Addiction and Pastoral Care

Rev. Alexander E. Sharp Guest Pieces

Dear Al, If only I’d know then what I know now! You suggested that I read Sophia Waters’ Addiction and Pastoral Care, and after I finished I wondered, “How would my 45 years of parish ministry been different if I had better understood the dynamics of addictive behavior and why did we never talk about it in seminary or the Church?” The assumption during all that time was that addictions were the result of bad choices, and therefore “sins,” or of genetic weaknesses, or of brain malfunctions. Waters, who is an Episcopal priest and pastoral counselor, says that we get closer to the truth if we see addictions as signs of “soul-sickness,” ways people have sought to cope with fear, loss, isolation, and hopelessness. They are a response to pain, not a search for pleasure. She acknowledges that over time an addict’s brain mutates, but that may well be more a result than a cause. She does not talk about genetics, which I wish she had. That prompts me to look back at what I might have missed . . . the dairy farmer who seemed a little unsteady while drinking morning coffee at the diner, the guy on the assembly line who missed a lot of days at work, the college professor who made perfect sense in the morning lecture but rambled in the afternoon discussion, the stock trader raring to go at 5 a.m. and asleep at 2 p.m., the homeless man on the corner who could make more money begging than working at minimum wage, except that he disappeared for months at a time. Now, I don’t want to see things that weren’t there, but I could have been more attentive. And then, I think about family members and close friends . . . So, Waters’ focus on addictions as the result of peoples’ desperate attempts to deal with pain that arise from personal, familial, and social dynamics offers me a new perspective. If it is not a sin, then the answer is not repentance and a pledge never to do it again. Rather, it is to offer solid pastoral care. She outlines two counseling techniques that reminded me of the Carl Rogers’ non-directive approach that I learned in seminary and tried to adhere to over the years. But she stresses that the Church must also provide a supportive community in which a person can find a safe place in which to confront the addiction. Simply making room for a 12-step program based on anonymity is not enough; there also must be open and generous inclusion. In addition to the Church ministering within its congregational self-definition, can the Church be faithful enough to assume a public role? Addictive behavior employs a lot of means to avoid pain – alcohol, obviously, but also drugs, food, gambling, pornography, and the internet, to name the obvious. Our society has tended to criminalize addictions, not address them. You and I remember when the War on Drugs begun in 1971; it has been a disaster. To define an addiction as a crime has opened doors to persecution based on race wealth, ethnicity, gender identity, and even religious affiliation. It has created a fractured society and economic system. What does the Church have to say about justice regarding this? And, does the Church have anything to say about businesses and governments getting rich by promoting addictive behavior? It seems contradictory: criminalizing, and at the same time, exploiting, but it is the norm. The one place where I have had some experience is in resisting casino gambling. It is a predatory business. The designers of the slot machines are psychologically savvy enough to make people feel that they are winning when they are losing. The goal is to drive people to “play to extinction,” as they lovingly say. So, the more money people lose the more money casinos and gambling parlors make and the more money governments tax. That, I think, the Church can call a “sin.” Waters’ book confirms a truism dear to me: “Things are more complex than we first thought.” This is true about addictive behavior, she insists, and caregivers and religious communities need to deal with this complexity in order to be of help to others – to those who are addicted, to those who love them, and to a society prone to take advantage of them. Thanks, Al, for the recommendation. Peace,Phil Review: Addiction and Pastoral Care “My aim,” Sonia Waters states, “is to take an issue that is often highly individualized and trace its webbed connections to the relational and social contexts that make one vulnerable to addiction, create its stigma, and complicate its recovery.” With that she begins her depiction of addiction not as a sin or a disease but rather as the result of a person trying to cope with personal, relational, and social vulnerabilities. Waters, who is an Episcopal priest, directs her analysis especially to pastoral caregivers, but her insights are eye-opening to a more general audience. Having said that addiction is not a sin or a disease, Waters devotes the rest of her book to what it is. Calling on her pastoral perspective, she uses the framework of “soul sickness” to describe the debilitating power of the combination of personal, relational, and social vulnerabilities. Addictions can start benignly enough as acts of self-protection – a drink after work to relax, a stop at the casino for excitement, a few minutes on the internet to check messages, and most of these acts do not lead to addiction. But for those who are caught in a net of “attachment vulnerabilities and social sufferings, poor stress-regulation and poor social skills, impulsive choices and genetic propensities,” the pain is enormous and constant. One of Waters’ persistent points is that pleasure is not the motivating factor for addiction, but pain. If addictive behavior is not a moral sin or a cerebral dysfunction but the result of an attempt to cope with the pain of living daily lives, then Waters points out that there are certain aspects of our public life that make matters worse rather than better. If a consistent factor that leads to addictive behavior is a sense of marginalization, then poverty, racial discrimination, gender-stereotyping, cultural prejudice, and criminalizing addiction only deepen the addict’s agony. In this public setting she sees the Church having a duel role as an “empathic body” for those within the religious community and as an advocate for addicts in the public domain. The Church can be a therapeutic community where everyone belongs and where alternative practices are offered “to manage negative affect and stress.” In that manner it can treat “soul-sickness” as the result of “solutions that have turned against us.” At the same time, the Church can advocate for addicts being treated as people needing compassionate attention and not as criminals needing jail time. American drug policies have been based on race and class, a bias made clear when the recent opioid epidemic moved from the back alley to Main Street, from the poor to the rich, from black to white. Only then did the definition move from a crime to punish to an addiction toaddress. In Chapter 5, entitled, “Soul-Sickness and the Legion,” Waters turns directly to her pastoral understanding of addiction and the primary role of the caregiver. She uses the episode in the Gospel of Mark 5:3-13 where Jesus cures a man suffering from a “Legion” of demonic powers: stress, pain, sleeplessness, estrangement, a bruised body, and an addled mind. The man personifies “soul-sickness” in Waters’ terms. He does not see the danger that he repeatedly confronts, he has retreated to a supremely self-protective mindset, and he is isolated from everyone. Ultimately, Jesus rids the man of his demons, but not through an act of power but by perceiving the “person within the possession,” sensitive to the fear the man might have about losing his protection against reality. Recovery, she emphasizes, is not the result of a magical intervention or a single act of resolve but of a long and complex process. The role of the pastoral caregiver is to create a space within which an addict can face bravely questions of meaning. “We co-create interpretation and meaning together, as we plan for spiritual renewal. At the most basic level, we can communicate Christian love by being an attuned listener, not shocked by these stories of moral failure, and consistent in our assurance of God’s loving presence.” In her final two chapters Waters outlines two specific patterns of pastoral interaction and applies them to working with an addict. She first outlines the foundations of Motivational Interviewing, with the emphasis on listening intently, asking open-ended questions, and reflecting back without judgment. Next she outlines the five stages of change therapy: an increased awareness of the need for change, an analysis of the pros and cons of current behavior, the creation of a plan for change, the implementation of the plan, and a commitment to sustaining the plan, with an expectation of re-starting after relapses. Both general patterns of pastoral caregiving accommodate the reality that recovery for an addict is not a quick and total reversal of behavior, but a long process that most likely will include many steps backward. And it just might be, Waters concludes, that as we enter the suffering and heartbreak of another, we will learn about our own brokenness. Phil BlackwellMarch 24, 2020

4 Things Christians Get Wrong About Addiction (That We Shouldn’t)

Rev. Alexander E. Sharp Guest Pieces

There are a lot of myths about what addiction is and how it functions. Many of these myths are not innocuous misunderstandings but mistakes that shape cultural opinion and public policy in ways that perpetuate unnecessary pain and suffering.  PEOPLE WHO ARE ADDICTED JUST COMPULSIVELY AND EXCLUSIVELY PURSUE PLEASURE. On a neurological level this is wrong. Addiction is associated with dopamine system in the brain. Dopamine is often connected with pleasure but it is fundamentally about wanting, not liking. This is clear when addictions deepen and a person continues in their addictive behavior long after they have lost the pleasure it might have once brought them.   It is also wrong on a theological level. Biola University professor Kent Dunnington argues “Addiction is not concerned primarily with sensible goods (hedonic pleasures) but rather with moral and intellectual goods…” What does this mean? When you hear the stories of those struggling with addiction, they might note early pleasure. But what drives the addiction is the moral good that they are pursuing. This might be to ease pain, to experience connection, relieve anxiety or experience transcendence.  In this case, Dunnington continues, addiction can be understood as a kind of misdirected worship. It is a pursuit of the kinds of moral goods that all humans desire but in a way that can not ultimately fulfill.  RELAPSE IS FAILURE. Relapse is the norm. It is a normal part of growth, not the enemy.  Bad ideas of recovery seem to be wrapped up in bad ideas around conversion. If you believe that conversion is a singular moment in a person’s life after which they never make a mistake again, then you are likely to believe something similar about recovery.  But, if we recognize that we are all people in process and that each of us will have moments that we go back to old patterns and habits, then we can see recovery in a new light. When a person has a setback, they understanding and support, not judgment and isolation.  When a person feels the pressure that they either need abstain for the rest of their lives entirely or be cut off from all their friends and loved ones, the pressure is often too great. What it motivates is for people to hide their relapses, which can often make them worse.  “Harm reduction,” is the term often used in the addiction and recovery world. It is philosophy that recognizes that few people change all at once and forever. Harm reduction encourages, “any positive change.” Over time, these positive changes can add up to large ones. And, it ensures that the relationships of support are there when a person is ready to change even more.  PAIN AND PUNISHMENT WILL SOLVE THE PROBLEM. One of the fundamental truths of Christianity is that grace and love, not judgment and punishment, are the most transformative forces in the universe.  Addiction is, by its very definition, self-harming behavior. And addiction damages the parts of the brain that helps us with long-term decision making. Increasing harm and long term consequences for those struggling with addiction doesn’t make sense. In fact, it actively makes addiction worse.  A study of more than 1,300 injecting drug users in Baltimore from 1988 to 2000 illustrates the point. The researchers wanted to find out what worked or what could predict recovery and examined demographic factors, drug use patterns, and whether the person sought drug treatment. The authors write, “Of great interest is that only a history of incarceration differentiated persons who successfully stopped using drugs from those who continued to use injection drugs over a 12-year period.”  Part of a successful recovery isn’t so much about the behavior a person stops doing as it is about the new goals they start working to achieve in their life. Having something worth doing that isn’t your addiction is key to overcoming it. Our current criminal justice system takes away people’s motivation and reason for change by limiting their opportunity and hope for a better life.  DRUGS ARE BAD. This probably sounds counter-intuitive if not just plain wrong. But this is a lesson I learned from experience. About 10 years ago I had a medical procedure go wrong and experienced incredibly painful complications. It was bad enough that I was admitted into the ICU and when into acute respiratory distress. I was put on heavy doses of narcotics.  As my doctor’s explained later, my body was under so much stress that if they hadn’t treated the pain, I might have experienced organ failure and died. One of the drugs they put me on was fentanyl, the synthetic opioid now driving overdoses across the country.  What can be a life saving medicine can also be a deadly poison.  Going all the way back to Augustine, Christians have had a theology that teaches everything created is good. What we call “sin” or “evil” is really just a disordering of that good. Fentanyl, while dangerous, isn’t inherently evil. It is our relationship to the drug that is good or bad.  That was what I learned as the months went by and what began as a medically needed dosage developed into an addiction. The drug I was on started doing more harm than good and instead of just giving me control over my pain I was starting to lose control.  It wasn’t that I simply pursued pleasure but was seeking relief from pain and the anxiety of being near-death in the hospital. When I struggled to abstain and relapsed, it wasn’t abject failure but another opportunity for growth. And it was never judgment, blame or confrontation that helped me along the way. Always empathy, compassion and grace.  Attacking a particular substance, or the people who use it, misses the point. We can make the most progress by focusing on the demand side of the equation more than the supply side. We need to understand the role an addiction plays in a person’s life and figure out how to help meet those needs. For some people, that could be access to housing or employment. Others might need medically assisted treatment (MAT) or therapies like Motivational Interviewing or Cognitive Behavioral Therapy or connection to relationships and communities of mutual support.  These lessons aren’t foreign to the Christian tradition but at the heart of it. Sadly, too often Christians have been a part of creating a culture of unrealistic expectations and shame around addiction. Some have focused on simply condemning a substance and those who use it instead of asking what pain, trauma or need might have driven someone to use in the first place.  We need to change how we talk about addiction and treat those who are struggling with it. Christians should be at the front line of reducing the stigma and shame around addiction, not increasing it.  This article was posted on the website of Relevant on July 10, 2019.  We are grateful for their permission to use it here.  

Responding to Addiction through Faith, Not “Fixing”

grygielny Faith Perspectives, Guest Pieces, Harm Reduction

Bob Feeny is a third-year student at the Divinity School at the University of Chicago. He is seeking ordination in the United Church of Christ.  I am never sure where to begin the story of my brother Jeff’s addiction. This is largely due to the fact that his story is not mine; I can only tell my story of his addiction.  I did not know it then, but I think that my story of my brother’s addiction began on Christmas Eve, 2007.  We were in the apartment where my mom and brother lived. My mother had recently stabilized after a few years of erratic bipolar swings and isolation worsened by an abusive relationship, and my brother had moved in with her after living with extended family for a few years.  We were spending Christmas together like a normal family. Things were good. We spent much of the evening with my aunt and uncle—both “functioning” alcoholics. At some point a bottle of vodka came out, and my 18-year old brother started drinking.  A few hours later he stood over the sink, violently ill. The next morning, instead of the up-at-dawn Christmas of our youth that I had hoped for, I sat around with my mother wondering when Jeff would emerge from upstairs. Fast-forward to Tuesday, November 22nd, 2016. It has been 4 months since I learned that my 27-year old brother had become addicted to heroin—and he has just sent me a text that reads, “I’m sorry man, I am too sick to come out for Thanksgiving.”  I had been out to see him as he had gotten clean. He was confident, we had a vision for his future, I was so hopeful for him. Clearly, he had relapsed. I could not begin to understand how this had happened.  He seemed so determined to change his life. But over time it became clear that willpower was not enough to keep my little brother clean.  His confidence began to seem foolish to me; my own hope, hubris. If I’m being honest, I resigned myself to the fact that my brother’s life was essentially over.  Given our family’s history of addiction and the staggering statistics surrounding this country’s opioid epidemic—this seemed like a warranted stance. Addiction seems to be a demon that America simply cannot cast out.  Decades of the War on Drugs have done nothing to mitigate the problem.  We’ve spent an unfathomable amount of resources telling people to “just say no,” and trying to convince them along with ourselves, that if they just find something to be hopeful about, they are going to drum up the confidence it takes to beat addiction.  Our response has been in vain. I wonder, however, if faith may offer us a unique perspective, one that has not yet been attempted.  It’s easy to mix up faith with hope. And certainly, the two are interrelated in many ways. However, as someone who loves an addict, I must admit that I am not capable of responding hopefully to every situation.   But what if faith really isn’t about hope?  What if faith is less like seeing the light at the end of the tunnel, and more like just standing knee-deep in sludge, in a tunnel that seems to go on as far as we can see in either direction?  What if faith is simply being willing to stand in that hopeless place, and know that somehow, God is present? I don’t know what the future holds for my brother.  I don’t know what to hope for, and quite frankly, I’m not sure that hope is really the best thing that people of faith can offer.  There are people everywhere willing to offer hope. Medical professionals, rehab centers, community health initiatives- these things all offer hope.  Some offer hope as a commodity, others are genuinely confident that addiction can be overcome. The truth is, all of these things are necessary at one point or another in recovery.   But all of these things look past the person suffering, into the person they can be if they just believe in themselves.  I want to believe that when Jesus tells his disciples that they lack faith, what he’s really telling them is that they’ve failed to see the child for who he is.  In their excitement about the possibility of ‘fixing’ him, they’ve refused to bear witness to his brokenness; they haven’t stood in the dark and the muck. I often struggle to imagine what it is that’s ultimately going to save my brother.  But maybe I don’t need to. Maybe faith doesn’t require me to visualize the positive ending.  Maybe it doesn’t require me to find a solution, or even to think that there is a solution. Maybe my mustard seed is having the courage to admit that I love my brother, Jeff, the addict, just as he is.  The person who may never hold a steady job. The person who may never find true love. The person who may die younger than I’d hoped.   My prayer for the Church is that as a people who have been transformed by God’s grace, we would never give up hope that lives shattered by addiction can be redeemed.  I pray that we would never lose our confidence that our God is a God who keeps transforming lives, opening up possibilities that we could never have imagined. With this hope, I pray that we will speak up about addiction, and champion research-based approaches to prevention, treatment, and policy reform regarding addiction.  But more than that, I pray that we as the Church would realize our truly unique contribution to casting out the demons of addiction: faith. Not the Hallmark version of faith, the one with the rosy flourishes and the sappy endings, but the faith that looks the demon square in the eyes, and refuses to stop seeing the soul that it tortures.  

A Choice That Must Be Widely Available

grygielny Guest Pieces, Marijuana Legalization, Medical Marijuana

I was pleased to see in Dr. Sanjay Gupta’s April 2018, Open Letter to Attorney General Jeff Sessions, in which he addressed how medicinal marijuana could help us work our way out of the opioid epidemic. It was Dr. Gupta’s plea to Attorney General Sessions that inspired me to share my own story. If I had known in 2009 and 2014 what I know now about cannabis, my recovery from brain surgery would have been much different. In 2005 the onset of migraines, vision problems, and pituitary dysfunction led to the discovery of a Rathke’s cleft cyst (RCC) in my brain. A Rathke’s cleft cyst is a benign growth that develops between the parts of the pituitary gland and the base of the brain. In 2009, after four years of increasing migraines and worsening symptoms, I decided to have the RCC removed by a neurosurgery team at the University of Colorado Hospital in Denver. The recovery was painful and took longer than I anticipated. My doctor prescribed me Oxycontin (oxycodone) for pain management. The Oxy successfully took the edge off the pain, but it also made me itchy, nauseous, constipated, irritable, and wholly unable to function normally. I had also heard stories of how addictive the medication could be as well as stories of accidental overdoses, and these concerned me. After about one week, I decided that the side effects were too much to manage, and I stopped taking it, only to be met with overwhelming pain. The Tylenol (acetaminophen) I was taking was not enough to manage the level of pain I was experiencing. I went back on the Oxycontin for another two weeks and battled through the side effects before finally deciding to quit Oxy once again and push through the remainder of my recovery with Tylenol only. By 2015 the hardest part of my recovery from this, and a second surgery, was behind me.  I was able to move away from relying on prescription pain medications to manage my migraines. I returned full-time to my position as a health and special education teacher at an alternative high school in Colorado, where I worked with youth ranging in age from 14 to 18 years. In 2014 the sale of recreational marijuana began in the state of Colorado, and when I returned to work after surgery my students had a lot of questions about marijuana. They did not understand the differences between medicinal and recreational uses or products, and quite frankly neither did I. One student asked if a child who was using cannabis for treatment of epilepsy was also getting high, and I didn’t know the answer. I was frustrated by the lack of updated and accurate curricula to address all of these issues appropriately. My coworker and I set out to create science-based youth marijuana prevention curricula that addressed marijuana as a legal substance and differentiated between medicinal use and recreational use as well as recognized the important differences between adult use and use during adolescence when the brain is still developing. We spent a year learning from and working with specialists in various fields to develop our programs. What we learned reshaped our educational approach to prevention but also reshaped my personal approach to pain management. We were able to move away from the egg-and-frying-pan scare tactics into the world of science- and research-based educational practices. In 2016, still suffering from periodic migraines largely a result of my previous brain surgeries, I decided to put to use my knowledge about cannabis, the endocannabinoid system, and the compounds THC and CBD to see whether I could find a better form of migraine prevention and migraine pain management. Not a fan of smoking, I researched tinctures and edibles, working to find a THC and CBD balance that was effective for me. Ultimately, I found a form of cannabis-based pain management that works better and more consistently than any of the prescription painkillers I have taken since 2005. By and large I am able to treat my migraine pain with high CBD cannabis-based products without suffering any side effects.    I have two teenage daughters, and I don’t hide from them the fact that I use medicinal marijuana to treat my migraines. Instead, I use it as an opportunity to talk with them about the important differences between my brain (as an adult) and their brains, which are still developing. We also talk about the medicinal uses of cannabis such as in treating childhood epilepsy and how that differs from recreational use. Had I known prior to my brain surgeries what I know now, I would not have had to choose between extreme pain and extreme Oxycontin side effects. I could have used cannabis as a form of pain management instead.  This is an option that should be afforded to everyone. Sarah Grippa is a high school teacher in Colorado and the Co-Founder of the Marijuana Education Initiative.

What if Medical Marijuana Were the Only Way to Help Your Child?

grygielny Guest Pieces, Marijuana Legalization, Medical Marijuana, TX

Christy and Mark Zartler are the parents of an eighteen-year old child, Kara, who has multiple disabilities, including autism. Rev. Alexander Sharp had the privilege of meeting them while participating in the Texas Marijuana Policy Conference in Austin.  They have been fighting a heroic battle for many years, at huge personal cost and risk, to help their daughter. They are advocates for legalizing medical marijuana. Please read their story here. Dear Friends of CNDP, My name is Christy Zartler. My husband Mark and I are parents of a severely autistic daughter. Eighteen years ago, I gave birth to premature identical twins. One of my twins, Kara, has multiple disabilities, including cerebral palsy and autism. Unfortunately, her primary mode of communication is self-abuse. She has had these behaviors since she was four. The worst of these behaviors is that she repeatedly hits herself in the head and face with close fists. She has been recorded in one school day to punch her face and ears 3,000 times. We had to do something for her. We’ve been to many physicians and she’s been on many different medications. Nothing worked. We’ve been trying to help her for 14 years. When Kara was 11 years old we found that cannabis in the form of an edible brownie stops these self-injurious episodes. After the discovery that cannabis was a very effective mood stabilizer for Kara, my husband tried a Cannabis vapor treatment.  We blow up a cannabis vapor balloon and give it like a nebulizer treatment; it takes about 5 minutes to work. Like a light switch, her brain shifts, her mood changes abruptly, and she’s back to more acceptable behavior. She can do activities that she enjoys like walking, playing with her rice bin, and eating. After the treatment she expresses joy and happiness. We believe it’s good medicine for her and it helps relieve pain in her legs. It works a hundred percent of the time. It’s not the only medicine she takes, but it’s a vital part of her program. It’s a medical necessity. We use it for rescue purposes, when she’s having these dangerous meltdowns.    In February 2017, my husband Mark released a treatment video to promote awareness for conditions like Kara’s. It shows that cannabis is an effective treatment. The video went viral. It’s been seen worldwide. We had no idea this would happen. Pictures and videos of her can be seen on her fb page “Kara Zartler”. Kara has always had a team of doctors. She is currently a patient at the Autism Center at The University of Texas Southwestern Medical Center. We haven’t given up on modern medicine. We can’t. She currently takes three pharmaceutical prescriptions. They help her, but nothing stops these severe episodes once they start. Once they get rolling, her mind gets into this loop. We’ve always told her doctors about the treatment. We take whatever legal risk we have to take because of drug interaction issues.  Our doctors can’t offer us advice back, except to look for interaction precautions from what they know. It would be a blessing if we could actually have a two-way conversation with them about the use of cannabis for her conditions. Families like ours need legal access to whole plant cannabis and recourses so that we can feel safe and sleep better. Cannabis oil possession carries stiff punishments. If you live within 1000 square feet of a school a six-month supply of cannabis oils for one person is 10 years to life in prison. Everyone tells us that we should just move, but the reality is that we can’t. Kara has been thriving in the Richardson School District since she was three years old. It’s been a long process, and now we finally have an excellent program going at her school. The chances of us replicating that in a different district are zero. We also have our social services here. We’re on the Texas Medicaid Waver programs so we have in home help that helps us care for Kara so that we don’t have to institutionalize her. Many families in our autism community who live in legal states believe that cannabis works for their autistic children. These parents have shared videos of their children. After cannabis treatment the children are interacting with people, making eye contact, doing tasks and activities, smiling and enjoying their surroundings. I believe that the sick children here in Texas deserve to have access to this less harmful medication. What we really need is for Texas lawmakers to recognize that cannabis is medicine. Sincerely,     Christy Zartler