Substance abuse (2)
Dr John Latham of Christian Medical Fellowship (CMF) continues his study of an urgent social problem
Prevention is better than cure, when it comes to substance abuse. We are not told in Scripture about the use or misuse of opiates or cocaine. However, the wise use of alcohol is extolled.
Alcohol was the most common psychoactive substance known in biblical times, so it is not surprising that several Scripture passages mention it.
Scripture gives guidance on what is permissible. 1 Timothy 5:23 allowed the medicinal use of wine long before medical studies suggested that on occasions one or two glasses of red wine per day are good for the cardiovascular system!
John 2:1-11 describes Jesus’ first miracle, changing water into wine at a wedding. This is a remarkable example of the Lord condoning the recreational use of alcohol in certain circumstances.
Luke 22:14-20 records the Passover meal that Jesus shared with his disciples, now known as the Last Supper. During the meal, Jesus drank wine and broke bread with his followers, and instituted the central ritual shared by virtually all Christians down through the ages, in remembrance of his sacrifice.
Proverbs 23:29-35 gives a graphic and clinical description of the appalling psychological, social and physical effects of alcohol misuse. Genesis 9:20-27 records how even the great Noah came to serious grief through the unwise use of too much wine.
The overarching principle for anyone born again and living a life of freedom in Christ must be one that Paul gave. To those who claimed ‘everything is permissible’, his response was ‘but not everything is beneficial’ (1 Corinthians 10:23).
I know that that passage was mainly concerned with religious eating codes, but I believe it may also be construed to include the use of psychoactive chemicals.
Certainly no Christian should be using any substance in a way that leads to dependence, is detrimental to health, or challenges God for supremacy in life.
No doctor or nurse should deny the need to care for the physical needs of addicted people, be they traumatic injuries, damage due to viral infections (including HIV) or organ damage such as cirrhosis.
However, negative attitudes pervade the thoughts of many healthcare professionals. I was once at a medical dinner where a GP announced that he would never treat drug addicts as they had brought their illness upon themselves. The same gentleman smoked two cigarettes with his after-dinner coffee!
Inner-city doctors, and especially GPs and emergency department staff, know how many consultations result from addiction or substance abuse. The cost of providing emergency and long-term care for substance misusers can be huge. Regardless of this, a duty of care seems incontrovertible.
A great deal of psychiatric and psychological illness has links (either cause or effect) with substance misuse. Acute psychosis caused by Ecstasy, or depression caused by alcohol abuse, are examples. Patients with psychological illness often self-medicate with alcohol.
Those in my practice being treated for opiate abuse frequently suffer psychological problems, so close liaison with psychiatrists specialising in substance abuse is essential.
In addition to these factors, I firmly believe there is a deep spiritual dimension to every single case of addiction.
Christian doctors should therefore be praying for their addicted patients, that the power of the addiction would be broken, either by natural medical means, supernatural means, or a mixture of the two.
There may be an opportunity for discussion of faith issues with addicted patients, especially in General Practice, where a long-term trust relationship can be built up.
The social consequences of substance abuse are wide ranging and appalling. A large percentage of homeless people and hostel residents abuse alcohol, drugs or both. The scourge of substance misuse has devastated families, communities and neighbourhoods.
Countless children have been orphaned or placed in care; many grandparents have to bring up the next generation because their sons or daughters are addicted. Violence, street crime and homicide are all consequences of addiction.
The various approaches to addiction and addicts can be summarised in three well-known statements. First: ‘Addicts only have themselves to blame, and treating them medically is just a cop-out’.
Addicts may indeed have themselves to blame, but if Jesus had taken this attitude to mankind’s sin he would never have thought it worth dying for us. If the medical services were to take this attitude and withhold clinically proven treatments from those who have harmed themselves, we would be guilty of negligence.
The second approach is: ‘Abstinence is the only acceptable solution to dependence. Prescribing substitutes such as methadone is unethical and is simply legalised drug pushing’.
Now, obviously abstinence is the most desired outcome, but if (as in the majority of cases) this seems impossible, I believe doctors are duty bound to offer a safer, controlled form of ‘harm reduction’. I can state, from my own experience with a methadone treatment programme, that it relieves suffering, reduces crime, allows proper family life and childcare, and gives the person the opportunity to receive care for other allied problems such as Hepatitis C and HIV infection.
Having said this, it should be the goal of any such treatment programme gradually to wean an addict off their dependence, in manageable steps.
Third, there is: ‘There is almost no support or help for substance-dependent medical students’.
Recently I came across the case of a medical student who died of a heroin overdose. Neither the medical school authorities nor his friends seem to have noticed his problems before the tragic event. I do know from discussion with students that heavy drinking and recreational drug-taking are common amongst their peers.
Most universities and medical schools are aware of this problem and offer expert medical and psychiatric help. Medical students are representative of society and young men and women are likely to use drugs recreationally (to begin with) and a certain percentage will become ensnared by dependence.
Obviously greater vigilance by university medical services, medical school staff and fellow students in a spirit of openness and honesty will perhaps prevent some addictive behaviour from becoming uncontrolled.
Clinical evidence now abounds that there are medical models available with which to treat many addictions, including those to alcohol and opiates. As doctors we have an obligation to help needy patients receive this treatment, though this may be harm reduction rather than cure.
Yet, as Christian health workers, we know that there is more than enough evidence to show that only salvation by faith in the Lord Jesus, repentance of past sins, and asking Christ into our lives, will bring certain cure and healing for those afflicted by addiction.
Galatians 5:19-23 lists the acts of the sinful nature (sexual immorality… drunkenness, orgies and the like) and then contrasts these with the fruit of the Spirit (love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control).
The former list is, incidentally, a fairly complete symptom schedule for addiction and the second list a description of those who have overcome the mental, bodily and spiritual control of addiction.
I conclude by humbly reiterating that in the midst of chaos there is hope. Although many physicians have been discouraged and even frightened by the prospect of dealing with addiction and its consequences (I have been one), there is spiritual healing and wisdom available from our heavenly Father, along with clinical expertise and knowledge within the medical profession.
Caring for those caught in addictions is an excellent way of healing God’s hurting creation, using the gifts he has given us.
With kind permission of CMF