Responding to alcohol and drug abuse

How the pastor may respond to substance abuse

Vergel L. Lattimore, Ph. D., is a professor of pastoral care and director of alcoholism and drug-abuse ministry, Methodist Theological School, Delaware, Ohio.

Working on his sermon, Pastor Paul heard a knock on his office door. There was Ann, a 34-year-old part-time public librarian. Right away, the pastor noticed that Ann was not her usual energetic and pleasant self.

"I've been away from church for the last two weeks," Ann said as she seated herself. "Pastor, I think I'm losing my faith." Tears swelled in her eyes. "I'm beginning to have some doubts about my marriage. The company has been sold, and Samuel's position is slated for termination. His drinking has in creased, and he gets bothered by minor irritations."

Such scenes occur many times in a pastor's line of duty, even in those religious traditions that prohibit alcohol use. The Institute for Public Health has identified substance abuse as the nation's number-one health problem. 1 Twenty-three percent of Americans report that drinking has caused problems in their families. 2 Alcohol and other drugs are a factor in 36 percent of suicides, 44 percent of spousal abuse, 50 percent of traffic fatalities, 17 to 53 percent of falls, and 38 percent of drownings. 3 Yet most pastors have only a limited knowledge of how to respond effectively to the crying needs of substance-abuse victims in their congregations. Let me suggest four key principles a pastor can use.

Evaluate before acting

When a person in trouble comes to you, you want to know: Why is this person seeking me out? And why now? Before rushing to save, listen! Listening does not mean that you should "play psychiatrist." But it does mean that you need to sort out what the person is trying to say verbally, physically, and emotionally. Does Ann communicate fear? Does her physical appearance seem characteristic of a person experiencing depression? Does she talk about her sense of loss in a detached manner? What is her tentative solution to her problem, and does it make sense? Is her communication "coded" something she can't say out loud but hopes you'll understand?

Before you effectively respond, quiet your heart, saddle your anxiety, open your mind, and engage your ears.

Clarify expectations

This may seem too simple to need saying. Isn't it obvious that Ann has come because she wants the pastor's intervention?

Not necessarily. Perhaps Ann wants simply to report what is happening in her family. She may be seeking moral support to implement a difficult decision. Perhaps she needs information. Perhaps she wants to find out how she may have contributed to the family problem. Ann may be hoping that the pastor can persuade her husband to change his behavior. She may want the intervention of the pastor, selected friends, or family members to let her husband know firmly but supportively the exact nature of the negative impact substance abusers have on the behavior of others.4

That's why Pastor Paul should identify what Ann is seeking before volunteering to help. He should raise questions that clarify what Ann hopes to accomplish. Concreteness and clarity go a long way in dealing with substance abuse.

Recognize limitations

Recognize your own level of competency and identify the problems that you are able to address. Historically, seminary and Bible-school curricula have not addressed the matter of alcohol and drug problems. Some have assumed that because the denomination has officially disallowed alcohol and drug use, the pastor has no need to know about them.

I am not suggesting that every pastor needs to be an addiction, treatment specialist, but I do believe that every pastor should have some basic skills to screen for alcohol and other drug addiction.

First, distinguish between sub stance use, abuse, and dependence. Although you may have strong convictions against alcohol or drug use, and although the potential for addiction is always present (and often unavoidable with narcotic substances), not every occasional user is an addict, not every casual drinker an alcoholic. Abuse is repetitive, excessive use of a drug or controlled substance. If a person fails to fulfill major work, school, or home obligations and continues to use a substance despite persistent legal, social, or interpersonal problems, abuse of the substance may be indicated.5

Substance dependence generally involves physical as well as psychological dependency. Substance-dependent persons develop tolerance (the need to in crease the amounts of the substance in order to achieve a desired effect). They show the effects of withdrawal if they don't get the substance. They make many unsuccessful attempts to decrease or discontinue use, while spending much time trying to acquire, use, or re cover from the effects of the substance that they are attempting to discontinue. They may also alter social, occupational, or recreational activities. 6

Intervene appropriately

Beyond basic screening, it is listening ability that is most vital when talking to a person who has come for counseling about an addiction issue.

Sometimes pastors go far beyond evaluation. As a pastor, you should have a good sense of what you are willing to do and what you are capable of doing. While one of the difficulties of helping people with addictions is trying to as certain the extent of the problem, the difficulty at the other end of the spectrum is that you can easily become pulled into doing far too much helping. Stories abound of pastors being called upon repeatedly, sometimes at all times of day or night, to intervene in situations in which they are, in fact, of minimal assistance when it comes to effecting meaningful change. Pastors who tend to feed on crises and the satisfaction of being desperately needed will respond and may not know when to end their response.

 

Beyond a certain level of intervention, your assistance may actually be counterproductive. Some addicted individuals will gladly promise you anything in order to get your tacit participation in their addicted world. The rides, cash, meals, and counseling you give simply help the addict stay addicted. At some point a pastor must say, "I will help you get a referral to a professional who can help you. But if you won't take the referral, if you don't begin to do what needs to be done to break this life pattern, I can't be of any further help to you either."

 

Knowing the referral process

Most pastors are generalists by training and experience, and this limits the pastor's ability to help deeply troubled people. Pastors should be able to recognize when and whether they can assist an addict at the critical points of need.

Some pastors get jealous about passing on their clients. They may feel they're abandoning a person. Perhaps being a helper to a chronically needy person feeds the pastor's ego. A referral is not an act of defeat but an act of love. A referral says, "There are other people with gifts, training, and resources who can help you. Let me introduce you to them!"

Referring pastors may weaken their argument for treatment by not being knowledgeable about what is available. Do enough research to be able to tell your parishioner about an agency's philosophy, values, procedures, location, fee arrangements, and hours of operation. Develop a file of referral professionals.

Referral for addiction counseling does not mean that you terminate your relationship with the individual. Most treatment centers and professionals affirm the importance of religious values and spiritual issues in the treatment process. Schedule a transitional visit or two in order to allow people to process the changing relationship.

Pastoral care and counseling with persons who are struggling with alcohol abuse and other chemical use can be extremely complex and challenging. Effective helping involves hearing with clarity, some ability to help technically and spiritually, and knowing how to set limits.

1 Institute for Health Policy, Substance
Abuse: The Nation's Number One Health

Problem: Key Indicators for Policy (Rockville,
Md.: Robert Wood lohnson Foundation,
1993).

2 G. Galhrp, G. and R Newport,
"Drinking in America," The Gallup Poll
Monthly
, (December 1990).

3 National Institute on Alcohol Abuse
and Alcoholism, Seventh Special Report on
the U.S. Congress on Alcohol and Health
(Rockville, Md: United States Department
of Health and Human Services, 1990).

4 An intervention should only be done
with the supervision of a trained
professional who can help the group
prepare the person's entry into treatment
or alternatives, should the person resist
offers of assistance.

5 American Psychiatric Association,
Diagnostic and Statistical Manual of Mental
Disorders
, fourth edition (Washington,
D.C.: 1994), 181.

6 Ibid., 182, 183.

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Vergel L. Lattimore, Ph. D., is a professor of pastoral care and director of alcoholism and drug-abuse ministry, Methodist Theological School, Delaware, Ohio.

May 1999

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