(This is the last of a series of articles discussing religious and spiritual issues in psychiatry. Part III ran in August Psychiatric Times, p32-Ed.)
As previously discussed, new research has made us look much more closely at the influence of religion and spirituality on overall health. Now more than 30 psychiatric residencies including Harvard, Baylor, and Georgetown provide focused training on addressing patients' religious/spiritual beliefs. The American Psychiatric Association's 1995 guidelines to respect and respond sensitively to patients' religious/spiritual beliefs considers the positive roles-not only the negative roles-that religion/spirituality might play in the treatment of mental illness.
Larson et al. (1998) summarized the work of more than 70 mental health, physical health, and neuroscience and addiction disorder researchers to review current findings and map out future directions. Their report stated: "The data from many of the studies conducted to date are both sufficiently robust and tantalizing to warrant continued and expanded clinical investigations."
Treatment of Drug Abuse
The lack of religious/spiritual commitment stands out as a risk factor for drug abuse, according to past reviews of published studies. Benson (1992) reviewed nearly 40 studies documenting that people with stronger religious commitment are less likely to become involved in substance abuse.
This study supported a review by Gorsuch and Butler (1976) who found that lack of religious commitment was a predictor of drug abuse. The researchers wrote:
Whenever religion is used in analysis, it predicts those who have not used an illicit drug regardless of whether the religious variable is defined in terms of membership, active participation, religious upbringing or the meaningfulness of religion as viewed by the person himself.
Lorch and Hughes (1985), as cited by the National Institute for Healthcare Research (1999), surveyed almost 14,000 youths and found that the analysis of six measures of religious commitment and eight measures of substance abuse revealed religious commitment was linked with less drug abuse. The measure of "importance of religion" was the best predictor in indicating lack of substance abuse. The authors stated, "This implies that the controls operating here are deeply internalized values and norms rather thanfearor peer pressure."
Developing and drawing upon spiritual resources can also make a difference in improving drug treatment. For instance, 45% of participants in a religious treatment program for opium addiction were still drug-free one year later, compared to only 5% of participants in a nonreligious public health service hospital treatment program-a ninefold difference (Desmond and Maddux, 1981).
Confirming other studies showing reduced depression and substance abuse, a study of 1,900 female twins found significantly lower rates of major depression, smoking and alcohol abuse among those who were more religious (Kendler et al., 1997). Since these twins had similar genetic makeup, the potential effects of nurture versus nature stood out more clearly.
Treatment of Alcohol Abuse
Religious/spiritual commitment also predicts fewer problems with alcohol (Hardesty and Kirby, 1995). Studies reveal that people lacking a strong religious commitment are more at risk to abuse alcohol (Gartner et al., 1991). Also, religious involvement tends to be low among people diagnosed for substance abuse treatment (Brizer, 1993). A study of the religious lives of alcoholics found that 89% of alcoholics had lost interest in religion during their teen-age years, whereas 48% among the community control group had increased interest in religion, and 32% had remained unchanged (Larson and Wilson, 1980). Alcoholics often report negative experiences with religion and hold concepts of God that are punitive, rather than loving and forgiving (Gorsuch, 1993).
Furthermore, a relationship between religious/spiritual commitment and the non-use or moderate use of alcohol has been documented. Amoateng and Bahr (1986) reported that, whether or not a religious tradition specifically proscribes alcohol use, those who are active in a religious group consumed substantially less alcohol than those who are not active.
Religion/spirituality is also often a strong force in recovery. Alcoholics Anonymous (AA) invokes a Higher Power to help alcoholics recover from addiction. Those who participate in AA are more likely to remain abstinent after inpatient or outpatient treatment (Montgomery et al., 1995).
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