Faculty Bibliography

This chapter is directed at defining the nature of spirituality and its relationship to empirical research and clinical practice. A preliminary understanding of the spiritual experience can be achieved on the basis of diverse theoretical and empirically grounded sources, which will be delineated: namely, physiology, psychology, and cross-cultural sources. Furthermore, the impact of spirituality on mental health and addiction in different cultural and clinical settings is explicated regarding both beneficial and compromising outcomes. Illustrations of its application in addiction and general psychiatry are given: in meditative practices, Alcoholics Anonymous, and treatment programs for addiction singly and comorbid with major mental illness. Given its prominence in Alcoholics Anonymous and related Twelve-Step groups, spirituality plays an important role in the rehabilitation of many substance-dependent people. The issue of spirituality, however, is prominent within contemporary culture as well in the form of theistic orientation, as evidenced in a probability sampling of American adults, among whom 95% of respondents reply positively when asked if they believe in 'God or a universal spirit.' Responses to a follow-up on this question suggest that this belief affects the daily lives of the majority (51%) of those sampled, as they indicated that they had talked to someone about God or some aspect of their faith or spirituality within the previous 24 h (Gallup, 2002)

Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality. An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports. In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine. The philosophical, historical, and societal aspects of coerced treatment are considered