The Concept of Spirituality in Relation to Addiction Recovery and General Psychiatry

  • Marc Galanter
Part of the Recent Developments in Alcoholism book series (RDIA, volume 18)


This chapter is directed at defining the nature of spirituality and its relationship to empirical research and clinical practice. A preliminary understanding of the spiritual experience can be achieved on the basis of diverse theoretical and empirically grounded sources, which will be delineated: namely, physiology, psychology, and cross-cultural sources. Furthermore, the impact of spirituality on mental health and addiction in different cultural and clinical settings is explicated regarding both beneficial and compromising outcomes. Illustrations of its application in addiction and general psychiatry are given: in meditative practices, Alcoholics Anonymous, and treatment programs for addiction singly and comorbid with major mental illness.

Given its prominence in Alcoholics Anonymous and related Twelve-Step groups, spirituality plays an important role in the rehabilitation of many substance-dependent people. The issue of spirituality, however, is prominent within contemporary culture as well in the form of theistic orientation, as evidenced in a probability sampling of American adults, among whom 95% of respondents reply positively when asked if they believe in “God or a universal spirit.” Responses to a follow-up on this question suggest that this belief affects the daily lives of the majority (51%) of those sampled, as they indicated that they had talked to someone about God or some aspect of their faith or spirituality within the previous 24 h (Gallup, 2002).


Mindfulness Meditation Inclusive Fitness Spiritual Experience Major Mental Illness Cultic Movement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This project was supported by The John Templeton Foundation.


  1. Alcoholics Anonymous. (1999, 2002). Alcoholics Anonymous membership surveys. New York: A.A. World Services.Google Scholar
  2. Allport, G. W. (1961). Pattern and growth in personality. New York: Holt, Reinhart and Winston.Google Scholar
  3. Benson, H. (1975). The relaxation response. New York: William Morrow.Google Scholar
  4. Bergin, A. E. (1991). Values and religious issues in psychotherapy and mental health. American Psychologist, 46, 394–403.PubMedCrossRefGoogle Scholar
  5. Blanke, O., Ortigue, S., Landis, T., & Seeck, M. (2002). Stimulating illusory own-body perceptions. Nature, 418, 269–270.CrossRefGoogle Scholar
  6. Borg, J., Bengt, A., Soderstrom, H., & Farde, L. (2003). The serotonin system and spiritual experiences. American Journal of Psychiatry, 160, 1965–1969.PubMedCrossRefGoogle Scholar
  7. Byrd, R. (1988). Positive therapeutic effects of intercessory prayer in a coronary care unit population. Southern Medical Journal, 81, 826–829.PubMedCrossRefGoogle Scholar
  8. Chappel, J. (1993). Long-term recovery from alcoholism. Psychiatric Clinics of North America, 16, 177–187.PubMedGoogle Scholar
  9. Cloninger, C. R., Svrakie, N. M., & Svrakie, D. M. (1997). Role of personality self-organization in development of mental order and disorder. Development and Psychopathology, 9, 881–906.PubMedCrossRefGoogle Scholar
  10. Comte, A. (1907). A general view of positivism. London: Routledge and Sons.Google Scholar
  11. Cook, C. C. H. (1988a). The Minnesota model in the management of drug and alcohol dependency: Miracle, method or myth? Part I: The philosophy and the programme. British Journal of Addiction, 83, 625–634.Google Scholar
  12. Cook, C. C. H. (1988b). The Minnesota model in the management of drug and alcohol dependency: Miracle, method or myth? Part II: Evidence and conclusions. British Journal of Addiction, 83, 735–748.Google Scholar
  13. Davidson, R., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564–470.PubMedCrossRefGoogle Scholar
  14. De Leon, G. (Ed.). (1997). Community as method. Westport, CT: Praeger.Google Scholar
  15. DeMarinis, V. (2003). Pastoral care, existential health, and existential epidemiology. A Swedish postmodern case study. Stockholm: Verbum.Google Scholar
  16. Durkheim, E. (1897). Le Suicide. Paris: Alcan.Google Scholar
  17. Eisenberg, D. M., Kessler, R. C., Van Rompay, M. I., Kaptchuk, T. J., Wilkey, S. A., Appel, S., et al. (2001). Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Annals of Internal Medicine, 35, 344–351.Google Scholar
  18. Epstein, M. (1995). Thoughts without a thinker. New York: Basic Books.Google Scholar
  19. Emrick, C., Tonigan, J., Montgomery, H., & Little, L. (1993). Alcoholics anonymous: What is currently known? In B. McCrady (Ed.), Research on Alcoholics Anonymous (pp 41–76). New Brunswick, NJ: Rutgers Center for Alcohol Studies.Google Scholar
  20. Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G., & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57–63.PubMedCrossRefGoogle Scholar
  21. Fox, J. R. (1964). Witchcraft and clanship in cochiti therapy. In A. Kiev (Ed.), Magic, faith and healing (pp. 174–200). New York: Free Press.Google Scholar
  22. Frances, A., Cooper, A. (1981). Descriptive and dynamic psychiatry: A perspective on DSM-III. American Journal of Psychiatry, 138, 1198–1202.PubMedGoogle Scholar
  23. Frank, J., Frank, J. B. (1961). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore MD: Johns Hopkins University Press.Google Scholar
  24. Frank, J. D. (1971). Therapeutic factors in psychotherapy. American Journal of Psychotherapy, 25, 350–361.PubMedGoogle Scholar
  25. Frankl, V. (1984). Man’s search for meaning (3rd ed.). New York: Touchstone, Simon & Schuster.Google Scholar
  26. Freud, S. (1961). Civilization and its discontents. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 21). London: Hogarth Press.Google Scholar
  27. Fromm, E. (1950). Psychoanalysis and religion. New Haven: Yale University Press.Google Scholar
  28. Galanter, M. (1978). The “relief effect”: A sociobiologic model for neurotic distress and large-group therapy. American Journal of Psychiatry, 135, 588–591.PubMedGoogle Scholar
  29. Galanter, M. (1981). Peer group influence on adolescent alcohol use. Bulletin of the New York Academy of Medicine, 57, 370–377.PubMedGoogle Scholar
  30. Galanter, M. (1983a). Engaged members of the unification church. Archives of General Psychiatry, 40, 1197–1202.CrossRefGoogle Scholar
  31. Galanter, M. (1983b). Unification church (“Moonie”) dropouts: Psychological readjustment after leaving a charismatic religious group. American Journal of Psychiatry, 140, 984–988.Google Scholar
  32. Galanter, M. (1997). Spiritual recovery movements and contemporary medical care. Psychiatry: Interpersonal and Biological Processes, 60, 236–248.Google Scholar
  33. Galanter, M., Buckley, P., Deutsch, A., & Rabkin, J. (1980). Large-group influence for decreased drug use. American Journal on Drug and Alcohol Abuse, 7, 291–304.CrossRefGoogle Scholar
  34. Galanter, M., Keller, D. S., Dermatis, H., & Egelko, S. (2002). The impact of managed care on substance abuse treatment: A report of the American Society of Addiction Medicine. Journal of Addictive Diseases, 19, 13–34.CrossRefGoogle Scholar
  35. Gallup, G. H. (2002). Religion in America 2002. Princeton NJ: Princeton Religious Research Center.Google Scholar
  36. Gazzaniga, M. S. (1970). The bisected brain. New York: Appleton-Century-Crofts.Google Scholar
  37. Gilman, S., Galanter, M., & Dermatis, H. (2001). Methadone anonymous: A Twelve-Step program for methadone maintained heroin addicts. Substance Abuse, 22, 247–256.PubMedGoogle Scholar
  38. Goffman, E. (1963). Stigma. New York: Simon & Schuster.Google Scholar
  39. Goldfarb, L., McDowell, D., Galanter, M., Lifshutz, H., & Dermatis, H. (1996). Medical student and patient attitudes toward religion and spirituality in the recovery process. American Journal of Drug and Alcohol Abuse, 22, 549–561.PubMedCrossRefGoogle Scholar
  40. Hamilton, W. (1975). Innate social aptitudes of man: An approach from evolutionary genetics. New York: John Wiley & Sons.Google Scholar
  41. Hobson, J. A., Pace-Schott, E. F., & Stickgold, R. (2000). Dreaming and the brain: Toward a cognitive neuroscience of conscious states. Behavioral and Brain Sciences, 23, 793–1121.PubMedCrossRefGoogle Scholar
  42. Humphreys, K., Moos, R. H., & Cohen, C. (1997). Social and community resources and long-term recovery from treated and untreated alcoholism. Journal of Studies on Alcohol, 58, 231–238.PubMedGoogle Scholar
  43. James, W. (1929). The varieties of religious experience. New York: Modern Library.Google Scholar
  44. Jung, C. (1978). Instinct and unconscious. In H. Read, M. Fordham, G. Adler, & W. McGuire (Eds.), The collected works of C.B. Jung. Princeton, NJ: Princeton University Press.Google Scholar
  45. Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163–190.PubMedCrossRefGoogle Scholar
  46. Kelley, H. H. (1967). Attribution theory in social psychology. In D. Levine (Ed.), Nebraska symposium on motivation (Vol. XV, pp. 192–238). Lincoln, NB: University of Nebraska Press.Google Scholar
  47. Kendler, K. (1997). Social support: A genetic-epidemiologic analysis. American Journal of Psychiatry, 154, 1398–1404.PubMedGoogle Scholar
  48. Kendler, K., Gardner, C., & Prescott, C. (1997). Religion, psychopathology, and substance use and abuse; a multimeasure, genetic-epidemiologic study. American Journal of Psychiatry, 154, 322–329.PubMedGoogle Scholar
  49. Kendler, K., Liu, X.-Q., Gardner, C., McCullough, M., Larson, D., & Prescott, C. (2003). Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. American Journal of Psychiatry, 160, 496–503.PubMedCrossRefGoogle Scholar
  50. Kessler, R. C., Davis, R. B., Foster, D. F., Van Rompay, M. I., Walters, E. E., Wilkey, S. A., et al. (2001a). Long-term trends in the use of complementary and alternative medical therapies in the United States. Annals of Internal Medicine, 135, 262–268.Google Scholar
  51. Kessler, R. C., Soukup, J., Davis, R. B., Foster, D. F., Wilkey, S. A., Van Rompay, M. I., et al. (2001b). The use of complementary and alternative therapies to treat anxiety and depression in the United States. American Journal of Psychiatry, 158, 289–294.Google Scholar
  52. Kraeplin, E. (1902). Clinical psychiatry: A textbook for students and physicians. New York: Macmillan.Google Scholar
  53. Kurtz, E. (1979). Not-God: A history of alcoholics anonymous. Center City, MN: Hazelden.Google Scholar
  54. Kurtz, E., & Ketcham, K. (1992). The spirituality of imperfection: Storytelling and the journey to wholeness. New York: Bantam.Google Scholar
  55. Laing, R. D. (1967). The politics of experience. New York: Pantheon Books.Google Scholar
  56. Leuchter, A. F., Cook, I. A., Witte, E. A., Morgan, M., & Abrams, M. (2002). Changes in brain function of depressed subjects during treatment with placebo. American Journal of Psychiatry, 159, 122–129.PubMedCrossRefGoogle Scholar
  57. Lifton, R. J. (1961). Thought reform and the psychology of totalism. New York: W.W. Norton.Google Scholar
  58. Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting & Clinical Psychology, 22, 31–40.CrossRefGoogle Scholar
  59. Margolin, A., Kleber, H., Avants, S., Konefal, J., Gawin, F., Stark, E., et al. (2002). Acupuncture for the treatment of cocaine addiction. Journal of the American Medical Association, 287, 55–63.PubMedCrossRefGoogle Scholar
  60. Marlatt, G., & Marques, J. (1977). Meditation, self-control, and alcohol use. In R. Stuart (Ed.), Behavioral self-management: Strategies, techniques, and outcomes (pp. 117–153). New York: Brunner/Mazel.Google Scholar
  61. Maslow, A. (1964). Religions, values and peak-experiences. Columbus: Ohio State University Press.Google Scholar
  62. McCrady, B., & Miller, W. N. (1983). Research on alcoholics anonymous. New Brunswick, NJ: Rutgers Center for Alcohol Studies.Google Scholar
  63. McDowell, D., Galanter, M., Goldfarb, L., & Lifshutz, H. (1996). Spirituality and the treatment of the dually diagnosed: an investigation of patient and staff attitudes. Journal of Addictive Diseases, 15, 55–68.PubMedCrossRefGoogle Scholar
  64. Miller, W., & Kurtz, E.(1994). Models of alcoholism used in treatment: Contrasting A.A. and other perspectives with which it is often confused. Journal of Studies on Alcohol, 55, 159–166.PubMedGoogle Scholar
  65. Miller, W., & Thoresen, C. (2003). Spirituality, religion, and health. An emerging research field. American Psychologist, 58, 24–35.PubMedCrossRefGoogle Scholar
  66. Montgomery, S. A., Reimitz, P. E., & Zivko, M. (1998). Mitrazapine vs. amitriptyline and the long-term treatment of depression: A double-blind placebo-controlled study. International Clinical Psychopharmacology, 13, 63–73.PubMedCrossRefGoogle Scholar
  67. Moseley, J. B., O’Malley, K., Peterson, N. J., Menke, T. J., Brody, B. A., Kuykendall, D. H., et al. (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine, 347, 81–88.PubMedCrossRefGoogle Scholar
  68. Mosher, L. R., & Menn, A. Z. (1978). Community residential treatment for schizophrenia: Two-year follow-up. Hospital and Community Psychiatry, 29, 715–723.PubMedGoogle Scholar
  69. Murray, H. A. (1938). Explorations in personality. New York: Oxford University Press.Google Scholar
  70. Patel, C., Marmot, M. G., Terry, D. J., Carruthers, M., Hunt, B., & Patel, M. (1985). Trial of relaxation in reducing coronary risk: Four year follow up. British Medical Journal Clinical Research, 290, 1103–1106.CrossRefGoogle Scholar
  71. Pfister, O. (1993). The illusion of a future: A friendly disagreement with professor Sigmund Freud. International Journal of Psychoanalysis, 74, 557–579.PubMedGoogle Scholar
  72. Project MATCH Research Group. (1998). Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes. Alcoholism: Clinical and Experimental Research, 22, 1300–1311.CrossRefGoogle Scholar
  73. Proudfoot, W., & Shaver, P. (1975). Attribution theory and the psychology of religion. Journal of the Scientific Study of Religion, 14, 317–330.CrossRefGoogle Scholar
  74. Rizzuto, A.-M. (1979). The birth of the living God: A psychoanalytic study. Chicago, IL: University of Chicago Press.Google Scholar
  75. Robins, E., & Guze, S. (1960). Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. American Journal of Psychiatry, 126, 983–987.Google Scholar
  76. Schachter, S., & Singer, J. E. (1962). Cognitive, social and physiological determinants of emotional state. Psychological Review, 69, 379–399.PubMedCrossRefGoogle Scholar
  77. Schneider, R., Staggers, F., Alexander, C., Sheppard, W., Rainforth, M., Kondwani, K., et al. (1995). A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension, 26, 820–827.PubMedCrossRefGoogle Scholar
  78. Silberstein, C., Metzger, E. J., & Galanter, M. (1996). The greenhouse: A modified therapeutic community for homeless addicts. In G. De Leon (Ed.), Healing communities: Therapeutic communities for special populations in special settings (pp. 263–272). Westport, CT: Greenwood Publishers.Google Scholar
  79. Sloan, R. P., Bagiella, E., & Powell, T. (1999). Religion, spirituality, and medicine. Lancet, 353, 664–667.PubMedCrossRefGoogle Scholar
  80. Stinchfield, R., & Owen, P. (1998). Hazelden's model of treatment and its outcome. Addictive Behaviors, 23, 669–683.PubMedCrossRefGoogle Scholar
  81. Substance Abuse and Mental Health Services Administration. (2000). Uniform Facility Data Set (UFDS): 1998. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  82. Suomi, S. (1999). Attachment in rhesus monkeys. In J. Cassidy, & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical application (pp. 181–197). New York: Guilford Press.Google Scholar
  83. Suomi, S. J., Harlow, H. F., & McKinney, W. T. (1972). Monkey psychiatrists. American Journal of Psychiatry, 128, 927–932.PubMedGoogle Scholar
  84. Suomi, S. J., Seaman, S. F., Lewis, J. K., DeLizio, R. D., & McKinney, W. T. (1978). Effects of imipramine treatment of separation-induced social disorders in rhesus monkeys. Archives of General Psychiatry, 35, 321–325.PubMedCrossRefGoogle Scholar
  85. Suzuki, D., Fromm, E., & De Martino, R. (1960). Zen Buddhism and psychoanalysis. New York: Grove Press.Google Scholar
  86. Tonigan, J., Miller, W., & Connors, G. (2000). Project MATCH client impressions about alcoholics anonymous: Measurement issues and relationship to treatment outcome. Alcoholism Treatment Quarterly, 18, 25–41.CrossRefGoogle Scholar
  87. Walsh, B. T., Seidman, S. N., Sysko, R., & Gould, M. (2002). Placebo response in studies of major depression. Journal of the American Medical Association, 287, 1840–1847.PubMedCrossRefGoogle Scholar
  88. Williams, J. (1985). The multiaxial system of DSM-III: Where did it come from and where should it go? Archives of General Psychiatry, 42, 175–180.PubMedCrossRefGoogle Scholar
  89. Wilson, E. O. (1978). On human nature. Cambridge: Harvard University Press.Google Scholar
  90. Winnicott, D. W. (1953). Transitional objects and transitional phenomena: A study of the first not-me possession. International Journal of Psychoanalysis, 34, 89–97.PubMedGoogle Scholar
  91. Yalom, I. D., & Lieberman, M. A. (1971). A study of encounter group casualties. Archives of General Psychiatry, 25, 16–30.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Professor of Psychiatry, and Director, Division of Alcoholism and Drug AbuseNYU School of MedicineNew YorkUSA

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