Abstinence and Harm Reduction in the Church
One of the most divisive debates in the area of addiction therapy has to do with two distinct models of recovery: harm reduction and abstinence.
Put simply, the abstinence model says that true recovery from addiction exists only if the addictive substance is entirely removed from the life of the addict. An example of a recovery program based on the abstinence model is the Alcoholic Anonymous 12-Step program, or the ABC program of sex education.
Harm reduction, by contrast, says that since not everyone is ready for complete abstinence, steps need to be taken to reduce the risk that a person poses to themselves or others when they partake of an addictive substance. Safe injection sites and legalized prostitution are examples of initiatives based on this therapeutic model.
According to those who support abstinence, proponents of harm reduction—by tolerating any use of an addictive substance—normalize and condone destructive behaviour by sending the message that such behaviours are permissible. They also argue that harm reduction simply displaces addictive behaviours rather than removing them.
On the other hand, proponents of harm reduction argue that those who hold to abstinence are guilty of black-and-white thinking that oversimplifies the complex realities of addiction and recovery. They also point to statistics that suggest that the success rate for abstinence programs such as AA is very low—possibly as low as 5%—as opposed to the supposedly higher rates of programs that use harm reduction methods.
Witnessing this debate (and feeling uncomfortable on both sides), I am reminded of a similar debate in the life of the Church. Indeed, I see the issue of abstinence versus harm reduction as a secular version of the fundamental challenge of the pastoral vocation, namely, how to guide fallen, broken human persons to take the concrete and practical steps they need to recover their true humanity in Jesus Christ.
We don’t need to belabour the ‘sin as addiction’ analogy to see that the Church preaches abstinence when it comes to sin. A person’s humanity cannot be fully recovered unless sin is extirpated from his or her life. Jesus calls us to “go and sin no more,” and to “be perfect as your Heavenly Father is perfect.” The primary and ultimate goal of the Church’s task is to lead us into abstinence from any behaviour or attitude that turns us away from the love of God, resulting in the destruction of ourselves and others.
But how exactly does the Church lead us on this path towards abstinence from sin, and is this the only possible approach we can take? Typically, when someone ‘falls off the wagon’ into sin, our pastoral method consists of an exhortation to ‘get back up and try again.’ In many cases, this leads on to restart the cycle: the commitment to abstinence, the slip and fall, the confession, the new commitment to abstinence, and so on.
I would suggest that lasting recovery from sin too often eludes us because our pastors have no way to recognize and bless incremental progress towards virtue. In the abstinence model, there is no such thing as ‘a little less drunk’ or 'nearly sober.' As a result, for some, the gap between their current reality of fallenness and the sinless ideal that they must attain appears too great, and they are left stuck in the cycle, falling down and getting back up again, without even a taste of lasting victory over sin. The final result can be discouragement, despondency, and an unwillingness even to try.
In this, the realm of addiction counselling can be helpful to us. It has become clear to many contemporary practitioners that both abstinence and harm reduction are complementary aspects long-term recovery. Harm reduction policies need a clear ‘end point’ for the addict, a vision of a life free from addictive substances. Abstinence provides that vision. At the same time, when the distance between the addict and the abstinent ‘endpoint’ is too wide to achieve recovery effectively, harm reduction can help shrink the gap.
Although not as widely known as it perhaps should be, the Church has taken a similar, balanced approach in working for the spiritual recovery of her members. The following account from the life of the Elder Paisios (d. 1994) is instructive:
Once on Mount Athos there was a monk who lived in Karyes. He drank and got drunk every day and was the cause of scandal to the pilgrims. Eventually, he died and this relieved some of the faithful who went on to tell Elder Paisios that they were delighted that this huge problem was finally solved.
Father Paisios answered them that he knew about the death of the monk, after seeing the entire battalion of angels who came to collect his soul. The pilgrims were amazed and some protested and tried to explain to the Elder of whom they were talking about, thinking that the Elder did not understand.
Elder Paisios explained to them: “This particular monk was born in Asia Minor, shortly before the destruction by the Turks when they gathered all the boys. So as not to take him from their parents, they would take him with them to the reaping, and so he wouldn’t cry, they just put raki* into his milk in order for him to sleep. Therefore he grew up as an alcoholic. There he found an elder and said to him that he was an alcoholic. The elder told him to do prostrations and prayers every night and beg the Panagia to help him to reduce by one the glasses he drank.
After a year he managed with struggle and repentance to make the 20 glasses he drank into 19 glasses. The struggle continued over the years and he reached 2-3 glasses, with which he would still get drunk.”
The world for years saw an alcoholic monk who scandalized the pilgrims, but God saw a fighter who fought a long struggle to reduce his passion.
It’s important to note that the alcoholic monk’s elder did not impose complete abstinence on him, but a gradual reduction of his intake of alcohol over the years. This harm reduction method in no way implied that the elder didn’t view abstinence from alcohol as the ultimate goal. It simply meant that he viewed the gradual, penitential struggle towards abstinence, incomplete as it was, as worthy of honour in God’s sight.
The above account—rare in the Orthodox tradition but welcome in our time—reminds us of the need to strike a greater balance with those in our pastoral care, including ourselves. While our goal should be to ‘go and sin no more’ through the abuse of alcohol, drugs, relationships, sex, food, money, material possessions, or anything else, there is room for an approach that honours our struggle to ‘sin a little less’ than before.
This is not a slippery slope or an excuse to sin, any more than the elder’s advice to the alcoholic monk was a license to get drunk. It’s just another way of saying that, while our Heavenly Father certainly wants us to return all the way home to His loving embrace, He certainly rejoices to see that we are on the way.
Put simply, the abstinence model says that true recovery from addiction exists only if the addictive substance is entirely removed from the life of the addict. An example of a recovery program based on the abstinence model is the Alcoholic Anonymous 12-Step program, or the ABC program of sex education.
Harm reduction, by contrast, says that since not everyone is ready for complete abstinence, steps need to be taken to reduce the risk that a person poses to themselves or others when they partake of an addictive substance. Safe injection sites and legalized prostitution are examples of initiatives based on this therapeutic model.
According to those who support abstinence, proponents of harm reduction—by tolerating any use of an addictive substance—normalize and condone destructive behaviour by sending the message that such behaviours are permissible. They also argue that harm reduction simply displaces addictive behaviours rather than removing them.
On the other hand, proponents of harm reduction argue that those who hold to abstinence are guilty of black-and-white thinking that oversimplifies the complex realities of addiction and recovery. They also point to statistics that suggest that the success rate for abstinence programs such as AA is very low—possibly as low as 5%—as opposed to the supposedly higher rates of programs that use harm reduction methods.
Witnessing this debate (and feeling uncomfortable on both sides), I am reminded of a similar debate in the life of the Church. Indeed, I see the issue of abstinence versus harm reduction as a secular version of the fundamental challenge of the pastoral vocation, namely, how to guide fallen, broken human persons to take the concrete and practical steps they need to recover their true humanity in Jesus Christ.
We don’t need to belabour the ‘sin as addiction’ analogy to see that the Church preaches abstinence when it comes to sin. A person’s humanity cannot be fully recovered unless sin is extirpated from his or her life. Jesus calls us to “go and sin no more,” and to “be perfect as your Heavenly Father is perfect.” The primary and ultimate goal of the Church’s task is to lead us into abstinence from any behaviour or attitude that turns us away from the love of God, resulting in the destruction of ourselves and others.
But how exactly does the Church lead us on this path towards abstinence from sin, and is this the only possible approach we can take? Typically, when someone ‘falls off the wagon’ into sin, our pastoral method consists of an exhortation to ‘get back up and try again.’ In many cases, this leads on to restart the cycle: the commitment to abstinence, the slip and fall, the confession, the new commitment to abstinence, and so on.
I would suggest that lasting recovery from sin too often eludes us because our pastors have no way to recognize and bless incremental progress towards virtue. In the abstinence model, there is no such thing as ‘a little less drunk’ or 'nearly sober.' As a result, for some, the gap between their current reality of fallenness and the sinless ideal that they must attain appears too great, and they are left stuck in the cycle, falling down and getting back up again, without even a taste of lasting victory over sin. The final result can be discouragement, despondency, and an unwillingness even to try.
In this, the realm of addiction counselling can be helpful to us. It has become clear to many contemporary practitioners that both abstinence and harm reduction are complementary aspects long-term recovery. Harm reduction policies need a clear ‘end point’ for the addict, a vision of a life free from addictive substances. Abstinence provides that vision. At the same time, when the distance between the addict and the abstinent ‘endpoint’ is too wide to achieve recovery effectively, harm reduction can help shrink the gap.
Although not as widely known as it perhaps should be, the Church has taken a similar, balanced approach in working for the spiritual recovery of her members. The following account from the life of the Elder Paisios (d. 1994) is instructive:
Once on Mount Athos there was a monk who lived in Karyes. He drank and got drunk every day and was the cause of scandal to the pilgrims. Eventually, he died and this relieved some of the faithful who went on to tell Elder Paisios that they were delighted that this huge problem was finally solved.
Father Paisios answered them that he knew about the death of the monk, after seeing the entire battalion of angels who came to collect his soul. The pilgrims were amazed and some protested and tried to explain to the Elder of whom they were talking about, thinking that the Elder did not understand.
Elder Paisios explained to them: “This particular monk was born in Asia Minor, shortly before the destruction by the Turks when they gathered all the boys. So as not to take him from their parents, they would take him with them to the reaping, and so he wouldn’t cry, they just put raki* into his milk in order for him to sleep. Therefore he grew up as an alcoholic. There he found an elder and said to him that he was an alcoholic. The elder told him to do prostrations and prayers every night and beg the Panagia to help him to reduce by one the glasses he drank.
After a year he managed with struggle and repentance to make the 20 glasses he drank into 19 glasses. The struggle continued over the years and he reached 2-3 glasses, with which he would still get drunk.”
The world for years saw an alcoholic monk who scandalized the pilgrims, but God saw a fighter who fought a long struggle to reduce his passion.
It’s important to note that the alcoholic monk’s elder did not impose complete abstinence on him, but a gradual reduction of his intake of alcohol over the years. This harm reduction method in no way implied that the elder didn’t view abstinence from alcohol as the ultimate goal. It simply meant that he viewed the gradual, penitential struggle towards abstinence, incomplete as it was, as worthy of honour in God’s sight.
The above account—rare in the Orthodox tradition but welcome in our time—reminds us of the need to strike a greater balance with those in our pastoral care, including ourselves. While our goal should be to ‘go and sin no more’ through the abuse of alcohol, drugs, relationships, sex, food, money, material possessions, or anything else, there is room for an approach that honours our struggle to ‘sin a little less’ than before.
This is not a slippery slope or an excuse to sin, any more than the elder’s advice to the alcoholic monk was a license to get drunk. It’s just another way of saying that, while our Heavenly Father certainly wants us to return all the way home to His loving embrace, He certainly rejoices to see that we are on the way.
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