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Faith-based Recovery Programs
Principles For Success

A Position Paper By Terence T. Gorski
February 2, 2001

On January 29, 2001 President George W. Bush signed an executive order designed to remove the obstacles that keep faith-based organizations from applying for federal funds for providing addiction treatment and other social services. In his state-of-the-union address in 2003 he reaffirmed his committed to the nation to provide the resources of the federal the government to help faith-based organizations provide services to addicted people. This will expand the ability of faith-based organizations to develop addiction treatment programs.

The President is right to acknowledge the role of faith-based programs in addiction treatment. Currently, about one half of all federal funding for addiction treatment goes to faith-based organizations. The three largest providers of Faith-based Addiction Treatment are The Salvation Army, Lutheran Social Services, and Catholic Charities. These three organizations of faith have a long and successful history in helping addicted people and their families.  It’s important to learn from their experiences.

One thing is certain - Faith-based organizations currently play an important role in bringing needed services to suffering addicts and their families. Under the President’s Faith-based initiative, the capabilities of faith-based organizations can expand to meet the needs of greater numbers of addicted people. 

The President’s focus on Faith-based Initiatives can become a powerful part of managing our national problems involving alcohol and drugs– but only if we insist that faith-based initiatives support and enhance a science-based understanding of addiction. It is only by harnessing the power of faith in combination with the power of medical science that we can offer addicted people and their families the best possible chance of recovery.

To bring about this close and effective collaboration between medical and faith-based approaches, we need to be clear about five basic principles:

1.         Addiction is a biopsychosocial illness that causes serious spiritual problems.

2.         Addicts are sick people who need to get well, not sinners who need to repent, bad people who need to become good, or criminals who need to be punished.

3.         Addiction is a health care problem that needs to be managed by a Public Health Addiction Policy.

4.         Quality treatment needs to be preserved by assuring that all faith-based treatment programs are held to the same standards for facilities, clinical program, and staff credentialing as other treatment programs.

5.         Faith-based funding needs to occur in addition to not at the expense of existing programs and not be taken from existing addiction, mental health, and social service budgets.

In this presentation, I’m going to review four things:

1.      The Role of Faith-based Programs In Addiction Recovery

2.      Principles of Effective Faith-based Treatment

3.      Practical Guidelines for Faith-based Addiction Programs

4.      Things Faith-based Recovery Programs Should Avoid

The Role of Faith-based Programs

As with the treatment of all illness, there is a role for spiritual and faith-based approaches. When properly integrated with proven treatment methods, faith-based approaches can enhance treatment and improve recovery rates. Spiritual counseling alone, in isolation from proven multimodality addiction treatment methods, will be insufficient to produce and sustain recovery.

It is easy to misinterpret an initiative to provide faith-based treatment for addiction as an endorsement for the position that addiction is moral problem and not a public health issue. This is not the intent of the executive order nor is it proper to interpret it this way. The intent is to make treatment and social services more available to suffering addicts and their families. The intent is to preserve high standards for program licensure and staff credentialing while assuring that faith-based components can be readily available for clients who want them and can benefit from them.

I strongly believe that if faith-based addiction treatment programs are to succeed, they need to be held to the same standard as all other addiction programs. Being a faith-based organization should not exempt an organization from meeting building codes, facility requirements, clinical programs standards, and staff credentialing requirements. To do so would pose a real danger to the addicts and their families who participate in treatment.

I am not alone in this belief. The three leading faith-based providers of addiction are the Salvation Army, Catholic Charities, and Lutheran Social Services. All three of these organizations provide addiction treatment within the constraints of current professional licensing and program accreditation.

Principles of Effective Faith-based Treatment

There are principles of effective treatment that faith-based organizations should follow if they want to have a successful and effective addiction program.  I want to discuss some ideas about how faith-based programs can improve the effectiveness of their ministry by understanding addiction as a biopsychosocial illness that causes serious spiritual problems. 

Addiction is a biopsychosocial illness 
that causes serious spiritual problems.

 

Addiction is a public health issue, not a moral issue.  To improve ministerial effectiveness, it’s important for faith-based recovery programs to carefully examine their basic beliefs about addiction to alcohol and other drugs.  Recent medical and scientific research shows that addiction is a multidimensional biopsychosocial problem requiring a broad base of multidimensional treatment intervention.

Addiction to alcohol and other drugs is primarily a public health problem that requires comprehensive biopsychosocial treatment supported by community-based recovery resources. 

Addiction is not primarily a moral or spiritual illness.  Many good people with strong spiritual programs can and do become addicted. Many addicts, especially in the late stages of their disease, are physically debilitated, psychological impaired, socially dysfunctional, and spiritually bankrupt.  Spiritual approaches are important, but by themselves are insufficient to produce and sustain recovery.

Spiritual approaches are important,
but of and by themselves
are usually insufficient
to produce and sustain recovery

 

Addiction is not a punishment inflicted by God upon sinners.  A person's spiritual health has little to do with whether or not a person becomes addicted.  Developing a spiritual program is an important part of the recovery process, but is not of and by itself sufficient for recovery to occur.

Recovery is a long-term process.  Cathartic spiritual conversion may be a first step, but without a progression of specific steps in recovery relapse is likely to occur.

1.      Being There When Addicts Ask for Help

Most addicts reach out for help when they have “hit bottom.”  Hitting bottom means that they are experiencing such severe consequences from their addiction that they are unable to manage the pain.

In other words, people seek help as the result of a “motivational crisis”.  A motivational crisis is a serious problem or situation that forces people to confront and take action to solve their problems with alcohol and drugs.

When addicts start to recover they are usually
physically ill, psychologically impaired,
socially dysfunctional and spiritually bankrupt.

 

When addicts start to recover they are usually physically ill, psychologically impaired, socially dysfunctional and spiritually bankrupt. Most successful treatment programs are based upon the principle that people get well “from the inside out.”  In other words, physical healing must come first, then psychological healing, then social healing.

Let’s explore this priority of recovery issues in a little different way.  When an addict enters treatment they are normally in a biopsychosocial crisis.  Job #1 is to work collaboratively with the client to stabilize all levels of the crisis.

The physical crisis may be directly caused by substance use.  This includes overdose, intoxication, withdrawal, and drug-induced medical problems.

The psychological crisis involves the inability to think clearly, logically, and rationally (cognitive impairment), the inability to manage feelings and emotions (affective impairments) which can take the form of either emotional volatility or over reaction or emotional numbness; and the inability to regulate behavior.  This involves problems with impulse control that leave the client vulnerable to relapse as a result of craving, problems with deferred gratification which make clients unwilling to invest time energy and resources up front in order to get a benefit later.  The client usually wants immediate gratification and instant results or they threaten to leave treatment.  And problems with self-motivation which leaves clients unable to do things that they know they need to do.  This is often seen as a state of apathy and is sometimes called becoming “amotivational.’

The social crisis most frequently involves: 

bullet         Lack of food, clothing, and shelter.  People seeking these basic survival needs are often said to be looking for “three hots and flop” which means three hot meals and a safe place to sleep

bullet         Involvement in battering or abusive relationships -- this is especially true for women and children

bullet         Legal problems involving the threat of arrest and incarceration

bullet         Financial problems leaving the person destitute

bullet         Alienation from family friends, and supportive social relationships

bullet         Involvement in an antisocial, violent, drug-dealing subculture or street culture

2.      Understanding the Spiritual Crisis of Addiction

The spiritual crisis of addiction involves the loss of meaning and purpose in a life. Addicts often believe that there is no higher power that can help them with the crisis.  They are alienated from the God of their understanding. In other words, most addicts who are experiencing a motivational crisis have consciously rejected the idea of God. They don’t believe that God can or will help them. 

Most addicted people look with skepticism upon anyone who demands that they embrace a religious approach in exchange for help in meeting their survival needs.  They will often comply and attend Church services and participate in religious rituals to get their survival needs met.  Privately, however, they often feel manipulated and exploited.  As a result, most will leave the program as soon as possible, usually to relapse.

3.      Meeting the Spiritual Needs of Addicts

A practical and effective approach to meeting the spiritual needs of addicts is summed up in a simple statement by Father Joseph Martin:  “Don’t give spiritual steak to spiritual infants.”

Don’t give spiritual steak to spiritual infants.
 -- Father Joseph Martin --

Father Martin is a Catholic priest who has dedicated his pastoral life to helping recovering people integrate spiritual principles into their recovery.  He strongly believes that the initial approach to an addict needs to be based in Christian love which seeks to give help with no expectation of a return.  This unconditional love is very different from the manipulative and abusive relationships that addicts are accustomed to.

Father Martin is convinced that most addicts come back to Alcoholics Anonymous because they experience this intangible thing called love at their first meeting and are drawn back to have that experience again.  Father Martin’s views are shared by many clergy who have devoted their lives to helping suffering addicts, their families, and their communities.

Father Martin also believes in directly meeting the current needs of addicts.  Again, this belief is exemplified in a simple statement:  “Although I strongly believe in the power of God, the Church, and Alcoholics Anonymous – if I get hit by a truck, please take me to a hospital emergency room, not to Church or an AA Meeting.” 

“Although I strongly believe in the power of God, the Church, and Alcoholics Anonymous – if I get hit by a truck, please take me to an emergency room, not to Church or an AA Meeting.
- Father Joseph Martin -

Practical Guidelines for Faith-based Addiction Programs

Let’s tie these ideas together into a practical approach that can be used by Faith-based recovery programs.

1.      Crisis Stabilization 

Faith-based programs need to be prepared to deal with addicts in crisis.  This means having strong working relationships with other community-based programs that can provide medical care, detoxification, psychiatric stabilization, housing, food, and clothing.  Remember that stabilization is a biopsychosocial process.  A person must recover from intoxication and withdrawal and be able to think clearly, manage feelings and emotions, and control behavior before they can be considered stable.

2.      Motivational Counseling

Faith-based programs need to involve addicts in a four-step motivational process: 

bullet         Identify and clarify the problems that caused them to seek help

bullet         Explore the relationship between each problems and their alcohol and drug use with the goal of helping the client see the correct cause and effect relationship between their alcohol and drug use, their problems, and their inability to solve their problems

bullet         Explore the immediate consequences of continuing to use alcohol and drugs with the goal of showing them that if they don’t make a commitment to stop using for at least a little while they will experience serious physical, psychological, and social problems

bullet         Get the client to make a short-term abstinence commitment and agree to participate in a structured program of activities.

3.      Focus On Powerlessness Over Alcohol & Drugs: 

Ask addicts to construct a life and addiction history.  This can be done by giving them a sheet of paper and dividing it into two columns.  In column one the client develops a life line by identifying the key events or major turning points in his or her life.  In column two the person describes their alcohol and drug use during that period of their life.  The are asked to reflect upon what they wanted alcohol and drugs to do for them, and whether or not they got what they wanted from alcohol or drug use.  The goal is to help the addict to see that whenever they put alcohol or drugs in their body, they do things that make their problems worse, not better.  This is captured in the AA culture with a simple idiom – “There is no problem so big and so complicated that it can’t be made worse by drinking and drugging.”

There is no problem so big and so complicated
that it can’t be made worse by drinking and drugging.

4.      Introduce the Spiritual Principle of Higher Power

Most addicts are spiritually bankrupt when they enter recovery.  In other words, they believe that there is no higher power that can help them.  They have lapsed into hopelessness.  They see no source of courage strength and hope that is available to them.  They often feel abandoned by God, angry at God, and have thoroughly rejected God as a source of help.  Therefore, to try and force them to accept God as their higher power at this point in recovery may not work.  In fact it may hurt by forcing the addict to comply with practices he or she doesn’t believe in, develop resentments, and then leave the program.

It is helpful, however, to gently introduce the concept of God in the form of an initial small step by asking this question: “Do you believe, that there might be someone who something who has the ability to help you.  Is there someone or something with more knowledge, skill, and strength who you could turn to for help.”  This opens the conversation to the topic of a higher power.

A higher power must, by definition, be someone or something that has knowledge, skills, and resources that you don’t have that can help you to recover.  A higher power does two things:  it provides immediate concrete help in times of crisis (I’m hungry so you give me a fish to eat.)  It provides a source of courage, strength, and hope based upon the belief that my immediate needs in the moment will always be met.  The higher power also makes available a set of principles and skills so the person can focus their courage, strength, and hope upon learning how to more effectively manage their life.  (We teach them how to fish, so they can eat without our help).

The minimum higher power is a person with more knowledge about recovery than you have who is willing to help you.  The next level of higher power is a group of such people working in harmony to help you stay sober and solve your problems.  The third level is a set if effective principles and practices that are used to  help people stay sober  he fourth and final level is a personal relationship with a spiritual higher power (the god of your understanding).

In the second step of AA they use the words “came to believe that a power greater than us can restore us to sanity.  This implies several things: 

bullet         First, that the addict is addictively insane and incapable of accessing internal resources to break out of their addiction. 

bullet         Second, that the addict currently does not believe that there is a power that can help them to recover. 

bullet         Third, the person is willing to “come to believe” that there is a source of courage strength and hope.

A number of simple spirituals exercises have been helpful in guiding people in the process of accepting the possibility that a Higher power or God exists, and that this Higher power is willing and able to help them.  Ask the addict this question:  “How would your life be different if you believed that there was a higher power that could help you?  What would you do differently right now if you did believe that a higher power would guide and support you?  What kind of a god would you be wiling to believe and trust in.  Let’s build a list of the characteristics of the kind of god that you believe would be willing and able to help you, and that you would be willing to accept help from.

It’s important to realize that God does not change, but our human understanding of God does change.  It is better for an addict to believe in some higher power that will help them sustain initial recovery and begin improving their life than to lapse into hopelessness, despair, and relapse.  Also, be aware that the addict will redefine their concept of God many times over the course of their life-long recovery. 

Addicts need to see that it’s possible that such a higher power exists. They need to focus their attention upon developing an image of that higher power which they find encouraging. Then they need to start searching for and trying to develop a relationship with that higher power.

I have helped many addicts to get started in their spiritual journey of recovery by asking them to tell me which is better:  to be hopeless and in despair because there is nothing and no one who can help you; or to believe that there is someone or something that can help you and to begin searching for it? 

At this stage addicts don’t have to believe in God. They just have to start believing that it's possible that God exists - that it's possible that God has the ability to help them.  And that God will be willing to provide the help.  This is what the phrase “came to believe” means.”

5.      Experiment With Turning It Over

Help the client to put all of the things in their lives into one of two categories: 

bullet         The things they have power over and 

bullet         The things that they don’t

We all have the power to learn how to manage our thoughts, feelings, and behaviors.  We also have the power to work in a rational and systematic way to solve problems and to develop effective and loving relationships with others. 

We don’t have the power to control people, places, things, or events.  We have to focus our energies upon doing things that are within our power, and then turning over everything with faith believing that all will be as it should, and knowing that we couldn’t do anything about it anyway.  This process allows the addict to focus energy and start having small success experience. 

This is a simple interpretation of the twelve step principle embodied in Step 3 – We made a decision to turn our will and our life over to the care of God.

6.      Prioritize Immediate Problems

Addicts need to prioritize their problems and focus on one problem at a time.  They have so many problems that it is easy for them to become overwhelmed.  You can help addicted people to clarify and prioritize their problems by pointing out that at this point in recovery they only have two problems:  not putting alcohol and drugs in their body (i.e. staying sober) and everything else. 

Then ask clients to describe the problems they are facing and ask them – Do you need to solve this problem right now in order to stay sober today?  If the answer is no, it goes into the pile labeled “Everything else.”  If the answer is yes, it goes into the pile labeled “Not Drinking and Drugging”. 

Once again, this exercise helps addicts to “turn over” problems that don’t need to be solved right now and to focus their energies on the immediate problems that will help them stay away from one drink and one drug, one ay at a time.

7.      Identify and Manage High Risk Situations

Ask the addict to identify any situation they are facing in the near future that could make them want to drink and use drugs.  Have them describe what they think will happen in detail.  Then ask a series of questions:  Is there any way you can responsibly avoid this situation?  What can you do differently if you get into the situation to get through it without drinking or drugging?  If you do drink or drug, what can you do to get back into recovery as quickly as possible.

8.      Take A Moral Inventory

A moral inventory is a systematic self-examination of strengths and weaknesses of my character.  A moral inventory does not deal with the problems outside of you.  It deals with the type of person you are on the inside that shapes your response to those problems.

To be effective a moral inventory must be done from a position of humility.  Humble people know who they are in both their strengths and their weaknesses.  They see what is wrong with their character and are willing to work toward improvement.  They also see what is right with their character.  They know their strengths and become willing to act on them.

A moral inventory is done more than once.  It is repeated many times in the course of recovery.  Therefore, it’s usually more effective to start with a simple moral inventory, so the client can have a success experience that will motivate them to take another inventory latter..

One way to do that is to divide a sheet of paper into two columns.  In column 1 list all of your strengths and in column 2 list all of weaknesses or faults.  Most addicts find very little to write in column one.  They are out of touch with their strengths.  Most have a very long list in column two.  They are very aware of their weaknesses and often exaggerate them.  Most addicts beat themselves to death with their weaknesses and use this as an excuse to drink and drug.  Because they are not aware of their strengths, they don’t know how to channel use their  strengths to stay sober.

Another basic exercise is to ask addicts to define four words:  good, bad, right, and wrong.  Addicts usually give vague and fuzzy definitions. How can anyone do a moral inventory if they are not clear about what is good and bad or what is right or wrong?  It’s important to help addicts see that that what is good and right always results in life, health, vitality, truth, fairness, justice, and freedom.  What is wrong or bad always results in death, illness, lethargy, deception, unfairness, injustice, and slavery.

Once a person has several success experiences with basic and simple moral inventories, they are ready to begin examining their character using other spiritual tools such as the ten commandments, the seven cardinal sins, a list primary virtues, etc.  The important thing is to help addicts to find some objective list of characteristics that work toward the good and can act as a standard against which to judge their behavior.  The purpose is to develop the ability to recognize when thoughts and behaviors start leading away from the good and toward the bad, to catch this shift early and to make changes.  The overall process develops the character.

9.      Teach Self Monitoring

AA calls self-monitoring a daily inventory.  I recommend that recovering people do two inventories a day:  a morning planning inventory and an evening review inventory.  The morning inventory involves a brief spiritual reading (there are many spiritual and recovery oriented daily meditation books available from Hazelden).  This reading sets a spiritual focus for the day.  The next step is to create a To Do List for the day and to transfer the activities onto a daily schedule.  The third step is to identify any high risk situations they might encounter that day that could cause them to use alcohol or other drugs.

The evening inventory involves reviewing what happened during the day and talking about it with someone who is supportive of recovery.

10.    Teach Relaxation, Meditation, & Prayer

Relaxation training teaches people how to consciously relax their bodies and detach from the constant flow of mental self-talk.  In a relaxed state meditation become possible. 

Mediation is the process of reflecting upon yourself as a spiritual being and the your relationship with the God of your understanding.  Once in a meditative state, prayer becomes possible. 

Prayer is the process of putting oneself into an active dialogue with the God of your understanding.  It involves dialogue – mentally reviewing important issues in your life and asking God to open you mind and heart and to help you see how they should be handled. 

Prayer is also becoming still and learning how to listen to the answers.  This means developing an inner awareness of our thoughts, memories, fantasies, and feelings.  It also means establishing a non-controlling awareness of what is going on around us.

Things Faith-based Recovery Programs Should Avoid

Now that we’ve discussed some features of a best-practice model for faith-based recovery programs, I want to discuss a number of things that experience has shown to be ineffective when ministering to addicted people.

1.      Don’t Use Poorly Trained People to Staff Your Program

There is definitely a role for volunteers in faith-based recovery programs.  Addicts, however, are seriously ill and are very difficult to manage.  This is why it’s best to have the program supervised by properly trained and credentialed addiction professionals.  The best ministerial and pastoral counseling skills, of and by themselves, usually prove inadequate when dealing with recovering addicts.  Specialty knowledge and skills are required.

2.      Conform With Building Codes & Facility Standards 

If you are going to treat addicts, do it right.  Make sure your facility meets building codes and proper requirements for residential or outpatient programs.  These codes and standards were developed to assure a physically safe environment.  If they are not followed everyone in the facility is put at risk.

3.      Don’t Explain Addiction As A Moral Problem

Addicts are not bad people who need to become good.  They are sick people who need to get well.

Addiction isn’t a moral problem.  It’s a complex biopsychosocial illness that destroys a person’s spiritual connection with self, other people, and the God of their understanding.  In AA terms it is a disease of body, mind, and spirit.

Addicted people don’t need to repent their addiction.  They need to recover from it.  Addicts may need to repent some of the things they did as a result of being addicted, but the symptoms of addiction are not sins, they are symptoms of a biopsychosocial illness.

4.      Don’t Expect Miracle Cures

Although miraculous cures for addiction have occurred, they don’t happen often.  Spiritual healing such a laying on of hands may help addicts to get into relationship with God and help them connect with a source of courage, strength, and hope.  Many people do claim that spiritual healing works with addicts.  I’ve seen many televised spiritual healing ceremonies that result in hundreds of people saying they were miraculously cured of addiction.  Those who stay in recovery, however, are those who follow through with a program of spiritual discipline that examines the person’s relationship with alcohol and drugs, strengthens their decision not to use alcohol or drugs, and reorganized their lives around a new set of core values. 

AA tells us that conversion experiences can be one of two varieties: 

bullet         dramatic experiences of change followed up by disciplined regular recovery activities; and 

bullet         the disciplined involvement in recovery activities that gradually brings about a new sense of spiritual awareness. 

Both are valid.  Both, however, require a life-long program of recovery activities and spiritual practices.  There are no quick fixes and few miraculous cures when it comes to addiction.

AA has a slogan supporting this position:  "Pray for potatoes, but be willing to pick up the hoe!"

5.      Don’t Confuse Recovery Activities & Spiritual Activities

It is important to make a clear distinction between recovery activities directed at identifying and managing the symptoms of addiction, and spiritual activities designed to establish a conscious contact with the God of you understanding and to improve character.  There is no doubt that these two activities overlap.  But distinctions should be made whenever possible.  Otherwise you run the risk of a person dropping the spiritual program because they reject the recovery activities, or dropping the recovery program because they reject the spiritual activities.

6.      Don’t Push Spirituality Or Religion

People respond best to spiritual approaches in recovery when they are not coerced or manipulated.  To give food to a hungry addict only if he or she agrees to sit through a Church service first is coercion.  They may comply in order to get fed, but I doubt they will open themselves up for a spiritual experience.  The primary goal should be to allow addicts to experience spirituality through the loving, caring, and honest interactions with the people working in the program.

A Final Word

Encouraging the development of Faith-based Recovery Programs can be an important part of making services more available to addicted people and their families.  To succeed, faith-based recovery programs need to recognize that addiction is a complex biopsychosocial illness that impairs spiritual well-being.  Spiritual approaches, in isolation from proven addiction treatment methods, are usually insufficient to produce and sustained recovery.  When spiritual programs are designed to work hand-in-hand with proven methods of addiction treatment, overall program effectiveness can increase.

If you’re going to provide a faith-based recovery program – it’s important to do it right. The program of Alcoholics Anonymous teaches us an important principle: “Half measures availed us nothing – we stood at a turning point.”

In many ways, this great nation is beginning to hit bottom on its failed attempt to manage the nation’s addiction problem through criminalization and a drug war. In a very real sense we are standing at a turning point. The President’s focus on Faith-based Initiatives can become a powerful part of the solution – but only if we insist that faith-based initiatives support and enhance a science-based understanding of addiction. It is only by harnessing the power of faith in combination with the power of medical science that we can offer addicted people and their families the best possible chance of recovery.

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