Read Lucky Severson's extended interview about spirituality and the treatment of addictions with Joseph A. Califano Jr., chairman and president of the National Center on Addiction and Substance Abuse at Columbia University:
Substance abuse treatment is still in a primitive state in the United States of America. We have a lot to learn. Success rates are, by and large, low. It's very difficult to get an individual off of this stuff. There is a tremendous problem in motivation, because it feels great to take this stuff. Alcoholics have had Antabuse for 30 years; we have 20 million alcoholics who don't want to take Antabuse. What drives somebody to go into treatment, and what kind of motivation do they need to stay the course and then stay sober after that?
If you talk to recovering alcoholics and drug addicts, the overwhelming proportion of them, and I'm talking something like 90 percent, are going to tell you that spirituality was a major factor. That doesn't mean they're born-again Christians. Some people have that kind of experience. President Bush, for example, who didn't go into any treatment program or Alcoholics Anonymous, had a born-again experience when he stopped drinking. But for most people spirituality -- a sense that there is a higher power, a sense that there's a God out there -- is a very important factor. What we really need to do is marry substance abuse treatment in a medical sense -- what doctors and treatment specialists can do -- with a spiritual component, because the combination is very powerful. It is a sum much greater than the parts.
If you talk to Catholic priests, Protestant ministers, and even rabbis, the ministers out there on the front lines serving the people, they will tell you that one of the biggest problems they face is alcohol and drug abuse. They'll tell you that family break-up is an enormous problem, domestic violence is an enormous problem, and not just in poor parishes but in the most affluent parishes on the Upper East Side or in Beverly Hills or in Georgetown -- and alcohol particularly, but drugs as well are implicated in that problem. We surveyed priests and ministers and rabbis, and over 90 percent of them said substance abuse was an important part of what they had to deal with in their parishes and temples.
We surveyed the seminaries and rabbinical schools, and we found that only 12 percent of those schools gave as much as an hour on substance abuse in the training of their priests and rabbis and ministers. It's not to turn them into treatment providers, but to give them enough of a sense of what substance abuse does to an individual. It's to give them a sense of how to identify someone who has a substance abuse problem and then what to do with that person. How do you get that person to go into treatment or to recognize it? How do you deal with the family of that person? How do you get the family of that substance abuser to deal with the problem they have, because there is a tremendous denial out there? One of the things that happen, for example: typically, mothers in a family get far more deeply into substance abuse than a father does before anything is done. Why? Well, Mom is making the family go. It works, you know? Maybe she's drunk two or three nights a week, but four or five nights a week the kids get fed, the beds get made, the house is clean, Dad gets his dinner, and they just let her sink further and further. It is little things like that that these priests and rabbis should get to understand, just to be able to identify and have a sense of so they can help their parishioners. And help them in what way? Well, have them get into a treatment program, which is very important. They have enormous power over those people in their congregations who are going to church or services regularly.
The stark fact is 95 percent of Americans believe in God, profess a belief in God. Less than 50 percent of psychiatrists and psychologists profess a belief in God, so we have this tremendous disconnect, and when you ask psychologists, as we did in connection with the report, "If you knew that spiritual or religious help would help your patient, would you get that patient into that? Would you promote that?" they say no. That's the tough piece. What we have to do is marry what psychiatrists and psychologists, particularly those who deal with substance abuse, can do to help an individual with what a spiritual awakening or reawakening and values and support can do to help an individual deal with this problem. You need every help you can get. You need every carrot and every stick that can be brought to bear to get yourself unhooked from alcohol or drugs.
Family physicians, who are on the front lines and are likely to see the patient and identify for the first time whether the patient has a problem, are much more comfortable saying to that patient or encouraging that patient to seek some spiritual support and help in connection to dealing with the problem. It is the psychiatrists and psychologists who still are, by far, the most reluctant. And that's unfortunate, because by the time a patient has gone to a psychologist to get individual treatment or individual help, that patient is at least willing to try to get rid of it. Why not give the patient every tool that might help him or her shake this?
In terms of substance abuse generally, medical schools are terrible. My daughter is in medical school here in New York, just finishing four years of medical school, and she's had two hours on substance abuse and addiction, which is probably the number one disease any family practitioner and most psychiatrists and some psychologists will face. Medical schools give students no more than a couple of hours on substance abuse and addiction, and rarely will that couple of hours include any indication that spirituality is an important factor. And what is one of the most successful programs for achieving sobriety, and certainly for maintaining sobriety? Alcoholics Anonymous, and it is imbued with a spiritual component, driven by a spiritual component.
Substance abuse is a chronic disease. It is like hypertension or diabetes. You have to take a pill for hypertension every day; you have to get your insulin every day for diabetes. People who are in recovery for substance abuse need support every day, or several times a week. It's the support for that chronic disease that carries them through for the rest of their lives, and a big piece of that support is spiritual support.
Substance abuse is the number one crime problem in the country. Eighty percent of the people in prison and in the juvenile justice system have drug or alcohol involvement at one point or another. Substance abuse is the number one health problem in the country. Smoking, drinking, and drugs are the largest causes and exacerbators of cardiovascular disease, cancer, and crippling respiratory illnesses. Seventy percent of the kids in the child welfare system are there because of drugs and alcohol-abusing parents. Most of the kids who get pregnant as teenagers -- one or both of them are high at the time of the act. The largest cause of the spread of AIDS is intravenous drug use and those who have sex relations with intravenous drug users, and now, in the gay community, those who are using ecstasy and methamphetamines. Women who were left on welfare after welfare reform -- most of those women have drug and alcohol problems. This is a problem that pervades our society. It's the elephant in the living room of all our social problems, and nobody wants to look at it.