The mechanism underlying the relationship between the spiritual struggles and life satisfaction of Polish codependent individuals participating in Al-Anon – pilot study

ABSTRACT Codependency is a serious mental, emotional, social, and physical problem. Little is known about the spiritual mechanism of recovery among codependent individuals participating in Al-Anon self-help groups. The aim of this study was to verify whether spiritual struggles are indirectly through spiritual growth and hope, related to life satisfaction of codependent individuals. The achieved results confirmed the indirect effect of spiritual struggles on life satisfaction through the spiritual growth and hope of codependent individuals participating in Al-Anon. The research confirmed the mechanism underlying the relationship between spiritual struggles and the life satisfaction of codependent individuals participating in Al-Anon.


Introduction
According to the Polish State Agency for Prevention of Alcohol-Related Problems (2008), there are about 800 thousand alcohol-dependent individuals in Poland and about 2-2.5 million harmful drinkers, which means that alcohol abuse problems affect 9% of the Polish population and are responsible for at least 10 thousand deaths a year. Living in a family with a member with an alcohol dependence problem leads to its dysfunctions (Leadley, Clark, & Caetano, 1999;Scharf et al., 2004). It is connected with sexual, physical, and emotional abuse (Markowitz, 2005), and can be a source of codependency (PARPA, 2022). The term codependent was its roots in the Alcoholic Anonymous fellowship and its successors, such as Al-Anon and Al-Ateen (Lyon & Greenberg, 1991), to stress that it regards not only partners of alcohol-addicted persons but also their children. Moreover, it touches also relatives of individuals addicted to other than alcohol substances and behavioral addiction, such as gambling (Harkness, 2014). Codependence has not yet been counted as a disease despite the diagnostic criteria established by Timmen and Cermak (1986) and Cermak (1986) already four decades ago. It between spiritual struggles and spiritual growth and life satisfaction. In the study, I based on findings from rich and extensive addiction literature regarding the alcohol-dependent individuals attending AA.
Considering the same form of support in self-help groups AA and Al-anon, it was reasonable to suppose that these spiritual mechanism is similar or even the same. It is need to emphasized that both of this form of self-help have the same functional structure and operate according to the same principles and values, which the most important element is spiritual 12-step Program (Twelve Steps and Twelve Traditions, 1981).
Based on the recent research (Wnuk, 2021a) this study aims to examine spiritual mechanism underlying the relationship between spiritual struggles and spiritual growth and life satisfaction of Al-Anon participants from Poland and the role of hope in these links.
It finds confirmation in the results of the studies. For example, both religious practices (Wnuk, 2021b;Yoon et al., 2015) and positive religious coping (Jackson & Bergeman, 2011;Santoro, Suchday, Benkhoukha, Ramanayake, & Kapur, 2016;Shannon, Oakes, Scheers, Richardson, & Stills, 2013) are factors positively correlated with spirituality. In a Wnuk study (2021b), religious practices of Chilean students such as prayer and Mass attendance were positively related to spiritual experiences. A Park et al. (2013) study conducted on a representative sample of American adults indicated that participants counted as highly religious, in comparison with those moderately religious, somewhat religious, and minimally religious or nonreligious, were found to score higher in prayer, attending religious services, positive religious coping, and daily spiritual experiences. In Van Dyke et al.'s (2009) research among adolescents, positive religious coping was strongly positively related to their spiritual experiences. In a sample consisting of mostly African-Americans, prayer was moderately correlated with spiritual experiences (Skarupski, Fitchett, Evans, & Mendes de Leon, 2010).
Spiritual experiences as a spiritual growth manifestation are not only a domain of religiously inclined individuals but also nonbelievers as a wide group that includes representatives of atheism, agnosticism, some forms of humanism, some kinds of secularism, anti-religiosity, irreligiosity, and indifference toward religion (Lee, 2012).
Religiosity can be one method for spiritual expression the same as other secular practices such for example mindfulness (Astin, 1997;Cobb, Kor, & Miller, 2015), meditation (Wachholtz & Pargament, 2008), or selfcompassion (Akin & Akin, 2017). Also, spiritual struggles are a phenomenon which regards not only religious people but also nonbelievers (Sedlar et al., 2018). Within AA and others based on this philosophy, selfhelp groups like Al-Anon, being open fellowship for the individuals with different worldviews, which encompasses both believers and nonbelievers, spiritual growth is treated as a way of healing (Alcoholics Anonymous, 2001). According to previous research, involvement in this form of support is beneficial for the recovery of alcohol-dependent individuals (Montgomery, Miller, & Tonigan, 1995;Wnuk, 2022) and members of their families (Young & Timko, 2015), available both for believers and nonbelievers within secular spirituality pathway (Wnuk, 2021c). Additionally, religious-affiliated can develop their spirituality based on religious worldview and this phenomenon is called religious spirituality. According to Wnuk's (2021c) research, both involvement in AA and religious commitment was positively correlated with spiritual experiences as two separate antecedents of spiritual growth.
In this study, all participants declared Roman Catholic denomination, and positive reference to God was tested as a form of coping with spiritual struggles. It is crucial for codependent individuals, who go to the Al-Anon looking for support because of angriness, chronic stress, tension, anxiety, loneliness, and isolation (Timko et al., 2013). For them, a relationship with God can become a "secure base" and the source of support delivering relief, peace, meaning, and direction. Considering that Poles is a very religious commitment nation (Pew Research Center (2018)) and religious socialization is a common process (Lun & Bond, 2013), religious ways of coping seem to be a natural way of codependent individuals to struggle with stress. Recent research has confirmed that in difficult and stressful situations such as the epidemic of Covid-19 was Polish population, more frequent than earlier used religious practices as a coping strategy (Boguszewski et al., 2020). Also, 11step from the 12-steps Program of spiritual growth implemented in self-help groups encourage building a bond with God through the spiritual practices "Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out" (Twelve steps and twelve traditions, 1981).
Because of the above, it was expected that Al-Anon participants used positive religious coping to struggle with stress as an efficient way to spiritual growth, reflected in spiritual experience's presence Hypothesis 1: In a sample of Al-Anon participants from Poland, positive religious coping was positively directly related to spiritual experiences.
Results of this research lead to the conclusion that spirituality/religiosity facilitates finding meaning and purpose in life and hope, which in turn are antecedents of positive outcomes and this mechanism is universal, being independent of the conceptions and measures of religiosity/spirituality, meaning in life, hope, and wellbeing and religious affiliation. Most of these studies were conducted on adolescents. For example, among Polish students, hope mediated between spiritual experiences and life satisfaction as well as positive affect (Wnuk & Marcinkowski, 2014). The same results were achieved in a sample of students from the Republic of South Africa using other measures of hope and religiosity (Nell & Rothmann, 2018). Among Chilean students, spiritual experiences were indirectly, through hope related to all measures of subjective well-being (Wnuk, 2021b). Also, in the population of alcoholaddicted individuals hope (Gutierrez, 2019;Gutierrez, Dorais, & Goshorn, 2020;Magura et al., 2003;Wnuk, 2022Wnuk, , 2017) play a beneficial role in the treatment process. For example, in a sample of Polish AA participants, spiritual experiences were negatively related to the severity of cognitive aspects of depression because of hope (Wnuk, 2021a). Some authors approach hope as a secular part of the spirituality dimension (Ellison, 1983;MacDonald, 2000) and the indicator of existential well-being (Baumeister & Vohs, 2002). For example among AA members hope, next to meaning in life, as a part of existential well-being predicted subjective wellbeing (Wnuk, 2022).
According to previous research in positive psychology, hope operationalized as a character strength compared to other strengths was the strongest predictor of life satisfaction (Park, Peterson, & Seligman, 2004a, 2004bProyer, Gander, Wyss, & Ruch, 2011). Hope as an emotion is a significant source of effective coping with stress and struggling with despair (Lazarus, 1999). It finds reflections in "broaden and built theory" in which hope, defined as a looking forward to the future and expecting the best to happen besides other positive emotions leads to a broadening of experience and the building of resources letting better adapt to demands and negative events and find the meaning and purpose (Fredrickson & Branigan, 2005). Some studies regarding behavioral and substance addictions have indicated the beneficial function of hope for positive outcomes of individuals participating in self-help groups. Magura et al. (2003) have shown that hope predicts abstinence and promotes healthy behaviors. In a sample of AA hope correlated positively with evaluation of life up to now and negatively with distress (Wnuk, 2017). Similar results were found among those diagnosed with obsessive-compulsive sexual behaviors from Poland who attended self-help group meetings. In participants of Sexaholics Anonymous (SA), hope was positively related to life satisfaction (Wnuk & Charzyńska, 2022) but among Sex and Love Addicted Anonymous (SLAA) with desire for life, passion for life, happiness, and satisfaction with some areas of life (Wnuk & Hędzelek, 2008).
Hypothesis 2: In a sample of Al-Anon participants from Poland, spiritual experiences are indirectly, through hope related to life satisfaction.

Participants
The research sample consisted of 40 codependent participants of Al-Anon.
Three criteria for participating in the study were applied. The first one was adulthood. The second was, living with a partner of an alcohol-addicted individual (regardless of the status of this partnership -marriage, cohabitation), and the third was attending to Al-Anon. There were no additional test of codependency syndrome severity. There were no additional tests for codependency syndrome severity. It was assumed that Al-Anon participants have started to participate in Al-Anon due to suffering from codependency symptoms, which Timko Timko et al. (2014) and Timko et al. (2013) have confirmed in their research Sociodemographic statistics in presented in Table 1. Males made up 50% and women 50%. Participation was voluntary and every subject gave their consent to take part in the study. Education levels consisted

Measure
The Daily Spiritual Experiences Scale (DSES) was used to assess a sense of connection with God, receiving strength, comfort, and love from God, experiences of peacefulness and awe, and a longing for closeness with God (Underwood & Teresi, 2002). The 16-item scale uses a 6-point response format ranging from never or almost never to many times a day. This measure has satisfying psychometric properties. Depending on population, the scale's reliability ranges from α = 0.86 to 0.95 (Loustalot et al., 2011). The short version consisting of six items was used. The Brief Religious Coping Scale (Brief RCOPE) is comprised of 14 items regarding positive and negative religious coping. Each question has a 4-point graded scale depending on how much the subject agrees/disagrees with the question. The more points scored, the more frequently the individual uses religious coping. The scale's reliability, depending on population, ranges from α = 0.78 to 0.94 (Pargament et al., 2011). In the study, only the items regarding positive religious coping were used.
The Hope Herth Index (HHI) (Dufault & Martocchio, 1985;Herth, 1992) is a scale used for the measurement of hope based on a definition of hope that states that hope is a multidimensional, dynamic life force, rather than traitoriented and one-dimensional. Hope, considered always possible, can be characterized as the certainty of achieving a good result in a goal that is personally significant (Dufault & Martocchio, 1985). Participants answered 12 questions expressed on the 4-step Likert-type scale. The reliability of this scale has satisfactory psychometrical features. The scale of reliability in a population suffering from illness was α = 0.97 and 0.91 using the testrestest method (Herth, 1992).
The Satisfaction with Life Scale (SWLS) (Diener, Emmons, Larsen, & Griffin, 1985) was used to measure life satisfaction. The SWLS consists of five items and each item was answered on a 5-point scale (ranging from 1 = strongly disagree to 5 = strongly agree). The reliability of this measure is 0.83, as determined by the test-retest method after a two-week repeated study, which rose to 0.84 after a month but then ranged between 0.64 and 0.82 after two months (Pavot & Diener, 1993).

Conceptual model and statistical analysis
Based on recent studies in AA, spiritual mechanism was explored to further understand how spiritual struggles and spiritual growth are connected with life satisfaction of Al-Anon participants from Poland. A conceptual model assumed that the life satisfaction of codependent individuals is an indirect result of spiritual growth through hope, and that spiritual growth are the consequences of spiritual struggles. A mediation model was used, assuming the indirect effect of an independent variable on the dependent variable through the mediator as equal to the total effect without the direct effect of an independent variable on the dependent variable (Agler & De Boeck, 2017), which is interpreted as a full mediation (Baron & Kenny, 1986) or indirectonly mediation (Hair et al., 2021). Three indirect effects (between positive religious coping and hope, between positive religious coping and life satisfaction, and between spiritual experiences and life satisfaction) were tested.
Spiritual struggles were measured by positive religious coping (Pargament & Exline, 2021), which encompasses ways of dealing with stressful situations through reference to a secure bond with a God as a source of support, relief, consolation, and direction (Pargament, Feuille, & Burdzy, 2011). Spiritual experience was treated as a manifestation of spiritual growth. Life satisfaction was a dependent measurable variable conceptualized as a cognitive indicator of subjective well-being regarding the evaluation of the life as a whole (Diener, 1984). The conceptual model reflecting the research hypotheses is presented in Scheme 1.
Statistical analyses were conducted using IBM SPSS Statistics software (Version 27.0). Structural equation modeling (SEM) was used to verify indirect-only mediation between religious coping and hope through spiritual experiences, between spiritual experiences and life satisfaction through hope, and between positive religious coping and life satisfaction via spiritual experiences and hope.
Theoretical model was tested using multiple goodness-of-fit indices including the standardized root mean square residuals (SRMR), the root mean square error of approximation (RMSEA), the comparative fit index (CFI), and goodness-of-fit index (GFI). For the RMSEA, values less than 0.08 proved a good fit to the data (Hu & Bentler, 1999;Kline, 2005). Values greater than 0.93 for CFI indicate good model fits, as does above 0.9 for GFI (Byrne, 1994). Due to the relatively small sample size, the Bollen-Stine bootstrapping method was used to increase the likelihood of veracity of the obtained results as well as to verify the statistical significance of indirect effects (Hayes, 2017).
SRMR value was lower than the acceptable level, which is less than 0.08 (Hu & Bentler, 1999). The RMSEA value was less than required for ideal fitting 0.05  Sheme 1. Results of path coefficients, based on a theoretical model. The standardized regression coefficients are presented. *p < .05, **p < .01, ***p < .001. A solid line was used to mark direct effects, but the dotted line to mark indirect effects. (Source: author's research). (Hu & Bentler, 1999;Kline, 2005). Also, CFI and GFI results were above the required 0.9 (Byrne, 1994).
The results of paths analysis are shown in Scheme 1. For better visibility and transparency, a solid line was used to reflect direct effects, but the dotted line reflected indirect effects.

Discussion
This study aimed to verify the beneficial role of spiritual growth and hope in the spiritual mechanism that underlies spiritual struggles and life satisfaction of codependent individuals from Poland participating in Al-Anon. The lack of research into this population makes it difficult to understand how religiousspiritual aspects of functioning can be related to subjective well-being and if this effect is beneficial or harmful.
According to achieved results in a sample of Al-Anon members, positive religious coping was an antecedent of spiritual experiences. Among Al-Anon participants, searching God and religious support in a crisis and difficult situations, led to spiritual experiences such as feeling God's presence, finding strength in religion or spirituality, feeling deep inner peace or harmony, feeling God's love through others, feeling spiritually touched by the beauty of creation, and a desire to be closer to God or in union with the divine (Underwood & Teresi, 2002).
As was shown not only for AA members from Poland (Wnuk, 2021c) but also Al-Anon participants use a relationship with God as an effective form of coping and struggles with stress on the way of spiritual growth. On the one hand, self-help groups are secular fellowships and have a skeptical approach to religion (Alcoholics Anonymous (AA), 2001; Kurtz & White, 2015). On the other hand, many newcomers and old-timers, especially in countries with strong religious backgrounds like Poland, go to AA and other self-help groups being at the same time representatives of particular religious denominations, developing spirituality also in a religious way. Among Polish AA participants, these are two separate forms of spiritual growth, as secular through the philosophy of self-help groups and the 12-steps Program and religious, which are not correlated (Wnuk, 2021c), despite the reference to God in the third and eleventh steps of 12-steps Program, but with emphasized on an individual and subjective conception of divinity which can be consistent with religious beliefs or not (Twelve Steps and Twelve Traditions, 1981). A probably analogous situation is in Polish Al-Anon, and future research is recommended to examine it.
Also, the hypothesis regarding the indirect relationship between spiritual growth and life satisfaction through hope was confirmed. It means that more frequent spiritual experiences positively correlate with hope, which in turn is related to bigger life satisfaction. It corresponds with recent research emphasizing the important role of hope (Chang et al., 2016;Nell & Rothmann, 2018;Wnuk, 2021a;Wnuk & Marcinkowski, 2014) in the spiritual mechanism underlying the relationship between religious and spiritual aspects of life and subjective well-being of codependent individuals attend to Al-Anon.
In a sample of polish participants of AA, spiritual growth was beneficial for building and shaping hope (Wnuk, 2021a). Also, the positive role of hope in life satisfaction was confirmed as a positive well-being indicator, not only this negative one cognitive symptoms of depression used in the previous research (Wnuk, 2021a).
About the hope of members of these two self-help groups, the main difference relies on the possibility to implement change in lives. Alcoholaddicted individuals can themselves decide about staying sober, and it depends only on their free and goodwill. Co-addicted subjects can change only their attitude toward their alcohol-dependent partner but cannot force him/her to stop drinking alcohol independent of their own beliefs regarding omnipotence in this issue (Young & Timko, 2015).
Findings advantages of hope for the well-being of Al-Anon participants are consistent with previous studies, which stressed that hope is a significant factor in recovery from alcohol addiction (Gutierrez et al., 2020;Jackson, Wernicke, & Haaga, 2003;May, Hunter, Ferrari, Noel, & Jason, 2015;Vaillant, 2014), element facilitating the presence of health-promoting behaviors (Magura et al., 2003) and consolidating changes (Yalom, 1985), and predictor of better life evaluation, subjective mental health, lower level of stress (Wnuk, 2017), and hopelessness (Wnuk, 2021c). In this study, hope was a stronger but still a moderate predictor of life satisfaction in comparison to SA sample, but it could be due to only three independent variables introduced to the model and only one of them as a mediator (Wnuk, 2022). Codependent individuals find themselves in very difficult and crisis situations in results of their emotional relationships with alcohol-dependent partners. Their mental, emotional, and spiritual suffering, such as being depressed or moody, being angry, missing what's important in life, being under stress, tense, anxious, or unable to relax, feeling hopelessness, as well as feeling lonely and isolated (Timko et al., 2013) enhanced their likelihood of searching for support in self-help groups and struggle with stress in cooperation with God. It has allowed them to reevaluate their lives and find hope in their difficult position. References to God and religion in the time of crisis allow overcoming it and, as a result, facilitate Al-Anon participants' appropriate attitudes toward suffering connected with codependency, finally making the life hopeful, purposefully, and relatively predictable. This kind of coping can provide relief, comfort, and distance from harmful situations and give hope for a better future.
The positive link between hope and life satisfaction can be considered within the "broaden and built theory" (Fredrickson & Branigan, 2005) and the role of hope as a positive emotion resulting from a feeling of unity with God and anticipate fortune, and positive life events in the future. Thanks to this kind of experience, the wider repertoire of behaviors allows for more appropriate reactions and adaptation to changing conditions.
It is important to note that the same spiritual mechanism identified in Chilean students in the relationship between religiosity and life satisfaction (Wnuk, 2021b) was confirmed among Al-Anon participants. Differences between these studies refer to the use of other religiosity indicators and additionally application affective measures of subjective well-being in the Chilean sample. It concludes that this mechanism is perhaps independent of the research population and cultural and religious affiliation background. Religious commitment, regardless of its manifestations is an antecedent of spiritual growth, which in turn indirectly through hope is positively correlated with life satisfaction and in Chilean students additionally with effective emotional regulation. To consider the relationship between religious-spiritual aspects and the life satisfaction of Al-Anon members is necessary to take into account that Poles is a very religious nation and this variable can moderate this link on the individual level. The country's level of religiosity influences the relationship between different aspects of religiosity and life satisfaction among individuals. More religious people are more satisfied in more religious countries and dissatisfied in less religious or these variables are not connected. Inversely less religious individuals are more content in less religious-cultural contexts and are not satisfied with more religious inclined nations (Stavrova, Fetchenhauer, & Schlösser, 2013). It means that on the positive indirect effect of religious struggles on life satisfaction, Al-Anon participants could influence religious inclined background and social learning as a result of modeling (Bandura, 1986).
The conducted research has theoretical and practical implications. First of all, the benefits of spiritual growth for Al-Anon members' treatment process due to the spiritual struggles have been confirmed. This mechanism is based on the indirect effect of positive reference to God in coping with stress on life satisfaction via spiritual growth and hope. This model was confirmed to explain 26.91% of the variance in life satisfaction. It means that additional variables are responsible for life satisfaction of the Al-Anon population, such as probably involvement in self-help groups (Kelly et al., 2011;Krentzman et al., 2013Krentzman et al., , 2017Tonigan et al., 2017), other antecedents of spiritual experiences (Akin & Akin, 2017;Astin, 1997;Wachholtz & Pargament, 2008), as well as variables involved in social mechanism such as social support (Bond, Kaskutas, & Weisner, 2003;Humphreys, Mankowski, Moos, & Finney, 1999;Kaskutas, Bond, & Humphreys, 2002;Kelly et al., 2010;Laudet, Cleland, Magura, Vogel, & Knight, 2004), and cognitive mechanism such as self-efficacy (Kadden & Litt, 2011;Kelly et al., 2010;Morgenstern, Labouvie, McCrady, Kahler, & Frey, 1997). One of these mechanisms regarding social support's role in this population was noticed in Timko et al. study (2014). However, this area of research still remains terra incognita and this study is one step toward progress to better and, in a more extensive way explore this issue.
From the practical point of view, the achieved results have emphasized the need to introduce to codependent individuals therapeutic interventions focused on hope building and implementing effective ways of coping, both these secular and these religious. This requires better recognition of the worldview preference of patients and potential resources, obstacles, problems, and barriers to propose adequate therapeutic forms of learning consistency with their values and possibilities. To undertake this type of activity is needed appropriate interpersonal skills and a lot of tact and sensitivity because they relate to the intimate sphere of life.
These therapeutic programs regarding hope have been used for alcoholdependent patients as fruitful tools in the recovery process (Koehn, O'Neill, & Sherry, 2012). Codependent, religious-affiliated clients should be engaged by therapists, medics, counselors, and social workers to use religious coping; it could be good sources of spiritual growth and, consistent with religious worldview, ways to achieve hope and satisfaction.
Codependent nonbelievers should participate in dedicated therapeutic programs focused on spiritual growth as a factor in fostering hope, which leads to contentment.

Limitations and future directions
The conducted study had an introductory character, creating incentive to further explore spiritual, social, or cognitive mechanisms as part of the treatment process for codependent individuals who are members of the Al-Anon fellowship.
The sample study was very small, but the use of the bootstrapping method balanced this limitation to a certain extent. A large sample gives the chance to explore potential moderators such as gender or duration of being in self-help groups and controlling sociodemographic variables like age, educational level, etc.
Cross-sectional model of research was used which do not allow the interpretation of achieved results from the cause-effect perspective, but give an opportunity to present the influence directions of particular variables.
Every participant declared a Roman Catholic denomination, which limits the generalizability of this study to Catholics from Poland participating in Al-Anon. Further research should be conducted on larger samples derived from other cultural contexts, among representatives other than Roman Catholics and non-religious participants of Al-Anon and less religious than Poles nations. It is crucial because the country's level of religiosity moderates the relationship between religiosity and the life satisfaction of individuals (Stavrova et al., 2013).
Only one cognitive element of subjective well-being was used. It is necessary in future research to use affective measures of subjective well-being and, additionally, negative indicators reflecting dysfunctional mental states, such as depression and anxiety. In future research, another measure of religiosity and additional indicators of spirituality should be used. Assessing the impact of every particular religious and spiritual aspect on existential well-being could have interesting results.
Additionally, next to spiritual mechanisms of change, social and cognitive mechanisms should be verified by using the social support measure (Bond et al., 2003;Humphreys et al., 1999;Kaskutas et a., 2002;Kelly et al., 2010;Laudet et al., 2004) and self-efficacy (Kadden & Litt, 2011;Kelly et al., 2010;Morgenstern et al., 1997) as results of involvement in self-help groups that can lead to positive outcomes.

Disclosure statement
No potential conflict of interest was reported by the author(s).