By Mark E. Shaw
Staff Note: This article originally appeared at The Biblical Counseling Coalition on June 13, 2018. It has been reposted with permission.
Two questions I am often asked are, “When do I refer an addict I am counseling for a medical detox?” and, “What drugs require detox?” Since I am neither a medical doctor nor a medically trained professional, my answers are straightforward and simple: always refer an addict to a medical doctor immediately for any drug use, including alcohol which is a drug in liquid form.  Alcohol withdrawal is extremely dangerous and potentially life-threatening though many in withdrawal from alcohol do not report feeling very sick. By contrast, opioid withdrawal is less dangerous and usually not life-threatening though many in withdrawal from opioids report feeling so sick that they think they might die. Some of them want to die because of how sick they feel!
One of the malicious myths about biblical counselors is that they do not like doctors and won’t work with them. That simply is untrue. As a counselor, I have found working with medical doctors to be extremely helpful. Not only do addicted persons have detox issues, but they will have other aches and pains they have neglected for months, and even years, that need the attention of a medical professional. Therefore, I refer them to a physician immediately, and follow up with the counselee to make sure he or she is following medical advice. In some instances, I ask the counselee to sign a release of confidential information form allowing me to speak to the physician directly. That’s extra work for me but it is worth it and vital since the addicted person has lived a life of deception for so long.
Neglecting their bodies and physical health is very common for those enslaved to the idolatrous desires of addiction. A key component of beginning a lifestyle of transformation from idolatry/addiction to Christ-likeness is improving physical health by creating new habits of sleep, exercise, food intake, and other physical disciplines that help in the spiritual transformation into Christ-likeness. While I may monitor those physical disciplines in terms of adherence to what the physician has recommended, my focus is on the spiritual disciplines of fostering a lifestyle of prayer, Bible study, fellowship with believers, and the like.
Spiritual growth is enhanced by adherence to physical disciplines and every counselee, addicted or not, will benefit from a commitment to both.
Although my focus as a soul physician is upon the internal character and heart issues of my counselee, having a medical physician focusing upon the externals is important.
Medical Care for the Soul?
The language in addiction treatment and rehabilitation programs is medical because of the disease concept of addiction, which is merely a theory, or an idea of mankind. Sadly, the disease theory been repeated so often that it is popularly accepted as a fact now. I wish the Bible would be so easily accepted as true by popular culture – because it really is true!
Words like disease, recovery, addiction, treatment, rehabilitation, and alcoholism are examples of the medicalized vocabulary in the addiction world that point to a medical solution and away from Christ. Terminology is important, and I Corinthians 2:12-16 (NASB) makes it clear that there are two languages believers speak:
Now we have received, not the spirit of the world, but the Spirit who is from God, so that we may know the things freely given to us by God, which things we also speak, not in words taught by human wisdom, but in those taught by the Spirit, combining spiritual thoughts with spiritual words. But a natural man does not accept the things of the Spirit of God, for they are foolishness to him; and he cannot understand them, because they are spiritually appraised. But he who is spiritual appraises all things, yet he himself is appraised by no one. For who has known the mind of the Lord, that he will instruct Him? But we have the mind of Christ.” (underline emphasis is mine)
There are several biblical words to be used when providing soul care for an addicted person. We don’t use the word disease but refer to sinful habits of the flesh. Instead of recovery, which means to return back to your original state, the biblical concept is transformation into the likeness of Christ and a new creation. Treatment is another medical word that sounds really scientific yet the irony is that a majority of programs used the same counseling methods that have been utilized unsuccessfully for years and are not based upon medical research but social research termed “evidence-based.” Social research is not the same as medical research and to use the phrase evidence-based for much of that research reveals a poor understanding of what is factual.
The driving force of the concept of treatment is a good one because treatment programs focus upon changing the cognitions of the counselee first. Rehabilitation programs then take the next step by focusing upon changing the behaviors of the counselee secondarily. In other words, the thinking of the addict must change before the behaviors of the addict will change.
Likewise, in biblical counseling, we agree that the thinking within the heart of an addict must change before the behaviors will change. We emphasize counseling that brings conviction where there are sin issues, comfort where there are suffering issues, and hope in Christ. But the terminology we use will focus upon idolatry not addiction since idolatry points to the heart issues involved while addiction points to a medical disease that has somehow attacked the person. The same is true for alcoholism which points to a man-made concept of a disease problem rather than a heart issue that fuels the thoughts and behaviors of drunkenness. Use of the word drunkard sounds mean at first, but in reality, that word points to a solution found only in Christ which is ultimately compassionate. Secular programs have to re-label biblical terminology because they do not have Christ to offer hurting souls! They will not share the Gospel because it is not good news for the problem of addiction and alcoholism though it is good news for the problem of idolatry and drunkenness.
If someone you counsel goes to a treatment and/or rehabilitation program, realize that the counsel they receive more than likely uses language that might sometimes be helpful to the extent of behavioral change and prolonging physical life. Counseling them after the completion of a non-biblical addiction program will require sessions dedicated to teaching and using new terminology. Be patient with them during this time and continue pointing them to Jesus Christ as the only answer for repentant sinners and to the Holy Spirit as the only comfort for the suffering saint.
Questions for Reflection
- How do the words you choose to use in counseling point your counselees in a particular direction?
- Since working with a medical doctor is important in counseling an addicted person, how can you reach out to medical professionals in your community?
Alcohol is a drug in liquid form though our culture does not often view it in this way. Cough syrup contains codeine and other drugs and is thought of as a drug in liquid form. Our culture separates alcohol and drugs but in reality alcohol is a drug.