James H. Berry
“Deaths of despair” is the appropriately grave moniker for the plague of premature deaths that has expanded across the United States over the past few decades. Middle-aged and young adults are dying at such record rates that the average life expectancy has declined each year since 2015.
The last time the United States saw a decline like this was in 1918, when World War I and especially the Spanish flu decimated large swaths of the population. But this time, the epidemic is not fueled by a virus or a war. Rather, elements much more pernicious and vexing are to blame: drug overdose, suicide, and liver failure due to drugs and alcohol. They are truly deaths of despair. The fact that these deaths are entirely preventable and rooted in human behavior adds a layer of maddening frustration.
As a psychiatrist who specializes in treating addiction, I am keenly aware of the frustration. Through my work, I have personally known scores of people who died too young.
When I graduated medical school and entered a psychiatry residency, I expected to see death in the intensive care units or the halls of hospice centers as elderly patients at the end of long lives were either kept alive by modern technologies or provided symptomatic relief as they passed from this life to the next. I expected to see death in emergency rooms as ambulances transported victims of gunshots or traumatic car accidents. I certainly did not expect to see death routinely in a psychiatric practice. Yet I am a daily witness to the self-destructive nature of addiction and the catastrophic consequences experienced by loved ones.
At the same time, I am a daily witness to lives reclaimed from the ashes. People do recover. People do change. Believe me; if this were not the case, I would have changed professions long ago. I actually love the work I do. There are few other areas of medical practice where a physician can see such dramatic improvement in the wellbeing of a patient. Fathers become better fathers. Wives become better wives. Students become better students. Employees become better employees. You get the picture. People begin attending to responsibilities, accomplishing goals, and enjoying life. Addiction is not a hopeless condition. It is a condition amenable to correction and treatment.
I am convinced that the church has a vital role in countering the deaths of despair. What is the antidote to despair? Life filled with hope, connection, and purpose. The church offers this life in abundance. Last year in Ordained Servant, I introduced the medical model of addiction (see “Flesh and Thorn: Understanding Addiction As Disease,” Ordained Servant Online, June/July 2018) to help church officers understand the nature of addiction as a biologic, psychologic, and social malady. In this article, I seek to give some guidance on ministering to those who are suffering from addiction.
In the throes of addiction, it is tempting to believe that nothing will change and one will be forever stuck on the treadmill of failure—failure to resist temptation, failure to obey God, failure to meet the simple obligation of choosing not to pick up the drug or the drink one more time. After a particularly hurtful or embarrassing episode, those in addiction frequently promise themselves or others to never use again—then fail.
For all of us, even apart from or before addiction, life is hard. Suffering is real. Finding relief by temporarily anesthetizing a hopeless certainty of perpetual physical and mental distress is a seductive solution. Done repeatedly over time, it becomes as natural as breathing. To cease using is akin to cutting off oxygen. Life without the substance becomes unimaginable, and thus giving into failure becomes an acceptable option.
Here we apply the hope of the gospel. In this body, we are stuck on the treadmill of failure. All of us. We are corrupt in every ounce of our being. We constantly fail to live according to the holy standards of God’s law. Thankfully, Christ succeeded by obeying God perfectly. His substitutionary death and glorious resurrection contain the hope of a new body to enjoy a new heaven and new earth upon Christ’s return. Through faith in Christ, we have the freedom to pursue righteousness. The Holy Spirit now dwells with our spirit and is a guarantee that failure is not our end. As we abide in Christ, he promises to carry us through this failure to glory. Our salvation does not depend on our sobriety. Neither our justification nor sanctification depend upon our efforts. Fostering hope by constantly drawing people to this truth is a balm for suffering souls.
How does one abide in Christ? By faithfully making use of the means of grace in the context of his body, the church.
Addiction is an intensely isolating condition that breeds soul-deadening guilt and shame. This guilt and shame further isolates those in addiction, in an unhealthy feedback loop. Often, the very community Christians suffering from addiction need the most is the community they most wish to avoid. We need to cultivate a culture of embracing broken people as broken people.
Here, I believe a renewed call for the church to return to the biblical practice of confession could be particularly useful. (For more on this practice, see Kelly M. Kapic, chapter 10, “Confession and the Other,” in Embodied Hope .) The receiver of the confession could be an elder or trusted member who accepts the confession not as one who is perfect, but from a position of brokenness. This serves to benefit both the confessor and the one receiving. Verbally acknowledging sin to another relieves the burden carried by oneself and encourages accountability. There is also something incredibly powerful in hearing God’s word of forgiveness from a brother or sister.
Confession also allows the one receiving the confession to examine himself or herself and recognize that there are no “acceptable” sins. We all have our own pet idols we crave more than God, pet idols to which we offer our worship. Possessions, recreations, recognition, career advancement, food—when these become idols, they are not as overtly or obviously destructive, and may even be socially acceptable, so we let ourselves off too easy. We should not.
Even more basically, Christians in the church should be spending time with one another. Fostering hospitality and inviting each other to supper or a bonfire or a game night can help those in addiction move beyond the shell of isolation. Shared activities can also create alternatives to times when one would typically engage in addictive behaviors. If you know that someone in your church is struggling with an addiction, ask which times of the day or week he or she is most vulnerable. Offer to be available by text or call whenever needed to help ride out the cravings or to talk through a difficult period. Your conversation or quiet presence can be a much-needed lifeline.
During time with one who is suffering, avoid the trap of believing that you need to fix the problem. You cannot fix it. No words or actions of yours have the power to truly heal anyone. Often those in addiction simply need to be heard or have a space where nothing is said at all. Just being with someone who is suffering may be therapeutic. Do not be afraid to say you do not know what to say, but that you are committed to being there for them.
Addiction lends itself to an exaggerated focus on self that is not helped by contemporary culture. As America celebrates choice and individual empowerment, we are constantly bombarded by messages of restlessness, of change, of self-fulfillment.
Participating in the life and fellowship of the church, however, gives one purpose beyond meeting one’s individual desires. Regular Sabbath-keeping and participation in the liturgical rhythm of worship shapes and forms us in a way that is a corrective to a culture that preaches instant satisfaction and dismisses delayed gratification. Keeping the Sabbath is radically countercultural. We do not get to choose whether or not to have a Sabbath day. God has determined it for us. In keeping it, we learn submission, patience, and communal joy.
During worship, we reorient our identity, passions, concerns, and desires to our God-given purpose of glorifying him. We come before God’s throne as sinful creatures in need of salvation and not just sick creatures in need of healing. We communally confess this reality and seek God’s forgiveness. We receive the declaration of his forgiveness and formally receive peace from his throne through his minister. God’s Word cleanses us as we hear Christ preached. With our tongues, we pour out our lamentations and praise in prayer and song. In the Lord’s Supper, we taste that the Lord is good. We do not grasp nor gorge upon the elements. God gives the elements to us through the hands of his church. We connect the reality that our physical sustenance, like our spiritual sustenance, is entirely dependent upon God. We look forward in eager anticipation to the overflowing richness of the table set for us in glory. On earth, the satisfaction of our food and drink lasts but a short while, but in heaven our enjoyment will be limitless as we feast upon our limitless God.
Service to others through diaconal needs or even simple tasks such as setting out snacks and coffee extends one beyond the self. All church members should be challenged to serve, but there is a particularly restorative value for those burdened by addiction to focus on the care of others. I encourage deacons to enlist these folk to help whenever there is opportunity.
We all wrestle with sin and are called to be holy. We all are to throw off everything that enslaves and ensnares. Our world is broken, and addiction is a manifestation of this brokenness. The church is for broken people. In her, we find the only sure fount of hope, connection, and purpose. We should open her doors wide and invite a dying world to enter and taste the goodness of the Lord.
The author is a ruling elder at Reformation OPC in Morgantown, WV, an addiction psychiatrist, associate professor, and interim chair of the Department of Behavioral Medicine and Psychiatry at West Virginia University. New Horizons, October 2019.