Higher Power, Brain Power: An Interpretive Phenomenological Analysis of the Spiritual and Religious Characteristics of 12-Step Recovery Programs in the Context of the Brain Disease Model of Addiction Público
Kime, Katie (2017)
Published
Abstract
An inverse relationship between spirituality and substance abuse consistently characterizes research findings on recovery from substance use disorders. Studies across medical and social sciences evaluate treatment strategies and efficacy measuring spiritual and religious (S/R) characteristics, but many employ simplistic single-item measures, and almost none engage scholarship in theology or religion. Growing public interest in and increasing research funding for brain disease models of addiction (BDMA) represent a significant shift in the medical and popular discourse on addiction. No investigations explore the impact of this shift on S/R characteristics of recovery. This oversight leads to further fragmentation and reduction of addiction research into isolated components that too often fail to attend to the lived experiences of people living with addictions.
This qualitative study uses interpretive phenomenological analysis to investigate the experiences of six North American adults, each with at least three years of recovery from addiction. In-depth key informant interviews track constructions of their experiences and etiologies of addiction. Through an analysis of these interviews, this project identifies two distinctive characteristics in such constructions. First, the cultural authority of neuroscience, regardless of the lack of medical agreement on or evidence supporting the BDMA, is a significant force in constructing the meanings of addiction for many seeking to recover because it engenders an increasingly mechanistic, agential, and mind-centered sense of self, resulting in changed conditions of belief for those in recovery. Second, the insights of Harvard philosopher Charles Taylor on secularity, particularly his notion of the buffered self, offer significant resources for understanding the functions of spirituality and religion in participants' recovery from addiction by providing a conceptual framework sufficient to understand a wide variety of spiritual/religious beliefs and practices ranging from orthodox Christianity to agnosticism.
Spiritual and religious characteristics of recovery persist, but an increasingly buffered model of the self necessitates different strategies in recovering from addiction. The findings describe innovations and paradoxical tensions within participant accounts. Attending to critical interventions impacting individuals in recovery, including their journeys of making meaning of experiences of addiction, reveals complex language and concepts required to describe the meanings of addiction and recovery.
Table of Contents
Table of Contents
Abstract i Dedication vi Acknowledgements vii List of Tables ix List of Abbreviations x Chapter 1: Introduction to the Study 1 Background 1 Overview of the U.S. history of alcoholism and Alcoholics Anonymous 1 The neuro-turn and "brainhood" as the context for emergence of BDMA 5 Concurrence of S/R characteristics and addiction across research findings 7 Problem Statement 7 Research Questions 12 Purpose of the Study 13 Project Overview 13 Chapter 2: Literature Review 16 Research on Alcoholics Anonymous (A.A.) and other 12-step programs 16 Criticism of 12-step programs 17 History of conceptual constructions of "addiction" 21 Mutability of addiction. 22 Contemporary social scientific definition of addiction. 24 Disease concept of alcoholism 25 BDMA: neuroscience-based theories and concepts of addiction. 31 Changes and challenges in defining "spirituality" 36 Research on the role of S/R characteristics in 12-step recovery 38 Implicit deployments of S/R components and metaphors in addiction etiologies within neuroscience and psychoanalysis 42 Omissions and reductions of S/R characteristics in addiction and recovery literature 43 Contributions from Religious Studies and Theology 46 Charles Taylor's theories of secularity 49 Sean Daniels and "The White Chip" 50 Chapter 3: Research Methodology 53 Nature of Study 53 Rationale for Choosing Interpretive Phenomenological Analysis (IPA) 53 Methodological Conceptual Framework of IPA 54 Idiographic 57 Inductive 57 Interrogative 58 Role of the Investigator 58 Sampling and Participant Selection Logic 59 Instrumentation 63 Interview 1. 64 Interview 2. 65 Data Analysis Plan 66 Chapter 4: Findings 68 Participants 69 Finding #1: Necessity of surrender to a higher power 71 Connie and Karl: no struggle with the "God part" of Higher Power 71 Navarro and Barry: release previous theological concepts before surrendering to new understanding of Higher Power. 75 Sean and Ursula: atheists who struggled with any transcendent belief 78 Finding #2: Higher valuing and use of the BDMA in younger participants 89 Sean: "My higher power is: Science. It's my faith in Science that keeps me sober." 90 Ursula: Medical and spiritual models are separate, but are mutually reinforcing rather than in conflict. 94 Barry: "My prefrontal cortex" had to "heal," "but you don't hear about it in the Big Book." 98 Finding #3: Lower valuing and use of neuro-turn concepts in older participants 101 Navarro: "My prayer and meditation" to deal with "my factory settings". 102 Karl: My "allergy" is the struggle between me, God, and "the demons". 104 Connie: "Don't get too burnt out" about "defining alcoholism" or "God stuff" 105 Chapter 5: Discussion 109 Analysis: BDMA engenders a more buffered account of the self than the disease model, "and it matters" 109 Charles Taylor's theory of buffered self as it relates to addiction and recovery. 110 BDMA as a more buffered account than the disease model of addiction 113 Context of the BDMA changes conditions of belief for those in recovery 117 Conclusion 122 Limitations 123 Recommendations: examples of promising further research trajectories 124 References 127 APPENDIX A: Emory IRB Expedited Approval Letter 149 APPENDIX B: Emory IRB SHB Participant Information Sheet 151 APPENDIX C: Introductory Email/Letter 153 APPENDIX D: Data Collection Instrument 158About this Dissertation
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