Assistant Professor Sonia Waters’ new book aims to both define substance addiction and help care for those in its grip.
In the midst of the persistent national epidemic of addiction to prescription painkillers and heroin, Sonia Waters, PhD ’13, began offering seminarians her course Addiction, Compulsion, and Grace. She noticed that students who saw addiction as a disease and those who saw it as a sin both ultimately came around to discussing addiction as an issue of free-will sin through the themes of “desire gone awry, gluttony, the pursuit of pleasure, turning away from God,” writes Waters, who joined the faculty as an assistant professor of pastoral theology in 2015. “These themes don’t quite fit the idea that addiction is a disease, but people who hold to the disease model don’t know what else to say about it, spiritually speaking.”
This unraveled seam led Waters to write Addiction and Pastoral Care (Eerdmans, February 2019) to draw together what is known about addiction, from neuroscience to its collateral effects, such as incarceration and poverty, to better understand addiction as a complex, progressive condition. “What actually causes addiction and then what we theologize about it,” Waters says, “are completely disconnected. While people could understand and sense the importance of the precursors to addiction and the pain that somebody goes through, their theological reflection was usually connected to the language of pleasure, desire, and idolatry.”
Waters turned to scripture to find a way to describe the unusual concatenation of traits surrounding addiction. She found it in Mark 5:3-13, in which the Gerasene demoniac, whom no one could control, not with shackles, nor with chains, sees Jesus and runs toward him, shouting: “What have you to do with me, Jesus, Son of the Most High God? I adjure you by God do not torment me.”
Jesus says, “Come out of the man, you unclean spirit.”
Then Jesus asks his name, to which the man replies, “My name is Legion; for we are many.”
The legion image of “many into one” helps to reframe addiction as an “intense, building sense of suffering,” she writes. As a soul-sickness, “addictive behavior self-organizes into an active evil that sticks to, corrupts, and entwines with a person’s state of being.”
Then she started thinking about the legion in the Gospel of Mark. “It is a possession,” Waters says. “It expresses the possessive nature of addiction: it has pathos, you see Jesus working with it over time, you progress into it and progress out of it.
Waters also notes how the story provides insight into pastoral care. “Jesus bargains with the demons and we notice that healing is a torment,” she says. “The legion does not want to be healed by Jesus, nor does an addict want to go through physical withdrawal and craving, or the loss of certainty about their identity or the future. We suffer, but do not know how to let go of what is ultimately harming us.”
Some of the difficulty in understanding addiction is the challenge people have in defining it, Waters postulates.
“Substance addictions are fascinating because they are positioned—or perhaps, more accurately, constructed—at the converging point of so many other discourses,” Waters writes. “Everyone, from neuroscientists to social workers, from public-health workers to the police force, has something to say about the causes and cures of addiction.”
Waters zeroes in on a significant contradiction in how society responds to addiction. On one hand, the “Diagnostic and Statistical Manual of Mental Health Disorders” (DSM-V) lists substance use disorder, which suggests that “these addictions are mental health disorders,” she writes. “But unlike most other mental health conditions, addictions are openly treated as a crime.”
In the legion of voices surrounding addictions, they can be “expressions of individual suffering and broken family systems,” Waters writes. “But they are also the province of politicians and presidents, who promise to keep the streets safe for our youth. They fuel the inordinate incarceration of African Americans and Hispanics in the war on drugs. They are attached to images of homelessness, prostitution, and degeneracy. They evoke our deepest assumptions about how human beings express agency and responsibility in the world.”
Lacking a single recent text she could assign her students provided another impetus for Addiction and Pastoral Care. “It would appear that this is my bailiwick—a sustained, interdisciplinary book on addiction,” one neither theology nor philosophy, Waters says, laughing.
Her aim is wide-sweeping: to present a new model for thinking about addiction, one that is neither all medical, nor all moral. “Being able to get addiction out of the idea of sin and into the idea of spiritual oppression is really important,” she says. “Addiction is not about pleasure. It’s about pain. It’s not about desire. It’s about spiritual oppression.”
She lays out why creating a new image of the soul in addiction is important. “Simply put, definition drives care,” Waters writes. Framing a condition influences how a problem is discussed and even how it might be solved. Her working premise for soul sickness is based on two ideas.
First, “we are created in brain, body, and spirit to be profoundly relational. From the beginning, God created us for interdependence, placing us in the circumference of other bodies: first, the body of our attachment figures, and later the body of the social world. As children and adults, we continue to need others to become whole,” she writes.
Waters follows with the concept of self-regulation, the ability to manage emotional states, which is directly tied to reliance on “other bodies.” If that relational foundation is missing or somehow incomplete in a person, they may find it difficult to self-regulate, or manage “overwhelming or uncomfortable negative effects,” she writes. Could impaired self-regulation be the main reason for engaging in addictive behaviors? Waters believes it is.
This same dynamic is at work on a social scale, where “our self-identity is always in reference to our position in relationship to the broader social body,” Waters writes. “The problems, connections, blessings, and oppressions met throughout our widening interaction with people, social systems, and institutions profoundly affect our functioning, along with our mental and physical health.”
Imagine then the stress caused by racism and homophobia. “In these cases, the social body itself causes our stress without repair. Our needs are neglected or our efforts to gain connection are rejected,” Waters writes. “Our attempts to find attunement or empathy, to regulate our stress through connection to the social body, are denied by others.”
Another major stressor on physical and mental health, Waters suggests, is financial insecurity, which is magnified at a time of rampant income inequality. (In 2015, the top one percent of Americans made 26.3 times as much income as the bottom 99 percent, according to a 2018 report from the Economic Policy Institute. The same group also charted wages from 2000 to 2017, which showed that workers of color at every education level made less money than white workers. See latest figures.)
“We often imagine that a person’s physical and mental health is a personal problem related to her or his biological functioning, genetics, or lifestyle choices,” Waters writes. All of that is true, “but broader studies show that differences in people’s health and well-being correspond to differences to their status within social systems.”
In a world besieged by addiction, Waters sees opportunities for greater involvement by pastors, namely a move away from “identify and refer: Identify, get them into rehab. Identify, give them a number for AA,” she says. Instead, she’d like pastoral counseling to encompass the act of sitting with someone and working through the “more ambivalent process of coming to the realization they have a problem and making a commitment to actually seek help,” she says.
An early reader of Waters’ book, Jan Ammon, minister of the Seminary’s chapel, sees a widespread gap between pastoral care and addictions, an area she believes some pastors may not feel confident enough to broach with their congregants. “Her book, which has really strong pastoral care threads woven throughout it, can be really helpful, even if it just encourages pastors to approach the topic of addiction with the people they’re caring for,” says Ammon. “And once you’ve approached it, how do you navigate it well? Her book really helps with that.”
At the same time, Waters realizes there can be an unspoken divide between pastors and addicts, one she’s observed when she speaks with pastor colleagues whose churches host groups such as Alcoholics Anonymous (AA).
“I’m surprised by how they think about the AA group that they house,” she says, noting that their concerns often center on competition for space and usually do not involve interaction between the church and the outside group. But what is even more striking “is the disconnect in having an AA or even an Overeaters Anonymous kind of group in churches,” she says, “and pastors’ lack of theological knowledge about what addiction is.”
In her expansive book, Waters devotes a detailed chapter called “This is Your Brain on Drugs” to changes in brain wiring as the result of addiction, which Ammon, a nurse in a former life, found fascinating and important given all the misunderstanding around physical addiction and what happens biologically to someone in the midst of one.
“Learning about the brain can also give us a more compelling picture for our theological reflection as we consider the progress of the disease,” Waters writes. “Most important for pastoral care, remember this: The brain that first chooses to take the drug is not the same brain that, years later, has to make the decision to stop taking it.”
When applying the recommended counseling methods, which she covers in subsequent chapters, it helps to “realize that the addict’s brain is not necessarily functioning the same way as ours are,” Waters writes. Instead of rationally weighing a decision to stop using substances, “they are deciding whether or not they are able to enter into the torment of rebalancing a brain that has already organized itself around the substance use.”
Addiction and Pastoral Care plumbs “motivational interviewing (MI) and change theory, two of the most used counseling practices in addiction care,” Waters says. An offshoot of the work of psychologist Carl Rogers, MI is based on “the belief that the person is the expert of her own life and can come to insight about what to do with her own problems,” she writes.
As a pastoral caregiver using MI, Waters notes that that it is not her purview to “play God, whether I feel like saving, healing, correcting, or even punishing the person before me,” nor does she have “power over the shape of her future.”
The goal here is to “avoid what MI calls the righting reflex,” a confrontational approach to press clients to alter their behavior, which research shows “does not tend to support long-term change,” Waters writes.
Meant for changing chronic behaviors, change theory offers five stages to help people identify where they are on a typically non-linear map toward change: precontemplation, contemplation, preparation, action, and maintenance. Waters explores each stage in detail, including the person’s emotions once they are back on solid ground.
Throughout the process, Waters counsels returning to the Gerasene to understand God’s compassion in addiction—and for a blueprint for how Waters recommends pastors care for soul sickness.
“Jesus meets the demon-possessed man before he can change himself,” writes Waters. “There is no need for him to come to consciousness about his spiritual sickness or to repent of his sins before he can draw near to Jesus.”
“Instead, Jesus meets him as he is. He cares for the Gerasene in his abject state. Jesus meets him on the shore before he changes, because the Gerasene cannot change his possession alone. It is only through the experience of a healing connection with Jesus that the man comes to his right mind and comes to believe.”