Grassroots Addiction Ministries Bring Meaning and Identity to Recovery

“Before, I hung out with drug users because they listened—they cared about me and my pain. I didn’t think I could answer God’s call. But God wants you to pass on lessons. Since you know the vice of crack, … you can help someone else [with the vice of crack]. God wants you to see we’re useful. It’s not true that we’re garbage. [He wants us to see] that we have a function.” —Carmen, a man recovering from addiction at Victory Academy, a Pentecostal addiction recovery mission in Puerto Rico. From Addicted to Christ: Remaking Men in Puerto Rican Pentecostal Drug Ministries.

Glenn Cook

Carmen is one of many recovering individuals interviewed by psychiatrist Helena Hansen, M.D., Ph.D., as part of her yearlong investigation of grassroots addiction ministries in Puerto Rico. She discussed what these ministries can teach addiction specialists trained in the biopsychosocial model at the 50th Anniversary Conference of the Black Psychiatrists of America, held in April at National Harbor, Md. Hansen is vice chair of the APA Council on Minority Mental Health and Health Disparities.

At the conference and in comments to Psychiatric News, Hansen described the Pentecostal ministries as potent sources of change and renewal. As reflected in Carmen’s testimony, these ministries offer recovering individuals a sense of agency through the use of spiritual techniques to sustain sobriety and freedom from drugs. They also provide a renewed sense of masculine purpose and identity in an island community where the flight of manufacturing has left many men without jobs.

Her work is recounted in the book Addicted to Christ: Remaking Men in Puerto Rican Pentecostal Drug Ministries, published last year.

This grassroots approach to recovery is relevant to U.S. addiction specialists who work with communities of color, where storefront Pentecostal ministries, or similar grassroots religious missions, also flourish, Hansen said.

“I suspect that if you were to look at people with substance use disorders in the big public hospitals of New York or in poor African-American and Latino neighborhoods, a good many of them would have come in contact with these [grassroots religious recovery missions],” she told Psychiatric News. “As practitioners, we would do very well to understand how our patients may be seeking help outside of our clinics. We should look for points of convergence and opportunities to collaborate and recognize that these movements offer something important—social connection and a sense of meaning, purpose, and identity outside of being an ‘addict.’ ”

Addiction Ministries Thrive in Blighted Communities

Her interest in grassroots ministries dates to her days before medical school when she was a program officer for the National AIDS Fund in New Jersey at the height of the HIV/AIDS epidemic in the 1980s. Her job was to find community organizers in need of funding for grassroots projects related to HIV/AIDS. It was then that she discovered storefront Pentecostal ministries offering health services to minority communities in Newark, Camden, and Trenton.

“These storefront ministries were widespread and vibrant institutions in neighborhoods that had very little in the way of an organized response to AIDS, and they were cropping up independently of each other,” Hansen said. “The ministers were charismatic, self-ordained leaders, many of whom had been formerly addicted themselves.”

She describes their origins in her book this way: Working-class addicted people were attempting to take matters into their own hands, to create and invest in a form of life outside of narcotics traffic. Some of them had converted days before and were now only blocks away from the crack houses and heroin shooting galleries they had known.

Pentecostalism, a charismatic form of Protestant Christianity that places special emphasis on a personal relationship with God through baptism, flourished in the American Midwest in the early part of the 20th century and later spread to cities.

Puerto Rico, a U.S. territory since 1898, became a target of Pentecostal missionaries, and some of the recovering people and leaders Hansen met in the N.J. ministries had migrated from the island. Storefront recovery ministries similar to those she had discovered in New Jersey were also found in Puerto Rico in neighborhoods blighted by the drug trade.

This led Hansen to spend a year there interviewing people recovering from addiction, observing religious practices, and participating in the daily life of the communities.

Many of the people with addiction were men who had become unemployed when jobs were moved to markets like Asia, where labor costs are less expensive—a phenomenon that men on the mainland also have experienced. “It’s been called a ‘crisis of masculinity,’ similar to the inner-city U.S. where men who might have been expected to support the family end up in the drug trade with another kind of masculinity based on violent performance and gang membership,” Hansen said.

Ministries Offer Ladders of Advancement

The grassroots addiction ministries in both Puerto Rico and the mainland offer a new kind of masculine spiritual authority, even for those without a job, Hansen said.

“The addiction ministries are very male dominated,” she said. “Addicts come in off the streets, and in recovery they may marry and become the spiritual head of a household, as well as become pastors or leaders in the church. It’s a way of recovering a dignified masculinity not dependent on employment in the formal economy.”

She added, “It works in a similar way on the mainland, offering ladders of advancement for men who have been economically displaced.”

The ministries’ approach to recovery also emphasizes the individual’s agency and power of choice to engage in spiritual practices that protect against relapse. This approach differs from the model in which most U.S. psychiatrists are trained—it defines addiction as a chronic, brain-based disease over which a patient has limited or no control. (Importantly, Hansen said that the ministries also do not endorse Alcoholics Anonymous.)

Are the ministries successful in helping addicts recover?

A study by Hansen and colleagues from several other institutions suggests that at the least they are not unsuccessful. (The findings were first presented at the College on Problems of Drug Dependence 2004 annual meeting in San Juan, Puerto Rico.)

After three months, Hansen and colleagues found that the faith-based treatment was superior to biopsychosocial treatment on measures of program retention and reduced drug use, although the statistical significance of the advantage washed out at six months.

She said that neither the ministries nor the biopsychosocial programs proactively treated psychiatric comorbidities, such as mood or anxiety disorders, which are common among those with drug dependence. This fact may have played a role in the high, six-month relapse rates of both programs.

What’s important, Hansen said, is that community recovery endeavors like the Pentecostal ministries offer something unique that patients—especially those in poor, minority communities—are liable to seek outside the clinic.

On the mainland there are instances of collaboration between clinics offering biopsychosocial treatment and community programs. Hansen cited the example of the Sobriety Garden at Bellevue Hospital in New York, where patients with substance use disorders cultivate a garden alongside people from the community.

Long-term recovery happens in the community. “In psychiatry we can start to think about how we can support our patients in getting connected to resources in the community where they can re-establish themselves with an identity and tangible skills they can put to use,” she said.  ■