As other chapters in this book have made clear, spirituality has a part to play in treatment planning in all areas of psychiatry. Patient-centred psychiatry will always properly consider the ways in which the spiritual/religious concerns of patients might have an impact upon treatment. These concerns can often be utilised to good effect, but sometimes, if they go unrecognised, they may present barriers to effective treatment. It is important to know, for example, if a patient might not take their prescribed medication because they feel that they need to trust in God, rather than in tablets. More positively, prayer, meditation and other religious practices can provide significant coping resources during the course of treatment and recovery, and it is helpful for the clinician to affirm this rather than neglect or, worse still, undermine it.

Historically, mental health care was provided within a religious context. As scientific approaches to the study of mind and brain developed from the seventeenth century onwards, the spiritual and religious elements of care became separated from the biological, psychological and social elements. The rift grew under the combined influences of biological reductionism, Darwinism, behaviourism and psychoanalysis. In the later twentieth century, a new wave of scientific research on spirituality and religion began to reverse this trend. Spirituality came to offer a more subjective and individualised approach to transcendence, which did not necessarily require religious affiliation. Psychiatrists have found a more positive place for spirituality in both clinical practice and research. This has been reflected internationally, in professional organisations, policy, debate and training. A growing evidence base demonstrates the positive benefits of spirituality/religion for mental health, and patient-centred care requires that spiritual/religious issues be addressed with sensitivity and respect.

Any role for spirituality in addressing the serious clinical and public health problems related to substance misuse and addiction might seem antiquated at best, and clinical malpractice at worst. Yet, from a phenomenological perspective, addiction often penetrates and pervades the core of conscious thought and behaviour, undermining personal values and meaning and purpose in life – factors that many people associate with a diminished sense of personal spirituality. Research on spiritual/religious identity and practices has shown that these both protect against the onset of substance misuse and help millions each year to recover from it. This chapter reviews the interplay of morality, spirituality/religion and substance misuse, suggests why addiction in particular is so prone to spiritual pathology, and describes why spirituality/religion have played such prominent roles in successful remission and stable recovery. Spiritually oriented treatment approaches to addiction are reviewed along with their implications for practice and research.

The vast majority of people worldwide are religious, but religions are enormously diverse. Psychiatric research has attended more to the paths that people take in pursuit of the special things that religion represents than it has to religion itself. Religion is generally supportive of good mental health, and facilitates coping with illness and adversity, but religious and spiritual struggles (e.g., anger towards God, demonic attributions, religious conflicts, guilt and doubt) can impair mental well-being. Religious experiences, both positive and negative, can be mistaken for psychopathology and therefore need to be taken into account in diagnosis, but a differential diagnosis between spiritual/religious experience and mental disorder is not always helpful. It is possible both to be having a meaningful religious experience and to be suffering from a diagnosable mental disorder. Good clinical practice requires an ability to talk with patients in a sensitive and respectful way about their religious concerns.