The Role of Spirituality in Substance Use Disorder Treatment

The pros and cons of incorporating faith into treatment facilities

Recovery is not easy. It often takes more than willpower alone. Substance Use Disorder (SUD) treatment is most successful when rehabilitation programs are utilized. However, there are a number of barriers that stand between a person struggling with addiction and recovery.

“The behavior and mental health world [are[ behind in their ability to make access easy. If you have a medical emergency, you would know exactly where to go; often, the process for mental health can feel cumbersome for someone struggling,” said Ronnie Vasquez, the Acute Care Director at Mental Health Partners of Colorado. Vasquez explained that the stigmatization of treatment for addiction can be a significant barrier to a person taking the first steps to finding support.

Historically, faith-based treatment centers held a “free-will” opinion around substance use, believing that there was a personal choice to use. More recently, many experts have moved away from this treatment ideology, though the stigma that addiction is a personal choice rather than a disease still exists. Furthermore, private, faith-based centers may not adhere to the more recent evidence-based practices that have proven most effective in helping those struggling with addiction. Some still abide by an abstinence-only approach to addiction treatment.

While there are some less-than-ideal factors in faith-based recovery, there are also major financial and community-based benefits, bringing to question the role of spirituality and religion in recovery.

Inside the Mental Health Partners Crisis Center

Substance use in Boulder County

The Boulder County County Coroner’s office reported that of the 403 deaths certified in 2022. 194 of those individuals had banned substances in their system at the time of death, with at least 73 deaths attributed directly to illegal drug use.. Dr. Nadia Haddad, the medical director at Mental Health Partners of Colorado, and board-certified psychiatrist and addiction specialist, spoke about the recent trends in Boulder County.

“When I started working here in 2019, opiate use was the most common, with people mostly abusing pharmaceutical drugs,” said Haddad. “About six months in, it moved more to fentanyl use. Now, it is almost exclusively fentanyl, which is very, very difficult to treat.” Haddad explained that most abused non-pharmaceutical drugs are contaminated with fentanyl at varying amounts, making them less predictable and more lethal, leading to a higher risk of an overdose.

Unfortunately, overdoses are also more likely to occur after a person has maintained a level of sobriety. In a study published by the National Library of Medicine, around 47% of individuals have a reduced tolerance to substances after twenty-eight days of sobriety, and 27% completely lose their tolerance in that time. The danger arises during relapse. Often a person will use a substance in the same manner as they did before detox, despite the physiological changes that occurred, leading to an unintended overdose.

New evidence-based practices look to reduce the risk of relapse and overdose by mitigating the previous beliefs of “abstinence only” and incorporating harm-reduction practices and medication-assisted treatment.

The Road to Recovery

Treatment can look different based on need, insurance, and availability. A detox center will mostly focus on getting an individual through their withdrawal symptoms. A residential program will provide around-the-clock care and treatment in a (usually) closed facility. Intensive Outpatient Programs (IOP) are a step down from residential, providing a safe place for clients to spend the day, participating in groups and medical care, with the freedom to go home at the end of the day. A sober living house is an overnight group living situation that bans illicit substance use but allows clients to return to life, and attend work, school, or other daily activities.

As a person moves through the levels of treatment, they might connect with a recovery group and/or therapist. Often, SUD is a co-occurring diagnosis, meaning that the individual is also dealing with a mental health disorder. Treating the whole person can help prevent relapse and examine the root cause of substance use. A recovery group can help people feel less isolated and develop a sense of accountability and connection among their peers.

Evidence-Based Practices

For SUD treatment, the most up-to-date practices include the medical and mental health treatment required to help a person struggling with addiction stay safe from overdose or lasting repercussions. “There has been a movement away from looking at addiction as if it were a criminal behavior to viewing it as an illness, and more recently, as a chronic illness,” said Dr. Brad Conner, the director of the Masters of Addiction Counseling program at Colorado State University. Conner goes on to explain the importance of not looking at relapse as a fault but rather as a piece of the recovery process, taking away the negative stigmatization of one-directional recovery. He explains that current evidence-based practices have moved away from a twenty-eight-day abstinence model and have started to view treatment as a lifelong process.

The risks of going “Cold Turkey”

Cutting off substance use immediately, without intervention, is referred to as going “cold turkey.” While it might be an effective way to remove a person from a triggering environment, it comes with risks that can prove uncomfortable at best, and deadly at worst. Dr. Haddad warned, “Detoxing from benzos [benzodiazepines] can cause seizures, and alcohol has the risk of Delirium Tremens, which there can be great support around in a detox or treatment center.” A sudden halt in alcohol use causes Delirium Tremens (DTs.) Because alcohol is a depressant, the sudden depletion in the system causes the brain and nervous system to get overstimulated, causing a spike in blood pressure, extreme excitability, and seizures

While not all substances are deadly during withdrawal, many have unpleasant symptoms that can make the person in recovery extremely sick. “It is horribly uncomfortable, and it can be extremely tempting to use during that time.” Haddad continues explaining that even when the symptoms of withdrawal are gone, craving can remain, putting the individual at risk of relapse and accidental overdose.

Medication Assisted Treatment

Medication Assisted Treatment (MAT) is an effective tool to help a person get through detoxification and the subsequent withdrawals. MAT uses FDA-approved drugs to help a person safely withdraw from a substance, as well as prevent future cravings with continued medicated use. “There is data showing a 90% relapse rate for heroin without the use of any MAT,” said Haddad, “it is really hard to do alone.”

For Opiate Use Disorder (OUD) there are three approved medications: Methadone and Buprenorphine which prevent withdrawal and minimize cravings, and Naltrexone, which blocks the effects of opiates. Both Buprenorphine and Naltrexone can be prescribed and taken once the individual returns home, while Methadone is administered in clinics. Naltrexone is also used in treating Alcohol Use Disorder, often as an aid in helping a person begin to limit use. Acamprosate and Disulfiram are both used for individuals who have already stopped drinking and need to lessen their cravings.

While MAT has a high success rate, Dr. Conner warns, “There can be more doctor visits, and some of the medications have unpleasant side effects.” For this reason, it is helpful to maintain contact with a care team while undergoing MAT.

Harm-Reduction Practices

The general principle of Harm-Reduction is to minimize the impact of illicit substances, whether it is through abstinence, safer use practices, or management of use. This philosophy accepts that substance use and addiction are a part of the world, and supporting a person who is using is more effective than condemning the behavior.

MAT falls under the umbrella of Harm-Reduction, but the practice also expands to preventing overdose and providing safe spaces and tools for individuals who are not ready to undergo treatment.

Where Does Faith Come in?

In speaking about faith-based practices, it is essential to remember that faith and spirituality can look vastly different depending on the individual and the culture. For that reason, lumping all faith-based treatment centers together is impossible. The historically popular Twelve-Step Programs, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) list their second step as acknowledging a higher power, though there is no dictation or indication of what that higher power has to be.

Dr. Brian Grim is the CEO and founder of the Religious Freedom and Business Foundation, as well as a former researcher for the PEW Research Center, and author of the article “Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse” which looked at the multifaceted role faith can play in recovery. He explained, “There is a spectrum of faith-based centers. Somewhere faith is front and forefront, and somewhere it is more in the background. The premise of any faith-based recovery is that they need a higher power to get out of addiction. Some will make that higher power nebulous, but often the intention is a god-like figure”

The Bad

Late Adapting of Evidence-Based Practices

Some Faith-Based practitioners are not always adaptors of the Harm-Reduction model, with some going so far as to disallow any medication at all. “I have seen clients who have been sent to private facilities that require they are removed from even their mood-stabilizing medication,” says Haddad, adding that the practice is highly harmful to the safety of the client.

While not using Harm-Reduction techniques can be up to the client, the problem arises when a treatment center needs to state that MAT is not provided clearly. Having the advocacy of a case manager or informed family member can be extremely beneficial when finding a treatment program.

Stigmatization

Unfortunately, for many, religious trauma can exist with those who are also dealing with SUD. The past stigmatization of substance use and the potential evangelizing in faith-based treatment can be enough to deter an individual from seeking treatment. Dr Grim explains, “Religion often gets a bad wrap in the news cycle, but it can cut both ways. People can be hurt when the teachings are abused.”

However, sometimes, the most immediate treatment could be a private, faith-based institution. In those cases, an individual might have to make a hard decision: wait for treatment or negate their principles. Dr. Conner states, “For better or worse, many faith-based [programs] will be lower cost and easier to get into. In those instances, a person may not feel connected immediately.” In these situations, Conner recommends the individual figure out what works for them in treatment and avoid getting bogged down in the belief system.

The Good

Volunteers and Availability

A benefit of faith-based SUD treatment is that they are privately funded through donations or private grants, and often use the work of volunteers for a higher patient-to-caregiver ratio. Some studies suggest that faith-based volunteer work saves the United States Government around $316 Million annually.

Furthermore, there are executive orders to prevent the government from funding faith-based groups, which prevents a collision of church and state, or mandated faith-based recovery for those sentenced to treatment from the court.

Forming Connections and Community

Most importantly, there is a lot of research indicating that connection and groups are paramount in treatment and lasting recovery. Finding a connection and belonging can help an individual stay accountable and feel purpose. While faith-based groups are far and away not the only option, they are a common way for people in recovery to join an established community.

Faith-based recovery, at it’s core, is not necessarily a negative model. However, like any institution, improper policies can have detrimental impacts on the individual. For that reason, it is important to know what to look for when seeking treatment.

When Seeking Treatment

• Ask for help. Engaging with trusted friends or family who are willing to help advocate is extremely helpful in navigating the system. If there are no available resources, try calling the SAMHSA helpline at 1-800-662-HELP (4357)
• Get connected with a care team. Starting with community-based organizations, such as Mental Health Partners of Colorado or reaching out to primary care physicians for referrals can be a great start.
• Remember that it is a process, and there is no perfect way to recover.