Role of Spirituality in Substance Abuse and Recovery

Introduction

Separation of drug addicts from these substances during treatment has several implications on the general wellbeing of the same. It is because addicts’ dependence on the drugs is very high and in most instances, they can hardly function without the influence of drugs. However, in order to function executively, independence from drugs and alcohol is of essence. The separation process is characterized by shame, rage, fear and many other factors that undermine the total recovery of the addicts. Studies conducted show that the process of mourning is fundamental because it enhances the release of the negative feelings that inhibit recovery. Indeed, mourning according to psychoanalysts enables the addicts to let go of the destructive relationships that they have with the drugs and establish constructive and productive viable relationships with human beings. In order to achieve this, it has been identified that spirituality plays a very fundamental role.

This concept means different things to different people but essentially, it has been contended that the influence of the Supreme Being enhances change in character. At this point in time, it is worth noting that change forms the background of the recovery process. Specifically, spirituality helps in the construction and reconstruction of personal narratives in the contexts of the purpose and meaning of the addicts’ life. It is in this consideration that this literature review provides an in depth analysis of the role of spirituality in substance abuse and the recovery of drug addicts. To enhance effective coherence of in the review, it is organized in subsections that exhaustively evaluate particularistic aspects of the theoretical construct of the subject under review, psychodynamic perspectives on addiction, psychodynamic perspectives on mourning, psychodynamic perspectives on rage, the concept of spirituality and its role in the recovery process, how spirituality can be employed in the construction of narratives, the application of the multiple code theory on mourning and the impact of rage and shame on the mourning process and ultimate recovery of the addicts.

 

General theory of affect

Object relations theory

Over time, the objects relations theory has gained popularity because of the fact that its application plays a fundamental role in psychoanalysis. The theory explicitly explores the active course of mind development as an individual grows and the influence of the different ‘real others’ that are found in that particular environment (Masterson, 1998). The term ‘object’ in this regard refers to the physical others as well as the others that are imagined. All these are found in a person’s holistic environment and influence growth in different ways. Ogden (1990) indicates that an individual’s rapports with the various objects are often initiated during the childhood interactions that an infant has with a care giver, the mother or any other individual that the infant shares a close relation with. Studies conducted in this regard show that these early interactions can be modified and improved through time due to the different experiences that an individual goes through (Grostein (1981). However, despite the modification, Klein (1962) affirms that the early interactions have a permanent effect on a person’s psychological wellbeing.

The infant usually interacts with and understands different objects differently in accordance with their functions and implications in its life. These are referred to by Ogden (1990) as part or whole objects. For example, he explains that the breast that provides milk and satisfies the infant when it is hungry is perceived as the good breast by the infant. However, one that does not contain milk and is of little help to the infant when it is hungry assumes a bad breast relationship. During this time, the infant is often subjective and sensitive to the different implications of the objects in its life. Moreover, it is from these relationships that the infant starts to internalize certain objects and develops a sense of imagination. As such it can fantasize about certain objects and develop an image of the same in the mind. According to Stephen (1997), these internal objects may be a direct representation of the real external ones, or may not. The presence of an ideal aiding environment results into the ultimate transformation of the part objects in to whole. To this end, the infant can then be able to accept the ambiguity and complexity of the whole objects (Gunstrip, 1995). For example, the infant will be in position to realize that both the bad and good breasts are part of the mother.

Fairbairn’s contributes to this subject and contends that the parents are the first individuals that the infant develops a relationship with because of the personal relationship that the infant shares with them (Fairbairn, 1952). The various interactions with the parents lead to the development of a special bond which further strengthens the attachment between the parents and the infant. According to Fairbairn, the future emotional experiences of the child are highly influenced by the emotional relationship that the child enjoys with the parents during infancy. To this end, he asserts that the libidinal objects that the child develops at infancy determine later relationships with others.

With regard to the relationship with the internal objects, Fairbairn asserts that effective parenting results in to the development of holistic individuals that can maintain a good relationship with real others through interactions. On the other hand, defective parenting produces children whose interactions with real individuals are relatively superficial and therefore defective. In this respect, instead of valuing actual relationships with real people, these children fantasize private relationships with the internal objects and in most instances live in their imagined world. In order to nurture socially acceptable individuals, it is important that parents provide a good environment for holistic growth during infancy.

Fairbairn (1952) also argues that in cases where the parents are missing, the infant’s mind internalizes the unresponsive (bad) aspects of its parents and visualizes the aspects as forming part of it due to the fact that the aspects are not actually available. He refers to this as the splitting ego effect. For instance, in cases where the mother of the infant is stressed but renounces this state, the child identifies with this state because s/he may be unable to establish a complete relationship with the mother during this period. As a result, the infant becomes stressed, not because of any external influence, but because of the fact that it can not effectively relate with the mother and the mother has denied the condition.

In his study, Winnicott shows that a child develops from an integrated condition to a distinct status from which s/he can be able to identify and relate with the objective world (Roadman, 2003). He asserts that the early environment, possibly provided by the mother provides an important basement upon which the future of the child is anchored. However, in order to attain a satisfactory level of development that is essential for survival, Winnicot argues that the child should be able to perceive the mother as neither a good nor bad object but rather an independent and complex individual who lives an independent life. This then helps the child to understand and acknowledge the contributions of the mother in his or her life. Generally, the propositions of Winnicott presented through his exploration of the development process create a good enough mother who is characterized by patience and tolerance. Thus in order to understand the patients well during therapy, he suggests that the medical practitioners should assume the ideal qualities of good enough mother and provide the best environment for the patient t recuperate.

The drive theory

This theory is based on the conception that human beings are born with certain structural expectations. Studies show that failure to fulfill these expectations results in to a state of anxiety which is basically destructive. Ogden (2005) explains that it is because anxiety leads to tensions that have adverse effects on the emotional wellbeing of human beings. However, when the expectations are met, the drive is then reduced and the being assumes a stable condition characterized by calm and relaxation. Proponents of this theory assert that drive often increases with time (Grostein, 1981).

With regard to psychoanalysis, the theoretical construct of drives is perceived to encompass different motivations and instincts which have distinct objects. Classic examples in this regard involve the drive in the direction or life (productivity and construction) and death (destruction). To this end, it is increasingly important that the therapists understand and appreciate the drives of their patients in order to derive the best approaches that they can utilize for effective recovery. For instance, by identifying the gaps and weaknesses in the provision of the expectations, timely interventions can be undertaken to avoid adverse effects.

The Inter-subjective theory of affect

This theory presumes than in order to address problems in an effective manner, there is need for an agreement between the differing parties (Carveth, 1994). A state of inter-subjectivity according to this theory is reached when the two or more differing parties agree on the same definition of a given condition even when they have different perceptions of the conflicting issue. Furthermore, the theory shows that inter-subjectivity plays a vital role in influencing our various ideas and relationships. To this end Atwood and Stolorow (1993) indicate that inter-subjectivity promotes peaceful conditions that are fundamental for human co-existence. Of particular importance according to them is the role of language in enhancing the state of inter-subjectivity. They assert that language enhances effective communication that enables the individuals to express themselves with ease and therefore reach a consensus quickly. According to this theory it is perceived public rather than private and is instrumental in initiating social relationships.

In light of modern psycho analysis, a study conducted by Carveth (1994) affirms that in order to attain inter subjectivity and enjoy its implications, it is important to forego the isolation that characterizes certain individuals. The myth of isolation to this end indicates that some individuals virtually exist on their own, independent of the world and other individuals. As such, they become vulnerable to the different forces and challenges that life presents. This vulnerability then culminates in to conditions of anxiety and anguish that in some instances becomes unbearable. It should be acknowledged that the state of anxiety highly inhibits effective emotional functioning of an individual.

To this effect, therapists recommend that patients are required to open up and involve third parties in making important decisions. In addition, when faced with any emotional and psychological problem, the patients should seek early interventions that can be readily provided by the persons that they are close to. This is instrumental in regulating the severity of the effect of mental problems to their wellbeing (Carveth, 1994). Basically, this theory shows that establishment of viable ‘real’ social relationships go a long way in avoiding psychological problems. It is because they give the patients a chance for relief during the early stages of their psychological anguish and relatively prevent situations of psychological breakdown and the associated mental difficulties.

The affect theory

Theorists in this regard contend that an affect refers to a sentiment or a feeling that is subjectively generated and is independent of any external influence. The affect theory is aimed at an organization of different affects in to distinct classes and provides a connection of each to a typical response. Often, the affect is internally felt but manifested externally through various expressions. Tomkins (1991) shows that all the affects can be easily recognized through different facial expressions that stem from a stimulus. For instance, the affect of pain or discontent can be easily identified through the act of frowning. On the other hand, the affect of happiness is revealed through smiling. The nine affects as identified by this theory include joy, excitement, rage, disgust, fear, distress, dissmell, humiliation and surprise (Tomkins, 1991).

With regard to modern psychoanalysis, the positive affects are always prescribed to the patients as opposed to the negative affects that are discouraged. During therapy, Kelly (1996) asserts that affects should be properly utilized to give the intended effect. Furthermore, it is argued that affects play a vital role in initiating and maintaining intimate relations that are fundamental in psychotherapy and mental health on the whole. It is because they emphasize positive relationships towards a particular goal and discourage the negative relationships. The employment of affects is also fundamental due to the fact that they encourage the members that are seeking mental health and recovery to express affects to each other in order to identify the extent of the progress and make prescriptions accordingly (Tomkins, 1991).

In addition affects can be very important in describing to the mental health patients the goals and objectives that are supposed to be achieved in the course of therapy. These are employed during narrative of different events that aid in therapy. Setting of goals provides an impetus fro the patients to employ individual effort and achieve the expected results within the set timeframe. Tomkins (1991) shows that not only does this help the patients to save time and resources that are used in therapy, but it also improves their productivity.

Furthermore, the affects are also associated with Christianity. To this effect, it can not be disputed that Christianity plays an important role in regulating feelings of violence, anger and suffering. On the contrary, it encourages feelings of love, peace and enjoyment. By optimizing the use of affects, therapists encourage the patients to embrace religion and spirituality. Studies conducted after its inception affirms that the theory plays a vital role in enhancing the process of therapy and positive results have been attained from its usability. Of particular reference is the employment of spiritual values and virtues during recovery. Kelly (1996) indicates that these values provide a framework for sustainable recovery.

 

Psychodynamic perspective on addiction

This perspective was initiated by Dr, Freud and it has been in use for almost a full century now (Mitchel & Black, 1995). Its contention is based on the presumption that there exist some complexities with regard to the extensive and expansive world of behavior. To this end, it is assumed that the unconscious forces that are found within the human being are key influences of why we behave the way we do and why we involve ourselves in addictive behavior. In this respect, Isaac (1958) shows that through the various modes of interpretation of the traumatic experiences that children often experience and the difficulties that they face during development, in future; they derive different meanings and relations with particular events, specific individuals and certain activities. At this juncture, it should be appreciated that the severe internal conflicts often originate from a persons childhood and if interventions are not made in a timely manner, studies show that this can result into mental illness at later stages of the child’s life.

According to Martin and Marcel (2008), this situation can happen because of the fact that these childhood conflicts have the ability to inhibit the effective growth and maturity of three structures which make up the human psyche. In their study, they show that these encompass the ID that initiates the sexual and force related drives, the ego that is found in the brain and provides reference between reality and unconsciousness and the super ego which provides control over the stimuli of the Id and symbolizes ethical ideals. Freud suggests that their recovery from this trap is determined by the extent of their understanding, their disentangling and their exposition of these instinctive forces, convictions and meanings (Priestly et al., 1998). Over time, this perception has undergone various changes that incline the key concepts to special adaptation, efforts to provide self medication for painful and unbearable emotions, a compulsive behavior and need for this self medication and an ultimate reflection of an abnormality in self organization.

The mental psychologists strongly believe that various mental issues result from the psychodynamic conflicts that can not be effectively addressed using the defense mechanism. In their study, Lende and Smith (2002) argue that often, employment of defense mechanisms as a response to the different conflicts provides a temporal internal satisfaction. However, Ornsten (2008) indicates that at the levels of the super ego and the id, this approach is ineffective and it is largely blamed for adoption of maladaptive behavior, which in most instances is addictive.

Likewise, other theorists have made enormous contributions to this field using more specific aspects of addictions. To this end, the psycho analytic contributions made by Glover with regard to drug addiction can be considered very invaluable on this body of knowledge. Other compulsive behaviors explored by this author include the prostitution and sadism. Specifically, he classified the different mental disorders and explored the mind development process and its implications on addiction and other compulsive and persistent behaviors (Martin & Marcel, 2008).

In his study, Sando Rado coined the word compulsion that is presently used to describe addictive behavior. According to him the addicts experienced pleasurable moments by use of specific pleasure centers found in the addicts brain that are sexual in nature (Priestly et al., 1998). From these reviews, the word compulsion has been widely used in the addiction studies. Additionally, he suggested that psychopathology was likely to be a cause of addiction rather than its preconception as a result of addiction.

Simmel in his study made so many contributions to the field of psychoanalysis and addictions. He pointed out that gambling is indeed an addiction because according to him, it is virtually an expression pleasure although it is also characterized by tension and fear (Lende & Smith, 2002). During adulthood, this is used to restrict feelings of guilt and anger. Priestly et al. (1998) argues that it is related to the failure to comprehend the meaning of socialization. According to Simmel, unlike winnings that can be really ecstatic, loosing implies restriction of parental affection.

Leon Wumser is yet another psychoanalytic who made significant contribution to the field of addiction. He particularly explored drug addiction and contented that this is influenced by intense inner conflicts of a being, family diseases and disturbances that are faced in the course of development. He presumes that addiction to drugs occurs because usually, the user adopts them as a defense mechanism against what he terms as undesirable internal and external reality. In his study, he also explores the relationship between addiction and phobia and shows that the two, despite being compulsive, are parallel to each other. He also points out that according to his field research, most of the drug addicts were maltreated when still young (Martin & Marcel, 2008). They then suppressed these feelings at that particular time and find it difficult to face the feelings during later stages of their lives. This makes them to assume addiction as a temporal comfort zone for them, away from the fears of the urge to experience the painful childhood feelings.

Henry Krystal then explored the psychoanalysis of alcohol addiction with regard to the relationship of the addict and the object. To this end, he indicates that often, the drug addict wishes to reconnect with an ideal object and dreads it at the same time (Ornsten, 2008). As a result, he assumes fantasy and drama and can not be separated from the addictive substance. Thus particular functions that are meant for perpetuating nurturance are inhibited and instead reserved in order to act as a representative of the object. This knowledge shows that the role of therapy in this is to enable the patient to expand the conscious of self recognition to his entire self. According to Kystal, this frees him from the urge to use the drug which then enables the patient to have access to the parts and functions that were initially isolated.

Khantzian also explored the concepts of self, ego and opiate addiction and proposed that addictions often occur because the addict fails to asses his or her self and the different situations that s/he experiences. As such, the addict fails to caution and protect the self against the dangers by involving in dangerous activities. It is because of the fact that initially, he or she failed to differentiate between the destructive and constructive activities ad make efforts to putting place measures. To this end, he argues that the therapy should aim at effectively addressing the hidden psychopathology and other behavioral defects. In order to achieve this, Khantian suggests that the addict should gain full control over his or her feelings and destructive behavior. It is because the ability to effectively address this lies in the inner self of the patient. To this end, it can be argued that despite the fact that the therapist’s help enhances recovery; the patient is the one to make the ultimate choice regarding the recovery from addiction.

Greenspan then develops a comprehensive model that fuses the developmental process and substance abuse in an effort to understand how each affects the other (Priestly, et al., 1998). In his study, he explores the different patterns of substance abuse and resultant addictions. He further argues that in order for the treatment to yield satisfactory results, it is important to understand the patterns and internalize the relationship between the inner and outer self of the addict and how the same contribute to the state of addiction. According to him, this is essential due to the fact that in most instances, addicts pretend and they may quit treatment before their internal problems are fully addressed.

Bernard Brickman argues that the traditional approaches to psychoanalysis did not effectively affect addictions. He supported this presumption using different studies and researches. He challenged the basic psychoanalysis assumptions with regard to psychoanalytic pathology (Lende & Smith, 2002). It is in this consideration that he proposed a holistic approach that is supported by various studies undertaken in other related disciplines like genetics and physiology amongst others. In general he recommended that abstinence should be the first intervention and should be taken during the early stages of addiction. According to him, this is a requirement for satisfactory analytic therapy. Additionally, he emphasizes that mutual help groups like alcohol anonymous play a critical role in the recovery of addicts.

Finally, Norman Zinberg contributes to this body of knowledge by highlighting that the physical and social environment of the addict also contributes in different ways to these conditions. His theory starts by acknowledging the fact that the attitude and overall personality of the user play primary roles in contributing to the condition. These propositions are very important during therapy in that the conditions in the hospital greatly differ from the home environment. According to him, these have different implications on the process of recovery. Generally, he contends that social factors including the social construct of the addictive practice contributes to different patterns regarding addiction. For instance, he indicates that in most societies, alcohol is associated with feasting and parties. To this end, frequent feasts and parties are likely to contribute to alcohol abuse.

Overall, he points out that therapy should adopt a multidimensional approach in order to realize optimal results (Martin & Marcel, 2008). He argues that despite the fact that behavioral change and drug administration play a vital role in the recovery process, external and independent aspects of the social and physical environment should also be given equal consideration.

The above reviews provide important insights about the psychological perception of addiction. To this effect, it can be ascertained that addiction is a multifaceted aspect and effective psychoanalysis is essential if effective treatment is to be given. Therapeutic efforts should also be complex in order to address all the aspects that impact upon the recovery process. Additionally, it is increasingly important for the psychological therapists to understand and appreciate the differing needs and requirements of their patients in order to provide customized services. Considering the fact that the patient’s past has various implications on his or her present, practitioners should start by understanding the patient’s past events and experiences. This forms the basement upon which successful psychotherapy is derived.

In addition, it should also be appreciated that the present society and life is characterized by stressful conditions and other forms of depressive events. It is in this consideration that this Ornsten (2008) suggests that the modern psychoanalysis should also put in to consideration the modern factors that lead to addictions. It is important that root causes of these factors that include economic, social and psychological difficulties are addressed in a timely and effective manner. This calls for integrated effort from all major stakeholders.

 

Psychodynamic perspectives of mourning

Mourning is a mental condition that is characterized by various processes and is triggered by a loss of an object that the individual has a great attachment to (Lerner, 1990). This takes some certain period of time that is depended upon the individual’s capability to overcome it. The individual goes through various stages and when the process is over, s/he is completely separated from the lost object. The process is characterized by intense pain and denial of the reality but gradually, the individual attains a level of acceptance. Eventually, Field shows that the person succumbs to the changes, accepts the loss and initiates new relationships with other objects (1999).

The grief that occurs as a result of mourning has various emotional and psychological implications to the person that is mourning. Essentially, the different stages of the mourning process that contribute significantly to the theoretical framework of mourning were discussed in detail by Bowlby. These were based upon the observations made to the infants when the mother’s presence was missing. The first phase according to this study includes numbing and is often characterized by painful feelings of distress (Berry, 2008). The feelings if not controlled may result in to psychological or mental breakdown. The individual may engage in certain activities that are physical in nature in an effort to express these feelings. Common activities include screaming, wailing and crying amongst others.

After this, the person that is mourning goes into a stage of yearning and looking for the missing individuals or objects. This happens because of the feelings of denial due to the fact that the loss could have been unexpected. The stage is still characterized by feelings of sadness and refusal of the loss. Usually, Lerner (1990) indicates that the individuals at this stage still hope that the lost object will at some time return to them. During this stage, the person is still susceptible to the external information about the lost object.

The third phase is then characterized by despair and lack of organization. This happens because of the inability of the lost object or person to return. It indicates the beginning of hopelessness and acceptance (Field, 1990). The fact that the lost object is not likely to return to the person makes the person confused and disorganized in various ways. In addition, the individuals’ affirmation that he relationship shared with the lost person is also lost contributes to the disorganization.

Finally, the stage of increased or reduced reorganizations follows. This according to Bowlby is depended on the person’s ability to appreciate the loss incurred. According to him, if the person fails to fully acknowledge the loss, s/he is unlikely to be organized during this stage. On the contrary, persons that perceive the loss as positive and part of the change process are often organized during this stage.

According to Bowlby, the time taken during the whole process and the sequence of the phases differ considerably from one individual to another. It is because various individuals posses different capabilities to deal with the loss and overcome it accordingly. In addition, the resources available during the mourning process also influence the period of time that an individual takes during mourning. In this respect, Berry (2008) argues that availability of resources such as therapy hastens the mourning process. Generally, the mourners’ movement through the process as described by Bowlby is oscillatory- forward and backward movement.

This study was based upon the principles of psychodynamic analysis that highly utilizes the role of emotion in the recovery of mental health. To this end, Freud argued that grief was important because of the fact that it enabled the person mourning to dispel painful feelings and detach from the given loss. This is important because the person then has a chance to realize his or her potential with regard to psychological resources. To this end, it is suggested that longer periods of mourning are relatively beneficial to the emotional wellbeing of the individuals (Lerner, 1990). However, this contention has faced various changes with Field (1999) arguing that the propositions are not backed with empirical data. Field researches conducted by various psychologists in this regard show that the period of mourning has limited influence on the psychological wellbeing of different persons.

However, modern approach to the process of mourning appreciates the role of the child’s environment. Additionally, the subjective reaction of the child to the process and the role of the third parties in enabling the child overcome the same are also acknowledged. While addressing the attachment theory, Boylby asserts that attachment as part of behavior mechanism that is fundamental for survival. Furthermore, with regard to grief and mourning, he indicates that these are disruptions that highly compromise the emotional stability of individuals. In addition, Field (1999) agues that disruptions in the relationships always occur due to insecurity as a result of lack of cooperation from parents. These complexities result in to depression and stress because of the feeling of failure experienced by the child. Further, the feelings are attributed to limited support from individuals who are supposed to offer the same.

Freud also did an extensive study regarding the psychodynamic aspects of mourning and ascertained that this state implied a real loss of person. He asserted that the process of mourning is part of melancholia and is pathological in nature. He showed that the feelings of accusations that are experienced during mourning are often directed towards the mourner, despite the fact that they are meant to be directed towards the lost person. To illustrate this, he gives the example of a loyal wife who