Addiction science has developed powerful models of reinforcement learning, cue reactivity, neuroadaptation, and impaired control. However, in clinical consultations, families, and in the private silence of relapse, many people describe something even more basic than craving: the loss of an inner home. They say “I feel empty”, “I can’t stand being with myself”, or “I have betrayed who I am”. Sometimes they choose a simple and devastating phrase: “my soul is ill”. This narrative review treats that expression as clinically meaningful, not metaphysical. We translate “illness of the soul” into five operational psychological dimensions directly relevant to addictive vulnerability and recovery: coherence (value–action alignment), dignity (moral worth protected from humiliation), care (self-compassion, boundaries, and prosocial concern), truth (contact with inner experience and reality), and purpose (meaning and direction). We integrate evidence from negative reinforcement and self-medication models, self-determination theory, research on shame and self-stigma, psychological f lexibility and experiential avoidance (ACT), compassion-focused approaches, and the emerging literature on moral injury. From this synthesis we propose the Meaning–Dignity Disconnection Model of Addiction (MDDMA), a clinically usable and empirically testable loop in which loss of meaning and injuries to dignity intensify shame, avoidance, and isolation, increasing reliance on substances or compulsive behaviors as rapid regulation strategies. We argue that recovery becomes more durable when treatment complements symptom reduction with restoration of meaning, moral repair, rebuilding of dignity, and reconnection with caring relationships. Beyond individual therapy, the model has implementation implications: programs that protect dignity, avoid humiliation, and offer reintegration pathways after slips may reduce dropout and relapse by preventing shame-driven secrecy. We conclude with testable hypotheses, a measurement map, and practical guidance for clinicians and programs seeking to protect dignity and strengthen long-term recovery capital.
This paper examines two historically distinct yet structurally convergent spiritual frameworks—the Twelve-Step program of Alcoholics Anonymous and the Chassidic theology of R. Shneur Zalman of Liadi’s Tanya—as clinical resources for patients confronting catastrophic illness. Both traditions address the fundamental problem of how human beings meet calamity: the disintegration of control, the assault on identity, and the summons to a posture beyond mere coping. Drawing on the Twelve-Step dictum that serenity emerges through surrender to a Higher Power and the Tanya’s insistence that concealment serves as the engine of spiritual ascent, we propose a dual-axis model for what we have elsewhere called “hermeneutic medicine”—an approach that treats the patient not as a problem to be solved but as a sacred text requiring interpretive wisdom [1,2]. The Twelve-Step axis offers ego-disarmament and radical acceptance; the Chassidic axis offers ego-reorientation and transformative joy. Together, they constitute a comprehensive clinical spirituality that addresses the therapeutic needs of patients across a spectrum of psychological readiness, from the newly diagnosed to those engaged in mature existential reckoning. We argue that this integrated framework provides clinicians with a theologically grounded yet clinically pragmatic vocabulary for the work of accompanying patients through illness, and that it corrects the spiritual minimalism of biomedical reductionism without falling into the spiritual overreach of premature metaphysical consolation [3,4].
Purpose: Adopting a de-pathologizing and process-oriented perspective, this study explored how individuals’ relationships with their smartphones gradually evolve, deepen, and transform throughout the development of smartphone addiction. Participants: Twenty-three adults aged 20 to 45 who self-identified a tendency toward smartphone addiction were purposively recruited from community and university networks. Methods: A narrative inquiry design was employed to capture participants’ lived experiences across time. Each participant took part in three semi-structured interviews conducted at one-month intervals and completed two creative reflection tasks: My Smartphone Story Journal and the Addiction-Imagination Picture Book. The data corpus of interviews and creative artifacts was analyzed using a holistic–content narrative approach to construct temporal trajectories and thematic patterns. Results: Three overarching themes were identified: (1) Experiencing the present: Smartphone use was marked by emotional ambivalence, combining comfort with restlessness and emptiness. (2) The path to smartphone addiction: Dependence developed gradually, with smartphones becoming steady yet consuming companions integrated into daily routines. (3) Human–smartphone relationships: Participants expressed concern about inseparability while striving to rebuild more human-centered and rational ways of use. Conclusions: Smartphone addiction emerged as an evolving human experience rather than a clinical condition. The findings highlight reflection, self-awareness, and meaning reconstruction as essential steps toward more balanced and mindful digital engagement.
Background: Adolescents and young adults in the United States have experienced substantial increases in substance use, depressive symptoms, and suicide-related behaviors after the COVID-19 pandemic. However, evidence remains limited on how alcohol, opioid, and polysubstance use co-occur with severe depressive disorder and suicidality. This study examined these associations and identified high-risk subgroups using nationally representative post-pandemic data. Methods: We conducted a cross-sectional secondary analysis of publicly available National Survey on Drug Use and Health data among adolescents and young adults aged 12–29 years. Survey weights and design variables were applied to generate nationally representative estimates. Weighted prevalence estimates described substance use and mental health outcomes, and prevalence ratios and multivariable logistic regression models were used to examine associations between substance use categories and severe depressive disorder and suicide-related outcomes, adjusting for sociodemographic and pandemic-related factors. Results: Overall, 40.9% of participants reported at least one adverse mental or behavioral health outcome. Symptoms of anxiety or depression were reported by 30.9%, increased substance use by 13.3%, and suicidal ideation by 10.7%. Young adults aged 18–24 years experienced the highest burden, including anxiety or depressive symptoms (62.9%) and suicidal ideation (25.5%). Unpaid adult caregivers demonstrated particularly elevated risk, with increased substance use reported by 32.9% (PR 5.28, 95% CI 4.59–6.07) and suicidal ideation by 30.7% (PR 8.64, 95% CI 7.23–10.33). Longitudinal analyses showed more than threefold higher odds of incident substance use (adjusted OR 3.33, 95% CI 1.75–6.31) and suicidal ideation (adjusted OR 3.03, 95% CI 1.20–7.63) among caregivers. Conclusions: Substance use, especially alcohol, opioids, and polysubstance involvement, is closely linked to severe depression and suicide risk among U.S. adolescents and young adults, highlighting the need for coordinated prevention efforts that address mental health, substance use, and social stressors together.
This article proposes a novel theological interpretation of Step One of the Twelve-Step recovery program—"We admitted we were powerless"—through the lens of Jewish mystical thought on being (yesh) and non-being (ayin). Drawing on the scholarship of Elliot Wolfson, Gershom Scholem, and the radical theology of Jonathan Eybeschutz, alongside the author's own clinical-theological work on divine concealment in therapeutic encounters, this essay argues that the admission of powerlessness constitutes not merely a psychological acknowledgment but an ontological revelation. The addict's encounter with powerlessness mirrors the kabbalistic understanding of ayin as the sacred ground from which authentic being emerges. This reframing resolves the apparent theodicy problem posed by addiction—namely, how a beneficent God permits such suffering—by relocating the question from explanatory theodicy to transformative encounter. The collapse of false selfhood in Step One becomes structurally identical to the mystical process of bitul (self-nullification), wherein non-being serves not as nihilistic void but as the generative matrix of spiritual rebirth.
