Definitions

To define religion is often to start an argument because every definition has trouble accounting for at least some cases. Here, we adapt Smith’s (1963) definition of religions as organisations as those that have (1) a dogma (in the nonpejorative sense of the word), meaning a set of shared beliefs that are taken on faith; and (2) a set of cumulative traditions, such as sacred writings and pictures, rituals, apologues, and buildings. By these two criteria, Christianity, Islam, and Hinduism are religions. In contrast, Alcoholics Anonymous (AA), despite its spiritual content, is not a religion because it does not define membership as requiring specific beliefs.

Spirituality is another much-debated term, although one with a shorter history than religion (Cook, 2004). Although emerging within the Christian tradition, it has come to be applied not only to all faith traditions, but also to an ineffable aspect of human nature. The following definition – although as arguable as any other – has been widely adopted in writings on spirituality and mental health:

Some individuals experience and develop their spiritual life in a religious context, but the connection is not essential. An atheist or agnostic could do so in an entirely nonreligious fashion.

Finally, values are clusters of interrelated goals (Kanfer & Schefft, 1988), and moral values are the subset of values that have an ethical weight to the person concerned. They are the things that people invoke when describing their sense of right and wrong or “the kind of person that I believe I should be.” Moral values go well beyond strictly health-related goals and could, for example, include being a good citizen or loyal friend, showing compassion in the face of suffering, and striving to seek and tell the truth. Values may be religiously derived directly by those in a faith tradition and indirectly through cultural norms that reflect religious influence (i.e., even secular societies such as the UK incorporate once explicitly religious values into their laws and norms). Moral values can also arise independently of any direct or indirect religious influence.

Religious and spiritual influences on the understanding of drinking problems

Up until the late 18th century, drinking problems (then known as “chronic inebriety”) were largely understood within Europe and North America as being a matter of morality. This was not necessarily the popularly understood moral model that is now so often denounced (i.e., that such people are morally bad in a category apart from other people). It rather reflected a Judeo-Christian understanding of drunkenness as being among a range of sins to which all human beings were more or less subject, all of which were primarily spiritual/religious concerns rather than medical ones. All of this changed in the 19th century under a progressive medicalization of the concept of inebriety.

The 19th-century Temperance Movement understood inebriety as a “disease of the will,” a disease caused by alcohol. However, in the 20th century, with the repeal of Prohibition in the United States and the waning of the Temperance Movement in Europe and North America, a new disease model arose. Associated particularly with the spiritual but not religious organization AA (see Chapter 14), this disease model identified certain individuals – “alcoholics” – as suffering from a disease that made them unable to control their drinking.

In Europe and North America, the Temperance Movement did more than simply change attitudes to drinking and drunkenness. It spawned a variety of projects aimed at “reclaiming the drunkard,” or, as we would now say, offering treatment for drinking problems. Many of these projects found inspiration and motivation in the Christian tradition. Perhaps most famously, the Salvation Army devoted itself (among other concerns) to helping those whose lives had been destroyed by alcohol, but it was not alone. Alongside the secular spirituality that emerged from AA, various Christian groups in Europe and North America continued to concern themselves with rescuing those whose lives were ruined by alcohol, and they did so in explicitly Christian ways.

Today, there continue to be numerous projects around the world that offer rehabilitation from addiction within a Christian framework. Differences of approach may be identified between more liberal and more conservative traditions. Typically, the latter are likely to define a sharper boundary with secular practice (although this is not always or necessarily the case). For example, Teen Challenge provides an example of an approach within which the concept of addiction is understood as more or less coterminous with the theological concept of sin. In this paradigm, recovery from addiction is more or less identical with the process of conversion and Christian growth that is expected in this tradition of all Christians. Less conservative Christians, in contrast, might be expected to rely on medical and other secular treatments, or else on a programme like AA, which is not explicitly linked to any particular faith or denomination.

For Christianity, concern for those whose lives have been shackled by bonds of addiction has been a part of a broader tradition of concern with social and spiritual bonds from which people need to be set free. Elsewhere in the world, and increasingly also in the West, treatment programmes are integrated with, inspired by, and motivated by other faith traditions, including Islam, Buddhism, and Native American religion (Abdel-Mawgoud, Fateem, & Al-Sharif, 1995; Barrett, 1997; Garrett & Carroll, 2000). These traditions each find their own distinctive point of contact with problems related to alcohol and other drugs.

Buddhism recognizes that all human beings have a tendency to develop attachments to things, which causes suffering. What might otherwise be identified as “addiction” is but one manifestation of this universal problem. Treatments founded on basic tenets of Buddhism (and which are not dissimilar to forms of cognitive behavioural therapy) thus lend themselves readily to the treatment of alcohol dependence (Marlatt & Kristeller, 1999).

In Islam, alcohol use is haram: forbidden on the basis of texts in the Quran. The response of this tradition to drinking problems has thus emphasized prevention (in the form of injunction to total abstinence) rather than treatment. Yet, as with any such injunction, adherence is not universal. UK-based Muslims are significantly less likely to drink than other Britons, but a plurality nonetheless at least occasionally consume alcohol (Valentine, Holloway, & Jayne, 2010). This population includes some problem drinkers whose personal and family shame may reduce the likelihood of seeking treatment, as well as others who seek treatment but find it poorly matched to their cultural and religious values. Fortunately, culturally tailored addiction treatment programmes and mutual help organizations that incorporate Islamic spiritual practices are emerging (Abdel-Mawgoud et al., 1995; Millati Islami World Services, 2015).

Native American religion deserves attention here because of the extremely high rates of alcohol-related problems that Native American peoples have experienced since beverage alcohol was introduced by European settlers. Although this might still leave its importance limited to North America, it also provides an example of the way in which spirituality and religious practices of a faith tradition may be woven into the fabric of treatment programmes based upon the 12 steps of AA or other models. Native American religion understands spiritual reality as more “real” than the visible order of the world, but addiction represents a closing down of connection with this reality. Treatment is therefore about reconnecting to this reality, and various treatment programmes now integrate traditional Native American practices such as talking circles, sweat lodges, tribal music, and pow wows in support of recovery from alcohol dependence.

Treatment programmes based explicitly on other faith traditions are relatively unusual in Western countries. However, scattered findings suggest that similar principles are at play regarding the treatment of drinking problems in these faith communities. For example, Morjaria and Orford found that South Asian men in the UK undergoing counselling for drinking problems experienced a reaffirmation of existing beliefs (Hindu or Sikh) during recovery. This contrasted with members of AA who underwent a “conversion” experience (Morjaria & Orford, 2002). However, both groups found a deeper sense of connectedness with God, and it is this spiritual dynamic of recovery, understood within the particular spiritual or religious tradition of the individual concerned, which seems to be of general importance in the treatment of drinking problems (and other forms of substance misuse).