Conference on problems of dependence

Below are papers read at the conference on Theological Understanding of the Addiction Problem:
Orthodox and Catholic Approaches
October 1-2, 2018, Sankt Petersburg (continuation)

Problems regarding attitudes towards alcohol and alcoholics

Archimandrite Meletios (Webber), a cleric of the church of St. Nicholas of Myra in Lycia, Amsterdam

If a young person gets cancer, almost everyone alive has a natural inclination to be as helpful and supportive as possible, or (at the very least) sympathetic.

If an older person gets cancer, most people might regard the situation as less of a tragedy, but nevertheless they would still tend to be sympathetic, and have positive feelings towards the person who is suffering.

Unless, of course, they also know that the person actually has lung cancer, and that they also know that the person concerned was a heavy smoker. In that case, sympathy tends to fade.

An alcoholic who is dying, quickly or slowly, of an alcohol-related disease tends to get no sympathy at all. On the contrary, he, or she, is surrounded on all sides by anger, frustration, shame and resentment.

So, what is the essential difference between the child with cancer, and the alcoholic? Why do we feel supportive of the former and dismissive of the latter?

The difference between the two conditions is real… but the most important distinction by far lies in the attitudes of the people surrounding the sick person, and not in any essential difference between the one condition (cancer) and the other (alcoholism). Both are complicated disorders of the entire human system, and both can be fatal.

The main qualitative difference between cancer and alcoholism lies in the attitude of the people around the one who is suffering.

Attitudes, whether of an individual or society as a whole, are not particularly responsive to common sense, logic or even education. They are often born of prejudice, i.e. firmly held beliefs, largely unexamined and untested, which we inherit unconsciously from family, social groupings, nations and (sometimes) religion.

Individuals, even within the Church, can (as individuals) afford to have any number of prejudices, leading to all sorts of mis-guided and (often) un-loving attitudes. The human condition seems to necessitate such. Apart from anything else, these attitudes provide a starting-point to our spiritual journey… the place from which God wants to rescue us. The Orthodox tradition calls us to examine our prejudices, particularly in the Sacrament of Confession. In approaching the Kingdom of Heaven, our attitudes need to be healed, along with our bodies and our souls.

The Church collectively, as the Body of Christ, does not and cannot have any such bad attitudes. Within the Church, all attitudes are constantly governed by ecclesiastical and patristic tradition, and that tradition is constantly enlivened by, and challenged by, the core teachings of Christ which we hear proclaimed daily in the services of the Church, particularly in the Gospel reading of the Divine Liturgy. For the Church, this challenge (both for the individual and for the Church as a whole) is a dynamic process, occurring in the present moment. Very often we, as individuals, try (but fail), to assign importance to decisions or creedal statements from the past in order to avoid meeting this challenge. That cannot, ultimately, work. The Orthodox Church builds on the past, moment by moment. However, we are not, as a Church, petrified by the past, for to be so would be to ignore the action of the Holy Spirit… the one sin which cannot be forgiven.

In examining how Christ received those who came to Him for healing, we very quickly receive a glimpse of the fact that He was actually much more interested in healing the downtrodden than in making the pious feel good about themselves. He reached out, sometimes over insurmountable barriers, to cure those who needed healing, no matter how 'unworthy' in terms of contemporary societal thinking they were (Samaritans, for example). Yet, He was dismissive of those who simply wanted to follow the religious status quo. We see this plainly in His dismissal of the young man who wanted to bury his father (a situation which in Jewish terms constituted a primary religious obligation) before becoming a disciple.

The fact that Christ sent the lepers He had healed to the priests in Jerusalem to complete their healing might also indicate that He saw healing as a multi-faceted process, not as a one-stage event. Christ provided the required physical and spiritual therapy, but the Jerusalem priests were needed to provide the societal aspects of their recovery.

Often missed is the fact that Christ quite explicitly sought gratitude as part of the healing process. How many modern doctors ever consider gratitude a part of healing?

Consider the following analogy: If someone comes to church suffering from appendicitis, we naturally and happily refer the person to a medical hospital to receive the treatment they need. This enables the person concerned to receive physical healing at the hands of others, often outside the Church, so that that person can be made fit to return to the Church to receive the 'eternal' healing which the Church has to offer.

If a person comes to church suffering from alcoholism, we can equally refer him or her to the best place for that person to receive healing, so that, in turn, he or she may return to the Church for the 'eternal' healing which the Church has to give. That place is often (though not necessarily always) Alcoholics Anonymous (AA).

* * *

To make life in general, and work with alcoholics and other addicts in particular, a little more complicated, we also need to consider whether there is a distinction that needs to be made between an alcoholic, per se, and a heavy drinker. The accepted wisdom says that there is a difference: the alcoholic is in the grips of an internal dysfunction which makes his drinking (and subsequent drunkenness) inevitable.

A heavy drinker is simply one who habitually, or through choice, drinks too much, too often.

However, attitudes around that person are a major element in making this distinction, and the results may be substantially different in different parts of the world. In countries where drunkenness (public or private) is regarded as a minor lapse, or merely the inevitability of people having a good time, there tends to be a blurring of this distinction. In countries where drunkenness is regarded as a very serious offence, it is probably true that the distinction is more important.

Both the alcoholic and the heavy drinker are in danger of inflicting damage on themselves and others (obviously… if they are driving, less obviously… if they have families, are employed or play a role in organised society), yet essentially the one is driven by a psychosomatic and spiritual disorder which requires extensive and difficult therapy… and the other is merely someone who has to change his or her lifestyle. How can you possibly tell the difference between the two? They look, sound and even smell exactly the same.

This may seem like an insoluble problem. At least, this is true for society at large. For the Orthodox Church, however, there is no such dilemma, for the following reason:

The Western Christian tradition, even during the pre-schism Church of the first millennium, tends to see the individual as a person with moral failings in need of forgiveness and redemption. Thus, in the West, the question as to whether alcoholism is a disease or simply a moral failing is of great importance.

Our Eastern Orthodox Christian tradition, on the other hand, tends to see the individual as a person who is sick, and in need of healing. Here the distinction as to whether alcoholism is a disease or a moral failing really ceases to be important. All men and women, for whatever reason, are accepted as people who are in need of the healing which Christ, through the Church, has to offer.

That the "disease model" of alcoholism should emerge first in the West is, perhaps, surprising (if not miraculous), and there may be very many reasons why this is so, beyond the scope of this short paper. However, it is self-evident that the "disease model" of addiction should naturally find a home in the Eastern tradition. Wherever or whenever there is opposition to this idea, and people want to define alcoholism merely as a moral failing, the content of their opposition actually comes from Western, not Orthodox, influence.

The paradox is complete.

* * *

Much has been written and discussed about the aetiology of alcoholism. The subject is largely one of interest to academics and therapists-in-training.

I would like, briefly, to focus on another aspect of the disease.

I have personally witnessed the healing recovery of many thousands of people who claim to be alcoholics, the vast majority of whom were convinced that they were, at some point in their lives, in the grip of a condition which would inevitably lead to disaster, incarceration (either in a prison or a mental institution) or death.

These same people, thousands and thousands of them, are now leading happy, productive lives, one day at a time, facing all the challenges which all people face, but with enormous confidence in God's power to heal and to forgive.

The vast majority of these people experience this process as one of healing, much as a person who goes to a hospital to be treated successfully for cancer. They do not, in my experience, ever see this process in terms of undergoing some sort of punishment or moral adjustment in order to be freed from their self-inflicted wickedness.

In plainer words, recovering alcoholics experience their participation in Alcoholics Anonymous as a part (very often a major part) of a miracle which enables them to participate once again in the life which God has given them. These people are, de facto, experts in the ways that the disease of alcoholism does its best to deprive them of that freedom. Recovering people tend to acknowledge that it is not this or that one aspect of recovery which brings recovery about, but is the whole event. Singling out one or two aspects of this recovery, and trying to apply them in a different context, is better than nothing, but not nearly as efficacious.

For the Orthodox Christian who is an alcoholic, the ultimate and most efficacious healing comes from the Church "plus" Alcoholics Anonymous. AA without the Church does not work so well. The Church without AA does not work so well either. This is a blunt truth, but verifiable only through personal experience. It is not, and cannot be, a matter of theoretical debate.

* * *

Unlike some diseases, the cure for alcoholism is not absolute, but contingent. The cure depends on a course of treatment which demands effort on the part of the patient himself, and does not rely merely on the skills of health professionals. The cure lies in the on-going effort of the recovering person to live a life based on certain principles and, at the present moment, these principles are most readily available in Alcoholics Anonymous.

To come to grips with this statement, it may be useful to widen the idea of 'disease' in order to include the concept of allergy.

Although allergies seem to be becoming more and more serious in our society, the reasons why this is true are not yet entirely clear. However, I hear no voices offering an opinion that allergies are in any sense outside the disease model… that they are rather the result of some sort of moral failing.

For example, many people, in growing numbers, are allergic to peanuts. If they eat a peanut… ever… they are likely to go into anaphylactic shock, and they may even die as a result. Nobody would dispute this condition is a disease, accepted as such by everyone, across the board.

When it comes to alcoholism, however, some people hesitate. Surely the alcoholic is willingly participating in his (or her) own illness and downfall?

Is not the same true of someone who knows that he or she is allergic to peanuts, and yet eats them anyway?

If alcoholism were to be viewed as an allergy, much like peanut allergy, the distinction between 'disease' and 'moral failing' would quickly disappear. The only difference between the two conditions is that the treatment for the one with a peanut allergy lies in the administration of a drug (usually epinephrine), whilst the treatment-of-choice for the alcoholic lies in participation in the life of Alcoholics Anonymous.

* * *

Ultimately, changing attitudes is a necessary and obvious part of the process of participating in the life of Christ within the Orthodox Church. At every level of Church life, from the patriarchal to the parochial, the individual attitudes of people colour this process and either help or hinder its course. Christ's call that we should "love one another" demands that even if it requires us to leave our comfort zone, we need to give the drinking alcoholic the best tools available to find healing … and having found healing, to continue on the path of salvation within the life of the Church. To date, the "best tool" by far is the programme of Alcoholics Anonymous, and the Fellowship which puts those principles into practice.

The Church does not feel the need to control or authorize (let alone understand) the therapeutic skills of doctors and nurses in order to bless their work. It is my deepest hope that the Church can, in practice, treat the therapeutic skills of those in Alcoholics Anonymous in exactly the same way, and (in the words of St Theophylact) "do good to those who are doers of good."

Addiction as a Psycho-Sensory Disorder

Archpriest George Aquaro, MDiv., Potlatch, Idaho, USA.

Your Eminence, Right Reverend and Reverend Clergy, Honorable Doctors, esteemed Ladies and Gentlemen!

It is indeed a great privilege today to address you all, and I sincerely thank His Eminence, Metropolitan Hilarion, for his kind invitation to attend this important gathering. Due to a number of obstacles, I was unable to be with you in person, and so I offer this brief presentation.

Of course, I will be the first to admit that this presentation will be an over-simplification of a very complex topic, but I hope less to provide answers than I do desire to stir up discussion among those who are far more spiritually developed and learned in theology. I do not pretend to have wisdom or learning, but I am a humble priest in far away Northern Idaho who struggles to stay on the narrow path that leads to the Heavenly Kingdom.

So, what does the Church have to say about addiction? Well, not much in a direct fashion. The concept itself is quite new¹. The Desert Fathers, who struggled with many afflictions of the soul, do not clearly speak of it.

Yet, this does not mean that they did not have an understanding of a concept which we now consider 'addiction.' Their understanding of the human person was that all men fight against a singular concept called 'temptation'², in which addiction can be understood as the most advanced degree. The addict is one who is utterly mastered by his temptations, no matter how hard he may try to break free.

So, to understand addiction from the theological perspective, we must begin with asking ourselves how we are tempted. Most of us, because of our modern education built upon the concept of psychology, will immediately say that we are tempted by thoughts, and that the addict or anyone else fighting with temptations must fight a battle with our thoughts.

So, what are thoughts? This may seem a silly question, but this is actually important: what is it to think? We have been thinking all of our lives, and most thoughts we can easily consider to be 'word thoughts.' Our ability to speak and assign a vocabulary to our thoughts is central not only to our daily activities, but also to our understanding of ourselves.

We think, "I am angry" or "I am hungry." It seems very clear for the most part. But our actual experience of life is far more than words. We have experiences and perceptions that cannot be adequately spoken of. Word thoughts are important, but they are not everything when it comes to human perception.

Psychology rests on the notion that human experiences can be, for the most part, rendered into word thoughts and communicated. Counselors expect their patients to speak of their thoughts in an accurate manner, and integrate new ideas and concepts by listening to the counselor's words, which are in turn a manifestation of his word thoughts about the patient or the world in general. Counselors can be aggressive or passive in this process, but what is most important is the use of vocabulary and words to guide the patient from illness to health.

If we turn to the Holy Fathers, we often see this approach in the stories of their counsels. Yet, if we explore such compendiums as the Philokalia, we see that verbal counseling is only a small part of the overall struggle with temptation. So, what is the difference between the Christian approach and the modern understanding of the human mind?

The Church begins with understanding that at the core of each human being is the Light of Christ, which, as we say during the Liturgy of the Presanctified Gifts, Illumines all men."³ Each human being is made in the Image and Likeness of Christ, as described in Genesis:

"Then the Lord God formed man of dust from the ground, and breathed into his nostrils the breath of life; and man became a living being" (Genesis 2:7).

Man is material fused with spiritual, and the 'psyche' of psychology is this intermediate realm between man's physical and spiritual natures. Thus man has three distinct experiences of life: he experiences spiritual things, he experiences physical things, and he experiences thoughts in which he tries to reconcile these two very different worlds.

So, we often read the Philokalia and focus on the logismoi and the battle with thoughts, but how often do we consider the senses? The senses in modern conceptualization is merely data for thought processes. Vision, hearing, smell, touch, and other bodily experiences are treated merely as raw physical information, no different from a weather forecast.

But, the ancients considered the senses to be a very important part of human experience⁴, and separate from thoughts. The Church treats them as important, so much so that we specifically apply the Holy Chrism to them. Why?

Let us consider for a moment what the senses do for the human person, and in so doing we return again to the human person as created by God. This person is created with desires or appetites. These appetites are the means by which man, who is a dependent creature, ensures his survival. Our appetites are shared with animals, and so we see how the lower part of man's brain is physiologically similar to animals. Appetites are a necessary part of survival. Without hunger, we would starve to death.

These appetites well up within man and cause him act, though not directly. The appetites enter into man's consciousness and cause him to experience discomfort. He must assuage them and is driven to act out in this world to meet his needs for survival. And, just like an animal, man must then perceive the world he exists in so as to take from it what he needs.

Perception, therefore begins with the senses. The senses are the primary way man experiences the world. He must use his vision, his hearing, his touch, and many other physical interactions, in order to find what he needs.

So, how does man know what food is if he is hungry? How do we know that bitter is bad but sweet is good? Here we find something which may be called 'instinct.' Man is created already knowing that sweet is good and bitter is bad. Sensory information comes with pre-existing 'value' that God has given us, and again we share with animals. No one teaches us what sweetness is, we simply know it.

But, the senses are not enough for men or animals to survive. Animals and men share the ability to have memories of various sensory experiences, so that we can either repeat or avoid actions. Thus, man remembers what is sweet and what is bitter. His senses gather information about things, and gradually he creates an understanding of his world, though the function of the imagination.

The imagination is where sensory information and memories come together, and man begins to deliberate. Thus, the human will begins to form, and it is out of this that man begins to depart from his animal brethren. Animals have imagination in that they can plan at an elementary level, but man has the additional capability to speak and use reason. Man can think in words and employ abstract concepts. And, we discover that man has desires far beyond animals. Man yearns for beauty, and he desires to express himself. Man seeks God and His providence.

Modern neurosciences have demonstrated that the language functions of the brain are not connected to decision-making. Marketing analysis shows that very few people can actually express in words why it is they prefer one brand over another⁵. Man is a sensory being that can think, rather than a thinking being that senses.

This is critical in understanding man's fall and the Original Sin which disrupted man's nature. Let us consider Genesis 3:1-7:

We see that Eve went through a series of sensory experiences of the Tree of Knowledge. First, her more basic sensory perception was of it meeting her dietary needs, but then we see that her sensory perception stirs up within her another desire, and thus we see that the senses and our deep desire are connected. Just as much as our appetites drive us to sense our world, so too our senses awaken our desires.

If we can then summarize the process that leads one from desire to action, then it would look something like this: man experiences a desire, his senses are aroused, and he begins to explore his surroundings while, at the same time, his imagination begins to operate and he plans. Higher thinking is then engaged and man analyzes his options and abstract factors. Then his senses locate the thing which he desires and an emotion takes place which discontinues higher thinking and takes the imaginary plan from theory to action. Action comes through a sensory process.

For this reason, the Holy Fathers cautioned us to guard our senses, often symbolized by the veil worn by monastics and the Christian tradition of asceticism. The Philokalia calls on Christians to protect their senses from excess pleasure so as not to stir up greater desire for them at the expense of desire for God. Man's will is limited, and he cannot be filled with desire for God and something else at the same time. Man cannot act upon things he cannot perceive.

This brings us to how man becomes an 'addict.' Addiction is the unavoidable compulsion to engage in a behavior which is self-destructive. If we agree that man is a sensory being that thinks, then perhaps addiction is a sensory problem. How so? Let us consider this further.

While the senses guide man to find the solution to his desires, they also aid man in avoiding those things that cause him harm. Thus, Adam and Eve 'saw' their nakedness and sought to cover themselves. Man has desires and anxieties, those things he wants and those things he avoids. It is a forward versus backward action.

In fact, our senses generally have an assigned desire or avoidance value for everything we can sense. There are very few things that we experience which have no value one way or another if we take the time to perceive them. Man is generally not ambivalent about his surroundings. And, man's primary drive is towards his desires. The senses are tuned to find what it is that we desire and acquire it.

Temptation comes to us when we have a desire without an easy way to fulfill it. In the case of Eve, her desire to be like God is understandable (after all, she was created in His Image and Likeness), but her sensory experience stirred up her desire more than she could restrain. Coupled with a faulty memory of God's actual admonition, Eve fell to the serpent's trap.

So it is that man continues to be tempted, where his desires are stirred up beyond his ability to remember God's saving commands.

Addiction takes this one step further, since addiction begins not with desire, but with man's fear. Addicts often report that their addiction began with two primary ingredients: a fear, and then a sensory experience which eliminated the fear.

The book Alcoholics Anonymous gives a rather unsatisfactory word for this experience in English, calling it an 'allergy.' The truth is that an allergy is entirely negative experience, while the addict reports quite the opposite. One's first drink or use of a drug is almost uniformly pleasurable experience, which is magnified by the addict's pre-existing anxiety. We may consider the 'allergy' to be a distortion of the senses, where one may be overly-sensitive to a particular substance or sensory experience.

Consider how administration of a sedative can be annoying to one trying to stay awake, but pleasurable to one seeking to rest. The mind assigns an additional sensory value to the same experience based on the disposition of the desires and anxieties. If the senses already suffer from a distortion which makes a sedative have an magnified affect on the person, then this can cause an increase in desire for this substance.

Here it is that we also have the problem that word therapy cannot address: no amount of counseling can convince an addict that he isn't feeling better when he uses his drug of choice. While his abstract thoughts may comprehend his dire situation, his senses do not. They perceive that he has found a cure to his anxiety.

This in turn leads to a further distortion, in which the initial use of the addictive substance was to avoid pain, but creates within the addict a desire for his drug. The reality is that there really is not desire, but rather an anxiety, but because the mind prefers desires, and the desire can be met with the drug, then the anxiety becomes distorted into a false desire we often refer to as a 'passion.'

Thus the addict, when he seeks to do what is good, and to follow his desires (because the God-created desires are inherently good), he invariably falls into sin and temptation because the distorted senses and passions over-ride his will.

So, how does one escape such a prison? As we can see, it is not easy to manage our senses. Our senses are so powerful, that they actually define how we feel about ourselves. After all, the senses not only show us what is in the outside world, but our condition in the world and how we fit into it. The sense of temperature and pain can tell us if we are standing in the sun, and if we have been there too long. So also our senses tell us how tall we are compared to others, and whether others are a threat or a benefit.

If the senses are distorted, just as people are born with vision problems or hearing impairment, then one's perception of the world is distorted... and so, too, is our sense of self. Only now have the neurosciences begun to use brain imaging to see what goes on inside the physical brain during various experiences, and can note that different people have different reactions to various forms of sensory stimuli.

In the well-documented research of Dr. Ramachandran about brain injuries and their effect on the sensory processes, he discovered that those suffering from 'xenomelia,' or people who desired to amputate their own limbs, had an impairment that made them feel like the limb was not their own⁶. Subtle distortions in the perceptive processes not only account for human 'taste' in food and fashion, but the countless ways each of us differ in our experiences of life. Take this in an extreme direction, and we have the root cause of psychopaths.

According to the Holy Fathers, there is no special differentiation between the appetites of men and women. Appetites are general to all humans, and rise up through the mind into the arena of the senses and imagination, where they interplay with how we perceive ourselves and what we are capable of attaining. Given that the sexual appetite for union with an 'other' arises in a general form only to acquire the definition of 'otherness' at the sensory level, we can see that the phenomenon of homosexuality is not psychological, but rather a distortion of the sense of self which in turn distorts the homosexual's appetites and sensory perception of others. It is a sensory problem, not really a psychological one. Of course, that is a topic for another day, but one can see the correlation.

Recovery begins when the addict recognizes that his deepest yearnings are for God, and that he acknowledges before God that his senses are deceptive. This is what 12 Step groups begin with in a very simple way. Addicts gather not to talk through their problems in a therapeutic fashion, but rather come together to acknowledge their perceptual problems and encourage one another to rely on the perceptions of others to guide their actions.

Word thoughts do come into play here, and are important, which is why I hope that my friends in the counseling arts do not consider this presentation to be demeaning of their important work. Counseling can help diminish fears and anxieties, but words alone cannot cure the passions that underlie the addiction. Furthermore, word thoughts, and thoughts themselves, auto-generate at a dizzying pace. One of the great dangers for men is to take our thoughts too seriously, and to condemn ourselves merely by the content of these thoughts that may simply be an expression of imaginary possibility rather than the result of a desire.

The monastic tradition focused precisely on this process by first requiring the monastic to quell his physical appetites and reign in his senses as a Rassophore before advancing to the Lesser Schema and tackling his thoughts. Only then, once the senses and thoughts have been brought to heel, can the monk advance to direct spiritual warfare with the devil himself, which is the Great Schema.

The addiction can only be treated by the surrender of the addict to God, and for God to gradually heal the senses of the addict. I submit to you here that addicts often have an overwhelming sensory experience of fear, which drives them to use. This propensity to experience intense anxiety, first at the physical level which then transitions to emotions and finally acting-out, is a key part of most addict's experiences.

Only by surrender to God and the confidence it brings, can an addict begin to understand how his sensory perceptions of anxiety are distorted and he can begin to find the strength to endure these experiences without acting out on his addiction.

I would like to thank my bishop, Metropolitan Hilarion, for his kindness in blessing me to address all of you, and I extend my warm regards to Dr. Yevgenie Protsenko, a great pioneer in addiction treatment in the Russian Federation. Please pray for me, and forgive me if I have caused you offense or boredom!

Glory to Jesus Christ!

¹White, William L. Slaying the Dragon: The History of Addiction Treatment and Recovery in America. 1998. Bloomington, IL: Chestnut Health Systems. pp. xiii.

²There are varying degrees and sources of temptation, primarily divided between those generated within the person himself versus intentional temptation by others, particularly the devil. Resistance to these latter temptations represent the high mark of Christian ascetical struggle.

³Antiochian Orthodox Christian Archdiocese of North America. The Liturgicon. 1989. Englewood, NJ: Antakya Press. (2nd ed. 1994). pp. 346-347.

⁴A fascinating and all-too-brief discussion of the ancient approach to the senses may be found in Onians, R. B. 1951. The Origins of European Thought about the Body, Mind, the Soul, the World, Time and Fate. Cambridge University Press. pp. 66-87.

⁵Gladwell, Malcolm. Blink: The Power of Thinking Without Thinking. 2007. New York: Back Bay Books.

⁶Ramachandran, V. S. Phantoms in the Brain: Probing the Mysteries of the Human Mind. 1998. New York: Harper Collins. pp. 131-139.