Returning the Lost Sheep: Ministry to the
Alcoholic and Addict: An Orthodox Perspective, Fr. Dimitrios Moraitis.
Self-published, 2013.
A review by Michael
Huber ThM, MA, CSAC, LPC, psychotherapist at BridgePoint Health, Sheboygan,
Wisconsin.
Reading through the
first two sections of this book I felt like I was in a time capsule of 30 years
ago—the beginnings of Hazelden treatment center, the Johnson Institute, the
modern renaissance of Alcoholics Anonymous, DePaul recovery hospitals,
prominent Catholic priests publishing spiritual recovery materials, Health
Communications, Inc. publishing house. Orthodoxy was late arriving in America so we
could expect Orthodoxy arriving late into the recovery scene, but thank God it
has with this now third Orthodox publication in the field.
Fr. Moraitis clearly
attempts to accomplish what those Catholic priests and a number of Protestant
ministers attempted to do 30 to 40 years ago—to bring awareness, information,
compassion and inspiration to Orthodox clergy in the current era. The
theological/pastoral thrust relies on the combination of Mt. 9:12 regarding
Jesus’ common sense saying that it’s the sick who need a physician and the
parable of the lost sheep from Lk. 15 to deliver the mission call which is
depicted prominently on the front cover. Not to overly criticize Orthodox
priests. It has been hard enough just establishing an extremely small minority
of Orthodox in the States with a minimum of worship and community life let
alone specialized ministry to those suffering
alcoholism and addiction. But perhaps it is time and this book is a
welcome and much needed addition.
Having read a brief
preview summary of the book I feared an over spiritualized approach by Fr.
Moraitis. But nothing could be further from the truth. Clearly Fr. Moraitis
follows in the path of those 30-40 years ago in the modern “tradition” of the
recovery movement as defined by the Alcoholics Anonymous subculture, along with
the AMA and US Department of Health and Human Services Substance Abuse and Mental
Health Services Administration definitions. He has picked up on all the details
well and communicates the “tradition” effectively. Thankfully he is up to date
and supportive of the latest scientific research establishing with certainty
the genetic/biological component of alcoholism and likely of some forms of
addiction in the modern world. It’s possible that Fr. Moraitis might receive
criticism from some for over relying on these “secular” sources.
Fr. Moraitis takes
the best of the recovery “tradition,” promotes it, and at the same time adapts
it to the ministry and theological approach of Orthodox clergy to whom this
work is primarily directed. Therefore, this work is an effective synthesis that
Orthodox priests can have full confidence in. As such its approach compliments
the current other two Orthodox works in this field by Fr. Webber and Victor
Mihailoff, whose book was earlier reviewed for the Orthodoxy and Recovery blog.
Fr. Moraitis neatly
assembles this work into three appropriate and progressive sections. Part One
deals with the above mentioned definition of alcoholism. He presents an
abundance of nationwide polls and even his own poll within the GOA to deliver the call to clergy involvement. He
unabashedly espouses the “disease” model as a part of the “tradition” supported
by modern era genetic research and the sources cited above.
In Part Two Fr.
Moraitis tackles the theological questions of alcoholism and addiction,
necessitating the reintroduction of the scientific research and genetic/biological
aspects to ward off the simplistic notion of sola sin. Using Clinebell’s research seven possible views of the
tension between “disease” and sin are suggested. Though he clearly leans toward
a view of a combination of these possibilities as representative of Orthodox
thought, he seems to leave it somewhat open for the individual priest to
wrestle with on his own. But it’s the heart matters that dominate for Fr.
Moraitis. Alcoholism and addiction can legitimately be viewed as opportunities
that bring the individual to a place of receptive humbleness for priests who
see the possibilities of ministry. Much of the book emphasizes this ministering
to the sick, rather than the healthy citing the wisdom of our Lord.
In this section Fr.
Moraitis cautions readers with regard to realistic expectations. It is so true
that when some people get a loved one into treatment the thought is that “now
everything will be fine.” The average number of relapses cited in the author’s
surveys is 15!! This often times includes multiple relapses following one or
more 30 day residential treatments.
Part Three is a
clever and well presented application of the 12 “Core Competencies for Clergy”
from the 2003 government report of the Expert
Consensus Panel Meeting. Fr. Moraitis takes each one and makes special
application for Orthodox clergy. It clearly works very well. There is an
excellent section in “Core Competency 2” where each Step of the 12 Steps is
explained with an appropriate Scripture verse and complements nicely the work of
Fr. Webber. It is in this section though that Fr. Moraitis’ tension between
strongly supporting AA, which has been very strong up to this point in the
book, and criticizing it (and the modern treatment program) regarding religious
integration reaches its zenith. There is no doubt that, despite his support of
AA, especially the 12 Steps within AA, some Orthodox clergy might have some
reservations referring individuals to AA as a result. The issue, a distinct
irony, is AA’s avoidance of promoting itself as a religious group actually
turns out to be one for many individuals.
The concluding
Appendix is a summary “Clergy Handbook” for quick reference and organization.
The book flows smoothly enough and is readable for any clergy. This reviewer
strongly agrees with back cover endorsements by Fr. Joseph Allen and Dr. Philip
Mamalakis, two prominent figures in the Orthodox pastoral counseling world.
What now follows is a
more technical and detailed look at certain relatively minor concerns this
reviewer has with some of the material presented in the book. Those clergy and
laymen who are more actively involved and knowledgeable in the field may want
to consider these things from this reviewer, a thirty year professional in both
mental health and alcohol/drug counseling.
The terms “alcoholic”
and “disease” are frequently used by the author in this volume. This reviewer tends
to greatly limit, if not eliminate the use of these terms. As I am fond of
saying, we don’t call people with cancer “cancerics.” The word “alcoholic” is a
throw back to more ignorant times that reflect the very thing Fr. Moraitis and
others are trying to eliminate--the moral stigma of the condition. Instead,
individuals are referred to as having genetically inherited the condition of
alcoholism. But those religious individuals who still regard alcoholism simply
as a sin would find this completely unacceptable. Certainly the individual with
alcoholism who continues to want to call him/herself an “alcoholic” for the
purpose of sobriety is more than welcome to as, of course, is common in AA
meetings.
In addition there continue to be significant
problems with the image of the word “disease” in modern culture despite Fr.
Moraitis’ consistent use of the U.S. government’s and AMA definitions of
alcoholism as a disease. Most people still associate “disease” with a virus or
“bug” that one catches, completely irrespective of choice and decision making.
Even though I completely agree with the “disease model” as Fr. Moraitis
presents it, I refer to alcoholism as the Medical Model definition of
alcoholism in which the genetic acquisition and biological components are
prominent. Why cause people to stumble over words and images needlessly?
I can’t help but
chuckle to myself when I read Fr. Moraitis’ “generally accepted definition of
alcoholism.” There is no such thing despite, again, Fr. Moraitis heavily
leaning upon the government information. If one were to interview 50 alcohol
and drug professionals, one would come up with at least 10 different models or
definitions of alcoholism. Furthermore, the Diagnostic and Statistical Manual
(DSM), which all professionals in both alcohol/drug and mental health fields
use for diagnoses, does not use the word “alcoholism” nor “addiction” for that
matter. In fact, in the latest edition of the DSM (5) drunken driving
convictions, as well as any other legal consequences, have been eliminated from
the criteria for an “alcohol use disorder.”
None the less, what
stands out is the approach of nonjudgmental compassion by Fr. Moraitis who
clearly is authentic in this practice. This is about loving some of the most
unlovable that there are—at least while they are in their state of “insanity.”
Having said that, Fr. Moraitis is not about emotional mush. He is completely
balanced with regard to insight and tough decision making regarding the aspects
of enmeshment with dysfunctional family systems—at times making the difficult
decisions to separate when appropriate and refusing to be cast in enabling
situations. His advice throughout clearly represents the wisdom of experience.
In Part 2 regarding
the theological considerations mention of “anger, frustration, agony,
depression, and fear” is referred to as “spiritual maladies.” These are NOT
“spiritual maladies” but psychological
ones. This is an important point. Especially with regard to depression,
religious individuals have sometimes not received treatment that could help
because it was viewed as a “spiritual” problem for which the clergy were not
equipped to effectively deal with. And in some cases has led to tragic deaths
completely needlessly because of this misunderstanding. “Spiritual malady”
strictly refers to that area of one’s relationship with God no matter what the
physical or psychological condition—something that Fr. Moraitis generally does
well in the rest of the book.
With regard to the
issue cited above regarding individuals making AA their “church,” there can be
no other way of saying it. At least in part, the church at large, including
Orthodoxy, has failed in regard to this matter. If church individuals with
alcoholism and/or addiction had been experiencing the genuine, authentic power
of the Christian life there would be far fewer individuals making AA their
“church.” From the perspective of this reviewer it is easy to understand why
individuals make AA their “church.” They have experienced genuine, heartfelt
spiritual awakenings and social camaraderie akin to war veterans that they
never came close to experiencing in traditional church settings. Why would they
then seek it out back in their old church? And, ironically again, it is because
they experienced it through classic, Christian based spiritual practice in the
12 Steps, but is certainly not associated with the former church experience.
Fr. Moraitis calls it
the “relativism” of AA and the modern treatment program. But, I believe, why
should Fr. Moraitis have expected any thing different? Ever since the 12 Steps
used “Higher Power” the die was cast. Throw in modern American sensitivity and
there was no doubt there would be no overt, obvious Christian emphasis in AA or
treatment programs except those operated under the auspices and financial
support of specific church groups, and there are some around the country. AA’s
appeal as a nonreligious group, casting off stereotypical “hell and brimstone”
images of God attracted (and kept) people. I completely agree with Fr. Moraitis
in his example/encounter with the homosexual in recovery regarding Orthodox
sacrificial practice. But the rest of “Christendom” is very relative compared
to Orthodoxy’s practice of progressive sacrifice let alone AA and secular
treatment programs. All the more for Fr. Moraitis to strongly attempt to
persuade Orthodox priests for active ministry to Orthodox individuals. This
reviewer sees no Orthodox since there is only a very small and struggling Greek
Church within a 50 mile radius of his clinic.
In addition, in the “Core
Competency 2” section Fr. Moraitis gives a good and succinct review of the
drugs of abuse, including opiates, which are now the rage across the country.
This reviewer is the lead therapist in the most prominent Suboxone program in
East Central Wisconsin. Fr. Moraitis’
statement that Suboxone should be used no longer than a few months is inaccurate.
The length of Suboxone treatment will vary considerably from one individual to
the next based upon a number of complex factors. I have had individuals with
milder symptoms and histories with good motivation take only several months
with good results. The majority are far more severe and require lengthier and
often multiple treatments.
From the perspective
of this therapist opiate addiction in many cases resembles alcoholism to a
large degree. In these cases there is likely a genetic component as well,
though, unlike alcoholism, we have yet to have the scientific evidence. Suffice
it to say that in our program we are proactive with patients to move them off
of Suboxone as quickly as is reasonably possible—something that is generally
not true with Methadone programs, though the philosophy of treatment is the
same. On average opiate dependence is capable of destroying an individual and
family far more quickly and effectively than alcoholism is. Therefore, Suboxone
has been incredibly effective for quickly saving individuals from destroying
themselves in almost every area of their lives. The advantage of Suboxone over
methadone is the inclusion of naloxone, an opiate blocker, sometimes referred
to as the life saving, emergency rendered Narcan in heroin overdoses, which has
received nationwide publicity as of late. The Orthodox priest ought to always consider the option of referring
an opiate addicted individual to a Suboxone prescribing physician in the area.
If the prescribing physician is not a part of other outpatient treatment
resources the individual should be referred to such and/or local NA groups.
I should also state
that there is medical treatment for
alcoholism as well—something that Fr. Moraitis fails to mention in the book.
Antabuse has been an historic, effective treatment for some with alcoholism
where all other interventions have failed. There is also some new evidence that
antabuse can cut craving for cocaine addicts, though the phenomenon of
“craving” in cocaine addicts is yet to be fully understood. In addition, in
some cases, the opiate blocker, naltrexone, and the newer Campral, have also
worked well in a minority of cases. There is also new evidence of the
effectiveness of gabapentin with some. The reader should understand that these
are not stand-alone treatments. The individual with alcoholism/addiction should
always be treated on multiple levels.
Also in this section
Fr. Moraitis succinctly describes and outlines the three stages of the
progression of alcoholism. This can be helpful for the uninitiated but as Fr.
Moraitis correctly states later in the book, these stages should not be
calcified into a rigid system. In most cases it doesn’t flow into a neat and
predictable progression. In addition, drug addiction will not progress the same
way alcoholism does in many cases.
But there are other
problems as well. The “Early Stages of Alcoholism” are described by symptoms of
“use to calm nerves,” “increase in tolerance,” “driving under the influence,”
“relief use” (this is no different than “calm nerves”), “secret irritation when
confronted by a spouse.” The fact of the matter is that the vast majority of
clients I see with these “symptoms” unequivocally do not have alcoholism. Some
of them even have no diagnosable alcohol problem whatsoever. In addition, I’ve
had a number of cases in which the spouse is complaining of the “alcoholic’s”
use to find out that the spouse is greatly exaggerating the use and objectively
there is no alcohol problem for the supposed “alcoholic.” In fact, collateral
reporting of a number of family members verifies that the spouse has had a
chronic habit of grossly over exaggerating many other things as well. In some
cases the “irritation” by the supposed “alcoholic” is the result of the spouse
chronically and falsely accusing the individual of a problem that doesn’t
exist.
Even the symptom of
“blackouts” is often not a solid indicator of what kind of alcohol difficulty
is present. I’ve had clients with blackouts who clearly do not have alcoholism.
I’ve had many cases of absolute certainty of alcoholism and those individuals
have never experienced a blackout.
In the “Middle Stage”
“alcoholics” are described as “egomaniacs with inferiority complexes.” This is
a gross stereotyping of the “original” “alcoholic” himself, Bill W., one of the
cofounders of AA who clearly had this character quality. From then on this
gross over generalization has taken place, another one of the many faults of
the “tradition” of AA. The truth of the matter is there are many individuals
with alcoholism who do not exhibit this character quality. The danger in this
should be obvious. I’ve had many individuals with alcoholism who have the
“inferiority complex” entirely without the “egomania.” These individuals should
not have alcoholism then, right?
Regarding the “Late
Stage” Fr. Moraitis’ discussion is thoroughly confusing besides being
inaccurate. He states many “alcoholics” die before reaching this stage. What
sense does that make? If the individual dies as the result of physiological
complications as the direct impact of alcoholism this automatically qualifies
the individual as having been in the late stage, perhaps for a lengthy period
of time prior to death. Several of the “symptoms” of the late stage are
described as “indefinable fears” and “unable to initiate action.” These “symptoms”
are typical of many clients I see with the character structure most common with
individuals with alcoholism but have no symptoms of alcoholism whatsoever. The
problem is that the majority of individuals with this character structure (the
Fear structure as Fr. George has frequently and accurately pointed out in his
blog) not only do not have alcoholism (or any drug addiction) they don’t have
any diagnosable alcohol problem at all.
The same exact thing
is applicable when Fr. Moraitis takes up “Spiritual Stages.” The described
symptom of “blaming God for their problems and consequences” is far more
observed in individuals with this character structure who have no symptoms of
an alcohol or drug difficulty. I have seen it happen way too many times when
well meaning but ignorant people read descriptions like these and falsely
accuse a loved one of a problem that they don’t have.
Ditto with the
so-called “dry drunk.” What are individuals called who exhibit the same exact
symptoms that “dry drunks” do but have never had an alcohol problem? The
recovery “tradition” again has erred in its assessment of this. They have
wrongly concluded that “dry drunk” symptoms are the direct manifestation of a
part of alcoholism when, in fact, they come from the character structure
dynamics of the individual.
I remember clearly 30
years ago reviewing a newly released video showing exemplars describing their
“discovery” of ACOA (Adult Child of an Alcoholic). Even though there were
absolutely no symptoms of alcoholism the exemplars attributed their difficulty
to alcohol “somewhere back in the family history.” This is just one more error
of the AA “tradition” attributing every thing that is wrong with the person to
alcohol. This is a terrible injustice and disservice to the individual and
completely misses the source of the difficulty.
The same exact thing
is true again when Fr. Moraitis, on pp. 136-7 in Core Competency 9 lists the
traits of “ACOA” individuals. All the traits listed for these individuals are
true in one degree or another of the vast majority of individuals with the
character structure referred to above but with no symptoms of alcoholism and
there is no history of alcoholism in the family.
This leads me to my
main criticism of the “traditional” recovery model, even though, like Fr.
Moraitis, I also support AA and refer appropriate individuals to it. Unlike the
Orthodox Tradition which was delivered by Divine authority, the recovery
“tradition”, as helpful as it oftentimes has been, is entirely fallible and
human. As with any human tradition the main downfall is the tradition’s
calcification which doesn’t allow for any new, creative depth and search for
truth. Time and again I have observed in alcohol/drug seminars and conventions
and AA and other meetings the “mythologizing” of Bill W. and the Big Book to the
degree that Bill W. takes on the aura of the religious prophet and the Big Book
is its Scriptures. This dynamic is completely consistent with the above
described character dynamics which exaggerates something beyond reality and partially
answers why some individuals make AA their “church.”
There has also been
the chronic difficulty of “who can help whom.” This is raised by Fr. Moraitis
when he quotes the AA tradition’s insistence that “drunks” best help other “drunks.”
(I’m sure you know how this reviewer feels about that term!) No doubt the
success that AA has had in this area has naturally contributed to this idea.
And, while it is true, it is far more often true that “drunks” “helping” other
“drunks” leads to far more and severe drinking in the end! It is not the fact
that the person is a “drunk.” It has everything to do with the quality,
maturity and advanced spiritual progression (the desire/willingness to become
sober and recover) of the individual than whether he/she is a “drunk” or not.
This is sometimes made into a big deal. Some individuals in AA do not trust
anyone outside AA who is not a “drunk.” The Orthodox priest will surely
encounter this and should unequivocally reject this notion. Is it absolutely required
that the Oncologist have cancer in order to treat cancer patients? The
ridiculous comparisons could go on and on.
This reviewer
heartily endorses the perspective of Fr. Moraitis who has seen the benefit of
incarceration for some individuals. The reviewer completely rejects the
so-called “California
model” which would send all chemical offenders (outside of perhaps episodes of
violence and dealing) to treatment facilities. Like Fr. Moraitis this reviewer
has had too many clients directly state that incarceration was an extremely
important part of their recovery. The “California
model” is extremely naïve regarding the willingness, participation and
potential successful outcomes of these individuals. As it turns out it would
only serve as an enabling device for many.
Finally, I’d like to
congratulate Fr. Moraitis and his seeming outstanding success with the
“traditional” intervention. Though he states that the intervention usually
fails on the first attempt success is generally accomplished with succeeding
tries. In the practice of this reviewer in alcohol soaked Wisconsin no traditional interventions take
place because there is generally no one inside or outside of the enmeshed
family substance dysfunction to recruit for such an intervention. Those few who
are or could be available are either too afraid or angry and/or disengaged to
put forth such an enormous effort. In Wisconsin
dysfunctional alcohol behaviors are generally accepted as a part of the
culture.