While discipling persons in recovery* is certainly not a game, Pick-up-sticks does capture something akin to the messiness of this sort of discipleship: The sticks drop and scatter randomly, and the goal is to pick up each stick without moving the others, even though they are piled one atop another. Somewhere in the mix is the master stick, the grand prize, worth 25 points, which is also the only stick that can be used to move other sticks. But getting the master stick isn’t straightforward. It’s a challenge. It’s the challenge of the game.
Discipling a person in recovery from addiction is like trying to remove the master stick from the bottom of the pile. It’s difficult, it’s messy, and it inevitably will trigger some other dysfunction or disorder that could cause a recurrence of addictive behavior. Welcome to the messy world of discipling a person in recovery.
To address this topic, I want, first, to define the terms that drive our care of persons in recovery. Second, we will consider the various approaches to recovery taken by Christian professionals in the field, with some comment on how to take an integrated approach to discipleship. Third, I will point out some of the key passages of Scripture that are useful in our biblical treatment of those in recovery. Finally, I will offer some conclusions regarding how to disciple persons in recovery.
I. Definition Drives Care
We can’t enter this world of addiction unless we understand the terms used in the field of addiction recovery. It would serve us well to remember that “definition drives care.”
The term “addiction” is highly controversial. What exactly is an addiction? Is it just a bad habit? Is it a disease or disorder? Is it a deeper spiritual problem? These are all questions that have been asked since the word addiction gained popular currency in the early twentieth century. There are three broad categories of thinking about addiction in common use today. The three models are the disease model (also called the medical model), the choice model (also called the moral model), and the habit model (also known by many other names). There are two qualifications to understand about these categories. First, although they are often called “models”, there is variation within each category. In this section I will give a brief overview without going into detail about the variations within each model. Second, these categories are not necessarily mutually exclusive although they have at times been employed in mutually exclusive ways.
1. The Disease Model
The most common understanding of addiction follows the disease model. In this model, addiction is treated as a general medical condition as in this definition offered by the American Society of Addiction Medicine:
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
A slightly different definition is offered by the American Psychiatric Association, which views addiction as a particular problem of the brain: “Addiction is a complex condition, a brain disease that is manifested in compulsive substance use despite harmful consequence.”
It is worth noting that this model is widely accepted among medical professionals, scientists, and politicians, and so one is most likely to encounter professionals using the word “addiction” as a medical category rather than as a moral/choice category. In fact, it is so prevalent that in 2007, Vice President Joe Biden introduced the Recognizing Addiction as a Disease Act in an attempt to codify the disease definition of addiction as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” Christian professionals such as Jonathan Benz have also embraced this broad categorization of addiction. Benz regularly refers to addiction as a “disease” in the sense that “like anybody with a medical diagnosis, be it diabetes or high blood pressure, addicts should not be blamed for having their illness.” Nonetheless, Benz also repeatedly refers to an addict’s responsibility in recovery. Alcoholics Anonymous likewise promotes viewing addiction through this lens: “Alcoholism is a disease … not a disgrace.”
Just as with any other model, what results from the disease model is a particular kind of care. Ever since Hippocrates introduced the concept of disease into natural history, treatment has tended toward a sickness rather than a person. Neurologist Oliver Sacks rightly complains that such accounts of natural history “tell us nothing about the individual and his history; they convey nothing of the person, and the experience of the person, as he faces, and struggles to survive, his disease.” The disease model alone cannot bear the weight of recovery. Taken in isolation from other categories of thought, adhering strictly to a disease concept may lead to agnosia—a lack of recognition of the person. The disease model is one aspect of understanding the complex issues of addiction. The disease model does not remove personal responsibility per se, although some professionals with whom I have worked seem to overlook this. It is likely that you will encounter professionals who view the disease/medical model as the opposite of the choice/moral model.
2. The Choice Model
Another way of defining addiction is the choice model, sometimes called the moral model. Perhaps the most well-known account of addiction as a choice is Jeffrey Schaler’s book Addiction Is A Choice, in which he argues that “physiology alone can never determine that someone will take a drug, or how often they will take it …. Their beliefs, values, and goals are also essential in forming their intentions.” Advocates of the choice model are just as likely to be exclusive as some are with the disease model. For instance, Mark Shaw has written extensively within the category of addiction as a choice and repeatedly poses the two categories in contradistinction. “Addiction,” he writes, “is a ‘worship disorder’ and not a man-made, theoretical ‘disease.’” (The Heart of Addiction: A Biblical Perspective, 2008, preface) Faith-based recovery programs are more likely to emphasize the choice model, and many of them exclusively so. For this reason, some local professional providers understand the choice model to be steeped in faith and contrary to the disease model. We should note, however, that there is nothing inherent within the disease model or the choice model that requires one to think of addiction exclusively as either a disease or a type of willful choice.
3. The Habit Model
In recent years, several attempts have been made to conceptualize addiction as something with which one suffers while also bearing personal responsibility. Linda Mercadante, Kent Dunnington, Marc Lewis, and Sonia Waters all insist that neither the disease model nor the choice model is comprehensive of what addiction really is. These scholars prefer other terms such as “habit” to capture the functioning and choosing aspects of addiction. They have an equal dissatisfaction with moralizing addiction as intentional sin and relegating it as a mere disease with which some people suffer. The habit model explores both the physiological and spiritual aspects of addiction. In the end, addiction is, per this definition, a very complicated bad habit.
There are many reasons to share the concern of scholars seeking a middle way. For instance, addiction is more than something that happens to a person; addiction comes from personal choices. On the other hand, people do not consciously choose to become enslaved to a substance; rather, they simply turn to the substance to meet a need and in the process become addicted. One of the earliest recorded medical references to addiction seems to have this same insight, when, in 1805, Dr. Benjamin Rush described “addiction” as a loss of control.
We must also carefully define “recovery,” which is only slightly less controversial a term than “addiction.” Two issues seem to stand out in the ongoing development of standardized terminology: what counts as recovery, and whether or not relapse is an expected part of recovery.
1. What counts as recovery?
Generally speaking, recovery is the process of overcoming harmful addictive behaviors and associated characteristics. The question, however, is when a person can be considered as “recovered”? One unfortunate outcome of the first step of Alcoholics Anonymous is the assumption that once a person is an addict, they are always an addict. But this is a misunderstanding of AA’s actual teaching. AA speaks of people who “have recovered” in ways that treat recovery as a process with a definite end. What point, then, is the end of recovery?
One account of recovery is known as Harm Reduction Strategy, in which the goal is to help a person achieve normal function by reducing the harmful effects of addictive behavior. For example, an alcoholic who frequently drives while under the influence may be convinced to begin designating a driver. While this strategy’s principles are useful, there are two problems with using it as the guiding model for recovery. First, harm reduction is a useful strategy for accomplishing the real goal of recovery—the complete cessation of harmful behavior. However, in most cases of recovery, mere harm reduction that allows for modest use of a substance is counterproductive. The second challenge is that harm reduction alone does not reflect the expressed end of people in the process of recovery: they expect more than just simply reducing the effects of their addiction.
Another definition of recovery is abstinence, or the practice of restraining oneself from indulging in a desired activity. This common understanding of recovery emphasizes a change of behavioral patterns: a person is recovered when their pattern of behavior has changed. Still, there are some limitations in this definition as well. This model of recovery lacks support from the U.S. Department of Housing and Urban Development (HUD), which does not provide assistance to organizations that require enrollment in an abstinence-based program of recovery. Secondly, it also creates a large gray area between recovery and relapse: If a person relapses, can they be said to have recovered in the first place?
A third definition of recovery emphasizes that addictive behavior stems from complex psychological and social phenomena. Recovery, therefore, is the treatment of pre-conditions. Thus, until one is healed from the pre-conditions (social, psychological, or physiological) that helped produce the addictive behavior in the first place, one is not recovered. There is growing acknowledgement that pre-conditions—often mental illness—must be addressed in the recovery process. In practice, the treatment of pre-conditions is part of recovery in either of the previous models. Treatment for pre-conditions is usually understood also as part of post-recovery maintenance. I believe ongoing research into pre-conditions and addiction recovery will continue to influence our understanding of recovery by expanding it further into the realm of neuro-science and the behavioral sciences.
Admittedly, none of the current definitions of recovery are without difficulties. Harm-reduction strategies should be part of recovery but are insufficient for defining the end point of recovery. Abstinence is the most widely used definition of recovery. I find it most useful of the three possibilities because it is most easily measurable. Yet, recovery from pre-addictive psychological and/or social factors should not be disregarded. It is very probable that a person who has recovered normal functioning and is practicing abstinence, will experience ongoing struggles with the desire to return to harmful addictive behavior, unless these pre-conditions are addressed.
2. Is relapse part of recovery?
The second significant question regarding recovery is how it relates to relapse. Although persons with addictions commonly use the term “relapse”, Beth Sanders, founder of the National Affiliation for Recovery Residences, has argued repeatedly that recovery operators ought to use the term “recurrence” instead, with the reasoning that “relapse” is socially derogatory and stigmatizes a person in recovery. Despite her judgment, “relapse” continues to be used by addicts themselves, operators of recovery residences, and professional staff.
I believe we can use both terms productively by distinguishing two kinds of behavior: Recurrence should be defined as an event in which a person in recovery repeats an addictive behavior. Relapse should be defined as a series of events in which a person both repeats addictive behavior, returning to previous harmful patterns, and abandons support. Unless both of these conditions for relapse are actualized, a person has only experienced a recurrence. This differentiation between relapse and recurrence has significant theological implications (as discussed later), and thus, while recurrence may be part of recovery, relapse is never part of recovery — it is counter-recovery.
The final term that drives care is “discipleship.” In the Christian worldview, recovery is a matter of discipleship, that is, of learning how to deny oneself, identifying with the crucified Lord daily, and following Jesus (Luke 9:23).
To disciple recovering addicts means to help a person learn how to abstain from harmful addictive behaviors and find healing in the joy of following Jesus.
To be a disciple is to be a learner. Our discipleship never ceases. It is discipleship that supports a person in recovery and beyond. It is discipleship that places every person on equal footing before the crucified Lord. Whether our sin has become addictive or not is ultimately immaterial to our need to be spiritually formed as disciples. To disciple recovering addicts means to help a person learn how to abstain from harmful addictive behaviors and find healing in the joy of following Jesus.
II. Christian Approaches to Recovery
Beyond defining the terms as we have, there are conceptual issues that need clarification before we are able to provide consistent care for persons in recovery. In this section I will describe the various approaches among Christian professionals in the recovery field. These approaches are not mutually exclusive, but may be implemented independently or integrated, the latter being the best in my opinion..
A. THE WAY OF ESCAPE
This is not a professional model of recovery, but is commonly employed by Christian believers. The grounds of this approach is 1 Corinthians 10:13, “God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it.” Often a caring person will offer this verse as assurance to an addict that recovery is possible. However, the difficulty is both practical and theological. Both experience and theology teach us that enslaved humanity is not able to navigate their own way out of sin. Very often the onus to figure it and get over an addiction is placed squarely on the shoulders of the addict, and failure to do so is seen as evidence of a lack of faith in God.
The mentality of well-intentioned people who use this verse this way, is that it is a promise to each individual as though each person is responsible for finding their own way of escape. This is a most unfortunate and devastating approach to person struggling with an addiction, whether it is heroin or pornography. It overlooks the fact that recovery is a communal process, and that none of us are able, alone, to recover from addictive behavior. Thus, the major oversight in the Way of Escape approach is the role of the church community in the life of discipleship. Very often our way of escaping temptation is accountability and community with other believers. It is Christian fellowship aided by the Holy Spirit, not self-sufficiency, that is the common and expected way of escape.
The other side of the equation is problematic too. This approach may imply that it is up to God to simply deliver the addict, without any recourse to a person’s choice or attitude in the matter. When a person fails to find freedom from their addiction, God is to blame for failing in his promise. Gerald May rightly describes these two problems and the solution in his book Addiction and Grace:
Addiction cannot be defeated by the human will acting on its own, nor by the human will opting out and turning everything over to the divine will. Instead, the power of grace flows most fully when human will chooses to act in harmony with divine will …. It is the difference between testing God by avoiding one’s own responsibilities and trusting God as one acts responsibly.
B. NORMALIZING ADDICTION
A second approach found among Christian professionals is the normalization of addiction. In his 1988 book, Addiction and Grace, psychologist Gerald May describes addiction as something common to humanity: “To be alive is to be addicted, and to be alive and addicted is to stand in need of grace.” He concludes, “We must work with our addictions, seeking the grace within them and trying to minimize their destructiveness instead of spending our time fantasizing what it would be like to be totally free from them.” Although this may seem to imply only a harm reduction strategy, May’s approach does provide an account for something more.
According to May, the aspect of addiction known as attachment is permanent.
We may control our behavior in response to our addictions, and we may, with grace, be delivered from bondage to them. Then, as time passes, their pull becomes less intense. But throughout our lives, their potential for reactivation continues to exist within us. The brain does not forget. From the standpoint of psychology, this means we can never become so well adjusted that we stop being vigilant.
As May makes clear, this model does not suggest that addiction cannot be overcome. Instead, the focus is how normal addiction is. He views gambling, alcoholism, opioid addiction, overeating, and workaholism as all the same in terms of their identity as addictions.
Is normalizing addiction helpful? Yes, as a de-stigmatization strategy. The stigma of being an alcoholic or drug abuser usually drives a person into isolation or even secrecy. But insofar as normalization might be understood approval of behavior, we would expect that one’s eagerness to recover would be dampened. The goal of normalization is not to weaken one’s attitude toward recovery but to provide a sense of solidarity and community.
All have been enslaved to sinful behaviors and stand in need of grace and recovery. Normalization allows the disciple-maker to place a person’s particular addictive behavior into a theological context in which all persons are equal before God. Although I have never been a drug addict, by adopting some measure of normalization into discipleship, I should be able to convey the idea that I am not spiritually advantaged before God because of that particular lack of experience. All have sinned (Rom. 3:23; Isaiah 53:6), so no one should cast stones. Our role as agents of recovery is sympathy and support rather than condemnation and stigmatization.
C. THE WORSHIP MODEL
An approach that seems to be growing in popularity within faith-based recovery programs is the view that addiction is idolatry, or what we may call the Worship Model. Addiction is a problem of wrong worship. Kent Dunnington argues that addiction is “a sort of counterfeit worship.” Mark Shaw says that idolatry is “the proper biblical name for substance abuse problems.” Gerald May describes “the distortion of ultimate concern” as a characteristic of addiction that can, in another word, be called idolatry. The higher power at work is the addiction, not God.
This model explicitly appeals to several aspects of Christian theology. Addiction is a turn inward upon ourselves. Anything that replaces God as our primary occupation in life is an idol. Idolatry, therefore, is never more apparent than when a person is caught up in addictive behavior.
Treatment for addiction according to this model gives special attention to symptoms: bitterness, guilt leading to the avoidance of emotional pain, discontentment with a desire for a “quick fix,” loneliness, depression and despair, people-pleasing, and the fear of others. Primary treatment is spiritual in nature. “Addiction is the outward manifestation of the inward problem of the lack of intimate relationship with your Heavenly Father.” Addiction is an idolatry problem; and idolatry is an intimacy problem. The solution is finding a healing relationship with God. May describes this process as detachment and reattachment.
D. THE SOCIAL MODEL
The final model considered here is the social model, which emphasizes the role of the community in the recovery process. This is popular in both faith-based and non-faith-based recovery contexts. Gerald May advocates the model from a Christian perspective: “Grace is always a present possibility for individuals, but its flow comes to fullness through community.” A Christian use of this model finds theological grounds in the doctrines of the Trinity and the Church.
Probably no other community than the church is better situated to provide an environment of recovery through the social model, which emphasizes the role of the community in the recovery process.
Each person, addicts and non-addicts, exist within some social sphere. Some are harmful and others helpful. “When the community surrounding an addicted person tries to help in any way that does not support ending the addiction, it will wind up supporting the addiction instead.” Very often an addicted person needs to be removed from a harmful social environment. But isolation—such as that practiced by the criminal justice system—is not the solution to recovery. What is needed is a new social environment; one that will contribute to recovery. The social model attempts to detach a person from their harmful environment, and reattach them to support within a healthy community.
Probably no other community than the church is better situated to provide an environment of recovery through the social model. Applying this model goes beyond just inviting someone to attend a church service or assuring them a ride on the bus for Sunday School. It urges us to be involved in their daily lives in deeper ways. Currently, our recovery staff implements a social model of recovery that includes multiple group activities daily. For some this includes residing in a recovery home where residents live as a family and support one another. Group therapy, corporate worship, family meals, and shared employment are all elements of the social model. The goal is to integrate each person into a highly functioning Christian “body.” When the Church is properly functioning, each member is able to mature spiritually (Ephesians 4:15-16).
* “Persons in recovery” is a better description but bulky phrase so I’ve chosen to use “addicts” in the title as a term of predication rather than identity.
- Sonia E. Waters, Addiction and Pastoral Care (Grand Rapids: Eerdmans, 2019), 54.
- American Society of Addiction Medicine, “Public Policy Statement: Short Definition of Addiction,” a paper published August 15, 2011. URL: https://www.asam.org/docs/default-source/publi c-policy-statements/ 1definition_of_addiction_short_4-11.pdf?sfvrsn=6e36cc2_0. Retrieve December 11, 2019. Emphasis added.
- American Psychiatric Association, “What Is Addiction?”. URL: https://www.psychiatry.org/patients-families/addi ction/what-is-addiction. Retrieved December 11, 2019. Emphasis added.
- Marc Lewis, The Biology of Desire: Why Addiction Is Not A Disease (New York: PublicAffairs, 2015), 11.
- Benz, Jonathan and Kristina Robb-Dover, The Recovery-Minded Church: Loving and Ministering to People with Addiction (Downers Grove, IL: IVP Books, 2016) 107.
- Linda Mercadante, Victims and Sinners: Spiritual Roots of Addiction and Recovery (Louisville: Westminister John Knox, 1996), 6.
- Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales (New York: Harper & Row, 1987), viii.
- Jeffrey A. Schaler, Addiction Is A Choice (Chicago: Open Court, 2000), 8.
- Mercadante, Victims and Sinners.
- Kent Dunnington, Addiction and Virtue: Beyond the Models of Disease and Choice (Downers Grove, IL: IV Academic, 2011).
- Marc Lewis, The Biology of Desire: Why Addiction Is Not A Disease (New York: PublicAffairs, 2015).
- Sonia Waters, Addiction and Pastoral Care (Grand Rapids: Eerdmans, 2019).
- Stanton Peele and Archie Brodsky, The Truth About Addiction and Recovery: The Life Process Program for Outgrowing Destructive Habits (New York: Simon and Schuster, 1991), 19, are an example of secular medical professionals who reject the idea that addiction is a disease.
- Dunnington, Addiction and Virtue, 99.
- Steven Polin, “Effective Responses to Evolving Fair Housing Challenges,” Address at the Annual Best Practices Summit of the National Affiliation for Recovery Residences, St. Louis, MO, October 14, 2019.
- Beth Sanders, “Managing Crises in Residence Operation—Interpersonal, Environmental, and Others,” Address at the Annual Best Practices Summit for the National Affiliation for Recovery Residences, St. Louis, MO, October 16, 2019.
- The Holy Bible, English Standard Version (Wheaton, IL: Crossway, 2001).
- May, Addiction and Grace, 139. Emphasis original.
- May, Addiction and Grace: Love and Spirituality in the Healing of Addictions (New York: HarperCollins, 1988), 11.
- May, Addiction and Grace, 40.
- May, Addiction and Grace, 90.
- Dunnington, Addiction and Virtue, 11.
- Shaw, The Heart of Addiction, viii-ix.
- May, Addiction and Grace, 30.
- Shaw, The Heart of Addiction, 101.
- Shaw, The Heart of Addiction, 213.
- May, Addiction and Grace, 52.
- May, Addiction and Grace, 51.