Summary of the impact

The estimated annual cost of addiction to drugs and alcohol in the UK is £37 billion, of which £1.2 billion is spent on treatment. Twelve-Step Programmes (TSPs) and Fellowships (TSFs) are proven to be as effective in the short term and more effective in the long term than other interventions (Project Match, 1997). The Higher Power Project (HPP) maps the spiritual and transformational experiences of those in TSPs. As governmental emphasis shifts from `harm reduction' towards `recovery', HPP's findings offer policy-makers, professionals and service-users a greater understanding of the `spiritual dimension' of TSPs and Fellowships, thereby informing policy and influencing practice.

Underpinning research

The Higher Power Project (HPP), launched in 2012 at the University of Chester, aims to map, evaluate and engage with the debate within healthcare and addictions treatment concerning the nature of the language of `spirituality' within the process of recovery (http://www.chester.ac.uk/higherpowerproject). The key researchers on the HPP are Dr Wendy Dossett (Principal Investigator and Senior Lecturer at Chester since September 2010) and Professor John Stoner (Researcher at Chester since May 2012).

TSPs are used by those recovering from addiction through mutual-aid Anonymous Fellowships (estimated worldwide membership ca. 3 million) and in a large proportion of addictions Treatment Centres. TSPs describe themselves as `spiritual not religious', but the use of the terms `God', `God of our understanding' and `Higher Power' in several of the Twelve Steps of recovery lead many professionals, as well as addicts themselves, to conclude that the steps are explicitly religious or even specifically Christian. This factor has been shown to be the most significant impediment to accessing TSPs/Fellowships, amongst professionals and addicts alike (Day et al, 2010). Dossett's article (2013) argues that in TSPs, there is a shift from explicit Christian terminology to that of non-religious spirituality. She locates this change in the context of the emergence of non-religious or secular spiritualties in late- or post-modern Western society, along with the predominance of a subjective turn in religious belief and affiliation.

Dossett then places this analytical framework alongside empirical findings from a qualitative study conducted as Phase 1 of HPP of ex-residents from a Treatment Centre in West Wales in sustained recovery. This study shows that whilst TSPs and membership of an Anonymous Fellowship(s) are central to their recoveries, the majority of them speak of a `spiritual' approach rather than any kind of religious conversion. Whilst these initial conclusions cannot be extrapolated to those in TSP recovery generally because of the small sample involved, they are of considerable interest because they suggest that (for this group) characterisations of TSPs as creedal or religious in the traditional sense, or requiring a conversion experience, are inappropriate. Work being undertaken by the HPP will thus produce data and develop theory to inform reflection on the language used within Fellowships and generate an evidence-based understanding of the phenomenology of `non-religious spirituality' amongst those undertaking TSPs.

Phase 2 of the qualitative research started in January 2013 and is supported by a grant from the Sir Halley Stewart Trust (£25.8K) over two years. It involves extending the pilot study to addicts from a wider breadth of cultures, social backgrounds, treatment centres and Anonymous Fellow-ships. Participants will be drawn from treatment centres in the UK and Anonymous Fellowship members from the UK, Ireland, Europe and North America. Data from these different groups will enable comparative studies across fellowships and treatment modalities, as well as across the demographic categories of age, gender, ethnicity, nationality, wealth, social class, education and other markers of social inclusion/exclusion. To date, the data from this study (70 participants) indicate that 75% would regard themselves as "spiritual" rather than "religious".

These findings are already being actively disseminated to, and influencing, a wide range of audiences, as described below.

References to the research

Selected by Psychology Progress, Canadian-based (international) association of academics and psychiatric practitioners (http://psychologyprogress.com/), as a `Key Research Article', September 2013: `selected from a wide variety of peer reviewed journals and ... judged to be of major importance in their respective fields'. http://psychologyprogress.com/addiction-spirituality-and-12-step-programmes/.

Details of the impact

HPP's impact strategy incorporates academics, organizations and professionals, and Anonymous Fellowships themselves. These form networks of stake-holders who facilitate core research and data-gathering, and build training and knowledge transfer projects. These in turn are having tangible impact in the form of evidence-based policy initiatives and further collaborative action- research.

1. Dissemination

HPP Conferences at Chester have been a primary forum for raising the profile of HPP findings and establishing a broad-based network of stake-holders.

• The first event, "A spiritual illness with a spiritual solution" (March 2012) was attended by 70 delegates from clinical, academic and service-user backgrounds.
• A two-day event in February 2013 comprised three sessions, reflecting the diverse and transnational nature of agencies involved:
• "Faith-based solutions to addiction" (colloquium);
• "Recovery from Addiction: Transatlantic inter-perspectives" (public lecture);
• "Practitioners' Seminar".

Papers at Academic Conferences provide opportunities to communicate and test out HPP's core research and its potential impact on support for addiction and recovery.

• British Sociological Association Sociology of Religion Study Group (March 2012): A critical appraisal of the language of "Higher Power" in recovery
• Society for the Study of Addictions Annual Symposium (November 2012): Higher Power recovery treatments as "post-modern negotiated spirituality"
• Contemporary Religion in Historical Perspective: Engaging outside Academia (The Open University, May 2013): `I don't do God': The potential contribution of Religious Studies to addictions recovery

Forthcoming:

• 25^th Anniversary Conference of INFORM (London School of Economics, January 2014): Secularisation and the past, present and future of Alcoholics Anonymous
• Seminar at Centre for Spirituality, Theology and Health (Durham University, February 2014): Beyond Cult or Cure: The negotiated language of 'higher power' in contemporary twelve-step programmes

Professional Journals

• Dossett, W. (2013) `The workings of the Higher Power...' QAADRANT (Journal of Quaker Action on Alcohol and Drugs), Spring, 71:2-3 (http://www.qaad.org/qaadrant/spring-2013).

2. Public Engagement, Training and Continuing Professional Development (October 2012-July 2013)

Presentations and workshops represent direct forms of engagement with policy-makers and service providers/users, helping to consolidate HPP's networking across the public and voluntary sectors, including faith-based organizations. Such events have included:

• London Buddhist Vihara
• Training day for staff from Hafan Wen Detox Centre, CAIS, & AVOW
• AA UK Board Annual Seminar, presentations on HPP and TSF
• Quaker Action on Alcohol and Drugs Annual Workshop, presentation on HPP
• Recovery Academy Symposium, workshop on `Championing Recovery'
• Tees, Esk and Wear Valleys NHS Foundation Trust Spirituality and Mental Health Symposium
• Rhoserchan Treatment Centre, Aberystwyth
• Castle Craig Treatment Hospital, Scotland
• Parkview Treatment Centre, Liverpool
• Public Health England
• Consultation Event on Welsh Government's Recovery Strategy hosted by AA for Professionals and AMs at the Senedd in Cardiff

Public Engagement and Social Media extend the reach of HPP's influence across researchers', service-users' and practitioners' forums:

• HPP has more than 1,200 followers on Twitter.
• The 350 strong database receiving regular updates range from policy-makers, TSF board members, research funders, addictions professionals, social and healthcare workers, to addicts in recovery.
• More than 100 addicts/alcoholics in 12-Step recovery globally have expressed an interest in participating in the HPP study.
• Dossett appeared on BBC Radio 4 "Beyond Belief" 18/03/2013 on a panel speaking about spirituality and addiction recovery.

3. Research Partnerships are an indication of HPP's contribution to practice in the form of policy initiatives and will generate further evidence-based evaluation in collaboration with a range of stake-holders:

• Wrexham Recovery from Addiction Pilot Project (WRAPP): a partnership project with Wrexham County Council and its service provider, AVOW, to trial Twelve-Step Facilitation with twenty clients with substance misuse issues. This intervention could be extended across the UK and play a significant role in the delivery of the Government's new recovery policy.
• AHRC Collaborative Doctoral Award: joint application with Castle Craig Hospital which proposes PhD studentships starting in 2014. Projects will explore spiritual dimensions of recovery in the UK's best known treatment hospitals, and will produce industry — relevant findings.
• Life in Recovery: discussions are underway with Monash University (Melbourne) to roll out David Best's Life in Recovery project, http://www.facesandvoicesofrecovery.org/publications/life_in_recovery_survey.php, with HPP participants.

4. Indicative Impact

• Addictions professionals across North Wales are now more likely to suggest TS participation. This significant culture change, resulting from a better informed professional community, is evidenced by local AA groups reporting more members from treatment services, and the HPP winning a bid (WRAPP) to enable TSF training.
• Preparations are in hand for an AA `Conference Question' on engaging more closely with the treatment profession. It is significant that a presentation from the HPP resulted in the initiation of this process, leading potentially to substantial culture change within AA itself towards greater engagement with the recovery agenda.

Sources to corroborate the impact

• A consultant psychiatrist at Woodbourne Priory Hospital, Birmingham may be contacted to corroborate the impact of the research for Alcoholics Anonymous.
• A trustee of the Society for the Study of Addiction may be contacted to corroborate the impact of a more nuanced understanding of spirituality in Anonymous Fellowships amongst addictions professionals.
• Representatives of the Association of Voluntary Organisations Wrexham (AVOW) and the Community Safety Team at Wrexham County Borough Council may be contacted to corroborate the impact of the project amongst addicts in Wrexham.
• The impact of the HPP for those in the addictions treatment industry can be corroborated by contacting a representative of Castle Craig Hospital, Scotland.
• In addition, the University holds on file correspondence from a range of professionals describing their perspective on the impact of the HPP.