“The book elucidates the agony of addiction in a fresh, new way. It emphasizes the role of trauma in setting the stage for debilitating behaviors, and explains the importance of community support in the healing process. With anecdotes of many people who grapple with addiction and have survived, as well as sad stories of addicts who died, this book provides healthy doses of grit and inspiration.” –Christopher Key Chapple, Loyola Marymount University
Medicine has struggled to understand addiction. This may be because it’s not entirely a medical problem. But science doesn’t consider spiritual aspects, and for the purposes of this discussion I’m willing to leave those aside.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the “bible” for diagnosis by professionals. The current version is DSM-V. Not surprisingly, the previous version was DSM-IV. The newer version introduced some major changes to the way substance abuse disorders are diagnosed.
DSM-IV, issued in 1994, generally offered two categories of substance abuse disorders: substance use disorder, and dependence. These corresponded to chronic abuse of a substance, and physical dependency on the substance. There were codes for various substances, distinguishing for example between opioid dependency and alcohol dependency. The DSM-V (2013) combines there and streamlines the diagnosis. As this summary explains, DSM-V
does away with separate “dependence” and “abuse” diagnoses and combines them into “substance use disorder.”
The current version sees substance abuse as a spectrum rather than two separate conditions.
While this does make diagnosis easier, it appears to me to move substance abuse treatment backward by failing to recognize the complexity of factors at play.
For example, let’s consider physical dependence. Anyone who takes opioids (or other physically-addictive medication) over a long period will become physically dependent. It doesn’t matter whether they began using for pleasure, or if they were prescribed the drug by a doctor because of a medical need. They will need the drug to avoid going into withdrawals, which are typically both painful and disorienting. And in the case of alcohol (and certain other drugs), withdrawal can be life-threatening. Someone dependent on alcohol, for example, will crave it. And the cause of this craving is biological: they’ll go into withdrawals if they don’t get it. This is what DSM-IV described as “dependence.”
Yet dependency alone does not indicate whether that person will return to the drug once separated from it. When the physical dependency is relieved through a withdrawal process, medically supervised or not, there is no further need for the drug. Many people, once relieved of their dependence, take what might be described as the sane response: they never touch it again.
On the other hand, let’s consider what is sometimes described as “risky use.” A person who is not dependent on a substance nevertheless seeks it out and abuses it. The cause of this is not physical but psychological. Whether they seek pleasure or to kill the pain of some past trauma, the drug serves a purpose in their lives. They choose to pursue it of their own free will. This is what DSM-IV described as “substance use disorder.”
Interestingly, substance use disorder does seem to be a spectrum. Some people are able to choose to quit of their own volition. Others need help to quit. And some pursue their obsession with the substance, as Alcoholics Anonymous observes, “into the gates of insanity or death.”
These two, very different, facets of substance abuse are combined in DSM-V into a single spectrum. Yet the opioid crisis should show us the fallacy of this “improvement.”
One of the popular news items in the opioid epidemic is the number of people who began using because an opioid was prescribed by their doctor for a medical condition. (Here’s an example.) This theory presumes that chronic physical pain is the cause of opioid use that results in dependence. And this may well be for some people.
Yet many, perhaps most, opioid addicts struggle with a condition I can only describe as “addiction.” Yes, they are physically dependent. Yet once separated from the drug, whether through rehab or incarceration, they return to it despite its adverse effects on their lives. Not because of physical pain, but because of a psychological obsession with what the drug does for them.
At the very least, in these people we can see an overlapping of two distinct conditions: dependency and an obsession to use. These are not the same. One is physical, the other is psychological. Both need to be treated for successful recovery. Yet without recognizing the difference between the two conditions, how can they be treated?
This is true for any drug user. For a successful result, a person who is dependent because of chronic pain must be treated differently from one who is not dependent but seeks the drug by choice. Yet in the case of the addict, who has both conditions, treating one or the other is simply pointless. Not only is it ineffective, but the failure of this approach erodes confidence that recovery is possible.
And recovery is possible! While success with opioid addiction recovery from a medical perspective remains dismally low, tens of thousands have recovered through other, non-medical methods. These include Twelve Step groups like Narcotics Anonymous, religious based programs like The Bridge Ministry, and many others.
Because when withdrawals end, that’s when the real healing begins. Now that we don’t have a physical need, how do we live without the psychological need? Medicine doesn’t do that. Even psychology tends to fall short in offering resources.
Perhaps this is because they don’t really understand what an addict needs, because the vast majority of medical professionals have never experienced it.
But those who have been there and recovered do know. It is to them we should look for answers. Oddly, that seems to be the one place science hasn’t looked. Which may be why their understanding of addiction and recovery sometimes seems to be moving backward.
For more on addiction, read my book, The Soul of an Addict, available in Paperback and Kindle editions.
Whether it’s jail or rehab, how does an addict stay clean when they get out?
I met William in his last week at a program that helped former inmates deal with addiction and prepare for the real world. We talked for almost an hour. I told him my history, and about how I stayed clean. He seemed excited to know someone in recovery. He took my number, and promised to call as soon as he got settled in his new apartment.
I never heard from him.
The are literally hundreds of thousands of men and women incarcerated for drug related offenses, many of them nonviolent. What happens when they get released? Some of these go to halfway houses or rehabilitation programs. Do these improve their chances? Thousands are voluntarily in rehabs. Are their chances any better?
There’s one aspect of addiction that few programs, and few theories of addiction, take into account: Addiction is a way of life. It defines what we do with our time. Conversely, it tells us what to do when we don’t know what to do.
This means the first day or two after getting out, whether from incarceration or from a program, are critical. Structure has been removed. Even if there’s a job to go to, which there often isn’t at that stage, there are still 16 hours in the day to navigate. In an unfamiliar world. With complete freedom of choice. After months or years of complete structure, the person is suddenly expected to know what to do with their time.
That’s not a reasonable expectation. Anyone who has become unemployed, or who has faced a quarantine that disrupts their normal routine (and that’s most of us now), knows that it isn’t easy to find a new routine. And we generally start with what we know, whether that’s exercise or prayer.
What an addict knows is not exercise or prayer. I say this as one who struggled with addiction for many years. The drug becomes the center of our lives, defining our identity and our purpose. And it tells us what to do with our time.
How long will a person wait for something new to happen before returning to their old ways? My experience indicates that it may be as little as 24 hours, and certainly not more than a few weeks.
This is the window of opportunity for the person to develop not only a new routine, but a new circle of friends and support. In the absence of those, he or she is alone and without tools for navigating their new reality.
If you think about how long it takes to find and adopt a new routine, find support, and make friends, this is a nearly impossible task.
So what is the answer?
Those who have relationships with supporters and friends before their release are more likely to succeed. They already have some of the most important pieces in place. If we want to support addicts in staying clean, this should begin while they’re still inside, whether it’s a rehab or a jail.
But secondly, when they get out we shouldn’t expect them to reach out to us. They have been conditioned not to trust, and to believe that those who need help are weak. It takes time for those beliefs to change– time they may not have. There’s also the shame factor. They may be ashamed of their social status, and of their need for help. They also may be afraid of rejection, betrayal, or abandonment– all common occurrences in the world of addiction.
We need to reach out to them! And we need to do so with persistence, but not harassment. They may or may not respond. They may or may not stay clean. Working with addicts always risks heartbreak, including the ultimate heartbreak of funerals. But we do it because there would otherwise be even more funerals.
William, my new friend who disappeared, taught me one thing: not to just give out my number, but to take his. I didn’t do that for him, and he is likely back in the trap of old behaviors. But I have done it for others since then.
For more on addiction, read The Soul of an Addict: Unlocking the Complex Nature of Addiction.
And Zachariah said to the angel, “How can I know this? For I am an old man, and my wife is advanced in her days.”
In reply, the angel said to him, “I am Gabriel, who stands in the presence of God, and I was sent to speak to you and bring this good news. Now see! Because you did not believe in my words, you will become mute and will be unable to speak until that day when these things happen, which will be fulfilled in their due time!”
Now the people were expecting Zachariah, and they were wondering about his delay in the sanctuary. But when he came out, he was unable to speak to them, and they realized he had seen a vision in the sanctuary. And he was beckoning to them, and he remained mute.
As soon as his time of service was complete, he returned to his home. And after this his wife, Elizabeth, became pregnant and hid herself for five months, saying, “Thus the Lord has done for me when he looked upon me: He took away my shame among the people.”
There are two particularly notable things in this passage. The first is Luke’s first jab at the religious establishment. Zachariah, Luke has already told us, is a priest who is “righteous” and “above reproach” (1:6). Yet Zechariah still doubts that God can and will act in this world. We’ll see a contrast with Mary, who accepts what the angel tells her with little argument. And which is the greater miracle: that an old woman should become pregnant (Sarah did!), or that a woman should become pregnant without the participation of a man? Yet Zachariah, the best representative of the temple structure, doubts the smaller miracle, while Mary, an unwed and uneducated young woman, trusts God to do even that which seems biologically impossible.
This is one of the first portrayals of the Kingdom: it is not for the educated elite. It asks, rather, for the childlike trust of a peasant.
Secondly, Elizabeth’s proclamation in 1:25 doesn’t mention the pregnancy of an old woman at all. For her, the miracle is instead that God removed her shame. Again, this heralds the Kingdom, where no one has fallen to far to be redeemed. What’s important is not that Zachariah and Elizabeth got what they wanted, namely a child. What’s important is the removal of their shame, for the Kingdom is a place where all is healed (not merely where everyone gets what they want).
It’s available! In both paperback and Kindle formats. The Soul of an Addict: Unlocking the Complex Nature of Addiction, by D.J. Mitchell.
Addiction is more complex than it may seem. Written for the non-addict who seeks to understand substance addiction, The Soul of an Addict shows that addiction not just a disease or a choice. Using statistics, anecdotes from the lives of addicts, and the author’s personal experience with addiction and recovery, the book argues that addiction affects all aspects of human existence, including identity, purpose, life structure, and morality. It serves as a religion in the addict’s life, and any approach to recovery must also provide these essential needs. With one in seven Americans struggling with substance abuse, this book brings a timely analysis for anyone concerned about addiction.
“A must-read… As a therapist I will be recommending this book to my clients.” –Milt McLelland, CMHC, Roots Counseling Center
For more information, click here.
Want a free look? Download the Introduction and first chapter here!
Want a sneak peek at Madarach’s Secret before it’s published? Download the first two chapters free!
“This is really well written! I love how you promote love, curiosity and communication. Can I go live on Parisa, please?” –A test reader.
My first non-fiction book is coming soon. The Soul of an Addict: Unlocking the Complex Nature of Addiction argues that addiction is far more complex than most models accept. Is it a disease? A choice? Yes. But it’s also more than either of these. In fact, addiction has the sociological characteristics of a religion.
The book is supported by statistics, anecdotes from my work with addicts, and stories from my own struggle with addiction. It will be available in two weeks.
Here’s an excerpt from Chapter Twelve, “What Is Recovery?”
Jenna was in her fifth round at a treatment facility when I met her. She dropped out before the end of the program and went back to using drugs.
Nate got clean and sober the first time he went to treatment and never used again.
Ben was sentenced to treatment by the court after his fifth conviction for DUI. He went to avoid prison, yet he got clean and stayed clean for many years.
Vivian had a spiritual experience after an alcoholic binge, attended Twelve Step meetings and never drank again.
Dan found sobriety in a church run by a pastor in recovery.
Al got sober through Twelve Step meetings while in prison for vehicular manslaughter.
Vern failed at treatment facilities and methadone clinics for years, but after doing some time in jail and living in his car for a year, he finally got clean in a Twelve Step program.
Treatment takes many forms, and has varying rates of success. But, whether an expensive rehab facility, a publicly funded treatment center, a church-based support group, or a cost-free Twelve Step meeting, some form of support is usually necessary to help us get out and stay out of our addiction. The reason is simple: If we knew how to stay clean and sober without treatment, if we could envision a way of life sufficient to replace addiction, we would have given up drugs already.
Treatment for drug and alcohol addiction is big business in the United States. In 2017, nearly three million people underwent treatment. It’s estimated that Americans spend $30-35 billion a year attending rehabilitation centers for drug and alcohol abuse.
That doesn’t include the nation’s largest single “treatment” system: prison. According to researchers Wendy Sawyer and Peter Wagner, nearly half of all federal prisoners, about 100,000 people, are incarcerated for nonviolent drug offenses. It’s estimated that half a million nonviolent drug offenders are incarcerated in state and local prison systems.  At an estimated $30,000 per prisoner per year, that’s another $15 billion expense that falls to the taxpayers.
In 2016, some 168,000 people on parole or probation were returned behind bars not because they committed a new crime but because of technical violations such as staying out past curfew. Sawyer and Wagner argue that the justice system is structured to promote failure, not to reward success.
It’s worth noting that those who go through treatment are more likely to be white (about 80%). Those who go to prison are more likely not to be white (about 70%). The rate of addiction does vary slightly between races, but perhaps not as expected. Of the three most populous races, whites lead in substance abuse problems with 7.7%. Blacks have a rate of 6.8%, and 6.6% of Hispanics struggle with substance abuse. Yet blacks are six times more likely to be incarcerated for drug offenses than whites.
Jacob, a young African-American man, was arrested for drug-related offenses. While represented by a public defender, he was sentenced to four years in prison. Later, he managed to pay an attorney several thousand dollars to have the judge reconsider the sentence. It was reduced to one year followed by a court-ordered drug treatment program. Financial resources clearly make a huge difference in the outcome of drug offenses in the criminal justice system.
There’s another troubling statistic. In 2017, more than 20 million Americans sought treatment for a substance abuse problem. Only 12% of them actually received treatment. That’s a huge improvement over prior years. In 2014, for example, only 7.5% of those seeking treatment actually received it. But still: out of every eight people who seek treatment, seven do not receive it. The most common reason cited, by almost half of those who could not obtain treatment, was lack of insurance coverage. They couldn’t afford the cost.
 Bose, Table 5.10A.
“What America Spends on Drug Addictions,” Addiction-Resources.com, 2005 (https://www.addiction-treatment.com/in-depth/what-america-spends-on-drug-addictions/, accessed August 14, 2019). There are many more recent estimates on what Americans spend on the substances themselves, but I was unable to find a more current estimate of the cost of rehab. Gabrielle Glaser, “The Irrationality of Alcoholics Anonymous,” Atlantic Feb 2015 (https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/, accessed August 15, 2019). “Offenses,” Federal Bureau of Prisons, Aug 9, 2019 (https://www.bop.gov/about/statistics/statistics_inmate_offenses.jsp, accessed August 14, 2019).
 Bose, “Results from the 2017 National Survey on Drug Use and Health: Detailed Tables, 2018 (https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf, accessed May 15, 2020).
 NAACP, “Criminal Justice Fact Sheet” (https://www.naacp.org/criminal-justice-fact-sheet/, accessed May 15, 2020). Numbers for Hispanics were not included. Also see Alana Rosenburg, et. al., “Comparing Black and White Drug Offenders: Implications for Racial Disparities in Criminal Justice and Reentry Policy and Programming,” J Drug Issues 2017 47(1), 132-142 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614457/, accessed May 15, 2020): Blacks are more likely to be incarcerated for smaller offenses; 49% of Blacks and only 10% of whites in the study were convicted of marijuana possession compared with 7% of Blacks and 50% of whites convicted for heroin possession.
 Rachel N. Lipari and Struther L. Van Horn, “Trends in Substance Abuse Disorders among Adults Aged 18 or Older,” The CBHSQ Report, SAMHSA, Jun 29 2017 (https://www.samhsa.gov/data/sites/default/files/report_2790/ShortReport-2790.html, accessed August 15, 2019). Compare Rachel N. Lipari, Eunice Park-Lee, and Struther Van Horn, “America’s Need For and Receipt Of Substance Abuse Treatment in 2015,” The CBHSQ Report, SAMHSA, Sep 16 2016 (https://www.samhsa.gov/data/sites/default/files/report_2716/ShortReport-2716.html, accessed August 15, 2019) reports that 10.6% of those who sought treatment received it in 2015. The percentage receiving treatment has
 Bose, Table 5.50A, shows 421 of 1,033 (41%) surveyed either didn’t have health insurance, or had health insurance that didn’t cover treatment.
I finished writing Benji’s Portal more than five years ago, and almost immediately began the sequel. But it got delayed by grad school…
I’m putting the finishing touches on it now, and it will be published before the end of the month. Here’s an excerpt:
“How is my sister?”
The doctor sighed.
“Unchanged, I’m afraid,” he said. “I’m sorry to say that we don’t know why she is sick.”
“How can you not know?” he asked. “Look at her! Something serious is happening to her. But you don’t know why?”
The doctor sighed again.
“Let me tell you what we do know,” he said. “Her condition stems from a problem in her brain. It’s not related to any other system. But we can’t identify why her brain is malfunctioning.”
“Why not?” Benji pressed.
“Brain chemistry is extremely complex,” the doctor explained. “And her brain chemistry, and presumably yours, differs from what we see on Parisa. Many of the chemicals are the same, but they appear to play different roles in your brain than in ours. So we don’t have the knowledge to determine what’s normal, and therefore we have no idea what’s not normal.”
“What about mine?” Benji asked. “If you checked mine, that should show you what normal is, right?”
“It would show us what is normal,” the doctor said, “for a young man who is just beginning puberty. But we don’t know how similar that would be to a young woman who has already reached biological adulthood.”
“So what do we do?” Benji asked. “You’re saying you can’t treat her?”
The doctor sighed again, his expression pained.
“That is what I’m saying,” he confirmed. “And it’s not an answer I’m happy with, but I’m afraid we just don’t have enough knowledge about her biology. I would suggest that you take her back to your home planet, where they are familiar with what normal brain chemistry looks like for someone from your planet.”
Benji felt his heart sink. On the one hand, he welcomed the chance to go back to Earth and see his parents. But on the other, he knew that his own people’s knowledge of brain chemistry was limited. His mom had often warned that psychiatrists threw medicines at a problem rather than trying to understand it. They had no ability to measure brain chemistry. Instead, they used trial and error, as if each patient was a guinea pig. Compared to Parisa, Earth was extremely primitive when it came to psychiatry.
But it didn’t look like he had much choice. Lisa needed help, and the doctors on Parisa couldn’t help her.
“Can I spend a few minutes alone with her?” Benji asked the doctor.
The doctor glanced at Tamar, and then back at Benji.
“Of course,” he replied.
Then he and Tamar left the room, closing the door behind them.
Now alone with Lisa, Benji went to her side and took her hand.
“What is wrong with you?” he asked yet again. “And what do I do about it?”
He began to cry, deep sobs that made his chest heave.
“How can I help you if I don’t know what’s wrong?” he lamented.
Then he heard a voice, though whether it was Lisa’s or his own, or someone else’s, he wasn’t sure.
“You’re not listening,” it said.
Benji stopped in mid sob.
“Listening to what?” he wondered.
“You’re asking a question, but you’re not listening for an answer,” the voice said. It sounded very far away.
“Okay,” Benji said in his mind. He asked again: “What is wrong with you, Lisa?”
He listened hard.
At first, he heard nothing. Then, gradually, he began to hear a whisper in his mind. As it grew louder, he recognized the voice as Lisa’s. But he couldn’t understand the meaning of her words.
“Black and white, grey and red,” Lisa said. “What happened has not happened. What I saw I did not see. What I did not see I will see again. Red and grey, white and black. Backward or forward, it is all the same.”
“Lisa?” Benji called, his mind to hers. “Lisa?”
“Benji,” she replied. “Thank God. I only can hear you a little through the noise, and I can’t see you through the colors.”
“What colors?” Benji asked.
“Black and white, grey and red,” she repeated.
“I don’t understand,” Benji said.
“Neither do I,” she replied. “Can you help me?”
Benji choked back a sob.
“I’m trying, Lisa,” he assured her. “I’m trying. But I don’t know what to do.”
“Farchedan,” she replied.
That struck him as an odd expression for her to use.
Benji emerged from the room to find the doctor and Tamar conversing together telepathically. He approached them and took their hands.
“You’re right,” he told them. “If there’s nothing you can do for Lisa here, then I should take her home. Our psychiatry is primitive compared to yours, but at least they’ll be familiar with her brain chemistry. And I don’t know what else to do. Maybe my parents will have some idea. I’m sure they’ll want to be with her, even if they don’t know how to help her. So I’m going to take her back to Earth.”
“I think that’s wise,” the doctor agreed.
Watch for news, more details, and updates!
Now the narrative begins. And it begins in an astounding way: the appearance of an angel to a priest. This was not uncommon in the Old Testament, but it hadn’t occurred in centuries. To its audience, this links the Gospel to the Old Testament, but also announces that something amazing is at hand: God, who seemed so distant for so long, is once again working in our world.
I find that most translations fail to capture the magnificence of this event. Here’s my translation:
Let us begin the narrative with a priest in the time of Herod, King of Judea. This priest’s name was Zacharia, and he was of the priestly division of Abia. His wife’s name was Elizabeth, and she was a descendent of Aaron. They were also both righteous in the eyes of God, living according to every commandment and ordinance of the Lord, and above reproach. But they were childless because Elizabeth was unable to conceive, and they were both advanced in age.
But now something happened as he fulfilled the priestly duties in the holiest part of the temple. According to the tradition of his order he had been given his turn by lot, and he entered into the sanctuary to burn incense. All the people were praying outside at the time set for the lighting of the incense. But then he perceived that an angel, a messenger from God, had come to stand by him on the right side of the sacred altar. And upon seeing this, Zacharias became agitated, and terror overwhelmed him.
But the angel said to him, “Do not be afraid, for your prayer has been heard. Your wife Elizabeth shall give birth to a son, and you shall name him John. And gladness and great joy will come to you, and because of his birth many will rejoice. For he will be great in the eyes of the Lord, and wine and strong drink he will neither drink nor desire. And he will be filled with the Holy Spirit even from his mother’s womb. And he will bring a great many of the children of Israel back toward the Lord their God. And he will go before Him with the spirit and power of Elijah to turn the hearts of the elders to those they are responsible for, and to transform the rebellious to righteousness, to prepare for the Lord a people made ready.”
Already, this Gospel is pointing toward structural change, a theme Luke emphasizes often. John will “turn the hearts of the elders” to the people, rather than to their own wealth and power. Luke echoes the calling of the prophets, to call the people back to God and “transform the rebellious to righteousness,” and to prepare the way of the Lord.
For a people who have been subjects of one empire or another for most of half a millennium, whose brief period of freedom ended just a few decades before with the arrival of the Romans, and who equated God’ Kingdom with the Kingdom of Israel, it seemed that God had been terribly silent for a very long time. But here, beginning with one righteous priest, God initiates a new relationship. We don’t see yet the fullness of that relationship, but even in this beginning, Luke points both backward to the prophets and forward to a new beginning.
Of course, this righteous priest doesn’t respond heroically, but that’s in the next passage.