New study identifies spiritual change among adolescents in treatment

A research team hopes that its latest study of factors that influence good outcomes in adolescents with substance use problems will lead more clinicians and programs to take a second look at spiritually based treatment approaches for youths.

The study, which will be published next spring in Alcoholism Treatment Quarterly, found that daily spiritual experiences (encompassing more than formal religious practices alone) served as a strong predictor of sobriety in a youth population with complex problems. Strikingly, while one-third of study participants had self-identified as agnostic or atheist at the start of the study, two-thirds of those individuals would claim some spiritual identity two months later, after receiving substance use treatment.

“There is some resistance to the [12-Step] model, but it’s something that’s important to consider,” says Matthew T. Lee, PhD, professor and chair of sociology at the University of Akron and lead author of the study. “There’s concern among some that it’s religious brainwashing or cult-like. I think it’s misunderstood by some clinicians.”

An interesting facet to the study involves its attempt to distinguish broader spirituality from the narrower realm of religious practices. This was intended not to put the two in a “horse race,” in Lee’s words, but to better understanding how they affect sobriety and other outcomes in young people.

Lee said that while formal religious practices at baseline predicted positive outcomes such as reduced narcissism at the two-month mark in this study, daily spiritual experiences on a broader scale were the most potent predictor of positive outcomes in the study.

Justice-involved population

Lee and colleagues first presented this research back in August at the American Sociological Association’s annual meeting in New York City. The study involved 195 substance-dependent adolescents ages 14 to 18 who received treatment at New Directions, a Northeast Ohio residential treatment facility for youths.

Co-investigator Maria Pagano, PhD, associate professor of psychiatry at the Case Western Reserve University School of Medicine, has worked with New Directions for several adolescent-focused research projects. This latest study is part of Case Western Reserve’s “Helping Others Live Sober” research initiative.

The vast majority of participants in this study were court-referred for treatment. “We wanted a population that really had multiple issues, not an easy one,” Lee said.

At treatment intake, the youths were asked both about their religious practices/beliefs and their daily spiritual experiences; the latter are not necessarily tied to a particular religious tradition and can involve sensing a divine presence, feeling inner peace, or having a sense of benevolence toward others. The latter is seen as an important variable because self-centeredness is believed to be at the root of many problems for addicts.

The young people were asked the same questions about religion and spirituality two months later, after receiving treatment in a New Directions program that has a 12-Step foundation but also uses modalities such as cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET).

The researchers found that most of the participating youths, regardless of their religious beliefs, reported having more daily spiritual experiences by the end of their treatment period. The finding regarding spiritual identity for the subgroup that had called themselves agnostic or atheist at the start of the study was particularly striking, though Lee said the researchers would have had to dig deeper to determine whether the newfound spiritual identity resulted from treatment success or if it preceded that success and helped drive it.

In addition, the study found that the spiritual changes in participants predicted factors such as improved drug use outcomes, reduced narcissism, and positive social behavior. This is important, Lee says, because some in the addiction field will tend to question the strength of the “spiritual conversions” that some individuals report experiencing.

For example, “People are very skeptical when inmates find religion in prison,” he says. “I reply, ‘Maybe they’re faking it, but also look at the objective factors, like their disciplinary problems going down.”

Further inquiry needed

The research team sees several areas for further study and believes the results they found in this analysis need to be replicated elsewhere. One area of focus for the future, Lee believes, would involve whether these spiritual changes continue to affect outcomes in a positive way looking a year out.

But the researchers believe that the study does demonstrate that youths can experience spiritual change during treatment, and that this in turn can affect a number of life factors in a positive way.

Pagano said in a news release about the research that “changes in spirituality during treatment may serve as the ‘switch’ that moves youth off of the track of substance dependency and onto the track of recovery and enhanced well-being, thereby countering harmful social trends like youth unemployment and decreased volunteering that have worked against addiction recovery.”