Alcohol dependency: pastor as addiction counselor

The first of this two-part series, “Alcohol Dependency: What Pastors Should Know” (March 2007), dealt with the statistics of alcohol abuse in order to provide statistically sound arguments for abstinence. Part two provides guidance for the pastor who has assumed, willingly or unwillingly, the role of addiction counselor.

Addiction counseling is not pleasant. Often struggling to find enough time to prepare the weekly sermon, visit the members who are hospitalized, provide pre marriage (and emergency marital) counseling, and so forth—the pastor finds it difficult to achieve competency in the fi eld of addiction counseling as well. Still, a lot can be done.

Diagnosis

To avoid giving wrong advice at the wrong time, pastors counseling those with addiction problems should start with a diagnosis. Which of the following categories best fi ts the observed pattern of alcohol (or drug) use?

1. Social use: Alcohol used infrequently, in small amounts, on special occasions, and not used to alter mood or performance.

2. Problematic use: Alcohol use limited to one or two occasions where—because of inexperience, ignorance, or testing the limits— overuse occurred and led to problems ranging from a hangover to a severe car accident. Yet the user learned from this experience, and, subsequently, a re-occurrence has not happened.

3. Dependent use: Continuing alcohol (or drug) use associated with negative consequences, such as loss of the ability to predict when drinking will occur, how much will be consumed, or what will happen thereafter. Frequently the dependent user will set rules for use but will be unable to follow those rules. Such users are often preoccupied with obtaining alcohol, using it, or recovering from its effects—all to the detriment of relationships, health, role fulfillment, spirituality, etc.

This assessment might sound relatively straightforward, but it is defi nitely diffi cult in practice. These nicely segregated categories are really broader “way stations” on what can be a continuous downward spiral. In addition, concerned family members often will minimize the magnitude and the consequences of the dependency. The parishioner who seeks help (or who has been sent for help by family and/or friends) will often hide evidence of alcohol use, lie about it, or invent a socially acceptable reason for the symptoms of dependency. These reasons can take a myriad of forms, such as blaming overwork for their lack of mental alertness, stress for their irritability, depression, or the other driver’s poor driving skills when a car accident occurs. Alcohol dependency cannot be classed as an extraneous habit grafted onto otherwise successful coping skills; it is a lifestyle. Thus, the lines between the above categories are often blurred.

The pastor should be aware that the diagnostic process is a difficult undertaking that can be uncomfortable to implement. This may be simply the result of inexperience, though not always, because the very nature of the problem all but guarantees that it will be emotionally challenging. The pastor must recognize the diffi culty in attempting to help solve an embarrassing problem whose existence may not yet have been acknowledged.

Outside help

Faced with these impediments to the first step toward diagnosis, what should the pastor do? Experience helps, and so will time. Observing the behavior of a parishioner and their interaction with friends and family over a period of a few weeks will often enable a pastor to ascertain the degree of dependence and thus make an informed diagnosis.

An acceptable alternative is available. The pastor may refer to a trusted professional any parishioner about whom the question of problematic use has been raised. This approach, however, is not without problems. Likely the parishioner will feel passed off onto someone they neither know nor trust. In addition, it will still require considerable decision making on the part of the pastor. Historically, many physicians believed that alcoholism was not a medical problem to be treated by physicians but rather a spiritual or moral problem to be treated by churches or social workers. As a result, beginning in 1935, alcoholics began a self-help approach that grew into a worldwide, remarkably effective solution—Alcoholics Anonymous (AA).

Let us assume that you, the pastor, have become sufficiently conversant with the fi eld of addiction counseling to realize that your parishioner experiences negative consequences from alcohol. The next step? Get AA involved. For that, you need to get involved with AA by attending an AA meeting so that you become familiar with the principles of the organization.

At the medical school where I teach, every medical student is required to attend at least one AA meeting. The students, almost without exception, have found this a positive, instructive, and eye-opening experience. Invariably they are surprised by the clientele attending, which can range from the well-dressed professional to the homemaker, and from the blue-collar worker to the homeless.

Before going, call your regional AA office and inform them that, as a pastor, you want to learn how to better help parishioners with drinking problems and want to come to a meeting (AA meetings are also open to nonalcoholics). Take an elder or deacon or another friend and spend some time listening and asking questions during the break and at the end of the meeting. Develop a relationship with a contact person from the regional office to whom you can address questions. Have AA brochures and meeting directories at your desk to share as the occasion arises.

Getting them in

Now comes the tricky part. How do you encourage a parishioner to take advantage of the local AA? One effective way to get over this hurdle is by creative misdirection. Do not try to convince them that they have a drinking problem, but encourage the already existing ambivalence on their part. “You may be right that you do not drink too much. Before you draw any fi rm conclusions, however, one way to help you decide is to attend several AA meetings and listen to the experience of others who have debated this same question.” If they agree and go, arrange to get back in touch with your parishioner after they have attended several AA meetings.

AA groups have no criteria for membership other than “a desire to stop drinking.” There are no dues, no fees, no requirement for when one’s last drink occurred, no specifically religious thinking or denominational affiliation. Meetings occur in the mornings before work, at noon, and in the evening. No good reason exists for someone not to attend. The principles have a spiritual base and, rightly understood, do not conflict with the Bible or religious belief in general.

The “Big Book” of AA (so called because originally it was printed on over-sized paper) and the Twelve Steps and Twelve Traditions are easy to read. They contain concepts that would benefit all, pastors included, if intentionally and consistently lived out.

Those abusing drugs have a similar resource called Narcotics Anonymous (NA). To get acquainted with the help that this group can provide, the process remains the same as with AA. In addition, it is of the utmost importance to involve the family members and concerned friends.

The severity with which a problem of dependency affects the family parallels the severity of the problem in the user. No matter how educated or capable the family members might be, they will still be emotionally traumatized. They may feel even more trapped and discouraged than the user because, unlike the user, they are powerless to address the dependence directly.

Professional organizations that physicians may join are available if they are interested in working with alcohol and drug issues. The Web sites of these organizations are listed on page 21. These groups have a certification and testing process for their physician members that confirms that those members have achieved competence in the field of addiction counseling. They are a good resource for pastors because they will enable them to know the range of treatment program options and to identify qualified counselors practicing in the local area. Contacting such organizations and developing a working relationship with one or two of them can be helpful for you, the pastor.

Different tactics

Most physicians who work in this field will be sensitive to the spiritual issues of patients. In your pastoral role, your responsibility includes the identification of local physicians who best address this aspect of wholeness. If you refer an individual to a physician, you should make sure that the counselors you choose are spiritually sensitive.

How you interact with the problem of alcohol dependence is ultimately driven by how you view it. If you believe that people use alcohol because they are ignorant and inexperienced, you will obviously spare no effort to educate them. Knowledge is useful, but something more than knowledge will be needed by most of your alcohol-dependent parishioners.

If you believe that people use alcohol because they are not spiritual enough, you will encourage them to pray and read the Bible more. There is no question that a deeper and more meaningful spiritual life helps in overcoming alcohol dependence. But being motivated does not equal knowing how to address the dependence, nor will increasing spirituality provide all of the necessary coping skills.

If you believe that drug abuse occurs in response to stress, you will advise your parishioner to search for ways to lessen stress. While lessening stress is often helpful, most of the time the problem is how your parishioner deals with stress and not the stress itself.

We have been given wise counsel on how to think about this issue. “Among the victims of intemperance are men of all classes and all professions. Men of high station, of eminent talents, of great attainments, have yielded to the indulgence of appetite until they are helpless to resist temptation. Some of them who were once in the possession of wealth are without home, without friends, in suffering, misery, disease, and degradation. They have lost their self-control. Unless a helping hand is held out to them, they will sink lower and lower. With these self-indulgence is not only a moral sin, but a physical disease.”*

Substance dependence cannot be categorized as a disease with a quick fix. Addiction counseling requires patience—and a lot of it. Recovery from dependence upon the initial drug of choice takes a long time and much effort on the part of both pastor and parishioner. Unfortunately, persons who succumb to one addiction will, later, quite likely succumb to another. Thus, with alcohol dependence under control, the addict will, all too often, replace the alcohol with addictive tranquilizers or pain pills or start binging on food. Once the secondary addiction comes under control, then gambling or sexual compulsivity may manifest itself. If substance abuse generally is overcome, the addictive person may become overly controlling, excessively religious, or better yet—and more socially acceptable—a workaholic. Regardless of the “drug” of choice, all forms of dependence lead inexorably to impaired emotional and relational health and to soul-destroying guilt.

If you, the pastor, fi nd yourself overwhelmed, take it as a warning sign that you are tackling a problem too large for you alone with your present skills. This should be your signal to build a support team and a referral system. The resources listed below will help you accomplish this. As a pastor, sooner or later you will have to deal with the problem. We hope this article helps as you prepare for this part of your ministry.