Subconscious surrender to God predicts long-term addiction recovery, study finds

A 1-year longitudinal study showed that the adoption of Surrender to God, a religious coping strategy, was associated with almost 3 times lower odds of substance use relapse over the course of one year in Christian patients, if the use of this strategy is measured using an implicit association task. However, explicit measurement of the application of this coping strategy was only associated with slightly decreased odds of relapse after a month, but not at 6- and 12-month assessments. The paper was published in Addictive Behaviors Reports.

Surrender to God is a religious coping strategy in substance use disorder recovery in which people relinquish their own desires and actions in order to follow what they believe to be God’s will. It may support recovery by helping people shift attention away from substance-related reinforcers and toward a future-oriented, transcendent source of meaning and support. This process has been described as humble detachment: letting go of preoccupation with craving while prioritizing awareness of God’s active and loving presence.

In this way, surrender to God may reduce worry, negative repetitive thinking, uncertainty intolerance, negative emotions, and craving. Previous studies have linked surrender to God with lower substance use and craving, lower anxiety and depression, greater meaning in life, and a stronger sense of being supported by God. However, there is still limited longitudinal evidence and no fully developed overarching theory showing that surrender to God causally promotes recovery.

There are two general approaches to measuring the application of this coping strategy—the explicit and the implicit approach. Explicitly, surrender to God is measured with self-report questionnaires in which participants indicate how much they consciously endorse entrusting their problems, choices, and recovery to God.

It can be measured with an Implicit Association Task, which assesses how strongly and automatically a person subconsciously associates the concept of “surrender to God” with themselves. This implicit measure may be useful because substance use can involve automatic, hard-to-control processes that are not fully captured by self-reports.

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Study author Henk-Jan Seesink and his colleagues hypothesized that Surrender to God, measured during treatment for substance use disorder, would be associated with lower chances of relapse, lower levels of substance use disorder symptoms, and greater meaning in life at follow-ups. They conducted a longitudinal study in which they followed individuals undergoing substance use disorder treatment up to a year after their treatment.

The study authors initially approached 462 patients with substance use disorder at a government-accredited Christian addiction and mental health clinic in Dordrecht, the Netherlands. At this clinic, a multidisciplinary team of addiction specialists provides treatment based on cognitive behavioral therapy for addiction, and on schema therapy for personality disorders where necessary. The patients were also free to participate in optional, non-governmentally funded religious activities, such as prayer meetings, and to choose whether to connect their faith and spirituality to treatment goals.

After early dropouts and excluding patients who were not Christians, the final number of participants included in the study was 177. However, only 101 (57%) of them provided their data after 12 months. Patients who were Christians were selected for the primary analyses of this study because Surrender to God was expected to be a valid predictor of outcomes mainly in these individuals.

Forty-nine percent of participants were treated for alcohol use disorder, 25% for cocaine, 11% for cannabis, and the remaining participants for other types of substances. Participants’ average age was 40 years. Around 75% of them were men.

Surrender to God was measured at the start of the study both explicitly (using the Dutch Surrender to God Scale) and implicitly (the Implicit Association Test for surrender). The study authors tracked relapse (the return to substance use) and assessed participants’ substance use disorder symptoms (using the Leeds Dependence Questionnaire) and meaning in life (the Multidimensional Existential Meaning Scale).

Results showed that the implicit measure of Surrender to God predicted strongly decreased odds of relapse (almost 3 times lower odds) over the course of one year, but not at the one-month follow-up assessment. In contrast, the explicit measure of Surrender to God predicted slightly lower odds of relapse up to one month after treatment, but not at the 6- or 12-month assessments. Surrender to God was not associated with a reduction in daily substance use disorder symptoms or an increase in meaning in life.

“These results suggest that explicit StG [Surrender to God] may be useful in predicting short-term relapse, and implicit StG may be useful in predicting longer-term relapse,” the study authors concluded.

The study contributes to the scientific understanding of coping strategies that might help prevent relapse in substance use disorder. However, it should be noted that the design of this study does not allow any causal inferences to be derived from the results. Additionally, the study had a very large attrition rate, meaning that a large share of participants dropped out or could not be reached before the end of the study. This non-response may have affected the findings.

The paper, “A One-Year longitudinal study on Surrender to God assessed during addiction treatment,” was authored by Henk-Jan Seesink, Cis Vrijmoeth, Brian D. Ostafin, Hanneke Schaap-Jonker, and Reinout W. Wiers.