Efficacy of a Spiritual Intervention in Improving the Psychospiritual Well-Being of People with Substance Use Disorders: A Pilot Randomized Controlled Trial

Background and Purpose: Substance use is highly associated with low levels of psychospiritual well-being, and the co-occurrence of substance use and psychospiritual problems can lead to a wide range of negative consequences. In addition, recovery is widely viewed as something more than abstinence from substance use and should include factors that describe one’s overall well-being. Therefore, an integrated treatment approach that aims to improve both substance use and psychospiritual well-being is called for in substance use treatment. Prayer is the most commonly used alternative health treatment in the United States and holds promise as an effective ingredient of integrated treatment to improve both substance use and psychospiritual well-being. Research supports prayer’s effectiveness in reducing substance use. However, research on prayer’s efficacy in improving psychospiritual well-being among people with substance use disorders is lacking. This study addressed this gap by testing the effects of a prayer intervention, called Two Way Prayer Meditation (TWPM), on the psychospiritual well-being of adults with substance use disorders. Hypotheses were that practicing TWPM would be associated with (1) lower psychological distress, (2) higher self-esteem, and (3) higher spiritual well-being.

Methods: This study employed a randomized controlled trial design with pretest and posttest. In total, 134 adults in four residential recovery programs participated in the study and were randomly assigned to either the TWPM condition or the treatment-as-usual control condition. Psychological distress and self-esteem were measured with the Outcome Questionnaire-30 and the Rosenberg's Self-Esteem Scale respectively. Spiritual well-being outcomes were measured with the Brief Multidimensional Measure of Religiousness/Spirituality and Christian Inventory of Spirituality. Intent-to-treat analyses were conducted using linear mixed models with participants nested within recovery programs. Sensitivity analyses were conducted by excluding cases with more than minimum number of missing items. Treatment effect sizes were estimated using Hedges’ g.

Results: Both primary and sensitivity analyses found significant treatment effects on daily spiritual experiences (condition x time, b= 4.50, standard error [SE]= .74, t= 6.05, p<.001, Hedges’s g= .62), reliance on God (b= 5.00, SE= 1.52, t= 3.29, p<.010, g= .49), private religious practice (b= 3.65, SE= 1.11, t= 3.29, p<.010, g= .36), and positive religious/spiritual coping (b= 1.77, SE= .35, t= 5.07, p<.001, g= .68).Treatment effects on psychological distress (g= .33), self-esteem (g= .41), and overall spirituality self-ranking (g= .32) reached significance in the primary analysis but not in the sensitivity analysis.

Conclusions and Implications: This study found evidence of TWPM’s efficacy in improving some aspects of the spiritual well-being of adults with substance use disorders. TWPM was also found to be promising in decreasing psychological distress and increasing self-esteem. Future research should replicate this study with a larger and more broadly representative sample. Longer follow-up periods and comparing TWPM to active control conditions such as other psychospiritual interventions would also be useful.