Addictions: Religion as a Treatment?

Recently my attention was drawn to an article in The Tablet, the self-styled International Catholic News Weekly. To say the content left me feeling a little dismayed, perhaps even incredulous, in almost equal measures, is probably something of an understatement.

Who logically sees any form of religious doctrine as a valid, let alone recommended, clinical intervention… for any ‘illness’? Apart from the Catholic Church apparently.

Cue screams of “bigot” and the tired accusations about religious xenophobia… but you couldn’t be further from the mark. And, before I go any further, anyone who knows me personally would evidence the fact; I respect and fully support everyone’s right to follow whichever faith or belief structure they might choose. I’m not concerned if that belief is one of our more traditional / mainstream religions, or any one of the ‘new-age’ /  ‘alternative’ tenets… that’s your choice. This blog is merely personal observations about at problematic issue, one that I have some personal concerns about.

Historically, religious doctrine has been at the forefront of supporting people who are ‘troubled’ by their ‘unsocial’ behaviours – like excessive drinking – but is this process still appropriate?

Religion is a social-cultural system of designated behaviours and practices, morals, worldviews, texts, sanctified places, prophecies, ethics, or organisations, that relates humanity to supernatural, transcendental, or spiritual elements. However, there is no scholarly consensus over what precisely constitutes a religion. (wikipedia.org)

Research supports the premise that; social-structure, a sense of community spirit and connection with others, in a safe and supportive environment of mutual-aid (see example) actually aids the process of recovery from addictive behaviours.

Devote followers of many diverse religious tenets, have always kept busy ‘saving’ their fellow humans, from themselves, especially when it comes to the harms caused by excessive of alcohol consumption. The followers of Catholicism, are no different (in this respect) to any of those who follow Methodism, Quakerism or, the Salvationists, who (arguably) built their religion around that process. Transition into support for drug addictions was to be expected and mostly unsurprising.

Interestingly, ‘church’ providers have historically delivered most of our residential ‘rehab’ facilities in the UK. This has been the case for decades however; I believe that religion, as a basis within any treatment structure, actually prevents many people from engaging in the process of recovery. Could this be a reason for, rehab facilities getting more ‘secretive’ about their religious connections in recent years?

Is any form of a religion based process still the best way forward? I say ‘still’ because undoubtedly, the process worked historically, but I don’t believe it can or does any longer, thanks to an increasingly secular society.

Don’t get me wrong, I’m not challenging or dismissing any past worth of those facilities, many people got to a better place in their life because of these services. Like many others, I value and would always applaud all people who offer their support to their fellow humans. Being disadvantaged in shape or form, as with addictions, is sadly a situation we could all find ourselves in one day.

The community and connection factors already outlined (above), are fundamental components of any effective recovery from addictions. As tribal animals, to a greater or lesser degree, we all need to feel connected to our fellow humans. Engaging with mutual-aid, where people help and support each other, is also a proven resource to aid recovery, from any addictive behaviour. My fundamental concern is; why does this process (apparently) nearly always have to find root within some religious or ‘faith’ based setting or context?

Research has shown that; Despite the effectiveness of 12-step groups, most people reporting a prior alcohol use disorder (AUD) do not sustain involvement in such groups at beneficial levels. (Read more)

Today, perhaps more than ever before, most treatment [for addictions] is ‘clinical’ and based in science, unlike previously. The range of subsequent support for sustained long-term recovery (after treatment), is now more diverse than was previously the case. The efficacy of some ongoing support structures are now (mostly) evidenced by science.

Which leads me to ask; why do we still have an expectation that everyone (impacted by addiction) will achieve and sustain long-term recovery by simply; going to (expensive) rehab (like the celebrities), and then becoming almost totally reliant upon mutual-aid meetings for the rest of their life?

Blind-faith and the reliance upon any religious doctrine is thankfully, no longer the foundation of addiction support services, at least not overtly. Some of commercial services (see here) are a little less transparent about their connections or faith basis (see here); despite still providing (some) worthwhile elements of support and structure for (some) people.

All that assumes the individual has been able to make an informed personal choice to follow that particular pathway. Too often, this isn’t the case. Many people, particularly those who have attended residential rehab facilities, report having their ‘choices’ forced upon them. Both by the people directing attendance to the resource but worryingly, also by the staff within these facilities. How can that be correct? Is this the best way to offer support for those in need?

I would suggest not. But, despite our increasingly secular society, with perhaps more humanist methodologies than before; faith based options still form a cornerstone of the support we provide for people with addiction issues.

In my opinion, all available support should be totally devoid of any religious based doctrine. It is also unethical and morally wrong for any faith based facility to be covert about their foundations and belief. But worse, these beliefs dressed as ‘treatment’ are foisted upon unsuspecting and vulnerable ‘patients’ (aka customers). Transparency and the availability of real choice are key for the success of any recovery journey but sadly, this isn’t always the case within the still prominent Commercial Recovery Commune.

But back to the example used here. Reporting (mostly) on the past ‘success’ and the 25th anniversary of THOMAS – a charity that “provides holistic drug and alcohol rehabilitation for people who struggle with addiction” – the article appeared to suggest, at least from the headline, that; “faith can transform addiction recovery.”

That may well be the case, for some people with an existing ‘belief’ or ‘faith’ however; something that is rarely considered is – what are the impacts for realisation of long-term sustained addiction recovery for the ‘non-believers”?

In addition to the THOMAS anniversary celebrations, which to be fair did form the main crux of the article, Father James McCartney, the founder and current CEO of THOMAS, was mostly offering his personal observations about; the current political and funding impacts for prison (and community) based addiction recovery and rehabilitation services… within a Catholic ‘news’ platform.

Ultimately if the government increases the budget for rehabilitation now, I think it will result in reduced spending on the prison system and cut public spending as a whole in future. (Fr Jim McCartney, THOMAS Founder and CEO)

I can wholeheartedly agree with Fr. McCartney when he says: “We need to look at prisons in a more creative way” – whilst working towards addressing the issues of rehabilitation and recovery from addictions. But personally, I believe that as a society, we are already moving in that direction, all be it at a slow pace, in some areas of the secure estate.

I think faith has a unique role in the rehabilitation process. Medical treatments have always been the dominant factor, but psychosocial treatment is transforming the process of rehabilitation. (Fr Jim McCartney)

McCartney bemoaned the passing of their “successful” (12-step based) THOMAS programme which was previously delivered at HMP Lancaster, prior to the decommissioning of Lancaster Castle as a prison.

…we went into the prison every week and then worked with the prisoners following release and the results were remarkable. (Fr Jim McCartney)

Congratulations but, irrespective of any favoured ‘old-hat’ methodology, that was actually some time ago. What about now? Unless McCartney has more recent experience to draw upon (which I’m unaware of), within that specific sector; is it really fair to base assumptions about treatment and support standards within (today’s) prisons upon knowledge gleaned some twenty years ago? I would suggest not.

We are seeing more psychosocial and spiritual methods being used in addiction treatment now, especially with the increased focus on the importance of mindfulness (Fr Jim McCartney)

Yes, that is the case and within the the lion’s share of the residential rehabilitation industry, where the vast majority of their resources a delivered from a 12-step perspective of total abstinence.

However and from my current experience; despite there still being some way to go, the general quality of recovery support structures, in many prisons, have improved immensely over recent years.

I have personally witnessed many appropriate treatment interventions, along with some very effective recovery support structures. All of which are being delivered amongst differing contracted service providers, across large swaths of the secure estate. But, the real success stories, for positive long-term and sustained recovery outcomes, often sit within the establishments which have successfully signposted and provided access to personally selected recovery pathway support… informed choice AND availability.

Now don’t get me wrong and please don’t see this as me being disparaging of James McCartney (or THOMAS) in any way. He clearly has many skills and empathy for those people in need of support. I’d be shocked at any priest who didn’t display and evidence those valuable traits. This is not a personal attack and I’m sure that Fr. McCartney’s work, supporting addictions recovery, over several decades, has been welcome, well received and immensely beneficial for many people.

McCartney is eminently more academically qualified than I am however; as with many (commercial) rehabilitation facilities, his organisation will undoubtedly be feeling the current pinch of austerity. That said, and any ‘marketing’ opportunities aside (which this story might have been about); perhaps these types of facility, which have roots in religious beliefs, are actually suffering from the proverbial own-goal? Could this factor alone be, the main reason behind so many facilities being covert and less than honest about their connections with faith and religion?

According to research: “Religious people were more likely to be suspicious and unwelcoming of people who are different, while secular people were more likely to be open and accepting of those who are of a different race, ethnicity, religion, or country.” (Religion, Secularism, and Xenophobia – Psychology Today)

No comparative ‘survey’ research should be taken as evidence that all religious people are ethnocentric/racist or, that all secular people are not. That’s not what was shown in the above piece. It simply illustrates percentages, averages, tendencies, and predilections. It’s just that when examining samples, the likelihood of such sentiments increases among religiously-active populations and decreases among secular populations.

So, why would Father McCartney not publicise his theological background, which is secreted or suspiciously absent from the pages of the THOMAS website? I’m sure he is (correctly) proud of his past personal and organisational achievements. Could this be another clever marketing ploy, to attract those secular ‘customers’ or, simply an innocent omission, because personal beliefs or skills are simply irrelevant to the overall service process? I couldn’t know for certain…perhaps it’s a combination of factors?

Deceit and often dictatorial process in this area should be of concern. It presents negative impacts for addiction recovery. These factors underpin so many people’s repeated past failures and often. helps to form the basis of any reluctance to engage with these forms of support.

Finally but, to reiterate my concerns; I’m not dismissing the value of Father McCartney’s past efforts, or any of the services his organisation has supplied in the past, or now. I am however worried that we (our society, the media and (some) staff within the treatment sector), are actually failing to support many people, within an increasingly secular society, on their personal recovery journey.

When people are searching for support; can it ever be right that we place any barriers in their way, because of our beliefs and our aspirations about theirs? These barriers often serve to prevent people from achieving their personal goals!

Addendum

Key points and summary from some recent research;

  1. Spirituality and religiosity are key components in several types of substance use interventions, including 12-step mutual aid groups.
  2. To determine causal evidence of their effectiveness, the featured review looked back over the previous three decades at studies using a randomised controlled trial design.
  3. While the authors did find evidence that they were effective, the findings could not be interpreted as proof positive that spiritual/religious components were the only active ingredients operating, or indeed confirm that they were operating at all.

References:

  • Alexandre B. Laudet (2008) The Road to Recovery: Where Are We Going and How Do We Get There? Empirically Driven Conclusions and Future Directions for Service Development and Research, Substance Use & Misuse, 43:12-13, 2001-2020, DOI: 10.1080/10826080802293459
  • Zemore SE, Kaskutas LA, Mericle A, Hemberg J. Comparison of 12-step groups to mutual help alternatives for AUD in a large, national study: Differences in membership characteristics and group participation, cohesion, and satisfaction. J Subst Abuse Treat. 2017;73:16–26. doi:10.1016/j.jsat.2016.10.004
  • Zemore SE, Lui C, Mericle A, Hemberg J, Kaskutas LA. A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD. J Subst Abuse Treat. 2018;88:18–26. doi:10.1016/j.jsat.2018.02.004
  • The efficacy of spiritual/religious interventions for substance use problems: a systematic review and meta-analysis of randomized controlled trials. Hai A.H., Franklin C., Park S. et al. Drug and Alcohol Dependence: 2019, 202, p. 134–148. https://doi.org/10.1016/j.drugalcdep.2019.04.045

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