The Need for Relationship in Healing Addiction: Moving Beyond Medicine
Andrea Clements, PhD, Professor, Department of Psychology, East Tennessee State University, Associate Director of Research Design and Implementation, ETSU Ballad Health Strong BRAIN Institute and co-founder and President, Uplift Appalachia; Natalie Cyphers, PhD, Associate Professor, DeSales University; Christopher Cook, Fellow and Professor Emeritus, The Wolfson Research Institute for Wellbeing, Durham University; and Tanner Clements, Secretary/Treasurer & Media Director, Uplift Appalachia
We will present a convincing case that embracing scriptural expectations for connection to God and others is needed alongside medicine in the prevention and treatment of addiction and promotion of human health and flourishing.
Much of medicine is focused on the individual as a unitary entity, and that is a significant limitation. We will present from the perspective that humans were created by God to live in community, having relationships with one another and God (“Then the Lord God said, “It is not good that the man should be alone; I will make him a helper fit for him.” Gen 2:18). We propose that the lack of genuine relationship with others and the tendency to turn to “fake” or “substitute” relationships is at the root of many health and social problems (“Blessed is the man who makes the Lord his trust, who does not turn to the proud, to those who go astray after a lie!” Ps 14:4). We will present a series of papers presenting the issue from a theological perspective, a neurobiological/psychological perspective, using addiction and its treatment as an example, and concluding with recommendations for promoting connection/relationship among people and with God as a way to promote health by breaking current cycles. We will again, use addiction treatment as a specific application, focusing on addressing the roots of addiction.
We will Introduce the topic briefly, then present the following papers:
1. This first paper will present the theological underpinning for connection including the tendency to substitute other things for real connection (substances, pornography, social media, online teaching, etc.). We were created by God for relationship/community. By declaring it “not good” that Adam, the first man, was alone (Gen 3), and “very good” after creation of a woman, we see the emphasis on interpersonal connection from the point of creation. Christian scripture supports that having a relationship with God makes this type of community qualitatively different than secular community (1 John 4:7-12). According to biblical texts that motivated the exploration of connection as the mechanism of the etiology and treatment of addiction, humans are made for loving relationships by a God who lives in loving relationships. Humans are whole creatures with each dimension – body, mind, soul (i.e., physical, psychological, spiritual) created by God to work in harmony with the other. To be unable or unwilling to live in loving relationships, is in tension with a God given nature and will inevitably be problematic for human beings as they seek after health and flourishing. We propose when unable to relate with God and humans, individuals turn to substitutes to fill the gap (e.g. social media vs. meeting with friends; text vs. phone or face to face; self-help apps vs. in-person support/therapy groups; online education vs. in-person class; pornography vs. marital sexual relationship). Lastly, one substitute for true relationship is problematic use of substances.
2.This second paper will address the neurobiological underpinnings of connection, then focus on addiction and medication assisted treatment (MAT; or medication for opioid use disorder (MOUD)) as a specific case of substituting something for connection. Neurobiologically, we are created to be in relationship with others. For simplicity, we will focus primarily on two fields of neurobiological evidence, developing brain connections under stressful and non-stressful conditions, and the development and function of the endogenous opioid system. Developing brain connections are made as safe, caring adults or even older children interact with a small child. This serve and return action, as it is often called, can happen in many, many ways. When this predictable back and forth interaction doesn’t occur, or when a child’s basic needs are not met, it affects brain development. When a child is raised in a stressful situation where they are scared or stressed, their brain is built around survival. The most developed part of their brain is the area involved in survival. Since that is the most developed part of their brain, they tend to default to use of that part survival-focused part of the brain, especially when they face stressors. The endogenous opioid system is active from birth, when the interaction between the infant and caregiver results in physiological responses in both. Infants are born with both opioid receptors and the capacity to produce endogenous opioids in response to interaction with a caregiver. The endogenous opioid system is activated, thereby activating waiting opioid receptors in response to and in support of bonding. This activation of the endogenous opioid system extends throughout life into adulthood. As people experience romantic love or laugh with friends, endogenous opioids are released. However, the innate activity of the endogenous opioid system can also be interrupted by the introduction of exogenous substances that activate the opioid receptors such as opioids, methamphetamine (meth), and other drugs. People addicted to substances often report their first use, particularly with opioids, as “being in love” or “being wrapped in a warm blanket” and wanting to feel that way forever. Even in adulthood, if opioid receptors are activated or blocked by an exogenous substance (e.g., heroin, fentanyl, oxycodone, and addiction treatment medications such as methadone, buprenorphine, and naltrexone), the person’s propensity to seek human interaction is reduced. These substances serve to “substitute for” the need for human interaction.
3.In this last paper we will wrap up with how we can and need to break the cycles of "substitute connections" because of the ongoing problems that result (focusing on restoring relationship with God and man). Recently, the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for The Application of Prevention Technologies released an information sheet highlighting the confirmed connection between adverse childhood experiences (ACEs) and problematic substance use. Some of those ACEs include general neglect and also include incarceration, mental illness, or substance use in the household, all of which would predict lack of parental involvement, thus likely contributing to lack of trust, poor attachment, under-activated opioid receptors, thus a propensity for addiction. Thus, put simply, broken relationships may lead to opioid addiction and while the exogenous opioid receptors are activated by those substances, human connection is impaired. The use of MAT either completely or partially activates the opioid receptors just as the abused opioid had, therefore, perpetuating the cycle of broken human connection. We propose exploring the effectiveness of a theologically informed model of addiction treatment that focuses on building connections with God and among people, with the idea that this will upregulate the endogenous opioid system, thus reducing the drive to use exogenous substances. This does not necessarily preclude medical or psychological treatments, but the motivation differs, and we believe that long-term MAT use may be counterproductive since it downregulates the release of endogenous opioids. Breaking the cycle of using exogenous opioids as a substitute for human connection or pseudorelationship, may provide new paths to not only the reduction of addiction but also for the restoration of relationships thus building the connections God called “very good.”
Much of medicine is focused on the individual as a unitary entity, and that is a significant limitation. We will present from the perspective that humans were created by God to live in community, having relationships with one another and God (“Then the Lord God said, “It is not good that the man should be alone; I will make him a helper fit for him.” Gen 2:18). We propose that the lack of genuine relationship with others and the tendency to turn to “fake” or “substitute” relationships is at the root of many health and social problems (“Blessed is the man who makes the Lord his trust, who does not turn to the proud, to those who go astray after a lie!” Ps 14:4). We will present a series of papers presenting the issue from a theological perspective, a neurobiological/psychological perspective, using addiction and its treatment as an example, and concluding with recommendations for promoting connection/relationship among people and with God as a way to promote health by breaking current cycles. We will again, use addiction treatment as a specific application, focusing on addressing the roots of addiction.
We will Introduce the topic briefly, then present the following papers:
1. This first paper will present the theological underpinning for connection including the tendency to substitute other things for real connection (substances, pornography, social media, online teaching, etc.). We were created by God for relationship/community. By declaring it “not good” that Adam, the first man, was alone (Gen 3), and “very good” after creation of a woman, we see the emphasis on interpersonal connection from the point of creation. Christian scripture supports that having a relationship with God makes this type of community qualitatively different than secular community (1 John 4:7-12). According to biblical texts that motivated the exploration of connection as the mechanism of the etiology and treatment of addiction, humans are made for loving relationships by a God who lives in loving relationships. Humans are whole creatures with each dimension – body, mind, soul (i.e., physical, psychological, spiritual) created by God to work in harmony with the other. To be unable or unwilling to live in loving relationships, is in tension with a God given nature and will inevitably be problematic for human beings as they seek after health and flourishing. We propose when unable to relate with God and humans, individuals turn to substitutes to fill the gap (e.g. social media vs. meeting with friends; text vs. phone or face to face; self-help apps vs. in-person support/therapy groups; online education vs. in-person class; pornography vs. marital sexual relationship). Lastly, one substitute for true relationship is problematic use of substances.
2.This second paper will address the neurobiological underpinnings of connection, then focus on addiction and medication assisted treatment (MAT; or medication for opioid use disorder (MOUD)) as a specific case of substituting something for connection. Neurobiologically, we are created to be in relationship with others. For simplicity, we will focus primarily on two fields of neurobiological evidence, developing brain connections under stressful and non-stressful conditions, and the development and function of the endogenous opioid system. Developing brain connections are made as safe, caring adults or even older children interact with a small child. This serve and return action, as it is often called, can happen in many, many ways. When this predictable back and forth interaction doesn’t occur, or when a child’s basic needs are not met, it affects brain development. When a child is raised in a stressful situation where they are scared or stressed, their brain is built around survival. The most developed part of their brain is the area involved in survival. Since that is the most developed part of their brain, they tend to default to use of that part survival-focused part of the brain, especially when they face stressors. The endogenous opioid system is active from birth, when the interaction between the infant and caregiver results in physiological responses in both. Infants are born with both opioid receptors and the capacity to produce endogenous opioids in response to interaction with a caregiver. The endogenous opioid system is activated, thereby activating waiting opioid receptors in response to and in support of bonding. This activation of the endogenous opioid system extends throughout life into adulthood. As people experience romantic love or laugh with friends, endogenous opioids are released. However, the innate activity of the endogenous opioid system can also be interrupted by the introduction of exogenous substances that activate the opioid receptors such as opioids, methamphetamine (meth), and other drugs. People addicted to substances often report their first use, particularly with opioids, as “being in love” or “being wrapped in a warm blanket” and wanting to feel that way forever. Even in adulthood, if opioid receptors are activated or blocked by an exogenous substance (e.g., heroin, fentanyl, oxycodone, and addiction treatment medications such as methadone, buprenorphine, and naltrexone), the person’s propensity to seek human interaction is reduced. These substances serve to “substitute for” the need for human interaction.
3.In this last paper we will wrap up with how we can and need to break the cycles of "substitute connections" because of the ongoing problems that result (focusing on restoring relationship with God and man). Recently, the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for The Application of Prevention Technologies released an information sheet highlighting the confirmed connection between adverse childhood experiences (ACEs) and problematic substance use. Some of those ACEs include general neglect and also include incarceration, mental illness, or substance use in the household, all of which would predict lack of parental involvement, thus likely contributing to lack of trust, poor attachment, under-activated opioid receptors, thus a propensity for addiction. Thus, put simply, broken relationships may lead to opioid addiction and while the exogenous opioid receptors are activated by those substances, human connection is impaired. The use of MAT either completely or partially activates the opioid receptors just as the abused opioid had, therefore, perpetuating the cycle of broken human connection. We propose exploring the effectiveness of a theologically informed model of addiction treatment that focuses on building connections with God and among people, with the idea that this will upregulate the endogenous opioid system, thus reducing the drive to use exogenous substances. This does not necessarily preclude medical or psychological treatments, but the motivation differs, and we believe that long-term MAT use may be counterproductive since it downregulates the release of endogenous opioids. Breaking the cycle of using exogenous opioids as a substitute for human connection or pseudorelationship, may provide new paths to not only the reduction of addiction but also for the restoration of relationships thus building the connections God called “very good.”