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Victims and Sinners: Spiritual Roots of Addiction and Recovery.

By Linda A. Mercadante. Westminster John Knox, 220 pp., $20.00.

The religious nature of Alcoholics Anonymous and the 12-Step program it initiated is not always noted, since AA understands alcohol addiction as a disease. This medical approach turns the afflicted into victims. It has the advantage of protecting the sufferer from the punitive judgments of moralists who think the disorder is purely voluntary. But the disease model of alcohol addiction has been discredited by social science and medical research, and the idea that applying a moral model to addictive behaviors necessarily condemns the addicted as weak-willed or bad people deserves to be discredited.

If neither the disease theory nor moralism is adequate for understanding addictive drinking, are there other alternatives? Linda A. Mercadante attempts to answer that question. A professor of theology at Methodist Theological School in Delaware, Ohio, Mercadante presents an explicitly Christian theological reflection on the AA philosophy and program. She argues that “theology can make a contribution by offering alternative views that avoid both excessive blame and excessive victimization.” Faith can involve people in the reordering experience of grace, open new relational possibilities and foster social involvements lacking in 12-Step recovery programs.

The Oxford Group, an evangelical Christian organization founded in the early 1900s, provided Bill Wilson with the theological foundations and the inspirational model for AA. Mercadante examines the way the addiction-recovery movement has both borrowed from and resisted theology’s sin-conversion motif. This resistance led to the “successful spread of the addiction-recovery paradigm to cover an ever-expanding range of human dysfunction.” The historical background is perhaps the most important part of this book.

Mercadante notes AA’s gender bias and criticizes the way it makes alcohol abuse a problem of “too much self-will.” This perspective overlooks the kind of sin and self-distortion that can arise from what she calls “inordinate self-loss.” She notes that recovery has entered the church through the small-group phenomenon and she cautions against an uncritical acceptance of the small-group format.

GOD found Kem sleeping on the ground near a building on the Detroit River.

The Motown singing star was homeless at the time–in the grips of a drug and alcohol addiction that kept him on the streets, in shelters and estranged from his family for roughly four years. He had been trying, he says now, to get back into a treatment center. But to be sure of getting a bed, you had to go every day. He had been out of the center for a week, and was down for the count.

“[God] was waiting. He was waiting on me,” says Kem, in the green room of Renaissance Unity, his home church in Warren, Mich. “I was sleeping near where they make the Detroit News and the Detroit Free Press, down on the river. There was no flash of light or anything–I was just tired and I didn’t know how to fix it.”

In other stages of Kem’s recovery, he’d had a plan to get his life together. But this time, he was at rock bottom and knew that he needed help. Although reluctant to discuss his recovery in depth, Kem says that at this point he gave up trying to do everything himself, and sought help through a program he declines to name.

“On that particular day, I realized that I was not living the life that I wanted to live,” says the entertainer, who won’t reveal his age. “I’d always had these high hopes and expectations of what I wanted out of my life, and I was no where near achieving those.”

This was the start of a journey from dope and despair at Mack and Third avenues to soulful songs in sold-out venues across the country. With his critically acclaimed debut CD, Kemistry, and a five-disc deal with Motown Records, the Detroit resident is getting airplay and accolades reminiscent of Motown acts of old.

The 10 songs on the CD, which he wrote, arranged and produced, are at times intensely personal and spiritual, unlike many of the songs you hear on the radio today. The first track, “Matter of Time,” is an autobiographical tale of struggle and redemption.

At a time when so many artists rely on sequencers and drum machines to create a full “band” sound, Kem’s album uses live musicians. “That’s the key to the magic of this record,” says saxophonist David McMurray, musical director for Kem’s band. “I think he has something really unique.”

It is a typical morning in the kitchen of Ramona’s railroad flat in suburban Atlanta: a pot of decaf coffee, oat bran muffins, and Percocet. Ramona (not her real name) washes down three of the oval, chalky, off-white pain pills with coffee and closes her eyes. This 42-year-old lesbian mother of two becomes suddenly animated and friendly. She shakes the prescription bottle. “this is my love. This is my life. I’ll take this drug till the day I die,” she says, hastening that day one tablet at a time.

There are at least two potentially lethal effects of long-term painkiller use. The drugs can significantly weaken or destroy the liver. And abrupt disruption of opiate use can send the body into shock, which is potentially lethal.

Painkiller addiction has arrived, big-time, among gays and lesbians. Lisa Kiebzak, who runs a substance abuse program serving people with HIV in St. Petersburg, Fla., says many of her GLBT clients use opiates such as Percocet, Vicodin, and OxyContin to heal psychological wounds. “What I see in the gay community today is what we’ve seen for a long time: a lot of people medicating themselves from their pasts, their presents, and their futures,” says Kiebzak, who works for the nonprofit Metropolitan Charities.

While the battle against the destructive allure of crystal meth addiction has energized gay activists nationwide, the abuse of legal painkillers poses a growing threat, experts say, largely because they’re relatively cheap and available, and the addiction is much harder to overcome. “If you step taking opiates [cold], you go into withdrawal,” Kiebzak says. “It can be fatal.”

The Substance Abuse and Mental Health Services Administration estimates that almost a quarter of Americans age 18 to 25 take painkillers recreationally, with a 40% jump in abuse of oxycodone (the generic name for OxyContin) from 2002 to 2003. The jump was 60% among adults 26 and older.

Blood-and-thunder sermons were a staple of parish life when I was young, but I didn’t expect one at the Call to Action convention in Milwaukee. It was George Tinker who delivered it — with all the appropriate gestures and dramatic pauses — just as we were winding down Sunday morning.

Did you know we are all in a state of mortal sin? State of mortal sin is something I have understood since I read James Joyce’s Portrait of the Artist as a Young Man nearly 70 years ago. Of course I had already heard a raft of sermons on the subject, some illustrated with everlasting flames and fiendish torturers. But they were intellectual abstractions. Joyce was the theologian who troubled my sleep with his portrait of an existence abandoned by God.

That is where — Tinker told us — we Christians are in the 21st century, and where we have been for centuries.

Q What can we do to instill some new enthusiasm into our diversity program?

A Any program can face the loss of employee interest after it has been in place for a period of time. Here are three ways to breathe new life into diversity programs:

First, audit your effort continuously and look for new ways to present information and new contexts in which to present it–all for the purpose of keeping the program interesting.

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Second, survey employees to determine quantitatively how well the program is being received. Always be sure to ask survey participants which elements of the program they think could stand improving and which elements, if any, they think are failing. It helps to remember the axiom that “everyone wants praise; everyone needs criticism.”

Third, broaden the program’s appeal and heighten participants’ awareness by highlighting new initiatives.

One substantial portion of the population that seldom gets attention in diversity programs consists of those who have served in the military. About 13 percent of Americans are military veterans, yet, except for affirmative action requirements that apply to them, they receive little recognition for their service.

Adding a diversity effort to recognize veterans would not be difficult. For example, you could use the two holidays that recognize veterans’ service to the country–Memorial Day and Veterans Day–as fulcrums for your diversity program’s recognition efforts.

In addition, you could contact any of the numerous government and veterans organizations to enlist the help of a program administrator for your initiative. One such organization is the National Committee for Employer Support of the Guard and Reserve, an agency within the Department of Defense. Its web site is www.esgr.org.

Finally, if your organization is ramping up its staffing, a recognition campaign can be introduced and integrated with your recruiting initiative.

A Commentary

In the last few years acupuncture and now auricular therapy have been used increasingly to treat substance use disorders (Unschuld, 1985). Studies of these modalities have validated their use, and more studies are needed and in process. Perhaps most important to the future are the growing acceptance of this treatment and the willingness of both Drug Courts and managed-care organizations to provide it via licensed practitioners for use with multiple addictions.

While the mechanisms of acupuncture are not fully understood, modern research has demonstrated that successful acupuncture treatment results in a number of changes in important body proteins that could, themselves, act to decrease physical symptoms. These include indications that acupuncture mobilizes the opioid peptides (i.e. enkephlins, endorphins, dynorphins) or increase levels of other peptides such as substance P and cholecystokinin (CCK) among many others. There are also indications that acupuncture may induce alterations in certain hormones including cortisol and ACTH to reduce stress (Han & Shao, 1990).

Since scientific research has shown that addiction, withdrawal, and recovery are all related to brain chemicals such as the opioid peptides and to stress-regulating hormones in the body, it is reasonable, then, that use of procedures that affect these systems be explored. Some may be reluctant to trust the effectiveness and safety of aucupuncture and auriculotherapy. However, the US Food & Drug Administration (FDA) has recognized electrical devices used in auriculotherapy and the acupuncture needle as medical devices. Research support for the effectiveness of the procedures is abundant and will be discussed later. While there are some who claim that there are not enough sound clinical studies to support efficacy of acupuncture, ear acupuncture or auriculotherapy, others would support its use. It is our contention that, in light of the positive studies, it would be unwise to dismiss its use as being worthless and that many more controlled studies are warranted (Micozzi, 1996).

Struggles to overcome addictions to drug and alcohol can often leave a person physically and mentally exhausted. The rigors of taking it “one day at a time” can sometimes lead people to turn to other addictions, such as caffeine, nicotine, or junk foods, to make up for lost energy and act as a sort of crutch.

In his new book, The Wellness-Recovery Connection, John Newport offers a step-by-step holistic program for the 50 million people in recovery. He is a leading wellness counselor who has been dealing with addiction for 25 years, and he shares his blueprints for adding years to recovering addicts’ lives.

Dr. Newport recognizes the “missing dimension” in recovery and identifies the reason that most people battling chemical dependencies fail or do not enjoy improved health while they are “clean” is that they do not adopt a wellness-oriented lifestyle.

The process of adopting this lfiestyle consists of several steps: nutrition, exercise, stress management, spiritual needs, social support, and taking full advantage of health care providers The author offers tips to readers on how to design and create their own blueprint.

The author explains all of the complex principles of wellness that can overwhelm someone on the verge of recovery. He brings a wide range of solutions within reach and takes the intimidation out of living one day to the next.

This book is important for anyone who is going through, or who knows someone going through, the trials of recovery.

In 1992, a conference devoted to discussing research on Alcoholics Anonymous (AA) was held at the Rutgers Center on Alcohol Studies in New Brunswick, New Jersey (1). A group of 35 professionals, who composed the “think/tank,” addressed the core question of how researchers could gain better access to and cooperation of AA and similar programs that are important for increasing our understanding of the recovery process from substance abuse (1). Recommendations by the group included a variety of techniques that researchers can use to increase success when working with AA and similar self-help programs, of which the academic community typically has difficulty gaining entry and researching. Many of the recommendations allude to a theme of partnership or collaboration between researchers and the organization. For example, researchers ale encouraged to attend meetings and learn about the program, as well as to develop friendship with group members outside of meetings; also researchers could work with “two-hatters” (those who are both members of community group and working with the research team) and utilize “interpreters” (i.e., a group member who speaks personally, but not as a spokesperson for the group) or “informants” (e.g., members willing to be trained and actually conduct the research). The think tank also proposed, that in order to fully appreciate the program’s framework of change, researchers should allow their change schemas to accommodate to the group’s and give members the opportunity to participate in the design of measurement instruments (1).

These recommendations, by some of the worlds’ leading minds in the area of substance abuse treatment, compliment the suggestions published by AA itself regarding participation of members in research. AA’s recommendations for the cooperation between investigators and AA members accomplish successful studies grew out of suggestions of the trustees’ Committee on Cooperation with the Professional Community (2).

An estimated 22 million people in the United States–9.5 percent of them African-American–are struggling with alcohol and drug addiction, according to the latest stats from the U.S. Department of Health and Human Services. Lucy Hall was one of them. First introduced to marijuana at age 14, Hall was sniffing cocaine by high school. In her twenties she started smoking crack. “I was at rock bottom,” she says. But when she sought treatment, she couldn’t find a facility for women. So in 1996, after completing her own recovery through various programs, Hall, now 43, founded the Mary Hall Freedom House, Inc. (named after her mother). The residential treatment facility in Atlanta provides housing, counseling, child care and job training for women who are addicted to drugs or alcohol. Additional services for patients’ children are aimed at breaking the cycle of abuse. “Society doesn’t see addiction as a disease,” says Hall. “Sisters are out there dying, not knowing there’s a choice.”

Hall sought treatment in 1989 after giving birth to her first child. “I left my daughter right there in the hospital and went to get high,” she says. But then she recalled how her own mother had died of alcoholism when Hall was 6. “I realized I didn’t want to die,” she says. “I wanted to see my daughter grow up.” Now a certified addiction counselor, Hall oversees a $2 million annual budget and manages a staff of 30. So far almost 1,400 women have been through the program. The facility houses 65 women–who live in separate apartments and stay six to 18 months–and about 20 kids. Hall, whose grandmother, aunt and two brothers also died of drug- or alcohol-related causes, believes that most substance abusers have low self-esteem. “Here we tell our patients, ‘We will love you until you learn to love yourself.

When human-rights activists Imani Walker, 42, and Malika Saada Saar, 34, say the nation’s drug treatment programs are in desperate need of improvement, they’re speaking from experience. Walker, a mother of four, struggled with drug addiction for years before finding a rehab program that encouraged her to heal, not just kick her habit. Saar taught writing workshops for women in recovery, and her students often described feeling abandoned by the system and powerless to change it. But Saar and Walker also knew that stories from women on the front lines are just what policy makers need to hear. In 2001 the duo started The Rebecca Project for Human Rights, a policy and advocacy group for low-income families struggling with substance abuse. Based in Washington, D.C., it trains women in recovery to lobby lawmakers for better access to programs in prisons and poor communities, and for more family-centered programs that understand how a parents’ demons can wound a child. “We see women go from being in a fragile, painful place to claiming their right to be in the halls of Congress and demand better policies for our families,” Saar says.

The Rebecca Project scored one of its biggest victories last June when several of its members helped convince Congress to allocate an extra $10 million to family-treatment programs nationwide–the first such increase in nine years. Now Saar and Walker, who have trained more than 40 mothers, are trying to expand Rebecca’s reach around the country. “We want to see more mothers who have experienced addiction claim their voices and say, ‘This is what we need,’” Walker says.