Adult Attachment Style, Spirituality, and Religiosity among Individuals in Treatment for Substance Use Disorders

Spirituality and religiosity are considered to be protective factors in the treatment of substance abuse. Little is known, however, about how adult attachment style may be associated with levels of spirituality and religiosity. This study explored adult attachment styles among individuals in inpatient treatment for substance abuse and dependence and determined if there were significant differences between spirituality and/or religiosity variables by adult attachment style within the sample. Results indicated that neither of the religiosity variables varied by attachment style, but that one of two subscales in the spirituality measure, existential purpose and meaning, did vary significantly. Specifically, differences between the Secure attachment group and the Fearful group were highly statistically significant, with the Secure group reporting higher levels of existential purpose and meaning. Differences between the Secure group and the Dismissing group approached significance, again with the Secure group’s scores being higher. This study has shown that social work and other mental health professionals serving individuals with substance related problems must understand that, in their efforts to increase spirituality in their clients as a protection against relapse, they should recognize the impact that attachment style may have on their clients’ spiritual lives. Florida Public Health Review, 2012; 9, 121-131. Background Spirituality is an important component of successful treatment for substance use disorders (Chen, 2006; Jarusiewics, 2000; Koski-Jannes & Turner, 1999; Miller, 1998; O’Connell, 1999; Sandoz, 1999). For example, Koski-Jannes and Turner (1999) found that spirituality was related to improved substance abuse and dependency treatment outcomes and to sustained therapeutic gains achieved during treatment for substance use disorders. Similarly, Jarusiewics (2000) found that substance abusers who relapsed during or after treatment were more likely to report lower levels of spirituality than those who remained abstinent, suggesting that spirituality may be an essential component of a successful addiction recovery treatment. Religiosity, a concept closely related to spirituality, has been studied in this population and found to be similarly protective (Seidlitz et al., 2002). Although this positive connection between spirituality and recovery and relapse prevention has been clearly established, recent research has noted that spirituality is a complex and multidimensional concept, suggesting that researchers need to consider which elements of spirituality are more influential in treatment. For example, Diaz, Horton, McIlveen, Weiner, and Williams (2011) utilized the Spiritual Transcendence Index (STI; Seidlitz et al., 2002) to examine the relationship between spirituality and depressive symptoms among substance abusers. The STI has a spirituality subscale that assesses for purpose and meaning in life, and a relational subscale that assesses for the relationship of the respondents with a transcendent being. The authors found that scores on the spirituality subscale were negatively related to depressive symptoms (that is, the higher the score on purpose and meaning, the lower the level of depression) whereas scores on the relational subscale were positively related to depressive symptoms (that is, the stronger the relationship with a transcendent being, the higher the level of depression). They speculated that this unexpected positive relationship might be due to differences in adult attachment style, a reasonable assumption since there is growing evidence that the insecure adult attachment styles are strongly related to depression (Conradi & de Jonge, 2009; Patrick, Hobson, Castle, Howard, & Maughan, 1994; Rosenstein & Horowitz, 1996; Shaver, Schachner, & Mikulincer, 2005). Unfortunately, little research has been conducted concerning adult attachment style among individuals in inpatient treatment for substance abuse issues, and none at all concerning the relationships between attachment style and levels of spirituality in this population. This is a serious gap in the literature since attachment style is a primary factor that influences a person’s ability to relate to others throughout his or her lifetime (Ainsworth, 1982, 1989; Bowlby, 1977, 1980, 1982), including relating to a transcendent being (Miner, 2007). The purpose of this study, then, is to address this gap in the knowledge base by exploring adult attachment