Spirituality can be defined in many ways and means something different for everyone. In 1967, it was defined as an experience or expression of the sacred and expressed in religious practices/rites but has expanded to more modern-day terminology of an individual's search for meaning while connected to the universe (Fridkis, 2011; University of Minnesota, n.d.). It is a quality that goes beyond religion and creates an atmosphere whereby the person is in harmony with a power apart from his or her own existence. Even those who do not believe in a higher being can still seek this relationship with something larger. Striving toward this is good for the individual, family, and the society as a whole.

Alcohol and substance abuse programs have been built around the practice and idea of spirituality. Starting in 1935 with the founding of Alcoholics Anonymous, 12-step programs encouraged "users" to rigorously look into their inner being (introspection), acknowledge their character flaws to someone else, make amends for what they have done wrong, and believe in a higher being (Brande, 2016). Although based on Christianity, these ideas are really able to be adopted by any religion/faith. Although not used by everyone, these beliefs have demonstrated to be highly effective in community-based recovery programs. Spirituality assists the person to build a better life in recovery.

Admission to an addiction recovery/rehabilitation center begins with multiple assessments of the patient. Several professionals evaluate the patient on admission determining the extent of the addiction, comorbid conditions, and determination of the best treatment plan. Part of the medical assessment (history and physical) performed by health care providers (physicians and nurse practitioners) was recently expanded at our facility to incorporate all aspects of a person's health. The "H&P" is not only the subjective history, physical examination, diagnosis, and plan. Immunization status, blood-borne and sexually transmitted infections, recreational activities, living environment, and family support are only a few of the health behaviors and psychosocial areas added this past year.

The area of spirituality also was added. In this section, questions regarding religion preferences, practices, and belief in a higher power are asked. To gain more depth, the patient is also asked about if they want added help in learning more about prayer, meditation, a particular religion, or changing their attitude toward the higher being. This increases the holistic approach toward all aspects of a person's life, which will be essential in recovery, not only centering on the physical elements of the addiction.

Over the course of a month and after completing over 20 admissions, I noted that only three of my patients had any religious preference, none of which were practiced, and although eight believed in a higher being, none were interested in learning more about prayer, mediation, or having their spiritual needs addressed during treatment. Many stated that addiction did not affect the spiritual aspects of their lives because they had none to begin with. Recovery from addiction requires an internal motivation to change. In addition to weighing the pros and cons (benefits [being clean and healthy] and risks [addiction]), an individual with a substance use disorder must have a "belief" that change is possible and the strength to achieve that change. However, without that belief, meaning, and purpose, is recovery possible for them? The cravings are strong, but will they have the inner strength to resist? Is the lack of spirituality within the millennial population connected to the rise in addiction? Is this why patients relapse so quickly after the detoxification process? Is there something missing in our society? What can health care providers do to promote this part of a person's health?

Many of these are rhetorical questions and do not have a definite answer; however, the lack of spirituality causes a failure to create purpose in life and the inability to live in harmony with oneself and others. No matter what, adding spirituality within recovery treatment adds more contemporary holistic healing possibilities to the plan. The person reconnects his or her inner self to the physical body, redeveloping a sense of meaning and purpose in one's life.

Part of spirituality is introspection, meaning to "look inside" oneself. Self-examination of one's actions and inner thoughts and how that affects his or her life and the lives of others allows the person to search his or her conscience, motives, and beliefs to better understand him or her. It is through introspection that an individual with a substance use disorder acknowledges strengths, weaknesses, risks, and ultimate goals toward recovery. As Carl Jung once quoted, "Your vision will become clear only when you can look into your own heart. Who looks outside, dreams; who looks inside, awakes" (Brainy Quotes, n.d.). Isn't it the inside strength that allows the person to awaken to a new and better life?

REFERENCES