Salvation and Deliverance in an Opioid-Addicted America
The rise of a major public health problem, such as AIDS or more recently Covid-19, is often met with a determined effort by society to confront it on a number of levels: undertaking medical research, developing statistical analyses, inculcating social attitudes, examining human behaviors as well as disseminating basic knowledge of the disease itself, among other things. Successfully treating most major diseases, then, has never been simply a function of biology and medical practice but also has also required an increasing social awareness of the problem, itself, so that more and more people actually care. Increasing social awareness as well as creating a fund of sympathy go a long way towards identifying vulnerable populations so that limited resources can be applied most effectively.
Ravaging certain segments of the American population today (with close to 50,000 deaths in 2017, according to the CDC), opioid addiction will not likely be brought under control any time soon. Part of the difficulty here is that treating this particular health issue will entail fostering those social attitudes needed to identify the extent of the problem as well as the particular populations most affected. One of the stubborn and annoying facts surrounding opioid addiction in America today is that many who succumb to its enslaving powers are simply invisible. They’re often white, blue collar or lower-class workers, middle aged, many of whom live in rural areas. Clay and Knox counties in Kentucky, for example, not only have high rates of opioid addiction (that media elites disparagingly refer to as “hillbilly heroin”) but of suicide as well. Given this situation, with this particular configuration of social forces in play today, the embarrassing and morally troubling question for some now has become, “Who cares?”
Indeed, the manner in which identity politics divvies up particular social groups into “oppressor” and “oppressed” has only made matters worse. Not fully aware of the class dynamics (beyond race and gender) that are currently playing out in American society, such an approach has not only kept these poor, suffering people by and large invisible, but it has also blamed these very same people, adding insult to injury by simply viewing them as “privileged.” Being white, male, and heterosexual has precluded the kind of care and concern, the elements of basic human decency and compassion, that should be offered to all people, especially those in dire straits. Of course, opioid addiction is not simply found among blue collar, middle-aged, white men. It’s just that it has unfortunately become a dogged problem there of late.
Addiction (as well as the dynamics of brain chemistry that keep it in place) don’t care at all, not one whit, about one’s race or gender or politics or sexual orientation or moral views or even one’s religious preferences. Simply put, the brain does what the brain does; get used to it! If there ever was a strong case for natural law, with its emphasis on consequences that are ignored to one’s own peril, then here it is. That’s been the experience of nearly everyone who has succumbed to opioids. Judith Grisel, a medical doctor and careful researcher, who was herself at one point in her own journey cross-addicted, has written an enormously helpful book on the subject, Never Enough: The Neuroscience and Experience of Addiction. In her very readable and engaging work, Dr. Grisel lays out the course of opioid addiction: The brain adapts, and ongoingly so, to drugs like opioids (Oxycodone, Oxycontin, Demerol, Dilaudid, and Fentanyl, for example) by producing an opponent process in order to bring the brain back to “normal,” its new set point (Grisel, Never Enough, p. 75). In other words, as the brain increasingly adapts to the introduction of opioids, with its strong opponent processes, it will take more and more of the drug to produce the same effect. The brain now “tolerates” the drug remarkably well with little or no high at all. If the dosage is then increased in order to chase the high or to get additional pain relief, then the brain will adapt to this situation as well, with more and even stronger opponent processes, and users will likely become dependent. With significant opponent brain changes well established, there will, once again, be no highs at all. It’s all been a will-o’-the-wisp. Instead, the drug will likely now be needed simply in order to feel “normal.”
Now here’s the nasty little biological fact that has led to so many deaths. While the brain adapts to the drug, resulting in greater tolerance, the lungs do not. As larger and larger doses of opioids are taken to fend off the agonies of withdrawal, the capacity of the lungs to breathe is increasingly and significantly diminished. At some point death will likely be the only consequence of this growing combination: more and more drugs with less and less lung function. Well before this last stage occurs, however, drug users will already be in prison: “Line up over there; your towels are on the bench.”
What should be the response of the church in the face of this growing crisis? During 2012, for example, doctors wrote more than 250 million prescriptions for opioids (Grisel, Never Enough, p. 64). At the outset one should recognize that those who are trapped within the web of opioid addiction are people in extremis. They may be teenagers who found their way into their parents’ or their friend’s parents’ medicine cabinet; they may be suburban housewives who were trying to take the edge off the petty annoyances of daily life after a recent surgery. It doesn’t matter. Though diverse in many respects, they are yet united in one very important way: they’re a population in critical need. Indeed, the specter of overdose and possible death looms large on their horizon. That’s what the statistics tell us. Accordingly, if a family member or friend or neighbor or co-worker confides in us the nature of their problem, then we should urge them to see their physician as soon as possible. Better yet, we can go with them to the doctor’s office in order to offer our care and ongoing emotional support. In some cases our friend or neighbor may actually require hospitalization as the best way forward. However, when they are finally clean, then what? Does the church have a response, a ministry, here as well?
In order to stay clean and not fall into the trap once more of a slavery that is ruled largely by brain chemistry, those who are on the path to recovery should be introduced to a disciplined way of living. Fortunately, the church doesn’t have to reinvent the wheel here. Many Twelve-Step programs (such as Narcotics Anonymous, Heroin Anonymous, and Alcoholics Anonymous) already exist whereby their members can learn to live, with increasing degrees of serenity, without drug X, whether that X be oxycontin, heroin or even alcohol.
Now here comes a splash-of-cold-water-in-the-face surprise. Not everyone in the church is on board with this course of treatment! In fact, some theologies are bitterly opposed to all Twelve-Step programs, period. The case is closed; the conversation is over. For example, the book, 12 Steps to Destruction, written by Martin and Deidre Bobgan, is typical of this genre. This work argues, for instance, that “Twelve-Step recovery programs are based upon the wisdom of men (sic)” (p. 17). Beyond this, it maintains that “the attempt to merge the psychological, codependency/recovery teachings with the Bible and Christianity results in one big psychoheresy” (p. 18). And to top it all, this book contends that “All Twelve-Step programs violate the declarations of the Reformation: Only Scripture; Only Christ; Only Grace; Only Faith; and Glory to God Only” (p. 120). Yikes!
To be sure, the book 12 Steps to Destruction, and the theology it represents, confuses the issues of deliverance and salvation, which are actually remarkably different things. But first let’s see how Twelve-Step members themselves might actually be guilty of this confusion, and then we’ll turn back to this critical and dismissive theology.
The first mix-up has to do with the issues of deliverance from a particular ill or moral problem or addiction, on the one hand, and salvation, understood as explicit faith in Jesus Christ that issues in freedom from the guilt and power of sin, on the other hand. The two, that is, deliverance and salvation, do indeed overlap at times but not always so. That men and women, for example, can get free from oxycontin, alcohol, pornography or a vicious habit of evil-speaking, for instance, doesn’t mean they’re redeemed. They may be saved in the Christian sense of that term, but then again maybe not. Ponder this: there are all sorts of people who have never had a problem with any of these things just noted but they’re still sinners badly in need of redemption, that is, in want of being forgiven and being made holy.
For its part, the theology that rejects Twelve-Step programs confuses deliverance and salvation in a different way, but it too ends up in significant error. Granted, all those who believe redemptively in Jesus Christ are delivered from the guilt and power of sin, as John Wesley clearly taught, and as such are set free from the bondages that once held them captive. We can rejoice in the face of all those powerful testimonies heard in the church in which faith in Jesus was explicitly proclaimed, often in the midst of shouts of joy, that Christ is a mighty deliverer who sets the captives free! Here salvation and deliverance from X overlap to the glory of God. Hallelujah!
Do men and women, however, have to exercise explicit faith in Jesus Christ in order to be delivered from X? Put another way, can Jews, Muslims, agnostics and even atheists be delivered from opioid addiction, for example, apart from explicit faith in Jesus Christ? The authors of 12 Steps to Destruction and others in the church seem to say No! Wesleyan theology, as well as broader catholic theology (Rome, Constantinople and Canterbury) however, offer a resounding “Yes!”
The problem with theologies that reject Twelve-Step programs is actually a theological one in the sense that sanctifying, redeeming grace does all the heavy lifting, so to speak, such that deliverance and redemption are inextricably bound together. However, if only sanctifying, regenerating grace leads to deliverance, then explicit faith in Jesus Christ will indeed be required. Now one of the conditions of any sound and competent theology is that it gets the basics right. In other words, it calls “the good” good and it calls “evil” evil. Again, a sound theology, generous in its conception, is able to acknowledge the good wherever it is found both within the church and beyond its walls--but never apart from Christ even though Jesus is not explicitly acknowledged. In short, these problematic theologies, many of which hail from the magisterial Reformation, lack a full-bodied understanding of what Wesleyans and others call prevenient grace.
Literally coming before salvific grace, properly speaking, prevenient grace allows catholic theologies, Wesleyan or otherwise, the freedom to acknowledge the goodness of Twelve-Step programs as ultimately rooted in Christ, in a frank recognition of “The true light that gives light to everyone” (John 1:9). Wesleyans, as well as others in the church, know that when bondages are broken Christ has indeed done the work, whether he is recognized or not. Indeed, prevenient grace is already present even before we are fully aware of that presence; that’s how good, gracious and merciful God is.
Twelve-Step programs then are neither outside the grace and goodness of God nor are they competitors to the gospel. Rather, they are a fine instance of what Wesley called prudential rules, a genuine means of grace, those courses of action suggested by reason and careful reflection that can lead us toward God, for “where the Spirit of the Lord is, there is freedom” (2 Corinthians 3:17, NIV). To be sure, prevenient grace is not saving grace, but it is an instrument of a God of holy love through which the captives can be set free. Now consider this: If God can deliver through the power of prevenient grace, imagine what the Most High can do in terms of regenerating, initially sanctifying grace. Glory!
Dr. Kenneth J. Collins is Professor of Historical Theology and Wesley Studies at Asbury Theological Seminary and is a member of Firebrand’s Editorial Board.