{'fraction_non_alphanumeric': 0.026465813417903123, 'fraction_numerical': 0.007248839053120399, 'mean_word_length': 5.061327231121282, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The Role of Spirituality in Treating Substance Use Disorders

Prolonged use and abuse of substances (alcohol, cocaine, and/or opiates) can often negatively affect the mind, body, and spirit of those individuals who use them, and progress into dependence and addiction. In order to effectively intervene, these same domains (mind, body, and spirit) must be addressed during treatment, and be part of the ongoing education and clinical supervision with the staff providing treatment. This article describes the findings of a qualitative Cross-Sectional Survey Design that examines the role and influence of Spirituality on a sample of 50 men and women diagnosed with substance use disorders (addiction), residing in a 30-day residential treatment program. Many treatment programs include information designed to educate individuals on the negative effects of substance use and abuse on the mind, body, and spirit from a variety of perspectives, but provide few practices and little understanding on the spiritual aspects of recovering from substance use disorders. Using an availability sampling method, survey data from 31 residents in treatment for substance use disorders/ addiction was collected. The finding of this study help provide an overview of Spirituality as it relates to the treatment of substance use disorders and addiction, and explain the value of using a Spiritual approach in the treatment of substance use disorders, as reported by the participants of this study.


Introduction
The abuse of substances and dependence on those substances is not a new phenomenon. Stories of humans seeking to alter or change their feelings and moods exist throughout history. According to the Partnership for Drug-Free Kids, 23.5 million people, roughly 1 in 10 individuals over the age of 12 years old are dependent on alcohol and other drugs (Data Summary 2010). Statistics from the NIDA website (2016) show that illicit drug use in the US has been increasing over the years, as evidenced by their data showing an increase from 8.3 % in 2002, to 9.4% in 2013. Other indicators of the rise in demand for drugs and the use of those drugs is the fact that from 1991 to 2011 the amount of prescriptions written for opiate pain medications in the US tripled from 76 million to 219 million, and that Mexican production of Heroin (of which the US is a major consumer) increased from 8 metric tons in 2005 to 50 metric tons in 2009, a six-fold increase. The devastation and impact of drug abuse and addiction has become so prominent in our society that it is now being called an "epidemic," and has become a major issue in the debates and campaigns of the candidates for the 2016 Presidential election.
The amount of people (many of them young) dying from opiate overdose on a daily basis is staggering, and has definitely captured the attention of the American public. A major concern about this rapidly rising threat to our society is that of those 23.5 million addicted to alcohol and drugs, only 11% receive treatment (Partnership for Drug-Free Kids 2010). Although the lack of treatment is an issue being addressed on a national level by the White House ONDCP as well as many other partner organizations, this paper is designed to explore and address an aspect of the treatment for addictive disorders that has proven to be important in the process of recovering from addiction, the role of Spirituality. Many competing theories on addiction have been put forth, and we now know much more about addiction and treatment than we have ever in our past, however the concept of Spirituality and its role in addictive disorders and their treatment remains somewhat vague and abstract, yet fertile for examination and exploration.
According to Khantian, "human psychological suffering and difficulties in tolerating suffering, as well as emotional and behavioral dysregulation, are at the heart of addictive disorders, and no treatment is complete without empathically understanding what addictive drugs do for and to a person to make addictive substances and behaviors so captivating and compelling" (2007, pg viii). Addictive drugs relieve human suffering and pain, and if we hope to design and provide effective treatment for addictive disorders, we must understand that pain and suffering, and how to relieve it without the use of drugs. The role of Spirituality is a key component of that understanding, which we need to include in treatment.
The concept of Spirituality has been around for a long time, has had varying definitions and interpretations, and has played a role in many people's lives. In ancient Greece, Spirituality was looked at as therapy, a place where people went to when in pain and distress to seek to mend their brokenness and to seek soothing relief [1]. Others have described it as a fundamental human drive for transcendent meaning and purpose that involves connectedness with oneself, others, and an ultimate reality; or, a way to be [2]. One common translation for Spirituality is that it is our breath, our life or essence, it is who we are. Spirituality has played a major role in self-help recovery programs and the treatment of substance use disorders (addictions) for a long time as well.
In his early writings, AA co-founder Bill Wilson wrote about Spirituality saying, "the most important thing about Spirituality is that those who have it don't know it. Anyone who claims to be an expert on Spirituality doesn't get it. You have it only as long as you seek it; as soon as you think you have it, you've lost it." Although vague and elusive in definition, Wilson was much more emphatic when he wrote about alcoholics saying, "we must find a Spiritual basis for living else we die" [1]. Brene Brown's definition captures the essence of Spirituality, as it relates to this research study, when she wrote "Spirituality is recognizing and celebrating that we are all inextricably connected to each other, a power greater than all of us, and that our connection to that power and to one another is grounded in love and compassion, and that practicing Spirituality brings a sense of perspective, meaning, and purpose to our lives (pg. 64)." Regardless of the lack of consensus around definition, and its difficulty to measure, Spirituality is said to be about our belief in a power or force greater than what we possess as individuals, and something that connects us all in some cosmic and universal fashion. Given the nature of what we understand Spirituality to be, it comes as no surprise that it has become such an integral part of recovering from substance use disorders, and has become so prevalent in self-help programs. Isolation, disconnection, shame, and pain are often at the heart of addiction, or substance use disorders, rendering individuals alone and broken (in spirit). Native Americans viewed addiction as a crisis of the Spirit, and Psychiatrist Victor Frankl wrote about addiction being about feelings of meaninglessness, denial, and the attempt to escape ourselves.
It appears that people in pain or distress, whether it is physical, emotional or spiritual, often seek relief from their discomfort through the use of substances like alcohol and/or drugs to alleviate their pain. Although drugs and alcohol do numb pain, they also have the ability to destroy relationships, and cause people to isolate and disconnect from others, ending up addicted and alone in their pain. The term Addiction, is derived from the Latin word addicere, meaning to have no voice, or to surrender oneself to a master. Recovery from addiction is a process of reconnecting and taking oneself back; finding their voice. One way to achieve this is by connecting to a higher power, to community and family, and to mutual support groups (Narcotics Anonymous, Alcoholics Anonymous, Rational Recovery, and Smart Recovery). By connecting to support groups, those seeking recovery often find the strength, power, and hope they need to continue their journey in recovery. This is far from a new concept or practice though, people have been doing it throughout history, in times of sorrow and mourning, and also in times of celebration and joy; humans connect with others and with a source of strength beyond what they possess individually, often called Spirit. According to Hodge, Spirituality is nurtured in community. He describes it as "oneness with others" that springs from a shared vision and goal, shared memory, and hope (pg. 224). It is through one another that we find our self by locating ourselves within a community of our fellow humans. Traditionally Spirituality is conveyed by telling our stories, which has been, and still is a form of healing for many, especially within mutual support groups.

Literature Review
Studies on Spirituality, and its value in the process of recovery from substance use disorders, provide a range of perspectives and definitions, however, many agree that Spirituality is a very abstract and personal phenomenon, which usually involves an awareness of the other, some form of meaning and connectedness with the holy (religious and non-religious alike), and transcends reality [2]. Studies often attempt to differentiate the notion of Spirituality from Religion by describing the latter as a set of beliefs and practices, usually following some type of doctrine set forth, whereas Spirituality is thought of more along the lines of a search for something beyond the self to connect with. According to research conducted by the New Hope Recovery Center (2014), Spirituality provides perspective, meaning, and purpose to life, a total restoration of what addiction or substance abuse take away, growth, wonder, awe, and the ability to be our true selves (pg. 1). Kearney (1990) found it to be "central to an individual's care, wellbeing, and growth (pg. 47)," and the essence of our humanness. Among the many studies on Spirituality, Kurtz & Ketcham [3] describe it not as a thing or feeling, but as awareness, or paying attention and being present to what is happening around us and in us. They studied how individuals find meaning through the telling of stories, and doing everyday things with an attentive mind, which helps us to see that we are a part of, and apart from everything in life. Kurtz and Ketcham also studied how people use their stories to convey experiences by opening the heart and mind to experience things which cannot be described. Regardless of the specifics around definition, the literature shows that Spirituality generally involves people trying to make sense of life situations to provide meaning or purpose.
As Crisp reports, "everyone is Spiritual, whether we want to be or not (pg. 13)." According to her, it's about being integrated and connected to community, rather than alone and alienated. Although difficult to reach a consensus on defining Spirituality, the research does agree that it begins with being open to the abstract and vague concepts put forth to describe it; a yearning and openness to connect.
Kurtz & White [4] further develop the concepts of "beyond and between" (pg. 58-81) with regards to addiction, saying that Spirituality helps individuals move beyond the bondage of self, and toward a connection between self and others, which they found to be fundamental to the existence of those studied. Their research underscores the value of community, and being with others, where the participants found acceptance.
However, Spirituality and its benefits have often been discredited by others for being too vague, abstract, and difficult to measure and prove. Regardless of a lack of consensus around a definition of Spirituality, there is no disputing its prevalence and importance in both recoveries from addiction, and in treating it. Many have researched the role and value of Spirituality in the 12-step recovery programs, and even prior to the founding of those programs. Kurtz [5] wrote about the Spirituality described by William James, and its relevance and influence on Alcoholics Anonymous (AA), where those addicted to alcohol could go for help with recovery. According to James, it was there (AA) that individuals suffering from addiction could identify and find acceptance among others, and begin to confront one's "dark side." James believed that the highest levels of Spirituality emerged only from an honest confrontation with the evil in oneself. Carl Jung has also been cited in the literature as suggesting that the only hope for alcoholics that he had known was a "spiritual experience." The role of Spirituality in helping the "sick-souled" to find their way back to a grounding or connection with meaningful relations and community is abundant in the literature throughout history. However, the role of Spirituality with regards to recovery from addiction largely became known within the context of its prominence in 12-step or mutual support groups like AA. White (1998), in his research of the history of addiction treatment, and recovery programs in America, found that even though the Spirituality found in AA was "open to personal interpretation (149)," it was (and still is) a driving force in recovery from alcohol addiction. According to White, this Spirituality, or set of beliefs about it, was important because it held its ground against the emerging mainstream belief in medicine, psychiatry, and their focus on the scientific causes of addiction. The science-based approach replaced the idea of addiction being a Spiritual sickness, and shifted to a medical disease model to guide our understanding and treatment.
Although the Spirituality and the scientific schools of thought were viewed as opposing forces in recovery, especially given the non-professionalism of AA, versus the medically trained doctors and scientists, White found that integrating both approaches provides the best understanding of recovery from addiction. And, according to research, two-thirds of those in recovery report using Spiritual practices [6]. However, much of the research has been focused on "Evidence-Based Practices," and little attention has been paid to the Spiritual aspects of recovery. The lack of studies on the power and value of Spirituality in recovering from addiction could be due to the multiple interpretations of Spirituality, its vagary and intangibility. This trend does appear to be changing though, and we are seeing more studies with a focus on the role and value of Spirituality in the research literature.
Dermatis et al. [7] surveyed residents in treatment for addiction, finding most believed that Spirituality was an important aspect of their treatment, and should be integrated into their program. It has long been known and proposed within the 12-step recovery community that addiction is a sickness that affects the mind, body, and Spirit, and to effectively treat and recover from this sickness, you must attend to all three of the above aspects. Citing one of the pioneer researchers in this area, Kurtz (1996) described that individuals recovering from addiction not only need to understand and treat the biological and psychological impact of addiction in order to recover, but also need to find meaning in their life, and learn how to experience a new life in recovery. According to him, this could not be achieved without connecting with others in recovery, connecting with self, and with a power greater than oneself, which is described as Spiritual. Once this occurs, there is a "letting go," or a "freeing" which allows one to escape from the "savage master" known as addiction. Kurtz found that addicts in recovery find meaning through telling their stories, and in order to do so, they need to feel safe and connected with others. White (2014) supports this emphasis on the Spiritual by writing, the corruption of character is a near-universal dimension of the addiction experience, making the reconstruction of character, identity, and interpersonal relationships central tasks within the long-term recovery process.
Kurtz, a person in long-term recovery himself, focused his research on returning to the Spiritual aspects of treatment and recovery, emphasizing the need to find a "sense of belonging," which is more a matter of the heart, and not our head. And, the therapeutic value of somehow getting in touch with the hole at the center or core that addicts experience. Galanter et al. [8] compared responses from addicts in three different treatment programs with non-treatment participants, finding those in treatment preferred more Spiritual focus and practice in their treatment, value it highly, look for it in treatment, and request more of it. Participants report it (Spirituality) increases their motivation for recovery, and they feel more open to change. One limitation cited in this study is the lack of long-term measure post-treatment.
Even in a non-addiction domain, Hodge & Wolasin [9] found that when threatened with sickness and poor health, people find comfort in a Spiritual worldview. And those studied report that having a Spiritual connection or worldview protected them from uncertainty and sickness by affirming their worth, value, and significance. The authors also found research in this area to be lacking, but hopeful as indicated by the Joint Commission on Health Care Organization's recommendation that hospital services address patient's Spiritual needs.
As the literature shows, there is an emphasis on integrating Spirituality into treatment for the sick and addicted, and a desire for it by those studied. Focusing on the historical practices within 12-step groups (AA) of the Spiritual aspects of recovery indicates that having some type of "Spiritual Awakening" as a result of practicing the steps, allows addicts to reconnect with others in community, and in interpersonal relationships, and provide meaning to their lives. It has also been shown [10] to help addicts manage their life experience without the need of substances. The authors articulate this within the context of Jung's "Spiritus contra Spiritum" framework of high Spirituality relates to low need for substances to manage life, and low Spirituality influences the need for substances. The findings of this research also supports previous findings on the value of Spirituality, citing 95% of those in the treatment environment studied, volunteered to participate, wanting to learn more and talk more about Spirituality, as it is what many said they lack and need to feel whole. Others have also found Spirituality to be a key construct in treatment of addictions, and addicts who participated in a study conducted by Torres Stone et al. [11] showed that when one becomes addicted, their Spiritual relationship and connectedness to the world around them is closed, and that recovery is a way to reconnect (pg. 238). In their study of the Native American culture and practice with regards to alcohol addiction, they report that addiction, which is understood by participants as a "crisis of the Spirit," requires a healing of the Spirit, mind, and body within a larger community.
Although fairly recent in the practices and interventions of treatment providers, and in the body of research (past 20+ years) literature around addiction treatment, the role and value of Spirituality in recovering from addiction has long been known and practiced within the 12-step programs. Studies continue to examine this topic, citing the value of integrating Spiritual awareness, education, and practices into treating addiction. Carrington [12], in a study of Social Work, compared differing ideologies around integrating Spirituality into practice, reporting a lack of guidelines for doing so, but also emphasizing the need for a "Integrated Spirituality Practice Framework." This framework would support a holistic approach to addressing all dimensions of an individual, and formalize paradigms to include in practice. According to Carrington, "as long as Spirituality remains abstract and nebulous, it will remain fringe," and not part become part of the theories and practices for effective intervention, which supports the need for more research.

Problem
Programs for addicts that do not include awareness and focus on Spirituality, and do not integrate it into the treatment, miss an important element in the treatment and recovery from addiction. Isolation, disconnection, and emotional trauma are often the effects of addiction. Abstinence alone is often short-lived, and does not repair the damage on the psyche and the soul caused by addiction, which needs a Spiritual connection in order to heal. This research describes the role and value of Spirituality in the recovery of the participants, and helps us understand its power in the recovery process, by surveying participants, and analyzing their responses.

Research Questions
This study addresses the following questions: A. How do you define Spirituality? B. What does Spirituality mean to you in relation to your treatment?

Research Design
This study used a qualitative Exploratory Cross-Sectional Survey Design to establish a foundation or basis for future research in the area of Spirituality and the treatment of addiction. The significance and implications in obtaining and analyzing participants' responses to questions regarding Spirituality can be used to influence decisions pertaining to treatment curriculum and clinical interventions. This research design has proven to be useful in helping improve the situation of client systems [13]. Qualitative research methods have also proven to be an effective means of data collection and analysis in studies of addiction, emphasizing the in-depth understanding of subjective, perceived meanings, interpretations, and behaviors of those individuals studied [14].

Sample and Sampling Technique
This study took place at Spring Hill Recovery Center, a 30-day inpatient residential rehabilitation program treating drug and alcohol addiction between June-July 2015. Researchers used an "availability sampling method" to solicit participants. Residents of the program voluntarily participated in completing surveys (see appendix) answering questions about their experience with Spirituality and treatment/recovery from addiction. All surveys were confidential and anonymous, excluding any identifying information, to protect the participants' identity, and were returned using a secure drop-box at a private location [15][16][17][18]. Research participants were comprised of 14 females, and 17 males, ranging from 20-64 years old, of mixed race and ethnicity.

Data Analysis
By previewing all survey results, the researchers coded and sorted data into sub-categories, journaling trends, themes, and questions raised, cross-checking their process and noting key observations. The goal was to reach an in-depth understanding of how participants view and value Spirituality in their treatment and recovery from addiction. The sub-categories consisted of: e. What is your comfort level discussing Spirituality?
Researchers used cluster diagrams to identify themes and to build theories, and counted specific responses, noting similarities, differences, and contradictions in the data [19]. The researchers drew upon their shared experience of working with addictions over the past 30 years as practitioners, clinical supervisors and administrators, and academic researchers to examine the survey responses and interpret their meaning and value regarding treating addiction.
Following a thorough examination and analysis, the data showed that respondents defined and attributed meaning to Spirituality in various ways. When sorted and coded, all definitions of Spirituality fell into the following categories:

Discussion
Addiction is a devastating condition that kills people daily, comes with staggering costs, and robs us of our most precious and valuable resource, our youth. A record 47,000 Americans fatally overdosed in 2014, an increase of 7% from the previous year, 1.5 times as many as dies in car crashes or gun violence. Addiction has become a major topic of discussion, from the schoolyards to the Presidential campaign trail. There is no doubting or escaping the fact that drug and alcohol addiction has grown to be a major issue facing our society, with professional treatment and abstinence as the only sensible options for changing this trend. Addiction is a condition that affects the mind, body, and Spirit of a human, and in order for treatment to be effective, these same areas need to be addressed. Many treatment programs treat the body (hospitalization and detox), and attempt to treat the mind (psychological, emotional interventions) as well. However, due to the elusive and mystical nature of Spirituality, it often is not included in treatment for addiction in formal treatment programs.
The authors of this study believe that individuals seeking treatment are open in welcoming Spirituality in treatment, and feel something is missing when it goes unattended. Addiction has often been called a "sickness of the soul," which causes a person to detach and disconnect from self and others, while struggling alone with feelings of shame, rejection, and alienation. As the addict spirals further downward into the darkness and abyss that is addiction, they continue to feel more and more hopeless, worthless, and unlovable, alone and isolated in their pain and misery. Treating the mind and body are a key aspect of changing the self-destructive course of addiction, but treating the Spirit cannot be omitted if the goal is effective treatment and full recovery.
The significance and value of including a Spiritual focus in treating addiction is supported in this research, with results showing not only the importance it holds for those in treatment to arrest their use of drugs and alcohol, but also in the larger aspect of recovery, the rebuilding their life. Addiction severely impacts all aspects of a human being, and all aspects need to heal in a recovery process. Spirituality has long been the basis for 12step programs, which is where many addicts migrate to upon completion of formal treatment.
Using a Spiritual (non-Religious) approach to recovering from addiction, 12-step programs have remained a welcoming environment that has helped many addicts find their way to recovery, and to rebuild all aspects of their life; mind, body, and Spirit. As this research study shows, to not address the Spiritual aspects of addiction ignores a valuable component of treatment that addicts.