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On a recent Saturday night, hundreds of people crowded into the Belmont-Watertown United Methodist Church to mark the 26th anniversary of a local Narcotics Anonymous, or NA, group. It was standing room only in the church, and applause erupted when Pastor Mike Clark took the podium.
"Somebody asked me half jokingly a couple weeks ago, 'Why does somebody like you spend so much time with people like us?' " Clark told the crowd. "I didn't know what they meant when they said somebody like me, and I don't know what they mean when they say people like you, because I think we're all people trying to get by and do the best we can."
Clark started leading this church 15 years ago. Among the first things he noticed were all the people coming to the church — not for Sunday services, but to the basement to attend 12-step meetings.
"I realized that people's lives were being saved every day in this building. And that it was happening in the basement, it was happening outside our angle of vision — and that's fine, it was happening anonymously — but that it was an amazing story of human transformation," Clark said.
There are about two dozen 12-step meetings held at Clark's church every week. Although he has no formal mental health or substance use disorder training, Clark became educated about addiction and has held about 1,500 pastoral counseling sessions with people in recovery. He says it's time for all churches to step up and try to blend what happens in their basements with what happens in their sanctuaries.
"In my experience, there are as many active addicts and alcoholics upstairs in churches as there are downstairs. But the ability to be honest about it and seek help unfortunately is a challenge for most people."Pastor Mike Clark
"In my experience, there are as many active alcoholics and addicts upstairs in churches as there are recovering alcoholics and addicts downstairs," Clark said. "But the ability to be honest about it and seek help unfortunately is a challenge for most people. So we've approached it here as not only trying to offer support to folks in the congregation, but also trying to find some appropriate ways for two very separate communities, historically, to say, actually, we might have some things in common."
John, who didn't want his last name used because of the AA requirement that participants remain anonymous, is one of those downstairs who also seeks help upstairs in the church with Pastor Clark.
"[Clark] has sort of become our honorary addict. Never mind other drugs, he's never had a drink in his life. But he has a connection with us and with other addicts," John said. "For a person who is not an addict to really work to understand where we've been and what we're trying to do — he's there."
With the opioid epidemic worsening nationally and in Massachusetts, and an estimated five people dying on average every day in this state, Clark believes it's imperative for religious leaders to get involved. He holds workshops and retreats around the state to talk about the epidemic. He says religious leaders need to learn about addiction not only to help those struggling with substance use disorders, but also to help family members dealing with the fallout or grief from losing a loved one.
"The opioid crisis presents us with a very serious challenge — the numbers of people who are being affected and who are dying, the families crushed. If the church isn't paying attention to that, I don't know what we should be paying attention to," Clark said.
'Overwhelmed By The Demand'
Many churches are paying attention — doing things like talking about substance use in sermons and holding public prayer services. The Massachusetts Council of Churches, a group of 17 Christian denominations, has held about a dozen training groups for clergy over the past year, according to the Rev. Laura Everett, the council's executive director.
"We are overwhelmed by the demand of spiritual caregivers and interfaith colleagues who are reaching out to us to provide more training sessions," Everett said. "We really think that clergy can model a supportive, pastorally appropriate, nonjudgmental way of speaking about addiction in ways that break the stigma and isolation that often comes with addiction."
The Rev. Janice Ford is an episcopal pastor with the Church of the Reconciliation in Webster. At a recent training in Salem, she advised those in the audience not to judge, but to listen and make sure not to proselytize.
"We're not looking to convert folks. That's not what this is about," Ford said. "When you provide spiritual care, you're trying to find, where is God in their addiction? Where is God in their life? That's what lived spirituality means."
Lived spirituality, Ford tells the group, could mean many things such as providing informational resources at the church about addiction and treatment or connecting congregants with others. Mostly, she says, it's letting people know that the church might be able to help.
While every church might offer varying levels of support, for Ford it's been a primary focus.
"Addiction is not just a medical or social problem," Ford said. "Addiction is a disease. It's not about people's morals. Helping these people is the same as our efforts for Syrian refugees — although many people might not think of it like that. What each clergy person does depends on a few things: time, skills and passion. For me, this has taken over my life."
It started taking over during Ford's work as a spiritual counselor at the Worcester County House of Correction. It was there where she quickly realized that most of the men incarcerated also had substance use disorders. They also didn't have much of a plan for after their release, so she decided to help by opening a sober house.
Seven months ago, after raising about $40,000 to renovate a 130-year-old building on church grounds that had been the home for the priest, Ford opened what's called Reconciliation House. It's a sober house for six men who went through treatment at the Worcester jail. The 2,000-square-foot, four-bedroom house is meticulous, with a common living room, kitchen and dining room where there is a bulletin board explaining the house rules: no illegal substances, mandatory drug testing, chores, abiding by curfew and attending 12-step meetings.
The men living at Reconciliation House say they're grateful to have a place to stay for up to six months to try to get their lives back on track.
"This quite literally has been a godsend," said Steve, who didn't want his last name used because of the stigma of being addicted and incarcerated. He's been living at Reconciliation House for four months. He met Rev. Ford during his latest stint in jail — a place he's cycled through many times over the past several years.
"It's extremely helpful to be encouraged to enlarge your spiritual experience. That's been a big part of my recovery and my newfound stability in life."Steve, a resident of Reconciliation House
"Since about 2010 it's just been kind of a living hell of that vicious cycle of incarceration, deprivation, misery," Steve said.
Now several months into recovery Steve has a full-time job at a local warehouse and is immersed in working the 12 steps of Alcoholics Anonymous. He credits a focus on spirituality as helping his reentry and his recovery.
"It's extremely helpful to be encouraged to enlarge your spiritual experience. That's been a big part of my recovery and my newfound stability in life," Steve said.
The Role Of Spirituality In Recovery
The issue of spirituality and addiction treatment is complicated and controversial. The vast majority — by some estimates more than 85 percent — of substance use disorder treatment in the U.S. is based on the 12 steps. Among other things, the steps ask adherents to believe that a "power greater than ourselves can restore us to sanity."
At Sunspire Health's Spring Hill treatment center in Ashby, patients attend group sessions that try to get them to think about their spirituality.
During one recent group called "Spirituality: A Search for Self-Awareness," counselor Tom Thelin urged those in attendance not to confuse religion with spirituality.
"A lot of people still think spirituality means I need to go to church, I need to pray or whatever your religious belief is," Thelin said. "Spirituality can incorporate religion, but it isn't the same as. So we're all kind of new at this language — it seems like a language we're not familiar with."
Thelin, a former Catholic priest, holds this session twice a week. Attendance is mandatory for all the patients, most of whom spend about a month at Spring Hill for post-detox treatment. This group was held in a loft area of a converted barn with windows overlooking a bucolic wooded area. About 15 people were sitting in chairs in a circle around Thelin. They ranged in age from early 20s to some in their 60s.
"In many of our groups we talk about: What is the purpose of our life? And I know it's not to suffer and die miserable. Our purpose in life is literally to live a life of purpose. That is, in giving we receive. This addiction is the exact opposite — it's all about getting for ourselves," Thelin tells the group, which appears split between those who believe that getting in touch with their spirituality will help their recovery and those who don't.
One young man asks: What is a higher power or spirituality? And if it's so important to my recovery, why can't you give me a definition?
"It's spirit, it's breath, it's a way of living. Everybody has spirituality like everybody has health — you either have poor health or good health," Thelin responds. "Good spirituality is we live a principled life, we live by a set of moral values, treat others the way you wish to be treated."
A young woman chimes in. I know it's not a particular religious belief like Jesus or Buddha, she says, but I've tried to find what you're talking about. I've climbed mountains to say prayers, and I've lost everything — including my son — but I can't seem to even want to take care of myself.
Another young man says that's because no one is going to take care of you more than yourself. You can't invent something to take care of you, he adds.
Thelin says it's not about inventing, but about finding yourself.
"Why is it we haven't taken care of ourselves? Because we lost track of who we are — that's it," Thelin says. "We're on a journey that's led us to feel as though I'm all alone because addiction separates us from the things that really matter — family, friends, life."
One man says he doesn't think he could stop using drugs without some sort of spiritual grounding.
"Spirituality to me is the part of me that's connected to the universe around me — sitting on the creek watching the water roll by, when I see a deer walk out, I'm connected to that," he says. "If you don't know who you are and where you stand in the world, you'll never find your way."
An Age-Old Debate
These age-old questions are part of what seems like an age-old debate in addiction treatment. Do people need to find their spirituality or purpose or higher power to successfully recover?
Thelin says yes.
"I would call the lack of loving the self the cancer of this. Without a sense of doing the work and going inside and being at peace, it's all noise on the outside so people will always look for answers. Spirituality is the very core of recovery."Tom Thelin
"I think it's the core, the kernel," Thelin says. "I would call the lack of loving the self the cancer of this. Without a sense of doing the work and going inside and being at peace, it's all noise on the outside so people will always look for answers. Spirituality is the very core of recovery."
Jim DiReda, another counselor at Spring Hill, says because addiction is a disease of isolation, connection must be established — with something. Although treatment for opioid use disorders increasingly relies on medications such as methadone or Suboxone to reduce cravings, Direda says they're only good for the short term. He says addiction is a disease that affects the mind, body and spirit — and all three need to be healed.
"This stuff is all about relationships," Direda says. "If there is no ability or there's no connection anywhere, then you're alone again. I don't know how many addicts that can be alone, feeling miserable or discontent, before that little thing in their brain starts saying, 'You don't have to feel like this, put two in the cooker, pour yourself a nice tall one, you don't have to deal with this.' Those are the messages that they combat all the time."
DiReda also works as a professor at Anna Maria College and he published research about this last year in the Journal of Psychology and Clinical Psychiatry. He surveyed 50 Spring Hill patients to ask if they felt spirituality was an important part of their recovery. More than 80 percent of them said yes, and most said they needed a community of people they felt responsible to in order to stay on track.
"People don't recover in isolation, they recover in community," DiReda says. "If you haven't built a recovery community into your life then I think the odds are pretty much that you're going to relapse. Because whatever got you to the place where you started to fill up with drugs and alcohol, that stuff hasn't gone away."
But many people who work in and study treatment don't accept that. They argue that there is no strong evidence supporting the efficacy of the 12 steps. Furthermore, they say with our increased understanding of the science behind addiction and the widespread belief that addiction is a disease that needs medical attention shows that spirituality does not belong in treatment.
"What does spirituality or morality or a good feeling toward others have to do with addiction? Zero. Addiction isn't about that. Addiction is a psychological symptom to help you get through feelings of being overwhelmed."Dr. Lance Dodes
"Twelve-step programs don't really make a lot of sense," says Dr. Lance Dodes, a former Harvard professor and supervising analyst emeritus at the Boston Psychoanalytic Institute. "What does spirituality or morality or a good feeling toward others have to do with addiction? Zero. Addiction isn't about that. Addiction is a psychological symptom to help you get through feelings of being overwhelmed."
The Treatment Research Institute, a national group that studies addiction treatment around the world, says 12-step programs are tough to research, largely because most of the participants adhere to the tenet of anonymity. Dr. Adam Brooks, chief executive officer of the institute, says all providers should individualize treatment and try to find what works — at least at the moment someone enters treatment.
"We have to have treatment that meets people at every level of where they are based on their level of readiness, based on their level of need for physical support for whatever withdrawal process that they're going through. We just need to be more flexible — including the 12-step programs," Brooks says.
He also said there is no strong evidence showing that the 12 steps — or spirituality-based programs — result in better outcomes than psychological counseling alone. For the best outcomes — at least when it comes to opioid use disorder — Brooks says most of the current research shows that medication combined with counseling is the way to go.
This story airs in two parts on April 20/21, 2017. The audio atop the post includes both parts.