Pastoral Psychol (2009) 58:315–322

DOI 10.1007/s11089-009-0196-8

The Frequency of Prayer, Meditation and Holistic

Interventions in Addictions Treatment:
A National Survey

Paul E. Priester & Josh Scherer & Jesse A. Steinfeldt &

Asma Jana-Masri & Terri Jashinsky & Janice E. Jones &
Cher Vang

Published online: 19 March 2009

# Springer Science + Business Media, LLC 2009

Abstract This study examines the prevalence of endorsing the twelve step approach and
the use of prayer, meditation, and holistic techniques in a national sample of 139 substance
abuse treatment centers. Ninety one percent of the programs endorsed a twelve step
orientation. Twenty six percent of the programs actively used prayer and 58% used
meditation as a component of treatment. Thirty three percent of the programs used some
form of a self-designated holistic technique. There was a divergent range of techniques that
were used by programs, falling into four broad categories: (1) nutrition, exercise, relaxation
and physical health; (2) recreation and adventure-based activities; (3) religious and spiritual
practices; and (4) the use of specific therapy modalities.

Keywords Addictions . Prayer . Meditation . Holistic techniques . Twelve step program

Spirituality is recognized as a potentially important part of the treatment of substance abuse

and addiction. Given the prevalence of twelve step programs in the field of addiction
treatment, there appears to be a widespread acknowledgement by both clients and
professionals of the therapeutic importance of spirituality, and its incorporation into
treatment has been identified as a supportive component in the process of recovery (Carroll
1993; Herbert 2003; Priester 2000). Nonetheless, inclusion of spirituality in recovery is not
recognized as important by all treatment professionals, nor is it considered appropriate for
all addiction clients (Day et al. 2003). This study examines the extent of the use of spiritual
approaches in alcohol and drug treatment centers. Specifically, this research project will
assess the prevalence of the following treatment approaches: the twelve step model, prayer,
meditation, and holistic treatments.

P. E. Priester (*) : J. Scherer : J. A. Steinfeldt : A. Jana-Masri : T. Jashinsky : C. Vang

School of Adult Learning, North Park University, 3225 West Foster Avenue, Chicago, IL 60625, USA
e-mail: ppriester@northpark.edu
e-mail: dr.elvis.priester@gmail.com

J. E. Jones
Cardinal Stritch University, Milwaukee, WI, USA
316 Pastoral Psychol (2009) 58:315–322

Twelve step-based treatment

With its essentially spiritual foundation, the twelve step philosophy and approach is an
often-employed component in a wide spectrum of substance abuse treatment modalities.
The second step states that a Power greater than oneself could restore one to sanity, while
steps 3, 5, 6, 7, 11 and 12 explicitly mention the role of a Higher Power in the recovery
process. Given its extent and history, the inclusion of 12 step programs in an assessment of
the prevalence of spirituality in addiction treatment is warranted.

Prayer

Prayer is considered by some to be the practice most central to spiritual belief (Heiler 1932).
In the 12 step model of addiction recovery, prayer is included not only as a central component
of Step 11, it is called for in two additional steps and is used ritually during support meetings
(Kus 1995). In a study of participants in twelve step recovery programs, Johnsen (1993)
found that subjects who had abstained from substance abuse had used prayer (or meditation)
more frequently than subjects who had relapsed. Washington and Moxley (2001) found that
use of prayer added structure and contributed to an emotionally safe environment for African-
American women in an inpatient recovery program. In spite of the above examples, relatively
little research has been performed to elucidate the prevalence of the use of prayer in addiction
recovery programs. This study will attempt to reveal the extent to which addiction recovery
centers currently use prayer in their treatment programs.

Meditation

Meditation is currently used in numerous forms in a variety of treatment contexts. Some

forms of meditation used are overtly spiritual in content while others incorporate a
distinctly secular approach to meditation. The forms of meditation that have been used in
addiction treatment can be loosely divided into three main categories. Devotional
meditation, which is often associated with the Christian tradition, is a reflective meditation
practice that incorporates contemplation and reflection upon an idea or meaningful passage,
biblical or otherwise (Carlson et al. 1988; Kus 1995). This form of meditation is often
incorporated in twelve step meetings. The use of this form of mediation is encouraged
outside of meeting as a daily morning practice (Alcoholics Anonymous World Services
1990; Hazelden Meditations 1996).
The second categorization of meditation involves other spiritual approaches that eschew
thinking and contemplation altogether, instead seeking to reduce conscious activity through
focused attention to attain a state of alert yet relaxed awareness. The practice of this form of
meditation is found in Buddhist and Himalayan traditions. An important distinction of this
form of meditation is that it is occurring contextually from within an organized religion.
The final category of meditation used in addiction treatment employs secular
modification of the aforementioned Eastern meditation approaches. In secular meditation,
relaxed awareness and focus of attention are used in a manner similar to that of Eastern
spiritual meditation traditions, but without underlying spiritual motivations. This secular
approach is often called the Relaxation Response (Benson 1975). These secular meditation
approaches, such as mindfulness meditation and relaxation response training, are employed
in various cognitive–behavioral therapies and addiction treatment models.
Pastoral Psychol (2009) 58:315–322 317

Empirical studies testing the effectiveness of meditation as a therapeutic intervention

have yielded mixed results. Perhaps the most extensive research on the effectiveness of
meditation in a variety of treatment contexts, including alcohol and drug addiction, has
utilized Transcendental Meditation (TM). In a review of this research, Hawkins (2003)
pointed out the demonstrated effectiveness of TM in reducing both substance use by
substance abuse clients and the risk factors that contribute to substance dependence in a
number of populations.
Alterman et al. (2004) found improvement in medical problems in substance-abuse
recovery patients who received mindfulness meditation training in addition to standard
treatment, but found no direct effects in terms of psychological health or substance-abuse
recovery. In a review of the effects of meditation across a variety of treatment modalities,
researchers have raised serious methodological concerns about much of the research on
meditation, Canter (2003) cited a lack of adequate control and biased recruited of
predisposed subjects, as well as a potential bias on the behalf of researchers who may have
a vested interest in proving the effectiveness of their chosen meditation technique. Such
equivocal support for the effectiveness of meditation in substance abuse treatment supports
the need for unbiased and methodologically sound empirical examinations of the
effectiveness of meditation in the treatment of substance abuse. Moreover, given such
ambivalence about its effectiveness, the current extent and use of meditation creates a
compelling research question.

Holistic treatment

An increasing variety of novel spiritual and non-spiritual treatment approaches termed

“holistic” are being introduced into the field of alcohol and drug treatment (Kissman and
Maurer 2002; O’Connell and Alexander 1994). The general principle of holistic treatment is
intervention at multiple levels and dimensions in an effort to treat the entire (or whole) person.
Holistic treatment has been conceived of in various ways, some approaches incorporating
purely secular components of health and relationships, and others including or even
exclusively focusing on spiritual components. Slaght et al. (2004), in their argument for
increased use of holistic intervention in addiction treatment, describe holistic treatment as
treatment that includes interventions related to exercise, nutrition, relaxation and social skills.
Ratner’s (1988) holistic addiction treatment model for gay clients and their families
includes a similar range of interventions, but also includes spiritual activities (meditation,
prayer, and 12 step meetings) as well as instruction and programming related to
homophobia. Rioux (1996) presents Participatory Holism, a model for addiction
counseling, as an intensive personalized program emphasizing spiritual awareness and
discovery based on Shamanic healing principles. The general principles of holistic
treatment, across various studies, seem to emphasize health and nutrition, exercise and
physical health, attention to relationships, emotional healing, and sometimes spirituality
and/or religion.
The inherent overlap of twelve step programs, prayer, meditation, and holistic treatment
raises many questions about their utility and use by practitioners. By utilizing a survey
format, this study intends to provide a descriptive overview of the extent of influence of the
12 step model and the use of both prayer and meditation in the field of substance abuse
treatment. Furthermore, this study intends to elucidate both the extent of holistic treatment
in alcohol and drug treatment centers as well as which types of interventions are considered
holistic by treatment providers.
318 Pastoral Psychol (2009) 58:315–322

Method

Participants

Two hundred and forty substance abuse treatment centers were randomly selected from the
Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment
Provider Directory. A stratified sampling technique was employed in order to ensure
representation from all regions of the country. Each treatment center was contacted via
telephone to identify the name of the clinical supervisor. A $100 honorarium was given to
one randomly selected participant. Participants wishing to participate in the honorarium
drawing enclosed a business card in the envelope, and the card was removed from the
survey to ensure anonymity in responses.

Instrument

The authors developed a survey for the purposes of this study. This survey asked questions
related to the research question: whether the program was 12 step-based; frequency of
prayer, meditation or holistic clinical practices; range of activities offered that were
considered holistic in nature; and demographic information on the counselors and clinical
population served at the agency.

Response rate

One hundred and thirty nine of the 240 surveys were returned for a response rate of 58%.
Given the overstressed nature of the population sampled, the authors consider this to be an
acceptable rate.

Procedure

Treatment centers were given forced-choice answers (e.g. Does your program use a twelve
step orientation?), with the exception of the questions regarding which specific holistic
interventions that were used at the clinic. In order to obtain results that were not constrained
by the framing of the question, participants answered open-ended questions identifying
these techniques (e.g., State the holistic technique that is used in your program). There was
ample space provided so that participants could enumerate responses to this question.

Results

Demographic information

Clinical aspects of the treatment centers Of the treatment centers, 13% were solely
inpatient, 55% were solely outpatient, and 32% offered both inpatient and outpatient
services. Fifty five percent of the clinics served solely adults, 4% served solely adolescents
and 45% served both adolescents and adults. In terms of organizational affiliation, 13% of
the clinics sampled were affiliated with a hospital, 3% were affiliated with a correction
system, 22% were affiliated with a private mental health practice, 3% were affiliated with a
faith-based organization, 11% were affiliated with the government, 39% were affiliated with
a community-based organization, and 4% were categorized as being affiliated with an
Pastoral Psychol (2009) 58:315–322 319

unspecified source. Twelve percent of the clinics identified themselves as a methadone

treatment center, while 87% of centers reported that they were not a methadone treatment
center, and 1% of clinics did not respond to this question.
In a typical month, the clinics sampled serve between 14 and 2000 clients (M=194.36,
SD=301.89). Additionally, the clinics sampled have between 1 and 120 full time
counselors (M=9.89, SD=14.56) and between 0 and 15 part time counselors (M=3.06,
SD=3.02).

Educational requirements of counselors In terms of minimum educational requirements

needed to be hired as a counselor, 10% of clinics sampled required no education, 24%
required a high school diploma, 6.2% required an associates degree, 43% required a
bachelor’s degree, 7% required a master’s degree, 2% required a doctorate, and 7% did not
provide information for this item.

Professional certification requirements of counselors Of the clinics sampled, 44% reported

that the minimum professional requirement for being hired as a counselor was certification
as a Substance Abuse Counselor (SAC). Thirty two percent reported that the minimum
professional requirement for being hired as a counselor was a provisional certification as a
SAC, while 16% reported that their minimum professional requirement for being hired for
as a counselor was no certification. Eight percent of respondents did not provide
information for this item.

Racial/ethnic composition The race/ethnicity of the counselors was: 74% European

American, 20% African American, 1% Native American, <1% Asian American and <1%
“other.” The race/ethnicity of clients receiving services at the surveyed clinics was: 65%
European American, 22% African American, 8% Latino, 3% Native American, 2% Asian
American and <1% “other.” Note that this racial/ethnic profile of counselors in our sample
approximately matches another national study of substance abuse treatment centers
(Matthews et al. 2002), with the exception that this sample had a higher level of African-
American clinicians. The racial/ethnic profile of the clients served at the sampled treatment
centers also closely approximates the national figures cited by SAMHSA (2005).

Twelve step orientation

Of the treatment centers in this sample, an overwhelming amount identified themselves

as operating from a 12 step orientation. Ninety one percent reported utilizing this
orientation, while only 9% did not identify their program as operating from this theoretical
paradigm.

Inclusion of prayer, meditation and holistic techniques in the treatment process

Of the surveyed treatment centers, 26% actively included prayer in the treatment process
while 74% did not include prayer. Regarding the use of meditation, 58% actively included
some form of the practice of meditation in the delivery of substance abuse treatment
services while 42% of the treatment centers do not include this practice. When asked, in a
general manner, about the inclusion of any holistic practices, 33% of the treatment centers
identified themselves as including some form of a holistic approach in the treatment process
while 67% denied using any of these techniques.
320 Pastoral Psychol (2009) 58:315–322

Specific holistic techniques

The clinical supervisors sampled in this survey identified a divergent range of self-
identified holistic practices that they incorporate into the treatment of chemical dependence.
The specific techniques and the percentage of treatment centers implementing them include:
relaxation therapy, 4%; spirituality group, 3%; recreation, 3%; acupuncture, 3%; adventure-
based experiential group, 2%; nutrition counseling, 2%; wellness model, 2%; experiential
group, 2%; visualization, 2%; journaling, 2%; yoga, 1%; neurotherapy (i.e. biofeedback),
1%; stress exercise, 1%; coaching, 1%; fulfillment model, 1%; Texas Christian University
Treatment Process program, 1%; Oigong, 1%; Eye Movement Desensitizing and
Reprocessing (EMDR), 1%; Right to Recovery, 1%; equine therapy, 1%; and labyrinth, 1%.

Discussion

Perhaps most striking in the results of this study is the continued predominance of the 12
step approach in alcohol and drug treatment centers. Of all treatment centers surveyed, 91%
indicated that they include a twelve step orientation treatment component in their delivery
of AODA services. These results demonstrate the influence and ubiquity of the 12 step
model in addiction treatment in the USA. Given the spiritual basis of the 12 step approach,
these results are significant if only in the fact that 90% of these centers (most of which can
be assumed to be secular given that only 3% reported being faith-based) employ a
conspicuously spiritual approach in their treatment.
Just over 25% of treatment centers indicated inclusion of prayer in their delivery of
services. This percentage appears to be rather small in comparison to the number of centers
that included a twelve step orientation, especially since by nature use of the 12 step model
includes use of prayer within its approach. Perhaps respondents tended to indicate use of
prayer only where prayer was used independently and purposefully in the delivery of
treatment. Nonetheless, given that over 90% of centers are willing to use an overtly spiritual
approach in the form of the 12 step model, which in itself includes prayer, it is surprising
that only 25% of treatment centers acknowledged the use of prayer in their delivery of
services.
Nearly twice as many centers indicated the use of meditation in their treatment services
(58%), demonstrating that meditation is considered to be a viable component by over half
of treatment centers surveyed. Because the survey simply asked respondents to indicate if
meditation was included in treatment delivery, with no further explanation, there is no way
to tell what type of meditation is incorporated at these centers. Centers may be using either
spiritual or secular forms of meditation, employing either a mindfulness or focusing
approach, or using a reflective or devotional approach to meditation.
As in the case of prayer, since meditation is included in the 12 step approach, it is
notable that a much smaller proportion of respondents indicated use of meditation than
respondents who acknowledged use of the 12 step model. If all respondents who indicated
inclusion of a 12 step orientation in their services are indeed using the approach in its
entirety, then it would be reasonable to expect that same number of respondents would be
using prayer and meditation, since they are both components of the 12 step process. This
was certainly not the case. One explanation for this discrepancy is that respondents may
have interpreted the separate presence of questions related to meditation and prayer on the
survey to mean that the survey was asking if these practices were used in treatment
independently and apart from the 12 step approach. On the other hand, it is also possible to
Pastoral Psychol (2009) 58:315–322 321

theorize that some centers which use the twelve step approach may not be including prayer
and meditation in the use of the program. From the results of this survey, however, it is
impossible to find a definite explanation for this discrepancy, or determine how much of the
use of prayer and meditation indicated is used apart from use of the 12 step approach.
A third of treatment centers responding to this survey indicated the use of holistic
components in their delivery of AODA services. Space was also provided for respondents
to explain what they meant by holistic treatment. Of the 32 respondents who indicated use
of holistic treatment components, 24 provided specific explanations of what they
considered “holistic.” These responses can be broken down into four main areas: (1)
nutrition, exercise, relaxation and physical health (including alternative healing methods
such as acupuncture); (2) recreation and adventure-based activities; (3) religious and
spiritual practices; (4) use of specific therapy modalities (e.g., Client Centered, EMDR,
coaching). There were, of course, interesting exceptions to these four broad categories, such
as use of horses (equine) in treatment delivery. The range of responses indicate that
treatment centers who deliver holistic treatment components conceive holistic include a
range of approaches, spiritual or secular, that address a variety of human experience and
interventions.

Limitations of this study

As mentioned earlier, this study is merely descriptive in nature, providing a rather gross
level analysis. As such, this study does not seek to provide a methodologically sound
empirical examination of the effectiveness of meditation or prayer in the treatment of
substance abuse. However, given the conflicting nature of the research supporting/refuting
the efficacy of incorporating these practices into treatment regimens, it is imperative to
begin this inquiry with a comprehensive assessment of practices in the field, and this study
was successful in reaching its aim to do so. As a field, a detailed understanding of the ways
that prayer and meditation are used in the treatment of substance dependence disorders is
missing, and this study can be used heuristically to stimulate such research.

Future research

Future research may determine the types or prayer, meditation, and holistic services
delivered by alcohol and drug treatment centers. Researchers may also conduct research to
determine the effectiveness of the above treatments and the variations of each type of
treatment (e.g. mindfulness vs. reflective meditation). It might be fruitful to explore the
discrepancy between the widespread use of twelve step approach but much lower indication
of the use of prayer and meditation, which are paradoxically inherent in the twelve step
program. Finally, researchers may want to continue to refine the current definition of
holistic treatment which reflects how it is currently conceived in the treatment community.

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