How spirituality helps overcome denial and supports recovery from substance use disorder: The role of meaning and hope

Substance use disorder (SUD) is a major public health issue that affects individuals across age, socioeconomic, and cultural groups. One of the most persistent psychological barriers to recovery is denial, a cognitive distortion characterized by minimizing or rationalizing substance use and its consequences. While traditional treatment approaches emphasize medical and behavioral interventions, growing evidence suggests that spirituality and belief in a higher power may play a critical role in long-term recovery. However, limited research has examined how spirituality specifically influences cognitive distortions such as denial. The present study examined the relationships among spirituality, denial, and psychological recovery outcomes—specifically meaning and hope—among individuals recovering from substance use disorders. Ninety young adults (ages 18–25) in recovery from alcohol use disorder were recruited from rehabilitation centers across the United States. Participants were categorized into low, moderate, or high spirituality groups based on self-reported scores on the Daily Spiritual Experience Scale (DSES). Denial was measured using the Denial of Use Scale, and meaning and hope were assessed using standardized questionnaires. Participants engaged in an eight-session, four-week intervention that varied by group: spiritually integrated practices, mindfulness-based activities, or cognitive-behavioral/self-reflection exercises without spiritual content. A multivariate analysis of covariance (MANCOVA), controlling for age and length of sobriety, revealed a significant multivariate effect of spirituality level on denial and meaning/hope. Follow-up ANCOVAs indicated that higher levels of spirituality were associated with significantly greater meaning and hope, while moderate levels of spirituality were associated with higher denial compared to the low-spirituality group. Significant interactions between spirituality level and gender were observed for both denial and meaning/hope, although gender alone was not a significant predictor. These findings suggest that spirituality may be particularly beneficial in enhancing hope and purpose during recovery, while partial or inconsistent spiritual engagement may not sufficiently reduce denial. Results highlight the importance of considering spirituality as a meaningful psychological resource in addiction treatment and underscore the need for more nuanced, individualized approaches to spiritually integrated care.