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This article was downloaded by: [University of Connecticut] On: 08 October 2014, At: 18:22 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Occupational Therapy in Mental Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/womh20 Spirituality and Substance Abuse Recovery Douglas N. Morris a , Ashley Johnson b , Amy Losier c , Meghan Pierce d & Vishaka Sridhar e a Florida Gulf Coast University , Fort Myers , Florida b Naples Community Hospital , Naples , Florida c All Children's Hospital , Fort Myers , Florida d EBS Healthcare , Boston , Massachusetts e All Children's Hospital , Clearwater , Florida Published online: 04 Mar 2013. To cite this article: Douglas N. Morris , Ashley Johnson , Amy Losier , Meghan Pierce & Vishaka Sridhar (2013) Spirituality and Substance Abuse Recovery, Occupational Therapy in Mental Health, 29:1, 78-84, DOI: 10.1080/0164212X.2013.761112 To link to this article: http://dx.doi.org/10.1080/0164212X.2013.761112 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms- and-conditions

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This article was downloaded by: [University of Connecticut]On: 08 October 2014, At: 18:22Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Occupational Therapy in Mental HealthPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/womh20

Spirituality and Substance AbuseRecoveryDouglas N. Morris a , Ashley Johnson b , Amy Losier c , Meghan Pierced & Vishaka Sridhar ea Florida Gulf Coast University , Fort Myers , Floridab Naples Community Hospital , Naples , Floridac All Children's Hospital , Fort Myers , Floridad EBS Healthcare , Boston , Massachusettse All Children's Hospital , Clearwater , FloridaPublished online: 04 Mar 2013.

To cite this article: Douglas N. Morris , Ashley Johnson , Amy Losier , Meghan Pierce & Vishaka Sridhar(2013) Spirituality and Substance Abuse Recovery, Occupational Therapy in Mental Health, 29:1,78-84, DOI: 10.1080/0164212X.2013.761112

To link to this article: http://dx.doi.org/10.1080/0164212X.2013.761112

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

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Occupational Therapy in Mental Health, 29:78–84, 2013Copyright © Taylor & Francis Group, LLCISSN: 0164-212X print/1541-3101 onlineDOI: 10.1080/0164212X.2013.761112

Spirituality and Substance Abuse Recovery

DOUGLAS N. MORRIS Florida Gulf Coast University, Fort Myers, Florida

ASHLEY JOHNSON Naples Community Hospital, Naples, Florida

AMY LOSIER All Children’s Hospital, Fort Myers, Florida

MEGHAN PIERCE EBS Healthcare, Boston, Massachusetts

VISHAKA SRIDHAR All Children’s Hospital, Clearwater, Florida

Researchers explored patient and staff perceptions of spiritual well-being and the spiritual needs of patients enrolled in a residential substance abuse treatment program. The Spiritual Well-Being Scale was used to gather quantitative data. Additionally, a brief ques-tionnaire containing one qualitative and two quantitative ques-tions was completed by both clients and staff. A statistically signifi-cant difference was found, indicating a more positive sense of spiritual well-being among patients upon discharge. Although the staff and clients of the residential program have similar perceptions regarding the concept of spiritual well-being, their definitions do not appear identical.

KEYWORDS spirituality, well-being, recovery, substance abuse

INTRODUCTION

A research group, guided by Douglas Morris, PhD, OTR/L, and including four students from the Masters of Science in Occupational Therapy Program at Florida Gulf Coast University (FGCU), conducted a study at Southwest

Address correspondence to Douglas N. Morris, PhD, OTR/L, 10501 FGCU Boulevard South, Fort Myers, FL 33965. E-mail: [email protected]

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Spirituality and Recovery 79

Florida Addiction Services (SWFAS). Based upon discussions with Rosemary Boisvert, OTR/L, the director of the Transitional Living Center (TLC) at SWFAS, the researchers identified the need to investigate the perceptions of spiritual well-being, as expressed by both the staff and patients at SWFAS. The Alcoholics Anonymous (AA) program, a spirituality oriented treatment approach for alcoholism (Tangenberg, 2005) is employed by SWFAS.

It is important to note that few studies have been conducted that have asked people in substance abuse recovery to define spirituality and discuss its meaning in their lives (Coward, 1994). Also, there are not current occupa-tion-based or occupational therapy-based evaluations of spirituality (Morris, 2007). The significance of this study is that it provides future researchers with qualitative data for defining spiritual well-being, thereby contributing to the wealth of literature available on spirituality and recovery. This research study is also important from an Occupational Therapy perspective, as spirituality is the central component of humanity in the Canadian Model of Occupational Performance (CMOP) (Griffith, Caron, Desrosiers, & Thibeault, 2007), and many meaningful activities, the primary method of occupational therapy interventions, contain spiritual elements (American Occupational Therapy Association [AOTA], 2008).

REVIEW OF LITERATURE

The Canadian Model of Occupational Performance (CMOP) and American Occupational Therapy Practice Framework: Domain and Process (OTPF) were used as the theoretical basis for this research. The CMOP focuses on the emergence of occupational performance through the reciprocation among the person, environment, and occupation. The person includes phys-ical, cognitive, and affective elements that are amalgamated by spirituality, which is the fundamental core of being. Therefore spirituality plays an essen-tial role in this model with respect to a person’s self-identity, self-direction, and occupational choice (Cole and Tufano, 2008).

A definition of spirituality is necessary to fully understand the funda-mental basis of the study. The recently revised OTPF defines spirituality as

the personal quest for understanding answers to ultimate questions about life, about meaning, and about relationship with the sacred or transcen-dent, which may (or may not) lead to or arise from the development of religious rituals and the formation of the community (Moreira-Almeida & Koenig, 2006, p. 844).

Wolf-Branigin and Duke (2007) investigated factors influencing the suc-cessful participation in a faith-based residential substance-abuse treatment program and found that spiritual activities are a valuable factor contributing

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to successful completion of therapy. Carter (1998) investigated the relation-ship between spiritual practices and long-term recovery from substance abuse. She found that spiritual practice is a greater indicator of recovery than merely embracing spiritual principles and, therefore, the practice of spiritual-ity within one’s daily routine is significant to solidifying a foundation for a positive recovery cycle (Carter, 1998).

Brooks and Matthews (2000) conducted a study to examine the impact of addiction counsellors’ spiritual well-being on the spiritual well-being of clients. The findings conclude that the patients’ sense of spiritual well-being was improved during treatment, but there was no significant correlation between the counsellors’ and clients’ spiritual well-being (Brooks & Matthews, 2000).

METHODOLOGY

The researchers used a non-experimental research design and mixed method study that included both qualitative and quantitative measures. The sample included patients participating in the residential treatment program (RTP) at SWFAS and the staff members who worked with those patients. In order to be included in the study, patients were required to be within five days of entry to or discharge from the RTP. All participants were also required to be legally independent and capable of providing informed consent.

Before commencing the data collection process, the research proto-col and methodology were approved by FGCU’s Institutional Review Board. The researchers visited SWFAS one to two times per week to obtain data from patients who satisfied the inclusion criteria. All staff members included in the study were surveyed during a monthly staff meeting. Informed con-sent was obtained from all study subjects. As patient participants completed the self-assessment, the survey data were coded as they were collected in order to match individual data from entry and discharge.

Patient data were collected at both entry and discharge from the RTP. Of the original 63 patients, 29 were excluded from the study because they only participated in either an entry or exit assessment, but not both. Because of the comparative nature of the study, the researchers only used the data from patients who had been surveyed at both entry to and discharge from the RTP. The assessment results from seven patients were incomplete, and not included in the results of the study. Consequently, data from 27 patients are included in the results of the study. Fourteen staff members were sur-veyed, and all were included in the study.

The research questions were investigated through the administration of the Spiritual Well-being (SWB) Scale and a supplemental questionnaire to patients at SWFAS. A similar questionnaire was used to collect data on the staff with the absence of the SWB Scale. The SWB Scale is a standardized

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Spirituality and Recovery 81

20-item self-assessment that was developed by Ellison and Paloutzian (Hill & Hood, 1996) to measure one’s perception of personal spiritual well-being. The measure contains two subscales: the Religious Well-being (RWB) Scale and the Existential Well-being (EWB) Scale. The religious dimension of the scale focuses on how one perceives the well-being of his or her spiritual life as it is expressed in relation to God. The existential dimension purports to measure how well the person is adjusted to self, community, and surround-ings. This component involves the existential notions of life purpose, life satisfaction, and positive or negative life experiences. Together these two scores measure the subjective quality of life, and the combined total scores for the RWB and the EWB equal the overall SWB score. The SWB Scale was administered only to the patients at SWFAS.

The supplemental questionnaire which was administered to both patients and staff sought to determine how staff beliefs compared to patients’ beliefs about spiritual well-being, spiritual need, and if spirituality was addressed through the treatment process. The questionnaire contained a single qualitative query, asking individuals to define spiritual well-being, and two quantitative questions focused on spiritual need and if it was addressed through treatment. The questionnaires given to patients and staff were not identical. A questionnaire was constructed specifically for each population, but the questions were very similar.

Quantitative data analysis was conducted through the use of SPSS Version 17.0. Paired t-tests were used to analyze the data from the SWB Scale. Descriptive statistics were used to compare the quantitative patient and staff data from the supplemental questionnaires because the sample sizes varied significantly and the questions were not identical. The qualitative questions were analyzed through summative content analysis.

ANALYSIS

The results for the quantitative data analysis of the SWB Scale consisted of a comparison of scores at entry to and discharge from the RTP at SWFAS. The 20-items were scored on a six-point Likert Scale with choices of strongly agree, moderately agree, agree, disagree, moderately disagree, and strongly disagree. The SWB Scale is a combination of both the EWB Scale and the RWB Scale, each of which were analyzed separately.

The mean scores for the EWB Scale were 41.6667 at entry and 52.1111 at exit from the RTP. According to the paired samples t-test, the comparison of the mean scores of the EWB Scale at entry to and exit from the RTP were statistically significant with two-tailed t-test score at the .000 level. With an alpha level of .05, two-tailed t-test scores less than this are considered to be statistically significant, indicating that the results were not likely due to chance. The EWB Scale had a t-statistic of –4.145. The mean score of the

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RWB Scale at entry was 48.4815, and at exit, the mean score was 53.1111. The results of the RWB Scale comparison also indicated a two-tailed t-test score of .028 and a t-statistic of –2.329. The interpretation can be made that the increase in the RWB Scale mean scores from entry to and exit from the RTP were also statistically significant, yet not quite as significant as the results of the EWB Scale comparison. The overall SWB score is derived by combin-ing the EWB scale and the RWB scale. The mean score of the SWB Scale at entry was 90.1481, and the mean score at exit was 105.2222. The SWB Scale t-statistic was –3.714, and the two-tailed t-test score was .0001, again indicat-ing an overall statistically significant change among these 27 patients from entry to and exit from the RTP at SWFAS.

In addition to the quantitative analysis of the SWB Scale, two of the supplemental items administered to both the patients and the 14 staff mem-bers were also analyzed quantitatively. Both items asked a similar question yet were worded differently to more appropriately address the targeted pop-ulation. Responses to both questions were gathered using a six-point Likert Scale format to keep the quantitative scoring consistent. The first item was stated, “I believe that patients have a spiritual need when entering the resi-dential treatment program.” This item was given to the patients at both entry to and exit from the RTP. At entry, 41% of the patients replied with “strongly agree,” while at exit 63% replied “strongly agree.” The staff was only given this item at one given time and 64% responded with “strongly agree.” The second item was stated, “Throughout the treatment process, SWFAS addresses the spiritual needs of the patients.” This item was given to the patients at discharge and was not meant to be a comparison from entry to discharge from the RTP. At discharge, 92% of the patients agreed in some way with the previous statement, with 70% of these responses being “strongly” to “moder-ately agree” and 22% being “agree.” The staff responded similarly with 92% agreeing with this item, with 71% of these responses being “strongly” to “moderately agree” and 21% being “agree.”

The remaining item on the supplemental questionnaire was qualitative in nature. This item was given to the patients at entry to and exit from the RTP. The same question was included in the staff survey, which was only administered once. The question asked was, “How do you personally define spiritual well-being?” and the research team sought to determine common themes found within the free responses of the staff and patients. The most frequently found terms among the definitions of spirituality of the patients were: “God,” “higher power,” “relationship” or “connection,” “a feeling” (e.g., peace, happiness), and “help.” The staff responses had many common themes with the patients; however, the greatest difference was that the most common response among the 14 staff members was one that related to “self” (myself, oneself, yourself). They also frequently responded with definitions relating to “belief or believing,” “higher power,” “God,” “connection,” and “feeling.”

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Spirituality and Recovery 83

LIMITATIONS

In retrospect, one of the questions written by the research team resulted in some confusion during data collection. The question “Throughout the treat-ment process, I believe that SWFAS has helped to address the spiritual needs of the clients going through the residential treatment program” included in the questionnaire did not apply to the patients at entry. This question left a number of patients perplexed. A few patients did not answer all questions of the SWB. It was also a difficult task to obtain data from individual patients at entry and discharge. This contributed to the small sample size of 27 patients.

CONCLUSION

The study was undertaken with the primary objective of determining the per-ceptions of spirituality among the patients at SWFAS. The results of this study revealed that the patients indicated a change in self-reported spiritual well-being between entry to and discharge from RTP, and that SWFAS does address the spiritual needs of their patients. Although the definitions of spirituality expressed by the staff and the patients were distinct, they shared some common themes.

Based upon the review of literature and findings of this study, the fol-lowing topics require further investigation to integrate more evidence-based information on spirituality and recovery. Firstly, it is necessary to determine what, specifically, contributed to the increased sense of spiritual well-being throughout the treatment process at SWFAS. Secondly, data on the influence of spirituality in maintaining long-term sobriety among the patients at SWFAS must be collected. Lastly, there is a need to develop an occupation-based measure of spiritual well-being, as there is no such measure documented.

ACKNOWLEDGMENTS

Douglas N. Morris, PhD, OTR/L, and the FGCU students, Ashley Johnson, OTS, Amy Losier, OTS, Meghan Pierce, OTS, and Vishaka Sridhar, OTS, would like to thank Rosemary Boisvert, OTR/L, and the SWFAS staff for their support and assistance with this research study.

REFERENCES

American Occupational Therapy Association [AOTA]. (2008). The occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625–683.

Brooks, C. W., & Matthews, C. O. (2000). The relationship among substance abuse counselors’ spiritual well-being, values, and self-actualizing characteristics and

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the impact on clients’ spiritual well-being. Journal of Addictions & Offender Counseling, 21, 23–34.

Carter, T. M. (1998). The effects of spiritual practices on recovery from substance abuse. Journal of Psychiatric and Mental Health Nursing, 5, 409–413.

Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy. Thorofare, NJ: Slack.

Coward, D. D. (1994). Meaning and purpose in the lives of persons with AIDS. Public Health Nursing, 11, 331–336.

Griffith, J., Caron, C. D., Desrosiers, J., & Thibeault, R. (2007). Defining spirituality and giving meaning to occupation: The perspective of community-dwelling older adults with autonomy loss. Canadian Journal of Occupational Therapy, 74, 78–90.

Hill, P. C., & Hood, R. W. (Eds.). (1996). Measures of religiosity. Birmingham, AL: Religious Education Press.

Moreira-Almeida, A., & Koenig, H. G. (2006). Retaining the meaning of the words religiousness and spirituality: A commentary on the WHOQOL SRPB group’s “A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life” (62:6, 2005, pp. 1486–1497). Social Science and Medicine, 63, 843–845.

Morris, D. N. (2007). Personal spiritual well-being, perceptions of the use of spiritual-ity, and spiritual care in occupational therapy practice (Doctoral dissertation). Touro University International.

Tangenberg, K. M. (2005). Twelve-step programs and faith-based recovery: Research controversies, provider perspectives, and practice implications. Journal of Evidence-Based Social Work, 2, 19–40.

Wolf-Branigin, M., & Duke, J. (2007). Spiritual involvement as a predictor to complet-ing a Salvation Army substance abuse treatment program. Research on Social Work Practice, 17, 239–245.

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