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
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
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:
Role of Faith-based Programs In Addiction Recovery
Principles of Effective Faith-based Treatment
Practical Guidelines for Faith-based Addiction Programs
Faith-based Recovery Programs Should Avoid
The Role of Faith-based
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
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.
alcohol and other drugs is primarily a public health problem that requires
comprehensive biopsychosocial treatment supported by community-based
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
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.
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.
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.
crisis may be directly caused by substance use. This includes overdose,
intoxication, withdrawal, and drug-induced medical problems.
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.’
crisis most frequently involves:
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
Involvement in battering or abusive relationships -- this is especially
true for women and children
Legal problems involving the threat of arrest and incarceration
Financial problems leaving the person destitute
Alienation from family friends, and supportive social relationships
Involvement in an antisocial, violent, drug-dealing subculture or street
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
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
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.
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.
Faith-based programs need to involve
addicts in a four-step motivational process:
Identify and clarify the problems that caused them to seek help
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
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
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:
First, that the addict is addictively insane and incapable of accessing
internal resources to break out of their addiction.
Second, that the addict currently does not believe that there is a power
that can help them to recover.
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
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:
The things they have power over and
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.
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
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
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
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
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
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
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
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
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:
dramatic experiences of change followed up by disciplined regular recovery
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.
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