Restoring Damaged Relationships Through the Art of Invitation: Application with Addicted Incarcerated Women
Social Work & Christianity, Vol. 46, No. 3 (2019), 27–50
Journal of the North American Association of Christians in Social Work
Katti J. Sneed & Debbie E. Teike
This article presents a description of Art of Invitation as a complementary approach to traditional addiction treatment through the alignment of Art of Invitation (AOI) with Substance Abuse and Mental Health Services Administration’s (SAMHSA) Ten Guiding Principles for Recovery. AOI is a faith-based relationship building approach that combines key Judeo/ Christian teachings with relationship building tools, skills, and concepts for those seeking to build and restore relationships. SAMHSA spearheads public health efforts to advance behavioral health within the United States. Each Guiding Principle is presented along with a description of how AOI is shared with incarcerated women, an often neglected population, participating in an inpatient treatment program housed in a community corrections facility.
Building and restoring relationships is a significant motivation for those recovering from addiction
(SAMSHA, 2012a). Additionally, many desire that spiritual and/or religious perspectives be offered alongside traditional recovery treatment modalities (Arnold, Avants, Margolin, & Marcotte, 2002). Yet, there is a lack of integrated addiction treatment options. The Art of Invitation (AOI), a faith-based psychoeducational relationship building approach, is one potential option for those recovering and desiring access to faith-based perspectives, along with traditional treatment modalities. Alignment with Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) Ten Guiding Principles of Recovery provides validity for AOI to be recognized as a viable resource in working with persons in recovery. Further support for AOI as a recovery resource for persons with substance use disorders is found in the literature where connections between SAMHSA’s Guiding Principles and AOI’s approach are established. The application of AOI with Women Recovering with a Purpose (WRAP) provides tangible examples for service providers and those supporting individuals in recovery of how integration between a faith-based offering and a traditional treatment provider is achieved.
Art of Invitation
AOI, a relationship building approach, is one option for those recovering from addiction who desire spiritual and religious integration with traditional treatment modalities. In 2009, AOI was created to equip seminary students with skills to overcome communication barriers with parishioners in their future vocation by Debbie Teike, LCSW. The program was subsequently presented in churches, a county jail, and nonprofit settings with modifications ranging from a one- time workshop style to a multi-week sessional style option fitting the needs of the audience (Teike & Sneed, 2018). Teike and Sneed (2018) conducted a phenomenological qualitative study and found support for universal application of AOI across a wide variety of populations (Teike & Sneed, 2018).
AOI is an integration of social science and Judeo/Christian teachings, specifically social exchange theory and the Golden Rule in practice (Teike & Sneed, 2018). Social exchange theory holds that people do what benefits
them in relationship and withdraw from interactions with negative impact (Cook, 1987; Thomas & Iding, 2012; Stafford, 2015). Blau (2008) and Bell (2009) note that if a moral conviction is in place, altruistic motives may account for exceptions to social exchange theory in its purest form. Such moral convictions can be found in Judeo-Christian traditions which support altruistic behavior without an expectation of personal reward (Friedman, 2002). In addition, Duhaime (2015) finds that meaningful connections with religious concepts increase prosocial behavior. Therefore, AOI has the potential to help those in recovery build and restore relationships as it combines Judeo-Christian teaching, respects social work tradition and ethics, and aligns with best practices for recovery as outlined in SAMHSA’s CSAT TEN Guiding Principles for recovery- oriented systems of care. It is possible that participants benefit through integration of these separate ideals, as Chamiec-Case (2015) purports, for a thoughtful and sensitive integration of faith and social work as having the potential to create much more together than could be accomplished separately.
AOI connects the altruistic value of being “invitational” to the desire to build and restore relationships, and helps participants develop a sense of relational “belonging” whether an “insider” or “outsider” in any particular circumstance (Teike & Sneed, 2018). An invitational approach strives to relate to others as equals, regardless of role or position. Equal status is found in John 3:16 (New International Version), which declares that God loves the whole world. Equal status is also established for Americans in the Declaration of Independence which states, “All men are created equal, that they are endowed by their Creator with certain unalienable rights that among these are life, liberty and the pursuit of happiness” (US 1776). These two references, among others shared in AOI, help individuals identify and connect internally with motivation to treat others and themselves as equals and to match communication style with their intent. Invitational, presentational, and confrontational options are explored and practiced, along with challenges commonly faced from conflicting values, unmet relational needs, emotional dysregulation, and difference of opinion.
Early in AOI teachings, participants identify their current and desired relationships along with why they are important. This exercise allows for awareness of the potential to increase the number of satisfying relationships as well as to reduce negative energy generated from any unhealthy relationships of significance. While embracing their personal power to make changes within these significant relationships, AOI participants often express hope as well as other emotions, including grief. Recovery itself can be conceptualized as a grieving process, a letting go of the past and moving toward the future (Denning, 2004). Grief work can be essential in moving past self-blame into a realm of higher consciousness and is an integral part of the human process and a spiritual journey (Carroll, McGinley, & Mack, 2000). Likewise, the heavy load of guilt that recovering people typically feel explains the desire many individuals have for reconciliation and renewal, even forgiveness (VanWormer & Davis, 2008).
After the personalization of one’s relational world, other structural elements of AOI are taught, which include: insider and outsider experiences, three interactional approaches (i.e. invitational, presentational, and confrontational), three keys to invitational communication, the second thought process, barriers to invitation (i.e. conflicting values, unmet relational needs, emotional dysregulation, and uninvitational thought) and strategies for overcoming relational barriers invitationally (Teike, 2012). AOI framework is shared through the presentation of ideas, individual and group exercises, videos, discussion, and accompanying written materials. AOI explains how an “invitational mindset” is key to successful interactions and communication (Teike & Sneed, 2018).
AOI seeks to strengthen one’s ability to gain self-control when relationally triggered so as to establish congruence between internal experience and external expression (Teike, 2012; Teike & Sneed, 2018). Cerasoli and Ford (2014) conclude that intrinsic motivation is significant to goal attainment. Using an invitational approach, congruence is achieved as participants match motive (e.g. valuing others as equals; treating others as self) to communication style (e.g. invitational as defined by the Golden Rule and 1 Corinthians 13). Participants have opportunity to discover personal motivation and choices in their interactional styles with others as they progress through units which focus upon value clarification, relational needs, emotional regulation and dysregulation, and perspective. According to AOI, being invitational comes from the heart, which is hidden from view by others (1 Sam 16:7).
Significance of Relationship Building for Those Recovering from Addiction
The disease of addiction is impacted by relationships and has devastating effects on relationships. In fact, recently, Luke, Redekop, and Jones (2018) conceptualized addiction as a “relational disorder,” linking the neurophysiology of substance use disorders to interpersonal relationships (p. 184). The singular focus on the substance (e.g. alcohol, meth, heroin) or process (e.g. gambling, pornography) takes priority over the needs of others, as well as one’s own health and well-being (Horvath, Misra, Epner, & Cooper, 2018). The by-product of this reality typically leaves all involved feeling deceived, abandoned, and hurt. The nature of addiction circumvents relationships, causing an inward focus and pre-occupation, and, in many cases obsession, with the item of addiction (VanWormer & Davis, 2008). Hari (2015) states, “The opposite of addiction isn’t sobriety—it’s connection” (p.32). Internal personal judgment, decision-making, and perceptions are corrupted, leaving the individual who is living with addiction isolated from substantial relationships (Bryan, Quist, Young, Steers, & Lu, 2016).
While relationships suffer from addictions, relationships can be restored (U. S. Surgeon General, 2016). People are built for relationships; belonging, connecting, and mattering one to another are essential ingredients of life (Baumeister & Leary, 1995; Cyranowski et al., 2013; Seppala, Rossomando, & Doty, 2013; Genesis 1:26; Genesis 2:18; Matthew 22: 36-40; Romans 12:5). God created us to live in community and encourages us to love, pray for, encourage, and bear with one another (Colossians 3:13, James 5:16, John 13, I Thessalonians 5:11). A common denominator in the recovery process is supportive persons who foster recovery characteristics like hope and gratitude, while suggesting strategies and resources for change (Sheedy & Whitter, 2013). Cavaiola, Fulmer, and Stout (2015) concluded that social support was a powerful influence in maintenance of long-term recovery and has a positive impact on self-reported improvements in quality of life areas (i.e. ability to cope, social functioning, and health). Moreover, reciprocity and trust across multiple formal and informal relationships has emerged as an essential theme in men who were incarcerated (Laferty, Treloar, Butler, Guthrie, & Chambers, 2018). Ranjbaran and colleagues (2018) identified peer influence to be a major factor in addiction tendencies in college-age adults. Those with whom people interact affect who they are and who they become. This finding has also been confirmed in several other studies: Haller, Handley, Chassin & Bountress, 2010; Tarter, Fishbein Tompset, Domoff, & Toro, 2013.
AOI and WRAP
Women Recovering with A Purpose (WRAP) is an inpatient treatment program, which is housed in a community corrections facility as a partnership between a county community corrections and mental health provider. The inpatient portion of WRAP spans four to six months and includes the following program components: Seeking Safety, which focuses upon safety from Post-Traumatic Stress Disorder (PTSD) and substance abuse; Residential Drug Abuse Program (RDAP), an interactive journaling program which includes individual work, group work, and counseling; Texas Christian University Mapping Enhanced Counseling, a cognitive strategy shown to be effective in increasing client motivation, engagement, participation, and retention in treatment; and Moving On, a program toward reintegration into the community (McClure, 2018). Once the inpatient component is completed, those in WRAP participate in aftercare through day reporting to Court Services-Community Corrections with an electronic monitor (McClure, 2018).
AOI is one of several community-based voluntary offerings for participants in WRAP (Gaskill, 2017). AOI in WRAP began in 2012 through the cooperation and support of a local church involved in jail ministry. Weekly AOI offerings as part of WRAP, lasting an hour and a half in duration, have been primarily presented by Debbie Teike, LCSW. Ms. Teike has had assistance from lay ministers and an IOP Coordinator who holds ICADC, CADAC II certification. The version of AOI presented in WRAP is consistent in content to material shared in other venues, but it is tailored to be meet the needs of those recovering from substance use disorders.
Alignment of AOI with SAMHSA CSAT Ten Guiding Principles for Recovery-Oriented Systems of Care
Individuals, organizations, agencies, and communities all over the country are organizing toward a better system of care for those affected by substance use disorders (NIDA, 2015). For the Art of Invitation or any other faith-based initiative to be recognized as a viable resource in working with persons in recovery, it needs to align with the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) Ten Guiding Principles of Recovery. These historical, landmark guiding principles were derived through a multi-stage process, following the National Summit on Recovery forum in 2005. Key stakeholders were tasked to develop a definition of recovery and a common understanding of best practices (Sheedy & Whitter, 2013). Revised in 2010, the guiding principles include the following: Hope, Person-driven, Many Pathways, Holistic, Peer Support, Relational, Culturally Based, Addresses Trauma, Strengths / Responsibility, and Respect (SAMHSA, 2012b). Below is a description of how AOI is aligned with each guiding principle and demonstrated through selected examples of AOI in WRAP.
Recovery Emerges from Hope
Hope is a quality emphasized throughout the literature on substance use counseling (Miller, 2003; Doweiko, 2006; Walker, Godlaski, & Staton- Tindall, 2013). Without hope, there can be no effort, no working toward a meaningful goal (VanWormer & Davis, 2003). Belief in a greater power can foster hope, as hope, according to Asher (2001), is the palpable feeling that goodness is going to emerge in the world, the uplifting, even joyful experience of anticipating things to come. The belief that a loving Higher Power is in control and has one’s best interest at heart creates feelings of hope that life will get better.
We would be remiss to discuss hope without also mentioning the connection between hope, forgiveness, and God. Forgiving oneself is a crucial element in recovery (Lund, 2017). Guilt and shame often lead to self-hatred. Self-hatred does not provide favorable grounds for a new sober life (Webb, Girsch, Conway-Williams, & Brewer, 2013). Religiosity and spirituality are known to have a positive connection with increasing forgive- ness (Hernandez, et al., 2012). Interestingly, McGuire (2008) and Day & Lynch (2013) comment that it is not the Christian doctrine which assists in recovery, but the lived religion and belief that provides a foundation to explore such treatment issues as forgiveness, shame, and guilt. Self-hatred and self-forgiveness can be seen as linked to receiving forgiveness from God, consequently leading to hope (Lyons, Deane, Caputi, & Kelly, 2011).
Through connecting with one’s value as redeemed and loved by God, participants come from a strengths- based perspective to navigate through potentially difficult conversations. This faith-based perspective, combined with communication tools, equips AOI participants to address stigma and judgment, which Miller and Carroll (2006) identify as very real deterrents to hope and change. One technique taught in AOI is the Three Keys to Invita- tion: 1. seeking to understand without judging, fixing, or having an agenda; 2. sharing openly and honestly; and 3. caring and receiving care. The Three Keys are concrete tools to help with communication and improving future, particularly conflictual, interpersonal interactions. In one session, a WRAP participant was able to reframe interviewing dialogue while addressing a felony in her background by introducing herself as a person embracing recovery rather than as someone who made bad choices. After practicing with the group, this woman now had hope that she could communicate positively about herself and be in a better position to obtain employment.
Recovery is Person-Centered
The AOI content is shared in a descriptive as opposed to prescriptive manner; this allows for a person-driven application of the material. Addiction professionals and AOI facilitators alike need to abandon expectations about who is in control. According to Denning (2004), “When clinicians view an addict as being the problem or not motivated or in denial, they are often speaking of this conflict in expectations surrounding control” (p. 108). AOI embraces the fact that motivation for change (including abstinence from substances) resides in the person, not the facilitator (SAMSHA, 2012a). Consistent with the social work value of self-determination, Denning (2004) goes on to encourage clinicians to clearly affirm clients’ right to live their own lives, find their own goals and make their own decisions while helping them actuate their intent. Puffer, Skalski, and Meade (2012) further hone in on the importance of the person-centered approach; clients then may guide the discussion of spiritual issues. While the format of AOI provides content for participants to build relationships
and seek spirituality, discussion is adjusted to focus upon questions and issues of interest to participants. For example, in the AOI section focusing upon values and relational barriers, participants identify spiritual, moral, and personal values and relational needs once hidden by active use of substances. They then ask questions within the group as they feel comfortable. This experience of reconnecting to spiritual values in a sober state creates awareness of values congruent with one’s true self, and the group experience allows participants to invitationally listen and share with others: new insights, intentions, and meanings for personal and relational growth. In AOI, no one is “called on” or pressured to share, providing respect for each person’s privacy and comfort level of self-disclosure.
Recovery occurs via Many Pathways
Addiction treatment has historically undergone many transformations in modalities and interventions. Long- term and short-term inpatient and outpatient group treatment, day treatment, various medication assisted programs, 12-step self-help models, and interventions like Stages of Change, Cognitive Behavioral, and Rational Emotive have been just a few options. Studies conducted over the past 25 years consistently show that participation in some sort of substance use treatment program is effective as measured by reductions in substance misuse, improvement in personal health and social functioning, and reductions in public health and safety risks (U. S. Surgeon General, 2016; Zabatsky, Mendenhall, Fowler, & Harris, 2017). Yet, the National Institute of Drug Abuse (NIDA, 2018) reports that in 2011, only 2.3 million of the 21.6 million Americans needing treatment for a drug or alcohol use problem received treatment. The U. S. Surgeon General cites one in 10 receive some form of specialty treatment. Flynn and associates (2003) summarized that, collectively, only a third of clients successfully completing traditional long-term treatment were still sober during follow- up studies. Therefore, traditional treatment centers should not be the sole option for persons desiring to remain sober. AOI recognizes and reinforces core components of traditional treatment, yet offers additional pro-social teachings leading toward restoration of healthy relationships, increased self-awareness in communication style, awareness of the barriers to establishing solid relationships, and connection to Biblical teachings.
Recovery is Holistic
Moral values are often compromised in the erratic acting out of addictive behaviors, urges, cognitions, and motivations (Rotgers, Morgenstern, & Walters, 2005). Therefore, it makes sense that recovery needs to include a holistic view of balancing a spiritual and faith component with mind and body as they intersect with all other areas of a person’s life (Sheedy & Whitter, 2013). Spirituality has been found to reduce stress in the present and worries about the future (Jarusiewicz, 2000). Spirituality and religiosity sought out in recovery provides internal strength, facilitates the ability to cope, and promotes altruism toward others (Arnold, Avants, Margolin, &Marcotte, 2002; Puffer; Skalski, & Meade, 2012).
Literature on health, spirituality, and religiosity continues to support its positive contributions across a wide range of health, mental health, and addictions interventions (Koenig, King, & Carson, 2012; Oxhandler & Pargament, 2014). Clients are asking for inclusion of their spiritual and religious beliefs (Arnold, Avants, Margolin, & Marcotte, 2002) and expressing a preference for healthcare providers to initiate this discussion as integration supports their healing process (Stanley et al., 2011; Barrera, Zeno, Bush, Barber, & Stanley, 2012). Many addiction treatment counsel- ors believe that when individuals are reconnected to a positive spiritual momentum, they are more likely to take control of their lives (DiLorenzo, Johnson, & Bussey, 2001). Nearly all (95%) of Americans report a belief in a God or a higher power, with 75% of them indicating that religion/spiri- tuality influences the decisions they make (Billioux, Sherman, & Latkin, 2014). Miller & Thoresen (2003) summarize the benefits of spirituality as clarifying what is trivial and what is truly vital in life, reducing self-critical and hostile cognitions while fostering love, compassion, and forgiveness. Pardini and colleagues (2000) conclude that counselors need to incorporate spirituality into their interventions with substance abusing individuals. Believing in a master creator allows individuals to make sense of their trials and tribulations. It gives a sense of understanding and desire to help others (Koenig, McCullough, & Larson, 2001). Studies on addic- tion recovery indicate that approaches to heightened spiritual awareness markedly increase a sense of purpose in life (O’Connell, 1999; Wigmore & Stanford, 2017), which is a critical ingredient
in recovery (VanWormer & Davis, 2003). Internalized spirituality provides recovering individuals with an optimistic life orientation, buffers against emotional negativity, and provides a means for managing stress (Miller, 2003; Lyons, Deane, Caputi, & Kelly, 2011).
Connecting to a higher power invites and entices human beings in recovery to choose good over evil (Richards & Bergin, 2005). This influence further encourages the individual to bring his or her life into harmony with universal moral truths or laws of living such as personal and social responsibility, family commitment, self-sacrifice, integrity, humility, and respect for life (Miller, 2005). Turner (1993) interviewed recovering individuals who were sober for two or more years. Sommer (1992) did the same with those having between four and seven years of recovery. Each noted the significant elements spirituality played in creating the changes in self-perception, worldview, and behaviors leading to long-term abstinence. A more recent study by Acheampong and colleagues (2016) concurred that high levels of religion/spirituality were directly associated with decreased odds of relapse, even with those in a very risky subpopulation of drug users, and with women in recovery from polysubstance use.
The efficacy and pervasiveness of mutual-help groups such as AA and NA are well established as the primary means through which most engage in the spiritual component of recovery (Kelly & Yeterian, 2011). A spiritual program not affiliated with any particular religion allows individuals the freedom to overcome potential stumbling blocks, as was the case for Bill Wilson in the early years of AA’s founding (Gross, 2010). The importance of mutual-help groups is honored and respected by AOI as people find support, coping strategies, value, respect, and continual motivation toward recovery (Kelly & Yeterian, 2011). The addition of a religiously affiliated experience can also be of significance to those with substance use disorders (Crisp, 2010). As Hodge (2011) affirms, many individuals desire to integrate spiritual and religious perspectives into treatment.
Spiritual and religious practices stemming from the Judeo/Christian tradition are integrated into the AOI experience through celebrations of the church year, such as Christmas and Easter. Movies, advent wreath making, and observance of Holy Week are a few examples of activities included as opportunities for experiencing meaningfully significant activities together. Rituals such as these can lead to feelings of “peace, joy, meaningfulness, reassurance, and even ecstasy for participants.” These optional spiritual and religious practices help connect to the sacred, heighten social inter- connection, and promote feelings of stability, balance, and unity (Canda & Furman, 2010, p. 345). Additionally, a form of centering prayer is sometimes offered at the end of AOI sessions as a mindfulness experience and an opportunity to rest in God’s presence. AOI prayer time purposes to provide what Ferguson, Willemsen, & Castaneto (2010) suggest is a goal of centering prayer —being in relationship with God.
Music, mindfulness breathing, and progressive relaxation exercises are incorporated into the centering prayer experience, allowing participants a time to rest and/or contemplate. Meditation can be experienced as a way to cultivate a sense of inner calm, harmony, and transcendence often associated with spiritual growth (Leigh, Bowen, & Marlatt, 2005). This is most likely accomplished once the individual learns a technique of turning off or bypassing cognitive processing of usual daily preoccupations and concerns, allowing access to these other aspects of being (Marlatt, 2002; Fox, Gutierrez, Haas, Braganza & Berger, 2015). A growing body of research indicates that practices such as prayer, transcendental meditation, Zen, and yoga have measurable effects on the physiological processes in the brain (Miller & Thoresen, 2003; Leigh, Bowen & Marlett, 2005; Koenig, King, & Carson 2012; Morelli, Torre, & Eisenberger, 2014). Pargament, Murray- Swank & Tarakeshwar (2005) further found that prayer is an important coping response in helping individuals deal with the noxious effects of stress. Evidence suggests that praying for others may exert a positive effect on the health of the person praying (Krause, 2003). Tangenberg (2001) emphasized the importance of chemically dependent mothers with HIV utilizing their spiritual beliefs and practices as a coping mechanism. In a similar study, Arnold and associates (2002) summarized that in managing the challenges of living with HIV infection, drug abusers turned to spirituality to cope and support their recovery program. The fact that spiritual contemplation can be registered in terms of brain activity leads to a neuro-scientific reality (Begley, 2001).
Recovery is Supported by Peers and Allies
The format of AOI in WRAP is similar to offerings of AOI in other set- tings, with the addition of observances for special events and celebrations of holidays. These enrichment activities are intentionally added to help create community and mutuality among the incarcerated women and facilitators. Incorporating a snack, conversation, and prayer with unfamiliar people from outside the correctional facility may equate to what Goldberg and Hoyt (2015) call a microcosm of reality. Participants in the small group become familiar with that which might also be experienced in the larger community in the form of support from peers and allies. Relational exchanges are shared pertaining to faith or not significant to faith at all. AOI aims to provide what Denton (1990) notes as a faith nurturing perspective, emphasizing love and support as opposed to a distancing frame of reference, with an “us vs them” mentality. Successfully engaging in meaningful relationship equates to acceptance. Acceptance helps reinforce hope for betterment.
Recovery is Supported Through Relationship and Social Networks
Social support is a significant factor in considering treatment, engagement in treatment, and recovery (Cavaiola, Fulmer, & Stout, 2015). Making new friends, connecting with the outside world, modeling social behaviors and norms outside of substances are described as being as significant to the AOI experience as the tools and concepts themselves. Participants get to know contacts from the church and community, receive and show care, and live out concepts of AOI in real time. Inclusion into the larger faith community is an essential part of recovery and can successfully foster a sense of hope (Robinson-Dawkins, 2011).
In addition to assisting with recovery in general, AOI’s focus on relationship building can directly assist persons who are incarcerated as they reintegrate into society. Berg and Huebner (2011) emphasize the importance of relationships in rebuilding after incarceration and find recidivism is reduced with strong social ties. Strong social bonds are essential for reintegration and yet relationship dynamic variables change over time (Hepburn & Griffin, 2004). Lafferty, Treloar, Butler, Guthrie, & Chambers (2016) reinforce the importance of developing social capital for reentry success and note the significance of trust and safety among other elements in the development of formal and informal interpersonal connections. Being away from community and family can be isolating (Weill, 2016), and reintegration into the community from incarceration is enhanced through strong social relationships, a stable residence, and employment among other prosocial behaviors (Western, Braga, David, & Sirois, 2015).
Congregations hold vast resources of social capital which hold potential for relational connection, stability in residence, and employment networking. Doors of connection are explored and experienced through AOI for those who desire to reconnect or make a new connection with the local church as noted by Trulear (2011).
Recovery is Culturally Based and Influenced
Hodge (2011) argues that religion and spirituality represent a fundamental aspect of culture which is significant to the cognitive and emotional lives of many substance abuse clients. Westermeyer (2014), in his study on Alcoholics Anonymous, concurs that culture and spirituality are closely interconnected. An individual’s spiritual and religious beliefs, like any other set of cultural values, are legitimate considerations in the clinical process. To the extent that these beliefs are pertinent to a client’s recovery, they deserve the same respectful, ethical, and skillful attention as any other relevant value. Hodge (2011) suggests that spirituality emphasizes the personal, whereas religion emphasizes the corporate. Individuals who are normally uninterested in seeking traditional chemical dependency treatment may be more open to treatment that incorporates spirituality as a central dimension of therapy as it connects to their cultural values.
While spirituality and religiosity have been found to be culturally relevant, Canda and Furman (2010) caution social workers from executing a spiritually and religiously based program for fear of exerting undue influence from a position of power, neglecting participants’ rights to self- determination. Additionally, they caution against inappropriate pressure and proselytizing. Not addressing ethical concerns and the possible
limitations of AOI would be an oversight (Hodge, & Lietz, 2014). Knowing oneself, one’s motivation, and one’s hidden agendas (Locke, Myers, & Herr, 2001) is fundamental to respecting the first standard listed in the NASW Code of Ethics (2017), 1.01 Commitment to Clients: “The primary responsibility is to promote the well- being of clients. In general, clients’ interests are primary.” Therefore, any interactions with participants must be purposefully intended to assist attendees in making desired changes. According to multicultural practice competencies, social workers’ awareness of their own biases, knowledge, and skills with regard to their respective cultural backgrounds is fundamental (Straussner, 2004).
To address multicultural practice competencies on a programmatic level, WRAP staff makes a non-pressuring invitation to participants of the opportunity to attend AOI each week; some subsequently attend, and others choose not to participate. For those who choose to attend, participants learn that AOI is a faith-based relationship building approach with a connection to God’s invitation to us and our invitation to one another. John 3:16, Matthew 7:12, and Luke 6:31 of the New Testament Scriptures are pivotal verses, shared initially to provide a brief introduction. Participants are told that no one is called on or singled out; all input and beliefs are honored.
The weekly experience of AOI is about sharing tools and concepts while listening without judgement or assessment. In this way, AOI is not clinical or diagnostic. While formed out of social work tradition, AOI is shared in WRAP as a non-denominational, faith-based approach, identified with the church. This is culturally relevant because most participants of AOI self-identify as Christian, and many have a familiarity with the Scriptures. The predominant religious affiliation of WRAP participants, expressed as Judeo-Christian, is not surprising in that 71 out of 100 people in the U. S. identify as Christian, with the South and Midwest showing the most pervasive presence (Alper, & Sandstrom, 2016). Some participants in AOI describe having had negative experiences with the church, while for others the church has been a place of sanctuary. AOI provides a non-judgmental space for group members to explore and/or reconnect with their spiritual and/or religious cultural beliefs and values. When participants attend from other faith perspectives, sensitivity is shown to respect and honor participant self-determination of religious preference. This type of sharing is consistent with AOI keys to invitation: seeking to understand without judging, sharing openly and honestly, and caring and receiving care. The voluntary nature of the program, feedback from participants and staff, along with the positive findings from the exploratory study suggesting universal application of AOI across populations (Teike & Sneed, 2018) suggest that the potential benefits of offering a religiously- and spiritually-based pro- gram outweigh the potential risks of exerting undue influence upon those in recovery programs such as WRAP.
Recovery is Supported by Addressing Trauma
The National Center on Substance Abuse and Child Welfare (2015) cites exposure to trauma as a significant factor in substance use disorders. A study of 60 female participants in a prison-based substance use treat- ment program found that over half were diagnosed with PTSD and had significantly higher rates of drug relapse upon release than did women with a background of substance misuse only (Kubiak, 2004). Typically, sources of the trauma were early childhood sexual abuse and/or later domestic violence and rape experiences.
One of the most important system changes for a person needing help with coexisting disorders is the development of integrated treatment programs, now the preferred model of SAMHSA (2005). A parallel development of the principle of “no wrong door” means the healthcare delivery system (mental health, physical health, and substance use treatment) has a “responsibility to address the range of client needs wherever and whenever a client presents for care” (SAMHSA 2005, p. 12).
As part of the system of care, AOI is not intended to replace the intense therapeutic work leading to healing from traumatic occurrences. Yet, AOI could be considered a trauma informed environment in that it promotes safety, provides for transparency of purpose and context, recognizes the importance of peers, is collaborative, fosters an environment of mutual respect, encourages individualized strength building, and seeks cultural competence (SAMHSA, 2014).
One of the leading experts in trauma, Van Der Kolk (2015) connects trauma with a sense of shame and self- hatred that becomes trapped in the mind and body. Often these feelings become overwhelming and, in an attempt to suppress unwanted emotions, persons turn to chemicals to cope, consequently leading to addiction (Puffer et. al. 2012). Therefore, the incorporation of religiosity and spirituality in addiction treatment, as found in AOI, is encouraged (Jacobsen, Southwick, & Kosten, 2001). Positive religious coping is characterized by a belief in a loving God or Higher Power that offers support and help (Piderman, Schneekloth, Pankratz, Maloney, & Altchuler, 2007), as well as the use of a theological framework that helps one make meaning out of suffering (Pargament, Koenig, & Perez, 2000).
Religious coping may be mobilized during times of acute stress, specifically when an individual’s typical coping strategies may be insufficient to meet the demands of the stressor (Koenig, King & Carson, 2012). This also motivates the individual, without high religiosity, to use religious coping (Pargament et al, 2000). Acute stress is common to all persons in recovery; when coupled with trauma, developing healthy coping strategies, including religious coping, becomes instrumental in maintaining long-term sobriety (Glaser, 2013).
Van Der Kolk (2015) purports mindfulness as a way to calm the survival regions of the brain triggered by trauma yet stresses this only becomes truly helpful when combined with self-compassion. AOI is specifically designed to increase each group member’s sense of self-value; this leads to self-care and self-compassion. AOI participants often end each weekly session with a mindfulness meditation and/or prayer and, subsequently, group members report experiencing a sense of peace.
Recovery Involves Individual, Family, and Community Strengths and Responsibility
“Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery” (SAMHSA, 2012b, p. 7). The role of the church within communities needs to be addressed. Griffith, Myers, and Compton (2016) suggest that the church can help eliminate stigma and provide sanctuary when it is intentional about caring for those recovering or needing specialized care. Their research is with significant mental illness, but the implications are there for those recovering from substance use as well. Perez (2009) suggests the number of persons struggling with addiction are staggering, resources are limited, and people of faith can make a difference.
AOI provides the opportunity for church communities to responsibly address discrimination and foster social inclusion on two levels. First, con- tent and group interaction aim to validate participant worth and value on an interpersonal level. Self-perception issues which stem from stigma and judgment, even stigma and judgment from within the church, are refuted. The director of WRAP (R. Gaskill, personal communication, March 16, 2018) suggests the power of AOI, from the women’s perspective, is when people who are not in recovery want to associate with them. Social ties can transform identity (Weill, 2016), and in AOI, facilitators and participants are sojourners of faith, equally loved by God. Facilitators of AOI create what Saleebey (2006) describes as a helping environment through which skills, attributes, and abilities are consciously modeled.
Second, AOI helps fight stigma and judgement within the church, which is part of the larger community. As women from WRAP re-enter life in the community, they have the potential opportunity to connect with those within the church with a common language and experience. Where invitational and compassionate community is found within the church, those who may have at one time felt overlooked, forgotten, stigmatized, insignificant, and/or like an outsider can find places of connection (Teike, 2012) as insiders, which is particularly significant for those who desire to be a part of the larger church community. Having returned to the com- munity, belonging is communicated through signs like greetings and other welcoming nonverbals (Crisp, 2010). As WRAP participants interact with AOI facilitators and others in the community, interpersonal validation and inclusion in non-drug related community activities becomes an ordinary, yet significant, means of fighting stigma and judgment.
Recovery is Based on Respect
Respect is at the heart of AOI. An invitational approach strives to relate to others as equals, regardless of role or position. Ferguson & Walker (2002) identify respect as being one of the top ten relational needs of human beings. This spiritually based conclusion aligns with the significant work of John Bowlby, author of Attachment Theory, and Mary Ainsworth, who established the importance of a secure base and essential human needs for security, belonging, and acceptance (Riggs, 2010). People thrive when these relational needs are met and struggle when they go unmet (Leary, 2010; Seppala, Rossomando, & Doty, 2013). Significant to recovery is the work of Lieberman (2010) who asserts that pain experienced from rejection and relational distress runs through the same biological centers as physical pain. Maslow suggested that basic needs of food, shelter, clothing and safety are the most critical; however, brain science has revealed that relief from extreme social pain is critical to survival as well (Lieberman, 2010).
A respectful environment is essential in promoting recovery. To support this ideal, participants of AOI share together experiences of respect and disrespect as they connect to choices of communication style. For example, as participants role play a scenario in which a landlord shares a lease with a tenant in a confrontational, presentational, or invitational style, respect or lack of respect is viscerally experienced and discussed from both sides of the exchange. Additionally, the relational needs of Jesus, Paul, Mary, and Moses provide tangible Biblical examples of instances when relational needs of significant spiritual leaders were met, as well as neglected. As discussions ensue, individual experiences, insights, and perspectives are respected as authentic and valuable.
Through consistent investment of time and attention, respectful conversation, patience, and care, AOI strives to communicate a high relational value which equates to what Leary (2010) suggests is needed to experience acceptance.
This article demonstrated the alignment of AOI with the Ten Guiding Principles set forth by SAMHSA as demonstrated through the application of AOI with incarcerated women in a treatment setting. The guiding principles include: 1) recovery emerges from hope, 2) recovery is person- centered, 3) recovery occurs via many pathways, 4) recovery is holistic, 5) recovery is supported by peers and allies, 6) recovery is supported through relationships and social networks, 7) recovery is culturally based and influenced, 8) recovery is supported by addressing trauma, 9) recovery involves individuals, family, and community strengths and responsibilities, and 10) recovery is based on respect.
While AOI did not originate with the purpose of intervening with persons struggling with addiction issues, past participants of AOI suggest that there are universal applications in both secular and faith-based settings (Teike & Sneed, 2108). AOI is an additional option that complements other traditional addiction treatments. Since 2012, AOI has been facilitated in a Midwestern USA county inpatient treatment program with incarcerated women called Women Recovering with A Purpose (WRAP). As a psychoeducational approach to relationship building, AOI is a synthesis of science, social work practice, and Judeo-Christian beliefs, creating what Califano Jr. (2002) calls a sum total experience that is greater than its parts. The women in AOI and WRAP have anecdotally, consistently, and voluntarily expressed appreciation for the content, as well as the approach of AOI, as it relates to a spiritually based, psychoeducational offering. Insights and connections vary from person to person; however, when given the opportunity to reflect upon their experience, WRAP participants express overwhelming agreement that AOI supports their needs and recovery.
As past participants support the use of AOI in diverse settings (Teike & Sneed, 2018), the church has an opportunity to utilize AOI not only to show God’s love and kindness, but also to provide tangible and relational support to those seeking a restored life. Goode, Lewis, and Trulear (2011) suggest that churches should have specific ministries that provide for culturally sensitive approaches to special needs. Whereas churches are oftentimes known for culturally sensitive ministries for those who are homebound, those who are hospitalized, and those in hospice, AOI could be used by ministries and/or chaplaincies as a means to integrate faith and care for those with substance use disorders. Substance use has often led to persons being
hungry, thirsty, sick, a stranger, and in prison – those identified by Jesus as in need of our care (Matthew 25: 35-36; Luke 25-37).
While widespread application has yet to be tested, utilization of AOI with the women of WRAP seems to show great promise for the purposeful application of AOI in recovery and incarceration settings. Further development of AOI should include training materials for those who desire to share AOI with those recovering and/or incarcerated. A formal study could allow for greater understanding of recovery benefits and best practices. Restoration of relationships during recovery is essential, and as many people desire spiritual and/or religious perspectives to be incorporated and/or offered with traditional treatment modalities, AOI is one approach for those seeking a Judeo-Christian connection.
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Katti J. Sneed, Ph.D., LCSW, LCAC is Director of the BSW Program at Indiana Wesleyan University, 4201 S. Washington Street, Marion, IN, 46953. Email: Katti.Sneed@indwes.edu
Debbie Teike, LCSW, is founder of the Art of Invitation workshop, 1032 Coles Drive, Columbus, IN, 47201. Email: Debbie@artofinvitation.org
Key Words: Relationship, Communication, Addiction, Substance Abuse, Spirituality, Religiosity, Restoration, Incarcerated women, Art of Invitation