Addiction
“How to Respond to Addictions”
Chris Sumey MD, member of St. Paul, Denver, CO (†CLC)
Introductory thought: How often do you hear statements like, “I’m addicted to chocolate,” or “He’s such a workaholic”? Comments like these are playful, but when someone develops a true addiction to drugs or alcohol, the results can be devastating. What is addiction… and is it a sin? One can be addicted to all sorts of substances (alcohol, cocaine, tobacco, etc.) or behaviors (gambling, pornography, and so on). This article will focus primarily on the former. First of all, we need to define some terms, since the word addiction is too loaded and vague. Clinically we use the words dependence and abuse. v
Abuse is a dependence
Dependence is defined as the presence of three or more of the following**: a) Tolerance: Developing a tolerance to the substance and/or behavior such that more and more is needed for the same effect b) Withdrawal: Absence of the substance/behavior leads to physical or psychological withdrawal c) Overuse: Using larger amounts than intended d) Desire to cut back e) Time: A great deal of time is used in pursuit of the substance/behavior f) Activities are given up due to the habit g) Persistent use despite knowing the negative effects **American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC. v
Abuse is a dependence that also has clear interference in the individual’s personal life. Examples include getting into legal problems or hazardous situations, failure to fulfill obligations at work/school/home, and relationship troubles with family and friends. Virtually all substances of abuse act directly on our brains, causing both short-term and long-term consequences. Drugs such as cocaine, amphetamines, and nicotine (found in tobacco) act on the basic reward pathways in the brain, which essentially “hardwires” a person to want to use those substances again and again. Alcohol and other depressants decrease the activity of the main inhibitory signals in the brain, which helps explain the lapses in judgment often seen with abuse of drugs. Anyone who has earnestly tried to break such an addiction can certainly identify with what the apostle Paul says in his letter to the Romans: “For the good that I will to do, I do not do; but the evil I will not to do, that I practice. Now if I do what I will not to do, it is no longer I who do it, but sin that dwells in me” [Romans 7:19]. So, is substance abuse sinful? With all the harm that we know these substances bring to the body, on-going use is clearly not honoring our body, which (as far as Christians are concerned) is “the temple of the Holy Spirit” [1 Corinthians 6:19]. By definition, substance abuse means neglecting one’s duties and leads to many selfish acts. This temptation does not come from God. In other words, we have only our own sinful flesh to blame for this predicament. “Let no one say when he is tempted, “I am tempted by God”; for God cannot be tempted by evil, nor does He Himself tempt anyone. 14 But each one is tempted when he is drawn away by his own desires and enticed. 15 Then, when desire has conceived, it gives birth to sin; and sin, when it is full-grown, brings forth death” [James 1:13-15]. There is a strong temptation to imagine that we are somehow better or stronger than those struggling with addiction, that we would never allow something like this to happen to us. We need to remind ourselves that the sinful nature which we all have is essentially an addiction to sin. “Jesus answered them, ‘Most assuredly, I say to you, whoever commits sin is a slave of sin’” [John 8:34]. When we see those who abuse substances “fall off the wagon,” we need to be mindful of our own daily relapses into sin. The apostle Paul includes “drunkards” among the list of the unrighteous who “…will not inherit the kingdom of God.” He goes on, however, to say: “And such were some of you. But you were washed, but you were sanctified, but you were justified in the name of the Lord Jesus and by the Spirit of our God” [1 Corinthians 6:9-10].
How to Respond to Addiction?
We need to make sure our own sinful pride is in check. The temptation is strong to consider ourselves somehow above this problem of addiction. One may think, “This would never happen to me,” “I would never allow things to get this bad,” or even, “That person must not have very strong faith if he/she is in this situation.” If we are to openly discuss another Christian’s addiction with them, we need to make clear we are doing so with the utmost humility. “For all have sinned and fall short of the glory of God” [Rom 3:23]. “Or how can you say to your brother, ‘Let me remove the speck from your eye’; and look, a plank is in your own eye? Hypocrite! First remove the plank from your own eye, and then you will see clearly to remove the speck from your brother’s eye” [Matt. 7:4-5]. Similarly, if someone is returning to church after a notable absence for help with a vice such as substance abuse, we will not want to react with disdain or an “I told you so” attitude. Rather we heed the parables of Jesus in Luke chapter 15. I envision that the prodigal son did not deliberately squander his wealth but rather was ensnared by evils such as alcohol abuse, gambling, and the like. Not until he hit rock bottom did he humbly return to his father for help. Likewise, our first reaction when confronting someone with an addiction should be to rejoice that the Lord has guided a lost sheep back to the fold for help. Get Help. If someone approaches you seeking help with his addiction, you do not need to carry this burden alone. Encourage the person to reach out to the pastor, as well as to be open with family and friends. This will not only widen the safety net but it will add accountability. It is advisable to seek help from a counselor and/or physician who is well-equipped to identify underlying mental health disorders and to deal with issues of substance withdrawal. They may also be able to offer substitution therapy, which aims to replace the harmful substance with a safer medication. With a few specific exceptions, quitting a drug “cold turkey” is usually the way to go. Too often patients want to taper off tobacco or alcohol very gradually, but because they don’t have a clear stopping point in mind, they inevitably lose sight of their goal. The substances that may be unsafe to quit immediately are alcohol and sedative medications (benzodiazepines and barbiturates). Those with heavier use are more at risk of withdrawal, which can include tremor, agitation, hallucinations, seizures, and death. If someone is ready to quit drinking alcohol but has a substantial daily intake (or if they have had withdrawal symptoms before), the aid of a physician should be sought.
Environment is key!
One of the most important aspects to successful drug or alcohol cessation is the person’s environment. A smoker whose spouse continues to smoke in the home will have a difficult time quitting. An alcoholic man whose entire social life revolves around the bar will soon be back drinking again. The substance or behavior needs to be as inaccessible as possible, and this usually requires a complete change, even including moving away from the alcoholic roommate or finding all new friends. “Do not be deceived: ‘Evil company corrupts good habits.’” [1 Cor. 15:33]
The most powerful tool to combat addiction is God’s Word
As powerless as one can feel to overcome an addiction, it is vitally important to emphasize the wonderful works that God has already done for us. He guides us through our daily Christian walk. Our redemption has already been accomplished by Jesus’ suffering and death. The Holy Spirit continues to work saving faith in our hearts. When Christians are toiling against the Old Adam to overcome these temptations, let them recall: “No temptation has overtaken you except such as is common to man; but God is faithful, who will not allow you to be tempted beyond what you are able, but with the temptation will also make the way of escape, that you may be able to bear it.” [1 Corinthians 10:13] Here we are reminded that we are never alone in fighting a particular temptation; many others have struggled with the same problems. Also, we should not despair and give in to the habit because the addiction is just too powerful, genetic, or “hard-wired,” but rather approach each new temptation looking for the way of escape through prayer, studying God’s Word, and reaching out to fellow Christians. The most powerful tool to combat addiction is God’s Word.
Those who are abusing or dependent upon substances or addictive behaviors need to be reminded first of their sin [1 Corinthians 6:9-10]. Lest someone be led into despair, we also want to provide the blessed gospel message, as the apostle does in the very next verse [1 Corinthians 6:11]. How to balance the law and the gospel is best based on the individual case. Are we dealing with a contrite, active member of the church with a heavy burden of guilt, or with one who is not well acquainted with his Savior and sees no real harm in his substance abuse? Ultimately, we know that no one can say it better than the Holy Spirit Himself. Therefore, we will want to sit down with the individual and search the Scriptures for guidance, praying for deliverance from such a hardship. “Blessed is the man who endures temptation; for when he has been proved, he will receive the crown of life which the Lord has promised to those who love Him” [James 1:12].