Field of Science

Spiritual guidance doesn't help substance abusers

Spirituality is traditionally a part of recovery programmes for substance abusers. Alcoholics Anonymous, for example, includes invocation of a higher power as part of its program. Surprisingly, however, nobody has looked too closely at whether such spiritual guidance is any help. Until now, that is.

A team from New Mexico, lead by Professor William Miller, has tested the effects of spiritual intervention in two meticulously designed studies. In addition to their usual treatment, patients were also also offered a series of one-on-one sessions with counsellors delivering a manual-guided form of spiritual direction designed by Miller specifically for this population. The guidance comprised the patients selection from:
... acceptance, celebration, fasting, gratitude, guidance, meditation, prayer, reconciliation, reflection, service to others, solitude, and worship. The chosen disciplines have historic roots of practice for hundreds or thousands of years, and are familiar within the Judeo-Christian tradition that is the most common religious background in the US population.
And what happened? Well, in both studies, normal treatment was highly effective, significantly and rapidly increasing the percentage of days that patients were able to stay off the drugs . The addition of spiritual guidance, however, had no effect.

Well, not quite no effect...

In turns out that, in Study 1, the patients who were given spiritual guidance suffered significantly more anxiety and depression in the first 6 months of the study. In fact, what happened was that patients just given usual treatment saw their anxiety and depression reduce. Spiritual guidance prevented that happening.

Now, this effect was not seen in Study 2. And the difference between the two studies was? Well, in the first study, the guidance was given by "three highly experienced, certified professional spiritual directors". In the second study, the guidance was provided by secular counsellors (with qualifications in psychology or social work).

In other words, spiritual guidance from religious enthusiasts can successfully put the fear of god into these people, but it doesn't get them off drugs. Drug rehabilitation is an expensive, time consuming, and vitally important business. Spending money on unvalidated spiritual intervention is a distraction.

It's time we got drug abuse counsellors off their addiction to religion.

W MILLER, A FORCEHIMES, M OLEARY, M LANOUE (2008). Spiritual direction in addiction treatment: Two clinical trials Journal of Substance Abuse Treatment, 35 (4), 434-442 DOI: 10.1016/j.jsat.2008.02.004


  1. One of the co-moderators of a blog I moderate has linked to the same article, and I have rebutted it. Please go over there and take a look at my criticism of this paper you've excerpted here.

  2. There is one very significant difference between the experimental intervention in the studies and the actual integration of spirituality in 12 programs. In the studies spiritual "experts" did counseling with addicts while in 12 programs a range or people share their spiritual (or not) experiences and addicts are free to find their own spiritual connection to help them recover.

    This freedom to find one's own spiritual belief and practice may make a difference which would not have shown up in the studies. Perhaps when addicts choose their own spiritual path they are evaluating their place in the world and seeking to find how they connect to something larger than themselves. This connection to the group of addicts (a common "higher power" for many newcomers to 12 step meeting) or to other spiritual concepts may make the difference. This connection seems more likely to be formed and strengthened if the addict seeks it out rather than having it imposed by a counselor or other "expert."

  3. lol I am a real life example of someone who stop drugs specifically because of "spiritual guidance" and it's what keeps me from going back. The poster should not make such a bold claim, considering that the topic is too broad to have a definte answer. There are MANY MANY MANY examples of people out there who have successfully recovered from drugs and alcohol either because spiritual guidance was involved or recovered as a direct result of spiritual guidance. I would be interested in seeing how this "article" would change if the many people who were once subtsance abusers but were in fact were helped by "spiritual guidance" were interviewed as well. God bless.

  4. Hi Nice Blog.SoberRecovery & SoberRecovery Community Forums lists hundreds of drug and alcohol treatment centers, drug addiction treatment and alcoholism treatment resources in the U.S.

  5. Spitituality has everything to do with my sobriety. Please read my spiritual blogs at:

  6. Not much of interest in the comments here, just a bunch of "Well Jeebus saved me from addiction, so it must work!" anecdotes. (And on a side note, I wonder how safe this is... if you beat your addiction because you think God told you to, that's great; but what happens if you start thinking God is telling you to kill your neighbor? Just sayin'....)

    I'd be far more interested in numbers. I have heard that AA does not actually yield particularly impressive success rates in comparison with, well, pretty much anything else -- but it is hard to find numbers except from wildly pro-AA sources.

  7. James, I don't see anyone in these comments discussing Jesus. It is true that in controlled studies AA does about as well as other forms of therapy such as cognitive behavioral therapy. One big difference is that AA is free and those other types of treatment can cost quite a lot. Here is an article about a pretty objective study which shows that AA is as effective (neither more nor less) than other types of treatment and therapy.

    The AA literature does not claim to have the only solution. It suggests that if you can stop drinking on your own, or with some other method to go ahead and do that. It also suggests that if you can moderate your drinking so it does not cause consequences in your life to go ahead and do that.

    AA is certainly not the only way and it does not help everyone, especially the first time they try it. There is no denying that many people who tried many other methods do eventually get and stay sober in AA for decades.

    Truly doing a controlled study which compares the actual AA experience (there is no such thing as "the" AA experience, since each AA group is autonomous and may be quite different from other groups) with other interventions is nearly impossible to do.

    I just hope everyone who needs help gets the help they need. When people are hyper-critical of any intervention which works and spread misinformation like "AA is a bunch of Jesus freaks" it may prevent some from getting the help they need.

  8. James, I don't see anyone in these comments discussing Jesus.

    Neither did I, I mentioned Jeebus. :p

    Sorry if my tone was a bit derisive, but my point still stands that the comments are all anecdotes. Your comment however was more what I was looking for.

    My problem with AA is not so much that "it's a bunch of Jesus freaks" but that -- in my limited experience, so maybe I'm just totally wrong -- pro-AA people have a tendency to paint like it is the only way that works. If the AA literature says something different, that's interesting, but that's not been my experience. I have heard people say that recovery is not possible without the whole surrendering oneself to a higher power stuff.

    Anyway, thanks for the link. This confirms what I have heard.

    I use my real name, so I don't want to go deeply into details.

  9. And by the way, the apologetics given by AA boosters in the NY Times article sound exactly like the apologetics given by those endorsing bogus "alternative medicine" cures and such. "It's about choice!" No shit, people have choices, but if one choice is based on reality and the other on unsubstantiated assertions....


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