What is Spiritual Malady?

Table of Contents


A spiritual malady is a deep-rooted inner conflict that manifests in the following ways:

  • Irritability
  • Restlessness
  • Sense of otherness

Today’s guide explores the spiritual malady meaning in the context of 12-step recovery groups like AA (Alcoholics Anonymous). According to AA, spiritual malady is often fueled by resentments and renders life unmanageable.

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Spiritual Malady and the Relapsing Nature of Alcoholism

AUD (alcohol use disorder) – the clinical term for alcoholism – is a chronic and relapsing brain condition. There are three areas that alcoholism affects: 

  • Body
  • Mind
  • Spirit

The role of physical dependence and psychological addiction in alcoholism partly explain why those with alcohol use disorder are unable to moderate or discontinue use. To initiate a full and sustained recovery, it is also helpful to address the spiritual role of this disease. 

According to Alcoholics Anonymous, informally known as The Big Book, when someone with alcoholism drinks, they have an abnormal reaction likened to an allergic reaction. Once a person with AUD takes an alcoholic drink, the body craves more on a physical level. This is why 12-step organizations believe it is not possible to conquer alcoholism using willpower alone. 

If someone with alcohol use disorder quits drinking cold turkey and starts white-knuckling their sobriety – a concept also known as dry drunk syndrome – they are often assailed by thoughts of being able to control and enjoy drinking without exceeding guidelines for moderate drinking. It is also commonplace for those with untreated alcoholism to downplay the negative consequences associated with alcohol abuse, while at the same time glorifying past episodes of drinking. These psychological cravings occur independently from the physical cravings outlined above, continuing beyond detox. 

The spiritual malady is explained on p64 of The Big Book

“Resentment is the number one offender…from it stems all forms of spiritual disease… When this spiritual malady is overcome, it is possible to straighten out mentally and physically.” 

Spiritual malady can trigger feelings of irritability, restlessness, and discontentedness. The overall sensation can feel like crawling out of your own skin. These feelings can become unmanageable – more on the unmanageability of life for alcoholics below. 

When these physical, mental, and spiritual components come together, an individual with alcohol use disorder will be rendered powerless to arrest a vicious cycle of obsessions, cravings, and alcohol abuse. 

The solution to spiritual malady offered by Alcoholics Anonymous is to affect a spiritual awakening – in essence a psychic shift or attitude adjustment. In The Big Book of AA, the 12 steps outlined are a formalized approach to achieving this transformational change.

An image of a woman with a blank stare, symbolizing spiritual malady

What is a Spiritual Malady?

A spiritual malady, then, reduces to a sense of otherness felt by many alcoholics that prevents them from feeling at peace with themselves and the world around them. 

Spiritual malady is addressed in the first of AA’s 12 steps:

We admitted we were powerless over alcohol—that our lives had become unmanageable.” 

Many people who first examine these 12 steps assume that their lives must be unmanageable because of the consequences of alcohol abuse. Step 1 does not refer to the breakdown of health, relationships, legal issues, or job loss, though. While all of these outcomes of alcoholism can render someone’s life unmanageable, they are externally unmanageable. The 1st step of AA points to the inwardly unmanageable aspect of an alcoholic’s life. This internal unmanageability manifests as: 

  • Irritability
  • Restlessness
  • Discontentment
  • Disconnection
  • Anxiety
  • Depression
  • Anger

The inward manageability of life referenced in step 1 goes by many names, including: 

  • Untreated alcoholism
  • Bedevilments (p52 of The Big Book)
  • Spiritual malady (p64 of The Big Book)

The Big Book promises alcoholics that once they overcome this spiritual malady, they will “straighten out mentally and physically.”

There are many symptoms that can present in the event of spiritual malady. The Big Book outlines the following flashpoints: 

  • Being irritable, restless, and discontented
  • Having problems with relationships
  • Inability to control your emotions
  • Feelings of misery or depression
  • Unhappiness
  • Uselessness
  • Fear
  • Not being able to help others
  • Being like an actor who wants to run the show
  • Self-delusion
  • Leading a double life
  • Living like a whirlwind running through the lives of loved ones
  • Selfishness
  • Being inconsiderate

The driving forces of the symptoms of spiritual malady is the ego, according to The Big Book. On p62, Bill W. states that “Selfishness-self-centeredness… the root of our troubles.” 

This is why, according to the precepts of AA, that the ego must be smashed by working the 12 steps – “Above everything, we alcoholics must be rid of the ego.” Bill W. adds that “there often seems no way of… getting rid of ego without the aid of a higher power.”

In step 10 of AA, the “world of the spirit” allows those with alcohol use disorder to move beyond the physical, emotional, and mental aspects of life, eliminating the ego and spiritual malady rather than remaining spiritually blocked from engaging with a higher power as you see it.

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Kickstart Your Recovery at California Detox in Laguna Beach, CA

Here at California Detox in Laguna Beach, we can help you unpack the physical, psychological, and spiritual aspects of alcoholism. 

Before you engage with inpatient or outpatient therapy at our luxury beachside rehab, take advantage of our supervised medical detox program. Your treatment team can administer a variety of medications that will streamline the intensity of cravings and withdrawal symptoms, preparing you for one of the following evidence-based treatment programs: 

  • Inpatient program (residential rehab program)
  • IOP (intensive outpatient program)
  • PHP (partial hospitalization program)
  • Virtual IOP (remote rehab program)
  • Dual diagnosis treatment program (for co-occurring disorders)

All treatment programs connect you with an individualized array of the following interventions: 

  • MAT (medication-assisted treatment)
  • Group therapy
  • Family therapy
  • Individual counseling
  • Psychotherapy (CBT and DBT)
  • Holistic therapies

While 12-step programming is not central to evidence-based alcohol addiction treatment at California Detox, we can help you access meetings of peer support groups throughout Southern California. Call 949.390.5377 for immediate assistance with a supervised detox.


According to Alcoholics Anonymous, a spiritual awakening is required to overcome a spiritual malady. This can be achieved by finding a higher power and implementing it into your life by relinquishing control of your life to this entity or concept – the higher power does not need to be a recognized god.
In the pages of The Big Book, the text upon which 12-step methodology is based, author Bill W. describes a spiritual malady as a stark void in the lives of alcoholics. The Big Book holds that it is through trying to fill this void or spiritual malady that people with alcohol use disorder self-medicate with alcohol.


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