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. Author manuscript; available in PMC: 2024 Dec 1.
Published in final edited form as: Spiritual Clin Pract (Wash D C ). 2022 Jun 2;10(4):337–349. doi: 10.1037/scp0000296

Spiritual Awakening in 12-Step Recovery: Impact Among Residential Aftercare Residents

Justin Bell 1, Mohammed Islam 2, Ted Bobak 1, Joseph R Ferrari 1, Leonard A Jason 1
PMCID: PMC10947114  NIHMSID: NIHMS1889564  PMID: 38505665

Abstract

Spiritually-based interventions in the form of 12-step programs are frequently offered as a part of substance use treatment programs in the United States. Programs based in the 12 steps guarantee that by working their program, an individual will undergo a process of transformation labeled a spiritual awakening. However, the impact of this experience on recovery factors and treatment adherence is unclear. The current study investigated adult residents (n = 115) who experienced a spiritual awakening attributed to 12-step group affiliation during their stay at residential aftercare facilities for substance use disorder. Self-efficacy and hope were greater for individuals who experienced a spiritual awakening versus those persons who did not experience awakening. Awakening was associated with greater affiliation to AA and decreased negative exit from the facility. Results revealed the potential for an awakening to improve treatment behavior and outcomes in a residential environment, as well as benefit an individual’s personal recovery resources. Further theoretical and clinical implications are discussed.

Keywords: awakening, spirituality, recovery, substance use, recovery homes

Inspired by the insights of Carl Jung and William James (Finlay, 2000), the mutual-support organization Alcoholics Anonymous (AA) defines the chronic consumption of alcohol (alcoholism) as a “spiritual malady” or “spiritual disease.” The group asserts experiences of spirituality have been fundamental to the success of their long-term members, in which attitudes that once guided their lives were replaced with entirely new motivations (Alcoholics Anonymous World Services [AAWS], 2001). The message of AA is clear: Any individual recovering from alcoholism can gain an entirely new life perspective, a spiritual awakening, by remaining open minded to spirituality and by working the 12-steps outlined in their basic text, Alcoholics Anonymous (AAWS 2001).

The implications of this claim are important to consider in the context of addiction treatment. When nearly three-quarters of substance use disorder (SUD) treatment programs provide 12-step programs to their clients (Grim & Grim, 2019), a question remains how experiencing a spiritual awakening in a recovery context impacts treatment outcomes and behaviors as a client. Moments of awakening are considered mystical, sometimes involving transitory shifts in sensory processing, awareness, and connection with others (de Castro, 2017). What comes after, however, is more important to the individual in recovery. AA describes the potential for radical personality change following a spiritual awakening where benevolent emotions of love, hope, and gratitude replace the negative emotions which previously drove the individual to drink (AAWS, 2001). If this is true, how might this inward change impact an individual’s outward relationship with their environment?

The dramatic perspective change described by AA to characterize a spiritual awakening can be considered a form of second order change in the context of addiction treatment (Jason et al., 2003). In fact, membership in the organization itself constitutes a form of second order change. In the context of treatment for addictive disorders, second order change serves as a contrast to first order change. First order change lacks sustainability, comprising short-term or incremental changes that do not address the community-level or system-level influences on problematic behavior (e.g., a detoxification program; Watzlawick et al., 1974). Interventions targeting first order change are liable to fail when the individual returns to their pre-treatment contexts. Without an environmental or perspective shift, the individual seeking treatment cycles repetitively through the same, ineffective interventions (Jason et al., 2003; Watzlawick et al., 1974). Interventions aimed at second order change, on the other hand, comprise a radical shift in perspective and influence the environmental components of an addictive disorder. These interventions are associated with more successful, long-lasting outcomes as they bring about meaningful, systematic change (Jason et al., 2003). By shifting an individual’s perspective toward appreciating values of love and care, and by strengthening their bond with a higher power and other recovering individuals in their life, a spiritual awakening may serve as this sort of change.

Definitions of Spiritual Awakening

Clinical definitions, as well as the texts of AA, have attempted to clarify what it means to experience a spiritual awakening (See McGee et al., 2019 for a recent review of definitions in the recovery context). In the spirituality literature, the event is typically portrayed as a sudden or gradual experience of transcendence; the moment of awakening being marked by feelings of oneness, a sense of awe, or unity with something greater than oneself (McClintock et al., 2016). This sense of connectedness allows the individual to suspend their ego and typical self-centered perspective, and, in contrast, is often accompanied by great knowledge or insight of one’s true nature, purpose, or values (Cornielle & Luke, 2021). Other feelings associated with experience include a sense of bliss, gratitude, tranquility, and an insight that love is the supreme principle in one’s life (Taylor, 2017).

The exact content and timeline of these experiences varies widely. For instance, a qualitative inquiry into the experiences of AA members who reported a spiritual awakening discovered a wide variety of phenomena associated with the experience (Galanter et al., 2014). Some individuals reported supernatural visions or hallucinations during their awakening, similar to AA co-founder Bill Wilson’s “white light experience.” Others reported more gradual epiphanies that developed into greater spiritual insights as they continued membership in the program (Galanter et al., 2014).

Spiritual awakenings may occur following periods of great psychological distress, referred to in the AA literature as “hitting bottom” (AAWS, 2001, p. 5). The occurrence may be associated with a feeling that one is out of options or that there a great dissonance between one’s values and actions (Miller & C’De Baca, 2001). Conceptual definitions of hitting bottom have theorized the event as driving spiritual growth and meaning in one’s life (Chen, 2018). As an individual experiences a process of surrender by witnessing their inability to control their substance use, they can more easily relinquish control towards a higher power in their life (Chen, 2010). Supportive of this assumption, a survey of 180 AA members who experienced a spiritual awakening found 57% of the sample reported having their awakening following the experience of hitting bottom (Galanter et al., 2014).

Benefits of Spiritual Awakening on Recovery

Regardless of the ability to perfectly capture this subjective experience, the positive benefits of a spiritual awakening on recovery are clear. Empirical research examining members of AA who reported a spiritual awakening found the experience associated with improved drinking and mental health outcomes, such as increased abstinence, decreased craving, and decreased depression (Galanter et al., 2014; Strobbe et al., 2013). Other powerful changes mentioned by AA members following their spiritual awakening include a loss of desire to drink, a sense of inner peace, and an increased desire to be in service of others (Forcehimes, 2004). Spiritual practices in 12-step programs, while not necessarily indicative of an awakening experience, are associated with increased abstinence, and this finding is replicated across several studies (Kaskutas et al., 2003; Kelly et al., 2011; Oakes et al., 2000; Robinson et al., 2007; Tonigan et al., 2003; Tonigan et al., 2013; Zemore et al., 2007).

In addition, experiencing a spiritual awakening may help strengthen an individual’s affiliation to 12-step groups. Galanter et al. (2014) found that reflective self-ratings of commitment to AA service increased for members the week following their spiritual awakening. However, when examining whether degree of spirituality was associated increased AA meeting attendance, Tonigan et al. (2013) reported attendance of AA meetings and spirituality were not related. In a study of 112 recovery home residents, a small proportion of the sample reported that spirituality was a motivator for attending AA, but for the vast majority (71%), spirituality did not motivate their attendance (Nealon-Woods et al., 1995). While spiritual feelings or motivations, as measured by Tonigan et al. (2013) and Nealon-Woods et al. (1995) may not be associated with affiliation to AA, it is unclear whether a spiritual awakening experience can propel an individual towards a stronger relationship with their 12-step program.

Spiritual awakenings may also support harmonious behavior in a residential environment by decreasing relapse risk. Decreased relapse and increased abstinence is associated with spiritual growth in recovery (Sterling et al., 2007), as a well as experience of spiritual awakening (Strobbe et al., 2013). These findings may be explained by spirituality’s relationship with abstinence-related coping self-efficacy, or one’s confidence to avoid substance use in specific situations (Sklar & Turner, 1999). In a study of individuals currently undergoing substance use treatment, spirituality and religiosity were significantly correlated with coping self-efficacy, as well as time in abstinence (Ely & Mosqueiro, 2021). Awakenings, achieved through the 12-step context, are commonly reported to reduce the desire to use substances, therefore further aiding in the ability to resist relapse (Forcehimes, 2004).

The strengthening of virtuous traits through awakening is a commonly understood benefit of the experience. Frequently, members of 12-step groups and treatment seekers who experience a spiritual awakening report an increased motivation to serve others, especially to the benefit of those continuing to suffer from substance use (Forcehimes, 2004; Galanter et al., 2014; Heinz et al., 2010). Positive changes also sometimes resulted from individual gaining a new spiritual perspective as a result of their awakening. Rather than viewing their higher power, which some label as God, as vindictive, judging, and vengeful, recovering individuals often report understanding their higher power as more loving, just, and merciful following the experience. This new understanding of a higher power translates into more positive behaviors towards others (e.g., praying to make the right choices/praying for others to get well; Heinz et al., 2010).

Positive behavioral changes are especially important in residential aftercare settings. In these environments, an individual may be removed from the facility if they relapse or participate in behavior disruptive to other residents (defined as a negative exit in the current study). Spiritual awakenings appear to encourage behaviors that make individuals’ choices more conducive to a communal, substance-free living environment. Reciprocally, these settings are designed in a way that support spiritual growth. Residential treatment settings often encourage or require their residents to participate in spiritually-based treatment resources by attending 12-step groups, and residents in these settings tend to score highly on measures of spirituality (Pardini et al., 2000). Through repeated spiritual practice in a residential environment and encouraged by principles outlined in 12-step groups (e.g., meditation and prayer as encouraged by AA’s step 11; AAWS, 2001), an individual may move further towards awakening. Spirituality and spiritual practices, it should be noted, are associated with experiences of spiritual awakening; individuals who have reported spiritual awakening experiences frequently report their spiritual practices and beliefs as triggering factors for their awakening experience (Cornielle & Luke, 2021). Therefore, residential treatment environments are ideal environments to both encourage spiritual awakening, as well as be benefitted by the potential positive outcomes of the experience.

Theoretical Explanations for the Benefits of Awakening

Theoretical conceptualizations of spirituality and spiritual awakenings explain why these phenomena are powerful, transformative influences on recovery. Vaillant (2008, 2013) conceptualized the experience of spirituality as composed of and giving rise to several positive emotions: awe, love/attachment, trust/ faith, compassion, gratitude, forgiveness, joy, and hope. According to Vaillant, these emotions encourage connection with others, an outcome valuable to fighting the isolative nature of addiction. They may counter the characteristics of self-centeredness and egotism AA claims is evident in the personality of an alcoholic (AAWS, 2001). Through transcendence, connection, and love, meaning in one’s life derives from living in relation to others, rather than acting on the ego. As one AA member reflected on their spiritual practice, “I’ve been able to have a deep connection to other people, relate with other people, relate more to, and with the world” (McInerney & Cross, 2021, p. 287). An increase in hope or decrease in hopelessness is especially common for recovery individuals following spiritual practice or awakening. In a focus group of 79 individuals seeking treatment for substance use, participants commonly described addiction as a dejected and desperate state, with the only sense of faith in life being placed on the drugs rather than a higher power (Heinz et al., 2010). Spirituality, on the other hand, was described by these individuals as hope itself. Spirituality was repeatedly named by participants as a primary source of hope in their lives. As one participant commented, “(Spirituality) is hope. If you got hope you’ll go further, strive further, set goals, it allows you to do more things” (Heinz et al., 2010, p. 8).

Theories related to recovery capital may also explain the transformative power of spiritual awakening experiences. Recovery capital refers to the many resources an individual can cultivate to recover from substance use disorders (Hennessy, 2017). According to the World Health Organization’s International Standards for the Treatment of Drug Use Disorders, a key pillar of recovery capital involves resources which allow an individual to discover or rediscover a meaningful and purposeful existence (WHO, 2020). Therefore, a spiritual awakening, cultivated through spiritual practices encouraged by AA, can be a key factor in promoting sustained recovery, strengthening the already present relationship, community, vocational, or coping resources already present in one’s life (Galanter et al., 2021).

Current Study

The current study examined the presence of one form of second order change, a spiritual awakening because of AA involvement, in the context of another, residence in a substance use aftercare treatment setting. More specifically, in the present study spiritual awakening among persons in recovery was assessed in the context of a safe, sober living setting known as Oxford House (OH; Jason et al., 2006; Jason & Ferrari, 2010). OHs comprise a distinct model of a sober living or recovery home, in which no professional staff members are involved, the house is run democratically, and new members are accepted with an 80% majority vote (Oxford House Manual, 2017). OH comprises over 3000 homes in the United States and currently is the only substance abuse recovery home model endorsed as evidenced-based by the Substance Abuse and Mental Health Services Administration (Oxford House Annual Report, 2020; SAMHSA, 2011). In individuals who reported a spiritual awakening following their entrance to OH, the authors examined the influence of such awakening on factors related to recovery across two time points (pre-spiritual awakening and post-spiritual awakening) and compared these factors to individuals who did not report a spiritual awakening while living in OH. Previous research supports the notion that interventions which promote second order change like OH residency and 12-step involvement jointly improve odds of recovery success (Groh et al., 2009). However, the present study hypothesized that experiencing a spiritual awakening while staying in an OH recovery home would be associated with increased self-efficacy and hope, decreased chance of negative exit from the house (leaving the house due to relapse or disruptive behavior), and strengthened affiliation with AA.

Method

Participants

A recent study estimated that there are over 17,500 recovery homes in the US housing over 270,000 individuals each year (Jason et al., 2020). The current study took place in Oxford House (OH) recovery homes, a network of over 3000 recovery homes in the US, housing over 20,000 individuals. Oxford Houses are entirely self-governed, with no on-site professional staff (Jason & Ferrari, 2010). Following the principles of democracy and self-reliance, all aspects of Oxford House operations are carried out under democratic procedures. These houses (typically 7–12 individuals) are gender-segregated, rented, and utilize self-support to pay all household expenses (Oxford House Annual Report, 2020).

Data for this study were collected as part of a longitudinal study which gathered data every 4 months for 2 years from residents of OH homes in North Carolina, Texas, and Oregon. Participants (Final n = 115) were recruited and interviewed by field research staff in face-to-face meetings. Participants received $20 for completion of the survey at each data collection point. Permission to do this study was obtained by the INSTITUTIONInstitutional Review Board (See AUTHOR, 2021 for a detailed outline of the data collection).

Psychometric Measures

Demographics.

Demographic characteristics of the sample were captured through several items on the Addiction Severity Index Lite (ASI-Lite; McLellan et al., 1980). The instrument consists of a semi-structured interview capturing several domains related to substance consumption, as well as current life condition (e.g., medical status, economic status, legal status, family status, psychiatric status). Gender was captured with an item providing the options of male, female, or other. Race was captured with an item asking participants to endorse what racial category they considered themselves, with options of White, Black, American Indian, Alaskan Native, Asian, Pacific Islander, or Hispanic (Mexican, Puerto Rican, Cuban, or other). Religious preference was captured with an option providing the following options, Protestant, Catholic, Jewish, Islamic, other, or none. In the analysis of race and religious preference, groups were collapsed into White (Non-Hispanic) and non-White and religious and non-religious, respectively.

Spiritual awakening.

Having had a spiritual awakening while staying in an OH recovery home was captured using a single item from Alcoholics Anonymous Affiliation Scale (AAA; Humphreys et al., 1998). Specifically, participants answered no to “Have you had a spiritual awakening or a conversion experience as a result of your involvement in AA?” at their first time taking the survey but answered yes at any subsequent time point to indicate they experienced a spiritual awakening during their course of staying at OH. Participants who were considered not to have had a spiritual awakening answered no to the item during the entire duration of data collection. Previous investigations of spiritual awakenings in the context of substance use recovery have used a one item (yes/no) measure to capture the occurrence of this experience (e.g., Galanter et al., 2012; Kaskutas et al., 2003; Strobbe et al., 2013; Zemore, 2007).

Categorical AA Affiliation.

Affiliation with Alcoholics Anonymous (AA) was determined by endorsement of four items on Alcoholics Anonymous Affiliation Scale (AAA; Humphreys et al., 1998): have a sponsor, have called a member for help, have done service for the program in the past 12 months, and have read AA literature in the past 12 months. Scoring positively on all 4 questions defined categorial AA affiliation, making this variable binomial. The decision to measure affiliation categorically, rather than through a sum score, was informed by prior literature arguing the categorical approach more accurately captures an individual’s involvement in the program as the make-up of key 12-step behaviors (Majer et al., 2010). This approach aligns with commonly offered suggestions from members of AA for achieving recovery success (Majer et al., 2010).

Negative Exit from Oxford House.

Having had a negative exit from OH was captured using two items from Form 90, a structured interview form adapted from Project MATCH (Tonigan et al., 1997). Project MATCH was a large, multi-site study to assess the degree that patient characteristics determine the effectiveness of popular alcohol use treatments. Form 90, utilized in the MATCH study, captures substance use consumption and related treatment domains, including reasons for exiting treatment (Tonigan et al., 1997). Participants were considered to have had a negative exit from OH if they answered yes to having moved out of OH, and this move was due to a “relapse” or “disruptive behavior.” Participants were considered to have had a positive exit from the house if their move out was due to any other reason (e.g., left by choice due to a better living situation or OH was too costly).

Coping self-efficacy.

Participants’ coping self-efficacy in terms of substance use abstinence was captured through the Drug Taking Confidence Questionnaire (DTCQ-8; Sklar & Turner, 1999). The scale asked participants to imagine themselves in 8 high-risk situations and rate confidence to resist the use of substances given the theoretical circumstances. Previous research associated self-efficacy and treatment outcomes like relapse, with self-efficacy acting as a moderating variable in the relapse process. Possessing a higher level of perceived self-efficacy to cope acts as a protective factor in high-risk situations and is associated with less risky substance use behavior in the presence of social support (Liu et al., 2020; Marlatt & Gordon, 1985). Respondents rated 8 items along a 6-point Likert Scale (1 = 0 – not at all confident; 6 = 100 – very confident). Sample items included “[I would be able to resist the urge to use:] If I were angry at the way things had turned out” and “If I had trouble sleeping.” A global self-efficacy score was calculated by taking the average of all the items. The 8-item version of this scale was previously validated for use with adults with SUD (Sklar & Turner, 1999), and for our sample, α = 0.86 to 0.99 (mean score = 5.33, SD = 1.23). While no specific cut-off scores for the global score are provided, the mean score for the sample falls on the high end of the scale’s range (1–6).

Hope.

Participants’ current state of hope was captured through Snyder’s State Hope Scale (Snyder et al., 1996). The scale achieved high reliability with a variety of populations since its inception (Brooks & Hirsch, 2017), including individuals seeking substance abuse treatment (Ekqvist & Kuusisto, 2020) and individuals living in OH (Jason et al., 2020). Respondents rated 9 items along an 8-point Likert Scale (1 = definitely false; 8 =definitely true). Sample items included “Right now, I see myself as being pretty successful” and “I can think of many ways to reach my current goals.” This 9-item hope scale was computed as a sum score and analyzed as a whole measure, and for this sample, α = 0.88 to 0.98 (mean score = 56.75, SD = 11.93). While no specific cut-off scores are provided for the scale, the mean score for the sample falls on the high range of the scale’s range (9–72).

Procedure

Residents in participating OHs could join the study at any time during the 2-year data collection period. Data was collected every four months over seven waves. Participation in the current study was then determined based on criteria related to the purposes of the study. First, a participant had to enter the study without reporting a spiritual awakening experience a baseline. Second, participants had to have provided at least one follow-up wave after baseline. Without these criteria, the differences before and after spiritual awakening could not be determined.

Over the 2-year collection period, 714 OH residents were contacted to participate, of which 666 (93%) agreed to participate. Following the inclusion criteria, 551 participants were excluded from the current study. There was a minimal amount of missing data (< 5% per variable), and missing data was only present on two outcome variables (coping self-efficacy & hope). As is standard practice with the chosen analyses, these participants were eliminated through listwise deletion.

Statistical Analysis

Pearson’s chi-square tests were used to assess the associations between experiencing a spiritual awakening and categorical affiliation with A.A., as well as negative exit from OH. Repeated measures analyses of covariance (ANCOVA) were used to assess change from time point 1 (TP1) to timepoint 2 (TP2) in hope scores and coping self-efficacy scores between those who did and did not report a spiritual awakening during their length of stay at an OH recovery home. All data analyses were performed using SPSS 28 (IBM, Armonk, NY).

Timepoints

For individuals who experienced a spiritual awakening, TP1 was defined as the wave completed immediately before reporting their spiritual awakening. For those who did not report a spiritual awakening, TP1 was defined as their first (baseline) wave. For the spiritual awakening group, the wave where a spiritual awakening was first reported was defined as TP2. For individuals who did not report a spiritual awakening, TP2 was selected as the wave they completed immediately following baseline. These decisions were made to keep all time intervals in our analyses one wave apart. In order to control for potential differences baseline differences in length of stay, length of stay was controlled for in our ANCOVA analyses. Previous research has reported a relationship between length of stay in OH and coping self-efficacy (e.g., Jason et al., 2016) Previous research has also reported increased length of stay in OH can strengthen the positive impact of hope on recovery outcomes (e.g., Mathis et al., 2009).

Results

Demographic Comparisons

The final sample consisted of 88 participants who experienced a spiritual awakening during their time at OH and 27 participants who never experienced a spiritual awakening. Chi-square analyses revealed these conditions were not significantly different in terms of gender (50.4% male in total sample), race (79.1% white), or religious preference. Groups also did not differ on marital status, employment status, or educational attainment. See Table 1 for details of these demographic comparisons

Table 1.

Demographic Descriptive Statistics

Spiritual Awakening
 No Awakening
% (N) % (N) χ2 p
Gender 3.404 .182
 Male 50.0 (44) 51.9 (14)
 Female 50.0 (44) 44.4 (12)
 Other 0.0 (0) 3.7 (1)
Race .118 .731
 White (Non-Hispanic) 78.4 (69) 81.5 (22)
 Non-White 21.6 (19) 18.5 (5)
Religion .000 .993
 Religious 70.5 (62) 70.4 (19)
 Non-Religious 29.5 (26) 29.6 (8)
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Note. Descriptive statistics and chi-square analysis of gender, race, and religion by group.

Categorical AA Affiliation

A chi-square analysis compared categorical affiliation to Alcoholics Anonymous (AA) between TP1 and TP2. This analysis revealed a significant relationship between experiencing a spiritual awakening and being categorically involved in AA There was no significant difference in proportion of individuals categorically involved in AA at TP1 between those who would have a spiritual awakening (31.8%) and those who would not (18.5%), X2 (1, N = 115) = 1.79, p > .05. However, at TP2, individuals who reported a spiritual awakening were more likely than individuals who did not to be categorically involved in AA, X2 (1, N = 115) = 26.57, p < .001. At TP2, 73.9% of those who experienced a spiritual awakening were categorically involved in AA, while the proportion of those who did not experience a spiritual awakening did not change (18.5%).

Negative Exit from OH

Among individuals in the sample, 65 individuals in the spiritual awakening group reported exiting from OH over the course of the study, while 12 did so in the non-spiritual awakening group. When these individuals were compared on the reasons for their exit (positive versus negative exit), chi-square analysis revealed that individuals who did not report a spiritual awakening were more likely than those who did to negatively exit from OH (exit from relapse or disruptive behavior), X2 (1, N = 77) = 16.33, p < .001. For individuals who experienced a spiritual awakening and exited the house, only 18.5% reported their exit was due to negative reasons. For individuals who did not report a spiritual awakening and exited the house, 75.0% exited due to negative reasons. Exploring reasons for negative exit, 100% of individuals who never experienced a spiritual awakening and negatively exited the house (n = 9) reported their exit was due to relapse. Of individuals who experienced a spiritual awakening and negatively exited the house (n = 6), 83.3% reported this exit was due to relapse, while 16.7% reported this exit was due to disruptive behavior.

Coping Self-Efficacy

A 2 (spiritual awakening or not) × 2 (time) repeated measures analysis of covariance (ANCOVA) was performed to analyze changes in coping self-efficacy (DTCQ-8 scores) across the two time points (TP1 and TP2), while controlling for length of stay in OH. Previous research has reported a relationship between length of stay in OH and coping self-efficacy. As can be seen in Table 2, there was a significant coping self-efficacy by spiritual awakening experience interaction effect after controlling for length of stay in OH, F(1, 112) = 15.60, p < .001, ηp2 = .122. The mean of the spiritual awakening group at TP1 was 5.36, 95% CI [5.14, 5.57], and 5.70 at TP2, 95% CI [5.43, 5.97]. The mean of the non-spiritual awakening group at TP1 was 5.18, 95% CI [4.78, 5.58], and 4.29 at TP2, 95% CI [3.80, 4.77]. These results suggest experiencing a spiritual awakening in OH seemed to strengthen one’s ability to resist substance use in high-risk situations, therefore enhancing recovery capital and lessening the chance of relapse in the pursuit of recovery.

Table 2.

Between Groups Repeated-Measures ANCOVAs (Hope & DTCQ-8)

Source of Variation df MS F p-value
Hope
 Time 1 106.711 1.202 .275
 Time x Length of Stay 1 40.066 .451 .503
 Time x Spiritual 1 720.815 8.116 .005*
 Error 109 88.809
DTCQ-8
 Time 1 1.425 1.431 .234
 Time x Length of Stay 1 .064 .065 .800
 Time x Spiritual 1 15.531 15.599 < .001**
 Error 112 .996
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Note. Two-way repeated-measures ANCOVA table for self-reported hope on the Snyder’s State Hope Scale (Hope) and self-reported situation-specific coping self-efficacy for substance use on the Drug-Taking Confidence Questionnaire (DTCQ-8) between groups (Spiritual), controlling for initial reported length of stay at Oxford House (Length of Stay).

*

p < .05

**

p < .001

Hope

A 2 (spiritual awakening or not) × 2 (time) repeated measures analysis of covariance (ANCOVA) was performed to analyze changes in state hope (Snyder’s State Hope Scale scores) across the two time points (TP1 and TP2), while controlling for length of stay in OH. In the spiritual awakening group, one individual did not provide a hope score at TP1 and one did not provide a hope score at TP2, leaving 86 individuals in that group in this analysis. In the non-spiritual awakening group, one individual did not provide a hope score at TP2, leaving 26 individuals in that group in this analysis. As can be seen in Table 2, there was a significant state hope by spiritual awakening experience interaction effect after controlling for length of stay in OH, F(1, 109) = 15.60, p < .01, ηp2 = .069. The mean of the spiritual awakening group at TP1 was 55.03, 95% CI [52.72, 57.34], and 60.54 at TP2, 95% CI [57.99, 63.09]. The mean of the non-spiritual awakening group at TP1 was 55.02, 95% CI [50.78, 59.26], and 51.90 at TP2, 95% CI [47.22, 56.58]. These results suggest experiencing a spiritual awakening is associated with increased state hope, supporting conceptions of spiritual experiences as comprising positive emotions like hope, which support connection and counter the self-isolating nature of addiction (Vaillant, 2008; 2013).

Discussion

The results of the current study support the notion offered by Alcoholics Anonymous (AA), that spiritual awakenings are powerfully transformative experiences for recovering individuals. While living in an Oxford House (OH) recovery home, individuals who reported a spiritual awakening were found to have greater affiliation to AA, increased coping self-efficacy, increased hope, and decreased chance of negative exit from the house compared to individuals who did not have a spiritual awakening. According to these results, not only did this experience positively shift an individual’s perspective, and improve their chances of recovery success, an awakening was associated with better adherence to the rules of their substance use treatment aftercare residence.

Results of this study align with previous investigations of spiritual awakenings in recovery and its influence on recovery-related outcomes. Similar to the current study, Galanter et al. (2014) investigated individuals in A.A. who reported having had experienced a spiritual awakening during their recovery journey. The study found decreases in craving and depression were reported by individuals following their awakening experience, as well as increases in AA affiliation, as measured by their commitment to AA sobriety and service. In addition, this study found a decreased chance of negative exit in participants who experienced a spiritual awakening. In our sample, most negative exits were attributable to relapse, further strengthening the notion that spiritual awakenings support abstinence. Strobbe et al. (2013) also examined AA members who reported a spiritual awakening, finding the event was associated with increased length of abstinence and the absence of heavy drinking behavior. This study expands upon a growing body of literature supportive of an awakening’s positive influence on recovery, by finding spiritual awakening is associated with increased coping self-efficacy and categorical A.A. affiliation. Coping self-efficacy to resist substance use in high-risk situations can act as a potent protective factor against relapse, strengthening an individual’s chances of success in recovery (Liu et al., 2020; Marlatt & Gordon, 1985).

The current study is the first to document the relationship between experiencing a spiritual awakening in recovery and the strengthening of hope. Results seem to support the conceptualization of spirituality offered by Vaillant (2008, 2013). Vaillant has theorized spirituality can be understood as experiences comprising several positive emotions: love, hope, joy, forgiveness, compassion, trust, gratitude and awe. It is perhaps due to the cultivation of these emotions through spiritual practice and awakening that a recovering individual finds the meaning they were lacking in active addiction. Where they were empty, they now feel whole. Or perhaps, as McGee (2020) suggests, the perspective shift experienced during a spiritual awakening makes addictive behavior not worth it for the individual any longer. As they come to appreciate the primacy of love in their life, as they relinquish their usual nature of “selfishness…self-centeredness”, as they shed their ego to follow a power greater than themselves, the recovering individual comes to regard actions that cause harm to others or themselves as undesirable or downright uncomfortable. Spiritual awakenings may be considered a form of second order change, a systematic change of behavior and perspective as defined by Jason et al. (2003). When accompanied by another second order change, residence in a recovery home, this can be a potent recipe for long-term recovery success.

It is important, however, to conceptualize the results of the current study in the context of participants’ characteristics. Previous investigation of recovery home residents reveal they typically score highly on measures of spirituality and that a majority of OH residents attest to possessing spiritual beliefs (Nealon-Woods et al., 1995; Pardini et al., 2000). These spiritual characteristics may result from OH’s emphasis on attending 12-step groups over other methods of treatment (e.g., Oxford House Traditions, 2022), coinciding with high rates of resident involvement in 12-step programs (Nealon-Woods et al., 1995). In the context of the current study’s findings, consumption of 12-step literature, increased contact with abstinence-supportive and spiritually focused peers, and salience of 12-step spiritually-based principles in an OH environment all may have acted as a framework in which to interpret a spiritual awakening experience.

Forcehimes (2004) describes the process by which the 12-steps of AA act as a framework for growth following the suffering of active substance use. The first, second, and third steps outlined by the program involve the manifestation of hope through spiritual means; by admitting a lack of control over substance use and gaining a relationship with some form of spiritual higher power who they can look towards for support, an individual no longer has to fear a future of permanent dependence on their addictive behaviors (Forcehimes, 2004). It is unknown then, exactly how much these 12-step perspectives influenced participants’ interpretation of their awakening. It is likely that the meaning framework provided by the OH environment and participation in a 12-step program allowed individuals in the current study to interpret their experience in the context of their recovery; to translate their awakening experience as hope and motivation to resist substance use. One potential confound, then, is the role of AA affiliation. The observed benefits of a spiritual awakening could be explained by a stronger relationship to a 12-step group. However, nearly 20% of the non-spiritual awakening sample reported a strong relationship with AA, attesting to the benefits of awakening above and beyond 12-step group affiliation.

The statistical results of this study should also be contextualized in terms of their practical significance. Participants who experienced a spiritual awakening reported statistically significant increases in self-efficacy, hope, and had a lower chance of negative exit from the house. However, self-efficacy and hope were generally high in the entire sample, and negative exit was relatively rare. The results should not be interpreted to conclude spiritual awakening is a lone factor in determining recovery success. Rather, the experience appears to be a helpful factor in a residential aftercare environment. It is useful to note that for individuals who did not experience a spiritual awakening, their hope and self-efficacy decreased across time points. One practical benefit of a spiritual awakening might be to strengthen those recovery resources that tend to diminish over time.

There were several limitations in this study. First, spiritual awakening was not specifically defined for participants in the current study and was captured with only a single item measure. While previous investigations of this phenomenon have often utilized a similar, single item measure (e.g., Galanter et al., 2012; Kaskutas et al., 2003; Strobbe et al., 2013; Zemore, 2007), others have utilized qualitative methods to understand perceptions of awakening (e.g., Forcehimes, 2004; Galanter et al., 2014, Heinz et al., 2010). It is important to note that all individuals in our sample were attending 12-step meetings and living in recovery housing inspired by the 12 step programs AA and Narcotics Anonymous (OH, 2019). These individuals were likely to have understood a concept that is often spoken of in the 12-step context and defined in the 12th step and second appendix of AA’s basic text (AAWS, 2001, Forcehimes, 2004). However, these same factors, as well as the self-report nature of this study, leave room for the influence of socially desirability. Living in an environment that emphasizes 12-step principles, with peers that frequently attend 12-step groups, may lead to a common understanding of the spiritual awakening experience. By the same token, these factors may pressure individuals to report experiencing an awakening in order to better fit in or be perceived as farther along in recovery than others.

Regardless, this study reveals the need to properly validate measures of spiritual awakening in the recovery context, as only preliminary efforts have been attempted so far (e.g., Galanter et al., 2014). AA has been noted for its peculiar approach to spirituality; its tenants and mechanisms of change not defined by any one religion but built of myriad interpretations of God and spiritual experience. Ultimately, the program emphasizes the personal journey over dogma (Kelly, 2016). Standard scales of religiosity, spirituality, or awakening meant for the general population may not adequately capture the experiences of those in 12-step groups.

Second, there was a lack of equal or near-equal groups. While 88 residents reported experiencing a spiritual awakening during their length of stay at OH, only 27 residents reported never having had a spiritual awakening. Therefore, participants in the two groups could not be properly matched on characteristics such as provided demographic information, or waves of the study analyzed. Chi-square analyses revealed these two groups were not significantly different on variables such as gender, race, religious preference, marital status, employment status, or educational attainment. In addition, groups were not significantly different in terms of AA affiliation at TP1.

The current study offers promising areas of direction for the treatment of SUD. The results of the current study reemphasize the role of spirituality in the treatment of substance use, even for individuals who may not identify as religious, or do not identify with a concept of God or other higher power. Individuals undergoing substance use treatment frequently report spirituality as an important factor for their recovery and express an interest in receiving more spiritually-focused treatment strategies (Arnold et al. 2002, Sterling et al., 2007). The current study reveals some of the tangible benefits that motivate these individuals’ desires. Clinicians working with clients in 12-step programs should not dismiss the importance of reported awakening experiences but realize their potential impact in achieving recovery goals.

The current study also reveals a need to integrate exploration and interpretation of spiritual experiences into other clinical settings, for the benefit of those without a spiritual identity. Participants in the current study were well integrated into 12-step groups and a 12-step residential environment and had the benefit of being able to process and interpret their awakening in the context of their 12-step identity, utilizing the steps of the program and their peers. Many individuals struggling with substance use feel outsiders to 12-step groups; barriers to participating in these groups include the aversion to the emphasis on spirituality, and the use of language like “God” and “prayer” which individuals may perceive as especially religious or feel run counter to the Western value of secularism (Laudet, 2003). For individuals without a convenient spiritual identity and interpretation framework, clinicians should consider developing inclusive spaces for individuals to discuss, interpret, and gain knowledge about their spirituality. For example, Heinz et al. (2010) asked methadone-maintained outpatients to consider the implementation of a spirituality discussion group at a substance use clinic, one that would be separate from offered 12-step meetings. Participants endorsed the idea for its potential inclusivity. Feeling ostracized from conventional spaces to discuss spirituality (e.g., religions, 12-step groups), these individuals imagined the discussion group as a space to throw off the constraints placed on them by other groups and avoid judgement for identifying as an atheist or agnostic. In clinical settings outside of the OH environment, discussion groups might act as a way to develop spiritual practices, interpret spirituality in a way that is comfortable for the individual, and ultimately gain similar benefits experienced by those who report an awakening through a 12-step program.

Including exploration of spirituality and spiritual practice as a component substance use treatment could not only could aid in recovery success, but also make clients more likely to stay in their treatment environments and less likely interfere with the recovery of others through conflict or substance use. Principles of love, hope, forgiveness, etc. may spread as a ripple effect through a treatment environment. A recent investigation of spirituality in SUD treatment programs found that 73% included a spirituality-based element in their program (Grim & Grim, 2019). However, Grim and Grim narrowly defined what constituted a spirituality-based element, counting only those programs which included 12-step meetings or the option to attend such meetings. There may be a need for spirituality-based treatments outside of the 12-step context for recovering individuals who do not attend 12-step programs.

Acknowledgments

This work was supported by the National Institute on Alcohol Abuse and Alcoholism [grant number AA022763]. The authors report there are no competing interests to declare.

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