioid labeling nationally. Congressman Greg Stanton (D-AZ-09) has introduced companion legislation in the House of Representatives.

The Safe Prescribing of Controlled Substances Act mandates education for prescribers that focuses on best practices for pain management and alternative non-opioid therapies for pain. Such education includes methods for diagnosing and treating a substance use disorder, linking patients to evidence-based treatment for substance use disorders, and tools to manage adherence and diversion of controlled substances. The legislation also requires the Department of Health and Human Services to monitor and evaluate the impact this new education requirement has on prescribing patterns.

The Council on Recovery supports these bipartisan efforts by the U.S. Congress to address the opioid epidemic.

If you or a loved one is struggling with opioid addiction or any substance use disorder, call The Council on Recovery at 713-942-4100 or contact us online.

Discrimination, immigration, treatment expectations, and family stigma are among barriers to Latinos seeking treatment

The following article was recently published on the research page of the Recovery Research Institute website. It explores a new study that indicates Latinos have the lowest treatment seeking rates compared to people of other racial and ethnic backgrounds.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

National studies have shown that individuals who identify as Latino are less likely to seek treatment for substance use disorder or complete treatment at specialty treatment facilities. Barriers to treatment engagement by race and ethnicity have been examined in only a few national studies and results are inconclusive. Identifying barriers to treatment is a foundational step that will allow for public health planning aimed at addressing barriers. The purpose of this in–depth qualitative study was to gain a better understanding of barriers to specialty treatment for substance use disorder that are more prominent among Latinos than other racial and ethnic groups.

HOW WAS THIS STUDY CONDUCTED?

From 2017-2018 the authors conducted a qualitative study which consisted of telephone interviews with participants from Riverside, Los Angeles, San Diego, and Oakland, CA; Brooklyn, NY; Chicago, IL; Miami, FL; and San Antonio, TX, recruited via craigslist (i.e., a web-based advertising platform) to compare barriers to treatment utilization among racial and ethnic groups.

WHAT DID THIS STUDY FIND?

Figure 1. Source: Pinedo et al, 2018

Latinos reported attitudinal barriers to specialty treatment more than other racial and ethnic groups (i.e., cultural, perceived treatment efficacy, and non-abstinent recovery goals). Overall, Latinos commonly felt specialty treatment providers did not understand their unique needs and experience. Specifically, they perceived healthcare providers to be unfamiliar with cultural issues such as discrimination and immigration. Providers were, therefore, discussed in terms of not being able to relate to personal experiences associated with being Latino including alcohol or other drug use which was in turn associated with low treatment efficacy. Being able to have a recovery goal of moderated alcohol use, and not complete abstinence, emerged as a larger barrier for Latinos in seeking treatment at specialty facilities. Its is unclear if these barriers could vary according to generation, meaning, foreign versus native born Latinos.

Social norms barriers towards specialty treatment (i.e., stigma and lack of social support) were more pronounced among Latinos than their White and Black counterparts. Stigma for seeking treatment was strong across all groups but most frequently mentioned by Latinos. Lack of social support from family emerged because it was viewed as “confirming” they had a problem and may tarnish the family.

Control over specialty treatment specifically logistical barriers, such as lack of health insurance, cost of treatment, transportation, and long wait times were highlighted by all racial and ethnic groups during interviews, however, showed no considerable differences in number of times mentioned between groups.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

This study identified specific barriers that discourage individuals who identify as Latino with alcohol or other drug use disorders from seeking treatment, and compared these to other racial and ethnic groups. Barrier identification is important because Latinos seek treatment at about half the rate as their White counterparts although higher estimates have been reported. Latino expectations that providers do not understand cultural issues like discrimination and immigration was an attitude barrier for seeking treatment. Researchers have suggested acknowledging important social contexts such as immigration and discrimination experiences in the delivery of specialty treatment for substance use disorders may increase service use. Latinos low expectations around treatment efficacy where rooted providers having no lived experience with alcohol or other drug problems and therefore are unable able to relate. Treatment facilities may need to promote their use of, or integration with, peer services as a means of showing that lived experience can be a part of the treatment process. Clinicians should be prepared to work with patients whose recovery goals include an initial goal of moderate alcohol use given about half of people in the US who have resolved a problem with alcohol or other drugs are not completely abstinent.

Stigma was heavily endorsed by Latinos including concerns over being seen by colleagues at a specialty treatment facility. To address this barrier, treatment centers might offer telemedicine which is when treatment is delivered using telecommunications technology like Skype but specially designed for secure health care communication.  In fact, a National Recovery Study found that individuals who identify as Hispanic were over one a half times as likely than White individuals to use recovery-related online technology. So, this may be a way to engage more Latinos with substance use disorder in treatment.

LIMITATIONS

  1. Qualitative studies like this use smaller samples to obtain richer ideas and explanations. This study was on only on a total of 54 individuals, of whom only 20 were Latino, recruited by advertisement, so it’s unclear to what extent findings may generalize to Latinos with substance use disorder as a whole. Particularly given the participants were assessed in terms of meeting diagnostic criteria over a 5 year window instead of 12 months, which is more standard.
  2. The barriers to treatment seeking identified in this qualitative study should be further tested in larger samples, and ideally, in a national study to determine the US prevalence of these barriers among racial and ethnic groups.
  3. Latino alone is a large group and there may be generational issues to consider in these outcomes related to foreign versus native born Latinos.

BOTTOM LINE

  • For individuals & families seeking recovery: This study of barriers to treatment for substance use disorder found that expectations of low efficacy were common. This low perceived efficacy of treatment was related to  experiences with treatment providers who had no lived experience with substance use disorder, or providers who were perceived to not understand stressful cultural issues like immigration and discrimination and its association with the onset, clinical course, and remission of substance use disorder. Talk to a treatment provider about setting expectations around the likelihood of remission, their use or integration with peer services, and provider cultural competency.
  • For scientists: This qualitative study found that social norms around low family support and acceptability of seeking treatment may be a barrier among individuals who identify as Latino. Preventative interventions aimed at adolescents and emerging adults that seek to improve the acceptability of using professional services for substance use disorders may have lasting impacts on creating a future culture of support and reduced stigma, that extends to families and communities across generations. In addition, it is important to develop and test strategies that can help engage Latino individuals with services. For example, 12-step facilitation for Spanish speaking Latinos since they value lived experience.
  • For policy makers: This was a qualitative study that examined barriers to specialty treatment for substance use disorder by race and ethnicity. Latino treatment seeking may be improved (and treatment seeking in general) by promoting the use of peer services (i.e., persons with lived experience in recovery), training providers in “cultural humility” in order to increase education around immigration and discrimination and its effect on recovery, and increasing privacy options during treatment. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied.
  • For treatment professionals and treatment systems: This was a qualitative study that examined barriers to specialty treatment for substance use disorder among individuals who identify as White, Latino, and Black. Latino treatment seeking may be improved by (and treatment seeking in general) by accommodating non-abstinent recovery goals around alcohol use, promoting organizational integration with evidence-based peer services (i.e., persons with lived experience in recovery), training providers in cultural humility to increase education around immigration and discrimination and its effect on recovery, and increase privacy options during treatment seeking. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied. It may be important for clinicians to process and problem solve around Latinos’ mistrust in professional treatment and address the family and cultural barriers they may face if attending treatment (i.e., stigma or lack of social support).

CITATIONS

Pinedo, M., Zemore, S. & Rogers, S. (2018). Understanding barriers to specialty substance abuse treatment among Latinos. Journal of Substance Abuse Treatment, 94, 1-8.

How Does Spirituality Change the Brain?

The following article by Dr. Mark Gold, recently published on the Addiction Policy Forum Blog, explores the growing body of research about what regions of the brain are changed during a person’s spiritual practice. It presents compelling ideas for how fellowship and treatment programs can empower individuals in recovery to use spirituality as a proven tool to improve their mental health.

Spirituality can be an important component of recovery from addiction, as it can be a key way for a person seeking recovery to connect to something outside themselves – spiritual practices have long been cornerstones of mutual aid groups, such as Alcoholics Anonymous. Recently, researchers and those looking at trends have concluded that Americans are becoming less religious but at the same time identify as more spiritual. Spiritual engagement can be a way to find, as the authors in the study write, a “sense of union with something larger than oneself.” In a recent study of the brain done at Yale directed by Dr. Mark Potenza, Neural Correlates of Spiritual Experiences, scientists used functional Magnetic Resonance Imaging (fMRI) to examine exactly how spirituality activated or deactivated, certain regions of the brain, changing how people perceive and interact with the world around them.

Dr. Christina Puchalski, Director of the George Washington Institute for Spirituality and Health, defines spirituality as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” Importantly, the authors of the study encouraged diverse, personally-motivated definitions of spiritual experience, examples of which included participation in a religious service at a house of worship, connection with nature, mindfulness meditation, and contemplative prayer.

How do we Measure the Effect of Spirituality?

Spirituality and religious practices are a key part of many people’s lives – 81% of U.S. adults describe themselves as spiritual, religious, or both. Despite the majority of American adults engaging in some form of spiritual practice, little is known about what happens in certain parts of the brain during these spiritual experiences. Although studies have linked specific brain measures to aspects of spirituality, none have sought to directly examine spiritual experiences, particularly when using a broader, modern definition of spirituality that may be independent of religiousness. This study used a special kind of brain imaging, functional magnetic resonance imaging (fMRI), to examine neural structures and systems that are activated when we engage in spiritual practice. By detecting changes in blood flow to certain regions of the brain, the fMRI is able to detect activity in the brain when participants were asked to recall spiritual experiences.

Methodology

A potential challenge in this study is the wide variety of spiritual experiences that individuals can find personally meaningful. The authors of the study sought to address this by using a personalized guided-imagery fMRI procedure in which participants were asked to describe a situation in which they felt “a strong connection with a higher power or a spiritual presence.” Their accounts were turned into a script, which was recorded and played back to the participant during fMRI. The brain activation measured during the participant’s recall of a spiritual moment was compared to measurements taken while participants listened to narrations of their neutral and stressful experiences.

Key to this study was that the accounts were completely self-directed by the participants — which enabled the researchers to identify commonalities in brain activity among diverse spiritual experiences.

How Does Spirituality Change the Brain?

04302019_inferiorparietallobe-2

The area highlighted in blue is the Inferior Parietal Lobe, which is associated with perceptual processing

Spiritual experiences were associated with lower levels of activity in certain parts of the brain:

  • The inferior parietal lobe (IPL), the part of the brain associated with perceptual processing, relating to the concept of self in time and space
  • The thalamus and striatum, the parts of the brain associated with emotional and sensory processing

This study furthers a growing body of research about spirituality and its connection to brain processing. These findings tell us that spiritual experiences shift perception, and can moderate the effects of stress on mental health. This study saw decreased activation in the parts of the brain responsible for stress and increased activity in the parts of the brain responsible for connection with others. A sense of union with someone or something outside of oneself and community engagement have been found to support a robust recovery from substance use disorders as well as other behavioral health issues. 

Looking to the Future

Marc Potenza, MD, PhD is an expert in Psychiatry, Behavioral Addictions, and his work at Yale in this important area is a welcome addition to the investigators working in this field. Neural Correlates of Spiritual Experiences has positive implications for instituting spiritual engagement in prevention, treatment, and recovery for substance use disorders. Importantly, participants were scanned while they recalled their own, individualized spiritual experience, but the results were consistent between participants. This means that a person does not have to participate in a certain type of spiritual practice to see the benefits, but can engage in whatever version of engagement is most compatible with their personal beliefs. This encourages treatment and recovery programs to encourage patients to pursue diverse means of spiritual engagement.

This study found a way to measure and visualize what many recovery and treatment communities have understood for years—that spirituality can reduce stress and create feelings of connectedness. By understanding what regions of the brain are changed during a person’s spiritual practice, fellowship and treatment programs can empower individuals in recovery to use spirituality as a proven tool to improve their mental health.

References:

  1. Smith, G., Van Capellen, P., (2018, March 7) Rising Spirituality in America [Audio Podcast]. Retrieved from https://www.pewtrusts.org/en/research-and-analysis/articles/2018/rising-spirituality-in-america.
  2. Lipka, M., Gecewicz, C., (2017, September 6). More Americans now say they’re spiritual but not religious. Retrieved from https://www.pewresearch.org/fact-tank/2017/09/06/more-americans-now-say-theyre-spiritual-but-not-religious/