Buddhist Recovery Network book review

“Treating Chemical Dependency Using the Twelve Steps, Buddhism, and Complementary Therapies”

Charles Alan Walker
UMI No. 3137285
Doctoral dissertation, Pacifica Graduate Institute, 2003.

School/perspective: Phenomenological academic study

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Academic Abstract:
“This study addressed the following problem: How do clinicians treat chemical dependency utilizing a Twelve Step approach in conjunction with Buddhist philosophies, complementary therapies, or both? This study utilized 12 research subjects. In selecting the subjects, a questionnaire was sent to Alcoholics Anonymous and Narcotics Anonymous meetings as well as Buddhist retreat centers and holistic healing centers. The subject requirements were a minimum of five years of continuous sobriety, possession of at least a bachelor’s degree, as well as no physical or sexual abuse experienced in the family of origin. The 12 subjects were divided into four research groups. These consisted of three female and male members who utilized Buddhist philosophies in conjunction with their Twelve Step programs as well as three female and male members who utilized complementary therapies in conjunction with their Twelve Step programs. Interviews were conducted with each subject asking them a series of 20 questions regarding their past chemical use as well as how they used Buddhism or complementary therapies in conjunction with their Twelve Step programs to obtain, maintain, and enhance their sobriety. The researcher utilized an ad hoc meaning generation approach for interpreting each subject’s interview responses. In this approach, there are a number of separate yet related techniques for generating meaning in qualitative data. Results supported the hypothesis that Buddhist philosophies and complementary therapies can be utilized to effectively support and enhance recovery in a Twelve Step program. The subjects reported that Twelve Step programs provided a culture of support for their recovery by attending meetings, working the Twelve Steps with a sponsor, as well as providing a spiritual path for living life sober. The subjects reported that Buddhist philosophies enhanced their Twelve Step recovery by teaching nonattachment to ego, focus, and awareness through meditation, as well as connection with a collective spirituality. The subjects reported that complementary therapies enhanced their Twelve Step recovery by providing various methodologies to reduce cravings, enhance detoxification, as well as provide ongoing practices to enhance their physical and spiritual connection.”

Chapter headings:

CHAPTER I: INTRODUCTION

Brief Overview of the Literature

Historical overview of chemicals-6th BCE-700 CE

Historical overview of chemical dependency treatment

Treatment of chemical dependency before 12-Step programs

Treatment of chemical dependency abroad before 12-Steps program

Treatment of chemical dependency utilizing the 12-Steps

Washingtonians

The Oxford Group

Alcoholics Anonymous

Narcotics Anonymous

Spiritual Elements of NA and AA

Complementary therapies and chemical dependency recovery

Acupuncture

Aromatherapy

Subtle energy healing modalities

Guided Imagery

Hypnosis

Meditation

Nutritional Support

Prayer

Tai Chi Chuan

Yoga

The politics of complementary therapies

History of Buddhism

Buddhist view of addiction

Buddhism and chemical dependency recovery

Buddhist teachings and recovery

Buddhist 12-Steps

Depth psychological perspectives

Statement of the Problem

CHAPTER II: METHOD

Introduction

Subjects

Procedure

Data analysis

Limitations and delimitations

Ethical assurances

CHAPTER III: RESULTS

CHAPTER IV: SUMMARY AND CONCLUSION

Research Implications

Clinical Ramifications

Further Exploration

Debriefing

APPENDIX A: History of AA

APPENDIX B: Ethics committee application

APPENDIX C: Informed consent form

REFERENCES

Selected excerpts:

Chapter I
“Significant improvements in relapse prevention were seen with the addition of meditation to the routine treatment program in an alcohol residential treatment facility. Complete abstinence 18 months after leaving the center was reported by 65% of the meditation group compared to 25% of the standard care group and 28% for the neurotherapy group (Taub, Steiner, et al., 1994).”

Chapter IV
“Both the women and men surveyed reported finding a sense of clarity and focus from the various Buddhist philosophies they practiced in their lives. While the men and women reported different experience of their Buddhist beliefs, the resulting common theme was that Twelve-Step recovery, whether around alcohol or drugs, had deeper sense of meaning, purpose and direction for each when practiced in conjunction with their respective Buddhist philosophies...”

“This male individualism versus female relationalism was also a primary difference in how the men and women surveyed approached the combination of Buddhist philosophy and Twelve-Step groups. The men, while at times part of Buddhist meditation or study groups, most often preferred to engage in a more solitary experiencing of Buddhist philosophy. The women described their need to be a part of both the societal collective as well as the greater collective spirituality inherent in all beings’ connectedness.”
“These differences appeared only when examining how each gender experienced Buddhist philosophies and practices in their lives. All of the men and women surveyed reported positive experiences in being part of their respective Twelve-Step groups.”
“Both the men and women surveyed reported that as they became more in touch with the philosophy and specific practices of Buddhism, they realized that their attachment to substances, desire and craving had led to their crossing the line from abuse to addiction. For each, they described their sense of craving and attachment appeared to be based in a search for spiritual connection and wholeness rather than the absence of spirituality they experienced. They spent their time and resources pursuing how to obtain more of their substances of choice in some vain attempt to fill the inner void that each reported experiencing. The women reported having this awareness much sooner than the men did.”
“Though a sense of regret was expressed at the various consequences each had experienced in their addictive behaviors, the most commonly occurring theme amongst those surveyed was one of incredible gratitude at being an addict. Each stated in their own words that addiction had forced them to examine their lifestyles, spirituality and belief systems in a manner that would not have occurred if they had not become addicted...”

“Through their exploration of Buddhist philosophy and Buddhist practice, each described finding the spiritual elements they had searched for and that their belief in the teachings of Buddha was the guiding spiritual force or Higher Power of their respective Twelve-Step programs. For each of these six participants, Buddhism provided a framework in which they were able to consistently explore their quest for knowledge, connection and identity.”

Chapter IV (speaking of early recovery)
“The common theme described was an inability to grasp such ethereal concepts as non-attachment to ego, the illusion of reality and the need for mindfulness meditation.”
“The males surveyed discussed their sense of grandiosity, need for control, need to cognitively understand Buddhism prevented them from allowing Buddhism to be a true adjunct for them in early recovery. Although each felt that further illumination of Buddhist practices was needed for integration to occur, none felt comfortable asking for assistance.”
“A common theme described was resistance from other members of AA or NA regarding Buddhist philosophy. Some members of these programs were resistant because their belief of Twelve-Step philosophy called for strict adherence to the concept of Higher Power or God rather than the Buddhist concept of Higher Self. This distinction was also cited as a source of confusion in early recovery. Those surveyed described an inability to distinguish between God, Higher Power, The Buddha, and the Higher Self.”
“In addition, many long-time Twelve-Step members rigidly believe that Twelve-Step attendance, reading recovery material, being of service to other addicts and working the Twelve-Steps are the only practices needed. Any other spiritual practice such as Buddhism can be viewed as a distraction that interferes with direct adherence to their need for Twelve-Step programs to be dogmatic [sic]. Some surveyed described an innate sense to not openly and honestly share their Buddhist beliefs due to this element present.”
“A final concern related to Buddhism in conjunction with Twelve-Step programs is that some Buddhists discontinue their Twelve-Step attendance over time because they believe that their path to spiritual enlightenment has moved beyond the confines of AA or NA. This is directly related to the Buddhist concept of non-attachment. While most described using a “light touch” to avoid attachment to Program ideals, for at least one woman surveyed, continued Twelve-Step attendance became a source of attachment she sought to avoid.”
“She elaborated by saying: In the Program, I always needed to identify myself as an alcoholic. Over time, I felt that this continuous process of addict identification kept me attached to being an alcoholic. I understand that I will always be an alcoholic, but I needed to move on in my spiritual path by recognizing I wasn’t just an alcoholic.”

Recommendations for future research
“To conduct a study that may be significantly more generalizable, the researcher makes the following recommendations. The first would be to conduct this study on a much larger scale. By increasing the sample size to a minimum of 25 in each research group would expand the breadth of information provided by the subjects studied. In addition to increasing the sample size, expanding the geographical area from which the subjects were selected would increase the ability to generalize the results.”
“Different selection criterion for the research subjects may generate more data for analysis. Future studies may include those who did experience overt or covert sexual or physical abuse in their family of origin histories. Studying specific schools of Buddhism or complementary therapies may provide a more focused understanding of how each potentially contributes to recovery. More specific educational requirements may also provide a more focused understanding. In future studies, researchers might differentiate among age groups. Maturity and life experience appear to be contributors to initial and ongoing sobriety.”
“An additional selection criterion for future subjects would be assessing if they had engaged in psychotherapy in the past or were currently doing so. Future studies could examine the efficacy of psychotherapy in conjunction with Twelve-Step programs, Buddhism, complementary therapies, or any combination of these selection criterions.”
“A thorough screening for dual diagnosis would be essential in future studies. This could include using the Mental Illness Screening Form (MISF), which screens for mental illness among people who have addictive disorders (MISF) or using the Dual Diagnosis Cage assessment (DD-CAGE), which screens signs of substance use/abuse problems in individuals with mental illness. A 1993 study found that 37% of alcohol abusers and 53% of drug abusers also have at least one serious mental illness (Anthenelli & Schuckit). The study goes on to state that approximately two million Americans with a severe mental illness also meet the criterion for substance abuse or dependence compared to 15% of the general population (Anthenelli & Schuckit, 1993).”
“Future research studies may find more effective means in which to interview research subjects and decrease subject concerns regarding anonymity and confidentiality. Also, interviews conducted during daytime hours may reduce subject fatigue.”
“Finally, various computer tools have been designed in aiding researchers with qualitative research. Programs such as ATLAS.ti and NUD*IST 4, provide researchers with the ability to code, select, and analyze various themes inherent in text as well as audio and visual files. Utilizing such a program would significantly increase the researcher’s ability to uncover the complexities inherent in analyzing subjective data.”

© 2003 Charles Walker

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Reviews posted:

Paul -

When I first came across this PhD through a friend’s research, I doubted it would be suitable for those in recovery. In the company of soaring tales of self-transformation, we didn’t really need a highly technical, largely unintelligible academic treatise mired in the complexities of addiction theory. But Charlie Walker’s PhD turned out to be anything but this. It is immensely readable and accessible, steering clear of heavy academic jargon. Charlie himself is a Buddhist in recovery, and at the time of writing the thesis had chalked up 18 years as a recovering addict, including nine spent as a professional addiction therapist. The thesis approaches Buddhist Recovery and Twelve Step recovery (and their potential interrelationship) far more methodically and rigorously than most other resources featured on the site. It is not as polished as the published books reviewed here (i.e., it would benefit from a good proof read), but it contains some interesting insights. The initial literature review presents an overview of Buddhism, chemical dependency treatment, AA, and complementary therapies (as per the index). The Buddhist Recovery study itself is based around individual in-depth interviews with six people in Phoenix Arizona utilising Buddhism in conjunction with 12 Step programs (3 men, 3 women). The conclusion is positive, with a great deal of qualitative (and some quantitative) research supporting the powerful role meditation and Buddhism can play in gaining and maintaining sobriety. With some minor qualifications, Buddhism and AA were seen as mutually supportive approaches. See the second extract for a summary of the research findings. From an academic point of view, it is a qualitative, phenomenological study. It is strange (for a PhD) that the Buddhist references aren’t made to primary sources (such as the Pali Canon), but to websites. There is also a tendency to take things on uncritically, such as the ‘Buddhist 12 Steps’. While there have been numerous thoughtful attempts to formulate a Buddhist 12 Steps, I don’t think we can imply that we have arrived at a definitive version as universally accepted as AA’s Twelve Steps. But I guess if the thesis had been more academically rigorous, it might have lost the readability that I applauded in the first place. Hopefully this will be the first in a number of studies in this area (see the researcher’s own recommendations for future research in the final excerpt below).

Michael -

I must admit that when Paul first suggested to me that I provide a review on what is a PhD Thesis, I was extremely sceptical to say the least. I immediately had visions of a rather dry and dusty, intellectual and highly technical tome that I would have to do my best to wade through. Imagine my great surprise then, when I discovered that it was actually a very accessible, interesting and insightful read. Never judge a "book" by its cover, that will teach me not to go into things with the weight of expectation. This study by Charlie Walker addresses the following problem: "How do clinicians treat chemical dependency utilizing a 12-Step approach in conjunction with Buddhist philosophies and/or complementary therapies?" Covering plenty of ground over a number of research subjects, he also conducts comprehensive interviews asking a series of questions with subjects (an equal number of males and females) who are using Buddhism in conjunction with their 12-Step programs to "obtain, maintain and enhance their sobriety", before drawing some great conclusions. Whilst not exactly the kind of reading I would first recommend to beginners, I nonetheless found this quite a valuable read with more than its share of well researched wisdom, and therefore might be something that would be interesting and worth exploring for those further along the path. I would, however, have absolutely no hesitation in strongly recommending that professionals and clinicians working in the field of chemical dependency, to whom this is ultimately aimed, check this out.

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