Understanding the "Spiritual Malady" in Alcohol Use Recovery

From common illnesses like chicken pox to rare conditions like "fish odor syndrome" (a metabolic disorder causing a strong fishy smell), no ailment is pleasant—and some can even disrupt our social lives. Fortunately, most are treatable today. But what about a "spiritual malady"? That's a different challenge altogether.

If you've spent time around Alcoholics Anonymous (AA), you've likely heard this term. It sounds serious—but what is it? How do you know if you have it, and can it be cured? Let's explore the AA concept of spiritual malady and consider how to reinterpret it in a more science-based, practical, and optimistic way.

When Inner Peace Falters

In AA terms, a spiritual malady refers to the inner turmoil, restlessness, and sense of disconnection often experienced by those with addiction. It's the emptiness felt when trapped by alcohol—a psychological "itch" that seems unscratchable, a feeling that something is missing, and a belief that drinking might fill that void.

To fully grasp this idea, it helps to see how it fits into AA's three-part model of alcohol misuse, as described by founder Bill W. in The Big Book of Alcoholics Anonymous. Understanding this framework clarifies why spirituality and a "Higher Power" are central to AA's approach to recovery.

The Threefold Nature of Alcohol Use Disorder (According to AA)

AA views alcohol use disorder (AUD) as having three interconnected parts:

• The Physical Side: This involves the body's craving for alcohol and compulsive drinking behaviors—like prioritizing alcohol even when it means hiding it in a coffee thermos.
• The Mental Side: This is the obsession—the constant mental chatter that glorifies alcohol as a solution, despite clear evidence to the contrary.
• The Spiritual Side: This is the spiritual malady—a feeling of being unfulfilled, restless, and disconnected, with thoughts, emotions, and beliefs out of alignment.

AA proposes that this "spiritual problem" requires a "spiritual solution," often framed as reliance on a Higher Power. Overcoming the spiritual malady is said to restore sanity and resolve the physical, mental, and spiritual chaos caused by alcohol.

Gaps in the Spiritual Malady Concept

At first glance, AA's three-part model aligns somewhat with scientific understanding, though in a different order. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes AUD as a cycle:

• Binge and Intoxication: Heavy drinking—the physical compulsion.
• Withdrawal and Negative Affect: Misery upon stopping—similar to spiritual restlessness.
• Preoccupation and Anticipation: Craving and relapse—the mental obsession.

However, labeling the core issue a "spiritual malady" falls short for many. Here's why:

1. The Science Behind the Cycle

AA's spiritual malady concept overlooks the neurobiology of AUD. The obsession, compulsion, and inner unrest are rooted in how alcohol affects the brain:

• Dopamine Release: Alcohol triggers dopamine, reinforcing the habit of drinking.
• GABA and Glutamate Imbalance: It increases relaxation (via GABA) but causes rebound anxiety, fueling the urge to drink again.
• Prefrontal Cortex Inhibition: Alcohol impairs decision-making, leading to regrettable actions.
• Dependence and Withdrawal: Over time, the brain adapts, making drinking necessary to feel "normal" and causing severe withdrawal symptoms.
• Cognitive Distortions: Subconscious beliefs about alcohol can keep people stuck in harmful patterns.

Science offers a hopeful path: neuroplasticity—the brain's ability to rewire itself—allows recovery. Abstinence, healthy dopamine-boosting activities, and cognitive behavioral therapy can Quitemate thoughts about alcohol, supporting a sustainable alcohol-free life.

2. The Problem of a "Judgy" Higher Power

AA's spiritual approach often includes language about "character defects" and "resentments," which can feel accusatory. While AA suggests a Higher Power can be anything—even a "doorknob"—it's frequently referred to as "God," typically in a traditional, judgmental sense. This can be off-putting for those seeking a more inclusive, science-aligned recovery path.

Blending Science and Spirituality

Rather than dismissing spirituality entirely, we can integrate it in a positive, evidence-based way. Instead of viewing ourselves as spiritually "sick," we can see spirituality as a tool to enrich recovery—not fix "flaws."

Spirituality, in this sense, is about finding meaning beyond oneself and connecting deeply with life. Practices like mindfulness, yoga, meditation, nature connection, and creative pursuits offer spiritual benefits backed by science:

• Craving Management: Meditation increases awareness of thoughts, helping manage urges.
• Neuroplasticity Promotion: Meditation encourages brain reorganization.
• Default Mode Network Regulation: Spiritual practices reduce activity in brain networks linked to rumination and negative patterns.
• Mirror Neuron Engagement: These practices foster empathy and connection, enhancing life satisfaction.
• Natural Dopamine Boost: Activities like meditation elevate mood without negative side effects.
• Stress Reduction: Spirituality lowers cortisol, reducing a common trigger for alcohol use.

A Positive Path Forward

Approaching spirituality with optimism can transform recovery into a journey of growth and fulfillment. As spiritual teacher Pema Chödrön writes:

"Feelings like disappointment, embarrassment, irritation, resentment, anger, jealousy, and fear, instead of being bad news, are actually very clear moments that teach us where it is that we’re holding back. They teach us to perk up and lean in when we feel we’d rather collapse and back away. They’re like messengers that show us, with terrifying clarity, exactly where we’re stuck."

In this view, discomfort isn't a "malady" but a guide—highlighting areas for growth. Here at Quitemate, we're here to support you every step of the way toward a healthier, more meaningful life.