Addiction and Pastoral Care

Nicholas Roberts

• Publisher: Canterbury Press
• Year: 2014
• Print ISBN: 9781848259744
• eBook ISBN: 9781848259768
• Topic: Theology & Religion
• Subtopic: Christian Ministry

Addiction can take many forms and there can hardly be a minister, or a prison, college or schools' chaplain who will not have encountered its damaging effects on individuals, their families and local communities. This handbook, from an experienced pastoral practitioner, aids those on the front line of caring for addicts and their families.

1. What is Addiction? The World of Drugs and Alcohol

Drugs are rarely out of the news. Apart from TV and newspaper accounts of things like binge drinking in relation to alcohol, we know that there is much misuse of both prescription and non-prescription drugs in our society today. We are familiar with names like cannabis, heroin or crack cocaine, which have been around for many years. Their procurement, or obtaining the money needed for this, is likely to involve crime, which is often violent. It is likely that the majority of people currently in prison for violent behaviour have been involved in the production and distribution of illicit drugs. New drugs come on to the market with increasing frequency, sometimes referred to (no doubt inaccurately) as ‘legal highs’, or party drugs: these are definitely not safe substances that can be used without the possibility of harm to the user. Recently the use of ‘spice’ has become problematic: in Manchester some people have been reduced, at least temporarily, to what has been described as a ‘zombie-like state’. Others have been paralysed, and this dangerous substance can cause serious cardiac and psychological problems. There has been violence and disruption through its use, particularly in prisons.

In response to the growing availability and use of these ‘legal highs’ the UK government introduced the Psychoactive Substances Act in 2016, but this has been challenged in the courts and its effectiveness is under scrutiny at the time of writing. Young people especially seem to be unaware of the serious long-term health risks of these substances which are readily available in pubs and nightclubs. Use of these substances is widespread in prisons where, as we have seen on the news, drones can be used to get them into the cells.

It was estimated in 20171 that in excess of 200,000 people worldwide are dying each year as a result of drug overdose and other related conditions such as HIV. In the USA, to give one example, 91 people per day die from opioid overdoses. On alcohol statistics, 3.3 million people worldwide die from alcohol-related conditions every year. And recent UK statistics tell us that in general 15 per cent of attendances at hospital casualty departments are directly linked to excessive alcohol consumption, a figure that rises to 70 per cent at weekends. This is by any standards alarming reading, particularly as we recognize the strain that A&E departments experience on their resources. And this is one good reason for looking at the situation and its causes, and thinking about what kind of help people should be getting to conquer their addictions, including the pastoral care offered by Christian ministers both in parishes and in other places where they work, including prisons.

As pastors it is likely that we will have met people who are using drugs, or know of family members who are at risk. We need to think how we might respond to their situation, particularly when an individual can be described as addicted to a substance such as heroin.

The first thing we need to do is learn something about the drug scene, and also about how to distinguish what might be considered normal use of alcohol, for example, from dependent or addictive use of alcohol, and a variety of other substances.

So in order to think in a systematic way about addiction in general, and particularly when it takes the form of dependence on such substances as alcohol, heroin or cocaine, we need to know how to define what we mean by addiction. Most of us know people who drink alcohol on a regular basis, but it would be odd to suggest that all use of alcohol is necessarily problematic. Some healthcare psychologists deny that addiction exists at all, although they represent one end of a spectrum of thinking on the subject, and many would disagree. But the widely held view is that some people do become addicted either to substances (such as alcohol) or activities (such as gambling), and that such addictions are best thought of as symptoms of a disease that in many cases will require some form of clinical treatment.

So what distinguishes normal enjoyment of such things from what may be regarded as pathological behaviour? A simple definition of addiction is offered by Professor Robert West of London University: addiction ‘is a syndrome in which a reward seeking behaviour has become out of control’.2

The American Psychiatric Association’s Diagnostic manual (DSM-V, 2013) and the World Health Organization’s International Classification of Diseases (1992) are useful in this context, both focusing on an excessive desire for the consumption of a variety of drugs and difficulties in giving up their use. In particular they recognize the diagnostic importance of tolerance – the need for constantly increasing amounts of the drug to achieve the same effect, and withdrawal symptoms when the drug is not available, or the use of the drug to relieve the symptoms that occur when the effect of the drug has worn off (the ‘morning after’ drink for the alcoholic, for example).

It is not easy to be precise about when a substance user has become substance dependent. In the UK, various governments have tried to provide guidelines about the number of units of alcohol that an individual can safely drink on a weekly basis.3 These numbers are revised, usually downwards, from time to time. A 70 cl bottle of whisky contains around 28 units of alcohol, and a 70 cl bottle of table wine usually somewhere between 9 and 12 units. People who frequently exceed these weekly amounts are at risk of addiction, and anyone regularly consuming a bottle of whisky or more on a daily basis, or its equivalent, is almost certainly an alcoholic. With illicit drugs the tolerance and withdrawal factors can be used as a gauge to calculate the degree of dependency on a case-by-case basis.

Looking at the reasons why people become addicted to alcohol and/or drugs, a number of factors need to be considered. From a scientific perspective, it is becoming widely accepted that there is a genetic element in addiction, and well-regarded biological studies in alcohol dependency in particular have shown that certain genetic profiles play a significant part in the development of an addiction. That must not be taken to mean that genes ‘cause’ addiction in a direct way, but they can predispose an individual to become substance dependent if the circumstances of his life provide further impetus in that direction. So we can talk realistically about an inherited vulnerability to substance dependency that affects some people.

Other factors may well contribute towards substance dependency. First, there is the mysterious and sometimes baffling nature of addiction. There is no universal reason why people become addicted, although it is easy – if usually unhelpful – to attribute its origins to weakness of the will or sinfulness. There may be as many reasons for addiction as there are addicted people – a view that does not make the pastoral task any easier, but is at least realistic. Those who have worked with addicted individuals will perhaps recognize this feeling of bafflement about the situation. It can be very hard to understand why someone becomes substance dependent when the circumstances of his life seem, superficially at least, to be positive and rewarding; or why after successful treatment for the addiction the individual reverts to substance-dependent living, which unfortunately occurs in many cases.

There are widely recognized pathways, however. One is the ‘chasing the dragon’ factor, the desire for the buzz that can come from the use of alcohol and other drugs such as heroin or ecstasy. Some writers have drawn a comparison between this and the excitement of sexual activity. The use of amphetamines (speed) first became well known in the UK in the 1960s, when this form of drug use started to be recognized in the news media, and the term ‘purple hearts’, a combination of amphetamine and barbiturate, often associated with young people in the entertainment industry, became familiar.

Second, in some social groups (perhaps particularly among young people) there can be peer pressure to engage in drug use, which can easily get out of control. There is here a ‘mimetic’ element, when people adopt the lifestyle of a particular social group without perhaps taking account of their own genuine personal wishes and needs. We should also take into account the availability, affordability and social acceptability of some substance use, particularly alcohol.

Third, people use drugs to try to combat negative or painful psychological experiences, such as depression or anxiety. These may, of course, be symptomatic of a possibly serious or long-term mental disturbance that could be better treated by proper clinical intervention; non-prescription drugs may well make the situation worse. Addiction can also be triggered by a difficult period in a person’s life, perhaps involving one or more major life-changing events – such as excessive stress, the loss of a job, the breakdown of a significant relationship, the loss of one’s home, or a bereavement. In the giving of good pastoral care it is essential to look for all potentially contributing factors.

All these factors may well play a part in the aetiology of an addictive episode or lifestyle, but pastors should be more concerned with the individual. There are many possible reasons for someone’s addicted behaviour, and we may only discover these as we get to know the person better in our pastoral engagement with him or her and others who are involved, such as the immediate family.

The world of drugs and alcohol

In Erica James’ novel The Holiday, addiction to drugs and alcohol plays a central role in the character of Mark. This is how she describes his descent into dependency on these two deceptive ‘friends’:

By his mid-twenties he had been drinking with a determined vengeance that had nothing to do with social drinking. It was warfare. A war against himself. It wasn’t the taste he craved, it was the obliterating effect he needed: the desire to drink was as strong as the desire to eat, if not stronger. Seeking refuge in sleep – and a sleep in which he wasn’t jerked awake by nightmares – he would fill himself with beer and whisky chasers until he collapsed on the bed and slept comatose for at least half the night.

Drugs came later, when desperation kicked in.

He had thought Kim was having an affair, but instead of confronting her, he put more energy into his drinking, until eventually, knowing he couldn’t go on as he was, he turned to cocaine: It would slow him down and take the pressure off, he thought. But it didn’t. In no time at all, he was addicted, not so much to the drug, but to the person he became when he was high. Without that buzz, he was nothing. A nobody. He got to the point where he couldn’t get out of bed, or go to the local shop for a loaf of bread, unless his confidence had been fuelled by a line or two. What little sense of value he had soon went, as did his money.

Many people use alcohol on social occasions – an evening at the pub with friends, for example, or a couple of glasses of wine with a meal. This is not, generally speaking, symptomatic of a dangerous addiction. And most of us use drugs, regularly or occasionally. For someone with Type 1 diabetes, a regular supply of insulin is vital to health. A headache can usually be brought under control quite quickly with paracetamol. Even the caffeine in our breakfast coffee and tea is a drug.

We would not be worried about people taking necessary maintenance doses of insulin, or an occasional analgesic to deal with a relatively brief interlude of pain (equally, we might be wise to recognize such pain as a possible physiological response to overwork or excessive stress). Many of us use other substances such as vitamin supplements, which are freely available in pharmacies and even in newsagents. All these substances can be obtained either by prescription or ‘over the counter’. But even with prescription drugs there is the possibility of addiction, particularly with regard to generic opioids and drugs like fentanyl, both of which are currently used in the symptom relief of some cancers and heart attack. These drugs are psychoactive, so their effect is psychological as well as physiological; this is what causes them, for some people, to become addictive, particularly because of the tolerance factor.

Alcohol can be easily obtained in most countries, at least if you are over 18 years old in the UK, and 21 in the USA. If I walk to my corner shop or visit a supermarket I can buy enough alco...

Table of contents

• Copyright information
• Contents
• Acknowledgements
• Introduction: The Need for this Book on Addiction and Pastoral Care
• 1. What is Addiction? The World of Drugs and Alcohol
• 2. Religion and Addiction: Religious Writing about Addiction from Gerald May Onwards
• 3. The Theological Understanding of Desire
• 4. The Pastoral Care of People with Addictions
• Concluding Reflections
• Community Resources for Working with Addicted People
• Bibliography