Spiritual assessment in biomedicine

The recent surge of interest in links between spirituality and health has generated many assessment approaches that seek to identify spiritual need and suggest strategic responses for health care practitioners.

The interpretations of spirituality made within health frameworks do not do justice to the way spirituality is understood in society in general.

Spiritual assessment should not impose a view or definition of spirituality, but should seek to elicit the thoughts, memories and experiences that give coherence to a person’s life.

Spiritual assessment tools should not be used without adequate exploration of the assumptions made. Assessment processes need to be adequately conceptualised and practically relevant.

In agencies organised according to biomedical priorities, spirituality is a personal coping mechanism that need not be incorporated into the health treatment plan.

Integration is the patient’s issue – patients must work out how to incorporate their experience of the biomedical system into the rest of their lives.

Social perspectives that regard spirituality as a means of social support view spiritual care as the responsibility of the cultural and religious communities supporting the patient.

Practitioners operating within a social model may be more intentional about involving these communities in care, but they still leave the decision to participate to the patient and family.

In both these approaches, it is for patients to decide whether they will seek spiritual care alongside the health care being provided.

However, spiritual care may be seen differently within a biopsychosocial framework. Here spirituality is related to quality of life and is thus one of the individual characteristics that shape health beliefs and motivations. It affects compliance and outcomes, and is thus legitimately an area of interest for clinicians.

Criteria for appropriate spiritual assessment

Spiritual assessment should thus not impose a view, let alone a definition, of spirituality, but should seek to elicit the thoughts, memories and experiences that give coherence to a person’s life. This implies taking seriously the idea that spirituality preserves identity and sense of self, particularly in professionalised environments, and ensuring that professional practice assessments are made within a framework that matters to the patient.

This means identifying spiritual needs and resources in ways that

• Respect patients’ perspectives and do not infringe privacy;
• Involve all members of the interdisciplinary team to the extent that they are able and willing to contribute;
• Permit clear documentation of needs, strategic responses to these needs, resources required, and outcomes;
• Integrate strategies into an overall care plan in ways that are readily understood by all members of the interdisciplinary team;
• Provide a shared framework for continuity of care between community agencies and inpatient services; and
• Provide a place for religious care but do not conflate spiritual issues with religious practice. While spiritual care in general may be provided by a team, specific religious care is best provided by a person from the same faith community, preferably one willing to participate in the team.

Appropriate process for spiritual assessment

Spiritual assessment must be a process, not merely an event, as it needs to take account of emergent insights and accommodate the patient’s exploration of particular issues if he or she so chooses.

The discussion here applies to health care contexts in which process is possible (such as general medical practice, community health or residential care), rather than the brief encounters of day surgery or the emergency room.

The process should begin with a form of screening, preferably one that maps significant relationships within the domain of spirituality. This screening can be carried out descriptively, noting connections as they emerge in taking patient histories and in general clinical and informal encounters by all members of the team.

For more information see; Bruce D Rumbold. A review of spiritual assessment in health care practice. Medical Journal of Australia 2007; 186 (10): S60-S62

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Epidemiology of Alcoholics Anonymous participation.

This chapter draws on AA membership surveys, US general population surveys, and longitudinal treatment data to compile profiles of those ever exposed to AA in their lifetime, those who no longer report AA meeting attendance, and those who attend AA meetings currently. We consider demographics (gender, age, ethnicity, marital status), receipt of specialty treatment, and short- and long-term abstinence rates among these AA exposure groups.

Results suggest stability in the representation of women and minorities among the AA membership, but a decline among youth.

Fully one-half of those completing AA’s most recent membership survey reported that they had been abstinent for more than 5 years.

Those receiving specialty treatment any given year are likely to report AA exposure that year.

Disengagement from AA does not appear to necessarily translate to loss of abstinence among those with initial high levels of AA exposure, but long-term abstinence is more likely among those with continued engagement.

Research report; Kaskutas LA, Ye Y, Greenfield TK, Witbrodt J, Bond J. Epidemiology of Alcoholics Anonymous participation. Recent Dev Alcohol. 2008;18:261-82.

See also;

• What About This Spiritual Awakening Thing?
• AA and Treatment Work Better Together
• Screening for Alcohol Problems

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Drug commonly used for alcoholism craving curbs urges of pathological gamblers

A drug commonly used to treat alcohol addiction has a similar effect on pathological gamblers – it curbs the urge to gamble and participate in gambling-related behavior, according to a new research at the University of Minnesota.

Seventy-seven people participated in the double-blind, placebo controlled study. Fifty-eight men and women took 50, 100, or 150 milligrams of naltrexone every day for 18 weeks.

• Forty percent of the 49 participants who took the drug and completed the study, quit gambling for at least one month.
• Their urge to gamble also significantly dropped in intensity and frequency.

The other 19 participants took a placebo. But, only 10.5 percent of those who took the placebo were able to abstain from gambling.

Study participants were aged 18 to 75 and reported gambling for 6 to 32 hours each week.

Dosage did not have an impact on the results, naltrexone was generally well tolerated, and men and women reported similar results.

“This is good news for people who have a gambling problem,” said Jon Grant, M.D., J.D., M.P.H., a University of Minnesota associate professor of psychiatry and principal investigator of the study. “This is the first time people have a proven medication that can help them get their behavior under control.”

The research is published in the June 2008 issue of the Journal of Clinical Psychiatry.

Compulsive gamblers are unable to control their behavior, and the habit often becomes a detriment in their lives, Grant said. He estimates between 1 to 3 percent of the population has a gambling problem.

While the drug is not a cure for gambling, Grant said it offers hope to many who are suffering from addiction. He also said the drug would most likely work best in combination with individual therapy.

“Medication can be helpful, but people with gambling addiction often have multiple other issues that should be addressed through therapy,” he said.

See also;

• Effects of Gambling Addiction
• Gamblers Anonymous
• How can I overcome my addiction to gambling?
• Subscribe to Twelve Step Facilitation by e-Mail

Counselling for Problem Gambling (Living Therapy) by Richard Bryant-Jeffries Read more about this title…

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Characteristics of Students with Fetal Alcohol Syndrome and Fetal Alcohol Effect

Students with FAS/E are as different from each other as any group of children. They come from all socioeconomic backgrounds. Each child presents a complex individual portrait of competencies and delays. Students with FAS/E must be recognized as individuals rather than as members of a homogeneous group.

FAS/E can affect individuals in varying degrees, from mild to severe in the following areas:

Cognitive Functioning.

The intellectual abilities of students with FAS/E can vary greatly. Many students with FAS/E have graduated from high school with minimal extra support and adaptations. To date, a wide range of IQ has been documented: 29 to 120 for FAS and 42 to 142 for FAE.

Other conditions commonly observed in children with FAS/E include:

• Learning Disabilities (LD),
• Attention Deficit/Hyperactivity Disorder (AD/HD),
• difficulty with sequencing,
• difficulty with memory,
• difficulty understanding cause/effect relationships, and/or
• weak generalizing skills.

Social/Emotional Functioning

Students with FAS/E may display a variety of atypical responses to unfamiliar or frustrating situations. Increased anxiety may result in withdrawal, outbursts or other acting out behaviours that may be harmful to the student or others in the group. A young child with FAS/E may have severe temper tantrums and find it hard to adjust to change. Many adolescents with FAS/E are prone to depression, poor judgment and impulsivity. They are often described as innocent, immature and easily vicitimized.

Other responses commonly observed in children with FAS/E include:

• stealing, lying and defiance,
• difficulty predicting and/or understanding the consequences of behaviour,
• easily manipulated and led by others,
• difficulty making and keeping friends,
• overly friendly and affectionate, easily approached by strangers, and/or
• perseverative or “stubborn.”

Physical Functioning

Basic physiological responses may be abnormal in students with FAS/E. This may present in one or more of the following ways:

• A high threshold for pain which can result in the student not being aware of a serious injury or infection.
• No perception of hunger or satiation.
• Difficulty perceiving extreme temperatures.
• Difficulty with visual/spatial perception and balance.

Some children with FAS/E excel in individual sports that require gross motor coordination such as swimming, skiing and roller-blading. Others have significant delays in gross and fine motor skill development which can affect all areas of functioning. In mild cases, delays in motor abilities can influence the acquisition of skills such as tying shoelaces and printing neatly. In more severe cases, children with FAS/E may have had problems learning to chew and swallow food.

Students with FAS/E have a higher than average incidence of a number of other medical concerns. These include:

• difficulties with vision,
• difficulties with hearing,
• heart problems,
• growth deficiency,
• neurological conditions such as seizure disorders, and/or
• impaired bone and/or joint development.

Teachers should be alert to the fact that a number of these health concerns can directly impact the student’s ability to achieve success in the classroom. In some cases, a student’s medical report will include recommendations for the school that may assist in program planning.

The student with FAS/E can bring gifts to your classroom, including a sense of humor, creativity, caring, a love of animals, determination, musical and artistic talent and a desire to please.

Through formal and informal assessments, you will be able to develop a plan that draws on your student’s strengths to support his or her educational needs. It is important to think about where the child has started from, where he or she is today, and the long term goals for tomorrow.

An essential ingredient throughout the process is developing and supporting the student’s self-esteem. Nothing lights up a child’s face more than achieving something through a learning experience. It is important to set up a classroom where this can take place as often as possible.

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Alcohol and substance abuse.

Alcoholic liver disease is an important cause of cirrhosis, liver-associated death, and need for liver transplant. Up to 50% of recipients use some alcohol, and perhaps 10% drink addictively.

Careful evaluation by an addiction medicine specialist is the best predictive instrument before transplant surgery, whereas the 6-month rule lacks sensitivity and specificity.

Addictive drinking, but not minor slips, is associated with increased mortality.

There is no standard therapy for alcoholism in alcoholics waiting for a transplant or for those who have undergone a transplant.

Stably abstinent, methadone-maintained opiate-dependent patients should continue methadone; are generally good candidates for liver transplant; and show low relapse rates.

Pre- and post-transplant smoking rates are high and cause significant morbidity and mortality. Transplant teams should encourage smoking cessation treatments.

Marijuana use in liver transplant recipients is common, although risks associated with this practice are unknown.

Research report’; Lucey MR, Weinrieb RM. Alcohol and substance abuse Semin Liver Dis. 2009 Feb;29(1):66-73. Epub 2009 Feb 23.

See also;

• AA and Treatment Work Better Together
• Address the drinking problem directly
• Brief-TSF can assist people cease alcohol consumption.
• Twelve Step Facilitation is designed to support people returning to their community

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Inhalants

Inhalants are common products found right in the home and are among the most popular and deadly substances kids abuse. Inhalant abuse can result in death from the very first use.

Health Hazards

Health Effects and Risks. Nearly all abused inhalants produce effects similar to anesthetics, which act to slow down the body’s functions. When inhaled in sufficient concentrations, inhalants can cause intoxicating effects that can last only a few minutes or several hours if inhalants are taken repeatedly. Initially, users may feel slightly stimulated; with successive inhalations, they may feel less inhibited and less in control; finally, a user can lose consciousness.

More Information

Signs of Inhalant Abuse

Parents and healthcare workers can be aware of the following signs of an inhalant abuse problem:

• Chemical odors on breath or clothing;
• Paint or other stains on face, hands, or clothes;
• Hidden empty spray paint or solvent containers and chemical-soaked rags or clothing;
• Drunk or disoriented appearance;
• Slurred speech;
• Nausea or loss of appetite;
• Inattentiveness, lack of coordination, irritability, and depression;
• Missing household items.

More at Inhalants

See also;

• Is Your Teen Using Drugs or Drinking?
• Alcohol intervention may help.
• Types of Dysfunctional Families

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Research Summary; Unsafe sex by people infected with HIV poses a grave public health risk. To examine whether alcohol use increases the likelihood of unsafe sex in people with HIV, investigators interviewed 262 patients from 2 HIV clinics. Alcohol consumption measures assessed use in the past 6 months and included drinking days, drinks per drinking day, binge drinking,* and hazardous drinking.**

• In the past 6 months, 63 percent of patients had been sexually active, 38 percent had unprotected sex (i.e., no condom), and 21 percent had multiple sex partners.
• All alcohol consumption measures were significantly associated with the likelihood of having any sex (odds ratios ranging from 1.5 to 2.9) and of having unprotected sex (odds ratios ranging from 1.4 to 2.7).
• One-third of hazardous drinkers — compared with 9 percent of nonhazardous drinkers — were having both unprotected sex and sex with multiple partners.

Heroin and cocaine use did not significantly affect the likelihood of having any or unprotected sex.

Comments by Jeffrey Samet, MD, MA, MPH:
This study demonstrates a clear association between alcohol use and unsafe sex in patients infected with HIV. As the authors note, determining the basis of this association (e.g., risk-taking personality, lowered sexual inhibitions due to alcohol) requires studies that demonstrate the relationship between the two behaviors. Nevertheless, these findings support the case for assessing alcohol use among all patients with HIV.

* 5 or more drinks per day for men, 3 or more drinks per day for women
** at least 1 binge episode, or greater than 14 drinks per week for men and greater than 7 drinks per week for women

Reference: Stein M, Herman DS, Trisvan E, et al. Alcohol use and sexual risk behavior among human immunodeficiency virus-positive persons. Alcohol Clin Exp Res. 2005; 29(5): 837-843.

From; Join Together Online

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One-Year Outcomes among Members of a Dual-Recovery Self-Help Program.

Research Objective: Self-help is gaining increased acceptance among treatment professionals as empirical support for of its effectiveness is growing and the advent of managed care warrants the use of cost-effective modalities. Traditional “one disease-one recovery” self-help programs cannot serve adequately the needs of the dually-diagnosed.

This paper presents one-year outcome data from a longitudinal study of the effectiveness of self-help for the dually-diagnosed.

Subjects are members of Double Trouble in Recovery (DTR), a 12-step self-help program designed to meet the special needs of those diagnosed with both a mental health disorder and a chemical addiction.Study.

Design: The study uses a 12-month prospective longitudinal design with follow-ups at 12 and 24 months after baseline. Subjects (N = 310) were recruited at 25 DTR meeting sites throughout New York City. Semi-structured instruments assess history and current status of mental health and substance abuse, treatment in both areas, and self help participation (DTR as well as traditional 12-step groups such as AA and NA).

Population Studied: Community-based individuals dually-diagnosed with a mental health disorder and substance abuse.

Principal Findings: S’s are mostly members of underserved minority groups with long histories of substance abuse and mental health disorders.

Most S’s attend outpatient treatment (for drug use, mental health or dual-diagnosis – 77%) and take psychotropic medications (87%).

At the 12 months follow-up,

• 76% were still attending DTR;
• 68% were also attending AA or NA.

Mean number of symptoms S’s. experienced in the past year decreased significantly;

• two-thirds (69%) of S’s reported that their mental health was “better” in the past month than it was at baseline.
• One-third (29%) reported substance use in the past year, compared to 42% at baseline (p = .002).

Substance use (less) was significantly associated with DTR attendance:

• Total time abstinent was related to lifetime length of DTR attendance (r = .25, p = .002) and
• past year substance use was related to number of months of DTR attendance in the past year (r = -.17, p = .02).

Conclusions: For dually-diagnosed individuals, continued participation in dual recovery self-help groups plays a significant role in the recovery process, particularly in the area of substance use.

Implications for Policy, Delivery or Practice: Participation in dual-recovery self-help groups, both during and after formal treatment, should be encouraged as part of an integrated lifelong recovery plan for dually-diagnosed individuals.

Research; One-Year Outcomes among Members of a Dual-Recovery Self-Help Program. Laudet A, Magura S, Vogel H, Knight E, Staines G; Abstr Acad Health Serv Res Health Policy Meet. 2000; 17.

More at; Double Trouble in Recovery

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• Subscribe to Twelve Step Facilitation by e-Mail

Dual Diagnosis; Counseling the Mentally Ill Substance Abuser by Katie Evans, J. Michael Sullivan Read more about this title…

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On any given day in the United States, one million people are in treatment for alcoholism or drug addiction. It is not getting into treatment, however, that makes the difference. Instead, it is what a person gets out of treatment. The fact that many people do not find success in treatment on their first attempt is due in part to a lack of understanding about what makes effective treatment.

The ten effective elements of treatment are;

1. There is no treatment formula that will work for everyone.

2. Medically supervised withdrawal is only one step in addiction treatment; alone it will do little.

3. Length of treatment counts

4. Drug addiction is a multidimensional problem, and treatment needs to address all of an individual’s needs

5. Counseling (individual and/or group) is a critical part of effective addiction treatment.

6. Medications are an important part of treatment for many people.

7. Drug testing during treatment is important.

8. Alcoholics and addicts with mental health disorders should be treated for both at the same time.

9.Addiction Treatment works even for people who don’t choose it of their own free will.

10. Don’t give up.

As with other chronic illnesses, relapses can occur during or after successful treatment episodes. Addicted individuals may need lengthy treatment and more than one time in treatment before they can enjoy long-term abstinence and full restoration to a drug free life. The period after treatment is just as important as being in treatment. Finding support and continuous work to stay drug free will be necessary. A slip or relapse is just an indicator that more work, and possibly more treatment, is necessary. Don’t give up.

Full story at Recovery Today

See also;

• AA and Treatment Work Better Together
• AA Offers Recovery Not Religion
• If you have healthcare training this manual may help.

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Why ’not drinking’?

We members of Alcoholics Anonymous see the answer to that question when we look honestly at our own past lives. Our experience clearly proves that any drinking at all leads to serious trouble for the alcoholic, or problem drinker. In the words of the American Medical Association:

Alcohol, aside from its addictive qualities, also has a psychological effect that modifies thinking and reasoning. One drink can change the thinking of an alcoholic so that he feels he can tolerate another, and then another, and another.

The alcoholic can learn to completely control his disease, but the affliction cannot be cured so that he can return to alcohol without adverse consequences.

And we repeat: Somewhat to our surprise, staying sober turns out not to be the grim, wet-blanket experience we had expected! While we were drinking, a life without alcohol seemed like no life at all. But for most members of A.A., living sober is really living-a joyous experience. We much prefer it to the troubles we had with drinking.

One more note: anyone can get sober. We have all done it lots of times. The trick is to stay and to live sober. That is what this booklet is about.

Living Sober, 1975, Alcoholics Anonymous World Services, Inc

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