Alcohol Treatment and Cognitive-Behavioral Therapy: Enhancing Effectiveness by Incorporating Spirituality and Religion

By Hodge, David R. | Social Work, January 2011 | Go to article overview

Alcohol Treatment and Cognitive-Behavioral Therapy: Enhancing Effectiveness by Incorporating Spirituality and Religion


Hodge, David R., Social Work


Alcoholism is a major social problem. In the United States, the total economic costs to society from alcohol abuse have been estimated at $148 billion (Simon, Patel, & Sleed, 2005). According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA, 2000a), over 700,000 Americans receive treatment for alcoholism on any given day. Treatment options have historically consisted of two relatively distinct alternatives: mutual aid groups (for example, Alcoholics Anonymous [AA]) and professional treatment (for example, mental health centers) (Magura, 2007).

Among professional treatments, one of the more effective approaches used to treat alcoholism is cognitive-behavioral therapy (CBT) (Longabaugh et al., 2005). Despite the effectiveness of CBT with some clients, this and other treatment modalities are ineffective with many others wrestling with alcohol dependency (Corte, 2007). Furthermore, among those who successfully complete treatment, relapse is often a problem (Corte, 2007; Piderman, Schneekloth, Pankratz, Maloney, & Altchuler, 2007). In short, research on treatment effectiveness is still in its infancy, and additional work is needed to enhance outcomes.

One approach that may enhance outcomes, at least for some clients, is the incorporation of spirituality into traditional CBT protocols. Although spirituality is a common dimension in mutual aid groups, it is comparatively rare in professional treatment settings (Magura, 2007). A survey of addiction treatment professionals (N = 317) found that 84 percent believed that spirituality should be emphasized more in treatment (Forman, Bovasso, & Woody, 2001). The importance of incorporating spirituality into treatment is also reflected in recent changes instituted by the Joint Commission--the most prominent health care accrediting organization in the United States--which now requires behavioral health organizations providing addiction services to administer a spiritual assessment (Hodge, 2006b; Koenig, 2007).

The purpose of this article is to acquaint readers with spiritually modified CBT, an approach that may speed recovery, enhance treatment compliance, prevent relapse, and reduce treatment disparities by providing more culturally congruent services. Although most practitioners are interested in incorporating spirituality into treatment, they also report receiving little, if any, training on the topic during their graduate education (Sheridan, 2009). The need for content on spirituality seems particularly pressing in light of the Joint Commission's new requirements. If accrediting organizations are going to require service providers to explore client spirituality, then content on how to help clients operationalize their spiritual strengths is vital. Spiritually modified CBT incorporates clients' spiritual strengths in ways that build on existing practice knowledge and skill sets in the area of CBT (Longabaugh et al., 2005).

Toward this end, the research on spiritually modified CBT is reviewed, rationales for its applicability with alcohol treatment are provided, positive outcomes that may be enhanced are delineated, and the process of constructing spiritually modified CBT self-statements is described and illustrated. To help ensure that this process occurs professionally, suggestions are offered for working with client spirituality in an ethical manner. First, however, the terms spirituality and religion are defined, and the role of client preferences in enhancing outcomes is discussed.

SPIRITUALITY AND RELIGION: DISTINCT BUT OVERLAPPING CONSTRUCTS

Although spirituality and religion are often used interchangeably, they can be seen as distinct but overlapping constructs (Canda & Furman, 2010; Derezotes, 2006). Spirituality is commonly understood as a person's existential relationship with God or the Transcendent (Gallup & Jones, 2000; Gilbert, 2000), whereas religion is often viewed as an expression of the spiritual relationship in particular forms, beliefs, and practices that have been developed--in community--with others who share similar experiences of transcendent reality (Gotterer, 2001; Miller, 1998). …

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