Concept: The key concepts of Inner Substance® are spirituality, cross-cultural bridging, transformative change, harm reduction, and an integral approach to treatment care.
What is Spirituality?
Spirituality is a core component of recovery from substance abuse and other chronic illnesses, yet little is known about the concept. Research in the substance abuse treatment field has tended to ignore spirituality because of the lack of clear definition and the difficulties studying internal feelings, but many treatment centers and individual staff members include spirituality in treatment planning. Some of the difficulties in providing spiritually based treatment are:
- The need to separate religion from spirituality to accommodate multiple belief systems
- The need to provide culturally-sensitive spiritual care
Spirituality and Religion
Bill Miller (1998) provides an excellent introduction to views of spirituality within the drug and alcohol research and treatment fields. He proposes that religion is a social institution with specific and often rigid beliefs practices, and rituals that are shared by a group of people. Spirituality is a personal, individual phenomenon with no boundaries or rigid beliefs or practices. Spirituality can stem from religion, but often exists completely separate from religion. From the beginning of the substance abuse treatment movement, addiction has been considered a spiritual disorder. The treatment field recognizes this, even if the research field has neglected the study of spirituality.
Ken Wilber (2000) placed spirituality within the realm of human development, although he noted that there is no consensus in the world literature as to whether spirituality develops separately from other lines of development, such as moral or cognitive development, whether it proceeds in a separate stage-like fashion, or is more accurately characterized as attitudes or experiences that people can have at any stage or age.
Because clients in substance abuse treatment come from a diverse religious and cultural backgrounds and some may have rejected formal religion, there is great value in developing treatment interventions that are cross-cultural and separate from any specific religious worldviews.
Spirituality and Culture
Who drops out of treatment and why? In an ideal world, all people would be treated fairly and given equal access to tools for recovery. However, we are far from that ideal world and instead, there is considerable stigma attached to many personal identities and behaviors. Because of social stigma in the form of racism, classism, homophobia, sexism, anti-Semitism, negative attitudes about drug users, and other forms of bias, clients with these stigmatized identities are more likely to avoid substance abuse treatment, drop out treatment early, or not complete treatment successfully.
Culture influences how we think about spirituality. Powerful (and often overlapping) influences include: the religious or spiritual traditions in which we were raised; our racial/ethnic heritage; our national origin; our gender and sexuality; our age; our education; our amount of exposure to diverse ideas and cultures; and a host of others.
Some cultures have spiritual practices deeply imbedded into the daily living activities, while other cultures, such as western, European- American cultures often think of spirituality as something separate from everyday practices.
How can we develop spiritual interventions that are respectful of all these diverse influences? Substance abuse treatment agencies can learn cross-cultural bridging interventions such as Inner Substance®, that use tools for honoring diversity and bridging differences in a healthy, inclusive manner
Listed below are some examples of the ways that values differ from mainstream Anglo-American and other racial/ ethnic and indigenous cultural groups (drawn from Randall-Davis, 1983). In Inner Substance® we discuss ways to bridge these differences in value systems.
COMPARISON OF CULTURAL VALUES
| Anglo-American | Other Ethnocultural |
|---|---|
| • Mastery over nature | • Harmony with nature |
| • Personal control over environment | • Fate |
| • Doing | • Being |
| • Time oriented | • Personal interaction over time |
| • Human equality | • Hierarchy/rank/status |
| • Individual/privacy | • Group welfare |
| • Youth | • Elders |
| • Self-help | • Birthright inheritance |
| • Competition | • Cooperation |
| • Future oriented | • Past/present oriented |
| • Informal | • Formal |
| • Direct/open/honest | • Indirect/ritual/”face” |
| • Practical | • Idealistic |
| • Materialistic | • Spiritual |
How would one bridge the differences? Here are a few examples:
| Bridging Paradigm |
|---|
| Harmony with nature; communion with nature; mastery when necessary. |
| Opportunity impacts outcome, broadens options. |
| Comfort and rejuvenation with ‘being’; enhanced productivity |
| Balancing your time between time commitments, personal relations. |
| Human equality; respect and honoring where appropriate with applied insight and wisdom. |
| Unique gifts and talents of the individual; privacy; discernment from isolation and secrecy; group welfare and collectivism; |
| Support youth as our future; validate our middle-aged as our work force and honor elder wisdom. |
| Self help; extended self awareness; cooperative reliance on others; collective responsibility. |
| Healthy competition (not at expense of others); cooperation |
| Being in the moment with acceptance of past influence and openness to the future |
| Appropriate conduct |
| Clear and authentic communication; appropriate timing and place. |
| Be aware of limitations while knowing how to manifest a dream. |
| Insight and clarity on your derivation of joy and happiness. |
There are many models for bridging cultures. Cross-cultural anthropologist Angeles Arrien, PhD (1993) offers her Four-Fold Way model that is drawn from extensive study of the indigenous peoples of the world. Inner Substance Intervention® draws from her model’s four universal principles of communication to form the foundations necessary for substance abuse treatment. Inner Substance Intervention is a model that fosters transformative change through the four universal principles and eight pathways to reduce harm. We provide a group process that is called the way of the council, where we implement the Inner Substance Intervention® tools.
What’s different about this approach?
The table below shows the differences between Twelve Step (AA/NA) models and Inner Substance®. Inner Substance can be used as a supplement to any other treatment approach such as Twelve Step models, cognitive behavioral treatments, motivational enhancement, and so on.
| Twelve Step | Inner Substance® |
|---|---|
| Based on concept of powerlessness | Based on concept of empowerment |
| Based on disease model | Based on integral model that includes disease model plus individual, socio-cultural, and societal influences |
| Tools include using slogans, the serenity prayer, working the steps (confessing powerlessness, taking a moral inventory, taking responsibility, making amends, etc) | Tools include cross-cultural methods of accessing spirituality and inner knowing |
| Terminal Uniqueness: Focus on the similarities of alcohol and/or drug addiction and denies or ignores other social identities (with exceptions: Special groups do exist such as women’s groups) | Absolute Uniqueness: Acknowledging individual gifts and talents and focusing on individual development within community, honoring individual differences while searching for universal themes |
| Based on a white, middle class, heterosexual male model | Based on cross-cultural themes identified in most of the world’s indigenous cultures |
| Based on Christian religion | Based on cross-cultural spirituality |
| Abstinence based | Harm reduction |
