The Buddhism and Addiction Series (Part III of III)

PART III:

Religious Dilemmas and Spiritual Solutions

Religion as a Barrier to Recovery

At first glance, it would seem that gay men with substance use disorder would be ideally matched to AA for post-treatment recovery maintenance or aftercare.  As previously noted, gay men are especially vulnerable to the development of a narcissistic personality structure.  The philosophy of the AA program is that addiction is essentially a “disorder of the self” characterized by narcissistic traits.  The AA program is unique in that it addresses both the underlying pathological personality structure, and the substance use disorder, by way of spiritual transformation.  However, when spirituality gives way to overt religiosity – as it often does in AA – the program becomes inaccessible and exclusive, and more foreboding than welcoming.

Alcoholics Anonymous is not allied with any religious denomination, nor does it take positions on controversies like gay rights (Alcoholics Anonymous, 2001).  Many members claim that AA is a spiritual rather than religious program, because there are no creeds, dogmas, nor theological doctrines to be learned (Galanter et al., 2007).  However, as was discussed in some detail in Part I supra, it is often difficult to distinguish the conceptual components of religion and spirituality.  AA may claim to be a spiritual rather than religious program, but the simplicity of that assertion belies the complexity of the issues at hand.  Though AA may be purely spiritual as a philosophical matter, the casual observer not attuned to such subtlety would likely conclude that many aspects of the organization are decidedly religious.

Near the time of the founding of Alcoholics Anonymous, one of its co-founders, Dr. Bob Smith, came into contact with the Oxford Group which was “a non-denominational, theologically conservative, evangelically-styled attempt to recapture . . . primitive Christianity” (McCrady, 1994, p. 1159).  Dr. Bob’s affiliation with the Oxford Groups, the early AA members’ religious backgrounds, and the cultural context of the 1930’s ensured that the fledgling recovery movement would take on a decidedly Judeo-Christian slant.  The influence of this religious heritage can still be found in both AA meetings and literature.  Most AA meetings close with a group recitation of the “Lord’s Prayer” (Eliason et al., 2006).  The nickname of the AA basic text, the “Big Book”, is likely a nod to the Christian bible (Eliason et al., 2006).  In the indexed portion of the AA Big Book, there are 260 references to “God” (including capitalized personal pronouns, and alternative titles such as “Creator”) appearing a rate of almost 1.5 times per page (Velten, 1996).  Even though the AA program allows for the selection of a personal God-concept, or God of one’s own understanding, the AA Big Book is nevertheless very specific as to how the individual shall relate to this God.  As Velten (1996) points out

the God of the 12 steps is vitally interested in human doings; likes to be supplicated in quite specific, prayerful ways; can restore people to sanity; likes to have people turn their will and their lives over to Him; listens to people’s searching and fearless moral inventories and likes them to admit to Him the exact nature of their wrongs; removes all defects of character from some people if they are entirely ready; prefers to be approached humbly by people asking Him to remove their shortcomings; likes to have people seek through prayer and meditation to improve their conscious contact with Him; and likes to have them pray for knowledge of His will and the power to carry it out.

Thus, when the AA Big Book speaks of choosing one’s own concept of God, what it means is that the individual is free to choose any concept so long as it is a patriarchal, theistic, anthropomorphic, personal deity.  In this respect, what the AA program giveth in spiritual liberty, it taketh away by religious dogma.  Several U.S. courts have taken issue with these overt religious expressions and have ruled that compulsory attendance at AA meetings is a violation of separation of church and state (SMART Recovery, 2012).  Nonetheless, the 78.4% of U.S. adults who are self-described Christians likely take no issue with the plainly religious language of the Big Book, the recitation of Christian prayers in meetings, and frequent reference to a theistic conception of God (Pew Research Center, 2008).  However, those who are disinclined to adhere to such beliefs are often left feeling estranged and a greater risk of relapse (Heinz et al., 2010).

In order to fully engage the AA fellowship, the individual must connect with the philosophy of the group (Borras et al., 2010).  Suspicion brought on by dubious distinctions between religion and spirituality can block a person from relating to and connecting with available social support in AA meetings (Chen, 2006).  Studies have shown that the overtly religious elements of AA alienate many persons who would otherwise benefit from the spiritual aspects of the program (Magura, 2007).  Atheists tend to avoid AA altogether, while agnostics may initially attend some meetings and then disassociate (Tonigan et al., 2002).  When asked to describe the reasons for dropping out of AA, respondents most often cite religiosity as the primary cause for leaving the group (Kelly, Kahler, & Humphreys, 2010).  Even those who are willing to explore belief in “God” or a “higher power”, or who are otherwise amenable to a spiritual solution, may find it difficult to embrace the image of God portrayed by members in meetings and in the AA Big Book itself (Avants & Margolin, 2004).  Though it would be unfair to characterize all AA groups as bastions of religion, it is reasonable to conclude that the meetings often will reflect the religious backgrounds of the members and cultural contexts in which they occur.  Thus, an AA meeting in the rural south will take on a decidedly Christian evangelical, fundamentalist tone wherein the concept of “God as judge” is often endorsed (Pew Research Center, 2008).   For reasons set forth in Part II supra, gay men are at risk to experience traumatic recall and activation of internalized homophobia in the face of overtly theistic religious references in AA.  As a result, gay men will find it difficult to trust the AA program and its members which they view as a threat.  This lack of trust will often lead to dissociation from the fellowship well before meaningful engagement can occur and recovery can begin (Chen, 2006).  However, due to limited alternatives for long-term aftercare, AA may be the only option for many gay men notwithstanding rightful objections to its religiosity.  The irony here is that if these barriers to access can be overcome, the spirituality of the AA program can be invoked to transcend the forces of internal and external oppression (Morrell, 1996).  Ultimately, when faced with this dilemma, it is incumbent upon the individual to heed the advice of first 100 members of AA who wrote:

To us, the Realm of the Spirit is broad, roomy, all-inclusive; never exclusive or forbidding to those who earnestly seek.  It is open, we believe, to all . . . Do not let any prejudice you may have against spiritual terms deter you from honestly asking yourself what they mean to you.  At the start, this was all we needed to commence spiritual growth . . . (Alcoholics Anonymous, 2001, pp. 46-47)

With this suggestion in mind, the remainder of this paper will argue that the philosophy and practice of Buddhism, which radically deconstructs the narcissistic personality structure, is the most suitable spiritual alternative to traditional theism for gay men in the context of AA.  Furthermore, Buddhism is non-theistic, and therefore any concerns related to a belief in personal deity are likewise alleviated.  In these respects, as a spiritual foundation upon which recovery may be built, Buddhism may fit more naturally with the AA philosophy than does the Judeo-Christian doctrine from which it was born.

Buddhist Philosophy and Practice

Buddhism began more than 2,500 years ago as the culmination of a six-year spiritual quest by Siddhartha Gautama (563-483 BCE) who would come to be known as the Buddha (Wada & Park, 2009).  The Buddha (trans. the enlightened or awakened one) was born a prince in northeast India to a wealthy Hindu family (Kelly, 2008).  Siddhartha’s father was the local king and made sure that his son lived a protected existence shielded from the truth of life’s suffering (Kelly, 2008).  At the age of 16, Siddhartha married a beautiful princess, Yasodhara, and they had a son named Rahula (Kelly, 2008).  Siddhartha spent the next 29 years living lavishly as a member of the royal family wanting for nothing and indulging in many worldly pleasures (Warren, 2012).  But he became dissatisfied with his life of privilege and embarked on a journey in which he sought wisdom from teachers of various spiritual traditions (Warren, 2012).  Upon leaving the palace he encountered a sick person, an old woman, and a dying man in whom he realized the truth of impermanence manifest by the inevitability of illness, aging, and death (Warren, 2012).  Siddhartha endeavored to escape these fates by engaging in extreme spiritual practices such as self-mortification and asceticism (Kelly, 2008).  Still unfulfilled and near death from starvation, he famously sat down to meditate beneath a sacred Bodhi tree where he vowed to remain until he obtained the wisdom which he had so desperately sought (Kelly, 2008).  After many days, during which time he faced considerable internal and external adversities, Siddhartha finally attained enlightenment – a state in which he saw the exact nature of existence, the causes of human suffering (dukkha), and the path to liberation from suffering (Kelly, 2008).

According to tradition, the first teaching which the Buddha gave after his enlightenment was of the Four Noble Truths.  Often described as the “Middle Way”, the Buddha’s teaching was based in many respects upon the suffering he had experienced living in the extremes of self-indulgence and self-deprivation.  The Four Noble Truths are summarized as follows:

1.         In the first of the Four Noble Truths, the Buddha essentially stated that in life, dukkha is inevitable (Warren, 2012).  Often translated as “suffering”, dukkha may more accurately be defined as dissatisfaction, pain, being off the mark, hard to bear, or unease (Kelly, 2008; Michalon, 2001).  Buddhism does not teach that every part of life leads to suffering, but that by its very nature it is flawed, often difficult, and imperfect (Michalon, 2001).

2.         In the second Noble Truth, the Buddha identified the source of dukkha as the three poisons:  greed (craving or attachment); hatred (aversion); and ignorance (delusion) (Kelly, 2008).

3.         The third of the Four Noble Truths sets forth the aim of Buddhist spiritual practice – the cessation of dukkha (Kelly, 2008).  In overcoming greed, hatred, and ignorance, the individual will become enlightened, reach a state of nirvana, and experience an end to suffering (Kelly, 2008).

4.         In the last of the Four Noble Truths, the Buddha described the Eightfold Path as the way leading to enlightenment.  This Path rests on the three bases of prajna (trans. wisdom), sila (trans. ethical conduct), and samadhi (trans. concentration).  (Kelly, 2008; Warren, 2012).   The bases are comprised of right view, right intention, right speech, right action, right livelihood, right mindfulness and right meditation (Kelly, 2008; Warren, 2012).

Commonly characterized as a major world religion, Buddhism is perhaps best described as a philosophical, psychological, and ethical system (Kelly, 2008).  Though Buddhism may be applied in ways that are therapeutic, its benefits extend to broader aspects of personal development including spiritual fulfillment and cultural enrichment (Kelly, 2008).  However, with the emergence in popularity of Dialectical Behavior Therapy (DBT) and Cognitive-Behavior Therapy (CBT), there has been an increase in research and implementation of Buddhist theory and practice in therapeutic settings (Kelly, 2008).  In psychology, Buddhist theory generally involves understanding the nature of consciousness, the mechanisms of cognitive processes, the role of conditionality, and the benefits of meditation (Kelly, 2008).  Buddhist mindfulness practice has been used in Mindfulness-Based Relapse Prevention (MBRP) to treat addictive behaviors; to generate acceptance in Acceptance and Commitment Therapy (ACT); as a tool to manage borderline personality disorder in DBT; as a means to decrease high-risk sexual behavior among drug addicts in 3-S Therapy; to facilitate and enhance cognitive restructuring in Mindfulness-Based Cognitive Therapy (MBCT); and to reduce pain, stress, and anxiety in Mindfulness-Based Stress Reduction (MBSR) (Avants & Margolin, 2004; Kelly, 2008; Kuan, 2012).  Moreover, because there are no deities to be worshipped, Buddhist theories and practice can be integrated into the therapeutic setting without offending or upending participants’ existing spiritual beliefs or non-belief (Margolin et al., 2007).

NarcissismShortly after his explication of the Four Noble Truths, the Buddha delivered his second sermon setting forth the principle of non-self (anatta) – an esoteric but profound teaching which Dhar (2011) claims distinguishes the Buddha from all other spiritual leaders.  For Westerners who are bound up tightly in ego and cling to a strong sense of self, the teaching of anatta is difficult to penetrate (Avants et al., 2005; Michalon, 2001).  As was set forth in Part II supra, narcissists often view the world from the perspective of self as center of the universe Oddly, Western psychology often reinforces this viewpoint with its focus on esteem building and solidifying a strong sense of self (Michalon, 2001).  As it turns out, many popular approaches to treatment may in fact reinforce rather than deconstruct the narcissistic personality structure (Michalon, 2001).  However, Buddhist psychological theory offers an alternative to traditional approaches through application of the principle of anatta – a powerful antidote to the pernicious effects of narcissism.

Basic to the teaching of anatta is the idea that there is no centralized self, or “I”, as it is usually perceived to exist (Wada & Park, 2009).  This idea of a unitary self is actually based on the individual’s strong identification to a set of ephemeral mental and physical aggregates (Falkenstrom, 2003; Michalon, 2001).  The aggregates (which are bodily form, consciousness, perception, feelings, and volitional mental formations) are in a constant state of flux, continuously flowing, and ever changing (Dhar, 2011, Falkenstrom, 2003; Michalon, 2001).  For example, in each moment, at the molecular level countless numbers of cells in our body die and are replaced by new ones; thoughts are subject to constant revision; and feelings come and go like the tides of the ocean (Wada, 2009).  Everyone experiences the impermanence of these aggregates, but nevertheless seeks to cling to certain states and to avoid others (Dhar, 2011).  Born in the tension between desire and fear, the “I” creates itself by contracting around positive experiences and avoiding negative ones in a state of perpetual pleasure-seeking and pain avoidance (Michalon, 2001; Smith, 2010).  The sense of self is thus based upon denial of the truth of anicca (trans. impermanence) and the false belief in the continuity of being (Michalon, 2001).  According to the Buddha, the sense of a fixed, centralized self persists only to allay the instinctive fear of extinction at death (Dhar, 2011).  But apart from the aggregates, there is no distinct being – “the feeler, the thinker, or the doer just as there is no forest apart from the trees, no car apart from the component parts . . . no river apart from the water flowing between the two banks” (Dhar, 2011, p. 400).  Tibetan Buddhists describe it as a mind stream – there is no solid core of self, but only a stream of thoughts, feelings, words and actions (Griffin, 2010).  Like the stream of a river, the self is constantly flowing, twisting, turning, and changing; and like a stream, though the self is unique, it is not solid (Griffin, 2010).

The teaching of anatta comes more fully to life when understood in the context of karma (trans. causes and conditions).  The non-duality of Buddhism recognizes the inherent unity, or interdependence, of the universe and resists false dichotomies like “self” and “other” (Eckstein & Mitchell, 2009; Wada, 2009).  It is these misperceptions that Buddhist philosophy principally seeks to expel (Smith, 2010).  Misapprehension of the truth of karma and dependent origination leads to the emergence of a sense of self.  The chain of causation begins with ignorance of the true nature of reality giving rise to volitional impulses; these impulses in turn affect the consciousness, and the state of the body and mind; the six sense bases then receive this stimuli through contact with the outer world; this gives rise to feeling which in turn leads to craving or aversion; the mind is then conditioned to certain beliefs (becoming), and the self is born (birth), and dukkha ensues (Falkenstrom, 2003).  When trapped in this cycle which Buddhists describe as samsara (trans. wheel or conditioned existence), the individual experiences continuous suffering and sorrow which arise from a sense of separateness.  The path to enlightenment thus begins with insight into the nature of non-self (anatta), the impermanence of being (anicca) and the interdependent nature of the universe (karma) (Griffin, 2010).

The principle of anatta stands in stark contrast to the reality of the narcissist who sees the self not only as distinct, but as the totality of existence.  In Buddhism, narcissism can be described as a false self-organization; and in this description, narcissistic vulnerability is directly proportional to the degree of clinging to self-images (Falkenstrom, 2003).  The narcissist clings to an ideal image of self (the “false self”) and directs hatred towards the inferior self-image (the “true self”) (Falkenstrom, 2003).  And like other forms of craving, attachment to or hatred for particular self-images leads to suffering (Falkenstrom, 2003).  But according to Buddhist principles, both the “true self” and the “false self” are illusions – together comprising a false dichotomy of existence that turn out to be opposite sides of the same illusory coin.  Insight into the true nature of being, anatta, pierces the narcissistic veil.  The grandiosity gap is obliterated when the boundaries of true self and false self from which it is formed are emptied.  In Buddhism, selflessness is not about something that once existed becoming non-existent; rather, the narcissistic self never existed in the first instance (Epstein, 1988).  Jung believed that total abolition of the ego was the only means by which true psychological transformation could occur (Michalon, 2001).  The process of deconstruction and reorganization has been described as follows:

The normal sense that I am a fixed, continuous point of observation from which I regard now this object, now, that is dispelled . . . My sense of being a separate observer or experiencer behind observation and experience is revealed to be the result of perceptual illusion . . . No enduring or substantial entity or observer or experiencer or agent – no self – can be found behind apart from these moment-by-moment events to which they could be attributed (anatta=“no self”) (Michalon, 2001, p. 208)

The Buddha was very pragmatic and encouraged his followers to test his teachings by direct experience rather than trusting his words with blind faith (Groves & Farmer, 1994).  Though the philosophy of anatta may seem abstract and impractical, the Buddha gave clear-cut direction for those who wish to extinguish the suffering attendant to the illusion of self.  Buddhist practice involves mindfulness of the aggregates and cultivation of insight into the nature of impermanence, suffering, and non-self (Dhar, 2011).  Meditation, as the key to understanding the Four Noble Truths and following the Eightfold Path, is central to the objective of liberation from narcissism and addiction (Epstein, 1986; Kelly, 2008).  In meditation, the individual sees the aggregates for what they are – the source of suffering – and develops disenchantment towards them.  When the view of self is uprooted, the fires of craving (raga) and aversion (dosa) are dampened, and the pure mind emerges characterized by lovingkindness (maitri), compassion (karuna), altruistic joy (mudita), and equanimity (upekkha) (Dhar, 2011).  Peace and well-being are not achieved by adding something, but by subtracting mental clutter (Eliot, 2006).  Learning to meet the present moment without resistance or elaboration is at the heart of Buddhist practice – a sight is a sight, a feeling a feeling, and a sound a sound – additions are but an insubstantial storyline (Falkenstrom, 2003).

Buddhist meditation practice may be divided into two broad categories:  concentration (samatha) and insight (vipassana) (Epstein, 1986; Epstein, 1988; Groves & Farmer, 1994).  In concentration practice, the individual learns to place the mind on a single object, often times the breath, as a means to develop one-pointed attention and absorption (Epstein, 1986; Falkenstrom, 2003).  The ultimate goal of samatha practice is the attainment of samadhi (trans. deep states of concentration) (Kuan, 2012).  Concentration practice usually involves mindfulness of the breath (anapanasati) in an effort to gain control over the so-called “monkey mind” which chatters away, jumping from limb to limb, tree to tree, thought to thought (Margolin et al., 2007).  Samatha can lead to profound experiences of tranquility and bliss, and therefore care must be taken to avoid attaching to these states, less the ultimate goal of letting go of craving and aversion is lost within the practice itself (Falkenstrom, 2003).  Insight practice likewise relies on cultivation of mindfulness wherein the ability to maintain moment-to-moment awareness of the changing objects of perception is developed (Epstein, 1986).  Insight meditation is based on the Four Foundations of Mindfulness to which attention is usually directed – the body, feelings, the mind, and mental phenomena (Falkenstrom, 2003).  Mindfulness involves bringing awareness to arising cognitive processes and the accompanying physical sensations thereby allowing thoughts to be experienced merely as mental events (Kelly, 2008; Kuan, 2012).  Mindfulness practice induces an “alternative information processing configuration” which aids in changing not specific thoughts and feelings, but the perceptual relationship to those thoughts and feelings (Kuan, 2012).  In this respect, mindfulness practice could be described as metacognitive activity (Witkiewitz et al., 2005).  Importantly, mindfulness involves accepting the stream of thoughts, or other stimuli, non-judgmentally, without over-identifying with them or reacting in habituated patterns (Kuan, 2012).  Judgments and other forms of cognitive-based commentary result in a loss of present-moment awareness and serve as a signal to the meditator to return to the mindfulness task at hand (Kuan, 2012).  In mindfulness practice, even craving when it arises is taken in as the object of meditation, its effects in both the mind and body are noticed, and it is observed to pass away (Falkenstrom, 2003).  As the path of insight is traversed, the impermanent and transient nature of the aggregates is realized, and hence the individual becomes awakened to the emptiness of self (Epstein, 1986; Falkenstrom, 2003; Michalon, 2001).  Insight meditation exposes “the ego as groundless, impermanent, and empty, and overcomes the denials that empower the wishful image of self” (Epstein, 1986, p. 153).  This shift in the perception of reality is akin to bringing light to darkness (Groves & Farmer, 1994).  Though the ultimate point of Buddhist meditation practice is the alleviation of suffering through insight, the relative importance of concentration practice should not be minimized.  The concentration skills which are cultivated in samatha are applied in insight practices which involve directing mindful attention to a variety of objects (Epstein, 1986).  That is not to say that samatha is merely a precursor to insight practice, for it is not until the absorption of concentration and insight precisely balance one another through persistent practice that the vestiges of narcissism may be finally abandoned (Epstein, 1986).

Taken to the extreme, the doctrine of anatta could be construed as a nihilistic philosophy.  However, the “I” exists on the relative level of reality for practical intents and purposes, though it does not exist on the ultimate, absolute level of reality which is one of deep dependency and interconnection (Michalon, 2001; Wada, 2009).  In The Heart Sutra, the Buddha stated that “form is emptiness and emptiness is form.”  It is important to hold this paradox in mind and understand that form and emptiness, self and non-self, are as Dogen described them, “intimate partners”.  Epstein (1988) argues that in mindfulness practice, rather than being forgotten, the ego is used as a means to observe its own manifestations in a state of detached awareness.  A more fluid ego is developed that is capable of absorbing destabilizing experiences (Epstein, 1988).  Rather than annihilation, the “true self” thus continues to exist on the relative level as the “sum of sensorimotor aliveness” (Falkenstrom, 2003, p. 1560).  Furthermore, practitioners who become morbidly preoccupied with anatta and emptiness become rigid, overly serious about their spiritual calling, and often show a lack of enthusiasm for living (Epstein, 1986).  Most likely, they have unwittingly attached to the image of non-self – a rather unfulfilling narcissistic substitute for narcissism (Epstein, 1986).  Just as the Buddha taught the “Middle Way” so too must the practitioner learn to balance insight into the true nature of reality and practical living.  Finally, care must also be taken to ensure that meditation is not used as a schizoaffective defense mechanism to avoid interpersonal relations.  Though meditation is often conducted in solitude, the tools are meant to be applied in a way to allow one to gain a greater sense of interconnectedness to others and the world about them, not to foster isolation (Falkenstrom, 2003).

AddictionFrom a Buddhist perspective, addiction is attachment to substances with associated craving (Groves & Farmer, 1994).  Suffering arises in the context of addiction in multiple ways including in the physical sense (such as through the pain of withdrawal), in the mental sense (fear of not getting the next fix), and in the existential sense (exasperation with the chaotic lifestyle) (Groves & Farmer, 1994).  Craving may be understood as a desire to continue a pleasant experience (such as the euphoria induced by drug ingestion); or as a desire for a different experience (such as aversion to anger, loneliness, and boredom) (Groves & Farmer, 1994).  Addicts cling to the hope that the drugs will relieve their suffering (Avants & Margolin, 2004).  The craving of addiction is aptly depicted by the hungry ghost (preta) in Buddhism who is tortured by unending desire and insatiable hunger (Groves & Farmer, 1994).  According to Kennedy (1985), “the drug addict is perhaps the archetype of the hungry ghost, barely alive to the world and concentrated solely upon the next dose – whose effects will soon fade away leaving him longing for another” (as cited by Groves & Farmer, 1994, p. 185).    Addiction is also seen in Buddhism as a habituated pattern of thoughts, feelings, and behavior that is no less impermanent and insubstantial than any other manifestation of the aggregates (Margolin et al. 2007).  From the perspective of the recovering addict, the concept of impermanence (anicca) stands for the good news that change is not only possible, but inevitable.  This principle can easily be applied to promote the idea that the individual can change the addictive patterns through recovery (Groves & Farmer, 1994).  Seen in this way, impermanence can be the source of new life and hope for recovery.

In addition to gaining insight into the nature of addiction, meditation leads to practical benefits for persons in recovery.  Addiction is characteristically about impulsive thinking and acting.  Mindfulness is the antithesis of impulsivity and teaches the individual to become nonreactive (Margolin et al., 2007).  The self-monitoring of mindfulness meditation helps to interrupt the trigger-response automaticity that is characteristic of addiction (Groves & Farmer, 1994).  Mindfulness meditation has been shown to reduce activity in areas of the brain that induce craving responses (Witkiewitz & Bowen, 2012).  Areas of the brain associated with inhibitory control are active during meditation (Margolin et al., 2007).  Mindfulness meditation practices are associated with neurological changes in the brain that result in increased alertness, relaxation, attention control, and reduced readiness for action – all of which act against impulsive addictive behavior (Witkiewitz, Marlatt & Walker, 2005).  Studies have shown mindfulness practices strengthen executive functioning of the brain thereby improving cognitive control and decision-making ability (Margoli et al., 2007).  Mindfulness training aids individuals in the prevention of relapse by “revitalizing their capacity for healthy adaptation, by easing the navigation of drug cravings and cues, by reducing emotional reactivity and cue salience, and by facilitating cue extinction through dampening the affective and semantic cascade associated with drug-related cues” (Dakwar, Mariani, & Levin, 2011, p. 168).  In studies involving prison inmates in both India and North America, use of vipassana meditation has been shown to contribute significantly to reduced recidivism, reduced post-incarceration substance use, and fewer psychiatric symptoms (Bowen et al., 2006).             

Warren (2012) identifies five Buddhist practices – enlightenment, compassion, acceptance, daily practice, and the community of practice (Sangha) – as spiritual foundations for addiction recovery.  As previously discussed, enlightenment relates to awareness of the insubstantial nature of the self (the truth of anatta and anicca), while daily practice refers to sustained commitment to mindfulness practice and meditation.  In the Mahayana tradition of Buddhism, compassion is closely tied to the liberation of suffering (Wada, 2009).  Compassion, which arises from an open heart, is the wish for the removal of suffering from all beings (Wada, 2009; Warren, 2012).  Compassion can arise from contact with others who suffer from addiction, and it leads to emotional transformations which allow the recovering person to become an “active self-healer” (Warren, 2012, p. 40).  Understanding the emptiness of self, and therefore the interdependent nature of the universe, leads to feelings of compassion for oneself and others (Wada, 2009).  In perceiving reality through the lens of non-duality, the truth emerges that suffering and longing for happiness are universal (Wada, 2009).  When individuals honestly explore their own pain, they learn that others suffer in the same ways and compassion arises (Griffin, 2010).  In this respect, compassion could be viewed as a measure of the acceptance of the truth of interdependence and connectedness to others.    Acceptance is a core principle in recovery and is often invoked by AA members who regularly cite the “Serenity Prayer” in meetings – “God, Grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference” (Dowd & McCleery, 2007).  Though a Christian prayer, the message is both practical and decidedly Buddhist.  Embedded in the prayer is recognition that suffering is an inescapable part of human life (Dowd & McCleery, 2007).  Wisdom is letting go of the desire to change the truth of suffering, allowing the experience to happen without avoidance, and accepting that peace and suffering ultimately are “One” (Warren, 2012).   In this respect, the concept of acceptance in both AA and in Buddhism largely coincides with the philosophy of the Greek Stoic philosopher Epictetus (135 A.C.E.) who wrote, “Men are disturbed, not by things, but by the principles and notions which they form concerning things.”

Byakuren Judith Ragir

Buddhist philosophy and practice may be readily incorporated into the 12-steps.  In fact, the 12-steps have been referred to as “American Buddhism”; and both William James and Carl Jung were strong proponents of Buddhist psychology (Buxton, 1987; Kuan, 2012; Michalon, 2001).  Membership in AA has increased 10-fold in Buddhist Japan over the last twenty years (Valliant, 2005).  Buddhism is often described as a non-theistic spiritual alternative for those who reject the anthropomorphism of theistic religions (Groves & Farmer, 1994).  Even though there is a lack of a Supreme Deity in Buddhism, there is no dearth of God-concepts or “higher powers” for 12-step purposes.  Instead of declaring allegiance to a Supreme Being, Buddhists “take refuge” in the Three Jewels which are the Buddha, the Dharma, and the Sangha (Groves & Farmer, 1994).  Together, the Three Jewels could be conceived as “God” or “higher powers”; and though they are impersonal in the sense that there is no micro-managing deity, this does not mean they are inaccessible or wholly impersonal (Griffin, 2010).  Griffin (2010) provides extensive guidance for Buddhist 12-step practitioners, particularly in his description of Dharma God as consisting of the Higher Power of Karma, the Higher Power of Mindfulness, the Higher Power of Wisdom, the Higher Power of Love, the Higher Power of the Eightfold Path, the Higher Power of Faith, the Higher Power of Presence, the Higher Power of Spiritual Awakening, and the Higher Power of the Group.  Seen in this light, the

Buddhist’s options within the 12-step framework are as varied as the needs of the individuals who will adapt them to their own recovery paths.  The 12-steps place particular emphasis on spiritual practices, and it is difficult to imagine a spiritual system that would allow for a more meaningful engagement with the 11th Step than would Buddhism with its emphasis on meditation practice.  From a broader perspective, meditation practice correlates with feelings of spiritual experience and reports of greater levels of spirituality (Wachholtz & Pargament, 2005).  Though outside the scope of this paper, both Griffin (2012) and Ragir (2013), a Zen Master who is also a 12-step adherent, outline in great detail the particularities of working each of the 12-steps from a Buddhist perspective, including providing Buddhist “translations” for AA slogans such as “Let Go, and Let God”.  In the end, Buddhism and the 12-steps share the view that addiction arises from a false, disordered perception of self.  Both systems seek to relieve the individual of the bondage of self as a means to achieve happiness, joy and freedom.  When the philosophical and spiritual foundation of both systems are understood, it becomes clear that Buddhism and the 12-steps may readily be integrated in a way that leads to the alteration of the core pathological personality elements that give rise to addiction in the first instance.

Conclusion

Both Buddhism and Alcoholics Anonymous share the view that addiction often arises from a pathological personality structure.  Thus, when practiced together, there is a countervailing synergy which works to diminish the sense of self that is at the root of the addictive disorder.  In this respect, Buddhism is the spiritual system which may be most logically integrated into the 12-step framework.  Additionally, AA offers a spiritual solution to a spiritual dilemma, and likewise Buddhism is a spiritual system in and of its own right that offers insight into questions related to suffering and the meaning of life.  Furthermore, Buddhism may seem a valid non-threatening alternative to mainstream Western religion for gay men who have often suffered religious abuse and persecution.  As practiced in North America, Buddhism tends to focus on mindfulness or direct meditative experiences as opposed to requiring adherence to rigid religious doctrine or allegiance to socially conservative spiritual leaders (Wada, 2009).  Many Buddhist centers in the United States have been active in a variety of social concerns including advocating for gay rights (Canda, 2002).  Therefore, as a theoretical proposition, gay men who exhibit both narcissistic personality traits and substance use disorder could reap substantial health benefits from the integration of Buddhist philosophy and meditation practice into the 12-step addiction recovery framework.

However, the propositions advanced herein raise several important questions for future research and study.  The very purpose of this paper has been to identify barriers faced by gay men in accessing 12-step recovery and to propose how those obstacles may be removed.  One concern which remains is whether adopting an esoteric spiritual philosophy is the most effective means for overcoming the isolation and sense of separateness which make recovery difficult for gay men in the first instance.  Even though Buddhism is a valid alternative to traditional theism, there is a risk that assuming the identity of “gay Buddhist” in a socially conservative Christian culture could exacerbate the sense of separateness and invoke further prejudice against the gay person.  Those who live close to a Buddhist Sangha or meditation center could turn to these groups for support in their endeavor to integrate Buddhism and the 12-steps, but many who live in rural areas will not have the luxury of this option.  The fact is that many who choose a Buddhist path in recovery will face the difficult challenge of overcoming religious and philosophical estrangement without the direct guidance of other Buddhist practitioners.  On the other hand, even though it would seem that the prototypical gay Buddhist will have scant in common on the surface level with an evangelical Christian, both may share fertile ground for spiritual growth.  Both the recovering Christian and the recovering Buddhist experienced the common peril of addiction, and both have found faith in a common spiritual solution.  These are powerful elements that can bind these AA members together notwithstanding differences related to religious dogma.  Ultimately, it may only be necessary to assume a “spiritual identity” and follow a “spiritual solution” for these unlikely bedfellows to unite in the fellowship of the AA spirit.  Buddhism which seems safe, inclusive and internally affirming could provide the needed spiritual identity for gay men to overcome isolation and to connect to the fellowship of AA.

With that being said, the overtly religious expressions and references to a theistic god will persist in AA notwithstanding the fact that some members have adopted Buddhist philosophy and meditation practices.  Those who bristle with antagonism at the use of Judeo-Christian vocabulary will continue to find it difficult to affiliate with AA even in light of newly discovered Buddhist philosophy.  For such persons, it may help to accept that AA meetings merely reflect the cultural contexts in which they occur, and that context is decidedly Judeo-Christian in the West.  As such, the process of recovery will likely only begin when there has been a deep surrender and a strong desire to go to any length to remain clean and sober – even if it means confronting prejudice against organized religion and accepting spiritual help.  From the depths of end-stage addiction, there emerges the sort of honesty, open-mindedness, and willingness that is required to sustain recovery.  Going forward, as Ragir (2013) points out, the Buddhist in 12-step fellowships must learn to make the translation from Judeo-Christian terminology to the non-theistic language of Buddhism.  Fortunately, there is a growing base of information related to Buddhism and the 12-steps to aid in such an endeavor (Griffin, 2010; Ragir, 2013).  Before referring gay men to a 12-step fellowship, treatment professionals should explore with their clients issues related to religious abuse and internalized homophobia.  Rather than ignoring the Judeo-Christian slant of many 12-step fellowships, practitioners should discuss this issue openly with clients and help them process any fears related thereto.  Recognizing that these clients will often have had little exposure to alternative forms of spirituality and few resources, practitioners will need to be prepared to make necessary referrals and provide resource material in an ethically appropriate manner.

Finally, from the scientific research perspective, sampling gay populations can prove to be a difficult challenge.  As a practical matter, gay men are difficult to study because they are a hidden population.  Sampling in urban areas, gay bars, or gay social events is the most feasible method, but it is difficult to say whether such results could be generalized to the gay population as a whole.  Even more difficult, if not impossible, would be obtaining a representative sample of gay men who attend AA in rural and suburban areas.  Therefore, a qualitative, ethnographic research design may be the best approach for testing the theories advanced herein.  On the other hand, if a representative sample of gay men could be obtained, studying the effects of application of Buddhist philosophy and meditation practice to measures of spirituality generally would provide some guidance in terms of specific application to the 12-step recovery context.  If it were found that gay men who adopt Buddhist philosophy and meditation practice report higher levels of self-acceptance (diminished internalized homophobia) and spirituality, lower levels of narcissism, and lower levels of substance use, then these results might be rationally extended to the treatment of sub-populations of gay men, such as those with substance use disorder.

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LINKS TO OTHER SERIES INSTALLMENTS:
Part I: Spirituality, Addiction & Recovery
Part II: Narcissism, Addiction, & Sexuality

(Parts I, II and III of this series were originally written in the Spring Semester of 2013 by the Site Administrator in partial fulfillment of the requirements for the Bachelor of Integrated Studies Degree at Murray State University)

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