The Health Belief Model, the Theory of Reasoned Action and the Social Learning Theory attempt to explain behavior change during treatment (Neft and MacMasters 2005). The three models have been integrated to help explain how spiritual change can effect a change in the behavior of someone with substance problems. The integrated model lacks solid theoretical or empirical mechanisms in achieving its purpose. The three models share a common goal of creating a shift from negative and punishing to positive and forgiving views of spirituality and of God. It proposes a framework of changes at several levels (Neft and MacMasters).
At the individual attributes level, the person presents his or her spiritual background or history, current level of spirituality and overall readiness for treatment in this manner (Neft and MacMasters 2005). Many substance abusers are detached from key societal institutions, such as the church. Around 85% of them are not receiving treatment at any given time, hence, their low readiness to treatment and change. They do not typically aspire for a change in their habit or a solution to their substance problem.
At the program elements level, a substance abuser remains a detached or separate entity and this presents itself as a problem in the recovery process (Neft and MacMasters 2005). A program philosophy of empathy, acceptance and forgiveness will be a sharp success in a substance abuser seeking these from others. The program structure and the element of discipline it introduces will establish order in place of chaos, which characterize the abuser's former lifestyle. Routines, chores and rules will take the place of chaos and random activities. Rituals and the social cohesiveness of group activities will also help. These activities may be a group Bible study, prayer or meditation, testimonials and recreational activities.
Social Learning Processes incorporate key determinants of behavior change (Neft and MacMasters 2005). The integrated model aims at meeting the necessary and sufficient conditions to behavior change. These are the strong intention to change one's behavior; the development of skills needed by the behavior change; and the elimination of environmental constraints or barriers to it. The application of these basic behavior concepts is most relevant to substance abuse from the early stage to the last (Neft and MacMasters).
Spiritual transformation processes focus on the search for meaning and this most fundamental in the person's recovery (Neft and MacMasters 2005). It involves a radical change from within, specifically through an identification of oneself with the sacred. Spiritual self-appraisals and coping will be pivotal. The appraisals and the connection will infuse the meaning he needs to make something out of his life experiences. He begins to see God as forgiving rather than punishing. This change of view is deemed all-important in recovery and shifts from negative to positive religious copies strategies (Neft and MacMasters).
In the face of existing and accepted research designs for examining treatment outcomes, intervention on the basis of spiritual change still requires a measure of complexity at the baseline or for follow-ups (Neft and MacMasters 2005). An integrative conceptual model can incorporate the factors at differing levels to influence the process. The design for a spiritual model should allow spiritual change, which can be assessed multi-dimensionally. This will bring out the necessary condition or conditions for behavior change desired by and for the substance abuser. The focus should then be on the mediating role of spirituality and spiritual change. Following this, the usefulness of the conceptual framework should be investigated empirically in measuring program outcomes. Ultimately, the variation in individual and program-level variables should be examined in relation to the observed outcomes of substance abuse treatment, using this spirituality-based model (Neft and MacMaster).
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