What is the Connection Between Alcohol and Spirituality?

Spirituality refers to the experience of consciously striving to integrate one’s life towards the ultimate value one perceives. Read on to learn more about how alcohol and spirituality may be connected.

What is Addiction?

Before diving into the connection between alcohol and spirituality, one must understand what addiction truly entails. Addiction is the state of psychological or physical dependence (or both) on the use of a drug (or drugs).¹,²

Types of Addiction

The chapter on “Substance-Related and Addictive Disorders” in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), encompasses the following classes of drugs:

Alcohol
Caffeine
Cannabis
Hallucinogens (e.g. PCP, LSD)
Inhalants (e.g. paint thinner, glue)
Opioids (e.g. codeine, oxycodone, heroin)
Sedatives, hypnotics, or anxiolytics (e.g. benzodiazepines, carbamates, barbiturates)
Stimulants (e.g. cocaine, amphetamine-type substances)
Tobacco

Gambling disorder is the only “behavioral addiction” additionally included in this chapter. Other behavioral addictions, such as sex addiction, exercise addiction, and shopping addiction, while popularly known, are not included because there is insufficient peer-reviewed evidence to establish the diagnostic criteria needed to identify the behaviors as mental disorders.

Signs of Addiction

Signs of a substance use disorder are behavioral, including:

Taking the substance in larger amounts or for a longer duration than intended
Repeatedly, unsuccessfully attempting to cut down or regulate substance use
Spending a lot of time obtaining, using, or recovering from the effects of the substance
Craving for the substance
Recurrent substance use resulting in failure to fulfill personal and occupational obligations
Continued substance use despite the social or interpersonal problems it causes
Quitting social, occupational, or recreational activities because of substance use
Recurrent substance use in dangerous situations
Continued substance use despite knowing that it causes psychological or physical problems
Increasing tolerance of the substance
Withdrawal symptoms occur when substance use stops

How is Addiction Diagnosed?

Diagnosis of a substance use disorder is based on a pathological pattern of behaviors related to the use of the substance. The diagnostic criteria for Alcohol Use Disorder are given in the DSM-5 as follows:

A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a twelve-month period:

Alcohol is often taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
Craving, or a strong desire or urge to use alcohol.
Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
Recurrent alcohol use in situations in which it is physically hazardous.
Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
Tolerance, as defined by either of the following:
- A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
- A markedly diminished effect with continued use of the same amount of alcohol.
Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for alcohol.
- Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Dual Diagnosis

Bipolar disorders, schizophrenia, and antisocial personality disorder are associated with a significantly increased rate of alcohol use disorder.

Treatment for Alcohol Abuse

Behavioral treatments, medications, and mutual-support groups are the most common types of treatment for alcohol abuse.

Self-Control

According to the DSM-5, individuals with lower levels of self-control may be particularly predisposed to develop substance use disorders, suggesting that the roots of substance use disorders for some persons can be seen in behaviors long before the onset of actual substance use itself.

Learning self-control is vital to recovery from alcohol abuse – for instance, self-control is what enables a person to refuse alcohol in social situations or to manage occasional drinking without returning to problematic use.³

Counseling

Behavioral treatments aim to change drinking behavior through counseling. Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy, contingency management approaches, marital and family counseling, brief interventions, twelve step facilitation therapy, and mindfulness-based relapse prevention (MBRP) are all forms of behavioral treatments. All forms help participants develop the skills needed to stop or reduce drinking, bolster the ability to manage emotions and stress, build a strong social support system, set reachable goals, and cope with or avoid triggers that may cause relapse.⁴

Treating Underlying Problems

When addressing alcohol abuse, it’s important to also seek simultaneous treatment for any accompanying medical and mental health issues, especially those that may contribute to alcohol abuse in the first place.

AA

A 2020 analysis found that Alcoholics Anonymous (AA) is the most effective path to abstinence – more so than psychotherapy, and at a lower cost.⁵ AA, which has been around for more than eighty years, uses the 12-Steps, a group of principles that are spiritual in nature, to help alcoholics “develop a satisfying life without alcohol”. Whether participants are male, female, young, old, veterans, or civilians, AA can be beneficial for people of all backgrounds.⁶

Detoxing

Detox is the process of eliminating alcohol or drugs from the body and is a prerequisite for the treatment of alcohol use disorder. When a person who has a history of heavy and prolonged alcohol use suddenly stops drinking, their body can go into the process of withdrawal. Symptoms of alcohol withdrawal, which may be relieved by administration of alcohol or benzodiazepines (e.g., diazepam), may include:

“Autonomic hyperactivity” (e.g., sweating, rapid heart rate)
Increased hand tremor
Insomnia
Nausea or vomiting
Transient visual, tactile, or auditory hallucinations or illusions
Psychomotor agitation
Anxiety
Generalized tonic-clonic seizures

Medication

The Food and Drug Administration (FDA) has approved the following three non-addictive medications for treating alcohol dependence:

Naltrexone
Acamprosate
Disulfiram

Other medications which have been approved for other uses show potential for also treating alcohol dependence, including:

Varenicline
Gabapentin
Topiramate

Spirituality vs. Religion

Spirituality and religion are not the same. Spirituality refers to the experience of consciously striving to integrate one’s life in terms – not of isolation and self-absorption but of self-transcendence towards the ultimate value (“the good”) one perceives. It is a conscious, chosen experience – not an experience such as one might have under the influence of a drug or mental illness. Spirituality is that part of human nature that seeks relations with the purpose and meaning of existence.⁷

To be religious implies participation in institutionally based practices and respect for the teachings of a tradition. Religions are organized in patterns of creed, code, and cult. Creed refers to the teachings of religion (beliefs). Code is the moral code that religion teaches. Cult includes the rituals, ceremonies, and observances of a religion (practices).

Belief in a god or a higher power isn’t necessary to be a spiritual person. This is evident from the existence of religions that do not believe in a god, such as Buddhism. What all religions seem to have in common is their outward focus – on compassion for others, service, solidarity, and fundamental core values. Therefore, it’s possible to be spiritual and religious without belief in a deity.

Role of Spirituality in Addiction

Benefits

Spirituality/religion (S/R) is a significant dimension of self-understanding and can be a source of meaning and resilience under challenging circumstances. The Handbook of Spirituality, Religion, and Mental Health, Second Edition (2020) provides a hypothetical patient worksheet for completing therapeutic cognitive reappraisals.

The table below includes common spiritual struggles during episodes of active substance abuse and the according to spiritual/religious (S/R) cognitive reappraisal (the term “God” may be substituted to fit the individual’s religious or spiritual beliefs).⁸

Spiritual Struggle	Maladaptive Belief	S/R Reappraisal
Personal failure	I’m an addict who has failed myself and others.	I am living with substance use disorder, and I trust that God will help me in my efforts to heal.
Hopelessness	I’ve ruined my life and I cannot stop using alcohol/ drugs.	Although things seem hopeless, nothing is impossible with God on my side.
Isolation/disconnection	I am so alone.	God’s love is with me always, I can seek His Presence.
Loss of self-identity and self-respect	I must be a weak person to have my life ruined by alcohol/drugs.	Alone I am weak, but with the grace of God, I am strong.
Loss of connection with personal/life goals	My life is pointless.	I trust that God will lead me on a path of recovery, and I will find a better life
Guilt and shame	My substance use is evidence that I don’t care enough about myself or others.	Nothing I have done is bigger than the mercy of God. As I achieve recovery, I will become better at taking care of myself and others.
Anger	I hate my life and having this disease.	If I am patient with myself and others, God will restore my peace.

Clinical Significance of Spirituality in Addiction

While the literature generally supports that spirituality/religion (S/R) protects against substance abuse and highlights S/R’s importance in recovery, high quality studies and reviews on S/R interventions for substance use problems are scant. In addition, much of the existing analysis is focused exclusively on AA, rather than non-AA S/R interventions.⁹

Studies on Spirituality and Addiction

The first systematic review and meta-analysis to examine the efficacy of S/R interventions in treating substance abuse problems was published in 2019. This meta-analysis suggests that S/R interventions are more efficacious than comparison interventions (e.g., CBT, motivational enhancement therapy, community reinforcement approach, and family therapy) for substance use outcomes.

Specifically, the meta-analysis found that twelve-step-oriented interventions reduced substance use significantly more than comparison interventions. However, the elements responsible for this outperformance aren’t clear, and more rigorous studies of such interventions are needed. The meta-analysis further states that more high-quality studies are needed before conclusions can be drawn about the efficacy of non-12-Step-oriented S/R interventions for substance use problems.

Finding Spirituality In Recovery

AA is the most widespread alcohol use disorder recovery organization, with millions of members worldwide. The 12‐Step program is intended to facilitate the internal psychological, emotional, and spiritual changes deemed necessary to sustain abstinence and lead to enhanced psychological well‐being and improved relationships.¹⁰

Regardless of whether you feel that you might benefit from the spiritual aspect of AA, this track record (of helping people overcome alcohol use disorder) remains to be beaten and, as previously discussed, has begun to garner more attention from the scientific community.