INTRODUCTION: Alcohol and drug dependency are becoming a serious problem worldwide. While alcohol and drug addiction prevalence varies among countries, addiction prevalence rates have been reported as high as 4-9% in the USA. Lifelong addiction/abuse rates are estimated to be 13.8% for alcohol and 6.2% for drugs. Addiction increases mortality 4.25-fold in intravenous drug use, and drug users are more prone to contract HIV and genital infections. Recently in our country, mortality events are increasing due to use of “bonsai”, which is a local mixture of various addictive drugs. In alcohol/drug abusers, suicidal events are frequent (up to 16-71%), often accompanied by psychiatric disorders such as antisocial personality disorder, schizophrenia, or bipolar mood diseases. Although Edlund could not find a relationship between drug addiction and religious beliefs, there are many studies reporting an inverse relationship between alcohol / drug addiction and religious faith. Kelly found a higher treatment response among religious cases in their studies, but the mechanism is not clear. Religious people have been found to have a low prevalence of drug and alcohol abuse because almost all religions have a negative attitude towards addiction and abuse. Studies involving religious living and belief in God in psychiatric diseases are limited in Muslim countries. In our study, we aimed to investigate the influence of religious beliefs on drug/alcohol addiction severity and psychopathologic dynamics among patients.
METHODS: We studied 139 patients who had been admitted consecutively to the outpatient clinic for Alcohol and Drug Research, Treatment and Training Center (AMATEM) at Ankara Numune Hospital in Turkey between May and July 2013 with a diagnosis of drug and alcohol dependency. We performed a cross-sectional study. Instruments we used for the study were Addiction Profile Index (API), God Perception Scale (GPS), Attachment to God Scale (AGS), and Adult Attachment Scale (AAS).
Addiction Profile Index: API is a self-report questionnaire consisting of sociodemographic data containing 37 items. API involves the following 5 subscales: characteristics of substance use; diagnosis of dependency; effects of substance use on the user; craving; motivation to quit using substances. Development, validity and reliability assessments of the scale were made by Ogel et al.
God Perception Scale: GPS is for measuring an individual’s perception of God. There are 22 self-report items. High scores show positive (loving/love based) perception, low scores show negative (punitive/fear-based) perception. Validity and reliability studies of the scale were made by Guler.
Attachment to God Scale: It contains 24 self-report items and evaluates the attachment to God as secure or anxious. Validity and reliability studies of the scale were made by Korkmaz.
Adult Attachment Scale: There are 18 items in a yes-no response form for the evaluation of three types of attachment, namely, secure, avoidant, and anxious/ambivalent. Validity and reliability of the scale were established by Kesebir. Statistical analyses were conducted using SPSS Statistics 20.0 program. For comparison of means, student t-test and one-way ANOVA test were used for parametric data, Mann-Whitney U and Kruskal Wallis tests for nonparametric data. Descriptive information is presented as N (%). Categorical group was compared by the Chi-Square test. Correlation analyses were performed by Pearson and Spearman Correlations. P-level was set to 0.05.
RESULTS: There were 133 males and 6 females, ages 18-65 years. Mean age was 27.84±8.99 (min 18-max 65). 51.1 percent of patients were between 18 and 25 years. 56 patients (40.3%) had been educated for 13 or more years. 133 patients (95.7%) were men, only 6 patients (4.3%) were women. 103 patients (74.1%) were single and 36 patients (25.9%) were married. 44 patients (31.7%) had children. 19 patients (13.7%) were using alcohol, 68 patients (48.9%) were using heroin and 52 patients (37.4%) were using alcohol and heroin/ other substances together. The scores of GPS, AGS and AAS did not differ by type of addictive substance. According to cut-off score of 10.7 at API, 93 (66.9%) of the patients were highly dependent and 46 (33.1%) of the patients were slightly dependent. AGS scores and anxious/ambivalent attachment scores of AAS were significantly higher in the highly dependent group. Conversely PGS scores were high in the slightly dependent patients. AGS-2 was correlated with Total API scores and subscales exact API-1. Anxious/ambivalent attachment scores of AAS were correlated with Total API and API-4 (craving). API-4 (craving) was correlated with AGS-2 scores (p=0.001, r=0.282), anxious/ambivalent attachment scores of AAS (p=0.010, r=0.218) and PGS scores (p=0.014, r=-0.209). API-5 (treatment motivation) was correlated with AGS-1 and 2. Anxious/ambivalent attachment of AAS was correlated with AGS-1 (r=-0.190, p=0.026), AGS-2 (r=0.184, p=0.031), PGS (r=-0.516, p=0.000). DISCUSSION: In our study of 139 addicts, 133 were male and 6 were female. Rates of alcohol addiction was 13.7%, heroin addiction 37.4% and mixed addiction was 48.9% among the cases. We found that 66.9% of the patients had high addiction profiles and 33.1% low addiction profiles. Cases with anxious/ambivalent adult attachment had high addiction profiles. Patients with secure and avoidant adult attachments did not exhibit such a relation. A review reported a study with 71 German opiate using, drug dependent adolescents (DDAs) and 39 non-clinical controls. Fearful attachment was predominant in DDAs, while controls were predominantly secure. Severity of drug use was positively correlated with fearful attachment. Our results were in accordance with this study. The addicts with anxious/ambivalent God attachments showed high addiction profiles, which is not encountered in cases with secure God attachment in this study. Similarly, Horton examined 328 college students and showed that secure attachment to God was not inversely associated with recent alcohol or marijuana use or any other substance use. Avoidant and anxious attachment to God are associated with higher levels of addiction. The Attachment Theory was first suggested by Bowlby, who is a pediatric psychoanalyst. This theory says that the attachment fashion, which is formed early in the infancy period between mother and baby, does extend into adult life and influences cognitive and emotional development. The attachment pattern between mother and baby determines the person’s future self-confidence, social attitudes, selfrespect, occupation selection, and marital status. This theory may be applied to religious beliefs and may be used as a tool for explaining of psychologic disorders. Kirkpatrick and Shave tried to bring together attachment theory and spirituality in their study. The correspondence hypothesis of Kirkpatrick makes direct relation between religious attachment and childhood mother attachment. When we evaluate our results, cases with punitive/fear based God perception showed high addiction profiles, in contrast to low addiction profiles of cases with loving/love based perceptions, as we expected. Almost all schools like the school of subject associations, the transpersonal school, and the phenomenological school in psychotherapy tried to explain the relationship between God perception and the perception of self and the world according to their point of view. As a result, perception of God and its positive or negative fashion is a result of a person’s environment, information, and religious background. In our study, we found a relationship between anxious adult attachments and negative god attachment patterns. However, we could not find this for persons having secure attachments. Such a result suggests a role of negative adult attachment patterns in the formation of negative God attachment patterns. Hence the influence of God attachment may exhibit a positive impact on dealing with psychiatric disorders, especially in addiction. It is believed that persons who are attached to God in a secure pattern live a more positive social and emotional life. They have stronger social relations and more optimistic approaches. According to the Attachment Theory, persons with a lovely/merciful attachment to God have higher self-confidence and self-respect. Persons with anxious attachment to God seek and expect stronger and more emotional religious feelings, while persons with an avoidant attachment pattern frequently avoid having close relations with God and beliefs. In particular, we can think that a punitive God perception may have a stronger impact on a person’s adult attachment in an Islamic population. We found higher craving rates among cases with negative adult attachment pattern, negative God attachments, and negative God Bulletin of Clinical Psychopharmacology, Vol: 25, Supplement: 1, 2015 - www.psikofarmakoloji.org S69 Candidates of TAP Outstanding Research Awards perception in both alcohol and drug users. Thorberg et al. found that anxious attachment partially mediated the relationship with craving in a heavily drinking population. Thus, abusers which attach anxiously probably require a secure field or need unconsciousness to divert in their lives. While attachment theory may be applied to many other psychologic conditions, our study showed, similar to many previous studies, a probable link between attachment theory and religious perceptions. Negative religious attachments were more linked to severity of alcohol/drug addictions than positive attachments. The attachment starts with the mother-baby relation and probably influences the relation with God and determines our beliefs. According to our study, the addiction pathology was related to religious perceptions, and the type of addictive drug was found related with addiction severity. We also suggest a complete approach in addiction treatment consisting of family life, religious perceptions, and general psychopathology. Such an approach may also be applied to government policies and future studies.