The CJN recently sat down with a group of experts to discuss five questions related to addiction and dependency in the Jewish community.
RABBI CHAIM STRAUCHLER
SPIRITUAL LEADER, SHAAREI SHOMAYIM CONGREGATION, TORONTO
DR. MOLYN LESZCZ
PSYCHIATRIST-IN-CHIEF, MOUNT SINAI HOSPITAL; PROFESSOR AND VICE-CHAIR, CLINICAL, IN THE DEPARTMENT OF PSYCHIATRY AT THE UNIVERSITY OF TORONTO
DIRECTOR OF OUTREACH AND EDUCATION, JEWISH ADDICTION COMMUNITY SERVICE (JACS)
DR. JAN MALAT
ASSISTANT PROFESSOR OF PSYCHIATRY, MEDICAL HEAD OF ASSESSMENT AND CONCURRENT DISORDERS WITHIN AMBULATORY CARE AND STRUCTURED TREATMENT PROGRAM AT CAMH
Going back a generation or two, there was an assumption that Jews were less likely to drink excessively than other groups. This stereotype has stuck around, but is it true?
Rabbi Strauchler: Speaking from a position of pastoral leadership, I have learned that chemical and process addictions are real issues within our Jewish community. The foundations of Jewish families, as well as the hopes and dreams of individuals, have been broken upon the rocks of these kinds of dependency.
The relative prevalence of addiction is not as relevant as is the wrongful belief that our community is somehow immune from these risks. What starts as a culture of a few shots of scotch on a Shabbat morning can snowball into something extremely destructive. I – and almost every other rabbi – have seen it. It behooves us as a community to speak honestly about these threats and to work against these problematic stereotypes.
Leszcz: For decades, many held the belief that addictions were not a concern in Jewish communities. Current evidence would note that this is anachronistic and outdated and that vulnerability to addictions is indeed becoming more and more prominent within the Jewish community.
In fact, a recent Canadian study reported that 20 per cent of those surveyed noted a family history of some form of addiction. Gathering accurate data is not easy, but certainly there is enough evidence to suggest that the experience of mental health professionals and rabbis seeing more and more Jewish people with addictions coming to them for care reflects a growing trend. (Israeli data is also helpful in this regard and suggests a lifetime prevalence of drug use in Israel of around 11 to 13 per cent, very much in line with Canadian normative standards.)
Gathering comprehensive data involves overcoming community denial. If we are to tackle this, we have to remove stigma and our own naiveté.
Kaufman: Working on the front line at JACS, I can testify that there is not a day that goes by without many phone calls from family members or addicts asking for help and advice. Weekly, more than 800 people walk through the doors of JACS in Toronto to attend one of our many support groups.
‘What starts as a few shots of scotch on a Shabbat morning can snowball into something extremely destructive. I – and almost every other rabbi – have seen it’
No segment of the Jewish community is immunized against addiction. In fact, a JACS support group for Orthodox parents who have children struggling with addiction has grown five times in size in the last year alone. Our weekly Here To Help introductory support group has grown so much that we have moved to larger premises to accommodate it.
Does the spiritual dimension of Alcoholics Anonymous and other 12-step groups pose a barrier to Jews?
Rabbi Strauchler: Tshuvah, or spiritual change, is one of the most fundamental beliefs of Judaism. Maimonides noted that repentance is not just for sins, but for attitudes, habits and character faults. For Jews, spirituality is essential to our total identity and not something to be segmented off into the synagogue.
Calling upon God when we are helpless is extremely Jewish – as the Psalmist says, “From despair did I call upon God; God answered me expansively” (Psalms, 118:5). Acknowledging our faults and speaking out about our failings – a process Jews call viddui – is a core concept of tshuvah. And Judaism also stresses the need to respond to our failures in a communal way. We support one another in the process of personal and communal change by coming together in prayer and introspection.
As a community, we can learn from AA that repentance and recovery are lifelong processes. It is not something that can be done once and forgotten. We are all alcoholics in one way or another – the question is only how long we have gone without a drink (or a sin). That’s why it behooves every Jew to seek out help when they face mental illness, including addiction issues.
If an AA group that can help in recovery exists in a Jewish environment, it should be utilized. If an AA group that can help in recovery exists in a non-Jewish environment, it should be utilized too.
Leszcz: The resistance to engage in AA or other 12-step groups emerges from many elements.
First, it requires a significant confrontation with one’s self in order to be willing to engage in treatment. Not uncommonly, people will resist the 12-step group as a cover for other sources of resistance, claiming that they are opposed to the apparent focus on turning things over to a higher power, which, for some, can feel like a commitment to a belief in God or some form of diminishment of one’s personal autonomy.
This is highly unfortunate because study after study shows that 12-step groups are highly valued by participants and are highly effective. Millions of individuals across North America participate in such groups on a weekly basis, and there are nearly one million groups meeting every week.
Indeed, each of the 12 steps can be translated into personal, interpersonal and psychosocial dimensions – with or without an engagement with a higher power or religious focus. It is useful to think in terms of relinquishing denial and counter-dependence – “I don’t have a problem” or “I could stop anytime” –that blocks access to treatment. We can view spirituality as rising above oneself and being concerned for others in one’s community, which is part of the spirit of the 12-step groups. Beginning to trust in the value and strength of meaningful interpersonal connection; seeking hope through engagement; trusting in the goodwill of others; owning personal responsibility and trying to repair oneself and one’s important relationships; seeking strength from engagement with others to address behaviours that damage relationships – all of these can be understood from various points of view, with or without involving God.
Kaufman: This church concern reflects part of the reason JACS was founded. JACS is partially a response to the Jewish community’s need to have a Jewish culturally and spiritually sensitive addiction organization to turn to for help. Still, even with all the Jewish support groups JACS runs weekly for parents, addicts and young adults, the 12-step meetings are a helpful adjunct to our work. Our counsellors often advise that people attend those meetings.
There are many reasons I have heard over the years for not attending 12-step meetings, including, “The meeting is being held in a church, I can’t go there.” To which I reply, “I have spoken to numerous senior Orthodox rabbis in Toronto, who all state that as long as meetings are not held in the main sanctuary of the church, you are allowed to attend a 12-step meeting there.”
What should family members do (or not do) if they think their loved one is addicted? Should we be aiming to “change” addicts?
Rabbi Strauchler: Family members often feel shame surrounding mental health issues, of which addiction is but one example. It is so important for them to hear that they are not alone. So many families are struggling with these issues.
What families should not do is be silent. They should not ignore a problem and just hope for the best. They should seek support from friends and medical professionals who can help guide them in these situations. They should turn to their rabbis for help. I speak for all my colleagues when I say, “We care about you and we want to offer you support.”
Malat: It can be very difficult to witness a family member repeatedly engaging in self-destructive behaviour without intervening. One of the biggest challenges for families is to find the right balance between supporting an addicted family member rather than trying to protect the person from the negative consequences related to the addiction, since allowing people to experience the negative consequences of their addiction often plays an important role in motivating them to change their behaviour and to accept help.
In addition, people often want to hide and minimize their addiction. This leaves families in a difficult position, since they are often feeling guilty and pressured to clean up the “mess” caused by addictive behaviour (i.e., debt, absenteeism, legal problems, harm to property, self and relationships). Families are often promised repeatedly that the behaviour will stop. When things don’t change, they often feel betrayed and helpless, which can lead to conflict, criticism and punishment.
It is best to avoid the trap of asking for promises from people with an addiction. Despite their best intentions in the moment, the power of the addiction often overrides any good intentions in the long term. It is an important but very difficult task for a family to set boundaries regarding the ways they are willing to help their loved ones (i.e., supporting the person in getting treatment) and ways they are not willing to be involved (i.e., paying off debts related to the addiction).
Another important challenge for many families is to adopt a more long-term focus, since the journey toward recovery can be a long and difficult one. On the one hand, it can be tempting to become prematurely excited by a quick recovery. On the other hand, one can become easily discouraged if there is yet another relapse.
Kaufman: I answer this question with another question: “Have you ever made a very difficult change in your life because someone asked you to?” Recognizing how difficult change is even without an addiction makes it clearer how much more difficult it is for a person being controlled by a powerful mind-altering drug to change. The fact is that no one can make anyone else change, even if it is for their own good, unless they choose to.
Addiction is called a family disease because the addict’s life creates havoc for other family members. The other children often feel rage because of the time, expense and family happiness that are utilized dealing with the addict. Therefore, your job is to heal and help yourself and your family. In addition, while you have no power to force someone into recovery, you might be able to take away some of the blocks that stop them from changing. Using your influence for the good is what working with an addiction counsellor trained in this area is about.
There is a common saying in the rooms of recovery referred to as “The 3 Cs”: “I did not cause, I cannot cure and I cannot control the addiction.” But there is a fourth C: contribute. The family members, or those who care for the addict, may naively contribute to the addict’s continued use by making excuses for his or her behaviour, having low expectations, providing shelter, money or transportation, co-signing for a loan, giving someone a job who is working below expectations – anything from verbal to nonverbal support. Those who support the addict in this manner are often called co-dependents.
The first step for co-dependents and family members requires that they break the code of silence surrounding the addict’s effects upon their and the addict’s life. The first three stages of recovery for both the addict and family members are overcoming denial, education and a firm commitment to the plan of recovery.
What are the relative merits of psychological therapies and pharmacological treatments?
Leszcz: Addictions are truly a biopsychosocial-spiritual ailment and we should utilize every tool in our resources, including biological interventions that reduce cravings or interfere with the effect of substances and block pleasure-seeking chemical release. There is no question that addictions are a brain disease, but there is also no question that a range of different interventions can be equally effective – and combining them increases effectiveness even further.
***On Tuesday, Jan. 31, a community-wide event entitled “Breaking the Stigma: Substance Abuse and Behavioural Addictions in the Jewish Community” is being held at Beth Tzedec Congregation, free admission.