Addiction and the Road to Damascus

Rev. Alexander E. Sharp Drug Education, Harm Reduction

Dear Friends and Colleagues, If asked to name the American thinkers of the past 150 years whom I most admire, I would place the great pragmatic philosopher William James at the very top of the list. Starting as a professor of physiology at Harvard in 1873, James virtually created psychology as an academic discipline. His Varieties of Religious Experience, published in 1890, endures as a religious classic. William R. Miller, distinguished professor emeritus of psychology and psychiatry at the University of New Mexico, should be considered among James’ most worthy successors. While he may not have created an academic discipline, Miller did, along with colleague Stephen Rollnick, develop a new therapeutic technique – Motivational Interviewing (MI) – now used worldwide to treat individuals suffering from alcoholism and addiction and more broadly seeking personal change.  It is easy to forget that until about 40 years ago, many people believed a confrontational “boot-camp” approach was an effective treatment for alcoholism and other addictions, The concepts of MI have helped to expose this misguided view.   Miller’s experience in working with addicts also led him to explore with academic rigor the notion of sudden personal conversion. He is the first scholar since William James to do so. In his book Quantum Change, he documents what he finds to be the reality and surprising frequency of such experiences. He is now exploring the ways MI and such “change” experiences might be related.  I am delighted to introduce Dr. Miller to you here, for two reasons. First, Clergy for a New Drug Policy is devoted to ending the so-called War on Drugs. The tenets of Motivational Interviewing make clear why criminalization as the primary weapon in this war, as currently fought, is a tragic response to drug possession and addiction. More broadly, these same principles offer the potential for human change regardless of the arena.   Dr. Miller recently participated in a webinar broadcast by the Center of Addiction and Faith (CAF), a Minneapolis-based organization that engages clergy and churches in responding to addiction. A selection of Dr. Miller’s comments under key issues is provided below.   On the origins and key tenets of Motivational Interviewing:   Early in my education, I was on an internship in Milwaukee, Wisconsin working on an alcoholism unit. It was run by a psychologist who was compassionate and scientifically oriented, so I felt very at home. I knew nothing about alcoholism, really, but had been trained in Carl Rogers’ person-centered and behavioral approaches. It was the patients who taught me about alcoholism. I began reading the literature on alcoholism from the 1970s, which said, “Alcoholics are pathological liars, completely in denial, out of touch with reality, and horribly difficult and defensive.” And I said, “Gee, those aren’t the same people I was talking to.” This puzzle was the beginning of Motivational Interviewing. I realized that that picture of people being very difficult, defensive, and dishonest was a function of the way we were treating addiction at that time — in a very confrontational, authoritarian, shut-up-and-listen kind of way. The spirit behind Motivational Interviewing is partnership rather than “I’m the expert and you’re only a recipient.” It’s two people talking to each other as peers. I have expertise, but so does my client. My client knows more about him- or herself than anybody else in the world. If we’re talking about a change in that person’s behavior, I need their expertise, as well as my own. Rather than saying “I have what you need, and I’m going to give it to you,” the communication in Motivational Interviewing is more “You have what you need, and together we’re going to find it.” A central principle is that it should be the person, the client, the patient, the student, who’s making the arguments for change and not me. If I’m arguing for change and they’re arguing against change, I’m in the wrong chair. On the importance of “self-acceptance” in personal change: Here was one of Carl Rogers’ interesting discoveries: that when you experience yourself as unacceptable, it’s very, very difficult to change. It’s paralyzing. And when you experience acceptance, profound acceptance — as you are — whether from a therapist, or a friend, or your family, or God, then it becomes possible to change.  Now, I don’t know why we’re wired that way, but we seem to be.  On the role confrontation and punishment in response to addictions:  Punishment suppresses behavior. It doesn’t teach anything new. It doesn’t say, “This is the way to go, … this is the way forward.” I began a very different approach to working with addiction accidentally and [found] very different outcomes. Human beings don’t generally take well to being told what’s wrong with them and what they should do. If you take a different, person-centered approach, you get a very different outcome. You find that you are working with a very different kind of person. When we also looked at the literature on confrontation, it is completely negative. There’s not a single clinical trial of a confrontational approach that produced a positive outcome. It was the norm at that time. We thought that that’s what those people needed.  But there never was any science to the notion that if you can just make people feel bad enough, they’ll change. And nor is that my faith. On the debate over addiction as a disease or a choice:  It’s an old idea that people with substance use disorders just can’t enter into a therapeutic relationship. There never was any science to that. Quite to the contrary, person-centered approaches like Motivational Interviewing have a very, very good track record. When we have this black-and-white way of thinking about things, there are only two possible outcomes, perfection or disaster. I’ve done outcome research for 40 years. Outcomes don’t look like that. They’re all over the map. It used to be alcohol dependence and alcohol abuse were different disorders. They’re not. It all lies along a continuum. Outcomes look the same way. We know that with chronic illnesses, we don’t expect people with diabetes to never taste sugar again. We don’t expect people with hypertension to abstain totally from salt in all forms. The main thing is to be moving in the right direction.  What is meant by the disease model is that you are completely different, incapable of controlling what you are doing.  For some people that’s helpful.  Identifying with that is the way they stay sober, and that’s good. However, if you don’t remain perfect, it can be discouraging.  We have a study in which we found that an endorsement of the disease model actually increases the relapse rate. People were more likely to not just use, but use catastrophically, when they believe that if one drinks one is a drunk. For some people, that’s helpful. For others, it’s not. That’s human nature and there’s not one solution, one answer for everybody. On the seemingly contradictory approaches to recovery (some evoking a “higher power,” others “personal agency”): One of the wonderful things about addiction treatment is we have a terrific menu of different science-based approaches that can help people. There isn’t one approach you should always do.   One of those is the 12-step program. It’s very nicely scientifically documented. (Alcoholics Anonymous itself is harder to document, although there are a lot of studies of it.) But a 12-step facilitation treatment works on average just as well as cognitive behavior therapy or Motivational Interviewing on average. So, if one thing isn’t working, try something different.   For Bill Wilson (founder of Alcoholics Anonymous), who was a banker and at the top of his game, learning powerlessness might have been the key. But if you’re working with individuals who have experienced deep trauma, they might need to focus on methods that will draw out personal agency. Feminist theology has questioned whether women in general need more powerlessness. Women for Sobriety and SMART Recovery and other kinds of approaches were developed as reasonable alternatives. Humility and ego busting and powerlessness doesn’t seem to be the path for them. On how churches and other communities can respond to addiction: First, make it a topic of conversation. So often there’s so much shame around this topic in the United States that you just don’t talk about it. You can change that norm in a church by preaching about it if you’re the pastor, by sharing stories in prayer time.  Bring it out of the closet. In this country we have made it a shameful thing. Albuquerque is an interesting example. The University of New Mexico Hospital operates the largest addiction treatment program in the state. But it’s not located at the University of New Mexico Hospital. It’s in a warehouse district out by the airport. Now, why is that? It’s because we don’t want “those people” around the hospital. Except guess what? They’re already there being treated for all kinds of other things. That’s not right. We have science-based, perfectly reasonable treatment methods that are rather like what therapists are doing anyhow with other kinds of clients. And yet, we’ve somehow come to believe that this is somebody else’s work. We should mainstream it in churches, in healthcare, in psychology, in social work, in homeless services. It’s just a really common part of life and not one to be shunned. On the importance of “small interventions:” Most of the things in my career that were most important were unexpected. And I learned early that when you don’t find what you predicted, that’s when you should get interested, become curious, and follow that, believe your data and follow your data.  In 1983, I was thinking of Motivational Interviewing as a kind of priming the pump or getting people ready for what would be real treatment. The unexpected thing that popped up was that after a conversation in this way, people often began changing without additional help.  My training as a therapist had been “the longer you spend with me, the better you’ll get.”  But I began to find that even after a relatively brief conversation, people seemed to turn a corner on what had been very longstanding destructive patterns.  It didn’t make sense to me, but we kept pursuing it. That has held up over time. If you look at the stories of healing and in writings about Jesus, they’re not long interactions. They are relatively brief encounters. He almost always touches the person, which is interesting. But these things are not long-term psychotherapy sessions. Something is happening that powerfully changes the person. On the possibility of personal conversions: Some people don’t know that the author of the hymn Amazing Grace was a slaver. His last trip was not the one on which he wrote Amazing Grace. He had a couple more exchanges. And so, it doesn’t necessarily happen all at once. It’s not always like Ebenezer Scrooge, where you’re totally transformed in the moment. But sometimes people are. I wrote a book called Quantum Change. The last psychologist I could find who was interested in this was William James, for whom psychology and religion naturally fit together at the beginning of the 20th century.  He was fascinated by people who are suddenly transformed and tells some of their stories in Varieties of Religious Experience.  I wondered, “Is that real? Does that actually happen in real life?” Well, the stories are found in biography and autobiography.  We found that it was not difficult at all to find people who had had such “turning point” experiences in their lives. They hadn’t told anybody. They often didn’t talk about it, because the experiences sometimes sound pretty crazy.  I just went into the study asking, “Does this even exist? Is there such a thing as an experience that happens within a few minutes or hours that permanently changes the person, like a one-way door?” It is real and it’s common. (For more on this aspect of Dr. Miller’s work click here.) On the relation of psychology and religion:  Psychology in the …

When Poverty Becomes a Crime 

Rev. Alexander E. Sharp Collateral Consequences, Harm Reduction

When it comes to criminal justice in the United States, it is comforting to believe that “poverty is not a crime” and we are all “innocent until proven guilty.”  But these are platitudes, mere empty words. Nobody knows this better than those who sit in jail awaiting trial, often for months, only because they are too poor to afford bail.     The 8th Amendment to our Constitution recognizes the use of bail. In a frontier society, bail might have been necessary to ensure that the accused did not skip town to avoid trial. Today, however, this is not an option for most of the poor in our crowded cities. Instead, money bail has become one of our many techniques to ensure that large numbers of poor people, mostly Black and Brown, end up in prison.  In 2016, the jail population was over 730,000 on any given day in the United States. Of this number, approximately two-thirds were detained solely because they could not post bond. Most were being held for non-violent offenses.  In the last few years, the use of money as bail, or “bond,” has been challenged in Washington D.C., New York, California, and perhaps most successfully, in New Jersey. In Illinois, legislation was filed yesterday –  The Pretrial Fairness Act  – that would reform the pretrial process in ways that are fundamental and long overdue. This legislation deserves our strongest possible support.   Why is the Pretrial Fairness Act so important? Most fundamentally, it would end money bail. It is simply immoral for personal wealth to determine whether someone will be detained in jail or permitted to go free.   More broadly, the use of money as bond is wrong because it creates two separate systems of justice. How does this happen?  In Cook County, Illinois, individuals await trial for an average of three months. Sitting in jail even for a few days, defendants can lose housing, jobs, participation in education and training programs, and may have to pay larcenous fines to recover an impounded car.     When people are not able to meet bail, they lose the chance to arrange a defense while awaiting trial. This is not true for the wealthy. Of greatest long-term consequence is the likelihood that those who have been detained often plead guilty rather than going to trial, especially when prosecutors pressure them to do so. (Shockingly, 95% of all cases in the Cook County system are settled through plea bargaining.)  Upon leaving prison, those individuals are burdened with a criminal conviction for the rest of their lives. So much for another platitude: “you’ve paid your debt to society.”  Since SB 4025 will end money bail, some will ask how we can ensure that the public will be protected from the release of potentially violent individuals. The answer is clear. Judges already have the ability, indeed the responsibility, to make such judgments. Wealth of the defendant should have no relevance. In fact, when bail is a choice, those who are dangerous but can afford it become a threat.  One of the very important things the Pretrial Fairness Act would do is require judges to do a much better job of determining who should sit in jail and who should be released. Right now, in too many cases, bewildered defendants, accompanied by public defenders who barely know them, appear before a judge for an average of about 40 seconds. The bill includes many other sensible reforms. It will, in effect, “deputize police,” thereby expanding their ability to release those arrested without requiring a pretrial appearance before a judge. Of special relevance to Clergy for a New Drug Policy, it does not permit the pretrial incarceration of people accused of low-level drug possession. In short, there are many important policy reasons why those of us in Illinois should support the Pretrial Fairness Act, and those of you across the country should insist upon similar legislation for your state.  But at the end of the day, the words of Sharone Mitchell, Director of the Illinois Justice Project, capture what matters most: “What we talking about is punishing people pretrial, not because a judge is saying that they’re too risky to be released or anything, but just because they are poor, and that’s just not right.”  

Yaa Gyasi Tackles the Opioid Epidemic, and So Much More, in Transcendent Kingdom

Tom Houseman Guest Pieces, Harm Reduction

“We read the Bible how we want to read it,” explains Gifty, the protagonist and narrator of Yaa Gyasi’s Transcendent Kingdom. “It doesn’t change, but we do.” If there is one idea at the core of Gyasi’s brilliant and heartbreaking new novel, it is about how people change, whether they want to or not, and what happens when they no longer recognize who they used to be, or when the people they love don’t recognize who they’ve become. Transcendent Kingdom is about contradictions, whether between religion and science, community and isolation, or what we choose and what is beyond our control. It is about the struggle that we all experience when faced with absolute confrontations, when there are no sides to be picked, clear right or wrong choices, or tidy resolutions. Sometimes the only answer to an impossible question is to accept that there is no answer, a conclusion that can be equally challenging to people looking to either a church or a laboratory for resolution. Gifty has lived in both places. The daughter of Ghanaian immigrants, Gifty grew up in the deeply religious and almost entirely white town of Huntsville, Alabama. Her life is a series of tragedies outside of her control: Her father moves back to Ghana, abandoning her family; her older brother dies of a heroin overdose; her mother develops depression and attempts suicide. Gifty feels like an outsider in Huntsville, but when she spends a summer in Ghana, she feels alienated from that culture as well. These are the contradictions that plague Gifty:  she is a foreigner wherever she goes, and the comfort she finds in religion is crushed by the losses she experiences. She decides to put her faith in science, to pursue her PhD in Neuroscience at Stanford. Gifty studies neuroscience because she wants to understand what went wrong in the brains of her mother and brother. She grapples with her own internal contradictions, knowing she shouldn’t blame either of them for their circumstances, but still feeling anger and resentment. “This science was a way for me to challenge myself,” she says, “to do something truly hard, and in so doing to work through all of my misunderstandings about [my brother’s] addiction and all of my shame. Because I still have so much shame. I’m full to the brim with it; I’m spilling over.” But even as she pursues knowledge through the scientific process, she cannot completely abandon her religious upbringing. “I have never, will never, tell anyone that I sometimes think this way,” she confesses, “but the more I do this work the more I believe in a kind of holiness in our connection to everything on Earth.” There are some questions, she knows, that science might never be able to answer. Transcendent Kingdom is Yaa Gyasi’s second novel, after her acclaimed debut Homegoing. Her writing is poetic in its bluntness, moving briskly while still allowing the reader to sit with its heaviest moments, and few novels have tackled the opioid epidemic with such ferocious honesty. Gifty’s response to her brother’s substance use disorder, and his death, reflect the pain and helplessness that so many people experience in the face of a loved one’s struggles: “In just that short amount of time, Nana’s addiction had become the sun around which all of our lives revolved. I didn’t want to stare directly at it.” But she is also willing to challenge her own assumptions and beliefs about this illness. “It’s true that for years before he died, I would look at his face and think, What a pity, what a waste. But the waste was my own. The waste was what I missed out on whenever I looked at him and saw just his addiction.” Gifty’s narration twists and weaves through time, from childhood to college to life as a PhD student in the space of paragraphs. There is no arc to the story because there is no arc to Gifty’s life. But Transcendent Kingdom is transfixing not in its tidiness, but in its messiness. It wrestles with questions not to give us answers, but to force us to ask them of ourselves. “The hard part,” Gifty explains about scientific experimentation, “is trying to figure out what the question is.” It can be hard to find the right questions to ask, especially when we might not want to know the answer. Everyone is full of contradictions, but Transcendent Kingdom is about loving someone, be it family, friends, ourselves, or God, in spite of those contradictions. It isn’t easy, but the struggle is intrinsic to the process. For Gifty, as for so many of us, it’s not about the answers. It’s about being willing to keep asking questions. Tom Houseman was the Policy Director of Clergy for a New Drug Policy for two years. He is currently seeking representation for his first novel. You can find him at www.tomhousemanwrites.com.

For Too Many, Our Jails and Prisons Have Become ‘Death Traps.’ This Must Not Continue.

Rev. Alexander E. Sharp Decriminalization, Harm Reduction, Take Action

Even in the best of times, but especially now, we must take great care not to put in jail those who do not belong there.  That is why on March 26, Clergy for a New Drug Policy was pleased to sign on to an open letter drafted by The Marijuana Policy Project: “Law Enforcement Officials, Medical Professionals, Clergy, and Cannabis Advocates Call for the Cease of Cannabis Arrests and Release of Incarcerated Cannabis Offenders in Light of COVID-19.” The letter notes that “prisons and jails are breeding grounds for infections and diseases due to close quarters and lack of ability to practice social distancing…all prisoners, whether young or old, are increasingly vulnerable to being infected with the novel coronavirus.”   We believe this letter has relevance to all of you, regardless of where you live.  In my community of Chicago, Cook County Jail has been cited nationally as a “death trap.” Close to 300 inmates are now infected, and 6 have died due to the virus. In response, the mission committee of my church assisted each member of the congregation in contacting our county commissioner. We asked that he urge the county board to  “(1) release as many prisoners as possible immediately to prevent the spread of COVID-19, (2) create safer and more sanitary conditions inside the jail for the prisoners and guards who remain, and (3) provide adequate health care for those who become ill.”   We also invited the members of our congregation to sign on to a petition urging Kim Foxx, our States Attorney, as the lead law enforcement officer for Cook County, to take additional steps to dramatically lower the number of people in the jail in response to COVID-19.  Specifically we asked that she: (1) “Decline to file new charges in cases that do not involve danger to a specific person; (2) Agree to release most people seeking bond reviews from custody without payment of money; (3) Immediately dismiss all pending misdemeanors and class 4 felony cases not involving danger to a specific person, starting with cases in which people are in jail; and, (4) Cease filing violations of probation and violations of bail bonds for technical violations or reasons not involving danger to a specific person.” The MPP letter notes that “many localities – including Baltimore, Suffolk County, Massachusetts; Cuyahoga County, Ohio; New Jersey; Los Angeles; and New York City – and the Federal Bureau of Prisons have already begun to release inmates incarcerated for non-violent, drug-related offenses with the understanding that infections in prisons and jails are rampant, and releasing inmate could save the lives of not only inmates but also the custodial, medical, and safety staff that serve them.” It is my experience that individuals in churches often want to raise their voices in ways that will make a difference, but are not quite sure how.  Contacting elected officials to urge them to take steps to prevent the spread of coronavirus among people being jailed for minor offenses, and those who work among them, is one important way we can protect the most vulnerable. Your local elected officials—including states attorneys, county commissioners, and sheriffs–will pay attention to you on this issue.  Call and write to them now.

“I Don’t Want to Come to Your Church, Your Synagogue, Your Circle. I Want You to Come to Ours.”

Rev. Alexander E. Sharp Harm Reduction

Kassandra Frederique: “The Drug War is a manifestation of the things that we have failed at. How do we have a conversation about alternatives? How do we build the capacity for our communities to care for each other?   “People create hospitals and churches. But sadly, what we also recognize is that both those institutions have failed us miserably.   If those institutions don’t see that they have helped to create the conditions in this moment, then we’re not actually having a conversation about what their true role is. “For some people, faith and spirituality fill a spiritual void. But if their institutions still traffic in stigma, miseducation, racism, sexism, a prosperity gospel… [AUDIENCE LAUGHTER]” Monique Tula:“I can’t get away from the fact that the War on Drugs is as much driven by capitalism as it is by racism. Today’s governing bodies and corporate CEOs are overwhelmingly white, wealthy, cis men. Although we’re seeing countries like China and India changing some of those demographics, the endgame looks like colonization and domination of the earth’s resources. This keeps the oppressed in a constant state of struggle: constantly distraught, constantly distracted, constantly divided. All we see is ‘other.’ “ Frederique: “You list the Fortune 500 companies. What about the faith community? The faith communities often have the same kind of leadership, the same kind of investment, the same commitment to upholding the status quo of the people that benefit most from capitalism.” Tula:“Or to upholding those Victorian values and religious dogma—the idea that abstinence and chastity will keep you off of the road to perdition.”  Frederique:“I’m excited for anyone that wants to help us end the overdose crisis. But what I ask about is the purpose of the faith institutions. Is it for control or as an ally towards freedom? Are you trying to control people or are you trying to give people strategies to take down the structure that created the circumstances we are navigating through right now? We can’t save anybody. We’re not going to fix anybody. We have to give folks the resources to do that healing within themselves.”   Tula:“I had this spiritual awakening sometime after the last Harm Reduction Conference in New Orleans, and I’ve been chasing that high ever since. I started listening to Eckhart Tolle. His latest book is called A New Earth. He writes about global transformations. One is the global market economy, driven by capitalism.  Another is the reality that people around the world are awakening to a new state of consciousness.  Although we exist in separate bodies in separate forms, the energy that flows through us is the same. At our core we’re actually connected.  “Tolle talks about how many of us are awakening to the primacy of unconditional love. He says that people are gaining this greater self-awareness.  We’re beginning to understand our symbiotic relationship with the planet which cannot be sustained if we continue to exploit its resources with no regard for the future, for our children. If we’re all connected, then harm to one is harm to us all. “Have you noticed that there is a shift away from top-down decision making, from those values that are rooted in the patriarchy and in white supremacy? “The reality is that there are enough resources on this planet for all of us.  It is just a matter of how they’re distributed. Policies that formed the foundation of the War on Drugs are rooted in a dying paradigm fueled by capitalism and criminalization.    “Let us remember Audre Lorde’s classic quote, ‘The Master’s Tools Will Never Dismantle the Master’s House.’ Problems can’t be solved with the same level of consciousness that gave rise into them in the first place. We need a shift—a complete shift—a new way of thinking. Deconstruction of the old world needs to happen in order to make space for this new consciousness to emerge. “Those of us who practice and believe in the power of harm reduction, we’re the culture makers. We’ve been on the edge, we’ve been on the fringe.  I want to point to my dear colleague Allan Clear, who was one of the founders of harm reduction in this country, the first executive director of the Harm Reduction Coalition 26 years ago. “We were not in churches very much. But I will say that there have been faith leaders and faith communities that low-key supported harm reduction since the very beginning. The first needle exchange program that I worked in was housed in a church in Cambridge, Massachusetts.  “Harm reduction is often limited to describing public health strategies and interventions to prevent people from contracting infectious diseases like HIV and hepatitis or fatal overdoses. But harm reduction is more than a public intervention. Think of these interventions as harm reduction with ‘lowercase HR.’ “Harm Reduction with ‘uppercase HR’ is a local grassroots advocacy effort that bridges public health with civil rights and community mobilization. Our aim is to shift power and resources to people most vulnerable to structural violence. We are challenging the prevailing notion that people who use drugs are bad and that they’re broken.” Frederique:“I struggle with ‘lowercase harm reduction.’  We think that the goal is syringe exchange or an overdose prevention center. We see Naloxone as harm reduction. Then abstinence-based organizations say, ‘We’re harm reductionists because we use Naloxone.’  That’s not what it is.  “Harm reduction is a beautiful thing.  I consider it a part of my ministry because of the church I belong to. But we operate in the framework of capitalism. This causes us to violate the integrity of our framework. “We are allowing other institutions to judge our spirituality in a way that we never would.  The fact that the academy can take something like syringe exchange or Naloxone and then talk about moral hazards shows that they are claiming the high ground.  “We have to be clear about who the moral compass is because those institutions are not without sin. They are so ready to tell us that we are the sinful ones. Why is it that we bow our heads down to false prophets? The economy is a false prophet, organized religion is a false prophet, the medical system is a false prophet. “We are the moral ground, high and low. There are no hierarchies in our morality. And that is why when we have a conversation about what the role of faith groups are in the overdose crisis, in the drug war, if you believe that you are the moral leader, that you will dictate what morality looks like, then keep it.  I don’t want to come to your church. I don’t want to come to your temple. I don’t want to come to your synagogue. I don’t want it to come to your circle. I want you to come to ours.” (This dialogue has been edited for clarity and length.)