Spirituality and Addictions
Spirituality and Addictions
According to past research looked at by Langman and Chang (2013), important factors in overcoming addictions are related to forgiveness, spirituality and guilt. Previous research focused on existential psychology suggest that if an individual can come to terms with their struggles, in this case addictions and psychological co-morbidity, and then look at the existential issues, in this case spirituality, they are struggling with due to their addictions, their psychological well being is positively impacted. Langman & Chang (2013) stated that as a result of their study, the addiction group reported having a high spirituality level. These authors stated that spirituality is a positive coping mechanism when it comes to recovery from addictions. (pg. 12). Having a regular practice of spirituality on an every day basis positively impacts alcohol dependence and heavy drinking. Past research noted by these authors have suggested that spirituality aids in building internal strength and provides individuals with optimism and meaning during stressful situations in their lives.
Labun & Emblen (2007), studied spirituality and health within the Punjabi Sikh community living in the Fraser Valley in British Columbia. They focused on the positive effects of spirituality on general health and when healing from illnesses. The individuals they interviewed mentioned topics of substance use. Overall, the participants shared that their understand of the Sikh faith stated that some illnesses are caused by personal lifestyle choices. Several participants shared that substance use and taking part in other harmful habits are a way of life that that Sikh teachings try to deter. Another important sharing from this study spoke of when individuals are suffering from being sick and ill, they tended to become more spiritual. During these moments, spirituality helped find a sense of purpose and meaning for their and suffering. The belief shared amongst these participants was that natural result of having a strong sense of spirituality led to being healthy. The connection between practicing prayers and the impact on the mind through mindfulness was expressed. This is a topic discussed quite extensively in this current paper as an aid in overcoming addictions.
Mindfulness and Neuroplasticity
Either if we are talking about religion or spirituality in their own defined elements, this author as stated before would like to elaborate on the part of spirituality, which is one aspect of religion, and focus on mindfulness practices and their effect on the brain at a neuroscience level and aiding in overcoming addictions through the process of neuroplasticity. According to Van Der Kolk, (pg. 204) trauma can not be treated directly. What has been done cannot be undone, however, it can be processed and dealt with. Trauma deprives the survivor the feeling of having control over themselves. A key aspect to recovery is being able to establish a sense of control and the ownership? of your body, mind and self. This is what mindfulness can help an individual achieve.
Neuroscience of Mindfulness
In 1979 Jon Kabat-Zinn founded at the University of Massachusetts School of Medicine, the Stress Reduction and Relaxation Program (Peltz & Black, 2014). Mindfulness was the key mechanism taught in this program with the idea that pain and stress may not be eliminated completely from ones life, however, through this practice they are about to connect with their sufferings with more ease. These authors stated that as human beings we are hard-wired to seek pleasure and avoid pain in order to survive and procreate. They described human suffering resulting from the thinking mind. Addictions was used as a metaphor for how human beings suffer. This thinking mind takes all of the information we are experiencing and then evaluates, judges, compares, concludes and reacts to its own productions as if they were true (Peltz & Black, pg. 605, 2014). Due to the thinking mind which complicates experiences at all levels of physical, instinctual, and emotional, lives become painful and in order to deal with these human being become attached to various addictions, such as, food, alcohol, drugs, sex, etc. The thinking mind then is the addiction along with the behaviors. There has been a normalcy placed on using and misusing substances and behaviors. The benefits of engaging in these behaviors are mostly short-term and the longer-effects lead to difficulties in physical and emotional well-being. These authors of this article discussed a case study and results showed how mindfulness training specifically through meditation practice helps to answer struggling questions like when our attachment to pleasure in order to avoid becomes a problem. Also, recognizing the difference between wanting and liking a behavior versus craving a behavior that causes suffering. One of challenges in dual diagnosis treatments brought up by the authors is to have patients take part in practices that challenges the addiction to the thinking mind. However, through the case study presented, once the patient was able to gain a sense of predictability and safety through a meditation practice, she was able to gain some help from it. Through feeling the pain, fear and the uncertainty and then to accept this pain, witness it and understand it personally, release and quietness can take place. Combining mindfulness with her recovery, psychotherapy and medicine, she was able to find moments where her mind was not obsessively thinking and she found some ease.
Garland et.al, (2016), stated that drug use is mediated by neuroplasticity in frontostriatal circuitry (Garland et.al, pg. 56, 2016). These authors suggested that mindfulness interrupts these automatic drug-use action schemas and restructure motivation and reward learning around non-drug related natural rewards may be beneficial in helping individuals with substance use disorders maintain abstinence. These authors discuss the trait of mindfulness and stated that although traits are thought of to be fixated characteristics, trait mindfulness has been suggested to increase through the practice of mindfulness meditation. The trait of mindfulness shows up in everyday life by an individual being able to demonstrate mindful characteristics an being nonreactive to and accepting of their own thoughts, emotions and perceptions at any moment. Neuroplasticity has been suggested in research to be the reason why trait mindfulness can change with repetitive practices. Studies have shown the considerable differences in gray matter volume in meditation practitioners and control groups. Amygdala volume decreased from mindfulness practices which related to stress reduction.
One study studying neuroimaging, took advanced meditative practitioners, persons with more than 10,000 hours of mediation practice, and with the use of electroencephalogram and functional magnetic resonance imaging as the subjects of the study performed Jhana meditation. These data showed that the emotional bliss and altered states of consciousness produced by this meditative technique were associated with robust activations within frontostriatal reward circuitry (Garland et al., pg. 58, 2016).
According to Tang, Holzel & Posner (2015), studies have shown the changes what areas of brains activate when at rest versus when practicing mindfulness. They discussed what they felt was the important parts of medication practice, which are, emotional regulation and attention control and self awareness. They went on to divide the attention control into another three categories of alerting, orienting and conflict monitoring. Through their review they were able to suggest that meditation does have a positive impact on conflict monitoring and orienting in the beginning stages and then alerting in longer term studies during later phases. These authors also reviewed studies on the effects of mindfulness and neuroplasticity in parts of the brain that regulate attention, which is the ACC. The ACC controls the executive attention and control. Studies have shown activation in this area of the brain region in meditators compared to control groups.
Neuroplasticity and dual-process models.
Dual process models in neuroscience state that there are two types of brains (Garland et al., 2016).
This dual-process model mentioned by these authors states that addiction causes dysregulated communication between the bottom-up neural processes that are responsible for the predictive value of a rewarding stimulus, such as, substance use, and the frontal-executive circuitry, lateral prefrontal cortex that instructs the top-down cognitive control processes. There is a weaker connection between the frontostriatal regions. This is apparent with reduced positive affect shared by individuals, increased craving and substance use slip when trying to abstain. This disconnection in the frontostriatal regions could suggest why there is a lack of self-control and drug use. The longer the exposure to substance use, the less the ability to respond to naturally rewarding stimulus. Therefore, then a higher dose of substances are required to feel better. Compulsive or automatic drug use as described above is mediated by neuroplasticity in frontostriatal circuitry. The lack of communication in this circuit is shown in the ability to react to drug-related cravings and the inability to respond to natural rewards. Behavioral interventions that target these automatized drug-use action schemas and restructure motivation and reward learning around nondrug-related natural rewards may be beneficial in helping individuals with substance use disorders maintain abstinence. By virtue of their therapeutic potential to target these two interrelated domains, mindfulness-based interventions (MBIs) may be efficacious for the treatment of addiction. (Garland et al., 2016, p. 56).
Mindfulness as a Treatment in Recovery from Alcohol Substance Use Disorder in the Punjabi Sikh Community
Mindfulness as a Treatment in Recovery from Alcohol Substance Use Disorder in the Punjabi Sikh Community
Addictions in any member of a family can impact all areas of a familys life including relationships with family members, social interactions, free time activities and monetarily (Sharma, et.al, 2019). Addictions cause harm to not only to the individual and the family, but society as well. According to the World Health Organization (WHO) (2010), alcohol use disorder has become more prevalent than drug use disorders with both being higher amongst men than women.
Kumar et al., (2018) stated the many effects of alcohol on the human body including, the brain, stomach, liver, heart, skin, hair, as well as longer term effects of neuritis, damage to nerve endings, and pancreas issues.
This paper will discuss addictions and the Punjabi Sikh community. According to Statistics Canada (2022), as of 2021 there are close to 800,000 Canadian Sikhs making up 2.1% of the population. Although there is no specific data on what percentage of the Sikhs in Canada are affected by addictions, Statistics Canada (2022) show that this population is the fourth largest religious group in Canada and the fastest growing. The purpose of this literature review is to show the effectiveness of psychoeducation and mindfulness and how this can be applied to the Punjabi Sikh community affected by addictions and professionals. The research is very limited about applying the Sikh spiritual practices as a treatment modality for addictions. Due to this fact, it is important to educate the Punjabi Sikh community about the science behind how spirituality, mindfulness in relation to neuroplasticity helps aid in recovery from addictions.
There are many contributing factors leading certain individuals to turn to addictions. These are important to discuss and bring into light in respect to the Punjabi Sikh population residing in North America and will be addressed in this paper. This population suffers from many barriers to treatment, such as being unaware of services, language and communication issues, shame and stigma, and trust issues (Galvani et al, pg.51, 2013).
The Punjabi Sikh population originate from a northern province in India, named Punjab (Labun & Emblen, 2007). Sikhs are not just a minority in Canada, but India as well. The religion of Sikhism was founded between the years of 1469-1708 by the Ten Gurus. Sikhism has attributes of both the Islamic and Hinduism faiths (Mojaria-Keval & Keval, 2015). The first Guru, Guru Nanak Dev Ji, was born in a higher-caste Hindu family and rejected the caste system. The Tenth Guru, Guru Gobind Singh, stated that after his passing, the next Guru would be the Guru Granth Sahib (GGS), the holy scripture written by the Ten Gurus as well as others. The Guru Granth Sahib is what guides the Sikhs today in expressing their faith and teachings. These scriptures are the eternal guide to Sikhism and are to be treated as a living guru/teacher. In the scriptures of the Guru Granth Sahib, salvation is achieved by following paths of love and seva (Mojaria-Keval & Keval, 2015). This author will note some scriptures from the GGS in relationship to addictions.
The Punjabi Sikh Diaspora
According to Ghosh (2017), a handful of Sikhs are known to have first arrived in Vancouver in the early 20th century. Sikhs initially started to immigrate to Canada due to their connection with the British Army (Labun & Emblen, 2007). From then to now, Sikhs have continued to immigrate to Canada in a steady number far from their involvements with the British Army. As a part of the Canadian immigration policy, the formation of the sponsorship system led to the majority of the immigrants from Punjab starting in the 1950s (Nayar & Sandhu, 2006). In the 1960s, the Canadian government loosened their immigration policy to include educated professionals from India to immigrate. Sikhs, although a minority in India, are one of the largest groups of Indians overseas. However, the majority of the immigrants have been blue collar laborers with very little education. The majority of the elderly Sikh population migrated at an age where they were unable to work even in these positions.
Largely, Punjab Sikh immigrants in Canada are from farming villages in India with very limited education, if any at all. Traditionally the land is passed on from generation to generation and village life is economically underdeveloped and traditional. These deep-rooted experiences followed the elderly Punjabi Sikh when immigrating to Canada. Therefore, the elderly came from societies that had not experienced industrialization and urbanization and were relocated into the Western capitalist society of Canada without having undergone the experience of modernization (Nayar & Sandhu, p. 141, 2006).
Current Treatment Modalities Western
Current Treatment Modalities Specific to SP Population
Majority of the limited research that has been completed in relation to alcohol problems within the Sikh Punjabi community has taken place in the UK. One project, the Shanti service, took place between the years of 2016-2019 in the UK (Galvani & Guru, 2020).
Reasons for Addictions
Acculturational stress
A model of acculturation explained by Berry (2022), states there are four models of acculturation, which are, integration, assimilation, separation and marginalization. Following Berrys model, Bekteshi & Kang (2020) define acculturative stress
as the disrupted state of being among immigrants resulting not only from acculturation related challenges such as conflicts steaming from shifts in ones perceptions, challenges in learning new language due to differences between native and host language, acculturation rate disparities among family members, differences in meaning of social support between host and native country, but also from broader environmental and historical contexts (Bekteshi & Kang pg. 899, 2020).
According to Tuck et al. (2016), it was pointed out that Sikhs living in the UK could be drinking more excessively than other religious groups studied as alcohol is used as a coping mechanism in response to acculturation stress.
Barriers to Support
According to Galvani et al. (2013), individuals from the Punjabi community voiced being aware that supports do exist, however, did not know what that help was, how to access it or where to begin looking and did not have knowledge about interventions or treatments. Language was another perceived barrier to access supports as well as literature not provided in the native language. In general, research has shown that minority groups received less quality care due to language barriers, cultural differences and lack of healthcare literacy (Bau et al., 2019). Aside from these more practical issues, members in the community expressed barriers due to stigma, shame, embarrassment and fear of lack of confidentiality due to these concerns. Males in the community felt they would be judged for seeking supports and it was not acceptable for them as the primary food providers in the family to seek supports. Mothers felt they could not seek supports for their sons due to being blamed for not raising them appropriately.
Although alcohol use is not a secret within the Punjabi Sikh community, families struggling with it attempt to hide it from other community members (Taak et al., 2020). Alcohol is highly stigmatized within the community. The Sikh religion prohibits the use of any substances and the shame and stigma attached with alcohol use are a strong reason why Punjabi Sikh families do not attempt to access services (Galvani et al., 2013). Therefore, due to the reasons discussed above, there are many practical and emotional barriers to this community seeking services.
Some community members have shown insight into the fact that alcohol abuse is connected to mental health struggles and the importance of addressing these (Ruprai, 2016). According to Taak et al. (2020), mental health struggles are considered a weakness suffered mostly by the elder generation. The lack of understanding of how the behavior of consuming alcohol affects others in their lives was apparent. Sikh Punjabis who do consume alcohol do not see their drinking as an issue as it is widely accepted socially in the culture, therefore, miss the early warning signs of addictions. According to the research study by Taak et al. (2020), participants did not express concerns about how alcohol affected their health and other social consequences as a result of drinking. These individuals believed that alcohol consumption was only a concern if it affected loved ones, including family, friends and relatives. The older generations are stubborn and unwilling to seek treatment for alcohol use (Taak et al., 2020).
Limitations of Information
Increase in female drinkers within the Sikh Population
Past research is very limited within this specific population and majority of the research has taken place in the UK. Though past research has focused on mostly male drinker and the rise in female drinkers has increased rapidly. Due to cultural standards that accept males to drink in order to be able to function as hard workers and breadwinners, more females tend to drink secretively and therefore, less likely to admit to family they are struggling with substance issues.
References
Ghosh, R. (2017). south asian immigration to canada. Canadian Issues (Association for Canadian Studies : 1999), , 53-56.
KAUR-AUJLA, H., SHAIN, F., & LILLIE, A. K. (2019). A GAP EXPOSED: What is known about sikh victims of domestic violence abuse (DVA) and their mental health? European Journal of Mental Health, 14(1), 179-189. https://doi.org/10.5708/EJMH.14.2019.1.10Labun, E., & Emblen, J. D. (2007). Spirituality and health in punjabi sikh. Journal of Holistic Nursing, 25(3), 141-148. https://doi.org/10.1177/0898010106293592
Mindfulness and Psychoeducation as a Treatment in Recovery from Alcohol Substance Use Disorder in the Punjabi Sikh Community
Chapter 2
Psychoeducation
Psychoeducation is important not only for the patients, but for family members and caregivers as well (Ekhtiari et al., 2017). Psychoeducation has helped in decreasing hospital stays, chances of relapse, and patient participation in treatment.
One paper looked at the impact of Psychoeducation (PE) around neuroscience in relation to addictions (Ekhtiari et al., 2017). These authors stated the individuals suffering from alcohol and substance use disorders have remained abstinent longer, as well as, had lower rates of consumption when provided PE.
Psychoeducation (PE) is defined as an intervention with systemic, structured, and
didactic knowledge transfer for an illness and its treatment, integrating emotional and
motivational aspects to enable patients to cope with the illness and to improve its
treatment adherence and efficacy. PE is considered an important component of treatmentin both medical and psych
iatric disorders, especially for mental health disorders
associated with lack of insight, such as a alcohol and substance use disorders (ASUDs)
(Ekhtiari et al., (2017, p. 239).
According to Thylstrup et al., (2015), individuals with Substance Use Disorder (SUD) and Personality Disorder showed higher efficacy of treatment for the substance use disorder when completing a psycho-educational treatment alongside a counselling program. During the follow-up at three and nine months, patients who were assigned to an additional psychoeducational intervention program displayed that it increased the effectiveness in treatment for substance use disorders. These authors stated that substance use is something that is difficult to treat in individuals with mental health disorders. By reducing substance use, reaching this population becomes more optimistic as more modalities of support can be provided, which can have a positive impact on the patients social and psychological stability (Thylstrup et al., 2015, p. 9). Psychoeducation explained caringly to patients can assist with patients understanding their struggles and the effects these struggles have on them and their lives. Having this knowledge may help patients make better choices and be open to help. (how to cite within a citation)? Compassionately explaining psychoeducation can help in building a positive therapeutic alliance.
Another group of authors stated that previous research showed that not having knowledge of what and how metacognitive deficits are and their affects, affects treatment results in individuals with substance use disorders. The knowledge of such is important due to the influence the lack of understanding has on treatment results (Rezapour et al., 2021). A psychoeducation program called Neuroscience-Informed Psychoeducation for Recovery [NIPER] was created to raise metacognition in the areas of cognition that are mostly affected by the use of drugs and alcohol (Rezapour et al., 2021). Metacognition is defined as an individuals ability to understand his/her cognitive functions and use these understandings to regulation them (Rezapour et al., 2021, p. 597). The authors stated the study was hoping to through metacognition awareness improving the areas of the cognitive affected the use of drugs and alcohol would lead to individuals wanting to put effort towards the processes this program proposed would help in the recovery process of the brain and cognitions. These authors stated that past studies have shown the having this lack of metacognition makes individuals struggling with substance use disorders to not comprehend the importance of needing to change these behaviors or to start treatment or even continue to remain in ongoing treatment if they do begin. The results of this study showed that by using the NIPER program, the participants with substance use disorders showed an improvement in their psychological wellbeing. The program also raised the motivation of these participants to take part in brain and cognition recovery programs (Rezapour et al, 2021, p. 598).
Psychoeducation Focused On Sprituality and Existential Wellness (this is not the real heading)
Relapse is an unfortunate reality of those struggling from overcoming addictions. One particular study studied the effects of a psychoeducation intervention on the relapse rate, social functioning, perceived wellness, and coping methods in individuals who have received treatment for and recovered from SUD (Kargin et al., 2020, p. 40). The focus was on helping to create a change in lifestyle that will be continued to follow through in the individuals daily life. This study found that the relapse rate was 0% compared to 31% relapse rate in the controlled group. At the end of the three month follow up period, a 3.4% in the relapse in the group that received the psychoeducation was reported in comparison to 20.7% in the control group. The scores on perceived wellness and emotional, spiritual, and intellectual wellness (Kagin et al., 2020, p. 44), also showed a higher score than the control group. The study mentioned that when individuals experience struggling with wellness, this has an effect on their existential health (Turhan et al., 2011) within Kagin article. Learn to quote. A previous study mentioned by Kargin 2020, studied coping mechanisms with spiritual health being one and stated that an intervention that was able to provide assistance to an individual that was positive and meaningful to them has a positive impact on their well-being. This positive effect has a healthy effect on rate of relapse. These show how PE interventions that incorporate existential wellness and spiritual wellness have a positive effect on SUD.
Music therapy has found to be helpful alongside PE in helping with relapse rates and increasing self-efficacy in individuals struggling with SUD (Kayaoglu & Altun, 2021). Symptoms like depression, anxiety and stress are not uncommon in people struggling with SUDs. Music therapy has been found to help improve symptoms associated with these mental health struggles. In this present study, the authors found that by providing PE around alcohol and substance use as well as teachings around coping skills in risky environments, relapse prevention, dealing with stress, impulse control and anger combined with music therapy had positive results. Initially PE was provided and then music therapy was offered following that. The results of the study showed that the patients who received combined PE with music therapy had lower percentage of relapse rates even after the fourth and six month follow up. The results showed a decrease in scored lower on stress and depression symptoms, which are causes of relapse. This study is important to the paper because in the Sikh religion, hymns are sung at the temple and homes. Combing this research based evidence on the effect of PE alongside music therapy can provide the PE needed by this community to better understand the effects of the hymns being sung to help aid them in overcoming addictions.
Another study focused on providing psychoeducation in a minority Muslim community within Canada about addictions (Hassan et al., 2019). These authors aimed to study a psychoeducational program that was spiritually-adapted specific to addictions for adult Muslims within their Mosques. The aim of the study was to see what the effects of this program being taught by Muslim community representatives in the mosques, medical professionals and other mental health professionals would have on the stigma tied to addictions, which can be a barrier to seek mental health support. The program was a ninety-minute seminar that integrated Islamic teachings from the Quaran and Hadith. The teachings of the Quran specific to alcohol and the similarities to existing recent treatment for alcohol use disorder were presented. Mosque organizers and various other instructors were provided specific information on the information that was going to be presented during the seminar.
Ninety-three individuals participated in the study. The results showed that 61.3% of the stated the presentation did increase their scientific understanding of addictions and the correlation between science and the Islamic teachings in regards to addictions. One participant stated, The Islamic context clearly highlights engaging in addiction behaviors and I see that it agrees with science (Hassan et al., 2021, p. 647). Sentiments around the struggles individuals with addictions face and the process of overcoming the addictions were positive. People shared having compassion and empathy along with having the desire to help struggling individuals. Participants shared having more knowledge around misunderstandings around quitting cold turkey and having the new gained knowledge about the genetic, biological and neurological studies on addictions gave them a better understanding of how discontinuing substance use is very difficult (Hassan et al., 2021, p. 648). Almost half the participants showed a desire to attend more seminars focused on neuroscience and genetics of other forms of addictions as well. This study shows the importance of creating more PE programs specific to individual spiritual communities in minority population.
Psychoeducation as prevention.
Psychoeducation can possibly lower the risk of commencing drinking amongst younger children and teens underage (Gilder et al., 2017). The study compared the effects of both Motivational Interviewing and Psychoeducation in youth and the effects on individuals that were currently consuming alcohol along with another group of individuals that had not started to drink. This study found that the actively drinking youth group prior to the interventions at follow up, showed a notable decrease in both amounts of alcohol, as well as frequency. The youth that had not started any consumption of alcohol prior to this study showed that a small percentage of youth, 17% started to drink after being provided the Psychoeducation. The authors of this study found that providing education around the cultural beliefs of their respective communities beliefs helped teens understand that important cultural ceremonies did not allow individuals to participate if they are under the influence of alcohol and that it is prohibited. This finding can be attributed to various communities where alcohol is a problem, but is actually prohibited during cultural prayers and ceremonies.
Mindfulness as a Treatment in Recovery from Alcohol Substance Use Disorder in the Punjabi Sikh Community
Mindfulness as a Treatment in Recovery from Alcohol Substance Use Disorder in the Punjabi Sikh Community
Addictions in any member of a family can impact all areas of a familys life including relationships with family members, social interactions, free time activities and monetarily (Sharma, et.al, 2019). Addictions cause harm to not only to the individual and the family, but society as well. According to the World Health Organization (WHO) (2010), alcohol use disorder has become more prevalent than drug use disorders with both being higher amongst men than women.
Kumar et al., (2018) stated the many effects of alcohol on the human body including, the brain, stomach, liver, heart, skin, hair, as well as longer term effects of neuritis, damage to nerve endings, and pancreas issues.
This paper will discuss addictions and the Punjabi Sikh community. According to Statistics Canada (2022), as of 2021 there are close to 800,000 Canadian Sikhs making up 2.1% of the population. Although there is no specific data on what percentage of the Sikhs in Canada are affected by addictions, Statistics Canada (2022) show that this population is the fourth largest religious group in Canada and the fastest growing. The purpose of this literature review is to show the effectiveness of psychoeducation and mindfulness and how this can be applied to the Punjabi Sikh community affected by addictions and professionals. The research is very limited about applying the Sikh spiritual practices as a treatment modality for addictions. Due to this fact, it is important to educate the Punjabi Sikh community about the science behind how spirituality, mindfulness in relation to neuroplasticity helps aid in recovery from addictions.
There are many contributing factors leading certain individuals to turn to addictions. These are important to discuss and bring into light in respect to the Punjabi Sikh population residing in North America and will be addressed in this paper. This population suffers from many barriers to treatment, such as being unaware of services, language and communication issues, shame and stigma, and trust issues (Galvani et al, pg.51, 2013).
The Punjabi Sikh population originate from a northern province in India, named Punjab (Labun & Emblen, 2007). Sikhs are not just a minority in Canada, but India as well. The religion of Sikhism was founded between the years of 1469-1708 by the Ten Gurus. Sikhism has attributes of both the Islamic and Hinduism faiths (Mojaria-Keval & Keval, 2015). The first Guru, Guru Nanak Dev Ji, was born in a higher-caste Hindu family and rejected the caste system. The Tenth Guru, Guru Gobind Singh, stated that after his passing, the next Guru would be the Guru Granth Sahib (GGS), the holy scripture written by the Ten Gurus as well as others. The Guru Granth Sahib is what guides the Sikhs today in expressing their faith and teachings. These scriptures are the eternal guide to Sikhism and are to be treated as a living guru/teacher. In the scriptures of the Guru Granth Sahib, salvation is achieved by following paths of love and seva (Mojaria-Keval & Keval, 2015). This author will note some scriptures from the GGS in relationship to addictions.
The Punjabi Sikh Diaspora
According to Ghosh (2017), a handful of Sikhs are known to have first arrived in Vancouver in the early 20th century. Sikhs initially started to immigrate to Canada due to their connection with the British Army (Labun & Emblen, 2007). From then to now, Sikhs have continued to immigrate to Canada in a steady number far from their involvements with the British Army. As a part of the Canadian immigration policy, the formation of the sponsorship system led to the majority of the immigrants from Punjab starting in the 1950s (Nayar & Sandhu, 2006). In the 1960s, the Canadian government loosened their immigration policy to include educated professionals from India to immigrate. Sikhs, although a minority in India, are one of the largest groups of Indians overseas. However, the majority of the immigrants have been blue collar laborers with very little education. The majority of the elderly Sikh population migrated at an age where they were unable to work even in these positions.
Largely, Punjab Sikh immigrants in Canada are from farming villages in India with very limited education, if any at all. Traditionally the land is passed on from generation to generation and village life is economically underdeveloped and traditional. These deep-rooted experiences followed the elderly Punjabi Sikh when immigrating to Canada. Therefore, the elderly came from societies that had not experienced industrialization and urbanization and were relocated into the Western capitalist society of Canada without having undergone the experience of modernization (Nayar & Sandhu, p. 141, 2006).
Current Treatment Modalities Western
Current Treatment Modalities Specific to SP Population
Majority of the limited research that has been completed in relation to alcohol problems within the Sikh Punjabi community has taken place in the UK. One project, the Shanti service, took place between the years of 2016-2019 in the UK (Galvani & Guru, 2020).
Reasons for Addictions
Acculturational stress
A model of acculturation explained by Berry (2022), states there are four models of acculturation, which are, integration, assimilation, separation and marginalization. Following Berrys model, Bekteshi & Kang (2020) define acculturative stress
as the disrupted state of being among immigrants resulting not only from acculturation related challenges such as conflicts steaming from shifts in ones perceptions, challenges in learning new language due to differences between native and host language, acculturation rate disparities among family members, differences in meaning of social support between host and native country, but also from broader environmental and historical contexts (Bekteshi & Kang pg. 899, 2020).
According to Tuck et al. (2016), it was pointed out that Sikhs living in the UK could be drinking more excessively than other religious groups studied as alcohol is used as a coping mechanism in response to acculturation stress.
Barriers to Support
According to Galvani et al. (2013), individuals from the Punjabi community voiced being aware that supports do exist, however, did not know what that help was, how to access it or where to begin looking and did not have knowledge about interventions or treatments. Language was another perceived barrier to access supports as well as literature not provided in the native language. In general, research has shown that minority groups received less quality care due to language barriers, cultural differences and lack of healthcare literacy (Bau et al., 2019). Aside from these more practical issues, members in the community expressed barriers due to stigma, shame, embarrassment and fear of lack of confidentiality due to these concerns. Males in the community felt they would be judged for seeking supports and it was not acceptable for them as the primary food providers in the family to seek supports. Mothers felt they could not seek supports for their sons due to being blamed for not raising them appropriately.
Although alcohol use is not a secret within the Punjabi Sikh community, families struggling with it attempt to hide it from other community members (Taak et al., 2020). Alcohol is highly stigmatized within the community. The Sikh religion prohibits the use of any substances and the shame and stigma attached with alcohol use are a strong reason why Punjabi Sikh families do not attempt to access services (Galvani et al., 2013). Therefore, due to the reasons discussed above, there are many practical and emotional barriers to this community seeking services.
Some community members have shown insight into the fact that alcohol abuse is connected to mental health struggles and the importance of addressing these (Ruprai, 2016). According to Taak et al. (2020), mental health struggles are considered a weakness suffered mostly by the elder generation. The lack of understanding of how the behavior of consuming alcohol affects others in their lives was apparent. Sikh Punjabis who do consume alcohol do not see their drinking as an issue as it is widely accepted socially in the culture, therefore, miss the early warning signs of addictions. According to the research study by Taak et al. (2020), participants did not express concerns about how alcohol affected their health and other social consequences as a result of drinking. These individuals believed that alcohol consumption was only a concern if it affected loved ones, including family, friends and relatives. The older generations are stubborn and unwilling to seek treatment for alcohol use (Taak et al., 2020).
Limitations of Information
Increase in female drinkers within the Sikh Population
Past research is very limited within this specific population and majority of the research has taken place in the UK. Though past research has focused on mostly male drinker and the rise in female drinkers has increased rapidly. Due to cultural standards that accept males to drink in order to be able to function as hard workers and breadwinners, more females tend to drink secretively and therefore, less likely to admit to family they are struggling with substance issues.
References
Ghosh, R. (2017). south asian immigration to canada. Canadian Issues (Association for Canadian Studies : 1999), , 53-56.
KAUR-AUJLA, H., SHAIN, F., & LILLIE, A. K. (2019). A GAP EXPOSED: What is known about sikh victims of domestic violence abuse (DVA) and their mental health? European Journal of Mental Health, 14(1), 179-189. https://doi.org/10.5708/EJMH.14.2019.1.10Labun, E., & Emblen, J. D. (2007). Spirituality and health in punjabi sikh. Journal of Holistic Nursing, 25(3), 141-148. https://doi.org/10.1177/0898010106293592
Chapter 2
Neuroplasticity
Neuroplasticity, also knows as neural plasticity or brain plasticity, is a process that involves adaptive structural and functional changes to the brain. A good definition is the ability of the nervous system to change activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections (Puderbaugh & Emmady, 2023, p. 1). (Mateos-Aparicio & Rodriguez-Moreno, 2019).
How addictions effect the Brain directly
According to Garland et al (2016), individuals that are suffering from substance use disorders show a less stronger connection between the regions of the brain that leads to a lower reported positive affect, higher levels of craving, and using substances after attempting to abstain.
According to Garami et al., 2018, a stress response takes place when an individual is faced with an event or situation that is seen as threatening and the individual lacks the ability to apply coping skills that are needed for regulating stress. These types of events engage both the stress and reward circuits at the same time in the brain. This lays a foundation for a neural substrate that can boost the pleasurable effects of consuming drugs, increase cravings and self-administration and elevates the risk of relapse. These authors also reiterate what other studies have stated that stress limits executive functioning, therefore self-control which can lead to the choice of drug use. Chronic stress is also known to be risk factor in developing drug addiction and relapse in individuals that are in sensitive situations due to the fact that stress pathways are continuously firing and they cause long-term changes physically, emotionally and behaviorally. Stress experienced in childhood and adolescence can effect the development of the parts of the brain responsible for the ability to control emotions and behaviors in response to stress along with decision-making, reward-behaviors, and impulsivity, including the prefrontal cortex (Garami et al, pg. 3, 2018).
According to Suckling & Nestor (2016), through magnetic resonance imaging, the neurobiology of addictions can be better understood. These authors stated that recent scientific technologies have helped investigate at molecular, cellular, and systems levels (Suckling & Nestor, pg. 360, 2016). Neuroimaging has contributed greatly to how neurological and psychiatric disorders are studied and understood. Various studies have suggested to show reduced grey matter, reduced cortical levels, more so in the frontal lobes. (put in other study too here). The results of the study based on analysis of several studies using a variety of neuroimaging technologies agreed with previous research about the impact trauma can have on addictive behaviors.
Neuroplasticity and Alcohols Use
There is an overwhelming of information on neuroplasticity. It is important to review the literature that helps explain how alcohol effects the brain and the process of recovery. According to a review completed by Seo & Sinha (2015), neuroadaptations that occur as a result of chronic alcohol use in vital neural circuits in charge of emotional and cognitive control, have a significant impact on both developing and recovering from alcohol. This specific review focused on neuroplasticity and alcoholism and how the neurobiological adaptations effect recovery from alcohol. Understanding why there are high relapse rates in individuals recovering from alcohol at a neurobiological level may help. One area of study that has showed great effects of this is specifically on the effects of alcohol on the structure and function of the brain, where these neuroadaptations can be formed and then the impact on the reward and decision-making systems in the brains. These neuroadaptations cause complications in relapse and recovery. Researchers have had to look to studying the brain to understand clinical and biological reasons that predict this risk of relapse. The major modes of studying this are neuroimaging techniques which can capture neuroplastic changes that may exist that make certain individuals more sensitive to alcoholism and relapse. The central nervous system (CNS) regulates homeostasis, emotion and decision making. Chronic and heavy alcohol consumers show changes in the CNS and have difficulty with being able to stop drinking and can experience more psychological and physiological symptoms when they do try to quit. According to these authors, a study that looked at individuals who are abstinent from alcohol showed that changed neural systems of stress and reward modulation leads them to be vulnerable to stress and increased cravings for alcohol along with withdrawal symptoms, such as, anxiety, negative emotions, disruption to the autonomic nervous system (ANS), tiredness and sleep problems.
As mentioned earlier by Seo & Sinha (2015), neuroplastic changes can be both positive or negative and the changes due to alcohol or other drugs is considered neuroadaptation. Neuroplasticity refers to changes in the nervous system that occur in response to various stimuli or experiences and include structural and functional re-organization (Seo & Sinha, 2015, p. 144). These authors earlier mentioned the effects on the CNS and ANS from chronic use of alcohol. They further go on to explain the effects chronic alcohol has on prefrontal-striatal limbic (PSL) circuit, which is in control of regulating motivation and emotion as well. The PSL circuit includes the striatal-limbic system in the amygdala and the prefrontal regulatory region, which encompasses the medial prefrontal cortex, (PFC). The anterior cingulate cortex (ACC), the orbitofrontal cortex (OFC) and the dorsolateral PFC are also a part of the PSL circuit. This information is relevant to this topic as the PSL is important as it plays a vital part in regulating the reward, stress and decision making systems through the various stages of alcoholism. These authors stated that keeping an intact PSL circuit is crucial in order for an individual to have the ability to deal with cravings and relapse. These authors stated that consumption of alcohol led to a reduction in connectivity amongst the amygdala and orbitofrontal cortex. This leads to individuals being unable to process socioemotional stimuli when having consumed alcohol due to decreased interaction with the amygdala.
Individuals using excessive alcohol leads to changes in their stress system, which may then lead to comorbid symptoms in connection to alcohol dependence such as anxiety, negative mood and a heightened sensitivity to stress and then stress-induced cravings for alcohol. These authors stated that stress can lead to an increase in alcohol cravings and compulsive consumption. Overall, chronic users of alcohol report an increase in sensitivity to stress and intense cravings due to stress. Individuals who experience the symptoms of withdrawal show higher levels of basal stress hormones, cortisol, norepinephrine and corticotropin-releasing factor (CRF). The amaygdala is involved in stress-induced physiological responses via modulation of CRF and norepinephrine pathways, which are well known for their contribution to negative reinforcement (Seo & Sinha, 2015, p. 146). These authors referenced a study that showed individuals who relapsed compared to those who did not relapse had reduced amygdala volumes. This was strongly connected with alcohol craving and consumption.
These authors go onto further suggest that disruptions to the limbic-striatal system could then lead to gradually weaken PFC. The damages in the PFC can enable recovery due to impacts on executive function, inhibitory control, and decision making. Various studies using neuroimaging have pointed towards structural and functional deficits in the prefrontal regulatory regions in chronic alcohol users. Reduced gay matter volume is detected through structural imaging studies and has been linked to unsuccessful treatment outcomes in chronic alcoholism. Another study discussed by these authors showed that a lower level of blood flow to the medial frontal lobe increased the chance of relapse and decrease change of recovery. The results of the information provided by these authors suggest the dealing with the negative neuroplastic changes could help in dealing with recovery from chronic alcoholism. The next section of this paper focuses on practices to help reverse these negative changes as neuroplasticity can take place positively and negatively.
References
Puderbaugh M, Emmady PD. Neuroplasticity. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK557811/
