Any role for spirituality in addressing the serious clinical and public health problems related to substance misuse and addiction might seem antiquated at best, and clinical malpractice at worst. Yet, from a phenomenological perspective, addiction often penetrates and pervades the core of conscious thought and behaviour, undermining personal values and meaning and purpose in life – factors that many people associate with a diminished sense of personal spirituality. Research on spiritual/religious identity and practices has shown that these both protect against the onset of substance misuse and help millions each year to recover from it. This chapter reviews the interplay of morality, spirituality/religion and substance misuse, suggests why addiction in particular is so prone to spiritual pathology, and describes why spirituality/religion have played such prominent roles in successful remission and stable recovery. Spiritually oriented treatment approaches to addiction are reviewed along with their implications for practice and research.

Mutual help programs are popular resources for persons with alcohol use disorder (AUD) and clinical referral to such programs is common. This chapter describes what is currently known about four established mutual help programs in the United States: Alcoholics Anonymous (AA), SMART Recovery, Women for Sobriety (WFS), and LifeRing. Strong correlational research indicates that AA is associated with increased abstinence and that this association arises in part because of increased social support, abstinence self-efficacy, and spiritual practices. There is little support that reductions in anger, selfishness, and depression account for AA-related benefit. Preliminary evidence indicates that persons reporting lower religiosity and higher education are more likely to affiliate with non-AA mutual help programs and that these programs may be efficacious. A series of recommendations are made to advance our knowledge of these mutual help programs, with an emphasis on the need for future investigations of SMART, WFS, and LifeRing.