Gendered Members of Alcoholics Anonymous: Varieties of Spiritual Experiences in Recovery

Women and men share similar as well as different strategies in developing their spirituality as part of their overall 12-Step experience. Special attention is paid to gender differences to account for a variety of spiritual experiences in recovery. The language and use of metaphors as women and men work the 12 Steps in achieving a “spiritual awakening” is explored, recognizing the predominantly male ethos of Alcoholics Anonymous since its inception. The influence of age in expressions of spirituality, distinguishing between young adults, middle-age adults, and older adults, is referenced. Need for further understanding of gender differences, with a focus on the spiritual dimensions of recovery, is recommended.     

Religiousness and Spirituality as Possible Recovery Variables in Treated and Natural Recoveries

Abstract

Treatment and natural recovered (TR/NR), current alcohol-dependent (CAD), and nonalcohol-dependent (NAD) individuals were compared on the Brief Multidimensional Measure of Religiousness and Spirituality (Idler et al., 2003). For convenience, participants were sampled from the Greater Toronto Area for the retrospective study. The TR/NAD groups had higher overall spirituality levels including the domains of private religious practices and daily spiritual experiences than the NR/CAD groups. The TR, NR, and NAD groups had higher levels of the religiousness domain of religious commitment, and higher levels of the spirituality domains of values/beliefs and forgiveness than the CAD group. Fifty percent of the TR and 25% of the NR groups considered spirituality important for maintenance of recovery, even though the latter group had low levels of the construct.     

The Role of Spirituality in Physician Recovery from Alcoholism

Spirituality is a key component of healing. Physicians in the United States have incorporated mind, body, and spiritual connections into their practice, but around the world it has had varying levels of acceptance and utilization by the medical community. When physicians become patients, they also find support and comfort through spirituality, especially those with alcohol use disorders. Physicians who participate in Alcoholics Anonymous (AA) or 12-Step Facilitation (TSF) therapy and experience a spiritual awakening are likely to have a sustained long-term recovery. Those who participate in physician health programs with mandatory AA meeting attendance have high rates of total abstinence.     

A Role for Spiritual Change in the Benefits of 12-Step Involvement

Background:  Emerging evidence implies a role for spirituality in recovery from substance abuse. The current study examines the hypothesis that spiritual change helps mediate (or explain) effects for involvement in 12-step groups on recovery outcomes among substance-abusing populations.
Methods:  Participants (baseline N  = 733) received treatment at 1 of 5 day hospital and 7 residential substance abuse treatment programs in California. Assessments included a baseline interview and 1-year follow-up; analyses incorporated regressions informed by Baron and Kenny (1986) and Sobel's (1982) test. To assess spirituality, measures included (1) the Religious Background and Behaviors scale and (2) an item assessing whether or not participants had had a spiritual awakening through their involvement with 12-step groups.
Results:  Results confirmed the hypothesis. Increases in 12-step involvement from baseline to follow-up predicted higher odds of total abstinence at follow-up, and this relationship was partially explained by increases in spirituality. Results held in multivariate analyses and regardless of which spirituality measure was analyzed.
Conclusions:  The present study provides further evidence that spiritual change contributes to recovery, at least within the context of 12-step involvement. The study also deepens our understanding of how 12-step involvement works.     

Is snoring intensity responsible for the sleep partner’s poor quality of sleep?

Purpose

This study aimed to determine if the intensity of breathing noise (including snoring) and/or the presence of abnormal breathing events (ABE) are factors that trigger arousal/awakening of a snorer??s bed partner.

Methods

We conducted a prospective multicenter study investigating couples where the male had a chronic disturbing snoring. We simultaneously recorded the male??s respiration and snoring and the female?? sleep. We counted the number of arousals and awakenings during N2 sleep and randomly took nine of each. Then, for periods before, during, and after each arousal and awakening, we observed on the respiratory tracings what was happening in terms of breathing noise intensity and presence/absence of snoring and/or ABE.

Results

Thirteen couples were analyzed. The intensity of breathing noise and the presence/absence of snoring and/or ABE were comparable before and at initiation of arousal/awakening and between arousal and awakening. However, breathing volume intensity was lower and the presence of snoring and/or ABE was less frequent when the bed partner returned back to sleep from awakening compared to the other periods (p always <0.001).

Conclusions

The intensity of breathing noise or the presence of ABE does not seem to be essential to trigger an arousal or an awakening. However, the persistence of noise or events may prolong the duration of wakefulness during the sleep period and could be one factor that explains the bothersome snoring.     

Spirituality,Alcohol and Other Drug Problems

Summary

A brief examination of the history, central figures, and literature of spirituality in addiction studies is followed by a review of central concepts and a look toward the future of spirituality research. Some current initiatives are also examined.     

Look What God Can Do

Abstract

This qualitative study describes how ten African American gay men understand and utilize spirituality while living with AIDS. The narrative data indicate spirituality is a significant strength for these men. The participants describe spirituality, a relationship with God, as interactive, integrative, and protective. They indicate that spirituality helps them live with AIDS and alleviates death anxiety. The participants also posit that their experience with AIDS has strengthened their spirituality. Spirituality is an important resource for the men in this study. The data suggests social workers who work with this population explore the salience of Spirituality in the lives of their clients.     

Socio-demographics,spirituality, and quality of life among community-dwelling and institutionalized older adults: A structural equation model

PurposeThe increasing life expectancy of the population prompts an array of health conditions that impair an older adults’ quality of life (QoL). Although demographics and spirituality have been associated with QoL, limited literature elucidated the exact mechanisms of their interactions, especially in a culturally-diverse country like Philippines. Hence, this study determined the relationship among socio-demographics, spirituality, and QoL of Filipino older adults in a community and institutional setting.Materials and methodsA predictive-correlational study among 200 randomly-selected community-dwelling and institutionalized older adults was conducted, with a 99% power and a medium effect size. Data were collected using a three-part questionnaire from September to November 2015. The questionnaire was composed of the robotfoto, Spirituality Assessment Scale, and modified Older People’s Quality of Life which assessed socio-demographics, spirituality, and QoL.ResultsAnalysis showed that institutionalization in a nursing home positively and negatively affected spirituality and QoL, generating an acceptable model (χ²/df = 2.12, RMSEA = 0.08, and CFI = 0.95). The negative direct effect of institutionalization on social relationship, leisure, & social activities QoL (β=–0.42, p < 0.01) also initiates a cascade of indirect negative effects on both spirituality and QoL dimensions.ConclusionsThe development of a structural model illustrating the interrelationship of socio-demographics, spirituality, and QoL helps healthcare professionals in predicting facets of spirituality and QoL that can be compromised by living in a nursing home. This understanding provides impetus in evaluating and refining geriatric healthcare programs, policies, and protocols to render individualized, holistic care in a socially-cohesive environment among older adults.     

Spirituality and Religiousness and Alcohol/Other Drug Problems

SUMMARY

Spirituality and religiousness are multidimensional concepts in their philosophical, theological and healthcare connotations. Both concepts have been discussed extensively in the literature describing the origins, diagnosis and treatment of alcohol and other drug problems. Recovery communities, especially Alcoholics Anonymous, have been studied in terms of their ongoing conversations about spirituality and religiousness in the process of recovery. The contributions of authors, such as James, Tiebout, Kurtz, Whitfield, Brown, Miller, Morgan and White to an understanding of those concepts are highlighted.     

Empiric Use of Flumazenil in Comatose Patients: Limited Applicability of Criteria to Define Low Risk

Study objective: To develop clinical rules for the safe and effective use of flumazenil in suspected benzodiazepine overdose. Methods: We assembled a retrospective series of 35 consecutive comatose patients admitted between October 1992 and July 1993 to a toxicologic ICU with the presumptive diagnosis of drug overdose. These patients were divided into two groups. Group A (low-risk) patients had a clinical picture compatible with uncomplicated benzodiazepine intoxication (calm, without abnormalities in pulse or blood pressure, lateralizing signs, hypertonia, hyperreflexia, or myoclonus) in the absence of predefined electrocardiographic or clinical signs of tricyclic antidepressant or other proconvulsant overdose, and absence of an available history of long-term benzodiazepine treatment or an underlying seizure disorder. Group B ("non-low risk") comprised all other patients. Efficacy of flumazenil was categorized as complete awakening (with normal level of alertness), partial awakening, or no change in alertness level. The safety of flumazenil was defined on the basis of the absence of seizures or death. Results: In group A (n=4), flumazenil was associated with complete awakening in three patients and partial awakening in one. No seizures were observed. In group B (n=31), flumazenil was associated with complete awakening in 4 patients, partial awakening in 5, and no response in 22. In group B, five seizures occurred. Conclusion: Comatose patients with clinical or ECG criteria thought to contraindicate the use of flumazenil have a reasonably high risk of seizures after administration of this drug. Low-risk patients may be able to receive flumazenil safely, but they may be only a small portion of comatose patients with suspected overdose. [Gueye PN, Hoffman JR, Taboulet P, Vicaut E, Baud FJ: Empiric use of flumazenil in comatose patients: Limited applicability of criteria to define low risk. Ann Emerg Med June 1996;27:730-735.]     

The effect of remimazolam on postoperative memory retention and delayed regeneration in breast surgery patients: Rationale and design of an exploratory,randomized, open,propofol-controlled,single-center clinical trial: A study protocol

Background:Remimazolam, a benzodiazepine ultra-short-acting sedative, has been used in general anesthesia since August 2020. It is used in awake surgeries that require awakening the patient in the middle of the surgery because of its rapid awakening effect as well as antagonistic interactions. If remimazolam has associated anterograde amnesia similar to benzodiazepines, it will have a positive effect on preventing psychological trauma. However, to our knowledge, the effect of remimazolam on anterograde amnesia has not been previously examined.Methods/design:The aim of this exploratory, open, propofol-controlled, single-center, randomized clinical trial is to examine the effect of remimazolam on postoperative memory retention and delayed regeneration. Seventy patients undergoing breast surgery will be included in the study. The patients will be randomly assigned to receive propofol or remimazolam as sedatives during surgery. The primary endpoint is the number of posters patients remember 24 hours after surgery (among 4 posters shown after awakening from anesthesia) as an assessment of anterograde amnesia. Secondary endpoints are retrograde amnesia, dose of analgesic given from the time the patient returns to the ward until 24 hours after surgery, immediate postoperative pain numerical rating scale scores, and pain numerical rating scale scores 24 hours after leaving the operating room. Recruitment will take place between October 2021 and March 2022 to achieve the target sample size.Discussion:To our knowledge, this is the first trial designed to examine the effects of remimazolam on postoperative memory retention and delayed regeneration in patients undergoing breast surgery.Trial registration:This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center on September 28, 2021 (UMIN-CTR: UMIN000045593).     

The influence of religious beliefs and practices on health care decision-making among HIV positive adolescents

ABSTRACT

It is unknown if religiousness/spirituality influences end-of-life treatment preferences among adolescents. Investigators assessed whether religiousness/spirituality moderates the relationship between an advance care planning intervention and end-of-life treatment preferences among 85 primarily African-American adolescents living with HIV/AIDS in outpatient-hospital-based HIV-specialty clinics in the United States. Adolescents aged 14–21 years living with HIV/AIDS and their families were randomized to three-weekly-60-minute sessions either: advance care planning (survey, goals of care conversation, advance directive); or control (developmental history, safety tips, nutrition/exercise). At 3-months post-intervention the intervention effect (decreasing the likelihood of choosing to continue treatments in all situations) was significantly moderated by religiousness/spirituality. Highly religious/spiritual adolescents were four times more likely to choose to continue treatments in all situations. Thus, intensive treatments at end-of-life may represent health equity, rather than health disparity. The belief believed that HIV is a punishment from God at baseline (15%, 14/94) was not associated with end-of-life treatment preferences. Twelve percent (11/94) reported they had stopped taking HIV medications for more than 3 days because of the belief in a miracle. Religiousness moderates adolescent’s medical decision-making. Adolescents who believe in miracles should receive chaplaincy referrals to help maintain medication adherence.     

Chronotherapy of Hypertension with Angiotensin Receptor Blockers–A Meta-Analysis of Blood Pressure Measured by Ambulatory Blood Pressure Monitoring in Randomized Trials

BackgroundWe performed this meta-analysis evaluating the efficacy of chronotherapy of hypertension with angiotensin receptor blockers (ARBs).MethodsWe searched Pubmed, Web of Science, and Cochrane for all published randomized trials that compare antihypertensive effects of ARBs between bedtime dosing and awakening dosing. Blood pressure (BP) was measured by ambulatory BP monitoring in patients with mild or moderate essential hypertension.ResultsThe effects of ARBs on BP were assessed in 805 essential hypertensive patients included in 8 trials with a follow-up of 12 ± 3 weeks. The sleep-time systolic and diastolic BP (SBP, DBP) with bedtime dosing greatly decreased as compared with awakening dosing (weighted mean differences [WMD] for SBP WMD ?5.23 [95% confidence intervals (CI), ?7.27, ?3.20] mm Hg, p < 0.001; WMD for DBP ?2.94 [95% CI, ?4.52, ?1.36] mm Hg, p < 0.001). The reduction of daytime SBP (WMD 0.98 [95% CI, ?0.20, 2.17] mm Hg, p = 0.10), DBP (WMD 0.11 [95% CI, ?0.68, 0.89] mm Hg, p = 0.79), 24 hour SBP (WMD ?0.75 [95% CI, ?1.93, 0.42] mm Hg, p = 0.21) and DBP (WMD ?0. 77 [95% CI, ?1.55 0.01] mm Hg, p = 0.05) with bedtime dosing was similar with awakening dosing.ConclusionsBedtime dosing with ARBs is more effective in lowering sleep-time BP than awakening dosing in patients with essential hypertension, suggesting a utilization of chronotherapy of hypertension with ARBs to reduce sleep-time high BP. Larger multi-ethnic studies are needed to investigate the efficacy of chronotherapy of hypertension.     

Toward an Enhanced Understanding of the Psychological Mechanisms by which Spirituality Aids Recovery in Alcoholics Anonymous

Alcoholics Anonymous (AA) is based on a spiritual program of action. In keeping with AA's spiritually based recovery theory, rigorous studies have revealed that spirituality may be one of the mechanisms through which AA aids recovery. A question that has lingered, however, is how exactly does an increase in spiritual beliefs and practices translate into more abstinence and remission? To help answer this question, this article reviews theory and research related to AA and spirituality as a mechanism of behavior change and offers five possible psychological pathways that may help explain how increases in spirituality may translate into enhanced abstinence and remission rates.     

Benzodiazepine-like Compounds in the Plasma of Patients with Fulminant Hepatic Failure

Background: Benzodiazepine-like compounds have been implicated in the pathogenesis of encephalopathy after fulminant hepatic failure. Methods: The levels and the nature of benzodiazepine-like compounds were determined in six cases of fulminant hepatic failure during the course of the disease. Blood samples were collected on admission and a few days later, when the neurologic status had improved in five cases and immediately before death in one case. The compounds were measured in sera with a binding technique after high-performance liquid chromatography purification and analyzed with mass spectrometry. Results: Their levels were highly variable in those with severe encephalopathy and were still increased on awakening in some cases. Diazepam and N-desmethyldiazepam were inconsistently present. Conclusions: The inconsistent presence of benzodiazepine-like compounds in encephalopathy after fulminant hepatic failure and their persistence, in some cases, at high levels on awakening from coma seem to indicate that the encephalopathy is not strictly dependent on the levels of these compounds.     

Effect of family presence on stress response after bypass surgery

BackgroundCoronary artery bypass grafting (CABG) is a major surgery that may cause severe surgical stress response (SR). Although the presence of family members in intensive care unit (ICU) is known to benefit intensive care patients socially and emotionally, its effects on surgical SR are unknown.ObjectivesTo investigate the effect of an informed family member (IFM)’s presence in the awakening process in ICU on patients’ SR after CABG.MethodsA nonrandomized controlled clinical study was completed with a total of 73 patients: 37 patients in the control (CG) and 36 in the intervention group (IG) underwent CABG surgery. In the CG patients, no family members were taken into the ICU during the awakening process and routine care and treatment practices were continued. In the IG patients, besides routine care and treatment practices, an IFM was taken into the ICU during the awakening process in accordance with the research method. Groups were statistically compared in terms of serum cortisol level which is the one of the main indicators of surgical SR, state anxiety, sedative drug requirements, and duration of intubation, sedation, and ICU stay. A p value <0.05 was accepted as statistically significant.ResultsPresence of an IFM in the ICU was found to be effective in decreasing serum cortisol level, state anxiety, sedative drug requirements, and the duration of intubation, sedation, and ICU stay (p<0.05).ConclusionsIn CABG, the presence of IFM in ICU is effective in reducing SR.     

Systemic arterial gas embolism (SAGE) as a complication of bronchoscopic lung biopsy: a case report and systematic literature review

BackgroundSystemic arterial gas embolism (SAGE) is a rare yet serious and underrecognized complication of bronchoscopic procedures. A recent case of presumed SAGE after transbronchial needle aspiration prompted a systematic literature review of SAGE after biopsy procedures during flexible bronchoscopy.MethodsWe performed a systematic database search for case reports and case series pertaining to SAGE after bronchoscopic lung biopsy; reports or series involving only bronchoscopic laser therapy or argon plasma coagulation (APC) were excluded. Patient data were extracted directly from published reports.ResultsA total of 29 unique patient reports were assessed for patient demographics, specifics of the procedure, clinical manifestations, diagnostic findings, and clinical outcomes. Cases of SAGE occurred after multiple types of bronchoscopic biopsy and under both positive and negative pressure ventilation. The most common clinical findings were neurologic, followed by cardiac manifestations; temporal patterns included acute onset of cardiac or neurologic emergencies immediately after biopsy, or delayed awakening post-procedure. There was a high mortality rate among cases (28%), with residual neurologic deficits also common (24%).DiscussionSAGE is an underrecognized but severe adverse effect of bronchoscopic lung biopsy, which often presents with acute coronary or cerebral ischemia or delayed awakening from sedation. It is important for all physicians who perform bronchoscopic biopsies to be aware of the clinical manifestations and therapeutic management of SAGE in order to mitigate morbidity and mortality among patients undergoing these procedures.     

Modifying factors of the health belief model associated with missed clinic appointments among individuals with sickle cell disease

ABSTRACT

Objectives: Outpatient care is critical in the management of chronic diseases, including sickle cell disease (SCD). Risk factors for poor adherence with clinic appointments in SCD are poorly defined. This exploratory study evaluated associations between modifying variables from the Health Belief Model and missed appointments.

Methods: We surveyed adults with SCD (n?=?211) and caregivers of children with SCD (n?=?331) between October 2014 and March 2016 in six centres across the U.S. The survey tool utilized the framework of the Health Belief Model, and included: social determinants, psychosocial variables, social support, health literacy and spirituality.

Results: A majority of adults (87%) and caregivers of children (65%) reported they missed a clinic appointment. Children (as reported by caregivers) were less likely to miss appointments than adults (OR:0.22; 95% CI:(0.13,0.39)). In adults, financial insecurity (OR:4.49; 95% CI:(1.20, 20.7)), health literacy (OR:4.64; 95% CI:(1.33, 16.15)), and age (OR:0.95; 95% CI:(0.91,0.99)) were significantly associated with missed appointments. In all participants, lower spirituality was associated with missed appointments (OR:1.83; 95%CI:(1.13, 2.94)). The most common reason for missing an appointment was forgetfulness (adults: 31%, children: 26%). A majority thought reminders would help (adults: 83%, children: 71%) using phone calls (adults: 62%, children: 61%) or text messages (adults: 56%, children: 51%).

Conclusions: Our findings demonstrate that modifying components of the Health Belief Model, including age, financial security, health literacy, spirituality, and lacking cues to action like reminders, are important in missed appointments and addressing these factors could improve appointment-keeping for adults and children with SCD.     

Integrating Spirituality and Culture with End-of-Life Care in Medical Education

ABSTRACT

To provide high-quality care that is responsive to spiritual concerns within a multicultural context, student physicians and other health care professionals must develop skills in spiritual care and be able to do so with patients from different cultures and different spiritual and religious backgrounds, particularly at the end of life. This article describes the experience of successfully introducing a curriculum on spirituality and multicultural literacy into the required Family Medicine Clerkship at Stanford University School of Medicine. Rather than a program of separate classes on spirituality, culture, and end-of-life care, an effective curriculum includes a matrix of learning activities that address: 1) a cross-cultural approach to spiritual needs, 2) spirituality at the end of life, 3) the impact of cultural values at the end of life, 4) the ways in which cultural and spiritual needs interact at the end of life, and 5) the interface between medical culture and a patient's culture. Integrating spirituality and culture with end-of-life care into the fabric of the medical school curriculum is an essential step toward serving our increasingly multicultural and multireligious society.     

Developing and testing a model of quality of life among chronically-ill,community-dwelling older adults: A structural equation model

PurposeAlthough healthy ageing aims for better quality of life, the inability of older adults to adequately care for themselves and their health impair the realization of such objective. Moreover, in a collectivist community like the Philippines, the family, community, and Transcendent are inseparable in promoting quality of life. This study developed and tested a model of quality of life (QoL) among chronically-ill, community-dwelling older adults.Materials and MethodsFrom August to November 2017, a cross-sectional study of 304 chronically-ill, community-dwelling older adults from selected rural communities in the Philippines was conducted. Respondents completed a five-part survey packet composed of the socio-demographic profile, modified Older People’s Quality of Life, Spirituality Assessment Scale, Hypertension Self-Care Profile, and Diabetes Self-Management Questionnaire.ResultsSocio-demographics, community satisfaction, spirituality, and disease self-management accounted 29.00% of QoL, generating a good model (χ²/df = 1.44, RMSEA = 0.038, and PNFI = 0.64). Spirituality (β = 0.34, p < 0.01) was the strongest predictor of QoL, while community satisfaction had both direct (β = 0.26, p < 0.01) and indirect (β = 0.08, p < 0.01) effects. Disease self-management directly (β = 0.15, p = 0.016) influenced QoL. In contrast, longer chronicity and larger family size impair QoL.ConclusionQuality of life among chronically-ill, community-dwelling older adults is a multi-faceted health construct influenced by socio-demographics, disease self-management, community satisfaction, and spirituality. The presented model highlights the positive effect of disease self-management, community satisfaction, and spirituality which can be utilized in developing appropriate community-based geriatric strategies, policies, and programs. Further, forming collaborative groups with socially-active community elderly and community-based self-care programs can be ventured to address the needs of older adults.