What I Hate I Do
How Addictions Hijack the Development of the Mind of Christ - A Pastoral Response
What is the No. 1 public health problem in the United States today? We live in an age where staying current with things that could be hazardous to our health seems like a full-time job, often requiring us to learn new acronyms to add to our medical vocabulary: H1N1, AIDS, STDs, etc.
While threats of viral epidemics like swine flu or mad cow disease flash across news screens, many leading authorities — including the U.S. Department of Health and Human Services Substance Abuse and the Mental Health Services Administration (SAMHSA) — believe addictions top the list.
Researchers estimate that approximately 10 percent of people ages 12 and older in the United States need treatment for alcohol or an illicit drug problem. That number does not include other activities these researchers include in an ever-widening umbrella of potentially addictive behaviors: gambling, eating disorders, sex/pornography, and compulsive Internet use.
A 2007 publication by the National Institute on Drug Abuse (NIDA) estimates that addictions to alcohol, nicotine, and illegal substances cost Americans up to half a trillion dollars a year when you consider medical, economic, criminal, and social impact. Every year abuse of illicit drugs and alcohol contributes to the death of more than 100,000 Americans. Tobacco causes an estimated 440,000 deaths per year. Four out of 10 deaths from AIDS are related to drug abuse.
Addictions are no respecter of persons, and the pastor is often the first person many come to when they or family members experience these issues. It is essential for those in ministry to have a basic understanding of the process of addiction and what recommendations they can make to those caught in this snare.
What Is Addiction?
In the 1930s, scientific interest in understanding addictive behaviors began to develop. Until then scientists thought people addicted to drugs were either morally flawed or merely lacking willpower. These views led to an emphasis on punishment rather than prevention or treatment. While spiritual/moral factors and our wills are involved in both the process of becoming addicted and recovery, revolutionary advances in our ability to understand how the brain functions have generated greater appreciation of the complexity of addictions and the physiological and environmental factors that contribute to the development and progression of addictive patterns.
God designed our bodies to be motivated to attend to important activities essential for life. Our ability to attach to or be reinforced by behaviors that are pleasant (generally promising positive benefits) and avoid painful activities (generally having the potential to endanger life) is critical to survival. Some of the naturally rewarding activities include satiating hunger and thirst, sexual activity, and a predisposition toward social relationships, which enhances safety.
Many brain mechanisms involved with these behaviors are located in the midbrain, primarily the limbic system, which has a key role in emotional modulation (both pleasure and pain) and memory. When functioning normally, neurotransmitters between the neurons (cells that comprise the nervous system) in the brain work together in a cascade of excitation or inhibition — between complex stimuli and complex responses — leading to an ultimate feeling of well-being. Of particular importance is a neural pathway often referred to as the brain reward system or brain reward circuit.
While our natural rewards typically activate this pathway, substances we take into our bodies that have the ability to mimic the actions of key neurotransmitters also can set it into action as well, producing a similar feeling of well-being. While the exact mechanisms — or site of action — may vary from substance to substance, they are alike in their ability to enhance the action of the brain reward system. Thus we say they share a final common pathway.
People begin to take drugs for a variety of reasons:
- To feel good.Most abused drugs produce strong initial feelings of pleasure/euphoria that are typically followed by other effects depending on what type of drug used. For instance, stimulants such as cocaine have a high followed by feelings of power, self-confidence, and increased energy. In contrast, feelings of relaxation and satisfaction follow the euphoria caused by opiates such as heroin.
- To feel better.People who suffer from stress-related or similar anxiety-type disorders or strong feelings of depression often begin using drugs in an attempt to lessen feelings of distress.
- To do better.Pressure to improve athletic or cognitive performance may lead some individuals to gain this edge via chemical enhancement.
- Curiosity and because others are doing it.Wanting to fit in and feel accepted by the larger group can lead people to attempt behaviors they might not otherwise try. In this respect, teens tend to be particularly vulnerable because in this stage of life they are frequently most susceptible to peer pressure.
Because the initial sensations of these drugs so intensely stimulate the brain reward circuit, the parts of the brain responsible for memory imprint it in such a way that this prompts the person to repeat the activity. Yet, even while one area of the brain is working to have the individual frequently engage in the behavior, the brain reward circuit is making adjustments to mute the impact of future use since it is geared toward keeping a certain state of equilibrium. We call this down regulation.The result of down regulation is that as a person uses a substance more frequently, it takes a greater amount of the substance to produce the same level of reaction in the brain reward circuit. We call this tolerance.
Once the body gets used to certain levels of a substance being present, even though not naturally occurring, it will often produce strong feelings of discomfort when levels begin to fall. We call this withdrawal. Depending on the type of drug involved, withdrawal can be both uncomfortable and, as in the case of alcohol, potentially life-endangering.
The phenomena of brain reward, tolerance, and withdrawal powerfully work together to maintain addictive patterns and can lead to continued use even in the face of negative consequences such as job loss, relationship failures, or legal consequences. Awareness of these factors aids in understanding why people may persist in addictive patterns even when they are experiencing pain and frustration as a result.
As noted earlier, one of the more recent developments in this field is the awareness that certain behavioral activities, like gambling, shopping, or compulsive Internet use, can also impact the brain reward system by tweaking naturally occurring responses to rewards greater than typical levels. There is not yet universal agreement among those who specialize in treating addictions that we should compare these activities to drug addictions, but there are many strong proponents. Aviel Goodman, one advocate of this position, has produced a set of criteria for addiction that can incorporate both drug-induced and behavioral addictions. (See sidebar “Criteria for Addictive Disorder.”2)
The foregoing discussion highlights insights yielded by recent scientific research to appreciate how Satan can twist and pervert neurophysiology — designed by God for our benefit — to create strongholds of addiction that hijack the developing mind of Christ in believers. It is not unusual for those who work in the addictions field to encounter people for whom the pleasure of their habit has long vanished; yet they feel compelled to continue in their behavior in an increasingly desperate attempt to feel normal. They have become embodiments of the apostle Paul’s lament in Romans 7:19, “the evil I do not want to do — this I keep on doing.”
Once people establish these habit patterns, they are often resistant to change. Difficult, however, does not equal impossible. With proper pastoral support and care, it is possible to assist others to walk in spiritual freedom.
The Recovery Process
How do you help someone who is seeking freedom from an addictive pattern? Addiction recovery often requires a multifaceted approach. The average pastor will not be qualified to provide all the services required. But he can be familiar with typical steps and know options that are available in his community so he can walk alongside someone as this person moves through recovery.
Familiarize yourself with health professionals in your community who specialize in addiction treatment. Also, know some self-help support ministries in your area that promote recovery.
Ask about addictive behaviors as an aspect of your pastoral counseling. As a routine part of intake, inquire if there are any behavioral patterns or activities the person feels are out of control or creating guilt for him. If asked specifically about addictive behaviors, most will disclose honestly if you ask in a nonthreatening manner.
If a pastor does not identify an active addictive pattern at the outset of counseling, this may create frustration for him and the counselee in making headway on the issue the patient and counselor selected as the counseling goal. For instance, it may be difficult for a couple to improve their marriage if one is misusing alcohol or illicit drugs.
Not everyone who has an addictive issue will have the same level of readiness to address it. James Porchaska and his colleagues, John Norcross and Carlo DiClemente,3 studied the stages of change people went through when making significant behavioral changes in their lives. Their model identified five predictable phases:
- Precontemplation: “What problem? Oh that, I would rather not discuss that right now.” Often considered part of denial, individuals at this point do not have any thought of changing their behavior anytime in the near future.
- Contemplation: “I’m thinking about it.” People in this stage are thinking about starting a change plan within the next month.
- Preparation: “I have made up my mind and I am getting ready.” In this interval, a person has begun to make specific plans and has chosen a start date for his program.
- Action: The person is actively implementing the plans developed in the previous stage.
- Maintenance: The individual has established new habit patterns and continues to take actions that reinforce the new behaviors.
Locating where an individual is in the change process allows you to target what kind of intervention he may be most amenable to. As an example, someone who is at the precontemplation phase usually will not be open to suggestions as to what steps might help him change his behavior, which is more of a preparation phase activity. Instead, it may be more helpful to have the person at the precontemplation phase consider what the life cost will be if he continues the present course or provide accurate information about how this pattern tends to impact the lives of others. This intervention is more relevant in helping someone move from the precontemplation to the contemplation stage.
After you identify an addictive issue as part of the presenting picture, I suggest the following steps to aid the individual in the recovery process.
Breaking the Addictive Cycle
Conventional wisdom in the recovery field says that as long as the person continues to engage in his addictive pattern, he will have difficulty making progress in putting other areas of his life in order. A person may drink alcohol to feel less stress about a painful part of his life. But it will be unlikely that he will satisfactorily resolve past hurts while he continues to misuse alcohol.
Depending on the type and intensity of the addictive behavior, the person may need medical evaluation and supervision as he moves through withdrawal. This is particularly true for some chemical addictions but less of a concern for the behavioral patterns such as gambling.
In addition to possibly needing a detox experience, many addicts benefit from a course of medication that enhances the body’s efficiency with the neurotransmitter serotonin while the brain reward circuit is attempting to reset itself to premorbid levels of functioning. While some family physicians are comfortable working with psychotropic medications, you may need to refer to a psychiatrist who will more likely have specific expertise in this area.
To disrupt an addictive pattern requires a person to become alert to the environmental cues and other triggers (e.g., uncomfortable emotional states) that set off cravings to engage in the addictive activity. The longer he has practiced the addiction, the greater the number of conditioned reinforcements there will be. Because of the intensity of emotional memories associated with these cues, it is often best for people, when possible, to reorganize their life to avoid being flooded by temptations. Even when someone cannot totally eliminate an element of his environment, he might be able to modify it in such a way to mute the intensity of the triggers. In colloquial terms this is often called “finding new playgrounds and playmates.”
Counselors frequently use the acronym HALT BAD for helping counselees identify uncomfortable or negative physical and emotional states that might lead to a desire to engage in an addictive behavior:
|H ungry||B ored|
|A ngry||A nxious|
|L onely||D epressed|
When the counselee becomes aware of one of these states, he is to employ a strategy worked out in the preparation phase that assists in moving through the temporary discomfort without resorting to addictive activities.
Psychologist and pastor Dr. Richard D. Dobbins developed a useful model “Putting off the Old Self, Putting on the New Self,” that aids counselees in rapid identification of their most salient triggers so they may substitute alternate actions that are healthier and will not threaten sobriety. (For further information on this model, visit http://enrichmentjournal.ag.org/200003/105_people_helping.cfm.)
Not everyone with an addictive problem may need to participate in a formal addiction treatment program. But, if someone has made several attempts to get sober and failed or is having difficulty creating a safe living environment for recovery, he may need a more intensive mode of treatment up to and including residential treatment. You may need to suggest a health professional who will often be the best suited for knowing what form of care best fits with the level of the addictive problem.
Encourage Support Group Participation
It is possible for a person to become abstinent without outside social support, but the probability for gaining and maintaining sobriety markedly increases for most people when they participate in a support group. This experience can be an essential component for several reasons:
- It provides a safe place to maintain openness with others. People in recovery circles often say, “You are only as sick as your secrets.” Having accountability with others prevents the enemy from gaining footholds in places that are shrouded in secrecy.
- The individual benefits from the collective wisdom of others who are also working on recovery. Hard-won experience shared by others a little further down the road in their recovery can be invaluable in preventing someone who is relatively less experienced from unnecessary frustrations and risks.
- The group can become the core of a recovering person’s healthy new friendships. Many recovering addicts know little about celebrating life without their addictive habit. New members often learn how to have fun and enjoy life for the first time without needing their addictive crutch.
Saddleback Church in California initiated a Christ-centered recovery program called Celebrate Recovery. Chapters of this program are now widespread throughout the United States. This ministry integrates steps familiar to those who have attended other recovery groups. Celebrate Recovery bases its principles for recovery on the Sermon on the Mount (the Beatitudes, Matthew 5). If one of these chapters is available in your area, I suggest you consider encouraging those with whom you are working to make it a part of their recovery program.
One interesting thing about Celebrate Recovery is that, even though there is a variety in the types of addictions for which people seek help, the group members usually find there are common attitudes and distortions in their belief systems even though the manner in which they act out looks different at the surface level. Jeff VanVonderen has called this a common soil out of which different plants of addiction grow.4
Help People Learn To Enjoy Their Relationship With God
While the majority of addicts who enter into recovery programs do not have a well-established devotional life, healthy recovery is greater when time is spent practicing the traditional Christian disciplines. Yes, Scripture memorization is invaluable so the Holy Spirit can bring it to a person’s mind in a moment of temptation. Notwithstanding, for most addicts it is better to spend 5 minutes reading and meditating on a verse of Scripture and enjoying relationship with God than it is to read for a longer period of time with the end result being dry and lifeless or merely a check marked off their to-do list.
Early recovery pioneers realized that most things people practiced in an addictive way were counterfeit attempts to find a deeper spiritual experience. G.K.Chestertoncaptured this sentiment when he said, “A manknockingon thedoor of abrothelisknockingforGod.”
Teaching those under your care how to enjoy their relationship with God is one of the places you can be the greatest blessing to them as their pastor. For many who have grown up with views of God that have been distorted by dysfunctional family relationships and faulty formal religious instruction, developing a healthier image of God will be foundational to their recovery.
Do Not Be Discouraged by Occasional Slips in the Recovery Process
Studies show that even when people are highly motivated to change their addictive behaviors, most often they have to make at least several attempts at recovery before they get it. Once again this demonstrates the power of spiritual temptation, environmental cues, and the persistence of conditioned brain responses even though they can anticipate that the outcome will have negative consequences.
However, knowing this can assist you and your counselees to recover and get back on track when a slip occurs rather than become discouraged and fall into full-blown relapse. The following figure developed by Prochaska and his research partners provides a visual to what we call the spiral path of recovery. People may cycle through the stages of change several times, but each time through leaves them a little closer to their goal than where they were previously until they ultimately establish their desired goal.
Source: Reproduced from Prochaska, J.O. et al. (1992). “In Search
of How People Change.” American Psychologist, 27, 1102–1114.
Help Counselees Establish Healthy Substitute Behaviors
To be complete, long-term recovery must be more than avoidance of undesirable behavior. In its place counselees must work to develop positive coping strategies that move them toward Christlikeness. Often the addictive pattern has circumvented the development of these skills at the appropriate developmental stage. For those who began their addiction at an early age, there may be much work required to establish substitute behaviors.
It gives me great joy as a pastor to see people find release from issues that have made them slaves to their own physiology. While all who make this trek have unique needs and considerations, this article has attempted to describe some issues faced by those with addictive problems and typical steps that will aid them in establishing recovery.
This path is the one experienced most by those taking this journey. For a few, the power of God may provide a sudden transformational release from addictive patterns, but this is not the norm. That is why we call it a miracle.
1. Romans 7:15.
2. Aviel Goodman, “Addiction: Definition and Implications,” British Journal of Addiction 85, (1990):1403–1408.
3. James O. Prochaska, Carlo C. DiClemente, and John C. Norcross, “In Search of How People Change: Applications to Addictive Behaviors,” American Psychologist, 27, (1992): 1102–1114.
4. Jeff VanVonderen, Tired of Trying To Measure Up (Minneapolis: Bethany House. 1989).
Addiction is a pervasive public health problem that destroys individuals, families, and communities. Recovery is a long-term process that for many people has a significant spiritual component. By combining forces, clergy and other treatment professionals can help address one of the most critical problems facing our nation. As clergy become more adept at recognizing signs of alcoholism and drug addiction — how to refer congregants and how to support families and children — more people will access and engage in treatment. And, as treatment professionals reach out to the faith community to encourage early intervention and recovery support, they will help more people. Connecting the addiction treatment and prevention community with the faith community offers additional resources for both parties.
STEPHANIE ABBOTT, M.A., Arlington, Virginia
Criteria for Addictive Disorder
A maladaptive pattern of behavior, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
- Tolerance, as defined by either of the following:
- a. A need for markedly increased amount or intensity of the behavior to achieve the desired effect.
- b. Markedly diminished effect with continued involvement in the behavior at the same level of intensity.
- Withdrawal, as manifested by either of the following:
- a. Characteristic psychophysiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior.
- b. The same (or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms.
- The behavior is often engaged in over a longer period, in greater quantity, or at a higher level of intensity than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control the behavior.
- A great deal of time is spent in activities necessary to prepare for the behavior, to engage in the behavior, or to recover from its effects.
- Important social, occupational, or recreational activities are given up or reduced because of the behavior.
- The behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior.
Adapted from Goodman, A. “Addiction: Definition and Implications.” British Journal of Addiction 85,(1990): 1403–1408.
Core Competencies for Clergy and Other Pastoral Ministers
The following core competencies are essential components for clergy and pastoral ministers in meeting the needs of persons with alcohol or other drug dependencies, and their family members.
- Be aware of the generally accepted definition of alcohol and other drug dependence and the societal stigma attached to alcohol and other drug dependence.
- Be knowledgeable about the signs of alcohol and other drug dependence; characteristics of withdrawal; effects on the individual and the family; and characteristics of the stages of recovery.
- Be aware that possible indicators of the disease may include, among others: marital conflict, family violence (physical, emotional, and verbal), suicide, hospitalization, or encounters with the criminal justice system.
- Understand that addiction erodes and blocks religious and spiritual development; and be able to effectively communicate the importance of spirituality and the practice of religion in recovery, using the Scripture, traditions, and rituals of the faith community.
- Be aware of the potential benefits of early intervention for the addicted person, family system, and affected children.
- Be aware of appropriate pastoral interactions with the addicted person, family system, and affected children.
- Be able to communicate and sustain an appropriate level of concern, and messages of hope and caring.
- Be familiar with and utilize available community resources to ensure a continuum of care for the addicted person, family system, and affected children.
- Have a general knowledge of and, where possible, exposure to the 12-step programs — AA, NA, Al-Anon, Nar-Anon, Alateen, ACOA, and other groups.
- Be able to acknowledge and address values, issues, and attitudes regarding alcohol and other drug use and dependence on oneself and one’s own family.
- Be able to shape, form, and educate a caring congregation that welcomes and supports persons and families affected by alcohol and other drug dependence.
- Be aware of how prevention strategies can benefit the larger community.
STEPHANIE ABBOTT, M.A., Arlington, Virginia
Baker, J. 2007. Life’s Healing Choices. New York: Howard Books.
National Institute on Drug Abuse (NIDA). 2007. Drugs, Brains, and Behavior: The Science of Addiction. Retrieved from http://www.drugabuse.gov/scienceofaddiction/. Accessed March 2, 2010.
Prochaska, J.O., J.C. Norcross, and C.C. DiClemente. 1994. Changing For Good: A Revolutionary Six-stage Program For Overcoming Bad Habits and Moving Your Life Positively Forward. New York: Avon Books.
Ryan, D. and J. Ryan. 1999. A Spiritual Kindergarten: Christian Perspectives on the Twelve Steps. Brea, California: Christian Recovery International.
VanVonderen, J. 2004. Good News for the Chemically Dependent and Those Who Love Them. Minneapolis: Bethany House.
Wilson, W.A, and C.M. Kuhn. 2005. “How Addiction Hijacks Our Reward System.” Cerebrum, 7(2), 53–66. Retrieved from http://www.dana.org/news/cerebrum/detail.aspx?id=806. Accessed March 2, 2010.