Treating adolescent substance use disorders (SUDs) can be challenging because of its multi-faceted nature. In an effort to address the complexity of adolescent SUDs treatment, Colistra, Campbell, and Brickner (2014) established seven (7) best practices: 1) Involve the adolescent’s family in treatment; 2) consider adolescent neurobiology in developing educational and treatment materials; 3) employ motivational interviewing (MI) for treatment goal co-creation; 4) explore thought and behavior relationship through cognitive behavioral therapy (CBT); 5) teach adolescents to understand feelings as passing mental events through mindfulness; 6) seek 12-step community participation; and, 7) develop and extend adolescents’ sense of spirituality. While extensive resources exist for the majority of the practices especially pertaining to MI, CBT, mindfulness, and 12-step groups; there is not only a dearth of evidence to support the idea of the efficacy of spirituality in treating adolescent SUDs, but there is also a lack of delineation between religion and spirituality within the treatment literature. Through this article, I will propose definitions of both religion and spirituality and provide a practical approach to their use that I have found to be effective in my own clinical work.
The working definitions for religion and spirituality that frame my work are:
- Religion: The modes of behavior associated with worshipping an absolute deity or idea.
- Spirituality: That which relates with the sacred.
I have found these definitions to be both easy to understand and use within a treatment setting. At first glance, an argument can made that religion is sacred and, therefore, not different from spirituality. At the semantic level, I might perhaps agree with that argument. However, at the pragmatic level, the need to separate the religion from spirituality is paramount. Colistra, Campbell, and Brickner (2014) stipulate, “…spirituality is not aligned with any one particular faith and care must be taken to ensure that no proselytizing occurs within a clinical setting” (p.9). Religion, as stated, must be kept out of a clinical setting, especially with adolescents, because: 1). Religion can be “absolute,” that is, there is ONLY one true way to believe in and worship a certain “god” or belief and if an adolescent doesn’t agree with that one way, he or she may become all the more confused; and, 2) Adolescents may not belong to a particular religion for any other reason than their parents make them. When looking at these two (2) reasons through the lens of the mechanics of SUDs, it becomes apparent why it must be kept out of treatment.
SUDs are as much a process as they are a disorder. There is an inherent cycle within SUDs that begins with anxiety, progresses towards compulsive use of a substance or process, which then results in shame, which then triggers anxiety, which then starts the process all over again. Religious membership often requires stringent behaviors and beliefs with which members may not always be able to adhere or agree. Depending on the religion, there could be dire consequences for failing to meet membership requirements that often result in members feeling ashamed of who they are. In the case of an adolescent who is still trying to figure out his or her identity, this shame may feed into a compulsive need to use a substance.
However, accessing someone’s sense of spirituality; that is, accessing a person’s own life’s sacred elements to find hope can not only be healthy, but also healing. In my experience, adolescents who present with SUDs have often lost a large sense of hope. The substance of abuse tends to be a numbing agent that curbs adverse emotions. But just as MI seeks to center on the client’s own needs in defining treatment goals, allowing an adolescent to explore his or own sense of spirituality without fear of judgement can restore some elements of hope. That’s not to say that a client’s religion can’t be sacred; however, it should be up to the client to determine what is sacred and if his or her religion provides that sense of connection, then so be it. However, it is not part of the clinician’s role to define that which is sacred for anyone else.
To illustrate, I once worked with a male fourteen-year-old who had convinced himself that he needed to smoke weed in order to be ok. He’d light up before school and manage to spark up throughout the day. His parents were not aware of his marijuana use, but realized that something was going on with him as his grades started to drop significantly. The first time I met with his mother and him, he could barely keep his eyes open. However, as I worked with him more and more the real problem became clear: He was gay and felt like he was going to Hell because of it. In discussing his belief, I he shared with me a deep love of fishing and the natural world and thought that it was people’s responsibility to care for the planet. It was clear to me that he had a deep sense of connection to all of life, but his religious background made it difficult for him to express that connection, as he felt judged and condemned. In time, he was able to discuss the conflict between his sexual orientation and his religion with his parents and was eventually able to resolve that conflict and had very little need to continue smoking weed, although he did take up boulder climbing (which caused his parents a whole new level of worry).
The best practices Colistra, Campbell, and Brickner (2014) put forth seek to address the complexity involved within an SUD. It is clear that building upon an adolescent’s relationship with that which is sacred to him or her can be beneficial in reducing both a SUD’s complexity and its adverse consequences. However, clinicians should make the appropriate delineation between religion and spirituality such that a client does not feel as though he or she is being converted through treatment. Religious practices run the risk of creating an overwhelming sense of shame within a client already experiencing difficult emotions, while building upon a client’s own sense of spirituality can be a healthy means of expressing a relationship outside of him or her self. I have shared my own definitions of religion and spirituality as a framework that can help implement all seven (7) of Colistra, Campbell, and Brickner’s (2014) best practices.
Colistra, A., Crite, C., & Campbell, J. (2014). Best Practices: Substance Use Disorder Treatment for Adolescents. Vistas Online, Article 43. Retrieved from http://counseling.ogr/knowledge-center/vistas.