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, 2019, Sankt Petersburg (continuation)

Violence application problem in rehabilitation centers for dependent people

Radik Galiakhmetov, Catholic Charity Center "Caritas St. Petersburg", Director of the program "Information and Counseling Center on violence and addictive behavior"

In this report, we will discuss the problem of violence application in the process of rehabilitation of dependent people and how this problem is widespread. I say "we" because I am speaking on behalf of a group of colleagues in the professional alliance "Association of Psychotherapists and Addiction Counselors" (unincorporated). At the moment, our association comprises 14 people, some of them are present at this conference. I'll name a few of them: Elena Rydalevskaya, Svetlana Moseeva, Ekaterina Savina, Vasily Akkuzin, Vitaliy Osipchuk and others. All of them have significant experience in helping dependent people and their families. For more than 4 years we have been discussing relevant issues of rehabilitation process at our meetings and more than half the time had to deal with the problem of violence application in many rehabilitation centers.

I'll start with a story: in the late 80's of the last century (and this is only 40 years ago) there were no rehabilitation centers in the Soviet Union, there was a state addictology, relying in its work on psychiatry. There were Occupational therapy detox centers as well.

The first rehabilitation centers were established in the first half of the 1990s. In St. Petersburg, it was the 10th rehabilitation department at the Municipal Addiction Hospital and the non-governmental rehabilitation center "House of Hope on the Hill". There were enthusiasts who stood at their origins, deeply worried about helping chemically dependent people. They and their colleagues were trained by specialists from Poland and the United States of America. Thus, these centers combined professionalism with sincere real concern for the rehabilitation process. There were just a few centers and a waiting list for admission.

In the second half of the 1990s and the beginning of the new millennium, many new rehabilitation centers were opened (commercial and non-commercial, governmental and non-governmental, Christian and secular). Some of them are still functioning, some others have been already closed. There was a competition among them that had its pros and cons. But all these centers had rehabilitation programs, that is, they relied on some methodological base in their work. Waiting lists for admission to well-known rehabilitation centers became shorter, there were no waiting lists to little-known ones at all.

About 10 years ago, a new wave of establishing centers began. If we set ourselves the goal to list all rehabilitation centers in our region now (St. Petersburg and the Leningrad Region), this list will be incomplete because they are numerous, and information about some of them cannot be found.

At the moment, we have a significant number of centers in Russia (it would be wrong to call them rehabilitation centers), whose main activity is a long-term patient retention. For this purpose they often use medications (not determined by the patient's condition) and even more often violence. They use locking in a room / basement, handcuffing, senseless tasks under pain of punishment, beatings and various other types and forms of violence.

If you look at the definitions of different types of violence (physical, sexual, psycho-emotional, spiritual), then they all have one thing in common: these are actions / words / attitudes directed against a person's personality, against his dignity.

The relationship between violence and addiction can be compared metaphorically to a tree. The roots of this tree are fear, anger, loneliness, shame, guilt, sorrow (actually ordinary feelings for each person), but the soil in which this tree grows is violence in all its manifestations. And these experiences in such soil give rise to a tree of addictions and fruits that poison the person himself and all who are close to him. For example, a child growing up in an alcoholic family feels guilty when he returns from the street after playing with friends and meets a quarrel between his parents. This happens repeatedly in different situations, and subsequently his joy and other wonderful experiences are always poisoned by fear and guilt.

The question arises: "Can violence cure a disease that is a consequence of violence?" The answer is obvious. At this moment it is appropriate to recall the words from the song of Sergei Chigrakov ("Chizh"):

"Mom, I'm very sick,
Mom, the wrong doctors are treating us.
Those who infected us with this, heal our wounds
That is why I am incurable.
Those who infected us with this, heal our wounds
That is why I am incurable".

Why has the violence application in the centers become possible? We can assume the following:

• it meets the relatives desire "to free oneself by putting him / her somewhere at last" (to get rid of him so much that the relatives usually do not know the address of the center, and one can hardly find it on the website);
• relatives are well aware that "he (the drug addict / alcoholic) would not agree to any treatment," which means "he must be forced / tricked";
• it is assumed that denial, which is inherent in addiction, justifies the use of violence;
• at the non-professional level, the term "compulsory treatment" is understood incorrectly;
• it is assumed that fear can stop the development of addiction;
• interagency wrangling leads to the fact that everyone is engaged in rehabilitation and at the same time no one;
• this work is not defined and is not regulated by law.

All of the above items create the conditions under which someone can quickly earn money:

• such "rehabilitation" does not require trained specialists and a program; cages, locks and strong fellows are required, and this means less expenses for establishing and maintenance of the center, and subsequently higher profits;
• long-term retention means payment of "treatment" by relatives for a long period of time.

What will be the solution to the problem of violence application in rehabilitation centers?

• to continue educational work for better understanding of the essence of alcoholism, drug addiction and other chemical and non-chemical dependencies. This work should be carried out including, and perhaps first of all, by representatives of nurturant professions;
• rehabilitation and activities of rehabilitation centers should be defined by law and regulated accordingly;
• to adopt the code of ethics regulating relations "specialist-patient", "specialist-relative of the patient", "specialist-specialist", "patient-patient" and all other levels of relations in rehabilitation.

We all have a lot to do to comprehend violence, to identify it and to renounce it.

What is a healthy alternative to violence? This is a relationship built on respect and love.

About love. One would think that it's quite simple. But it happens that love leads to saying "I know better how you should live and be" and this is the basis for violence.

There is a wonderful word - "humility." This word is very important in the process of rehabilitation, because "pride" is one of the very first and main obstacles to change, to recovery. Humility must be taught. How? Through fear, we will receive the humility of a slave, but a slave who is not of God. Humility through love makes us free. And it turns out that there is love that makes us dependent and there is love that makes us free. It is not so easy to sort this matter out. This is not a question of theory, it is a question of attitude to man.

Indispensable value of 12 step programs combined with orthodox treatment of addictions

Priest Christophe Lepoutre, rector of the Chapel of the Mother of God the Inexhaustible Cup in Natural Bridge Station, Virginia (USA), Russian Orthodox Church Outside Russia; professional pastoral counselor (Master's Degree) specializing in the treatment of various addictions; Executive Director of the nonprofit organization "The Fellowship of the Inexhaustible Cup"

My share today will be in two parts. The first begins with encouraging all of you and those treating addictions to consider the great value of 12 step recovery as a foundation of the treatment for addictions.

As you all know, America historically brought forth 12 step recovery many years ago beginning with AA/NA for the treatment of alcohol and drug abuse, Al-anon for the treatment of co-dependency living with or associated with addicts, SA(sexaholicsanonymous.com) for the treatment of a sexual addiction, powerlessness over lust which leads to chronic masturbation, pornography, adulterous relationships, etc. and finally EDA/OA for the treatment of eating disorders which includes compulsive overeaters.

Twelve step fellowship recovery programs continue to provide the gift of sobriety which begins with physical sobriety and then offers all addicted individuals an opportunity to treat the emotional and spiritual aspects of the three-fold addiction treatment that they are in need of. I also encourage all of you to consider the wonderful program of ACA Red Book for the treatment of the relationship illness co-dependency. It brings what Al-anon offers, a basic treatment of the illness co-dependency, to a whole new graduate like level. Since I am not able to give much more information due to our lack of time, let me say that the value of 12 step and especially the first three steps opens the door for many addicted individuals to re-establish a functional and working relationship with Almighty God and with others. Addicted individuals especially need to address the fact that their concept of God is often broken down by parents and authority figures over the generations and needs healing and recovery. Most addicts are not actually ready to take advantage of the body of Christ in church without first healing their concept of God. This is done very effectively by participating in meetings, having a sponsor and working/living the 12 steps of recovery. It also provides an avenue by which individuals learn and develop a means to be reconciled to Almighty God and to those that have harmed or transgressed them over the years. They also gain some of the foundation blocks to restore trust in all vital relationships which include a measure of humility, and obedience in order to give up a life of self-sufficiency and being disconnected with God and others which is rooted in pride. Sobriety/recovery also includes freedom and healing from the two major roots of addictions for every addicted individual and co-dependent which are resentment and fear.

For further information, the work of over thirty years of recovery, hundreds of hours of pastoral counseling/psychotherapy in treating addictions which combines 12 step recovery along with the Orthodox methods of treatment is now available. Go to Ancient Faith Radio and look up Healing Addictions, an Orthodox Method of Treatment, Part I and the Recovery Continues, Part 2, which I have developed by the grace of God. All of the work regarding recovery and sobriety were also done under the careful and prayerful supervision of one of the greatest Orthodox missionaries which America has ever produced. His name is Archpriest Fr. Gordon Walker (blessed memory) of the Antiochian Orthodox Church in America.

It is also important for me to emphasize especially the first podcast after the Introduction in the Recovery Continues, Part 2 called "Listen to our Bishops". In this episode I discuss the value of the icon of the Inexhaustible Cup appearing in the year 1878 in the city of Serpukhov, Russia and the Society of Sobriety which established shortly after the appearance of the icon. In this episode, I quote His Holiness, the late Patriarch Alexy II, His Holiness Patriarch Kirill and His Eminence, Metropolitan Hilarion (Alfeyev), the First Hierarch of the Russian Orthodox Church Outside of Russia. In those quotations, they make clear the value of 12 step recovery and encourage all those who are in need of treating addictions to participate and in their own way have clearly given individuals who are Orthodox their blessing as a result.

Having emphasized the value of twelve step recovery everyone knows that it is still a means to an end and has its own shortcomings. The end of course is the Lord High God, the revelation of the One and Only Living God, the Blessed Trinity, the Father, Son and Holy Spirit. I am now going to try to give you a brief Orthodox perspective on the treatment of addictions, especially looking at going beyond technical sobriety.

Beyond technical sobriety …

While the acquisition of physical sobriety is a great gift for the individual who suffers with an addiction, in and of itself this is not sufficient. Many individuals who are engaged in a 12-step recovery program, including Orthodox Christians, reach a crossroads in their life, and they are in need of healing at a deeper level. They are in need of a new found freedom, mainly, the acquisition of emotional and spiritual sobriety.

The 12-step programs are to be commended, however, they do not go far enough. Someone may appear to be sober on the outside, but without this inner transformation, which is not adequately addressed in the 12-step program, the recovering addict will display characteristics of selfishness, resentment, and fear resultant from a lack of faith in a loving God. They remain miserable, angry, depressed, prone to self-pity, restless, and discontent. They persist in a state of denial while looking to blame those around them, rather than taking a deeper responsibility for themselves.

The 12-step program is concerned with what they call the "dry drunk syndrome". This term refers to an individual who has not experienced the deeper levels of sobriety that are emotional and spiritual in nature. Contentment comes from maintaining a certain number of days of physical sobriety. These persons find themselves "dry" (not drinking), but they continue in the habits of addiction. This often includes living a double life and stashing a great number of skeletons in the closet.

Compounding this problem is the reality that more than half of all alcoholics suffer from multiple addictions. One of the best kept secrets among alcoholics and addicts is the presence of a sexual addiction, which they act out in secret with destructive behaviors such as masturbation, internet pornography and/or infidelity.

Significantly, because the fullness of sobriety is not acquired in the first place, those who suffer from the "dry drunk syndrome", and have been involved in the 12-step fellowship for many years, present a distressing scenario. Some of these persons, after long periods of physical sobriety, end up having a relapse and committing suicide. This is because they have been acting out with a separate addiction which has not been treated. According to some estimates, and based upon my own professional experience, many addicts suffering from alcoholism, drugs, sexual addiction, overeating, and overworking, are themselves adult children of addictive or dysfunctional households.

Among the multiple addictions is included the relationship disease of "co-dependency". The obvious symptoms of this illness are that the afflicted person is heavily invested in over managing, fixing, and controlling others. It is always marked by the need to seek the approval of others above all else. Those involved in helping professions especially doctors, nurses, therapists, and clergy are the most vulnerable and often disguise this destructive tendency in the name of helping others.

Orthodox Psychotherapy: The science of the Fathers and sobriety

The Orthodox Church contains within it the most pure, comprehensive, and holistic methods of treatment available to mankind for the healing of the soul and body. Deeper levels of spiritual and emotional sobriety are given to all them that seek the Lord within the Holy Orthodox Church, which is considered by the fathers as a "spiritual hospital".

Metropolitan Hierotheos Vlachos, Abbot of the Birth of the Theotokos Monastery in Nafpaktos, Greece, writes in his work "The Science of Spiritual Medicine: Orthodox Psychotherapy in Action": "The whole therapeutic method of the Orthodox Church is not aimed simply at making human beings morally and socially balanced, but at re-establishing their relationship with God and one another. This comes about through the healing of the soul's wounds and the cure of the passions through the Sacraments and the Church's ascetic practice".

This statement captures the essence of the Orthodox perspective on the topic of healing, which differs vastly from the Western approach to therapy. Orthodox psychotherapy is the science of healing found in the One, Holy, and Apostolic Orthodox Church. Its primary focus is our need to re-establish and to be reconciled first with God, and then with our neighbor and ourselves. This places the first commandment of our Lord in its proper perspective "Thou shalt love the Lord thy God with all thy heart, and with all thy soul, and will all thy mind" (Mt 22:37).

As a result of the healing of the primary relationship with the Lord God, one is then able to love one's neighbor as oneself. The principles of Orthodox psychotherapy also stress the need to heal the soul and heart, and as a result of this healing, the mind will be healed, as it mirrors and reflects the condition of the inner heart.

The Fathers describe the soul as the nous (the eye of the heart), which has the primary function of giving the human being the noetic capacity to "see" God, or to have communion with His uncreated light. The capacity of this eye of our heart to see is contingent upon the state of purification that one's soul has undergone. This cleansing is needed to free it from the darkness resultant from the Fall of man, as well as from the worldly influence that surrounds us.

In addition to the nous, there are two other parts to the human soul. These are defined by the Fathers as the intelligent function and the irascible function. Because of the complexity of this theology, this requires a separate article at some future date. However, very briefly, the intelligent function is not to be confused with knowledge of God that is achieved intellectually, rather it is the knowledge from the heart of the mysteries of God. The irascible function permits us to willingly abide by the commandments of the Lord, to discern right from wrong, and to understand God's will for us.

All of the soul's functions became dysfunctional as a result of man's separation from God, at the Fall. This simultaneously caused man to live outside of harmony with the Lord's creation and with his own neighbors.

But the methods of treatment found in the Orthodox Church are designed to remove the sins and obstacles from our hearts, which keep us from experiencing the fullness of intimacy with our loving God.

The first of three functions of the soul is called by Saint Gregory Palamas the "appetitive function". The word "appetite" means to have a longing for (inherent craving), hunger and thirst for God. We might ask why God created this function within the soul in the first place? Before the Fall, this need was satisfied by Communion with our God and Maker. From this perspective, it is clear that all addictions have their roots in the dysfunction of the soul's appetitive function. Mankind prone to sin chooses to fill the void and meet this need with created things, rather than receiving from and being satisfied with the living water and the immaterial manna (food), which can only be provided by Almighty God. We must all come to terms with this insatiable desire and our futile attempts to fill the void in our souls with any number of created things. Our persistent wrong choices only create more separation from God and others, deepen our unsatisfied hunger and thirst, and lead to self-destructive behaviors (addictions).

Where to begin

One of the shortcomings of the 12-step fellowship is that, while it is important to focus on the removal of character defects which hinder our relationship with God and others, there is not enough emphasis on replacing these defects with virtues. Thus, there is a void, an emptiness that is not being filled, which has a burdensome impact upon the human soul.

On the other hand, one of the fellowship's greatest contributions is the program's emphasis on the need to include actions of sobriety. The program strongly teaches that no one gets sober relying on their own thinking process. Sobriety is attained by sober actions. Examples of sober actions are going to meetings, calling one's sponsor, working the steps, reading the literature, and participating in the fellowship. Individuals in recovery, as well as members of the Orthodox Church, can learn a great deal about how to improve their spiritual life with this emphasis on doing something about it instead of just talking about it.

For the individual, recovering addict or not, wishing to become more serious about accessing the fullness of "the methods of treatment" in the Orthodox Church, here are some suggestions to get started.

• Come to terms with our spiritual hunger and thirst by becoming aware of our sins. Many individuals are in a state of denial about their personal sins and only a crisis brings about getting their attention. Others are complacent about their futile attempts to fill the void in their soul with created things. For all of us, every act of disobedience (sin) toward our loving God and neighbor has its consequences. Much of our pain and sorrow is self-inflicted.
• Admit that our own self-will and self-sufficiency fuel our common enemy, which is pride and arrogance. It is time to admit that we act like orphaned children who have not experienced the fullness of the adoption which God, our Father, grants to each of us.
• We must acknowledge that the removal of our sins and the acquisition of purity of the heart will include receiving from the Lord that which we are lacking. Our loving God, the Father, desires to satisfy our hunger and to quench our spiritual thirst.
• Take practical actions of sobriety: walk humbly and become childlike; seek or renew the guidance of a spiritual father or parish priest, and be willing to begin, under his direction, a daily rule of prayer at home; set aside a minimum of one-half hour each day for personal prayer, and include within this time the proper use of the prayer of the heart, the Jesus Prayer.
• Take five minutes a day to pray for others.

The Fellowship of the Inexhaustible Cup

Please consider joining The Fellowship of the Inexhaustible Cup, a ministry of intercession. This ministry of prayer for others is dedicated to the Mother of God and her Holy Icon of the Inexhaustible Cup. Participation in the Fellowship requires only 5-6 minutes of Akathist prayers daily, including reading names from a prayer list, and joining the Mother of God in prayer, who herself is the queen of intercession. More information regarding this ministry and its outreach pastoral counseling services provided as part of this nonprofit work can be found at www.inexhaustiblecup.org.

We began this discussion with talking about some of the major core issues which all recovering addicts have in common, namely: overcoming selfishness/self-centeredness, resentments and fear. There is no greater method of treatment available to us in the overcoming of both selfishness and resentment than the practice of praying for others. The grace of Our Lord Jesus Christ is greatly showered upon them that are willing to walk humbly and obediently in their imitation of Him, as well as following the example of Our Lady, who prays continuously for people in need.

My wife of 32 years, Matushka Syncletiki, and I, have learned first-hand about the magnificent benefits of setting aside time to pray for others, both living and departed, on a daily basis. I assure everyone reading this article that any sacrifice that we have made to consistently pray in this manner on a daily basis, has been outweighed by the benefits which we have experienced. Our loving Father is always pleased with those children who imitate Our Lord and His mother by praying for others. He pours out rich and abundant blessings upon us in response to our "actions of love" for others.

Please consider joining our fellowship with the use of minimum Akathist prayers to the Mother of God, the Inexhaustible Cup along with a small monthly contribution which will help us who live by faith to produce more work in the fight against the enemy who is invested in promoting all manner of addictions and their destructive effects. For further information, click the membership section on our website (www.inexhaustiblecup.org). If you have any questions or are seeking further information about this article, or professional pastoral counseling (services rendered) for our members, you may contact Fr. Christophe directly at: orthodoxpsychotherapy@gmail.com or by telephone or text at 540-676-7484 (USA). Thank you very much for your consideration and may our Lord bless you and keep you.