Ministry, philanthropy, social services? The Church and the challenge of addictions

Ministry, philanthropy, social services? The Church and the challenge of addictions

Assoc. Prof. Sebastian Moldovan*

Abstract:The first part of the present article is dedicated to the place that addiction holds

in the contemporary knowledge and conscience. At the same time it identifies an aspect, which is less noticed, although extremely significant for the theological perspective on addiction, i.e. its connection to love. The second part tackles sever-al facets of the contribution that the Orthodox Church has and can further nurture in the understanding of addictions, and in the recovery of the persons affected by them. This contribution refers especially to the issues of the opportunity of the three types of possible interventions mentioned in the title.

Key-words: addiction, love, ministry, philanthropy, social services, Romanian Orthodox

Church

I. A sign of the times

For all one knows, in order to define its own identity in the unstoppable flow of birthing and dying, every age has carved out of people’s common living a se-ries of experiences that it found effective at bringing its greatest aspirations into the foreground. As these experiences are identified and interpreted in the light of the dominant meta-narrations, they are also meant to illustrate models of human success and failure, and thus to translate for the common conscience the normal, the excellent and the pathological. Of the three categories of normativity, it seems

* PhD Sebastian Moldovan, Associated Professor at the „Andrei Şaguna” Orthodox Faculty of Theology, „Lucian Blaga” University of Sibiu,. E-mail: [email protected].

RT, 95 (2013), nr. 1, p. 157-177

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Assoc. Prof. Sebastian Moldovan

that the last one - the pathological, is acknowledged as having the most marked epitomic potentiality. It is not by chance that ages often distinguish themselves by their greatest woes. Slavery, barbarism, or cancer - to name just a few - makes us immediately think of certain epochs and places in the history. As far as we are concerned, it is interesting to note that, although the past century has managed to get ahead of all its previous epochs brutality-wise, violence doesn’t seem to be the malignity that most appeals to us. The thymotic evil appears to cede this place to an epithymetic evil. The addictive behaviour is becoming more and more visible on the semiotic forefront of our age. Or rather, to be more correct, its expanse and globalisation are.1 Dependence and attachment, which we currently understand as synonyms to the more academic term “addiction”, are obviously common human experiences that make their début in the intrauterine period, and then continue throughout the first childhood and well into the adult age. Naturally, we do de-pend on parents or other care-takers. It is also natural for us to form an attachment to those, as well as to other persons, things, activities, events that contribute to whatever we deem as fulfilling for us. Addiction is, however, a distinctive form of dependence or attachment.

In spite of all efforts made by researchers in the past decades, we still have no unanimously accepted definition. An exhaustive synthesis of the literature in the field identifies the following defining elements of the addictive behaviour, re-gardless of whether this concerns substance use or involvement in other activities: a) action aimed at reaching appetitive effects; b) over-preoccupation (correlated with the tolerance effect and withdrawal symptoms, c) temporary satiation, (d) loss of control, and (e) suffering negative consequences.2 Among these, the trait that is set apart by its very own title – either addiction, or dependence - as the most significant of all, is the loss of control - the loss of self-control to be more precise. Therefore, addiction takes the shape of a sort of pathology of the will, of the self-determination, and thus enters the problematics of morality. Yet this is not a novel perspective. Aristotle, St. Paul, Augustine, Thomas Aquinas, the whole ancient and Mediaeval Christian tradition, up to Alcoholics Anonymous and Dr. Jellinek have seen drunkenness, for instance, as a moral failure, a weakening of the will, an unfortunate yet imputable result of the conflict between two dispro-

1 Bruce K. Alexander, The Globalisation Of Addiction: A Study In Poverty Of The Spirit, Oxford University Press. 2008.

2 Steve Sussman, and Alan N. Sussman, “Considering the definition of addiction”, Inter-national journal of environmental research and public health 8.10 (2011), p. 4025-4038. See also Mark Griffiths, “A ‘components’ model of addiction within a biopsychosocial framework”, Journal of Substance Use, 10.4 (2005), p. 191-197, Doug Sellman, “The 10 most important things known about addiction”, Addiction 105.1 (2010), p. 6-13.

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portionate “laws” or powers of the inner self (see Rom 7:19).3 The birth of the dis-ease concept shakes most of the blame off addiction, but that does not change its placement. On the contrary, the self-control, now considered irrecoverably lost in relation to the “object” of dependence, is essentially the one that needs restoring, in other plausible life areas, no doubt.

Putting aside for now, the issue of definition, let us note the relationship between distinguishing addiction as a mal du siècle and the contemporary me-ta-narrations. Two of them can be thought as characteristic for the West-European modernity and for the latter’s cultural-colonial progenies: the progress – the grad-ual and relentless accession of control and efficiency, by way of scientific method-ology, on the path of rational knowledge and towards an enlightened, prosperous, and lately sustainable human society; the emancipation – promoting freedom and equality as inalienable principles of an open society that is regulated by autonomy and justice. To these, post-modernity adds the meta-narration on the fulfilment of each individual’s own potential, via ways of life that provide maximum self-satis-faction. Each of these cast their own light on the interpretation of addiction,4 and yet the emancipation and fulfilment have a particular relevance for the compre-hension of addiction in the consumer society context. While drunkenness is evil to the traditional Christianity, as it puts salvation in jeopardy (see Eph 5:18), and to the industrial Calvinist-born capitalism, as it does not live up to its standards of productivity and efficiency, to the current consumerism, wherein one’s identity derives especially from one’s exercising the freedom of choice between various consumer goods, any behaviour that impairs this choice is deemed guilty. Or, due to its compulsive character, addiction appears to be a consumption mechanism that restricts its own choice until it consumes itself, much to the detriment of the all-consumption. The attempt to stop its terminal evolution and limit its effects via the harm reduction approach, proves very efficiently that the moral imperative, which governs contemporary life, is to minimise the risks attached to freedom through a hedonism that is very well tempered (or calculated) by the exigencies of a “superior power”, i.e. the health of the body, and in particular, the sanity of the will. However, after having been universalised and fetishised, health and self-re-alisation induce the premises of a real addiction epidemic, insofar as the persis-tent and continuous human fallibility keeps generating excessive behaviours. The internal dislocation suffered by the individual – due to the humility of a life, that

3 Christopher C.H. Cook, Alcohol, addiction and Christian ethics, Cambridge University Press, 2006; Peter Ferentzy, “From Sin to Disease: Differences and Similarities between Past and Current Conceptions of Chronic Drunkenness”, Contemporary Drug Problems, 28 (2001), p. 363-390.

4 Peter J. Adams, Annabel Prescott, Robyn Dixon, “Strange bedfellows: Meta-narrative tradi-tions in the alcohol and other drug field”, Drug and Alcohol Review, 31.4 (2012), p. 591-597.

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though passing, it is yet full of drawbacks, and in the proximity of another life, that is accessible to him via the acknowledgement of his own weaknesses - and the act of engaging that individual in the fast track of authenticity, of the evermore ambi-tious “quality” of his life, come to join the massive social-economical dislocation of the liberal capitalism, and therefore to trigger a globalisation of addiction, both geographically and behaviourally. Gambling, shopping, physical exercises, work, virtual socializing, along with the “classic” substance, sex or pornography use, lay the addictions list practically open to any adaptive acquired behaviour that is developed in order to cope with anxiety, fear, or the pains caused by alienation and less-then-fulfilment.5 The international reports confirm the situation: millions of fellow people suffer from or die every year because of substance use, and even more of them have to face the consequences of behaviours that are all the more adverse, as they are recurrent. The economical and social costs of addictions are huge, and we all have to pay.6

II. How do we define addiction?

As already stated, the burden of having to define addiction is notorious. The countless theoretical models that were developed in the past decades can be divid-ed according to how they delegate responsibility, to the identified mechanisms, the recommended therapies, and other criteria.7 The diversity of aetiological factors, the wide spectrum of intensity and acuteness, the individual variety of the pro-gression have recently led to the consideration that addiction might be a complex adaptive phenomenon. In this viewpoint, the “addictivity” is an emergent proper-ty of the dynamic relationship between the person (the self experience), his/her own behaviour, and culture (the significances ascribed to the factors involved).8 Along the same lines, it was proposed that addiction be considered a syndrome, a complex of signs and symptoms that express a primary pathological condition. The settling of addiction takes place in three phases: a) the remote neurobiologi-cal and psychosocial antecedents, which are responsible for the vulnerability to

5 Bruce K. Alexander, op. cit.; Michael Winkelman, and Keith Bletzer, “Drugs and Modern-ization” in Casey Conerly, Robert B. Edgerton (eds.), A companion to psychological anthropology: Modernity and psychocultural change, Malden, MA: Blackwell Publishing, 2005, p. 337-357; Ger-da Reith, “Consumption and its discontents: addiction, identity and the problems of freedom”, The British journal of sociology, 55.2 (2004), p. 283-300.

6 UN Office on Drugs and Crime, World Drug Report 2012, available on-line at http://www.unodc.org/unodc/en/data-and-analysis/WDR-2012.html.

7 EMCDDA/Robert West, Models of addictions, European Monitoring Centre for Drugs and Drug Addiction, 2013 (to be published).

8 Mark D. Griffiths, and Michael Larkin, “Conceptualizing addiction: The case for a “com-plex systems” account”, Addiction Research & Theory, 12.2 (2004), p. 99-102.

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pathogenesis; b) the pre-morbid phase where, in the context of certain immediate favourable antecedents – bio-psychosocial events – , a person is exposed to and becomes engaged in a repetitive behaviour that generates a desired and consistent subjective change; c) the phase where addiction acquires expression, manifesta-tions, and consequences – when already settled, the addiction has distinct outward expressions (e.g. drug use, alcoholism, smoking, gambling), each of them hav-ing both their unique manifestations and consequences (e.g. sepsis in the case of injecting drugs, lung carcinoma in the case of smoking, cirrhosis of the liver in the case of alcoholism), and a series of shared manifestations and consequences that are biological (e.g. neuro-anatomical alterations), psychological (psychopa-thology, comorbidity), social (deviance, criminality), and also similar behavioural patterns (parallel natural histories), the co-occurrence of a number of addictions, a certain specificity of the substance or of the consumption behaviour, as well as of the administered treatments.9 The advantage of the syndrome model is that it can take into account all the levels of the phenomenon, starting from its macro-so-cial stage that deals with the cultural construction of addiction, and down to the intra-individual stage that covers the neurological processes. At the same time, the model follows the development of addiction in time, into the trajectory of a life-style or a “career” (a chronic condition, according to the medical model).10

Certain aspects pertaining to this synthetic viewpoint have a special rele-vance for the problematics of our theme. It allows for a uniform apprehension of addiction without impairing the acknowledgement of the specific mechanisms involved through the exaggeration and minimisation of some against the others. This can be accomplished by way of an appropriate recognition and approach of the central role that motivation plays in the human behaviour.11 In this context, the important thing for us is to acknowledge that not all the wants (anticipated pleasure or satisfaction) and needs (anticipated relief from, or avoidance of, dis-comfort) are equally valued, and that a truly fundamental motivation does exist, and it is called love. Indeed, more and more studies are beginning to emphasize love’s cardinal role in the human flourishing of individuals and groups as well. For instance, the Study of Adult Development, a Harvard generational research,

9 Howard J. Shaffer et al., “Toward a syndrome model of addiction: Multiple expressions, common etiology”, Harvard review of psychiatry, 12.6 (2004), p. 367-374.

10 Matthew D. Graham, et al., “Addiction as a complex social process: An action theoretical perspective”, Addiction Research & Theory, 16.2 (2008), p. 121-133; Michael Windle, “A multilevel developmental contextual approach to substance use and addiction”, BioSocieties, 5.1 (2010), p. 124-136; Velibor B. Kovac, “The more the ‘merrier’: A multi-sourced model of addiction”, Addic-tion Research & Theory, 21.1 (2013), p. 19-32.

11 According to the PRIME model (Plans, Responses, Impulses, Motives, Evaluations) pro-posed by Robert West in his Theory of addiction, Wiley-Blackwell, 2006.

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prospectively charted the lives of more than 800 men and women for over 60 years (1938-2009) in order to discover the factors that are the cause of successful ageing. The findings of this study have been summarized by its current coordina-tor along the following lines: “The only thing that really matters in life are your relationships to other people” and “Happiness equals love. Full stop.”12 With sup-port coming from current investigations carried in the neurobiological field, the scientific research tends to confirm the age-old wisdom (1Cor 13:1-13) that grants love pre-eminence over all other human virtues.

III. Addiction and love

Obviously, love comes under many shapes and forms: erotic (romantic, pas-sionate), companionate, parental, filial, fraternal, platonic - between friends, univer-sal (altruistic, agapic), and religious. For reasons of convenience, we shall abbreviate them as erotic love, attachment,13 and religious love. The relationships between the three, wherein the humanity lives and breathes, are oftentimes emphasized by con-trast. However, a new research trend pleads for a close resemblance between them, claiming that there are significant psychological, neurological, and behavioural par-allels to be drawn not only within their own circle, but also between them and ad-dictions. Two immemorial truisms still hold true, that erotic love constantly admits to its own dependence (“I cannot live without you”), and that the dependence on substances for instance, is often expressed as if it were a love story; their similitudes regarding the neurological component are presently open to be mentally absorbed. It is intriguing, though, that the similitude spectrum is expanding towards social bond-ing on the one hand, and towards a relationship with the divinity, on the other. In short, is dependence actually their common denominator? Can one coin erotic love, attachment, and religious love as addictions, similar to the excessive use of alcohol, food, or drugs? Could they be subsumed to that same syndrome?

The numerous models that translate addiction provide quite a fuzzy image; yet lying there in the landscape of the research site, amongst similarities and dif-ferences, one can clearly spot a correlation between them. The main arguments employed today are neurological.14 Favourable to the apprehension of all forms of

12 George E. Vaillant, Triumphs of Experience. The Men of the Harvard Grant Study, Harvard University Press, 2012. A summary statement from the author can be retrieved on-lie at http://www.duodecim.fi/xmedia/duo/pilli/duo99210x.pdf.

13 Defined as a selective long-lasting relationship that is mostly unselfish, which can be found in parent-offspring relationships, pair bonds, and friendship.

14 There are two major types of methods utilised in the research: invasive methods, which are used with mammals (particularly rodents) with the purpose of detecting the changes that occur in the circuits of neurotransmitters, and electromagnetic imagistic methods that can be used with humans

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love as addiction, the study of substance addiction, and of the psychology of love, highlights certain significant overlaps in all aspects characteristic to the addictive process, overlaps that are also present at a neurological level, as each system that is involved in addictions is also identifiable within the process of social attach-ment.15 To be accurate, the use of drugs and the interaction with social partners activate and modify common systems of neurotransmitters. This concerns in par-ticular the reward mesolimbic system, which is associated with sex, romantic love and attachment, all at the same time.16

On the other hand, a series of studies draw attention to the heterogeneity of reward mechanisms. There are different systems that distinguish between different stimuli, regardless of whether they concern various natural stimuli (food, sexual activity, attachment), or artificial ones (drugs). Specifically, comparative studies done on love - romantic/passionate, attachment, maternal, and unconditional (al-truistic) - prove that, beside the common subcortical dopaminergic reward-related

as well, which track the neuronal correlation of behaviours and note which part of the brain is acti-vated by which act. Obviously, the major thesis of the neuroscientific paradigm is that the proximate origin of behaviour is the brain.

15 According to Pankseep, opioid addiction and social bonding display the following series of parallels: 1) drug dependence – social bonding; 2) drug tolerance – estrangement; 3) drug with-drawal (psychic pain, lachrymation, anorexia, despondency, insomnia, aggressiveness) – separation distress (loneliness, crying, loss of appetite, depression, sleeplessness, irritability). Jaak Panksepp, Affective Neuroscience: The Foundations of Human and Animal Emotions, Oxford University Press, 1998, p. 255. In a more detailed study, Burkett and Young argue that there is “a deep and systematic concordance ... between the brain regions and neurochemicals involved in both addiction and social attachment”. James P. Burkett, and Larry J. Young “The behavioral, anatomical and pharmacological parallels between social attachment, love and addiction”, Psychopharmacology, 224.1 (2012), p. 2.

16 From an anatomical and neuro-chemical point of view, the motivation behind the use of drugs, as well as the one behind a couple’s bond and a mother’s care, is correlated with dopamine release in the mesolimbic dopaminergic paths of reward and motivation. Some researchers iden-tify a reward deficiency syndrome (RDS), a term they use in order to mark those behaviours that are connected to a hipodopaminergic state, as a predisposition towards obsessive, compulsive, and impulsive behaviours. Those who suffer from RDS do not manage to reach an acceptable state of satisfaction, and thus they often end up treating their affliction with substance intakes (alcohol, stimulants, nicotine, but also junk food, chocolate etc.), or with behaviours that help them tempo-rarily raise the level of feel-good chemicals, especially dopamine. Due to an anti-reward balancing mechanism, in reaction to the supersaturation with dopamine and other neurotransmitters, the brain reduces the production of dopamine and dopamine receptors. This gradually diminishes the natu-ral process of cerebral satisfaction, thus inducing an ever growing need for more stimulants, and therefore, closing the vicious circle of addiction. Kenneth Blum et al., “The addictive brain: all roads lead to dopamine”, Journal of psychoactive drugs, 44.2 (2012), p. 134-143; B. W. Downs et al, “Have We Hatched the Addiction Egg: Reward Deficiency Syndrome Solution System™”, Journal of Genetical Syndroms and Gene Therapies, 4.136 (2013), available on-line at http://dx.doi.org/10.4172/2157-7412.1000136.

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brain systems, different types of love also involve distinct cerebral networks.17 Also, at a psycho-somatic level, unlike addictions, whose evolution normally leads to the alteration of both physical and mental health, all the forms of love have a major contribution to the well-being of the individuals. Moreover, while the addictive behaviour usually impairs other gratification means, including the one that relates to the others, the stable and satisfactory social relations have both a preventive, and therapeutic potential, in relation to addictions. It is not by chance that all the known efficient treatment forms include some means of social rehabil-itation and reinsertion. Therefore, whereas addiction and love involve essentially shared neuronal mechanisms, their consequences are mostly contradictory.

The proposed explanation to this paradox in the light of evolutionist biology is based on the role that food and procreation play in the act of survival. It seems that the forms of love developed surrounding the parental attachment (mother-child) and the bond within a couple, which have later evolved in order to preserve the union between two persons for a sufficient length of time that would allow the chil-dren to grow. The correlated cerebral circuits are therefore similar. Hence, the neu-rophysiology of the natural strategies of survival would thus provide the biological support for addictions. The intense pleasure or profound relaxation produced by the drug use, on the one hand, and the euphoria induced by the romantic love or sexual relationship - i.e. the satisfaction, security and serenity procured by a fulfilled need for attachment, on the other, would both represent manifestations of the same sys-tems, activated at low intensities and with distinct dynamics: normal (balanced) in the case of love, and pathological (excessive, unbalanced) in the case of addictions. The distinct manifestations of the two behaviours are the expression of the attempt to compensate, via an inadequate consumption or behaviour that becomes more and more excessive and addictive, a reward deficit (pleasure and appeasement) that are normally provided by social bonding relationships. In this respect, there is

17 A. Lajtha, H. Sershen, “Heterogeneity of reward mechanisms”, Neurochemical research, 35.6 (2010), p. 851-867. Stephanie Ortigue et al., “Neuroimaging of Love: fMRI Meta-Analysis Ev-idence toward New Perspectives in Sexual Medicine”, The journal of sexual medicine, 7.11 (2010), p. 3541-3552; Lucy l. Brown, “Addiction, sex, romantic love and attachment”, in Joseph Frascella et al., “Shared brain vulnerabilities open the way for nonsubstance addictions: Carving addiction at a new joint?”, Annals of the New York Academy of Sciences, 1187.1 (2010), p. 294-315; A. De Boer, E. M. Van Buel, and G. J. Ter Horst, “Love is more than just a kiss: a neurobiological perspec-tive on love and affection”, Neuroscience, 201 (2012), p. 114-124; Caroline M. Hostetler, Andrey E. Ryabinin, „Love and addiction: the devil is in the differences: a commentary on “The behav-ioral, anatomical and pharmacological parallels between social attachment, love and addiction”, Psychopharmacology, 224.1(2012), p. 27-29; Bianca P. Acevedo, Arthur P. Aron, “Romantic Love, Pair-bonding, and the Dopaminergic Reward System”, available on-line at portal.idc.ac.il/en/Sym-posium/HSPSP/2012/Documents/cacevedo12.pdf.

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some talk about the “hijacking” and corruption through addiction of the neuronal processes correlated to the forms of love.

According to the attachment theory18 - which is one of the most interesting models to explain the pathogenesis of addiction -, in the case of unsatisfactory, distressed or insecure bonding relationships, arisen between parents and children in the early childhood, or later-on, due to the individual’s psycho-social disloca-tion, the persons may develop inefficient ways of coping with their predicament. That has them susceptible to the attempt to “self-treat” their issue, as they proceed to using the compensatory resources at hand, which grant them immediate and momentary gratification. It is important to stress that, although it involves wanting (motivation for reward) and liking (pleasure, hedonia) – emotions that are includ-ed in the reward complex system, alongside with learning -, addiction is known to produce pleasure and then satisfy the desire only momentarily and with an ever increasing discomfort. This thing proves that whatever it is that the dependent person is searching for, it is not the pleasure per se, but a fulfilling and bonding connection. From a neurological point of view, addiction is a sort of love, while phenomenology sees it only as a surrogate.19

As far as the love that one has for the divinity is concerned, the scientific research is now beginning to pay attention to it, a fact that was unimaginable up until the past decade. Neurological studies done on the religious phenomenon, or on spirituality, as this field of “irrationality” is also deemed, line out the fact that, during the act of praying, a heightened activity occurs in the very same brain area of cerebral reward-motivation that is activated during interpersonal attachments.20 Moreover, there are a few other similarities between drug addiction, intense love, and the love aimed to a “Higher Power”: all three behaviours have the ability to increase emotional intensity more than other pleasant activities do; not getting the object targeted by the behaviour leads to symptoms of withdrawal, desolation, abandonment; the preoccupation towards this object can draw a person in, up to

18 Judith R. Schore, and Alan N. Schore, “Modern attachment theory: The central role of affect regulation in development and treatment”, Clinical Social Work Journal, 36.1 (2008), p. 9-20; Philip J. Flores, “Addiction as an attachment disorder: Implications for group therapy”, Internation-al Journal of Group Psychotherapy, 51.1, Special issue (2001), p. 63-81.

19 Margaret R. Zellneret al., “Affective neuroscientific and neuropsychoanalytic approaches to two intractable psychiatric problems: Why depression feels so bad and what addicts really want”, Neuroscience & Biobehavioral Reviews, 35.9 (2011), p. 2000-2008.

20 For a summary, see Patrick McNamara, The Neuroscience of Religious Experience, Cam-bridge University Press, 2009, p. 80-144; William Grassie, The New Sciences of Religion, Plagrave Macmillan, 2010, p. 93-110.

Steve Sussman et al., “Drug addiction, love, and the higher power”, Evaluation & the Health Professions 34.3 (2011), p. 362-370.

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the point that he/she gives up on other daily life opportunities or duties; finally, all of the above prove that an emotional and psychological dependence on the drug, the loved one, or the divinity is ensconced in the soul.21 From a theological standpoint, these observations are far from surprising. For the Eastern patristic tradition, the love a person has for God, which is a natural response to God’s love for that person, has been plundered by the lapse into sin, and replaced by the love for anything that seems to fill in the void. As we shall further see, this is the birth of an opportunity for a promising marriage between theology and humanistic sciences, and it all relates to what is most likely the core fundamental anthropological determination: I love, therefore I am (Fr. Sophrony Sakharov). In this case, the contemporary knowledge and conscience regarding addiction challenge us to attempt an answer to the ulti-mate question: What and how can we love so that our souls would endure?

IV. Public place expectations

Once acknowledged as suffering, the addiction invites compassion, as well as the intervention of those who are able to contribute to its alleviation or elimination. This setting in motion, which nowadays practically includes all the state or civil social sectors, cannot fail to include the religious communities, especially the Chris-tian ones, whose contribution to the formation of a conscience related to social in-tervention has not only been decisive throughout history, but is currently still active In a country such as Romania, with a population almost completely religious, the input of the cult of the majority – of the Orthodox Christian persuasion - can only be relevant, both from a positive and a negative point of view. But what this input is, when the addiction phenomenon is concerned, is an issue that has not yet entered a pretty much needed public debate.22 I will touch upon some of its aspects here.

21 For a summary, see Patrick McNamara, The Neuroscience of Religious Experience, Cam-bridge University Press, 2009, p. 80-144; William Grassie, The New Sciences of Religion, Plagrave Macmillan, 2010, p. 93-110. Steve Sussman et al., “Drug addiction, love, and the higher power”, Evaluation & the Health Professions 34.3 (2011), p. 362-370.

22 The meaning of such a debate is in itself debatable, all the more so as the place of the Church in the topography of the public space is still under realignment, following the forced mar-ginalisation suffered under the Communist regime. During the two decades after the regime change, the ROC seemed to have been caught in the dialectics of the relationship between the indisputable popular prestige (although slightly eroding) the Church enjoys among the other institutions, and the officer-of-the-state status of the clergy. The situation is not exclusively beneficial for the Church or the society, and that has direct implications on the manner that the Church is socially active - the area of addictions included -, and on the outcome of its activities. See, Radu Preda, “Servicii şi de-servicii sociale. Din experienţa filantropică a Bisericii Ortodoxe din România” [Social services and disservices. The philanthropic experience of the Orthodox Church in Romania, Studia Universitatis Babes-Bolyai-Theologia Orthodoxa 2 (2011), p. 189-204.

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As stated before, addiction proves to be not only one suffering amongst many, but also the expression of a self-consciousness of humanity that admits to being at major cross-roads, which is quite fitting for the current age. The global dimension of the phenomenon and the complexity of its processes depict to us the overwhelming picture of an impasse. Neither the criminalisation “warfare” against drugs, nor the abstinence seem to be acceptable to our contemporaries; all that the harm reduction approach and the consumerism do is normalise addic-tions (the former), and escalate them (the latter). Globally speaking, a solution would require no less than the re-establishment of the social-political order, i.e. the eradication of psycho-social disruption and alienation.23 At the level of the neuronal mechanisms, the most daring suggested therapies are the nutritional sup-plements produced through nutrigenomic technologies, and the administration of oxytocin.24 At the same time, the statement one of the most renowned addictionol-ogists, William R. Miller made, that science seems to be on the verge of “rediscov-ering the fire”, i.e. the unmatched therapeutic value of agapic love, expresses an increasingly obvious tendency of the medical science to recover the long forgotten wisdom of the ancestors.25

The Church may envisage in it at least the premise of a first step taken by the scientist mentality, which is usually infatuated with the presumption of its own com-ing of age, towards an alternative that is open to a “superior power”. However, it still remains to be seen whether the acknowledgement of its own limits, and its disposi-tion to learn would also trigger a transformation of science itself through a paradigm change, or whether it would better suffice it to colonise the classical self-sufficient reductionism on the basis of the rediscovery of traditional approaches, by emptying the latter of their own contents, i.e. “demystification”.26 Plainly put, will the medical science and public healthcare system learn to love genuinely, or will they simply practice a kind of professionalised love, an “as-if-love”?

In any case, the debated re-convergence of science and religion resets the relationship between the two domains, not only at epistemological level, but also in terms of social recognition and justification, that is in political terms. Or, the

23 Bruce K. Alexander, “Addiction: The Urgent Need for a Paradigm Shift”, Substance use & misuse, 47.13-14 (2012), p. 1475-1482; Ron Roizen, “Ron Roizen on Bruce Alexander’s “Addic-tion: The Urgent Need for a Paradigm Shift”. A Measurement Nightmare”, Substance use & misuse, 47.13-14 (2012), p. 1485-1489.

24 B. W. Downs et al., op. cit.; Iain S. McGregor, and Michael T. Bowen, “Breaking the loop: ox-ytocin as a potential treatment for drug addiction”, Hormones and behavior, 61.3 (2012), p. 331-339.

25 William R. Miller, „Rediscovering fire: Small interventions, large effects”, Psychology of Addictive Behaviors, 14.1 (2000), p. 6-18.

26 Kenneth Blum et al., Neuroscience and demystification of the 12 step program and fellow-ship, Springer, 2013 (in press).

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increased acknowledgement of the role religion plays in the res republica, through its contribution to the well being of the citizens, has consequences that are not exclusively beneficial, at least they are not inertial. Insofar as religion is acknowl-edged for what it can offer, it is also required to provide more. After periods of marginalisation or persecution, we note the temptation to reabsorb it into a new form of social enchantement, through the sacralisation of happiness.27 The happi-ness here and now, of course. Can the Church offer such a thing?

It is worth mentioning here the only study (2007) dedicated to how the persons with an ill-mental health condition are perceived, and to the treatments employed by the Romanian population and the mental health professionals (psychiatrists, psy-chologists, general practitioners, nurses, social workers).28 Over three quarters of the population think that alcoholism, studied here on an equal footing with depres-sion and schizophrenia, is caused by stressful situations (“hardships”) - which are considered to be the central cause for all the mental conditions mentioned above -, a little over a half of the population attribute it to a faulty education, and a little under a half to heredity; it is only a third of the people that admits “a chemical im-balance in the brain” as one of its causes. For the Romanian population, an adequate treatment of alcoholism starts with non-medical methods such as discussions with family and friends (84%) and resorting to a psychologist and social worker (74%). Next comes a visit to the psychiatrist (70%), the family physician (67%), and the priest and church (65%). The least appreciated are the use of medication (54%) and the admittance into a psychiatric facility (42%). By comparison with a similar study, in the USA people choose to go to the priest/church and to the psychologist/social worker (equal share of 90%), less try to discuss the issue with family and friends (70%), and even less use medical means (30%). In its entirety, the health care sys-tem is evaluated as “average” by professionals. The psychologists however, tend to label it as “bad”. The blame is often laid upon the insufficient degree or lack of development and sustenance of the social assistance and inclusion services that tar-get addicts, the defective way the resources are managed, the lack of financial funds and the “indifference and negligence coming from the authorities”. The interviewed professionals believe in the necessity of reforming the system, in the sense of dein-stitutionalisation and community psychiatry. Should this happen, then actions like informing and sensitising the population, educating and stimulating the involvement

27 Gilles Lipovetsky, Le bonheur paradoxal. Essai sur la société d’hyperconsommation, Gal-limard, 2006.

28 M. S. Stănculescu et al., “Persoanele cu probleme de sănătate mintală în România: stere-otipuri, cauze şi modalităţi de îngrijire percepute, atitudini şi distanţă socială” [People with mental health problems in Romania: stereotypes, perceived causes and ways to care, attitudes and social distance], Calitatea vieţii, 3–4 (2008), p. 284–316.

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of the families become imperatives. There are demands to develop specific nation-al programs, through the establishment of rehabilitation and reintegration centres, and also by actively involving the civil society in them (NGOs, priests, educators, media). Most of the professionals consider that the NGOs active in this field are too few and insufficiently involved in the education and sensitisation of the population. The involvement of priests and educators in the matter is appreciated as even less adequate. Interestingly enough for us, the professionals count the priests among the least knowledgeable key actors in matters of mental health (at a level that is compa-rable with that of educators and local authorities, which come right behind that of NGO representatives and social workers). Therefore, the involvement of the Church would be welcomed - its long delay is already giving way to negative opinions.

V. The contribution of the Church

We can identify at least three aspects that are required by an ample commit-ment in such an endeavour, and these aspects constitute important research themes for the Orthodox theology:

How to interpret addiction within the Orthodox Spirituality, and determine its relationship with the medical and psychological theories, while attending to the ever increasing importance of neurology in psy-sciences and the progressive medicalisation of the issue of mental health. A simple confrontation of the last definition given by the American Society of Addiction Medicine (2011) to addic-tion with the definition given by a classic of the patristic theology, St. Maximos the Confessor (7th cent.) to passion/vice, points to the likely research horizon under this perspective. According to ASAM, “addiction is a primary, chronic dis-ease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviours.”29 According to St. Maximos, “passion is an impulse of the soul contrary to nature, as in the case of mindless love or mindless hatred for someone or for some sensible thing… Again, vice is the wrong use of our conceptual images of things, which leads us to misuse the things themselves” (II, 16-17). 30

The ASAM definition does not point directly to love (or hatred), yet its cen-tral research foundation is made up of the neurology of reward processes and its

29 Available on-line at http://www.asam.org/for-the-public/definition-of-addiction.30 St. Maximos the Confessor, “Four Hundreds Texts on Love”, in G. E. H Palmer, Kallistos

Ware, and Philip Sherrard, The Philokalia: The Complete Text, Volume 2, Faber and Faber, 1982. The Latin capitals refer to the number of century, the Arabic to the chapter.

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connections with the other cerebral functions. These are phylogenetically linked to the survival strategies, and especially to those regarding the attachment to one’s most significant others (parents, spouses, friends), an affectionateness that shows under the various forms of love, as discussed in a previous paragraph. On his part, while speaking of passions from the viewpoint of love, St. Maximos distin-guishes between its various forms.31 Moreover, we find with him the correspond-ence between the substitutive character of addiction compared to the need for attachment, which is brought forward by the neuropsychology of affectionateness, and the understanding of passions as plundered and degenerate forms of love.32 The similarities are powerful, and they are still in want of a much more in-depth investigation. Do the above definitions refer to the same phenomenon? Are all passions addictions, or only some of them? What parts of the human nature are involved in each, and what dynamic interactions between them can be identified? The relation between affectionateness and cognition is, amongst others, very in-teresting to tackle. While the spheres of affectionateness and emotions has had a spectacular come-back in the area of clinical research and practice after decades of cognitivism, many of the dispassion-related concerns of contemporary pasto-ral guidance continue to favour “the warfare against the thoughts”, in a way that mostly resembles the cognitive-behavioural approach.33 While he equally empha-sized both components in his definition, St. Maximos acknowledges the influence of affectivity over cognition: “If you wish to master your thoughts, concentrate on the passions and you will easily drive the thoughts arising from them out of your intellect” (III,13). Another matter of interest is related to how the spiritual tra-dition can, with its characteristic dualism, account for the somatic component of addictions highlighted by the neurological research, at the same time as it denies

31 “Men love one another, commendably or reprehensibly, for the following five resaons; either for the sake of God, as the virtous man loves everyone and as the man not yet virtous loves the virtous; or by nature, as parents love their children and the children their parents; or because of self-esteem, as he who is praised love the man who praises him; or because of avarice, as with one who loves a rich man for what he can gat out of him; or because of self-indulgence, as the man who serves his belly and his genitals. The first of these in commendable, the second is of an intermediate kind, the rest are dominated by passion” (II, 9).

32 “If, the, the Creator of everything that is beautiful is superior to all His creation, on what grounds does the intellect abandon what is superior to all and engross itself in what is worst to all - I mean the passion of the flesh? Clearly this happens because the intellect has lived with these pas-sions and grown accustomed since birth, whereas it has not yet had perfect experience of Him who is superior to all and beyound all things” (III. 72).

33 See, for example, Tadei, the abbot of Vitovnitza monastery, Cum iţi sunt gândurile, aşa iţi este şi viaţa, [What are your thoughts so is your life], Predania, 2012. For a comprehensive treatment of the topic, see Alexis Trader, Ancient Christian Wisdom and Aaron Beck’s Cognitive Therapy, Peter Lang, 2011.

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the biological reductionism? The rise of the so-called neuro-theology elicits a re-sponse from us and also forewarns us that this matter is not lacking in ambiguity: on the one hand, the spiritual experiences are scientifically confirmed, and on the other hand, they are naturalised and thus their transcendence is negated. But for a few rare and timid exceptions, the Orthodox theology has not yet paid any atten-tion to the challenges posed by neurology.34

2. The spiritual perspective of the Orthodox Church is heavily therapeutic. Although it pays attention to diagnosis, this perspective focuses mostly on the intervention, i.e. the methods that help one attain a state of dispassion, a clean conscience and subconscious, and become better unified with God. Whilst in the landscape of Orthodox spirituality, all diseases, both somatic and psychologi-cal proceed from man’s alienation from God, and their cure lies in regaining fa-miliarity with Him - the only state that gives life sense and plenum, the modern psy-sciences are mostly symptom-relief oriented and thus unable to address the issue of fulfilling man’s ultimate need for God. However, it is difficult to demon-strate that the Orthodox Church might have managed to apply this kind of spirit-uality beyond the monasteries’ walls - in parochial communities of the modern and post-modern civilisation. The pastoral, ritualistic and moral minimalism has also proved incapable of a significant contribution to the improvement in health or recovery of the persons suffering from addictions or mental disorders. In fact, the cases presented in the contemporary hagiographic and ecclesiastical literature are equally rare. Addictions appear to be the hard-core division of the passions, and it is unclear why this fact is not tackled as such in the Pastoral Theology (including Canon Law here). The lists of sins in the confession guide-books and in the prayers for the remission of sins mention them (sometimes these contexts evoke various “ways” in which the said sins can be committed), but they seem to be less important than those sins related to the binding through the word (oaths, curses, incantations, etc.). However, when sins become a mass phenomenon, the pastoral discretion (“For it is shameful even to speak of those things”, Eph 5:12) risks falling into indulgence or even complicity.

Instead, the psychiatric medicine, the psychotherapies, and most remarkably, the self-help (literally, mutual-help groups and therapeutic communities) move-ment, generated by the rise of the Alcoholics Anonymous, produced all sorts of results, whether modest or important, yet material for this increasingly wide ambit of human suffering. Furthermore, they are more and more open to spirituality and

34 Amongst these, see Lazar Puhalo, The Neurobiology of Sin, Synaxis Press, 2010, and Erik Bohlin, „Healing the Mind: The Nexus between Contemporary Psychology and Eastern Christian Practice”, accesibil la http://www.erikbohlin.net/Articles/healing_the_mind.htm. It is not useless to emphasize the need for caution in assessing these attempts.

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to the inclusion of the ability to iatrogenically exploit the beliefs and values of the patients, in the professional standard of “cultural competence”.35 The recovery of the therapeutic dimension of the ecclesial life is the main objective of the recent pleas for an “Orthodox Psychotherapy” (Hierotheos Vlachos, Dmitry Avdeev), or a “Neptic Psychotherapy” (Andrew/Zoran Vujisic), although the use of the secular term Psychotherapy in a syntagma meant to denote Orthodox spiritual therapy, is debatable. In any case, the polemical or dialogical confrontation between the two therapeutic perspectives is more and more stringent.36

3. Whereas the relation between the Orthodox spiritual therapeutics and the secular one is important mainly for their prospective collaboration within the framework of certain special mental health care services, in order to prove them relevant from a pastoral point of view, a different and generally ignored aspect may be deemed decisive, i.e. the communitary dimension of the Orthodox spirit-uality. The communion pretext, closely connected with the assertion of personal-ism, is commonly found in the Orthodox academic theology. The reality, though, is that the ecclesial communion is reduced to almost exclusively an ideological, ritual and administrative unity, which is hardly able to keep the unity of the mass-es of individuals that are more or less known to the clergy or to one another. The meaning of the “crisis of church individualism” (Christos Yannaras) is categorical for our topic: can those who suffer from mental disorders or addictions develop a conscious relationship with God in the absence of a profound communion of life and destiny with others, or worse, in spite of a communion that is in and of itself pathological? The explosion of addictions to TV, internet and virtual social networks, and the phenomenon of codependency prove that this is not likely to happen. It is a bitter, although possibly curative irony, that it was the AA move-ment and its emulations, and not the Orthodox ecclesial life that rediscovered the therapeutic power of communion last century, as an expression of the ontological relational character of life and faith. Recently, a few Orthodox monasteries have started to develop therapeutic communities around them, in order to help the ad-dicts (Grigoriou from the Holy Mountain, Danilov from Moscow, Kovilij from

35 Philippe Huguelet, Harold G. Koenig (eds.), Religion and spirituality in psychiatry, Cam-bridge University Press, 2009.

36 Metropolitan Hierotheos Vlachos, Orthodox Psychotherapy: The Science of the Fathers, Birth of the Theotokou Monastery (2nd Ed.), 2005; Idem, The Science of Spiritual Medicine: Ortho-dox Psychotherapy in Action, Birth of the Theotokos Monastery, 2010; Dmitri Avdeev, Când sufletul este bolnav, [When Soul is Sick] Sophia, 2005; Vasileios Thermos, Thirst for Love and Truth: En-counters of Orthodox Theology and Psychological Science, Alexander Press, 2010; Zoran Vujisić, The Art and Science of Healing The Soul: A Guide to Orthodox Psychotherapy, VDM Verlag Dr. Müller, 2010; Idem, “Neptic-psychotherapeutic treatment and substance (ab)use”, European Jour-nal of Science and Theology, 9 (suppl.1) (2013), p. 131-142.

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Serbia, Machaira from Cyprus, Gouvernetou from Crete), and the “Old World” community project was created on purpose to be easily replicated and spread.37

VI. Ministry, philanthropy, social services

Following closely the means that can be employed by the Church in order to deal with the issue of addiction, we may identify three major initiatives: the pasto-ral, the philanthropic, and the social services kinds of undertaking.

Before going further into details, it is necessary that we ask who the depend-ent persons are in Romania. There is no data regarding the religious affiliation and practice of the users of alcohol, tobacco and other drugs, nor is there any data on the prevalence of substance use amongst the members of the Church. However, if we are to take into account the majority of population’s declared affiliation to the Orthodox Church, as well as the widely acknowledged adequateness and per-vasion of the alcohol and tobacco use, then a significant overlapping of the two categories becomes highly plausible. In the case of other addictions, the situation is very difficult to intuit, although there is no reason to suspect it differs too much.

Thus, it is likely that many dependent persons/addicts are baptised. Even if we suppose that their relationship with the Church is not exactly a close one, and therefore to minister to such persons seems hard to even imagine, as addictions have a propensity to set in relatively early in the adolescence, the responsibility of a pastoral intervention is evident primarily in the area of initial prevention. An en-tire series of educational activities, which were developed in schools over the last few years, have partnered, among others, with local units of the Church, i.e. local parishes or missionary departments of the eparchies. However, while the premises of an addictive behaviour are established in infancy and early childhood, such as the theory of attachment states, prevention should take place inside families and target the parents, on whose attachment to their offspring depends the child’s level of attachment in response. It is true that the Church has held a campaign against domestic violence for 2 years (2006-2007), but the effects within the population of that are yet to be measured.38 As the pastoral activity falls under the shepherd – the parish priest, it also depends on two major factors: its assigned time and the

37 Eugene N. Protsenko, “Christian Therapeutic Community in Addiction Treatment”, Euro-pean Journal of Science and Theology, 9 (suppl.1) (2013), p. 143-153.

38 “Strengthening Community-Based Initiatives in HIV/AIDS and Family Violence in Ro-mania”

JSI Final Narrative Report, 2007, available at pdf.usaid.gov/pdf_docs/PDACL704.pdf. On the perceptions and attitudes of priests and teachers of religion to this phenomenon, see Rodica Ţugui, Daniela Ţigmeanu, Asistenţa socială în Biserică. Evaluări şi cercetări în cadrul pro-

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competence of the shepherd in the area. The limited character of both said factors – which many priests who are already involved in such activities complain about – is critical, as the recovery, even if it begins right here, cannot only be attained through the Holy Mysteries of Confession and Holy Unction, the main available pastoral means to the priest nowadays. In the Orthodox spirituality therapeutic vision, the forgiveness of sins equals spiritual healing, that is the changing of one’s life, which requires that an ample and lengthy interaction with the dependent-pen-itents - and most often, with their families or entourage - be initiated, in order to tackle co-dependence as well. A minimal knowledge of the addiction phenomenon and of the recovery means (secondary and tertiary prevention, in particular) is required from and deemed indispensable to the priests. Yet this is but superficially taught in college, within courses held in subject matters such as Spirituality and Moral Theology, and the way it is done is completely theoretical and unspecific, during lectures on passions and dispassion. An important objective of the Nation-al Anti-Drug Program, launched by the Romanian Patriarchate in 2008, targets the raising of awareness among the future priests, and the formation of addiction counsellors via a special course.39

Before that, there is however the problem of attracting addicts in the area of pastoral action. As shown by the data of the above-mentioned survey, many Romanians seem to consider appealing to the priest for help in addictions. On the other hand, assessments related to the addressability of the services for addicts show that only a small proportion of addicts ask for help, suggesting an unmet need in the field of pastoral and spiritual support as well.40 All that we know for sure is that addiction reporting by family members is far more widespread than personal call for the priest. A locus classicus of the Christian attitude towards one’s neighbour points to the outreach action as a model to be followed in this regard: “I was in need and you have come to me!” (see Mt 25:36). This is where the fundamental question of how addiction is understood by the Church raises. Is it a sin or a disease? Which is the addict’s responsibility in his situation? Is there a discrimination based on the responsibility of the addicts who are being helped? The cited text does not seem to justify this as poverty, imprisonment or

gramelor sociale ale Bisericii Ortodoxe Române, [Social work in the Church. Evaluation and research in the social programs of the Romanian Orthodox Church] Doxologia, 2010.

39 The internet site of the NADP is http://www.ortodoxantidrog.ro. For the handbook, see Iulian Negru, Floyd Frantz, Nicoleta Amariei, Pastoraţia persoanelor dependente de alcool [The pastoral care for persons suffering with alcoholism], Basilica, 2012. More on this Program, in Sebas-tian Moldovan, “The Orthodox Church-run Program for the Treatment of Addictions in Romania”, European Journal of Science and Theology, 9 (suppl.1), (2013), p. 173-184.

40 See the yearly country reports of the National Antidrug Agency, at http://www.emcdda.europa.eu/countries/romania.

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disease can have many causes. Being inspired by the AA philosophy, the NADP promoters propose understanding addiction as disease and focus on fighting the old attitudes which considered it a moral vice. This option may be exaggerated; the connection between sin and disease is much closer in the Orthodox spiritual tradition than in other Christian traditions in which sin is only a guilty moral transgression. Moreover, the fact that Christ was made “sin on our behalf” (2 Cor 5:20-21) and descended into hell (1 Pt 3:18-19) shows His identification with any human failure and our intervention is on Him, whatever the failure and whoever the responsibility belongs to. In this vision, forgiveness presupposes healing the will of the person in question through the synergistic process of repentance. But as its pathology always develops in the context of interpersonal relationships of various amplitudes, as the theory of attachment and of social dislocation clearly points out to the mental illnesses, the healing process is only possible in a saluto-genic relational context. Like life, responsibility is always shared.

„When an addict enters the room, a bag of problems enters,” says an addic-tions counselor. Co-morbidity and the negative social implications of addiction are another reason why the problem cannot be isolated from the individual’s moral choices. They also show that addiction goes beyond pastoral action restricted to the universal priesthood of the laity, i.e. to philanthropy. The priest has neither the time nor the competence to deal with the whole range of problems. The other members of the addict’s parish have to follow the model of the Matthean text. We have no indication that this is happening other than spontaneously and sporadi-cally. There is no specific catechetical education in this regard. NADP takes into account the role of the spiritual and natural parents, but not that of brethren in faith. The few systematic initiatives for the benefit of the addicts who do not be-long to diocesan centers are organized as services. Philanthropy, communion with the fallen fellow, is simply the reverse of the Eucharist, communion with Christ.41 In fact, the spiritual health of the individuals depends more on that of the social environment they belong to, especially of the parish and of the two families they live with than on the relationship with the priest. This one can only be a catalyst.

Although timid and belated, the third way to intervene - by organizing spe-cialized services- starts to grow. NADP started and continues to operate precisely based on programs for people with addictions, especially alcoholics, which are supported by the Church.42 The professionalization of social work and subjecting

41 As I have previously argued, in Sebastian Moldovan, “Pentru o pastoraţie integrală” [For a comprehensive ministry], Anuarul Academic al Facultăţii de Teologie „Andrei Şaguna” din Sibiu 2005-2006, Editura Universităţii Lucian Blaga, 2008, p. 241-257.

42 More information about these programs can be found in annual reports on social work BOR, for example, “Filantropia” Federation, Annual Report 2011, available http://federatia-filant-

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it to the authority’s requirements in view of its accreditation as social services is a firm option of the current leadership of The Romanian Orthodox Church. The Organization and Functioning Regulation of the Social Assistance System in the Romanian Orthodox Church states that “social assistance is conducted in accord-ance with the State’s rules for the organization and functioning of the Romanian Orthodox Church, as well as with the rules in force related to the social service providers” (emphasis mine).43 An expected benefit of this alignment of the Church in the rules of the public-private game in the modern secular state is the possibility of financing this activity with public money. “Turning the Church into a Non-Prof-it Organization”, as someone called it is to restrict the manifestation of faith in the private space and go out in public only with activities which are justifiable in terms of common interest, in the manner prescribed by profane regulations. In ad-dition, the Regulation designs work according to a hierarchical, centralized model under the umbrella of patriarchal, diocesan and deanery structures. The local and communitarian level appears rather like a concession: “Social assistance can be done by the parish too” (art. 18, emphasis mine).44

VII. A place to be reborn45

With all the advantages of such an approach, whose origins in the Christian care for the good management (oikonomia) of God’s earthly gifts are undeniable, its limitations are highlighted precisely by the issue discussed here. There is an increasing recognition of the fact that the best results in the field of addictions and mental health in general, are given by methods that exploit the most the initiative and involvement of those directly affected by the issues in question, namely the support groups and the therapeutic communities. The “person-centered” inter-ventions are also successful among professional psychotherapeutics as they are very careful about the human relationship between the professional and the ben-

ropia.ro/en/resurse-2/media/rapoarte-anuale. Almost all of them use slightly adapted forms of the so called Minnesota Model.

43 Available on-line at http://www.patriarhia.ro/ro/opera_social_filantropica/biroul_pentru_asistenta_social_filantropica_3.html.

44 There are few evaluations of the social activities of the Romanian Orthodox Church’s structures and they prove the same interest to standardize for efficiency and effectiveness through management techniques such as monitoring, “good practices” and “standards of quality”; see Renaldo Niţă, Sinteza raportului de analiză a capacităţii organizaţionale de livrare de servicii sociale şi filantropice [Summary analysis report on the organizational capacity of social and phil-anthropic service delivery], n.d., passim, available at http://www.iocc.ro/ro/achizitii-publice/doc_download/10-raport-servicii-sociale-sinteza.

45 Pannayotis Nellas, “L’Église, un lieu pour renaître”, Contacts, 33(114) (1981), p. 82-102.

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eficiary, regardless of the specific technique used.46 The need for comprehensive and integrated services to adequately meet the needs of those affected has been a certainty for a long time. However, no integrated service system may provide more than a temporary support which is limited for its beneficiaries, which is a major impairment for long-term or chronic conditions such as addictions. Sooner or later, involvement of the community in which the addict is marginalized and in the bosom of which he will return as a fully integrated person is not only inev-itable but also decisive for the outcome of the therapeutic intervention and assis-tance. Counting on specialization, professionalization and good management, by not using the personal resources and the resources of the community, family and parish, church intervention is both likely to betray the logic of communitarian, philanthropic and Eucharist love - a form of self-secularization - and to generate a more severe form of addiction within communities, maintaining two ecclesial deadly sins: individualism and helplessness. The Sacrament of the Eucharist and the concrete love of one’s neighbor in the family and community are the most comprehensive, integrated, and transformative “services” that can penetrate into one’s personal life. Professional expertise, including the pastoral one, has the im-portant role to facilitate their valorization.47 Just as it challenges us to consider the problematics of addiction, the dynamics and performance of the family and the parish represents the most important item that can ever be found on the agendas of ecclesial meetings, and of the dedicated pastoral-missionary years in the Romani-an Orthodox Church.48

46 Barry L. Duncan et al., The heart and soul of change: Delivering what works in therapy, American Psychological Association, 2010.

47 Peter Adams, “The Wizard of Oz and the new alcohol and drug professional”, in A. Roche, J. McDonald (eds.), Catching Clouds: Exploring Diversity in Workforce Development in the Alcohol and Other Drug Field, 2002, p. 193-200.

48 The research was done within the program ‘Postdoctoral studies in the field of ethics of policy in public healthcare’, which is supported by POSDRU/89/1.5/S/61879, G.T. Popa University of Medicine and Pharmacy Iaşi, Romania. I am grateful to Ana-Maria Ilieş for providing the English translation.

Ministry, philanthropy, social services? The Church and the challenge of addictions

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