I have studied addiction from the laboratory bench to the bedside for more than 50 years. In that time, we’ve learned a great deal about addiction, withdrawal, craving, treatment, and relapse. And we now understand that dopamine, reward, stress, and some brain changes make quitting extremely difficult.

But what is the crux of addiction that makes it so difficult to treat? How do some people stop using while others relapse repeatedly, sometimes fatally?

Alcoholics Anonymous (A.A.) offered an answer long before neuroscientists could look at dopamine in the living brain. Putting a stop to drinking is only the beginning.

When Bill Wilson and Dr. Bob Smith founded Alcoholics Anonymous in 1935, they weren’t thinking about dopamine. They knew addiction and recovery from the patient’s perspective. Nearly a century later, neuroscience is catching up. What A.A. called “spirituality” may involve measurable changes in thinking, behavior, social connections, and brain function. A.A. began with clinical observation and lived experience. Modern neuroscience is helping explain why recovery works.

Smith famously summarized A.A.’s core work as simply “love and service.” Helping newcomers gives recovering individuals a sense of meaning, boosts self-efficacy (confidence in staying sober), and breaks the cycle of obsessive self-focus.

People might struggle to remember who and what they were before they developed a substance use disorder (SUD). Treatment is tough; it takes time, and people need persistence and resilience. With continued treatment, good things may then happen—relationships, accountability, purpose, and hope.

True, A.A. has spiritual roots, but it’s not a religion. A.A. members are encouraged to find a power greater than themselves. That may be God, or helping others, or something else. Spirituality has always been part of the A.A. founders’ core message and approach. Now science is catching up. But what exactly is spirituality doing?

New Study

In a recent 2026 JAMA Psychiatry meta-analysis, Howard Koh and colleagues examined 55 longitudinal studies involving 540,712 people. Religious or spiritual involvement was associated with a 13% lower relative risk of harmful alcohol or other substance use. More-than-weekly religious-service attendance was associated with an 18% lower risk.

Association is not causation, but these are still impressive numbers. People involved in religious communities may also have more supportive families, different friends, greater supervision, and social expectations discouraging drug use, which may influence the numbers.

There’s another important thing to remember about this study. About 87% of the study’s extracted effects concerned prevention. Preventing addiction and treating established addiction aren’t the same thing.

Spiritual, Not Religious

Another study added important information. Paul McClure and Lindsay Wilkinson examined 1,711 adults in the Midlife Development in the United States study. People who attended substance-use recovery groups were 2-3 times more likely to identify as spiritual but not religious. More frequent participation was particularly associated with this identity.

Anyone who has treated SUDs has seen patients who seemed absolutely hopeless. But people surprise themselves and us all the time. They change in ways that cannot be explained by a negative urine drug screen.

Addiction changes priorities. Family, work, relationships, and ordinary pleasures lose their appeal. Behavior and motivation shift from everyday rewards to drugs and drug-related cues.

Addiction Essential Reads

Drug users remember that drugs produced pleasure. But that becomes a memory. Over time, continued use becomes increasingly prompted by the need to avoid withdrawal, dysphoria, and distress. The next drink, dose, or high takes priority.

Many patients entering treatment are depressed, anxious, and unable to experience pleasure. Some have independent psychiatric disorders. Others have symptoms produced or amplified by chronic substance use and withdrawal.

Detox or cold turkey stopping the drug does not immediately restore normal brain or reward function. This is one reason early recovery is so difficult. The drug is gone, but pleasure, motivation, and hope may not have returned.

Can Spirituality Help?

We don’t have evidence that prayer restores dopamine neurons or reverses addiction-related neuroadaptations. Those claims would go well beyond the science. But consider what happens in a recovery community. A meeting provides structure. A sponsor provides accountability. A recovering person helps someone newly sober, consolidating their own sobriety. Friendships develop. People resume positive activities they had ended with addiction.

People with SUDs find it hard to believe that helping another person can become more rewarding than getting high. But when they change, helping others can become a reason for living. These changes may be essential to sustained recovery.

The brain learns from experience. Recovery requires new experiences, new habits, and new rewards.

A.A. Was Ahead of Science

A.A. has been helping people recover since 1935 through personal testimony rather than rigorous clinical research. Then a 2020 Cochrane review of 27 studies found that manualized A.A. and Twelve-Step Facilitation often produced better continuous abstinence outcomes in alcohol use disorder than other established treatments.

John Kelly is the expert on how A.A. works. Kelly says that when social networks change for the better, coping improves. Abstinence becomes more acceptable, and recovery becomes part of a person’s identity. A.A. does not work because someone is told to believe in God (which A.A. does not do). It may work because people change their behavior, their friends, their expectations, and their lives.

Before and After Addiction

Research is finally asking the big questions. Do religious or spiritual involvement reduce the risk of developing harmful substance use? The 2026 meta-analysis suggests it may.

Can A.A. improve recovery after alcohol use disorder has developed? Randomized trials and systematic reviews support that conclusion.

While these are different questions, we know that spirituality is relevant to SUD risk and is also very helpful in SUD treatment.

SUDs develop quickly because of secrecy, stigma, fear, and deep shame. Admitting powerlessness and ceding control to a “Higher Power”—whether defined as God, nature, or the collective wisdom of the group—can help by relieving the crushing burden of trying to control everything alone.

It is up to the individual to figure out. But some patients derive strength from organized religion. Others reject religion but find purpose in service, meditation, nature, family, or secular recovery groups.

What matters most isn’t whether someone attends church. It is whether they have relationships, purpose, and support that help them stay well.

What Should Clinicians Do?

Ask whether religion or spirituality matters to this patient. Has it helped during difficult times? Does the patient want spirituality included in treatment?

Spirituality is not a replacement for medicine, and a sponsor is not a substitute for a physician. Patients with opioid use disorder need medications like buprenorphine or methadone. Severe alcohol withdrawal requires medical detox and naltrexone. Depression, psychosis, and trauma require appropriate assessment and treatment.

Addiction hijacks the brain’s dopamine and pleasure pathways. Spiritual practices like prayer, meditation, and intense fellowship stimulate similar reward and emotional-regulation centers in the brain, affording a healthy psychological substitute. But recovery programs also change how people live, whom they trust, what they value, and what they look forward to.

Stopping drug use is essential, but so is building a life worth staying sober for.