Leaps of faith: the role of religious development in recovering integrity among Jewish alcoholics and drug addicts

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1 Mental Health, Religion & Culture March 2005; 8(1): Leaps of faith: the role of religious development in recovering integrity among Jewish alcoholics and drug addicts CHARLES D. BLAKENEY 1,2, RONNIE F. BLAKENEY 1,2 & K. HELMUT REICH 1 1 University of Fribourg, Switzerland, 2 Beit T shuvah Synagogue and Recovery Center, California, USA Abstract This is a report from a longitudinal study of chronic drug and alcohol addicts in treatment at Beit T shuvah Synagogue s recovery centre in California. The research asks: How does it work? What works for whom? What does spirituality have to do with it? A basic assumption is that addicts suffer from one (or more) structural splits: a split between affect and logic or a split between self and context. Effective treatment is construed as recovering integrity, mending the split(s). The study reports an analysis of 28 semi-clinical interviews with male and female chronic drug addicts, mean age 34 (range 20 78). We analysed the interviews in terms of (i) structural splits, (ii) relational and contextual reasoning (RCR): recognising, reconciling and transcending apparently contradictory views and experiences; (iii) experiences of spiritual awakening. In terms of the trajectory from (i) to (ii) and (iii), we classified respondents as either stuck in the split (chronic disintegration); or integrity recovered. Finally, based on the analysis of these data, we provide a theoretical roadmap from divided self to recovered integrity. Introduction This paper reports on a qualitative component of an ongoing longitudinal study of a population of men and women who are chronic drug and alcohol addicts who have come into Beit T shuvah Synagogue s recovery centre for treatment. Beit T shuvah is the only Torah (that is Hebrew Bible) based 12 step (that is, Alcoholics Anonymous) community funded residential recovery programme in the USA. The residential programme houses 100 people, about 60 in the core programme, about 6 months in duration, and another 40 in sober living or independent living programmes. The directors knew that their programme was effective. They asked us: How does it work? What works for whom? And, How can we improve what we do? There is increasing credible evidence that religion/spirituality plays an important role in recovery from addiction (Miller, 1998; Moos, 2003; Stark, & Bainbridge, 1998; Tonigan, Miller, & Schermer, 2002). Participation in religious institutions, the social and ritualistic aspects of religion, and spirituality both personal and collective prayer and a Correspondence: Ronnie Frankel Blakeney, Dep. Erziehungswissenschaften, University of Fribourg; Regina Mundi, Rue Faucigny 2, 1700 Fribourg, Switzerland. ISSN print/issn online ß 2005 Taylor & Francis Ltd DOI: /

2 64 Charles D. Blakeney et al. connection with the transcendent, ultimate, divine are said to enhance the likelihood of maintaining sobriety (Koenig, McCullough, & Larsen, 2001; Wills, Yaeger, & Sandy, 2003). Recently, research has focussed on spiritual transformation as a mechanism of the turning point in the process of recovery. This insight comes from a long tradition in psychology, galvanised by William James (1903/1982). James postulated that some individuals are divided souls. In terms of religious development, after their transformation they are described as the twice born who, through a conversion experience, are saved, redeemed, returned. It is a matter of revelation. While salvation may be construed as a Christian concept, it has a Jewish equivalent: the process of T shuvah, return. Recent research in neuroscience confirms the neural equivalent of James divided soul: emotional recognition and emotional regulation are disconnected from moral judgement in the pre-frontal cortex of chronic alcoholics (Adolphs, Tranel, & Damasio, 2003; Damasio, 1994; Sullivan, Deshmukh, Desmond, Lim, & Pfefferbaum, 2000a; Sullivan, Fama, Rosenbloom, & Pfefferbaum, 2002). Habitual patterns of misbehaviour have also been associated with developmental splits between emotion and cognition in moral problem-solving (Blakeney, & Blakeney, 1996; Keller, & Edelstein, 1993; Selman, 2003). After two years of abstinence chronic alcoholics recover neural integrity (Sullivan, Rosenbloom, Lim, & Pfefferbaum, 2000b). After 14 months of developmental intervention, seriously troubled teens recover developmental integrity (Blakeney, & Blakeney, 1991). It stands to reason, then, that if chronic alcohol and drug addicts are characterised by neural and/or developmental splits, they, too, should be able to recover integrity. Integrity is one aspect of positive psychology (Seligman, 2002). It speaks to general character, consistency between judgement and action, behaviour and ultimate meaning (Carter, 1996; Cox, La Caze, & Levine, 2001). Although, increasingly, research shows at least a mediated effect of religion/spirituality on recovery from addictions and maintaining abstinence (Wills et al., 2003) little is known about the mechanisms by which recovering addicts undergo spiritual transformation. Much of the current research that examines the relationship of religion/spirituality to health outcomes including recovery from addictions, valorises epidemiology and objective, predictive measurement (Hill, & Pargament, 2003; Powell, Shahabi, & Thoreson, 2003). This may be a reaction to the historically tenuous relationship between scientific psychology and religious and spiritual traditions (Cole, & Pargament, 1999; Miller, & Thoreson, 2003). It nevertheless has the negative side effect of limiting the potential for the development and testing of hypotheses that might be generated through qualitative research. Quantitative survey data lack detail and depth, while case studies lack rigor. As a consequence this study used in-depth semi-clinical interviews (Kohlberg, 1984; Vaillant, 2000) to explore how divided selves recover integrity. Is there a relationship between Divided Selves and Recovering Integrity that is mediated by religion/spirituality? What does spiritual transformation have to do with recovering integrity? To illustrate the theme of this paper we begin with excerpts from two interviews. Firstly Joel: I was a general internist, I had a solo practice. I closed my practice 14 months ago...i lost my marriage, lost my practice I lost my home...in one fell swoop, after I relapsed... In Vegas, I drank so much I puked, I spent all my money, gambled till all hours of night. [Have you had a spiritual awakening?] Yeah. I had the gradual kind. What I seek through spirituality is a connectedness to get rid of that loneliness...i guess what s changed is my idea of G-d and how I view G-d. I can turn to G-d for help. Now here is Ben: I m 51 years old, and it s been a 32 year struggle seeking spirituality. I feel like I have to stand on my own feet and be on guard. I feel empty. I have little sparks, but life is more pain and suffering and despair. I keep

3 Leaps of faith 65 banging my head against the wall thinking these drugs are the solution. They put me in jails, prisons, mental hospitals. Destitute, homeless. I can t face life as just me. I m defeated. I would surrender, but I can t figure out who to surrender to. The first interviewee seemed to be on the mend ; the second still has not yet found a way to recovery although he feels the need to make a turn. Background to the study Preliminary findings from the longitudinal data In an ongoing quantitative examination of a Jewish faith-based residential recovery programme (Blakeney, Blakeney, & Maeillo, 2003) Integrity was assessed in four groups of chronic alcohol and drug addicts (CADs) who varied by level of social integration (SI). Integrity was recovered among those who continued to progress in treatment. This parallels the findings of research on AA (Alcoholics Anonymous), where ongoing participation predicts to ongoing abstinence (Tonigan, 2003) and to research on religious participation (Richard, Bell, & Carlson, 2000) which, at least among sober alcoholics, finds that church attendance is correlated with continued sobriety. The curious finding in the quantitative analysis of data, was that at SI2 (average 45 days sober) there was an increase in the standard deviation on the moral measure, suggesting that people s paths toward recovery diverged. On average, moral stage was lower at SI2 than at any other time in treatment. Religious development was not lower at SI2, however. We speculated that there might be some spiritual awakening at this phase of treatment because there was a shift in Locus of Control from Self and Chance to G-d. Was there, indeed a spiritual awakening that characterised the process of recovery for some participants but not for others? The three questions we address here are: what is the nature of the Splits; how are they reconciled (integrated); and what has G-d got to do with it? We use interview data to predict whether addicts with structural splits are likely to effectively maintain sobriety and, ultimately, to recover their integrity. Method Subjects In order to better understand the qualitative nature of this transformation, we conducted semi-clinical interviews with the members of one group from each programme level (SI Levels 1 4) (a total of 28 male and female residents), average age 34 (range 20 78). On average they had been addicted for 12 years (range 7 38). They had been in 3 14 previous treatment programs. In the tradition of William James, we present narrative data wherein Jewish men and women chronic alcoholics and drug addicts describe their spiritual, moral and religious transformations. We analyse these interviews in order to describe three phenomena common to the process of recovering integrity: First, we examine the disintegrated condition of 28 addicts before recovery with respect to structural splits. Then we describe 24 of those addicts experiences of the initial phases of recovering integrity. Finally, we share the leaps of faith, voiced by 17 people in the sample, for whom the emergence of a spiritual awakening or connection marked a turning point. Figure 1 presents a schema that summarises the cases analysed. The concentric circles represent the group of 28 (outer ring) as they fit each of the criteria we illustrate.

4 66 Charles D. Blakeney et al. Sample n=28 Split, addicted n=24 Recognise split, recovering integrity n=20 Spiritual awakening n=17 Figure 1. Nested circles: Splits, awakening, integrity. Of the 28, 24 exhibited the divided self (split among moral, religious and emotional development). Of the 24 who were split in SI1 (less than 30 days sober), 20 recognised the split and recovered (some) integrity within 6 months. Of the 20 who recovered integrity, 17 reported a spiritual awakening. Those 4 who were not split did not report a transformative (leap of faith) experience. Those four who were found split by examination, but who did not report a recognition (awareness) of the split, had neither a transformative experience and nor did they recover developmental integrity. Interview protocol We began the interviews by inviting participants to tell us their story, how they came to be at Beit T shuvah. We probed and shaped the stories gently with such suggestions as: can you remember, when you were about 11 or 12 years old? and in AA they say that insanity means doing the same thing over and over and expecting a different result. Have you ever felt like that? From transcribed interviews we coded (1) evidence of splits (affect logic; self context); (2) transcendent, spiritual, or religious experiences or insights; and (3) evidence of integrity, or movement in the direction of integrity. We then looked at the relationship of the above to (a) the time of their addiction and (b) the time of their recovery. Finally, based on the above, we categorised the subjects in terms of the likelihood of their eventual recovery of integrity.

5 Leaps of faith 67 Methodological caveat With respect to the subjects under study, we were interested in the role of spirituality in recovering integrity. This, of course, begs two questions: (1) how are we defining spirituality? and (2) from whose perspective? For purposes of this paper, we give to the subjects the opportunity to define and use spirituality or religion in their own ways. In practice, most think of religion as institutional and spiritual as personal (between G-d, the Divine, the Higher Power) and oneself. Spirituality crosses religious doctrines, Religion is doctrinaire. Although few residents, on entrance, considered themselves religious (fewer than one in three), nearly half see themselves as spiritual. With respect to the question of perspective, phenomenologically, we use the subjects own, first person perspectives and definitions of spiritual awakening, and then we analyse, interpret and classify responses based on our (collective) third person perspectives. This raises an interesting dilemma with respect to classification of the time one split. Our assumption is that by definition few addicts, in the throes of their addiction, are aware of the splits between the affective and logical domains; between their accommodation to the perspectives of others, and their profound ego-centrism; between their contextually determined or their contextually detached behaviour and judgements. Thus, their own retroactive reconstruction is subject to interpretation in light of the subsequent perspective. This methodological question has been dealt with by Miller and Thoreson (2003), Plant and Sherman (2001) and others, and is beyond the scope of the present paper. Criteria for analysis The criteria that we use for the analysis are: 1. Structural splits (affect: logic, self context) present or not on entrance into the recovery programme. 2. Recognition of the split (a) and awakening if it occurs (b). Recognition may or may not come as a spiritual awakening. 3. Recovering integrity. Criterion 1: Structural splits By split we mean two (or more) structurally different ways of being and knowing without conscious awareness of the split of mind. In previous work with emotional disturbed adolescent girls (Blakeney, & Blakeney, 1996) we identified (a) intrapsychic and (b) interpersonal structural splits. The first, an intrapsychic split, is between affect and logic. Denial is one example of an intrapsychic split wherein painful feelings are denied (cf. Vaillant, 1993, for a fuller explanation). An interpersonal split is an imbalance between enmeshment with the context (over accommodation to others) or detachment from context (over-assimilative ego-centrism). Affect logic splits. We coded an affect logic split when there was evidence that feelings did not inform moral judgement (see Figure 2). There are two forms of A L split: impulsive ( I ) and abstract logic (A). In the more common form, habitual misbehaviour is impulsive and judged by the individual as wrong, but (negative) feelings are not integrated into moral logic. That is, the individual knows better, but continues to repeat the cycle of impulsive misbehaviour and feeling bad. The A split, on the other hand, is characterised by the

6 68 Charles D. Blakeney et al. 1. Normal (Piaget) Affect Moral Logic Moral Behaviour 2. Impulsive Affect Moral (Mis)behaviour 3. Denial Affect Logic (Moral) Behaviour Figure 2. Splits among emotional regulation, moral judgement and (mis)behaviour. absence of an affective feedback loop from (mis)behaviour. The A split doesn t experience either the impulse to misbehave or regretful feelings after the (mis)behaviour. Misbehaviour is thus divorced from personal (affectively integrated) responsibility. Here is an example of the I form of A L split. It s like the feelings take over, and the emotions are just pouring out of my body. I m walking down the street, and I m saying to myself: this is the wrong thing to do, what am I doing? There s this mental switch that happens. It defies my morals and my entire being, you know, my soul. It might start with toes and go up slowly, but there s this point of no return, and as much thought as much will as I want to exercise...it s too late. Here is an example of the A form of the A L split: I was doing alright until Crack came along. Self context splits. The second form of structural splits are self context imbalances (S C). In theory, the split can take two forms: detached or enmeshed (cf. Selman, & Schultz, 1990). The detached split is ego-centric, unaware of the wants, needs, consequences or perspectives of others. This is normal in a 6- or 7-year-old but developmentally problematic in an adult. The enmeshed split, on the other side, is divided from her/his own wants, needs, consequential concerns and moral perspective. People with a self context split are typically oriented one way or the other, however some alternate between detached and enmeshed. The key point is that, at least during their active addiction, they are unable to integrate the two ways of being and knowing. Here is one example of the ego-centric split, detached from context: I had surgery and found out that I liked Vicodin. I had it around, so I took it. My grandfather was a doctor, so when I wanted more, I just went into his study, found a prescription pad, and wrote myself a prescription. Did you think there was anything wrong with that? No. It never made me sick. Here is an example of the enmeshed split: She dieted, danced and dyed her hair blonde to meet her father s expectations. She made doctors appointments and plane reservations and charity lunches to meet her mother s expectations. She smoked marijuana and snorted cocaine to meet her friend s expectations. She came into rehab to meet her grandfather s expectations, and when I asked if I could ask her a few questions she responded: My pleasure. Criterion 2a: Conscious recognition of the split From the point of view of Piagetian theory (Piaget, 1981), a new, hierarchical integration occurs through the conscious awareness of the inadequacy of the prior way of knowing, and the (gradual or sudden) reorganisation of the component parts into a new, categorically

7 Leaps of faith 69 more adequate structure. From the psycho-dynamic point of view (Freud, & Breuer, 1895/ 2000), bringing (unconscious) process to consciousness is a major function of psychotherapy. From the point of view of Alcoholics Anonymous (1994) a searching and fearless moral inventory which brings one s character defects to consciousness, is the fourth step toward recovery from alcoholism. Thus, one criterion for recovering integrity is a conscious recognition of the splits. Here is an example: I used to think I was so smart, keeping my life compartmentalised, looking good in one area while the rest is, uh, I didn t want people to see the other side of me (long pause) I d tell complete strangers deep secrets, just to unburden myself. But not open up even to my grandmother, who was the most important person in my life, or to my wife (sob) It turns out I wasn t so smart, (laughter) (italics ours). Criterion 2b: Spiritual awakening Spiritual awakening can come as part of the conscious recognition, the spiritual equivalent of Piaget s Aha! response. Or it can come after there has been a conscious recognition of the split, as part of the turn toward recovering integrity. An interview was scored as positive for spiritual awakening when the subject shared an experience of understanding G-d, a Higher Power, transcendence, the Divine Mystery, etc, as new-found, or rediscovered. Spiritual dawning was scored whether the experience was produced spontaneously or in response to a specific question (have you ever had what you would call a spiritual experience?). For example, the following defined a spiritual experience: For me it s little points in your vocabulary where you re aware of a transformation in your perception of who you are. Criterion 3: Recovered integrity Recovered integrity is the predicted outcome of the process that moved subjects from split (divided selves) through recognition and spiritual awakening to integrity. Initially we raised the question of the role of the spiritual awakening in recovering integrity. Integrity is assessed by evidence that moral reasoning, emotional self-regulation and conceptions of ultimate meaning (Oser, & Gmünder, 1991) are mutually accessible (Twerski, 1997), informative and transformative within the contexts (Reich, 2002) of personal meaningful decision-making and behaviour. Results Phenomenologically, how do recovering addicts experience the development of integrity? How do they integrate emotions and reasoning differently in recovery? How has their self context balance shifted? How do their sense of ultimate meaning and their experience of what AA calls a Higher Power inform those changes? We present results from 28 semi-structured interviews. We analysed the interviews in terms of (1) the divided self, visioned as structural splits (between affect and logic, [A L], and/or between self and context [S C]; see above); (2) in terms of relational and contextual reasoning (Reich, 2002), that is recognising and reconciling contradictions (including splits); (3) experiences of spiritual awakening, and (4) recovering integrity. In terms of the trajectory from 1 to 2 and 3, then to 4, we classified respondents as either (a) stuck in the split (chronic disintegration) (cf. Winnicott, 1971, for a fuller description);

8 70 Charles D. Blakeney et al. or (b) integrity recovered. Finally, based on the analysis of these data, we present a theoretical roadmap from divided self to recovered integrity. Structural splits (the divided self) Among the 28 interviewees, 24 were coded as structurally split in the self-report of their religious, ego, and moral reasoning during their addiction. (see Figure 1). The most common structural split in this sample is between emotional self-regulation as a function of ego development (ESRFED how I see myself in the face of stress) and moral judgement development (how I make decisions about right and wrong). The affect logic split takes two forms: impulsivity and denial. Four subjects had only the A L split; 3 had only the S C (self context) split and 11 had both A L and S C splits. That is, they lacked both intrapsychic (affect logic) and interpersonal (self context) integrity. In addition, two subjects used abstract reasoning that was detached from context in the affective, logical and spiritual domains (a problem of reality testing ). Finally, four subjects were scored as developmentally but not structurally split. That is, they were stuck in a developmental transition. In this paper only the structural splits are discussed. The following response was scored as A L, S C split, that is, no integrity: Jerry: What my disease will do is go into stealth mode. Once I did a really smart thing. I got a job in a wine store. I m stealing. I m getting drunk at work. From there they fired me. How was that Smart? Getting a job was a smart thing. From there things started to snowball, like a little rock being pushed off a mountain. Here Jerry uses logic divorced from both affect and context in a mathematical formulation. Work is a good thing. I have a job therefore I m doing a good thing. There is no (previous) signal that a job in a wine store is, in this context, a bad thing. Further, even at the time of the interview (4 months sober in his third attempt), this 32-year-old continued to split off his disease from his self. That way, his disease (in Hebrew, the Yetzer Hara, the evil inclination) is in control, not integrated, and he becomes the little rock, while some outside force pushes him off the mountain. In all, 24 out of 28 subjects were scored as split in the way they described themselves during their active addiction. Of those 24, 20 described their current state of self-understanding as recognising and/or integrating the splits. Of those 20, 17 reported some experience of spiritual awakening. The following examples illustrate a recognition, reconciliation and transcendence of the splits identified above. Recognition Daniel (emphasis added to mark the elements of recognition): For the first two or three months I d go along with the rules, and be saying the right thing, doing the right thing. But deep down I d be saying something different. Deep down I wanted something different, and so both parts of me weren t working together as a whole. And there d be a boiling point, when something in me would say, look, I m doing everything they re telling me to do, I don t want to do this, I m bored, I m going out and do what I want to do, and kind of exert my life plan. Sometimes I feel like I don t have power over my actions, that people are directing me to a certain life. So when I go out and use it s like my choice of what I want to do with my life, and against everybody else s. It s like the feelings take over, and the emotions are just pouring out of my body, and I want to ask somebody what should I do so badly, it s amazing

9 Leaps of faith 71 to me that as I was going to use, and I m walking down the street, and I m saying to myself: this is the wrong thing to do, what am I doing? And my whole body was, I always thought my body was separate from my thinking, and as I was saying no. Don t do this in my thinking, it was too late. I d keep on walking, and like when you way hard wired I was thinking it was like past the point of no return and there s this mental switch that happens, and I ve never been able to pinpoint it, and my disease takes over everything else that tries to contradict it. It defies my morals and my entire being, you know, my soul. It might start with toes and go up slowly, but there s this point of no return, and as much thought as much will as I want to exercise...it s too late. Here Daniel tells us, from a point of view that stands outside himself, that he recognises the split between his feelings and his thoughts. There are times when he knows better, but when his impulses get so strong that he can t control them. The feelings, without recourse to logic, guide his feet. Of course this is the set up for shame and guilt, which themselves can be reasons to use. The point here is that Daniel recognises the split, and is therefore less subject to it. Another example of recognising the split is Rachel (emphasis added to mark the elements of recognition): I think the soul, like we have two parts, what they call the good inclination and the evil inclination, and I try to be really good, and when I m not really good, then I try to be really bad. And I try, but I can t connect the two. I ve heard a lot that one recovers when one is able to integrate the good and bad parts of the person into one being, but it often feels to me that I m split down the middle, completely moral and correct and go with the guidelines of society or completely rebel and go against the guidelines of society, and I haven t been able to connect the two parts of my soul. Rachel, for her part, has a self context split. She sees herself as alternating between enmeshment with the (good) social context, or detached from, rebelling against that social context. In practice, she alternates between enmeshment in two contexts: member of society and rebel against society. The split soul, as she describes it, is the inability to reconcile the parts, and thus to recover integrity. Recognition of the split, however, is, in the words of Alcoholics Anonymous Twelve Steps, the First Step. Reconciliation Leah (emphasis added to mark the elements of recognition): I tell my body how to feel, the feelings are inside my body, being honest, it s hard to talk about, but I know that my soul and my intellect doesn t want me to do it, but my body forces me to act...i told somebody about it and it didn t feel shameful because I was honest about it and I told somebody: this is who I am, the good and the bad, and I don t have to run out in confusion and fear that someone doesn t know me. Leah has gone a step beyond Rachel. She recognises the split and is attempting to reconcile the good and the bad, feelings in my body and my intellect, by talking about them, owning them. Sara (emphasis added to mark the elements of recognition): I look at how I was, and I don t know where those ten years went. I still thought I was a good kid. I finished college, I worked hard, had my own apartment, paid my own rent. And that didn t change how I thought of myself, even when I was sleeping with my dealer to get drugs, and stealing from the man I lived with to pay for drugs. I don t think I felt anything I was numb, and when I wasn t numb, I took more drugs to stay numb. I still intellectualize instead of feeling, but now I know it, so I try to write, which helps, or listen to music, so I can feel again. It s pretty basic. Now I m trying to go from point A to point B instead of from point A to Point C. In this case, Sara had split her sense of herself off from the social context. She could maintain an image of herself as a good girl, even though she was behaving in ways that contradicted her perceptions (I even thought of myself as good when I was sleeping with my dealer to get

10 72 Charles D. Blakeney et al. drugs). There was no feedback loop between her sense of who she was, and what she was doing everyday. The split creates a breakdown in the normal developmental process, so that the individual is also developmentally stuck (Where did those ten years go?) Sara has recognised the split (I still intellectualise instead of feeling, but now I know it) and has found ways to begin to reconcile, reintegrate, feelings and thoughts (I try to write, which helps). Recognition, awakening The recognition of the split and the need to recover integrity can come gradually or suddenly, once and for all or over and over again. In this data set, there were 17 examples of awakening associated with recognition. Jacob is one of the younger subjects (age 24) to have been awakened by a jolt to the head. Beit T shuvah Synagogue and Recovery Center is Jake s second rehabilitation programme. The first was a respected, traditional medical model 30-day programme. He entered the 30-day programme voluntary, soon after he finished High School, for help with his addiction to marijuana and his increasing reliance on alcohol. It didn t work. The next 6 years are a blur of increasing drug and alcohol use and decreasing ability to function (selling his school books for dope money, then dropping out of college; losing his job, his car, his apartment, his girlfriend; stealing from friends and family; spending time in jail). This time, Jake tells us, his coming to Beit T shuvah was a G-d shot. When I got pulled over by the cops, I had this total calm, sitting on the curb, when I should have been freaked out. I panicked later, in the jail cell, but right then, it was a spiritual experience. I was very calm, and I just saw that I was going to have to switch where I was at. It was a real spiritual experience because the things that led up to me being right there at that time I was being really hard headed and somehow I knew that this was G-d, putting me in check. It was either stop what I was doing or die. It was a pivotal point in my life, when all this happened, my family was gone. I was all alone. And it was like G-d slapped me in the head and said: Time to wake up. After that, I had a different understanding of how I had to push myself. Jake had no conscious recognition of a split from the time he tried to get help with his marijuana addiction until G-d slapped him in the head. His was the experience of enmeshment with the social context (adolescent drug users), until the drugs themselves took over and then Impulsivity reigned: the years were a blur, as Leah reported. In Jake s case, however, unlike Leah, he didn t become aware of the split (the impulsivity or enmeshment) until the cop pulled him over and this total calm came over him and he knew I was going to have to switch. In this case, spiritual awakening preceded recognition. Transcendence, spiritual awakening, doesn t always come like a bolt that hits you in the head. David (age 48) gave an example of finding G-d within the social context: I always believed in G-d, but I believed G-d forsook me. Now I know I can turn to G-d for help... Once, when I was in despair, a counsellor walked by and said that I didn t have to sit in misery, I could walk away, and there was like a light from his words, that I wasn t forsaken. For me that was a spiritual experience. David s awakening supported recovering integrity by reconnecting him to the social context, where he felt, before then, that he wasn t good enough to belong. Discussion Are these experiences of conversion of the variety William James described a hundred years ago? Are they likely to stick? Is the experience of spiritual awakening common among recovering addicts? What function does it serve in the addict s ability to recover her/his integrity? In this paper we describe the role of religious experience in recovering

11 Leaps of faith 73 integrity among chronic alcohol and drug addicts. We conclude by suggesting that although not all chronic addicts have structural splits, for those who have affect logic splits and self context splits both recognition and awakening are necessary to reconcile the splits. We may speculate that G-d, in these cases of spiritual dawning and spiritual return, is meeting some particular developmental need depending on the perception of the hole to be filled, or mountain to be climbed. All we can say, at the moment, is that for 17 of these chronic alcohol and drug addicts G-d had become, in Buber s words, the Du, to their Ich, the ultimate transcendent Other in relation that provides a holding environment, in Winnicott s sense, for the quickening of self. William James (1903/1982, p. 189) wrote, of the conversion experience: To be converted, to be regenerated, to receive grace, to experience religion, to gain an assurance, are so many phrases which denote the process, gradual or sudden, by which a self, hitherto divided, and consciously wrong, inferior and unhappy, becomes unified and consciously right, superior and happy, in consequence of its firmer hold upon religious realities. This, at least, is what conversion signifies in general terms, whether or not we believe that a direct divine operation is needed to bring such a moral change about. For James, conversion is the process by which a divided self becomes whole. The divided self has its religious parallel in human brokenness. It has it s developmental parallel in structural splits, it has its neurological parallel in neural disintegration and it has it s moral equivalent in the lack of integrity. From religious, psychological and moral perspectives, Integrity is an acceptable developmental aim of human being and becoming. It is also, we suggest, an important goal and measure of recovery. The last question that we proposed to address in this paper is whether one might predict recovery from the observation of splits, recognition and awakening. The important observation in this paper is that when there is a split, a spiritual awakening, while not a necessary condition of recovery, facilitates recognition and recovering integrity. It is sometimes a wake-up call. As a wake-up call to the A L split, the spiritual awakening jump-starts the process of recognising and reconciling the intra-psychic split. On the other hand, Awakening is sometimes the recognition of connection, of being held, of belonging. It thus provides the holding environment for reconciling the S C split. Held by the support of the spiritual community, the wake-up call can be the beginning of a new way of understanding and being in the way that Tonigan et al. (2002) describe happening with Alcoholics Anonymous. The implications of these findings yield something like a road map to recovered integrity for those who come into treatment with divided selves (see Figure 3). In Figure 3 we see the steps that describe the common pathway among those who entered Beit T shuvah divided. Divided self: Divided self is phenomenologically two discrete ways of being in the world whose differences (and hence potential reconciliation) are outside of individual awareness or consciousness. William James (1903/1982, p. 167) refers to the Divided Self as having an a certain discordancy; an incompletely unified moral and intellectual constitution. He says that in the divided self the higher wishes lack the intensity ( the dynamogenic quality ) to effectively erupt into life. That is, in the divided self, the higher moral judging self lacks the capacity (or will) to conserve feelings into a permanent scale of values which Piaget describes as necessary to guide actual behaviour. Coming to Beit T shuvah: Clients come to Beit T shuvah voluntarily, although one-third are court ordered to treatment somewhere, and one-third are there as an alternative to jail. There is no medical detoxification on the grounds, so some residents go first into a hospital for some days.

12 74 Charles D. Blakeney et al. Time 4a: Recovering integrity Time 4: Joining community Time 3a: Spiritual community support Time 3: Recognition of the split Time 2a: Spiritual awakening Time 2: Programme engagement Time 1a: Beit T'shuvah entry Time 1: Divided self Point zero: Stuck in addiction Reciprocal interweaving in the path to recovered integrity Internal steps Relationship to community Time 4: Recovering integrity Joining community Time 3: Recognition of split Spiritual community support Time 2: Spiritual awakening Engage with community Time 1: Divided self Enter Beit T shuvah Point zero: Stuck in addiction Outside community Reciprocal interweaving in the path to recovered integrity such that a given internal processes and a reciprocal community relationship are each necessary for the next step, but the order of internal/community may vary at each time. For example programme entry (coming in to Beit T shuvah) may precipitate the divided self, or alternately, a divided self may bring one to the steps of Beit T shuvah (Time 1). Engaging with community can precipitate a spiritual awakening, or awakening can engender engagement (Time 2). Likewise, community support creates a safe environment in which an individual can become aware of her/his split (Time 3). Integrity demands responsibility to, for and within community (Time 4), and becoming a fully participating member of the community creates the climate and opportunity for recovering integrity. The question of which comes first, awakening or recognition, requires longitudinal research. Figure 3. The road to recovered integrity. Engaging with the programme: Residents are required to participate in a structured programme of groups and classes for the first four months in residence. Although sleeping late and not showing up are not necessarily grounds for dismissal, they are seen as symptomatic, warning signals for impending relapses. The Rabbi exhorts residents to just hold on. It s gonna be a wild ride. Residents who are likely to make it engage actively in what the programme has to offer, as in all 12 step recovery programmes, the sine qua non is: suit up, and show up. Awakening: What we might call a spiritual dawning (a kind of pre-awakening eye-blinking activity) is the conscious recognition that something is changing, changing for the better, and the individual is not sure how, why or where the new change is coming from. Again, according to James (1903/1982, p. 175) It may come gradually or it may come abruptly; it may come through altered feelings, or through altered powers of action; new intellectual insights, or experiences which we shall later have to designate as mystical. However it comes, it brings a characteristic sort of relief...it often transforms the most intolerable misery into the profoundest and most enduring happiness. Recognising the split: At this phase in the process the heretofore unconscious split comes to consciousness. The individual can speak about her/his two parts. And often does,

13 Leaps of faith 75 referring to the out of control part of her/himself as my disease. At this phase the recovering addicts are actively struggling to bring their feelings in line with their moral judgements; to construct a self-consistent identity; to accept themselves and be honest in relationships, etc. Spiritual support: The ongoing program engagement now takes on a new challenge; accepting spiritual support without letting go of moral agency. Holding on to moral agency without going over into (ego-centric) self-will. Engaging in community, giving back (Cole, & Pargament, 1999), taking responsibility to do service without being swallowed. In these ways, the integration (fit and flow) of self context, affect logic in the religious moral community requires an exercise in relational contextual reasoning (Reich, 2002). Integrating moral agency and community connection is a major step toward recovering integrity. Recovering integrity: Integrity, we argue, is what s being recovered in recovery. Integrity is a way to understand and operationalise general character. It includes but is not limited to moral judgement development, because integrity demands consistency between judgement and action. It implies a self-consistent moral self, whose feelings, thoughts and behaviour form a mutually informative and transformative regulatory system. A person of integrity, aware of his or her feelings, aware of conflicts, context and what is ultimately at stake, chooses and carries out right action. By integrity we mean more than consistency, wholeness, and general character. As a developmental construct integrity includes the fit and flow between domains, and the potential for transformation. In answer to the initial questions asked by Director Rosetto and Rabbi Borovitz: The How: It works by making a space for spirituality and spiritual awakening through both the faith based and 12 step programming, and by creating a community where belonging can allow for healing the developmental splits over a relatively long time period (9 12 months, or longer). The What: The cognitive stimulation of discussing the moral dilemmas in Torah (Bible) study; the collective emotional experience of Sabbath services; and the concrete, daily action of the 12 steps are the features most often mentioned by participants as necessary to their hanging on. The Who: The stages of recognition, awakening, recovering integrity are most likely to happen for those residents who have divided selves at the time of their program entry. Those who are embedded, stuck or undivided are not as likely to benefit from what the programme has to offer. Confirming our developmental approach (Blasi, 1998; Kohlberg, 1984; Piaget, 1981) disequilibrium, internal and external conflict, is conducive to growth but only in the presence of supportive relationships and contexts (Kegan, 1994; Vaillant, 2002). Questions for further research As usual, more questions were raised than answers given. Among our favourites are: What moral sense do alcoholics and drug addicts make of their alcohol and drug use? What sense do addicts make of their leap of faith? Is there a temporary moral setback that accompanies religious development? How does religious development hold the self together until moral development, ego development and emotional self-regulation can be reorganised? How do alcoholics and addicts in recovery integrate their stories into new identities?

14 76 Charles D. Blakeney et al. What will the answers to these questions mean for better understanding addiction, relapse and recovery? Acknowledgements We thank the participants without whose collaboration this paper could not have been written, and the anonymous reviewers for helpful comments on an earlier version. References Adolphs, R., Tranel, D., & Damasio, A. R. (2003). Dissociable neural systems for recognizing emotions. Brain and Cognition, 52, Alcoholics Anonymous (1994). Alcoholics Anonymous. World Service: New York. Blakeney, C. D., & Blakeney, R. F. (1991). Understanding and reforming moral misbehavior among behaviorally disordered children. Journal of Behavioral Disorders, 16, Blakeney, R. F., & Blakeney, C. D. (1996). A therapeutic just community for troubled girls. Reclaiming children and youth. Journal of Emotional and Behavioral Problems, 5, , 172. Blakeney, R. F., Blakeney, C. D., & Maeillo, C. (2003, September). Recovering developmental integrity in addiction treatment, Paper presented at the 10th International Conference on Treatment of Addictive Behaviours, Heidelberg, Germany, 9 11 September. Blasi, A. (1998). Loevinger s theory of ego development and its relationship to the cognitive-developmental approach. In Personality development, P. M. Westenberg, A. Blasi, & L. D. Cohn (Eds), pp Mahweh, NJ: Lawrence Erlbaum. Carter, S. L. (1996). Integrity. NY: Basic Books. Cole, B. S., & Pargament, K. I. (1999). Spiritual surrender: A paradoxical path to control. In Integrating spirituality into treatment, W. R. Miller (Ed.), pp Washington, DC: American Psychological Association. Cox, D., La Caze, M., & Levine, M. (2001). Integrity. In The stanford encyclopedia of philosophy, E. N. Zalta (Ed.), Retrieved July 15, 2001, from Damasio, A. R. (1994). Descartes error: Emotion, reason and the human brain. New York: Putnam. Freud, S., & Breuer, J. (2000). Studies on hysteria. New York: Basic Books (Original work published 1895). Hill, P. C., & Pargament, K. I. (2003). Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. American Psychologist, 58, James, W. (1902/1982). The varieties of religious experience. New York/London/Bombay: Longmans, Green & Co. (Original work published 1902). Kegan, R. (1994). In over our Heads: The mental demands of modern life. Cambridge, MA: Harvard University Press. Keller, M., & Edelstein, W. (1993). The development of the moral self from childhood to adolescence. In The moral self, G. G. Noam, & T. G. Wren (Eds), pp Cambridge, MA: MIT Press. Koenig, H. G., McCullough, M. E., & Larsen, D. B. (2001). Handbook of religion and health. New York: Oxford University Press. Kohlberg, L. (1984). Essays on moral development: II. The psychology of moral development. San Francisco: Harper and Row. Miller, W. R., & Thoreson, C. E. (2003). Spirituality, religion, and health: An emerging research field. American Psychologist, 58, Miller, W. R. (1998). Researching the spiritual dimensions of alcohol and other drug problems. Addiction, 93, Moos, R. H. (2003). Addictive disorders in context: Principles and puzzles of effective treatment and recovery. Psychology of Addictive Behaviors, 17, Oser, F., & Gmünder, P. (1991). Religious judgement: A developmental approach. Birmingham, AL: Religious Education Press. Piaget, J. (1981). Intelligence and affectivity: Their relationship in child development. Palo Alto, CA: Annual Reviews. Powell, L. H., Shahabi, L., & Thoreson, C. E. (2003). Religion and spirituality: Linkages to physical health. American Psychologist, 58, Reich, K. H. (2002). Developing the horizons of the mind. Relational and contextual reasoning and the resolution of cognitive conflict. Cambridge: Cambridge University Press. Richard, A. J., Bell, D. C., & Carlson, J. W. (2000). Individual religiosity, moral community and drug user treatment. Journal for the Scientific Study of Religion, 39, Seligman, M. (2002). Authentic happiness. New York: Free Press. Selman, R., & Schultz, L. H. (1990). Making a friend in youth: Developmental theory and pair therapy. Chicago: University of Chicago Press.

15 Leaps of faith 77 Selman, R. (2003). Promoting social awareness. Cambridge, MA: Sage. Stark, R., & Bainbridge, W. S. (1998). Religion, deviance and social control. New York: Routledge. Sullivan, E. V., Deshmukh, A., Desmond, J. E., Lim, K. O., & Pfefferbaum, A. (2000a). Cerebellar volume decline in normal aging, alcoholism, and Korsakoff s syndrome: Relation to ataxia. Neuropsychology, 14, Sullivan, E. V., Fama, R., Rosenbloom, M. J., & Pfefferbaum, A. (2002). A profile of neuropsychological deficits in alcoholic women. Neuropsychology, 16, Sullivan, E. V., Rosenbloom, M. J., Lim, K. O., & Pfefferbaum, A. (2000b). Longitudinal changes in cognition, gait, and balance in abstinent and relapsed alcoholic men: relationships to changes in brain structure. Neuropsychology, 14, Tonigan, J. S., Miller, W. R., & Schermer, C. (2002). Atheists, agnostics and Alcoholics Anonymous. Journal of Studies on Alcohol, 63, Twerski, A. (1997). Addictive thinking. Understanding self-deception. 2nd Ed. Center City, MN: Hazledon. Vaillant, G. E. (1993). The wisdom of the ego. Cambridge, MA: Harvard University Press. Vaillant, G. E. (2000). The natural history of alcoholism, revisited, 2nd Edn. Cambridge, MA: Harvard University Press. Vaillant, G. E. (2002). Aging well: surprising guideposts to a happier life from the landmark Harvard study of adult development. Boston: Little Brown & Co. Wills, T. A., Yaeger, A. M., & Sandy, J. M. (2003). Buffering effect of religiousity for adolescent substance use. Psychology of Addictive Behaviors, 17, Winnicott, D. W. (1971). Playing and reality. London: Tavistock Publications.

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