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Understanding spiritual change and
its impact on outcomes

We know that through the Twelve Steps, many people with alcohol and other drug
addiction achieve recovery. We know that the spiritual process of the Steps triggers a transformation. People accept their powerlessness, they turn their lives over to "God as we understood Him," they do a moral inventory and seek forgiveness, they make amends and continue to take personal inventory, they pray, they carry the message to others.

Understanding spiritual changeWhether people reach the Steps through mutual-help support groups or by intense orientation from formal treatment, research documents that a Twelve Step approach works. The Steps inspire a dramatic change in our relationships with self, others and a Higher Power. A spiritual change takes place. But exactly how that spiritual change occurs--or the specific mechanisms responsible for it--is something that has been largely unstudied. That is why Hazelden's Butler Center for Research has launched an extensive study to examine this process of spiritual change. The study, "Spiritual Transformation and Recovery," began in October 2008 and will examine various measures of spirituality in 200 Hazelden patients in primary residential treatment.

Seeking scientific validation

"There are several studies that show that Twelve Step Facilitation works, and for 60 years we've seen the Steps work their magic at Hazelden," said Val Slaymaker, PhD, executive director of the Butler Center for Research. "But we really don't understand the mechanism of spiritual change and its impact on outcomes. We want to know what changes and when and how it relates to outcomes.

"We know about a cognitive component that helps change stinkin' thinkin,' and there's a behavioral component," she continued. "But the spiritual component is integral to recovery, and it's time we give it the scientific validation it deserves."

Slaymaker, the study's principal investigator, says the Big Book of Alcoholics Anonymous outlines the theoretical explanation of spiritual change. In the chapter "How It Works," it says self-centeredness and selfishness form the root of an alcoholic's troubles. "Resentment is the number one offender. It destroys more alcoholics than anything else. From it stems all forms of spiritual disease, for we have been not only mentally and physically ill, we have been spiritually sick." (page 64)

Only by understanding changes in self-centeredness, selfishness, resentment and the development of a desire for closeness with a Higher Power, will we understand how best to facilitate this process among those who struggle, Slaymaker adds.

The gratitude-to-resentment ratio

The simplest indicator of spiritual change will be the ratio of gratitude to resentment, said John MacDougall, DMin, director of Spiritual Guidance at Hazelden. "If a patient has three times the gratitude compared to resentment, then he or she is probably okay. If it's the reverse, we know that person will need more work."

MacDougall and his staff of spiritual care professionals were consulted in developing the study, which is funded by a grant from the Woodbury Foundation. "It's really about quantifying the spiritual component of care," said MacDougall. "We want to gauge the spiritual state of the person. We want to know if there is a different outcome for people leaving treatment with a positive spiritual state versus a less spiritual state."

Quantifying Factors of Change

Slaymaker said the study's subjects will undergo spiritual assessments at intake, midway through treatment, at the end of treatment, and at 1-, 6-, and 12-month followup. Specific measures of spirituality will be quantified, including gratitude, daily spiritual experience, the meaning of life, the promise of spiritual awakening, working the Steps, and more.

The study will address the following questions:

The data will be completed and analyzed in 2011 and the findings will be disseminated via scholarly publications and research presentations. The study's intent is to inform clinicians of the spiritual components that are most effective at influencing change.

"We hope the results of this study will give treatment providers a better understanding of the process of spiritual change and its influence on outcome," said Slaymaker. "We hope to better identify the characteristics of patients who will struggle so that we can target specific treatment efforts earlier in the process. Ultimately, it is all about helping more people find and sustain recovery."

Published in The Voice, October 2009

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