sociological perspective on addiction

Addition recovery is a difficult and resource-intensive process for addicts and recovery workers alike. Addictive behaviors, especially those resulting from psychoactive substances, are “one of the most intractable therapeutic problems” (Zafiridis, 2001; 22). Addicts who require recovery services typically manifest emotional, psychological, and physiological needs. Recovery workers who assist addicts in the recovery process strive to develop recovery strategies that meet these needs in a manner that reduces stress and promotes equilibrium, as the goal of recovery is to help patients recognize the influences of addiction and give them the tools necessary to overcome them. Unfortunately, research on recovery services suggests that these are often ineffective, as former patients experience a high rate of recidivism and relapse back to established behaviors, often resuming the same habits that led them to addiction.

Recent research has been done on the effects of spirituality in treating addiction. Chen (2006) explored the personal and emotional status of inmates with a history of addictive behaviors and who had received recovery treatment supplemented with an emphasis on spirituality. The inmates who participated in this program demonstrated “a higher sense of coherence and meaning in life and a gradual reduction in the intensity of negative emotions (anxiety, depression, and hostility)” than those inmates who did not participate (p. 306). Similarly, Arnold et al. (2002) found that addicts who participated in an opiate recovery program and who were encouraged to develop their spiritual backgrounds as part of the program improved their hopefulness and their willingness to continue ongoing recovery work. These and other studies suggest a correlation between spirituality and an addict’s improved chances to not only complete a recovery program but to preserve the message of the program and resist recidivism.

Additional research is required to clarify the influence of spirituality in addiction recovery programs. The proposed research study is designed to isolate the effects of spirituality on persons working to overcome addiction in a local Narcotics Anonymous program. The selection of Narcotics Anonymous (NA) was done on the basis of a strong spiritual theme that is found in the program. However, NA emphasizes that addicts develop a “triangle of self-obsession” towards their addiction, and through moving past their anger the addict can recognize that they have lost their emotional, psychological, and physiological connection to the addictive substance of their choice. The benefits of this self-obsession are questioned in the literature, as is the influence of spirituality throughout the program. The proposed research study strives to identify how the spiritual component of NA affects addicts and influences the outcome of their participations. A qualitative case study of 15 persons participating in a local Narcotics Anonymous program will be conducted to identify how spirituality may serve in helping to construct an integrated self as measured by Referential activity.

Background

In the original handbook issued by Narcotics Anonymous World Services (1983) it was argued that the single greatest challenge for addicts was to overcome the emotional, psychological, and physiological dependence that addictive substances create in addicts. The addict tends to demonstrate childish tendencies, especially those that represent “the self-centeredness of the child” (p. 1). Addicts cannot break from challenges that reduce their sense of importance, and:

We never seem to find the self-sufficiency that others do. We continue to depend on the world around us and refuse to accept that we will not be given everything. We become self-obsessed; our wants and needs become demands. We reach a point where contentment and fulfillment are impossible. People, places, and things cannot possibly fill the emptiness inside of us, and we react to them with resentment, anger, and fear (p. 1).

According to the handbook, addicts who are overwhelmed by these negative emotions cannot break away from them without help. Indeed, they are looking for help; the addict turns to substance abuse because he wants to feel good about himself and the illusion of power and stability attained through drugs and alcohol is the closest he can come to achieving this elusive goal. Serious problems emerge when the addict can no longer obtain the feelings he craves and has to increase both the amount of substances he requires and the frequency of intake. As time progresses, it becomes more difficult to sustain the illusion of power and stability, and the addict finds that the negative emotions that he is working to suppress begin to dominate his life.

In the NA philosophy, addicts who enter the recovery program find themselves caught between these negative emotions and their dependence on addictive substances. These two separate influences combine and these further reduce the addicts’ internal equilibrium, as “resentment, anger, and fear make up the triangle of self-obsession. All of our defects of character are forms of these three reactions. Self-obsession is at the heart of our insanity” (p. 1). When these three reactions combine, the outcome can be devastating:

Resentment is the way most of us react to our past. It is the reliving of past experiences, again and again in our minds. Anger is the way most of us deal with the present. It is our reaction to and denial of reality. Fear is what we feel when we think about the future. It is our response to the unknown; a fantasy in reverse. All three of these things are expressions of our self-obsession. They are the way that we react when people, places, and things (past, present, and future) do not live up to our demands (p. 1).

The NA philosophy refers to addicts and how addicts differ from developed persons who demonstrate a stable emotional, psychological, and physiological equilibrium. To overcome these negative emotions and eliminate self-obsession, NA emphasizes the transition between an addict’s past life, the present, and opportunities found in the future:

In Narcotics Anonymous, we are given a new way of life and a new set of tools. These are the Twelve Steps, and we work them to the best of our ability. If we stay clean, and can learn to practice these principles in all our affairs, a miracle happens. We find freedom – from drugs, from our addiction, and from our self-obsession. Resentment is replaced with acceptance; anger is replaced with love; and fear is replaced with faith” (p. 1).

The scientific literature on Narcotics Anonymous, as with its sister program, Alcoholics Anonymous (AA), shows that researchers have challenged these principles on the grounds that recovery programs that rely on spirituality and religious faith are unlikely to succeed (Goldfarb et al, 1996). There are multiple reasons cited for failure, such as lack of medical care (Goldfarb et al, 1996), emphasis on an unseen spiritual connection instead of a tangible relationship developed with a significant relationship, and the need for the addict to rely on spirituality throughout all stages of treatment and recovery and accepting that their failures are their own (Goldfarb et al, 1996; Zafiridis, 2001). Goldfarb et al. (1996) studied the relationship between spirituality and addiction recovery and found that programs such as Narcotics Anonymous failed to emphasize the medical requirements of recovering drug addicts. The researchers hypothesized that the failure of these programs could be attributed to a lack of medical attention during critical periods, such as in withdrawal when opiates were gradually processed by the body and caused significant physical pain. It has been argued that the theoretical basis for NA and AA is fallacious, and that the programs constructed on this background fail to consider the causes of addiction as the “inadequacy of the therapeutic programs known today becomes even more obvious when the therapeutic approach aims at: a) complete abstinence from all legal or illegal substances, b) vocational rehabilitation and, c) termination of illegal activity” (Zafiridis, 2001; 22). These procedures fail to address the causes of addiction or the lifestyle choices made by addicts, and propose reform strategies that force addicts to sever all past connections and to rebuild themselves anew, effectively devaluing their past and their personalities.

While researchers have historically challenged the theoretical foundation of self-help programs such as AA and NA, one of the foremost arguments in favor of these programs is that persons who participate in these programs demonstrate the desire to overcome addiction. Zafiridis (2001) noted that “participation in such groups requires positive motivation that a significant percentage of addicts don’t maintain” and that addicts who demonstrate willingness to make positive change differentiate themselves from those addicts who have accepted their condition (p. 23). Indeed, a central tenant of the AA and NA philosophies is that admitting that a problem exists is the first step towards recovery. Yet researchers have historically emphasized that a second tenant of the program, faith in a higher power, is incompatible with the idea of self-help as it removes personal responsibility from the equation (Zafridis, 2001; Brown et al, 2002).

Recent literature provides evidence that there might be other ways of exploring the Narcotics Anonymous and Alcoholics Anonymous programs. In a research study conducted by Chen (2006), a comparison between NA programs demonstrated that those programs that incorporated spirituality were more likely to have a positive influence on addicts than the NA programs that did not have a spiritual component. The focus of Chen’s research was the “12 Step” strategy that has long been used as an optional component of both NA and AA rehabilitation program. Avants, Beitel, and Margolin (2005) found that recovery programs that incorporate a “spiritual self-schema” that help addicts imagine themselves as they would like to be helps cultivate feelings of self-reliance and reduces the likelihood that addicts will engage in high-risk behaviors. Brown et al. (2002) suggested that the success of these programs could be attributed to format, particularly the requirement that all participants attend meetings on a frequent and regular basis.

Significance of the Problem

Substance addiction in the United States is a significant problem. In the most recent data released by the Bureau of Justice Statistics (2009), it was found that “114 million Americans age 12 or older (46% of the population) reported illicit drug use at least once in their lifetime” (para 16). Additionally, “14% reported use of a drug within the past year” and “8% reported use of a drug within the past month” (para 16). Substance abuse causes serious consequences for addicts, their families, and their communities, and creates socio-economic, political, and economic repercussions. For example, in 2006 it was estimated that “that 1.7 million emergency visits (ED) were nationwide were associated with drug misuse or abuse” (Bureau of Justice Statistics, 2009; para 18). Of these visits, cocaine is the drug most likely to put the user at risk, as:

• Cocaine was involved in 548,608 ED visits.
• Marijuana was involved in 290,563 ED visits.
• Heroin was involved in 189,780 ED visits.
• Stimulants, including amphetamines and methamphetamine, were involved in 107,575 ED visits.
• Other illicit drugs, such as PCP, Ecstacy, and GHB, were much less frequent than any of the above (Bureau of Justice Statistics, 2009; para 19).

The physiological effects of cocaine are severe and place abnormal stress on the body through acting as a nervous system stimulant. Crack cocaine exacerbates these health hazards and creates additional threats for the user as “Evidence suggests that users who smoke or inject cocaine may be at even greater risk of causing harm to themselves than those who snort the substance. For example, cocaine smokers also suffer from acute respiratory problems including coughing, shortness of breath, and severe chest pains with lung trauma and bleeding” (Office of National Drug Control Policy, 2009; para 14). Additionally, “a user who injects cocaine is at risk of transmitting or acquiring diseases if needles or other injection equipment are shared” (Office of National Drug Control Policy, 2009; para 14). The risk of addiction with crack cocaine is high, and dependency on the drug is quick to develop.

Research indicates that minorities are more likely to suffer the negative effects of crack cocaine use than are whites; not only is crack cocaine more likely to be available in minority communities, the economic conditions found therein are conducive to the creation of cocaine-centered economies (Fryer et al, 2006). In a cocaine-centered economy, residents are affected by conditions in which education and job opportunities are limited, which fosters dependence on substance abuse. Professionals in the drug trade are likely to be the wealthiest persons in such communities and hold influence over the other community members (Fryer et al, 2006). In such communities, addiction is pervasive and, while not accepted, is generally tolerated as a fact of life. Rehabilitation programs designed to help these persons are likely to face resistance from some community members and be perceived as an intrusion (Fryer et al, 2006). Religion and spirituality have long played an important role among minorities, especially in African-American communities (Brome et al, 2000; Arnold et al, 2002; Hill et al, 2003). Researchers who explore the relationship between spirituality and substance abuse programs have found that incorporating spirituality into these programs has had positive effects among African-American drug addicts (Brome et al, 2000; Hill et al, 2003; Fowler et al, 2004). The significance of religion and spirituality as a component of recovery among African-American former drug addicts has caused some researchers to perceive spirituality and religion as “culturally relevant” tools that can promote therapy and recovery (Fowler et al, 2004; 1267). Other researchers have defined spirituality and religion in the context of the therapy process for African-American addicts as “an essential aspect of psychiatric care” (Carter, 2002; 372). It is possible that spirituality can be beneficial to members of other racial, cultural, and ethnic backgrounds, but this area of inquiry has not been explored to the same extent as that of African-Americans. Additionally, the receptiveness of different racial, cultural, and ethnic groups to spiritual and religious therapy suggests that certain groups are more likely to resist spiritual therapies and be more receptive to psychological or psycho-social therapies (Carter, 2002). However, the extent of these disparities remains unknown.

Purpose of the Study

The purpose of the study is to explore the effects of a Narcotics Anonymous program that utilizes the 12-step program and encourages participants to explore the negative emotions of resentment, anger, and fear and determine how spiritual practice may help in processing these emotions in such a way that purpose and meaning can be derived from the experience. A governing principle of the 12-step program is that an addict must put his or her faith in a higher power to make effective personal change. The effectiveness of the 12-step program can be improved if its influence on addicts is explored and the theoretical background of the program isolated. Outcomes of the research can be applied to future addiction recovery programs where addicts from different backgrounds can receive therapy that reflects their personality and socio-cultural background. Tailoring the nature of therapy to the participant’s personality might improve the effectiveness of the therapy and reduce recidivism.

Problem Statement

The problem statement that governs the study is stated as follows:

Past research suggests that religion and spirituality can increase the effectiveness of drug rehabilitation programs and reduce recidivism among addicts, but it is not known whether the emphasis on resentment, anger, and fear as endorsed by Narcotics Anonymous should be classified as a component of spiritual rehabilitation.

Research Questions

The following research questions are used to direct the study:

R1: How does the 12-Step program as described by Narcotics Anonymous affect drug users?

R2: How is the concept of a Higher Power being used, what function is it serving in the various phases of the referential process?

R3: How does spirituality influence the stages of recovery?