Introduction

Spiritual struggles are a common coping characteristic for every human regardless of religious affiliation, social status, cultural background, age, or sex (Pargament & Exline, 2021a).They have their roots in the search for significance as a dominant motive connected to involvement in finding meaning, mission, direction, and purpose in life (Frankl, 1992). They become especially important in the face of major life stressors, physical illness, or mental disorders (Flannelly, 2017; Pargament & Exline, 2021b). For example, Frankl’s “tragic optimism” (1992) references a potentially hopeless situation when painful, meaningless, and purposeless circumstances, such as chronic disease, addiction, loss of close relatives, or other major stressful situations, become opportunities to flourish and spiritually grow by finding meaning and transforming these experiences into something purposeful and hope-filled.

The results of previous studies that focused on the effects of spiritual struggles have been ambiguous. Most research has indicated the harmful influence of spiritual struggles on mental health and well-being (Bockrath et al., 2021), but some researchers have emphasized their beneficial effects, such as spiritual growth (Exline et al., 2017; Pargament & Exline, 2021b; van Tongeren et al., 2018; Wilt et al., 2019) or simultaneous growth and decline (Desai & Pargament, 2015).

Spiritual struggles are an insufficiently explored topic in the area of addiction (Piderman et al., 2007). On the one hand, research has shown that spiritual struggles are related to problem drinking (Krause et al., 2018; Stauner et al., 2019), pornography addiction (Grubbs et al., 2017), and problematic gambling behavior (Gutierrez et al., 2020). On the other hand, there is a lack of research regarding the role that spiritual struggles play in the recovery of alcohol-addicted individuals participating in AA as one form of therapy focused on spiritual growth and coping with spiritual struggles (Alcoholics Anonymous, 2001). The 12-step program used in AA as a spiritual signpost is an effective tool for spiritual growth and achieving sobriety (Alcoholics Anonymous, 1981). The purpose of this study was to examine positive references to God as a way to cope with the spiritual struggles of alcohol-dependent individuals participating in AA as a premise for spiritual growth, which is correlated with a happy and alcohol-abstinent life. The spiritual mechanism underlying the relationship between positive religious coping and God’s support and recovery was tested to show potential pathways leading from positive references to God and God’s support to spiritual transformation and to indicate the positive outcomes associated with this.

Review of literature

Detrimental and beneficial effects of spiritual struggles

A meta-analysis conducted by Bockrath et al. (2021) showed that spiritual struggles are an antecedent to psychological adjustment that is three times more harmful than a beneficial factor for mental health and well-being. Because spiritual struggles may be connected to desirable and undesirable psychological and spiritual results, it is important to examine the factors responsible for adjusting to these struggles. Based on a literature review, some suggestions about the positive relationship between spiritual struggles and psychological adjustments can be identified. Recent research has shed light on this topic, emphasizing the role of wholeness (Hart et al., 2020), meaning-making (Desai & Pargament, 2015), communication with the sacred (van Tongeren et al., 2018), perceptions of helpful action by God (Exline et al., 2017), and perceptions of divine action (Wilt et al., 2019). For example, the results of longitudinal research in a sample of couples 18 months after their transition to parenthood confirmed that positive religious coping three months postdelivery led to communication with the sacred nine months postdelivery, which was related to increased spiritual growth 21 months postdelivery (van Tongeren et al., 2018). Also, among students from three U.S. universities, perception of God’s helpful actions, both directly and indirectly through positive religious coping, was positively related to spiritual growth (Exline et al., 2017).

Spiritual struggles and alcohol addiction treatment

In Poland, alcohol abuse and dependence are severe social problems that generate significant costs for medical care. In this country, the annual indicator of alcohol use per capita has grown progressively since 1993, achieving its apogee in 2018, when the average Pole drank more than three times more alcohol than in 1993. According to statistics, 800,000 Poles are alcohol dependent, and 2–2.5 million abuse alcohol (State Agency for Solving the Alcohol Problem, 2021). Participation in AA has been one of the self-help forms of therapy for alcohol-dependent individuals, functioning in Poland since 1973 (Tadeusz, 2012), and it holds 2,300 meetings per week throughout the country (State Agency for Solving the Alcohol Problem, 2021).

The AA approach is based on the conception of a chronic, progressive, and deadly disease that touches every sphere of life (mental, social, physical, and spiritual) and has its roots in spiritual decline (Alcoholics Anonymous, 2001). Spiritual transformation, which may occur in AA (Neff & MacMaster, 2005; Wnuk, 2021a), is recognized as a remedy for this disease, giving a chance via a 12-step spiritual program to stop the progression of the disease and achieve sobriety characterized by alcohol abstinence and a satisfying, fruitful life (Alcoholics Anonymous, 2001). Studies have confirmed that AA involvement is an effective way of treating alcohol-dependent individuals (Humphreys et al., 2014; Kingree & Thompson, 2011; Witbrodt et al., 2012) and that spiritual struggles and spiritual-change mechanisms play a role in this process (Kelly, 2017; Kelly et al., 2011; Krentzman et al., 2013; Krentzman et al., 2011; Krentzman et al., 2017; Tonigan et al., 2013; Wnuk, 2021b).

AA’s 12-step program motivates participants to effectively cope with their spiritual struggles through positive references to God in dealing with stress and to look for God’s support. This is exemplified in the third step of this program, which requires one to “make a decision to turn our will and our lives over to the care of God as we understood Him.” It is connected with a change in the image of God from abandoning, punishing, and arousing fear to loving and merciful (Alcoholics Anonymous, 1981).

There is a lack of research on the image that alcohol-dependent people have of God, but some suggestions from other behavioral addictions can be useful. For example, when comparing a group at high risk for smartphone addiction and a normal control group, the first group had a significantly worse image of God as less responsive, accepting, benevolent, and present (Shim, 2019). Also, step eleven in the 12-step program contains encouragement to build a relationship with God and presents ways to do that: “Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out” (Alcoholics Anonymous, 1981).

God’s support is one element of religious support that encompasses convictions about God’s caring and help, feeling appreciated by God, and being close to God (Bjorck et al., 2019). Positive religious coping refers to effectively dealing with spiritual struggles (Pargament & Exline, 2021a). It is a type of spiritual coping used in confronting stressful situations that reflects a secure connection with a transcendent force and spiritual connections with others (Pargament et al., 2011). In this approach, God is treated as a potential source of direction, love, and care in times of crisis. Studies have shown that positive religious coping and God’s support are positively correlated with similar constructs, but the moderate strength of this effect does not confirm that these are the same concept (Bjorck & Kim, 2009). Previous research has indicated that God’s support in stressful situations can moderate the relationship between positive religious coping and positive outcomes (Bjorck & Kim, 2009; Wnuk, 2021c). For example, in a sample of Polish students, positive religious coping was more strongly related to life satisfaction if they more strongly perceived God’s support. Also, in Van Tongeren et al.’s research (2018), positive religious coping positively influenced spiritual growth indirectly via communication with the sacred, whereas other longitudinal research conducted on alcohol-dependent individuals found that positive religious coping did not effect change in spiritual experiences (Krentzman et al., 2017).

In a sample of alcohol-dependent individuals, spiritual development has been related to positive outcomes, such as abstinence or a reduction in alcohol consumption (Brown et al., 2007; Kelly & Eddie, 2020; Zemore, 2007), reduced stress, increased social support (Laudet et al., 2006), greater meaning in life (Lyons et al., 2011; Wnuk, 2021a), and increased hope (Gutierrez, 2019; Wnuk, 2021b), forgiveness (Lyons et al., 2011), and life satisfaction (Laudet et al., 2006). For example, in Wnuk’s (2021b) study, spiritual experiences positively predicted abstinence duration, sense of hope, and meaning in life of AA participants.

The current study had three hypotheses. In a sample of AA participants from Poland, God’s support is a moderator in the relationship between positive religious coping and spiritual growth (hypothesis 1). In a sample of AA participants from Poland, spiritual growth is positively related to recovery (hypothesis 2). In a sample of AA participants from Poland, positive religious coping is indirectly related to recovery through God’s support mediating the role of spiritual growth (hypothesis 3).

Materials and methods

Theoretical model and statistical analyses

The theoretical model of the research is shown in Fig. 1. The role of the relationships between positive religious coping and God’s support for spiritual growth and the recovery of alcohol-dependent individuals participating in AA was examined. Positive religious coping was used as an indicator of overcoming spiritual struggles (Pargament, 1997). Spiritual growth was examined via spiritual experiences reflecting a connection to the sacred, other people, and nature. For example, in a sample of oncology patients, spiritual experiences in comparison to intrinsic religiosity were more strongly positively related to spiritual growth and more weakly negatively correlated with spiritual decline (Cole et al., 2008). The anticipated positive association between God’s support and positive religious coping in spiritual growth is based on recent research indicating perceptions of helpful action by God (Exline et al., 2017) and the perception of divine action (Wilt et al., 2019) as antecedents to spiritual transformation. Recovery was verified using three indicators—negative emotions, abstinence duration, and happiness—to give the most comprehensive picture of this phenomenon. This was due to the proposed universal mechanism underlying the relationship between spiritual struggles and recovery for three rather weak correlated indicators of healing. There was the possibility of another specific mechanism for every dependent variable. Happiness is not a lack of dysfunctional states like negative emotions (Seligman, 2002), the same as alcohol abstinence is necessary but insufficient for leading a happy and satisfying life. Sobriety means not only abstaining from alcohol but also personifying mental, emotional, and spiritual transformation, not just changing compulsive behavior (Helm, 2019). This approach is reflected in the AA literature where abstinence as a purpose is achievable without spiritual growth but sobriety as a primary goal of recovery based on a 12-step program is rooted in the spiritual development process (Alcoholics Anonymous, 2001).

Fig. 1
figure 1

The Role of God’s support as a Moderator in the Relationship Between Positive Religious Coping and Spiritual Growth (RCOPE = Religious Coping Scale)

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The statistical analyses used IBM SPSS version 26.0. The statistical fit of the model was verified by structural equation modeling (SEM) in AMOS. The following fit model indices were used: comparative fit index (CFI), Tucker-Lewis index (TLI), goodness-of-fit index (GFI), root mean square error of approximation (RMSEA), and standard root mean square residuals (SRMR). Because of the small sample size, bootstrapping was applied using 5,000 resamples within a 95% bias-corrected confidence interval. The test statistic differs significantly from zero when the interval does not include 0 (Hayes, 2018). To reduce potential multicollinearity problems, the variance inflation factor (VIF) was used (Witten et al., 2011).

Participants

In this research, participants were alcohol-dependent individuals from Poland who attended AA meetings. Every participant consented to this study. Questionnaires were distributed before the AA meeting by a psychologist and were picked up at the next meeting. From the 200 distributed questionnaires, 115 were returned.

Demographics

Demographics statistics are presented Table 1.

Table 1 Sociodemographics statistics in a sample of participants in Alcoholics Anonymous (N = 115)
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All the research participants were affiliated with the Roman Catholic Church, and their mean age was 50 years (SD = 10.7). Most were men with a high school or university education. The mean abstinence duration was 5.61 years (SD = 5.78), and the mean length of AA participation was 8.04 years (SD = 7.51).

Measures

The Daily Spiritual Experiences Scale is a 16-item measure of a spiritual area of life independent of religious affiliation (Underwood, 2011). The participants responded on a 6-point scale ranging from 1 (never or almost never) to 6 (many times a day). The more points participants obtain, the more frequent spiritual experiences they feel. This measure has good psychometric properties. In this study, a short, 6-item version of this tool was applied, which had been applied in previous studies, confirming its satisfactory validity and reliability (Wnuk, 2021a, 2023).

The Religious Support Scale consists of 21 items referring to three dimensions of perceived religious support: congregational support, church-leader support, and God’s support (Fiala et al., 2002). Respondents answer questions on a 5-point rating scale (1 = strongly disagree, 5 = strongly agree). The scale’s reliability using the α-Cronbach coefficient was 0.91 for congregational support, 0.75 for God’s support, and 0.9 for church-leader support (Fiala et al., 2002). In the present study, only the God’s support subscale was used. In previous research in a sample of Polish students, satisfactory reliability was noticed (α-Cronbach 0.82) (Wnuk, 2021c).

The Brief Religious Coping Scale (Brief RCOPE) is used to verify spiritual struggles (Pargament & Exline, 2021b) and references positive and negative religious coping methods; it includes seven questions for every dimension. The participants responded on a 5-point Likert scale (ranging from 1 = not at all to 5 = a great deal). This measure is characterized by a satisfactory level of reliability and internal validity (Pargament et al., 2011). In this study, only questions about positive religious coping were used, reflecting a secure relationship with a caring God and a belief that life has a greater benevolent meaning (Pargament et al., 1998).

The Current Happiness Scale assesses a person’s level of happiness using one of four possible answers: not happy (0), happy (1), quite happy (2), and very happy (3) (Czapinski, 1992).

Negative emotions were verified by a measure used in the National Health Interview Survey (National Center for Health Statistics, 2018). It consists of six items about negative feelings of irritation, worthlessness, hopelessness, or sadness. Respondents answered on a 5-point scale ranging from never, rarely, usually, and often to always.

The abstinence duration was examined by entering the number of years without alcohol consumption.

Results

Preliminary results

The descriptive statistics are shown in Table 2, and Pearson’s correlation coefficients are presented in Table 3.

Table 2 Descriptive statistics in a sample of participants in alcoholics anonymous (N = 115)
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Table 3 Pearson’s correlation coefficients in a sample of participants in alcoholics anonymous (N = 115)
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Positive religious coping was positively related to God’s support, spiritual experiences, and abstinence duration. God’s support correlated positively with positive religious coping, spiritual experiences, abstinence duration, and happiness and negatively with negative emotions. Spiritual experiences were positively related to abstinence duration and happiness and negatively to negative emotions. Also, recovery indicators were intercorrelated. Happiness was positively correlated with abstinence duration and negatively correlated with negative emotions, which was negatively related to abstinence duration. Also, only in a group of research participants characterized by strong perception of support from God was positive religious coping positively related to spiritual growth; among those with weak God’s support, this link was irrelevant (see Fig. 1).

Path model

The VIF values for the research variables indicated a lack of multicollinearity. The highest value referenced by God’s support was 3.63, which was less than the threshold level of 10.0 (Witten et al., 2011). Because the skewness and kurtosis values did not exceed the threshold criteria (Kline, 2005), which suggested that the distribution of the variables was approximate to a normal distribution, the maximum likelihood method of SEM was used.

The standardized parameters of the path analyses are shown in Fig. 2.

Fig. 2
figure 2

Path Analysis. Note. The standardized regression coefficients are presented. *p < .05, **p < .01, ***p < .001. The covariances are not shown for the sake of legibility. There was a residual correlation between abstinence duration and happiness (r = .24; p < .005), negative emotions and happiness (r =  −.24; p < .005), negative emotions and abstinence duration (r =  −.39; p < .001) and positive religious coping and God’s support (r = .74; p < .001)

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The values of the fit criteria of the model confirmed that the model was well fitted to the data: χ2(9) = 12.93; p = 0.17; CMIN/df = 1.44; CFI = 0.98; GFI = 0.96; TLI = 0.97; NFI = 0.96; RMSEA = 0.062 (90% CI [0.000, 0.132]), RMSR = 0.04. Additionally, the results of the Bollen-Stine bootstrapping method (p = 0.18) for 5,000 samples provided the basis for considering the model a good fit.

The results showed a statistically significant direct interactive effect of positive religious coping and God’s support on spiritual experiences (95% CI [0.018, 0.328], p = .027, β = 0.17). The direct effects of spiritual experiences on negative emotions (95% CI [−0.433, −0.096], p = .004, β =  −0.27), happiness (95% CI [0.120, 0.453], p = .002, β = 0.30), and abstinence duration (95% CI [0.101, 0.441], p = .002, β = 0.28) were relevant.

Interactive indirect effects of positive religious coping and God’s support via spiritual experiences on negative emotions (95% CI [− 0.117, − 0.006], p = 0.018, β =  −0.05), happiness (95% CI [0.008, 0.128], p = 0.016, β = 0.05), and abstinence duration (95% CI [0.007, 0.121], p = .015, β = 0.05) were statistically significant.

Discussion

The purpose of this study was to verify that God’s support is a crucial factor underlying the relationships between positive religious coping and spiritual growth and the recovery of alcohol-dependent individuals in Poland participating in AA.

Hypothesis 1, regarding the moderating role of God’s support in the relationship between positive religious coping and spiritual growth, was confirmed. The mechanism of the benefits was shown to come from God’s support, underlying the link between positive and spiritual growth. As confirmed, favorable references to God by alcohol-dependent individuals as a method to confront stress are fruitful for spiritual transformation, but only when a belief in divine support accompanies it. Without filling this condition, positive religious coping is irrelevant for spiritual growth. This means that using positive religious coping offers the opportunity for spiritual growth only among alcohol-dependent AA participants who have a strong sense of God’s supportive action. For individuals who are not convinced of God’s helpful activity and God’s concern, a positive appeal to God is not related to the presence of spiritual experiences.

These findings correspond with recent studies confirming that positive perceptions of divine interventions and helpful and supportive actions attributed to God in a time of spiritual crisis are necessary for spiritual growth (Exline et al., 2017; van Tongeren et al., 2018; Wilt et al., 2019). Similar to a longitudinal study conducted by van Tongeren et al. (2018), positive religious coping was related to spiritual growth, but only in a group with a close relationship with God that was verified not by God’s support but by communication with God. Also, as in Wnuk’s study (2021c), favorable outcomes were the consequence of positive religious coping in a group of AA participants who manifested perception of strong support received from God. In contradiction to this study, this relationship was irrelevant in individuals who declared a weak God’s support. In Wnuk’s study (2021c), a positive effect of positive religious coping on life satisfaction was observed in all three groups with less than average, average, and more than average results for God’s support but was weakest in those in the first group and strongest in those in the third group. This study showed for the first time that the spiritual growth of alcohol-dependent individuals in overcoming stress requires God’s support; without that, even positive references to God in a stressful situation will not be effective.

Hypothesis 2, regarding a positive link between spiritual growth and the recovery of individuals involved in AA, was also confirmed. Consistent with previous research, spiritual growth is not only a positive antecedent to abstinence or a reduction in alcohol consumption (Brown et al., 2007; Kelly & Eddie, 2020; Tonigan et al., 2017; Wnuk, 2021b; Zemore, 2007) but also to positive (Gutierrez, 2019; Lyons et al., 2011) and to negative (Laudet et al., 2006) measures of recovery, such as negative emotions. This current research indicates spiritual transformation, which can occur in AA self-help groups, as a possible remedy for alcohol dependency. The 12-step program is widely recognized as spiritual (Tonigan et al., 2013) and is dedicated to all alcohol-dependent individuals who perceive themselves as religion-affiliated or non-affiliated (religious skeptics, agnostics, and atheists) (Tonigan et al., 2002), allowing spiritual growth through both religious spirituality and secular spirituality (Kurtz & White, 2015; Wnuk, 2021a) as two ways to achieve this goal.

In accordance with the suggestions in AA literature (Alcoholics Anonymous, 2001) it was shown that the sine qua non condition for spiritual growth is perception of strong support from God as a probable result of the 11th-step recommendation about developing a relationship with God through prayer (Alcoholics Anonymous, 1981). This change in the divine image from abandoning and vengeful should occur in step three during the giving of the will and life over to the care of God (Alcoholics Anonymous, 1981).

In light of the results, hypothesis 3, that positive religious coping is indirectly related to recovery through spiritual growth, was confirmed, but only in the group with a higher result on God’s support. Positive religious coping was indirectly, through spiritual growth, related to abstinence, happiness, and negative emotions, but only among the individuals feeling a strong sense of God’s support. These findings parallel recent studies that have explored spiritual struggles, spiritual growth, and well-being indicators (Chang et al., 2018; Zarzycka & Zietek, 2019), suggesting that the direction between these variables leads from spiritual struggles through spiritual growth to positive outcomes. It was confirmed that the spiritual mechanism underlying the links between positive religious coping and recovery are complex and have two additional conditions: a strong belief in God’s support and the presence of spiritual growth. This means that religious coping is positively and directly related to spiritual growth and indirectly linked with abstinence, negative emotions, and happiness via spiritual growth, but only in AA participants with a close relationship with God. Possessing a weak God’s support is related to a lack of direct, relevant association between positive religious coping and spiritual experiences and of indirect links with other recovery indicators. This mechanism was confirmed to be universal, comprehensive, and applicable to all recovery indicators.

Notably, previous suggestions contained in AA literature that abstinence and sobriety are not the same were empirically confirmed. The moderate association between abstinence duration and negative emotions and the weak association between happiness and abstinence duration and happiness and distress implicate three different levels of alcohol-dependency recovery and confirm that abstinence is not the same state as sobriety (Helm, 2019).

The recovery process can be situated on three levels. The next level is possible to realize but requires one to attain the previous level and leads from abstinence through the reduction of negative emotions to happiness. The first level of recovery reflects alcohol abstinence as a necessary factor for reducing negative emotions. The second is the lack of negative emotions as essential for achieving happiness but is not the same as happiness, and the third is happiness as a manifestation of sobriety.

The theoretical implications of this study focus on the benevolent role of the spiritual and religious dimensions in the alcohol-dependence treatment of AA participants. Also, the mechanisms underlying the relationship between positive religious coping and spiritual growth and recovery in this sample were explored and explained, emphasizing the benefits of relying on God’s support. The practical implications of this study stress seeking to develop a relationship with God and perception of receiving God’s support as effective ways to strengthen the relationship between positive religious coping and spiritual growth as a predictor of alcohol abstinence and happiness. It is important to emphasize that spiritual growth is not exclusive to individuals with religious worldviews (Mercadante, 2020; Sedlar et al., 2018). It is also available to people whose worldviews have roots in evolution, natural selection, etc.

Based on these results, therapists, psychologists, and physicians taking care of alcohol-dependent religiously inclined patients should motivate them to restore their relationship with God and build a bond with God. If they are believers, turning to God in stressful situations can be fruitful for them if they perceive receiving God’s support and can be an effective way to achieve spiritual growth and successful treatment for alcohol dependence. Nonbelievers should be encouraged to search for and find a power greater than themselves to attain this. They should also be supported in their spiritual struggles and striving for spiritual growth. In accomplishing this task, therapists should remember the need for worldview independence to avoid potentially harming patients by imposing their worldviews on them.

Limitations and future research

This study was limited to Roman Catholic alcohol-dependent individuals from Poland who were participants in AA with relatively long-term abstinence and involvement in AA. Research regarding alcohol dependence in another cultural context, especially a less religious one, and representing other denominations than Roman Catholic and without stable alcohol abstinence and long duration in AA, is needed. Research among self-help group members diagnosed with behavioral addictions could also yield interesting results. This could offer a chance to verify the potential universality of the recovery model presented here and generalize the achieved results to others diagnosed with substance and behavioral addiction, including those with other religious affiliations and nonbelievers. This is crucial because spiritual struggles also are experienced by atheists (Sedlar et al., 2018) and individuals identifying themselves as spiritual but nonreligious (Mercadante, 2020) who attend AA and other self-help groups and follow the suggestions of the 12-step spiritual program (Kurtz & White, 2015).

Using other spiritual struggle, spiritual growth, and recovery measures and exploring other factors underlying the relationship between spiritual struggles and spiritual growth are recommended (Desai & Pargament, 2015; Exline et al., 2017; Hart et al., 2020; van Tongeren et al., 2018; Wilt et al., 2019). Finally, longitudinal (not cross-sectional) research should be employed. Without that, we can indicate only potential directions between research variables, as was done in this research, but with links to cause and effect. The lack of verification of other models means that another direction of research variables is possible, such as, for example spiritual growth as an antecedent to God’s support.