What Is the “Spiritual Malady” in AA?

There are many maladies out there — anything from chicken pox to “fish odor syndrome” (a metabolic disorder where the body is unable to break down trimethylamine, a compound with a strong fishy odor). None of them are fun (and some might hamper our social life), but thankfully in our day and age, most are curable. But what about a “spiritual malady”? Now that’s a doozy.

And yet, if you’ve spent any time around AA folks, chances are the term has come up. Whatever a “spiritual malady” is, it sounds serious. How do you know if you have it? And can you cure it? Let’s find out what the spiritual malady is in AA terms, and explore some ways to reframe the concept into one that’s a bit more science-based, practical, and optimistic.

When Spirits Get “Sick”

What is a spiritual malady? In short, it’s the inner turmoil, restlessness, and disconnection that many people struggling with addiction experience. It’s the void we feel when we’re stuck in the alcohol trap. It’s the psychological “itch” we can’t manage to scratch — the feeling that something’s missing (and that a drink might make it better). 

However, there’s more to the concept of a spiritual malady. Definitions tend to feel slippery until we look at how it fits into the three-part model of alcohol misuse as described by AA founder Bill W. in The Big Book of Alcoholics Anonymous. Once we understand the central role it plays in the way AA portrays alcoholism (or, to use the more scientifically accurate term, alcohol use disorder or AUD), it becomes clear why the idea of a Higher Power (and spirituality in general) is so central to “the program.”

The Threefold Nature of AUD (According to AA)

AA sees alcohol use disorder as a three-part problem:

1. The physical side. The physical aspect of AUD is the most obvious one. It refers to our physical craving for alcohol and our behavior around booze. It’s the compulsion to keep drinking no matter what and put alcohol first (even if that means putting it in our coffee thermos to stay under the radar).
2. The mental side. The mental obsession goes on behind the scenes and occupies our thoughts during our waking moments (and probably sneaks into our dreams at night). It’s the rumination and mental chatter that makes us see booze as the elixir of life and solution to our problems — even though it’s blatantly obvious that alcohol isn’t delivering on its empty promises.
3. The spiritual side. And now we come to the spiritual malady — the sense of being unfulfilled, restless, and disconnected. Specifically, our thoughts, emotions, and beliefs are not aligned; we’re not guided by a set of principles. 

The “spiritual problem,” in turn, calls for a “spiritual solution.” And in AA, that spiritual solution is the Higher Power. When “the spiritual malady is overcome,” this Higher Power is supposed to “restore us to sanity” and tidy up the physical, mental, and spiritual mess that booze has stirred up in our life.

Spiritual Malady: Gaps and Flaws

At first glance, this three-part breakdown actually matches the scientific description of AUD fairly well (albeit in a slightly different order). The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes AUD as a three-step cycle:

1. The binge and intoxication stage. We drink — a lot. This is the “physical aspect,” or compulsion.
2. The withdrawal and negative affect stage. We stop for a bit and feel miserable. This is the spiritual restlessness bit.
3. The preoccupation and anticipation stage. We crave booze and eventually give in. This is the obsession with drinking, or the mental part.

That said, for many, it’s ultimately not satisfying to simply call the problem a “spiritual malady” and call it a day. Let’s look at the reasons why.

1. The Missing Science Behind the Cycle

For one thing, the AA definition of the “spiritual malady” that drives us to obsess about booze and compulsively seek it out misses the science behind the three-step cycle of AUD as it’s described by the NIAAA. The obsession and compulsion — as well as the spiritual malaise — have to do with the way alcohol affects the brain. For a deep dive, check out “Understanding Alcohol Dependence: Health Issues, Causes, and How To Overcome.” Here’s the gist:

• Alcohol floods the brain with dopamine. That warm fuzzy feeling we get after a few first sips? That’s dopamine in action. This reward neurochemical plays a key role in habit formation, driving us toward things that make us feel good — for better or worse.
• It boosts GABA and lowers glutamate. Alcohol also makes us feel relaxed by increasing the inhibitory neurotransmitter GABA and lowering glutamate, its excitatory counterpart. However, the rebound anxiety we get a few hours later leaves us feeling more on edge than ever, making it harder to resist taking the next drink to temporarily calm the neurochemical storm.
• It inhibits the prefrontal cortex. We’re not at our sharpest when we’ve had a few drinks, and are more likely to behave in ways that leave us feeling embarrassed the next morning or even put us in danger. That’s because alcohol throws a wrench in the workings of the prefrontal cortex — the decision-making hub of the brain.
• These effects lead to dependence over time. Over time, tolerance rises and the brain gets used to the “new normal.” The “pleasure” we once got from booze is all but nonexistent — we drink just to stay at “baseline.”
• Withdrawal effects and cravings make it hard to put down the drink. If we try to stop, our brain and body stage an all-out revolt, leading to symptoms that range from mild unease and nausea to seizures and delirium tremens (DTs). We’re likely to experience cravings — that mental obsession as described by AA.
• Cognitive distortions make it even harder to stop. There’s also a scientific explanation of the “spiritual” unrest that AA describes. Our subconscious beliefs about booze are likely to make it harder for us to see the reality of our situation, leading to misalignment that keeps us acting against our own best interests. 

The best part about getting science on board? It also points the way out of the trap. While AA promises that the Higher Power can “restore us to sanity” when “the spiritual malady is overcome,” we’re never entirely free. The potential of getting off track if we stop going to meetings or “working the Steps” is always looming in the background, fostering a new type of dependence and sometimes becoming a self-fulfilling prophecy. Granted, it’s better to be dependent on a self-help group instead of on an addictive substance, but for some, it can feel like being stuck in permanent limbo.

Science, in turn, points us to a more satisfying way out of the alcohol trap. Research shows that those brain changes that make it so difficult to put down that drink can be reversed thanks to the power of neuroplasticity — the brain’s ability to rewire itself. And while it’s still not a good idea for those who struggled with AUD to drink again, abstaining from booze while actively seeking out healthy ways to boost dopamine can change the way we see alcohol for good. Moreover, we can use science-based methods such as cognitive behavioral therapy to reframe our cognitive distortions around booze, making it easier to stick to our new alcohol-free lifestyle.

A Judgy “Higher Power”

Another problem is the “flavor” of spirituality as it appears in many AA communities, texts, and discussions. To put it bluntly, it can be, well, judgy. There’s a lot of talk of “character defects” and “resentments” that contribute to the spiritual malady and drive us to drink. If we stick around long enough we’ll probably certainly hear that our moral compass is on the fritz, that our thoughts are a “dangerous neighborhood,” and that our natural inclination is to lie (“We’re alcoholics, that’s what we do!”).

And while newcomers are often reassured that the “Higher Power” that will absolve us of these failings “can be anything, even a doorknob,” most AA members do call it “God.” And in addition to not being a doorknob, that “God” is often reminiscent of the Protestant “bearded man upstairs” type. (And in all honesty, are we really going to talk to a doorknob about our drinking problem?)

When Science Meets Spirituality 

However, let’s not throw the baby out with the bathwater just yet. There’s actually a more fulfilling (and less accusatory) way to weave spirituality into the picture — one that doesn’t clash with the science and is ultimately more positive and optimistic.

One of the biggest hiccups in the “spiritual malady” concept is the “malady” bit. But what if there’s no need to think of ourselves as spiritually “sick”? What if instead we look at spirituality as a way to deepen our recovery — a powerful tool to add to our growing toolbox rather than a repair kit to fix our “flawed” character?

There are many spiritual paths out there, all of which ultimately come down to finding meaning in something greater than ourselves and connecting with the world around us in a way that’s inspiring, satisfying, and motivating. And while the many organized religions around the world have a lot to offer, there are many other spiritual paths to consider. Mindfulness-based practices such as yoga and meditation, connecting with nature, and even pursuing creative passions all have an element of spirituality that we can harness in our alcohol journey. For a deep dive, check out “Exploring Spirituality in Recovery.” For now, let’s look at the science-based benefits of adding a spiritual element to our recovery toolbox:

• Spiritual practices help us coast through cravings. Meditation — the practice of becoming aware of our own thoughts — is central to many spiritual practices and is known to be a powerful craving buster. By looking at which thoughts we want to jump on board with and which ones we want to let go of, we gain more control over our urges.
• They promote neuroplasticity. Science has revealed the mechanism behind this powerful effect with neuroimaging studies demonstrating the brain “on meditation” literally reorganizing itself through a process known as neuroplasticity (forming new connections).
• They reorganize our brain. Alcohol misuse and other addictive behaviors are associated with disruptions in the so-called default mode network (DMN) of the brain. The DMN is our brain’s “autopilot” mode, active at times when we’re “going with the flow” and not engaging our decision-making abilities. It’s associated with self-referential thinking, rumination, and negative thought patterns, all of which contribute to cravings.
  
  Studies show that spiritual practices reduce DMN activity in the brain and engage the prefrontal cortex. The result? We get “unstuck” as we gain greater control of our actions and develop a new sense of purpose.
• They engage mirror neurons. Spiritual practices are all about connecting with others and developing our sense of empathy. This is where mirror neurons come in. Science shows that mirror neurons fire when we watch someone else perform an action rather than performing it ourselves. Engaging mirror neuron networks, in turn, promotes neuroplasticity and enhances our deep, authentic satisfaction with life, making alcohol irrelevant and unnecessary. 
• They boost dopamine and provide fulfillment. Remember how we said alcohol floods our brain with dopamine? Spiritual practices such as meditation can do the same! But unlike booze, this “natural high” won’t make us pass out on our friend’s couch or leave an embarrassing voicemail that leads to next-day regrets.
• They reduce stress and lower cortisol. Spiritual practices can lower levels of cortisol, the body’s primary stress hormone. Stress is a common trigger when it comes to alcohol misuse, so any practices that take the edge off are in our favor.

Sounds exciting, doesn’t it? Try it out for yourself and see how spirituality could revamp your recovery. It’s all about enriching your life instead of fixing flaws!

A Positive Path

The key to making spirituality work for us rather than against us is to approach it with a positive and optimistic mindset. After all, our struggle with booze might just lead us to discover a way of living that’s filled with more authentic joy and meaning than we ever imagined. Here’s how spiritual author and Tibetan nun Pema Chödrön puts it:

“…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. This very moment is the perfect teacher, and, lucky for us, it’s with us wherever we are.”

Chödrön’s version of spirituality, in turn, is all about acceptance and love — toward others and for ourselves. Rather than a “spiritual malady,” the pain and discomfort we feel are “spiritual messengers” pointing out places where there’s room to grow and change. And here at Reframe, we’re ready to help you every step of the way!