Diaconia: Aid to drug-addicts
It is well known from history that the Church always attached a special importance to Christ's call for Christians: "You are the light of the world". It means that the Church and every Christian have as one of their essential tasks to bear incessantly their witness to Christ before the whole world. At the same time, witness was understood not only as preaching the Gospel in words, but also as "preaching love" expressed in charity and compassion for those who suffer and need support. Today this work is described as the "social service" of the Church. It involves primarily efforts to tackle the most painful problems society faces today. Among the most urgent of them is the growing epidemic of drug-addiction. Significantly, as various estimates have shown, the number of people who take drugs in Russia today ranges from 3 to 8 million.
At first glance it seems that this problem is purely medical, and there is nothing that the Church can do to help, except to pray. But if we remember that the cause of any physical illness lies in sin, we shall understand that the root causes of drug-addiction are to be found in the spiritual sphere of human life.
There are also physiological preconditions for drug-addiction, of course, but experience has shown that even if a drug-addict is relieved of the abstention syndrome, in a while he or she will take up drugs again. This also suggests that drug-addiction may have some causes deeper than purely physiological ones.
The point is that drugs are substances that make certain artificial changes in human consciousness. A person under the influence of drugs ceases to be conscious of real life. In a sense, he "falls out" of reality. What is the reason then that compels people to change the state of their consciousness?
There are very many reasons for this, but in general they can be confined to one. The point is that an encounter with real life and with particular external and internal problems it presents makes a drug-addict wish to escape it. Instead of trying to overcome them a person in his fear and helplessness seeks to hide away from a circumstance or from himself, fleeing to an artificial, unreal, world created by his own illusions, where he feels as safe as nowhere else.
It is this opportunity for an escape from real life that drugs offer, but it is an escape that will not last forever. At a certain point any drug-addict comes to realize that he will destroy himself if he continues to take drugs. It is possible to come out of this state only for a person who has an irresistible desire to change his life and himself fully and radically.
It is clear from the above that the principal cause of drug-addiction lies in one's feeling of ontological loneliness and desolation in face of an incomprehensible and sometimes hostile world. As a result, a person does not understand himself and his place in this world and wishes to escape into a little world of his own which has nothing to do with reality. A person cannot liberate himself from this slavery without finding a real spiritual foundation to fill the vacuum in his heart and mind.
A Christian begins to find this foundation when he meets God. It is in this endeavor that the Church can help a drug-addict to cure himself. In his powerlessness before the disease, he comes to God, realizing that only He can help him to sort out things about himself and his relations with the world around him. Feeling God's love for him, he comes to see that he is no longer alone with his problems because God is always with him.
It does not mean, however, that a drug-addict is only to wait for God's help, doing nothing. Further on a very difficult work has to be done to rethink one's entire life and repent of the sins one committed, trying hard not to repeat them. One has to make up for the damage, both material and moral, one has done to other people. One has to do all that is possible to help other drug-addicts to get rid of their dependency. Clearly, all these efforts can be affective only if a person becomes a member of the Church, so that he may participate regularly in the sacraments of Penance and Communion and to have an opportunity for private talks with his spiritual father.
Motivated by the above view of the problem of drug-addiction, we, in the Church of the Intercession at the Yerino village near Podolsk, have been giving, with the blessing of Metropolitan Juvenaly of Krutitsy and Kolomna, all the help that is possible for us to chemically-dependent people.
We see our primary task in creating conditions for inchurching those who come to us. It is possible to do only in an atmosphere of love and sharing in which it is inadmissible to show condemnation or prejudice towards a person, even if he or she is a drug-addict or an alcoholic.
It is also very important that a person should be thoroughly prepared for his first confession by making a careful analysis of his life to discover the spiritual causes of his dependence.
Special attention in the life of a recovering drug-addict should be given to the restoration of his ability for normal communication with people around him, i.e., to his social rehabilitation. It is much easier to achieve in a church community and even more easily in a community where some parishioners are former drug-addicts or alcoholics. Such people make up approximately one third of our parish today, and we try to involve them in parish work as much as we can.
We have enumerated some really feasible methods and forms of work carried out in our parish. Clearly, it is only a small part of what the Church as a whole can do to help overcome the global problem of alcoholism and drug-addiction in our country. Therefore, we will be glad to enter in any kind of cooperation with other parishes working in this field.
Rev. Eugene Genning
Evidently, drug-addiction is now coming to the forefront as a problem which poses a serious threat to the physical, social and, most importantly, spiritual well being of the country. In fact, this threat has been there for quite a while now, but the government has been preoccupied with many other, ostensibly more important issues, while the public has turned a blind eye on drug-addiction, just as on many other problems. However, to ignore the problem of drugs and drug-addiction is no longer possible as it makes itself felt at every corner by bursting in every aspect of social life.
Unfortunately, steps taken by the government to fight drugs have been confined almost exclusively to anti-trafficking measures, mostly against "small fish", such as street peddlers, pushers and individual users. Incidentally, all legislative and administrative innovations, which have re-introduced administrative and in some cases even criminal prosecution of drug users, have effectively cut off any opportunity to help them. Indeed, it is possible to help only those who want to be helped and ask for it. But will you ask for help voluntarily if you know you may not only become a social outcast but also taste the amenities of Russian detention and correction system? That is to say, the problem has been customarily hammered deep inside, instead of being identified and addressed. As has been the case in other, similar, situations, these measures have opened up ample opportunities for illicit profiteering and open abuse, as well as for all sorts of occult, shamanic and esoteric projects initiated by individual practitioners and groups to deal with the problem of drug-addiction.
This is why it is so important that Christians, both in the Russian Orthodox Church and other confessions, should be actively involved in solving this urgent and acute problem. Many people will ask: What can Christians do in this area and, more generally, what is the Christian approach to drug-addiction?
Apparently, the answers to these questions depend on how the phenomenon of drug-addiction is understood. It is certainly evident to Christians that people's desire of drugs and the dependency on drugs as any other dependency is first of all a spiritual problem, though it also has its biological, mental and societal causes and manifestations.
It has now become clear that unless a dependency is dealt with in all its complexity as a precisely spiritual disease always affecting both the mind and the body, the approach to its treatment will be either essentially wrong or limited and inadequate. Either way, assistance will not only be ineffective, but more often than not even harmful for the soul of affected person. At the same time, this reduced approach can be offered and practiced by quite sincere and devout Christians. This, nonetheless, does not prevent them from being misled in such complicated illness as dependency on drugs.
Thus, it often happens to this day that Christian physicians, narcologists and even psychotherapists tend to treat the dependency with medicines, primarily, psychedelic drugs. In doing so, they refuse to see that medicines cannot at all solve the problem, as experience and practice have long established that drug-addiction is incurable medically. Moreover, they delude the patient into believing that recovery can be achieved fast and easy, thus stopping the patient from seeing the need for serious spiritual effort. Besides, this approach often replaces one type of drugs by another.
Christian psychiatrists and Christian experts, who tend to view drug dependence as a behavioral abnormality and unhealthy lifestyle, equally often use various psychological or para-psychological methods, such as discussion groups, family clubs, special-interest clubs, or apply a wide range of techniques from Gestalt psychology to psychodrama, psychoanalysis, etc. They practice these methods despite the fact that their ineffectiveness has long been established. Actually, almost all the founders of major psychological schools and trends, who tried to use these methods to cure drug addiction and failed, stated so publicly as far back as the beginning of the 20th century.
Unfortunately, even those who are well aware of the spiritual character of drug dependency often tend to ignore its complexity and offer simplistic approaches to its treatment. They assume, quite correctly, that as long as drug addiction represents an illness of the spirit it should be treated by spiritual methods. However, they understand spiritual methods as participation in sacraments and worship alone. Sometimes they add to it Biblical studies. Equally common is a recommendation to treat drug addiction by "fasting and prayer", which are again understood narrowly, as fasting is believed to be confined to abstention from certain kind of food, while prayer to saying a due number of prayers. Another kind of the same reduced approach is reliance on an instantaneous and miraculous recovery of those who suffer from alcoholism or drug addiction.
This kind of approach can be observed in any Christian environment. It is very often seen in Protestant denominations. It is also typical of many Catholic orders and societies and widespread among the Orthodox.
Every form of assistance to drug addicts, which is practical and real, and every truly effective approach towards the treatment of drug addiction are essentially variations of the same therapeutic community.
How can this reductionism be overcome? What approaches can help find really holistic and effective means for overcoming drug addiction? Is there a way out?
Yes, there is a way out! And it is not some sort of a new sensational remedy, like a panacea against cancer. No, what we mean is the experience of actual recovery achieved by thousands of addicts who have started living a complete, meaningful and happy life.
This experience has been there for quite a while. The essence of this method with all the diversity of its forms can be briefly described as the therapeutic community.
Obviously, the effectiveness of this approach lies in its complex nature, as it helps to restore for a person a healthy vital milieu in all the diversity of life's spiritual, social, emotional and even biological dimensions. Secondly, the most effective therapeutic communities, like those built on the so-called Minnesota Model, are based methodologically on the 12-Step Program, which is a well-developed and time-tested version of how Christian principles can be lived up in the everyday life of an individual and society understood here as a community of recovering people.
This is expressly not to propose another panacea or to sell my own approach, as has often been the case with many proposals. This is to point out that every form of assistance to drug addicts, which is practical and real, not perceived, and every truly effective approach towards the treatment of drug addiction are essentially variations of the same therapeutic community.
There are many variations of this kind already known today. They include therapeutic communities for drug addicts, in-patient rehabilitation centers of various types, rehabilitation programs for outpatients, as well as numerous self-assistance groups and movements. There are also successful attempts to change the public opinion on drug and other dependencies and to introduce elements of the therapeutic community in official practice. The best example of bringing the above forms under one roof is the so-called Minnesota method of treatment and prevention, which has been instrumental in fighting alcoholism and drug addiction throughout the vast North American continent.
As was mentioned above, the Minnesota model is based methodologically on a 12-Step Program. This program seeks to live up human relations in the initial, early Christian, sense of "therapy" (from the Greek therapeia) as "joint service of God and one another".
The core of the therapeutic community and the 12-Step Program lies in repentance. The Greek equivalent of the Russian word for repentance is metanoia, or 'change of mind', 'change of thinking'. Repentance is turning one's entire life towards God. "Love the Lord your God with all your heart and with all your soul and with all your heart". This is exactly the change that happens in those who start working under the 12-Step Program.
From the program's very first Step, repentance is a prerequisite for and a result of "working by steps". Without repentance it is impossible either to accept or to admit one's weakness and lack of control over one's own life (Step 1). Without repentance it is impossible to understand and, most importantly, to feel that "it is only the Power stronger than our own that can bring us back to sense" (Step 2). It is so if only because one has to admit the inadequate nature of one's own judgment and the limited nature of one's own efforts. Unless one starts to repent, one can never ask God for help or "commit one's will and life to God" (Step 3). Step 4 is a thorough analysis of one's past in all its aspects, even the most shady ones, an unbiased evaluation of all the actions one has committed. It is not accidental that this Step is to be made not in the very beginning but only after the first three Steps. At this stage a person comes to find a new spiritual basis for his or her actions and a new vision of what has happened to him or her and to other people. Psychologically, Step 5 is a direct equivalent to confession. Steps 6 and 7, preceded by a due preparation, are a direct appeal to God for purification and delivery from sin. Steps 8 and 9 are an attempt to live by the most important Christian commandment to love one's neighbor. It means to revive the principle of restitutio, which was practiced in the early Christian communities to make up for the damage inflicted and to restore human relationship breached by bad actions. Step 10 introduces repentance into a person's everyday life and makes repentance an integral part of his new life. Step 11 points to the need to discern, through persistent prayer, the will of God towards one's own self and thus to reject one's own willfulness, appealing to God as the source of inspiration to fulfil His will. Finally, Step 12 also includes repentance, because in bringing to other people the good news of his own recovery, a person will, in the first place, tell them his whole story, expressing naturally his attitude to it.
For many people the 12-Step Program has become a step on the way to God and the Church. This appears to account for the high effectiveness of the Program and of the therapeutic approaches based on it. These approaches do not constitute a therapy in its traditional sense, but a new way of life, or, in other words, nothing else but a certain systematization and a kind of concretization of the principles of Christian life applied to particular matters. It is a real practice of restoring authentic conciliarity. Of course, the formation of communality and mature religiosity need to be structured for the primary reason that in the human mentality, i.e., in the inner person, there is a great deal of obstacles impeding one from coming to God. These obstacles can be removed only if a person works actively on his own. This work is not opposed to the action of God's grace received through his participation in the life of the Church, especially through the communion. This work is his response to the action of this grace, or more often, his preparation for the true acceptance of grace.
The Minnesota model was developed in the late 40s. This was an attempt to combine spiritual principles in group work based on the 12-Step Program with modern achievements in psychiatry, sociology and other disciplines.
The Minnesota model of treatment is based on the following perception:
In the beginning the Minnesota Model was developed as an in-patient treatment program whereby patients stayed in for 28 or so days. Later other forms emerged, such as a 60-day in-patient treatment program built on the therapeutic community conception, an "intermediate" treatment program and adaptation institutions, such as "half-way homes", a daytime in-patient establishment, outpatient programs, etc.
The Old World outpatient rehabilitation program functioning in Moscow can be mentioned as one of the first to appear in Russia. It began operating five years ago. The work under the Old World program, just as other programs based on the Minnesota model, has as its task to help patients start spiritual efforts of their own, guided by the principles of the 12-Step Program. Patients treated under this program form a therapeutic community built on Christian foundations as the leading factor in their recovery.
I would like to emphasize that in spite of the Protestant origin of some of its aspects, the approach used by the Old World program, just as by some other programs, for instance, the Dependency Treatment Center in St. Petersburg, is quite Orthodox in its essence. This is attested to by the fact that a great number of patients, formerly committed atheists or agnostics, have come to a conscious and profound faith and become active parishioners at many parishes of the Orthodox Church in Moscow, St. Petersburg and other cities. This is also borne out by the fact that these programs have benefited from the active cooperation of those Russian Orthodox clergy who have undertaken to study their work not superficially but profoundly and impartially.
Eugene N. Protsenko
The Return public foundation has been engaged in social work for over 11 years. It has carried out projects and researches aimed at providing assistance to those who take drugs. The staff of the foundation are Orthodox Christians. Their work has been blessed by Metropolitan Vladimir of St. Petersburg and Ladoga.
At present the foundation is realizing the following projects, which are of importance for both St. Petersburg and Russia:
All these are part of the system of medical and social readaptation offered by the foundation to drug-addicts with pathologies accompanying drug-addiction.
Under the HIV-AIDS Prevention Bus project, drug-addicts are offered new syringes and medical and psychological assistance. Blood tests are conducted among drug-addicts to identify those with hepatitis B and offer vaccination. The project also provides for a behavioral and demographical research targeted at such risk-groups as street children and women prostitutes.
The rehabilitation program includes two hot telephone lines and outpatient reception hours twice a week. The drug-addicts who have shown the will to abandon drugs and undergone the necessary tests are offered to check in the Melnichny Ruchey rehabilitation center. The basic conditions for staying in the Center are written in the Agreement, which a patient signs at the time of check-in. The foundation staff believes it necessary to create such conditions for patients that will promote a profound change in their personality. They are led to accept a different hierarchy of values, to assimilate the norms of Christian righteousness and morality and to make a beginning for inchurching and repentance. To this end, the Center has established the following guarding rules:
There is also a medical room for giving symptomatic medial aid. One can check in the rehabilitation center, however, only if one has effectively got rid of the abstention syndrome. It is because the basic purpose for staying in the Center is not to get medical treatment, but to overcome the psychological dependency on drugs through inchurching and repentance. If the emptiness that tortures a patient after giving up drugs is not filled with a beneficial contents, he will continue walking on the verge of precipice.
Thus the Return foundation is in a position today to offer drug-addicts a fairly wide range of services, beginning from the first contact in the Bus to support at the outpatient center to a prolonged rehabilitation program at the country centers.
The demographic and behavioral studies carried out under various projects run by the foundation have made it possible to develop a right strategy both for the on-going projects and for the development of new ones. This has been decisive in making the foundation so effective, in securing its leading role in the sphere of drug-addiction treatment in St. Petersburg and in keeping it so popular among drug-addicts.
In fact, the popularity of the foundation's oldest project at Melnichny Ruchey is so great that it has attracted patients not only from St. Petersburg and the Northwest Region, but also from Moscow, Siberia, the Far East, Ukraine and Belarus. This project, as well as the previous detoxification center project closed now because of the new Russian law on drugs, has served over 1,500 people. About 20% of them achieved lasting remission.
Three projects run by the foundation have enjoyed the support of the European Council through TACIS-Lien, a partner organization of the French Médecins du Monde and the Austrian CARE charity. We have been supported by the Diakonical Service of Germany, the French foreign ministry, Soros's Open Society foundation and other organizations. We are especially indebted to our friends, Ms. Francisca Rich of the Faith in the Second World, Switzerland, and Mr. Alexander Yelchaninov of Aide aux Chrétiens de Russie, France. Recently we have received the news that the Return has been recommended for registration as the EXPO 2000 project in Hanover among the best projects in the world.
Rehabilitation Center at the Church of Our Lady "Joy to All the Afflicted" and its program of assistance to drug-addictsThe Khomyakov Rehabilitation Center for Victims of Non-traditional Religions at the Church of Our Lady "Joy to All the Afflicted", which is located in Bolshaya Ordynka 20, has been engaged in the problem of drug-addiction for three years. The general thrust of the Center is religious rehabilitation. It implies bringing a person to the sacraments of the Church, primarily confession and communion, in which the Lord Himself really changes a person, that is to say, introducing a person to the Christian Orthodox way of life. This presupposes a whole complex of programs aimed to restore the personality of a drug-addicted person.
The necessary part of work with drug-addicts is catechism. To this end, regular talks are held with them for a week. These talks may be individual or corporate, depending on the ability of a person to take in the necessary information. In some cases, visiting people at home is used for this kind of work. During these talks, people are introduced to the Christian understanding of life, receive answers to their questions, learn to pray and get prepared for confession.
Another form of work is a program of pilgrimages to holy places in Orthodox Russia. Normally they last from one to three days. Drug-addicts visit holy places in order to attend divine services there, make confession, communicate and venerate Orthodox shrines. On their way to a holy place they are engaged in reading morning, evening and pre-communion prayers and reciting thanksgivings and akathistoses. They are also given talks and lessons on Lives of Saints. These trips give people an opportunity to see the uniting factor of the Church and to feel and receive real help from God.
In addition to short-term pilgrimages, the Center runs a program of small groups' trips, from 2 to 5 persons, to resort hotels in predominantly southern Russia for a stay from 10 to 25 days. Resort hotels are comfortable and suitable for observing the condition of the Center's charges. During their stay there, trips are arranged to holy places. Thus drug-addicts are introduced to Orthodox faith, church sacraments and prayer.
Work in churches and monasteries constitutes another important form of work with drug-addicts. Productive work for the glory of God helps to revive the souls of those who suffer. To this end, drug-addicts are sent to the churches and monasteries that need restoration. They work there putting the church territories in order and giving a hand in churches themselves. They are entrusted with work according to their abilities, depending on their condition. Some drug-addicts manage to find themselves in this work and choose to stay at churches and monasteries for a long time.
Work with drug-addicts presupposes communication with their relatives and friends, because one's passion for drugs is a common problem for one's entire family. Talks, trips and other activities are conducted, where possible, together with the relatives of the Center's patients.
At present, the Center is developing a project for an inpatient department in Moscow that will offer a rehabilitation course including medical services and psychological assistance. After a period of detoxification, the patients' psychological condition will be treated on their basis of Christian Orthodox education.
Those participants in the Center's programs who have managed, with God's help, to get rid of their dependency on drugs, start to live church life. Some come back to their families, while others remain in touch with the Center and help it run its programs using their own experience.
The continual growth of drug-addiction among women will lead to grave consequences for society if immediate measures are not taken. Unfortunately, the problem of women's drug-addiction remains unsolvable at present on the level of state-run medical and social institutions. It was in search of ways to deal with this problem and in the awareness that women and children are the first to be helped, because teenagers' drug-addictions threatens the very future of society as a whole, that the idea emerged to develop a project of a Rehabilitation Center for Drug-Addicted Women. This Center has been opened quite recently, in late June 1999. It now operates at the Crisis Center for Women Victims of Violence.
The main purpose of the Center is to give social and psychological support to women and girls suffering from drug-addiction and to their relatives. The primary task of the Center is to achieve rehabilitation and stable results in treating drug-addicts during remission.
The Center was established under the patronage of the Orthodox Church and with the support of the Round Table of Churches in Minsk. The spiritual means of rehabilitation therefore play a special role in our work. It is a well-established fact that even after the physiological dependence on drugs is eliminated, people continue to suffer from the psychological dependence on them. That is why what former drug-addicts, who have decided to change their life and to get rid of their ruinous passion, need most of all is a therapy of their souls revealing to them new horizons of spirituality. The Center gives them an opportunity to be introduced to Orthodox values and to open for themselves the riches of a truly sublime spirituality. For some of them it is a first step towards discovering themselves as free and spiritual personalities.
The introduction to religious values has been realized in various ways. Among them are spiritual talks and one's own studies of religious books with a discussion on them to follow. The latter method appears to be especially important for creating in the Center an atmosphere of spiritual fellowship which in itself is curative for people seeking to find themselves. Besides, it is planned to involve volunteers in various social activities. This thrust is feasible because the Center works in close cooperation with the Crisis Center for Women and with a women's asylum. Pilgrimages to shrines and visits to monasteries will become an important thrust in this work. Women undergoing rehabilitation in the Center will also be invited to work together with the Orthodox Class of the Envila Women's Non-governmental Institute (WNI).
In addition to rehabilitation, the Center plans to carry out the following tasks:
One of the ways to fulfil these tasks is to provide people with necessary information and educate them. Working at the Center at present are psychological counselors, a psychotherapist, a narcologist, students from the WNI department of psychology, social workers from the Belorussian Women's Union and WNI teachers and specialists in applied arts.
The Center functions two times a week. It seeks to develop a model for intensive cooperation with state-run and private narcological services to ensure the best results of its work.
Practice has shown that it is important that drug-addicts should be supported by their families and friends. The Center is developing a model of psychological and psychotherapeutic work with relatives and family members, putting emphasis on the social and psychological prevention of drug-addiction in families. Unfortunately, most relatives and friends of drug-addicts simply do not understand the problems experienced by drug-addicts. Their incorrect attitude can aggravate the patient's condition.
At the first stage of its work the Center has focused on psychotherapeutic group work. If needed, however, it can offer individual consultations, as one of its rules states that "anyone can turn to anyone for an individual advice and private talk". Group therapy helps a person not only to grow as a personality, but also to develop his communication skills and to acquire habits of cooperation and partnership based on mutual understanding and assistance, which is essential for a person who has radically changed his way of life but has not found yet his own niche in society. Those dependent on drugs who have undergone treatment in out- and in-patient narcological institutions and who have applied for help to the Women's Rehabilitation Center have proved to be really incapable of adapting themselves to a new way of life and finding themselves in a real world without drugs. Rehabilitation of drug-addicts has shown that women as the most discriminated group in our society are far less capable of adapting themselves to a new external reality. Their inner condition has been considerably affected by the rapidly changing market economy and the stereotypes established in society. Their inability to respond in an adequate way to external irritants generates a lack of confidence in their abilities and a feeling of inferiority and despair, which tends to incite them to resume their former way of life and to provoke a recurrence of their disease.
This is precisely what happens in most cases. Those women who have decided to change themselves and their life and who have taken a treatment of their drug dependence on the physical level have proved to be incapable of getting rid by themselves of their dependence on the psychological level. This inability tends to weaken their motivation for recovery, to worsen their mental and emotional condition and to bring back their disease. Therefore, the primary task of the project in its initial stage is to develop a system of rehabilitation for drug-dependent women and girls and to test it in practice.
In further stages of its work the Center plans to pay considerable attention to art therapy. It is planned to set up an applied-arts shop and a self-reliant treatment and rehabilitation center through involving patients in the work of the shop and marketing its products and services.
We hope and will do all that is possible for us to implement this project. The most important thing is to believe, to help one another and to do all that is necessary to achieve it. Indeed, "helping others, we help ourselves".
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