A recent study is one of the first to examine the relationship between adult attachment style, dimensions of spiritual well-being, and depressive symptoms in people undergoing addiction treatment.

The study, published in the Journal of Social Service Research, asked participants enrolled in inpatient care for substance use disorder to complete three questionnaires. The first, the Spiritual Well Being Scale (SWB) (Ellison, 1983) is a 20-item self-report scale that measures well-being in two areas, existential well-being, i.e. “I know who I am, where I come from, and where I am going,” and relational or religious well-being, i.e. “I have a personally meaningful relationship with God.” The second questionnaire, the Relationship Questionnaire (RQ) (Bartholomew and Horowitz, 1991) categorizes the ways in which participants relate with or attach to others, rating their attachment styles as secure or insecure, with three subcategories for the insecure group. Finally, participants completed the Center for Epidemiologic Studies Depression Scale (CES-D), a 20-item self-report scale that measures symptoms of depression.

Analysis of the data from these questionnaires showed a high level of depressive symptoms in 43 of the 68 participants who completed the CES-D, underscoring the relationship between depression and substance use disorder. The RQ was a significant predictor of depression, with 80% of people with insecure attachment styles reporting depressive symptoms, versus only 42% of people with secure attachment styles. But the most surprising data came from the SWB scale. The relational or religious portion of the SWB data did not seem to be a contributing or protective factor for depression, yet the existential portion was the most significant factor, more so than data indicating attachment style. This information suggests that adequate levels of existential purpose can protect against depressive symptoms. This finding may open up new possibilities for treatment providers who care for those with depression and substance use disorder.

The researchers examined ways to foster creativity, service, and solitude in the treatment setting toward increasing this sense of existential purpose and meaning, hoping it would lead to better treatment outcomes. They found, “…that encouraging people’s creative talents (painting, writing), giving them opportunities to serve others, and helping them to connect to core values and their true self through prayer and meditation helped them to discover ultimate purpose and meaning as part of their recovery process.”

“Programs such as the 12-step model might want to take into consideration the relative importance of the two spiritual dimensions and put into place programmatic support for the development of purpose and meaning in life rather than only stressing the perceived closeness to God,” said study co-author, Tammy Malloy, LCSW, chief clinical officer, Behavioral Health of the Palm Beaches (BHOPB).