Spirituality is frequently enmeshed in discussions regarding addictions prevention, treatment, and recovery. Yet, there is little effort to define what is meant by "spiritual." Perhaps, this is because of the importance of spirituality in "The Big Book," Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism (Alcoholics Anonymous World Services, 1955). In the foreword to the second edition of this book, there is recollection of a "sudden spiritual experience" (1955, p xvi). However, there is little explanation as to exactly what this "spiritual experience" entails. Later, in the chapter titled, "We Agnostics," spirituality is differentiated from religion and a belief in God. In this chapter, there is a mandate that alcoholics have to "find a power greater than" themselves (p. 45). As described, it is acknowledged that this journey will entail talking about God and that this may stir up "anti-religious" feelings. But the emphasis here is not on the formalized religious understanding of God that is often derived through prescriptive rules and rituals but through the creation of an individual relationship with a God of one's own understanding. The intention in this text is that the "realm of the Spirit is broad, roomy, all inclusive; and never exclusive or forbidding" (p. 46). The emphasis is on coming to know a personal conception of God or that "Power Greater than yourself." It is explicit that this is foundational to "commence spiritual growth" (p. 47). At the end of this same text, in Appendix II-"Spiritual Experience," the essentials of the program in Alcoholics Anonymous (AA) are identified. These essentials could also be applied to the spiritual life. They are "willingness, honesty and open-mindedness" (p. 570).
This special edition of the Journal of Addictions Nursing is focused on spirituality and addictions across the continuum of prevention to recovery. Four articles in this special edition provide reviews of relevant literature related to spirituality and addictions for adults as well as adolescents, whereas one is an empirical study addressing this topic. Three of the articles specifically focus on understanding the role spirituality has within the context of AA. In reviewing these submissions, several themes arose. The first is the difficulty in defining "spirituality" and differentiating it from "religion." A universal definition of spirituality is lacking in the literature. Because it is difficult to differentiate religion from spirituality, conceptualization and measurement issues often result in conflicting as well as confusing findings. Differentiating religion from spirituality is also relevant to practice. Feigenbaum, for example, presents a historical review of the role of spirituality within the history of AA. She emphasizes that contemporary legal discussions raise concern about whether AA programs are religiously based and argues that AA was not established as a religious association but one emphasizing the inherent spiritual nature of human beings.
The need to better understand potential mediators and moderators of the relationship between religion/spirituality also arose. Walton-Moss and colleagues point out the need to examine in more depth potential moderators such as gender and race. Tusa and Burgholzer's review focuses on the effectiveness of spirituality within the context of 12-step recovery programs and discusses pathways through which spirituality is found to exert its influence. Strobbe and colleagues examine the role of attendance at AA meetings among patients in Poland and the concept of spiritual awakening in predicting alcohol use over time. Kub and Solari-Twadell's review focuses on the role of religiosity/spirituality in the prevention, treatment, and recovery of addictions in the adolescent population.
In seeking articles for this special edition, the editors had to actively engage with authors to submit publications addressing spirituality and addiction. Although there is an interest in the topic and that interest is evident globally (Strobbe et al.; Kub & Solari-Twadell), it is still an underresearched area. Nevertheless, it is a topic that is acknowledged to have great importance to practice. Tusa and Burgholzer and Feigenbaum stress the importance of understanding the principles of AA to make appropriate referrals and promote positive outcomes for clients. Kub and Solari-Twadell stress the importance of interdisciplinary work in defining the concept of spirituality for adolescents as a means of promoting positive youth development.
These articles overall illustrate and summarize many of the strengths and limitations in the study of spirituality and addictions. The editors of this special topic issue on spirituality and addictions hope the articles included will stimulate others to develop further studies directed toward understanding more fully the significance of spirituality in the prevention, treatment, and recovery from addictive illness. As Strobbe and colleagues state, "spirituality has established itself as a viable area of research," but there is clearly a need to tackle methodological and conceptualization issues. If these issues are not addressed, there will continue to be vagueness in understanding the construct of spirituality and a lack of consideration of the dynamics of the "spirit" in the prevention, treatment, and recovery from this chronic progressive illness. The intention of the editors is that others, with the capability and interest in research, will find a passion in focusing on spirituality as a worthwhile aspect of addictive illness. May new programs of research directed to spirituality and addiction culminate in reputable findings with associated outcomes that will benefit all.
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