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Substance abuse

August 2009 | by John Latham

Substance abuse

 

Dr John Latham of Christian Medical Fellowship (CMF) explains how hard it is for substance mis-users to break free of their addiction.

 

‘Freedom is a word I seldom use without meaning’, sang Bob Dylan.

     But freedom is a word frequently used in Scripture to describe the effect God has on individual believers: ‘The Spirit of the Sovereign Lord is on me, because the Lord has anointed me to preach good news to the poor. He has sent me to bind up the broken-hearted, to proclaim freedom for the captives and release from darkness for the prisoners’ (Isaiah 61:1-2). This was the passage Jesus read, when he stood up to read in the synagogue at Nazareth (Luke 4:16-21).

     Addiction is the antithesis of freedom and in my experience substance mis-users (even those with little concept of sin) understand the idea that addiction is slavery, whilst release from addiction is freedom. In counselling people whose lives are controlled by substances or habits, these biblical principles are instantly understood.

 

The problem

 

My work over nearly 20 years as an inner-city Dublin general practitioner (GP) has been hugely affected by the widespread misuse of alcohol and other drugs. I feel confident in estimating that at least 30 per cent of my clinical and organisational energy in caring for this community has been expended in dealing with the consequences of substance misuse.

     Our surgery is on a street corner, very close to a cheap off-licence. Nearly every day the drinkers gather outside, swigging from cans and bottles, singing and frequently vomiting, urinating and defecating over the side of our building. They are usually gentle men and women, bewildered and lost in a world where they have searched for meaning and been disappointed.

     So pervasive and corrosive is the effect of alcohol, cocaine, heroin, ecstasy, cannabis and of course tobacco, on this already deprived area that I am sometimes tempted to cry out with anger, frustration and sorrow at the terrible waste of human potential, health, happiness and life.

     Even as I write, I mourn the tragic death of a dear patient who accomplished much in giving up heroin and rebuilding his life, only to succumb to the despair of a long battle with AIDS. He threw himself under a train early one morning.

     Yet, as a Christian and as a doctor I have great cause for hope and a clear purpose in continuing my spiritual and clinical battle against the odds. I will illustrate some aspects of this fight by describing the struggles of patients I have known (details altered).

 

Sean’s story

 

Sean was a tall, good-looking young man. He was the eldest of three boys in an inner-city family. At the age of 14 he was offered heroin. This was about 1982, when Dublin was being flooded with heroin by one infamous drug-dealing family.

     Unfortunately Sean loved heroin and he soon became ‘strung out’ (needing regular fixes every day). When I got to know him in the late eighties he was the father of a beautiful little daughter and was becoming very sick with HIV-related illness.

     He still looked striking, was well dressed and rode a motorcycle around town doing deals here and there in the inner-city flat complexes. He became terminally ill in 1989 despite the best medical efforts of the time.

     In his final weeks Sean was severely cachectic, bed-ridden and helpless. He was the first person for whom I prescribed methadone. His two younger brothers fed and cleaned him, and tenderly helped the nurses and family. They were grief-stricken when he died.

     Neither of them had tried drugs before Sean’s death, but they both started injecting heroin subsequently and have been close to the grave themselves on several occasions. They are now stable on a methadone programme and are working, looking after their families, and keeping on the right side of the law. These two boys found a measure of freedom by following a treatment programme, but have yet to experience the true liberation of knowing Christ.

     Even in the midst of these terribly sad situations, God is clearly at work. At least one member of the infamous drug dealing family mentioned above (many of whom have died or remain in prison) has become a Christian and is a pastor in England.

     He spreads the gospel with great vigour to the amazement of his family and neighbourhood. What a victory for real freedom!

 

Jimmy’s story

 

One biblical principle that is a great inspiration and is borne out in the lives of addicted people who have found freedom in Christ is that of being ‘dead to sin and alive to God’ (Romans 6:11).

     Often we see the reverse. Paul states in Romans 6:12-13: ‘Do not let sin reign in your mortal body so that you obey its evil desires. Do not offer the parts of your body to sin, as instruments of wickedness, but rather offer yourselves to God’. When I see ravaged young bodies with thrombosed veins, enlarged livers and other bodily manifestations of sin, these verses become vividly alive.

     But Paul goes further: ‘Don’t you know that when you offer yourselves to someone to obey him as slaves, you are slaves to the one whom you obey – whether you are slaves to sin, which leads to death, or to obedience, which leads to righteousness?’ (Romans 6:16).

     Jimmy was one such young man, who was a slave to sin and continually offered the parts of his body as instruments of wickedness. However, he found freedom in Christ in a most unlikely way. As a severely addicted heroin mis-user he required several hundred pounds in cash each day to feed his habit.

     One evening he broke into the house of an elderly woman to steal her television and video. However, since the house was unoccupied, he decided to sit down and have some heroin before legging it with the loot.

     The dose of ‘gear’ was too strong and he became comatose. Jimmy was woken some time later by the house owner who shook his shoulder vigorously, proclaiming, ‘Wake up, Jesus loves you!’

     Jimmy was so impressed that he went to church with the woman the next day. He subsequently did an induction course with Teen Challenge (a Christian organisation dedicated to working alongside people with addictions) in Dublin and then spent nearly two years at a Teen Challenge residential centre in Wales.

     He is now married with a child and is a Christian worker. The local police who once treated him as a troublesome villain now consider him a changed person and a useful community liaison man.

 

Christopher’s story

 

Another biblical principle is that ‘No one can serve two masters. Either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve both God and money’ (Matthew 6:24). This is well illustrated in the divided loyalties of the addicted person, who may not primarily serve money (though he may steal it), but who certainly serves his habit.

     Doctors and medical students are not immune from this. They commonly fall into the trap of serving more than one master and sometimes substance dependence becomes the most powerful one. Christopher was just such a doctor. He was a vocationally trained, single-handed GP with ongoing academic commitments and a strong social conscience.

     He was a committed Catholic and devoted husband and father. But he began injecting pethidine and morphine and writing more and more prescriptions for these, until the police and Medical Council investigated his suspicious prescribing. He was prohibited from prescribing controlled drugs and his name was published in national newspapers.

     Christopher commenced a drug treatment programme and continued to run his practice. He has been ‘drug free’ for several years and has had his full prescribing privileges restored.

     What exactly is addiction? Addiction is a process by which drug-taking behaviour evolves into compulsive patterns of drug seeking, often at the expense of most other activities. It leads to an inability to cease drug taking.

     I can think of several commodities or activities to which people may be addicted – drugs, alcohol, sex, food, stealing (kleptomania) and even religious practice.

 

Dependence

 

This article is about addiction to chemical substances. A medical definition of addiction is found in The International statistical classification of Diseases and related Health Problems (Geneva: WHO, 1992-4).

     Dependence is defined as when three or more of the following features are manifested – a strong compulsion to take the substance; difficulties in controlling substance-taking behaviour; physiological withdrawal, causing either withdrawal symptoms or substance use to avoid withdrawal symptoms; substance tolerance, with increased doses needed to achieve the same effects; progressive neglect of other activities and interests; and persistence with the substance, despite clear evidence of its harmful consequences.

     I think that the verses from Romans 6 already quoted fit in well with the picture painted by this classification. An addicted person persists in the habit beyond the point where the body and soul become obviously and progressively damaged, so that the addiction is a definite form of slavery.

     However, through Christ and with responsible medical practice, freedom from substance abuse can be found for the addict. I will explore the topic again next month.

With kind permission of CMF

Dr John Latham