CHRISTIAN THERAPEUTIC COMMUNITY IN ADDICTION TREATMENT - Eugene Protsenko about the OLD WORLD Charity's history and its methods

 THIS ARTICLE WAS TRANSLATED INTO ENGLISH FOR THE PRESENTATION ON THE CONFERENCE ON ORTHODOX PSYCHOTHERAPY IN CHICAGO, USA, 22-26 JUNE 2010

 In 1984 I graduated from Moscow University as a neuropsychologist and started to work in one of Moscow's neurosurgery clinics. I could not even imagine then that a time would come in my life devoted to work with drug-addicts and alcoholics – these problems seemed to me very far then.

But very soon I become disappointed with positivistic physiological approaches to the human being. This fact as well as some personal circumstances forced me to think on changing my attitude to the world. I came to Christ, was baptized in 1983, and began to learn living the church life that was rather new for me. These changes led me to seek new areas in which to exert my efforts.

I got a job of a psychologist in addiction treatment center, where I met many patients in despair and helplessness, who were captive to dependency on alcohol and drugs. These people were seeking a way out and could not find it. And what was more tragic, general medicine, psychiatry, psychology or psychotherapy could offer nothing to them as a cure. Or, rather, there were many proposals, but their complete ineffectiveness was absolutely clear to these people, mostly from their own experience, for most of them had gone through a number of different “treatments”.

As you know, addiction in its different manifestation is one of the most threatening problems of nowadays and is one of the greatest killers of people all over the Globe. Russia is not an exception. The statistics of the last few years show a steady growth of alcoholism and addiction in our country. The total number of registered patients with these diseases in Russia exceeds a million. According to experts, the actual number of such patients surpasses this amount at least by a factor of six. And this problem looks even worse and much more grave when we consider that every member of an addict’s family, especially their spouses and children, suffers from consequences of addiction which often result in personality dysfunctions. Thus, the number of victims of this disease is increased threefold or more.

Beside physical and moral sufferings, caused by these illnesses, patients, and their families are confronted with a variety of extremely negative social and economic consequences. The sharp decrease of efficiency at work, absenteeism, industrial injuries, and damage to machinery are only a portion of the problems arising in economic sphere. A disproportionate number of crimes is committed in a state of alcoholic or narcotic intoxication or for motives connected with the use of drugs or alcohol. A significant percentage (up to 85 %) of HIV/AIDS in Russia is also connected with the intravenous injections of an illegal drug. More than two thirds of those who are addicted to alcohol or drugs are young people in below the age of 25, approximately half of them are 12-16 year old teenagers.

My experience, shared by most other specialists I talked with, and a number of books and articles I read on the topic led me to the conclusion, that any addiction is rooted in deep spiritual defects of a person, transmitted by his or her family and by the entire society. This means that the addiction cannot be removed exclusively by with medical, psychological, or social measures. Also in the Church there was absolutely no understanding how to help addicts, nor any practical ways to do it.

The situation seemed to be desperate until in 1988 I was introduced to some groups of the Alcoholics Anonymous movement (AA) that had just begun to appear and to the Twelve Steps program on which their work is based. This program struck me by its closeness to the Christian understanding of the world. It was later that I learned that it was actually developed in a Christian environment and was a manifestation of principles of the life of early Christian communities and an interpretation of these principles as applied to overcoming such a specific problem as alcoholic dependence.

Soon I was quite unexpectedly included in the first group of specialists invited by the American International Research and Training Institute for Alcoholism to come for six months-long internship in the USA treatment centers.

During preceding years, I and some of my colleagues, thanks to bilateral contacts with specialists working on the problem of drug-addiction in other countries and through reading relevant books, made a careful study of the experience, gained by the MONAR movement and also Church and public therapeutic groups in Poland, the CeIS and many other therapeutic communities for drug-addicts in Italy, the Daytop community in Latvia and similar groups and movements in Great Britain and the USA.

Even at that time, a synopsis and analysis of the available data showed us quite convincingly that the only real solution to the problems of alcoholism and drug-addiction lay in creating a large network of activities and programs, encompassing all of the aspects of this problem: biological, genetic, mental, social and, most importantly, spiritual.

After my visit to the USA this conviction grew, since what I had seen here, in your country, was a large-scale realization of this option in practice. We had been thoroughly introduced to the widely applied so-called Minnesota model of dealing with the addiction problem. It represents a comprehensive and complex approach based on a combination of principles underlying the AA's 12 Steps program and the achievements of modern psychology, medicine, sociology, pedagogy and other disciplines. Time has shown the great effectiveness of this approach when used on the national level. Indeed, the USA is the only country in the world that for several decades has managed not only to check the growth but also considerably decrease the incidence of alcoholism and drug-addiction.

Having come back to Russia, therefore, some of my colleagues and I attempted to reflect on the undoubtedly valuable American experience, trying to adjust it to Russian realities and to re-think it from the Orthodox perspective.

The first step in our efforts was taken in 1992 when we started the Old Word rehabilitation program which since 1995 was continued under the auspices of the Old World Christian public charity. The program was founded to help people suffering from addiction and their relatives to recover from their fatal disease and/or its consequnces.

The name of the program and the charity was a reminder that, although American treatment centers were taken as models, the principles underlying the program of treatment were not at all an American innovation but a reflection of the age-old Christian, particularly, Orthodox tradition. And the light (in Russian language we have the same word for “world” and for “light”) of Christianity is really "old". Indeed, it is almost two thousand years older then the Alcoholics Anonymous movement and those American patterns of treatment, served as the bases of this movement.  

Our program represents an Orthodox reflection of the Western experience. It is based on the principle of the therapeutic community and includes an intensive and specially organized psychological and spiritual work on the steps of the 12 Steps program.

Group and individual work under the Old World program has been carried out every night for about eleven years now, without interruptions or holidays. The work with recovering people, organized according to a clear-cut and stable structure, is the basic means of ensuring recovery. It includes talks and discussions on the psychological, medical and spiritual problems of dependency; small groups, general meetings of all participants and their relatives, individual counseling, work with family members, especially designed written homework, regular therapeutic conferences and working meetings of the participants, daily meetings with visiting priests for those who wish them, prayer groups, catechism and Bible study groups.

A participant remains in treatment in the "Old World" program for approximately 20-25 months (depending on his progress in resolving treatment goals). The program consists of three stages. During the first stage the person deals with the problem of denial, and is provided basic information about AA and NA, the disease of alcoholism and drug addiction. In the second stage he works individually and in groups on his personal issues, and in the last stage he is working on his family, legal, medical and job problems, while continuing to receive more information on chemical dependency. Also the aftercare planning is begun during this final stage of treatment.

With years of experience, this program has a track record of effectiveness, nearly ten times exceeding one of the traditional treatment methods. More than 300 patients have gone through the program since 1992, and about 65% of them (or 92% of those who graduated the whole program) have maintained stable, long-term sobriety.

More than 150 family members have participated in weekly support groups and workshops for relatives of our patients.  

For many years we worked without any permanent financing, existing on small occasional donations from various organizations and private persons. In 2001 we received a grant from an American Christian ”Mustard Seed” Foundation and some support from the Church Mission Society in England, which helped us to continue the construction of the “City Of Refuge” Therapeutic Community, a long-term rehabilitation and reintegration center for young drug addicts and alcoholics, that was started several years ago together with one of the parishes of Russian Orthodox Church. The TC is located on Church property in a two-storey house, where 10 to 15 patients can stay for approximately two years and a half. The staying there is free of charge. The residents participate in specially organized recovery processes, work on the construction of the building, and in various workshops and in farming, thereby making the center self-supporting. Last months our residents also help in reconstruction of a Moscow church, where we conduct our therapeutic sessions and counseling of patients and their relatives. The patients are also can to participate in the parish life: prayer, Divine Liturgy, Church education, and charity work. 

The crucially important part of the program consists of working with staff members and volunteers. Most of them belong to the same parish of the Russian Orthodox Church, which means that we often have The Holy Communion together, pray together in the Church, and participate in Holy Sacraments. It obviously helps our patients and us to feel ourselves as a Christian community.

We also have small groups for staff, bible lessons, 12 step self-help groups, discussions, individual supervision and many other forms of staff work to enable and support each of us to work on our own spiritual, psychological and communicational problems as well as to grow professionally.

All the decisions are made with the participation of every staff member, and we have plenty of regular work meetings, treatment conferences and other discussions for that.

It is also important, that many of our staff members and volunteers are recovering themselves, having graduated from the “Old World” program and then gone through at least a two-years long special educational and training process.

Along with the rehabilitation work, we continue our efforts to develop a comprehensive approach to the problem of alcoholism and drug-addiction, taking the following practical steps:

For many years we have been providing an addiction hot-line phone. The Old World program staff holds regular lessons with the volunteers’ team of the hot line, helping them to acquire the knowledge and skills necessary for this kind of service.

At the grassroots level we plan to continue active prevention and educational services with different age groups, and with social and professional organizations. Beside, the “Old World” staff will continue to participate in teaching of qualified Christian chemical dependency therapists for such systems. We are also creating an Informational Center to help coordinate the work of different people, groups and organizations dealing with alcoholism and drug addiction

The Old World staff teaches at the Moscow State University, Moscow Russian Orthodox Institute, Moscow Evangelical Seminary, Russian Open Social University, and some other educational institutions. We also supervise these students in their practical work and in writing their term and graduation papers.

We are actively participating in prevention work, preparing publications or mass media appearances, devoted to the problems of alcoholism and drug-addiction.

We have also maintained co-operation with other organizations and contacts with colleagues in different countries. Specialists, - Christian counselors and psychologists, including those who work in the addiction prevention and treatment field have often visited us. They give talks to the participants of the rehabilitation program and their relatives, deliver lectures and provide training for professionals in the field and for the general public. Thus, we have hosted experts from the Great Britain, Italy, Poland, the USA, Egypt, Spain and other countries.

We have continued to compile our library where everyone can borrow books or other materials on the problems of addiction and rehabilitation. We have also been engaged in informational work, regularly updating special computer databases of organizations working in the filed of rehabilitation and related areas.

Through all of these efforts we are creating a system which will include several related spiritually based programs including outpatient and inpatient treatment, day care, halfway houses, foster homes and prevention all of which are designed to respond to the needs of people at different stages of their disease.

We practice such an approach because it is evident for every expert that the problem of addiction cannot be reduced to one specific aspect, – biological, social, psychological or any other, although addiction is certainly influenced by biological, social and psychological factors and generates consequences in all these areas. Like all Christian professionals we also recognize the spiritual nature of addiction and consider spiritual defects of human nature as a foundation of any addiction. However, what is not so common is our view that addiction is a complex phenomena that is formed in the course of interaction of spiritual, biological, social, and psychological factors. We are sure, therefore, that the problem, to be resolved, demands all of these factors to be taken into account. Nevertheless, worldwide experience across several decades shows that this can be the only solution of the problem. There is no possibility of helping an addict to recover if we miss or ignore one or more of these components of the complex addiction phenomenon.

One of the most integrated approach to this problem models the whole diversity of health in real life and helps to restore all parts of the addict’s personality without missing any of them and taking into primary account the most important, spiritual, dimension of a human being.

 We call this approach “A Therapeutic Community”, using this term in a somewhat broader (or, rather, deeper) sense than it is commonly used.  Let me explain what I mean by that.

 The term “Therapeutic Community”, TC, as it is employed today, refers to a phenomenon which emerged simultaneously in England and in America in the middle of the twentieth century. It is most familiar to the mental health professionals as denoting a type of residential treatment for psychiatric patients, developed by Dr. Maxwell Jones in two hospitals in England and Scotland.

 Now the term “Therapeutic Community” is also widely applying to a form of non-psychiatrically oriented self-help residential treatment in the addiction field, operated primarily by an ex-addict staff, possibly with a limited assistance of trained professionals. The first of these communities, Synanon, was founded in the early 60’s in America by Charles Dederich, a recovering alcoholic, who gained his sobriety in AA (“Alcoholics Anonymous”). A few years later another large TC, Daytop Village, was founded by two professionals, Dr. Dan Casriel and Dr. Alexander Bassin with the help of a Synanon’ graduate, David Deitch.

During the next four decades therapeutic communities became one of the most widespread and widely known forms of addiction treatment. In 1975 the World Federation of Therapeutic Communities was founded, and Monsignor William O’Brien was elected its president. Now the Federation includes more than 2000 TCs from almost all countries around the Globe.

In his initial President’s message William O’Brien expressed the philosophy of the organization: “Therapeutic communities are all too familiar with the struggle to survive in an environment which is harshly adverse. We have seen the tragic results of an ever-expanding emphasis on the medical and the pharmacological. We are weary of simplistic, phantasmagoric solution dependent on chemistry to solve a dilemma that is not chemical. Somewhere along the road there has been far too much focus upon chemistry and far too little focus on human dilemmas, i.e. the disintegration of the family and its attendant values. Said breakdown results in a monumental see of turmoil for which the symptom of addiction represent only the top of iceberg.” 

There are two simple rules at the core of treatment: 1) no physical violence; 2) no narcotics or other chemicals, and by inference, no other shell under which to hide.

The researchers of TC phenomena, William Filstead and Jean Rossi, have identified a number of organizational elements within the process: “First, there is a shift in the conceptualization of the patient role from a passive to an active agent in treatment. Secondly, the two-class system of staff and patients, with its resultant authority pyramids, is flattened, and efforts to develop a sense of oneness through such procedure as daily community meetings, patient government, etc., are employed. Thirdly, there is the shift in the staff’s role. The traditional professional role is quite inappropriate to the therapeutic community. Therefore, in order to operate an effective therapeutic community, the professionals have to loose their professionalism. This means that the program (or the community) becomes the prime identity, the profession becomes secondary. Fourthly, open communication between staff-patient, patient-patient, and staff-staff is essential. Finally it is important to have the program resemble, as closely, as possible, the real world “outside” the institutional setting.”

 Residents stay within the Therapeutic Communities as a result of the strong group process, the genuine love and the responsible concern that each member of the community gives to his or her brother and sister.

 And there is nothing surprising in it, because modern TCs, as well as their forerunner, 12 Steps program have a clearly Christian origin. For example, the AA developed from Christian Oxford Group – a Protestant Church movement, which put as their goals to revival in practice the principles of early Christianity.        

 “Hobart Mowrer, a noted psychologist has done extensive researches on the linkage between the TC of 20th century and early Christian development (Mowrer O. Hobart “Therapeutic Groups and Communities”. Proceedings of the 1st World Conference of Therapeutic Communities). In small groups of early Christians we find the practice of exomologesis (this Greek word describes the process, which “involves complete openness about one’s life, past and present, to be followed by important personal changes), with the support and encouragement of other members of the Congregation”. There is practice of mutual honesty, amendment of life and a growing involvement and concern for others. The concept also involves self-disclosure and confession of sin, followed by appropriate announcement of penance, pleas for forgiveness and plans for making restitution. A final period of friendly fellowship, Koinonia  closes the meeting. This general procedure continued until the Council of Nicea, A.D.325, when Constantine ended the requirement of open personal disclosure and replaced it with private confession to a priest.

The principles of Aedificatio Mutua (mutual edification) and Correptio Fraterna (brotherly correction) lie deep within the teaching of the New Testament. There are many references to this throughout the Bible. In Thessalonians 5:11 we read Paul exhorting: “encourage one process involves man’s taking his fellows to task for their actions. In Colossians, 3:16 Paul further enjoins: “teach and admonish one another”. The regular confrontations that are a daily experience within the Therapeutic Community embody a precept in Hebrews 3:13 “But exhort one another everyday, as long as it called “today” that none of you may be hardened by the deceitfulness of sin”.

This excursion into the past can very well provide a sense of continuity to many of the key concepts embodied within the 20th century Therapeutic Community, and moreover, provide some needed perspective in a century where humility has become an almost anachronistic trait.

…The rebirth, growth and subsequent proliferation of Therapeutic Communities around the World in the past few decades represent one of the most fascinating social developments of our time.

 We can find all these principles in every 12 steps movements as well as in a number of “community based” approaches to resolve different kind of human problem.

 It is interesting, that the term “Therapeutic Community” is even deeper in its meaning than the term’s inventors could probably imagine. 

 The word “Therapeutic” comes from the Greek words qerapeίa and its derivates. In modern languages we equate this word with “treatment”. But if we look up this word in an Ancient-Greek-English dictionary, we find that the first meaning there will be “obeisance”, “veneration”, “worship”, “care (of)”, etc.

Another part of the term is derived from the Latin root “-munus”, which means “responsibility”,  “burden”, “load”, as well as “mercy, charity, grace” and also “favour”.  The prefix “co-“ means something that is forming and developing in the process of human interaction (and deeper, in the process of interaction of people with their Creator). It is very significant, that the word “Communio”, that in many languages means the greatest Christian sacrament, is derived from the same root.   

 Thus, the “Therapeutic Community” does not primarily means a “Treatment commune” but has a meaning “A com-unity of people, who take each other burdens, having a goal to worship our Lord and to serve one another and God”.  

 It is obviously, that we can apply this term in this sence to a number of approaches, and first of all – self-help movements, especially those, that use the “12 Step programs” as a foundation of recovery. As I mentioned earlier, the pioneering TCs, Synanon and Daytop, were founded by or with the support of people, recovering from their own addiction (alcoholism) and working through the Steps of Alcoholics Anonymous. And if we look at the essence of the Steps and at the nature of the work people in AA or in other similar movements are doing, we can easily see that these movements also constitute therapeutic communities.

 Let me add to my presentation a scheme that we use in our lectures and counseling sessions. This scheme illustrates correlation between all the elements (causes, routes and consequences) of addiction and its opposite: freedom. We can see also contrast of trunks of these trees: com-munity and co-dependency, i.e. contrast of real unity people with one another and with God versus unhealthy cohesion causing all kinds of addictions and other problems. 



 

 


Tree of Freedom


Tree of Additions


Soil


True Love that mention St.John (1 John 4:7-8). Beloved, let us love one another, for love is from God; and everyone who loves is born of God and knows God. The one who does not love does not know God, for God is love.


Fear (as lack of Lov


     Roots


Faith (God is the center of Universe)


Egoism, selfishness (Ego or Self is the center of Universe)

 


Rind (providing feeding of the whole tree

Serenity (In Russian language the very word (смирение) means acceptance of everything is going on with peace in heart)

Pride (Russian word for pride - гордость – is derived from a root that means separation, division)


Trunk


Community (com-munus: serving one another, bearing of one another’s burdens, consecrating one another, also – sacrificing for another), Compare also communion (Eucharist) – the greatest Christian sacrament – and also Union, Unity with one another and primarily with God

Codependence (Co-dependency, i.e. dependency, developing in the course of human transactions throughout the whole life of a human being)


Branches


True bonding with people in marriage, real friendship, brotherhood in Christ, relationship with Him and through His Heavenly Church with other people. Plenty joyful life of His Kingdom.


All kinds of dependencies and addictions (alcoholism, drug addiction, overeating, gambling, sex-addiction, workaholizm, dependency on other people etc.)


Fruits


Epistle to Galatians, 5:22-23 “But the fruit of the Spirit is love, joy, peace, patience (in other translation – longsuffering), kindness (goodness), faithfulness, gentleness (meekness), self-control (temperance); against such things there is no law”.


Lust, gluttony, envy, greed, resentment, intolerance, guilt, sloth etc.

I am almost at the end of my presentation, and after quoting Monsignor O’Brien, I would like to share Abraham Maslow’s reflections following his visit to one of the Daytop communities:

 “It seems to me that there is a fair amount of evidence that the things that people need as basic human beings are few in number. It is not very complicated. They need a feeling of protection and safety, to be taken care of when they are young so that they feel safe. Second, they need a feeling of belongingness, some kind of a family, clan or group, or something they feel that they are in and belong to by right. Third, they have to have the feeling that people have affection for them, that they are worth being loved. And Fourth, they must experience respect and esteem. And that’s about it… Could it be that Daytop is effective because it provides an environment where these feelings are possible?… Isn’t it a pity we’re not all addicts; because if we were, we could come to this wonderful place!” (A.H. Maslow: “The Farther Reaches of Human Nature”, NY 1971). 

 Let me finish with the words of a prayer that is read at every meeting of one of the largest Therapeutic Community in the world – 12 step movement (AA, NA, etc): “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference”.

This prayer has a continuation, which is less known. Here is it:

“Living one day at a time, enjoying one moment at a time; accepting hardship as a pathway to peace; taking, as Jesus did, this sinful world as it is, not as I would have it; trusting that You will make all things right if I surrender to Your will; so that I may be reasonably happy in this life and supremely happy with You forever in the next. Amen”.