In Twelve Step recovery programs, the idea of a “spiritual malady” is central to understanding addiction. This is not just a physical or psychological condition, but as a deeper, internal conflict. A spiritual malady refers to a mental and emotional imbalance that lies at the core of addictive behavior. It is the inner void that people try to “fill” with things like substances, relationships, or compulsive habits.
This malady can manifest in behaviors like resentment, selfishness, fear, and compulsive control. In many ways, it is the personification of the emotional and spiritual chaos behind the feeling that life has become unmanageable. For many in recovery, managing this inner state is just as essential as abstaining from drugs or alcohol. It’s the work of emotional cleanup and ongoing self-awareness of spiritual maladies that helps someone not just get sober, but stay that way.
Signs of a Spiritual Malady
People experiencing a spiritual malady may not always recognize it at first. Often, it doesn’t show up as something obvious like withdrawal symptoms or physical cravings. Instead, it takes the form of chronic emotional discomfort and a persistent sense of internal dissatisfaction.
Let’s take a look at common signs of a spiritual malady, according to the Twelve Steps and its surrounding culture:
No Value Judgment
One of the classic examples of a spiritual malady is the feeling that you don’t belong. You may feel different from everyone around you in every sense of the word, almost as if you were born on a different planet. This sense of separation or detachment from others can lead to isolation, loneliness, and may leave you feeling desperate to figure out any way to fit in. Often, this desperation to fit in can lead to experimentation with addictive substances.
Irritability
When your internal world feels out of sync, even the smallest of frustrations or annoyances can trigger intense, disproportionate reactions. Irritability is a frequent sign of spiritual unrest, where life feels like it’s always rubbing you the wrong way no matter the external circumstances.
Restlessness
Feelings of a deep, persistent sense of unease often come with a spiritual malady. This restlessness isn’t just physical, but emotional and psychological as well. There’s a constant need to move, change, or distract oneself. This can often lead to impulsive decisions or relapse.
Anxiety
Anxiety is unique in that it can both be a symptom and cause of spiritual malady. When people are disconnected from themselves and others, worry tends to fill the space. Anxiety often emerges from feeling like things are out of control, or that they’re in our control and we’re failing at maintaining peace or order.
Anger
Unaddressed emotional pain frequently shows up as anger. Someone experiencing a spiritual malady may find themselves quick to lash out or harbor long-standing resentment. This anger may be directed at others, their circumstances, or even at themselves.
Acts of Selfishishness
Addiction often comes with a self-centered mindset, defined as focusing on one’s own needs, desires, and survival. Even in recovery, this selfishness can persist if the deeper spiritual malady isn’t addressed. It may show up as an inability to consider others’ perspectives or difficulty forming healthy relationships.
Wanting More Control
One of the more common signs of a spiritual malady is the constant need to control people, outcomes, and situations. When your internal world feels unstable, controlling the external world can seem like the only solution. This desire for control is usually rooted in fear and can ultimately lead to frustration and burnout.
What Causes a Spiritual Malady?
Understanding this sense of spiritual imbalance comes is a key part of the healing process. While it may manifest differently in each person, several common roots tend to feed a spiritual malady. These may include:
Ego
In 12-step programs, the ego is often viewed as a false self. It is defined as the part of us that tries to assert control, superiority, or separation from others. When someone is suffering from addiction, the ego can become inflated, defensive, or even overly protective. Rather than surrendering to a power greater than oneself, the person may insist on doing things their own way. This can often lead to repeated failures and deeper emotional pain.
Feeling Like We Aren't Able to Help Other People
A sense of purpose is often what gives life meaning. When someone feels like they have nothing to offer others (or worse, that they’re a burden), it can contribute to feelings of worthlessness. This belief can deepen the spiritual void and increase isolation, which are dangerous triggers for relapse.
Feeling Different From Others
Many in recovery recall wondering to themselves why other people can drink normally or why other people can enjoy life without even needing drugs or alcohol. This feeling of being different or defective compared to others, can feed into feelings of shame and self-pity. Both of these are powerful forces that can keep the spiritual malady alive.
Self-Medication and Further Isolation
Substance use often starts as a form of self-medication, especially for untreated mental health issues like depression, anxiety disorders, or unresolved trauma. Unfortunately, the more someone uses these substances to cope, the more disconnected they become from others. Relationships break down, communication suffers, and the person ends up feeling more alone than ever. This can deepen spiritual disconnection, within the person and between them and other people.
How to Address a Spiritual Malady
The good news is that a spiritual malady isn’t permanent. In the view of Twelve Steps, it’s a condition that can be treated through spiritual growth, personal surrender, and emotional healing.
While the 12-step process can provide a structured way to address and heal spiritual maladies, two steps in particular can directly address it:
Determining a Personal Higher Power
For many, the concept of a Higher Power is daunting. This can be especially true if they’ve had negative experiences with religion or authority. However, in the Twelve Steps, a Higher Power is not necessarily religious. It’s simply a force greater than oneself that offers guidance, strength, and perspective. For some, this could be God. For others, it could be nature, love, the fellowship of the group, or the collective wisdom of those who’ve walked the path of sobriety before.
Discovering what your Higher Power looks like is a personal journey. It doesn’t need to conform to anyone else’s definition. What matters most is that it provides a sense of connection and something to lean on when your own strength falls short.
Surrender to the Higher Power
Once you have defined your Higher Power, the next step is to surrender to it. This is defined as letting go of the need to control everything, and trusting that recovery is possible through a power greater than oneself.
This surrender is not weakness; it’s an act of courage and humility. It opens the door to transformation and healing. In the later stages of recovery, this surrender often culminates in what’s called a “spiritual awakening.” This doesn’t have to be a dramatic, life-altering epiphany. It might simply be the moment someone realizes that they are not alone, that they are loved, and that they have a place in the world. It can be the moment when a person’s internal chaos begins to settle and peace starts to take root.
Heal from Addiction and Learn More at First Steps Recovery
A spiritual malady may not show up on a lab test or medical scan. But for many in recovery, it’s the most painful part of addiction. It’s the ache beneath the cravings, the loneliness behind the binge, the fear that no amount of substance can fix. But by recognizing the signs of a spiritual malady, understanding its root causes, and surrendering to a power greater than oneself, real and lasting healing becomes possible.
Recovery isn’t just about quitting drugs or alcohol. It’s about rediscovering who you are underneath the haze of the substance (and the pain attached to it). It’s about reconnecting with the world and finding peace within yourself. At First Steps Recovery, we believe that lasting sobriety requires more than just detoxing from substances. It requires healing the whole person, including the spiritual and emotional self.
This is why our programs integrate both clinical treatment and holistic care, providing individuals with the tools they need to reconnect with themselves, others, and their sense of purpose. Our compassionate team walks alongside each client as they explore their spiritual beliefs, define their personal Higher Power, and begin the journey toward a more balanced and fulfilling life. Through individual counseling, group therapy, meditation, and much more, we help those in treatment rebuild not just their lives, but their sense of identity, hope, and belonging.
Whether you’re at the beginning of your recovery or looking for deeper healing after relapse, First Steps Recovery is here to support your path to wellness. Contact us today to begin your journey on the road to recovery.
Dr. Curl is the Medical Director and primary on-site provider for First Steps Recovery. He is a Board Certified Internist and Addiction Medicine Specialist having attended the David Geffen School of Medicine at UCLA and completing his residency at Mount Auburn Hospital with Harvard Medical School. Following several years work as an internist and physiatrist (physical medicine and rehabilitation). Dr. Curl completed the Addiction Medicine Fellowship at Howard University in Washington DC and participated as a RAM Scholar (Research in Addiction Medicine). While part of the fellowship, Dr. Curl pursued research investigating the barriers to expanding and improving medication for opioid use disorder. Following his fellowship, Dr. Curl spearheaded the Opiate Use Disorder outpatient clinic and worked in the Department of Psychiatry and Behavioral Sciences within the Howard University Hospital. In 2023, Dr. Curl completed his Board Certification in Addiction Medicine.
