Pastoral Counseling and the Alcoholic

A Study Paper of the Lutheran Church in America, by Conrad L. Bergendoff, M.A., M.Div., no date

There are today, by conservative estimates, 9,000,000 alcoholics in the United States. If one assumes that each alcoholic affects the lives of at least three other people in a critical manner, we are faced with a problem of monumental proportions.

Alcoholism, the third leading cause of death in the United States, is a moral and spiritual problem, as well as physical and psychological.

The pastor has both assets and liabilities in dealing with the alcoholic. The pastor generally occupies a privileged position in the community and "is often the first person to whom the alcoholic and his or her family turn when it becomes evident that drinking has become a problem."

Unfortunately, the pastor is often an "enabler," a person who, by failing to be confrontive, "enables" the alcoholic to continue on a disastrous course. A study by the University of Iowa indicates that there is generally a seven year time span between the onset of alcoholism and the first appearance of a client at a treatment center. This means that a number of people, including clergy, have probably suspected incipient alcoholism, but for whatever reason, have said little.

It is Vernon Johnson's view that even creating a crisis may, in the long run, be more beneficial to the alcoholic than diplomatic silence.

What is the pastor's role in regard to alcoholism? Certainly it is not judgmental. Howard Clinebell has made a survey of 146 ministers who attended the Yale School of Alcohol Studies and discovered the following: those ministers who viewed alcoholism as simply a sin were approached for help by an average of only 2.3 persons annually, whereas those who felt alcoholism was a sickness received overtures for help from an average of 9.3 persons annually. Clinebell also discovered that ministers who took a rigid stand against all forms of drinking and who promoted prohibition "saw only one-fourth as many alcoholics during the course of a year's counseling ministry as the minister who advocated no particular position for others to adhere to in this matter."

The first and perhaps most important task of the pastor is accurate knowledge of the nature of alcoholism and of the alcoholic.

Alcoholism is a serious compulsive disease which gets progressively worse if drinking continues. Unchecked, it is fatal. Any approach which ignores these facts is doomed to failure. The alcoholic cannot "taper off," and cannot invent some spurious kind of "controlled drinking." He, or she, must stop drinking altogether.

But how is this achieved? A wise and courageous minister will be quick to detect signs of alcoholism: loss of time at work, financial problems, marital problems, legal problems -- possibly occurring in a family that has previously known none of these.

Since only 2 to 5% of alcoholics are on skid row, it is obvious that the rest are in all the remaining strata of society. A letter from the President of the Lutheran Church in America to the clergy of that denomination states, "Alcoholism affects one family out of every five in the average Lutheran parish." This means that alcoholism is all around us; we do not need to look far.

However, realizing the magnitude of the problem by itself does nothing to solve it. Joseph Kellerman, executive director of the Charlotte, North Carolina Council on Alcoholism, quotes a statement by a physician which illustrates the importance of having a constructive attitude to the problem. "A Boy Scout with a bottle of aspirin, a pup tent, understanding and compassion can effect better treatment for an alcoholic than a doctor with the finest medical means if he is hostile and prejudiced against the patient." Kellerman, himself a clergyman, then comments, "If this is true of the doctor, how much more of the minister."

There are no miraculous cures for alcoholism. It is a complex problem. The alcoholic is frequently armed with elaborate defense mechanisms and is highly skilled at self-deceit. Furthermore, alcohol, for the alcoholic, is addictive. The incipient alcoholic soon drinks excessively "whenever drinking occurs. He has lost the freedom of choice."

One of the first goals of treatment, therefore, is endeavoring to have the client take Step 1 of Alcoholics Anonymous (AA), which is the admission of powerlessness over alcohol, and the realization that life has become unmanageable. Few people wish to admit powerlessness over anything, but most leaders in the field feel that unless alcoholics are willing to take Step 1 and to take drastic measures to change their lives, further drinking is inevitable. The minister may early detect, or suspect, alcoholism in a family, but probably will not be able, alone, to bring an alcoholic to such an admission of powerlessness.

The pastor, however, who occupies a position of trust in a congregation, has several tools available. First is AA. Many alcoholics have been helped by AA alone. AA is tough, supportive, and non-judgmental, three ingredients that seem to work for the alcoholic, whether male or female.

However, for many alcoholics, AA alone is not enough. A treatment center which recognizes the complex character of alcoholism may be needed. The male alcoholic, for example, frequently has the assertive level of a high school freshman. He may need training in assertiveness. There may be a marital conflict which will need couples counseling. The alert pastor will know when to refer to a treatment center.

Before referral takes place, however, there are several questions that must be answered. The first of these and perhaps the most difficult is how may the alcoholic be identified? It is important to recognize, to begin with, that amount consumed does not necessarily have anything to do with whether a person is an alcoholic. Loss of control is probably a better criterion of alcoholism than amount. As Robert Hammond has described, "Once he (the alcoholic) starts drinking, he may no more control his compulsion to continue drinking than the tuberculosis patient can voluntarily control his coughing."

Associated with loss of control is a very simple definition, "the person uses alcohol to the extent that it interferes with living a successful life."

Granted, one may debate the meaning of the word "successful," but if the result of drinking is that a person is in trouble socially, spiritually, economically, medically, there is a reasonable suspicion that the person is, in fact, an alcoholic.

Chronic abuse of alcohol also tends to cause mental disorder. Whether this is the area of a degeneration of the ethical sense or increasing fits of rage and delusion, there is almost always an emotional concomitant to the physical addiction.

One good clue to identifying the alcoholic is this: if drinking causes continuing difficulty in any area of life -- job, family, health, or financial -- the person needs assistance.

This leads to a second important question. How does one give assistance? Most alcoholics will deny that alcohol is a problem, even in the face of overwhelming evidence to the contrary. One or more crises may be inevitable before the alcoholic is even willing to consider the possibility that alcohol is a problem in his or her life. It takes a kind of "tough love" both to induce the alcoholic to seek treatment and to give appropriate pastoral support after the alcoholic has assented to treatment.

There is a danger that the pastor, in relating to the alcoholic, may err either by an oversolicitousness, which may interfere with the treatment process, or by non-involvement to the point of ignoring the alcoholic. Either extreme is inimical to the alcoholic's recovery.

Only one in three alcoholics is able to maintain sobriety for a year. Hence, it is imperative that anyone dealing in a professional manner with the alcoholic understand the difficulty in moving from an alcoholic way of life to a sober way of living. Sober living is not joyless living, but to the alcoholic in initial stages of recovery it may appear so. The pastor should appreciate the normality of wide mood swings in the first stages of recovery. For example, a sudden surge of religious feeling may demonstrate itself. Enthusiasms of various kinds may surface. Value systems may undergo radical upheaval.

The understanding minister will bear with all this, recognizing that change is inevitable if the recovery process is to be successful.

THE PASTOR'S OPPORTUNITY
It is important to recognize that self. insight in regard to the problem of alcoholism is negligible. The alcoholic tends to lose contact with his or her emotional life. Defense systems grow so that the person can survive in the face of mounting difficulties. The greater the pain, the higher and more rigid the defense becomes. The point is reached when the alcoholic does not know what is happening inside, and becomes a victim of his or her own defense mechanisms. Naturally, a whole host of negative emotions have now developed: anxiety, guilt, shame, and remorse among them. Little wonder that Alcoholics Anonymous advises the alcoholic, "One day at a time." Emotions like that are not reversed easily, and the recovering alcoholic must, above all else, learn patience.

An old Puritan saying was that, "Man proposes, God disposes." And, indeed, the circumstances that bring any individual alcoholic to treatment have a certain ring of inevitability to them. Regardless of one's theology, however, certain specific things have to be done by specific individuals before intervention becomes successful.

For example, the choosing of a good treatment center. If requested by a family to assist in choosing a treatment center, the minister should discover what kind of treatment services are available. A comprehensive program should include detoxification, inpatient, outpatient, emergency, and consultation services.

Some knowledge of what a treatment center does is also helpful. Does the center have a full-time physician for the medical aspects of alcoholism? Is the facility cooperative with the churches in the area? Are the counselors well trained?

The recognition of alcoholism is of little consequence unless the treatment center to which a person is referred is well qualified to assist alcoholics both to assess their predicament and to give some hope that a sober way of life can be more challenging and ultimately more fruitful than to continue drinking. This is a difficult task, for the alcoholic, at the onset of treatment, is generally tense and depressed, lonely and discouraged.

As both problems and rationalizations about the problems have increased for the alcoholic, receptivity to the assistance of any kind of counseling has probably diminished. The alcoholic, immediately before treatment, is probably as emotionally isolated as it is possible to be. The pastor will probably have to pull back temporarily and allow treatment facility staff the freedom to adequately assess and confront the alcoholic. However, in course of treatment, the client is advised to take Step 5 of AA's 12 Steps: "Admitted to God, to ourselves, and to another human being, the exact nature of our wrongs." Clients should be encouraged to take this step with ministers of their own choice. Many ministers have performed this service.

Alcoholism is not only a major medical problem, it is a spiritual problem. Pastors may be trained in many areas, but the lonely travail of alcoholism may elude them unless they are sensitive to its clues, prompt to intervene, and willing to refer to a competent treatment center when necessary. The pastor, in good conscience, cannot "pass by on the other side," but like the Good Samaritan must be ready to bind up the wounds of anyone in distress.

CONCLUSION
Alcoholism develops as part of a total life style. It may begin in a hundred small ways: sneaking a drink, missing appointments, a diminished awareness of one's surroundings. The actual addiction to the chemical, ethyl alcohol, may be hard to spot. A person may believe that, because one does not drink before 5 p.m., or drinks only on weekends, or is too young, then alcoholism is not possible. But these qualifications are myths. A far more important question is: whether a person gets into any kind of difficulty, legal problems (particularly those associated with driving while intoxicated), financial problems or trouble on the job. These problems may all be disguised, but if drinking excessively can be linked with any of them, a drinking problem quite likely exists.

If there is any suspicion of alcoholism, pastors should immediately make themselves available to those persons and convey an understanding attitude. They should also contact immediate members of the families and elicit specific behaviors of the incipient or actual alcoholic. Pastors should point out that, by doing nothing, the family only postpones the inevitable. Alcoholism is always progressive. A family reluctant to face the problem this year may be faced with worse crises next year. A compassionate but forceful minister may well make the difference in advising a treatment center before a marriage breaks up, or a job is lost, or a person is arrested for driving while intoxicated. One does not "help" an alcoholic, one thrusts reality upon him or her. Vernon Johnson argues that, `Every time you try to rescue an alcoholic, you are delaying useful treatment."

No one wants to be an alcoholic, yet few alcoholics really want to stop drinking. All kinds of techniques, therefore, will be used to avoid or evade those who try to be of assistance. The steadfast refusal of both a minister and significant members of an alcoholic's family to allow any escape hatch is imperative.

How a pastor best deals with an alcoholic's family, whether the person is a practicing alcoholic or a recovering alcoholic, may be of crucial significance, for he or she may often have the opportunity to become a successful catalyst in suggesting treatment or in giving social and spiritual support.

As with any serious physical or mental problem, early detection of alcoholism enhances the possibility of recovery. The pastor who understands the nature of alcoholism and is unafraid of constructive confrontation may well be a significant factor in guiding a family through the difficult times that invariably go with alcoholism.

Chaplain Conrad L. Bergendoff is one of many LCA pastors and lay persons who are working with alcohol and other drug problems. Since we do not know who most of them are, the Division for Mission in North America (DMNA) is interested in receiving their names and addresses, and descriptions of what they are doing. Please send such information to the Rev. Cedric W. Tilberg, DMNA, 231 Madison Avenue, New York, NY 10016.

The DMNA has had a staff working group interested in developing churchwide program in this area of great concern. With the help of representatives of two other churchwide agencies and four LCA pastors who are specially engaged in dealing with alcohol and other drug problems, the working group prepared a report to the DMNA management committee. The report dealt with the size and nature of these problems, issues facing the church, and suggestions for action by the DMNA or other churchwide agencies. The division, in its regular contacts with synodical committees on social ministry, is promoting use of Alcoholism and Addiction, a study program written by the Rev. Karl A. Schneider and produced by the Division for Parish Services for private reading and congregational study (Fortress Church Supply Stores, $3.50). The DMNA is also joining with other denominations in an ecumenical approach.

These increasing activities reflect a conviction that the churches have a crucial role to play in dealing with the pervasive problems associated with alcohol and other drug abuse.