Should Pastors Refer to Residential Programs?

In a previous post, I encouraged pastors that they are competent to counsel addiction. You can find that article here. However, when pastors press into addiction they will find many challenges along the way. In this post, I want to help pastors think through if and when it is appropriate to refer those battling addiction to a residential program.

I will begin with a brief reminder of the call of a pastor to care for their flock and then consider some practical wisdom for when to consider sending someone to a residential program.

In Acts 20:28, when speaking to the Ephesians elders, Paul urges, “Pay careful attention to yourselves and to all the flock, in which the Holy Spirit has made you overseers, to care for the church of God, which he obtained with his own blood.” Note the responsibility of an elder, “to pay careful attention to” and “to care for the church of God.” 

Pastors (I’m using the term interchangeably with elders as I believe Scripture teaches they refer to the same office) are to provide spiritual oversight and care for those in their church. 1 Peter exhorts pastors to "shepherd the flock of God.” The pastoral care that elders are to provide must include whatever struggles their particular people battle, including addiction. This is a high calling that includes providing spiritual guidance and biblical counsel to them. 

Can Pastors Refer Addiction Cases to Residential Programs?

There are three answers to this question:

1. Always refer addictions (The pastor is not trained/addiction is outside their scope of responsibility)

2. Never refer addictions (The pastor should never abdicate this responsibility)

3. Sometimes refer addictions (With qualifications)

I strongly disagree with A (See again previous article), sympathize with B, and stand firmly with C. This is for various reasons. First, when reading the New Testament, one would find it difficult to overlook the gospel partnership Paul shared with various churches. He wrote letters to numerous churches offering counsel and wisdom for specific situations though he wasn’t a member of those churches. In 1 Corinthians 5, for example, Paul gives specific instruction to the church in Corinth in how to handle a case of sexual sin in the church and provides a framework for church discipline. Gospel partnership means we can ask for help when we need it even when it comes to the members of our churches. Of course, Pastors want to be very careful when thinking about who to partner with (more about that point below). And this doesn’t give a greenlight to abdicating the responsibility to pastoral care. This is, put simply, humbly asking for help. The pastor must still maintain oversight of the person but he is able to ask for help. The other reasons for sometimes referring addictions are more practical so I’ll address them under the headings below.

Consider your limitations

One of the challenges pastors will face is that certain issues will demand more of the pastor’s time. Addiction ministry is incredibly demanding for several reasons. First, sin is by nature progressive. James 1:15 reminds us that sin, “when it is fully grown brings forth death.” In other words, sin gets worse and worse apart from repentance. Each sin will have slight differences in the way they progress toward death. Those battling addiction have been living a lifestyle of intense darkness that often involves lying, stealing, sexual immorality, and much more. The issues they will need counsel for are numerous. In addition, consider the physiology of addiction. Addicts are putting chemicals in their body at high levels. The substances they use change them, often with long term effects. A long-term methamphetamine user will have difficulty staying awake and focusing as their body tries to return back to normal. This often presents a challenge in counseling that requires much time and patience. Or consider the damage addictions can do in relationships. How difficult is it to counsel a husband whose addiction has caused so much damage in the marriage? There is hope and help for each of these dynamics but it takes a significant amount of thought and time. So the pastor must consider his own limitations. 

For me personally, I love all the work of pastoral ministry. I love people. I love wrestling with biblical texts. I love praying for and with God’s people. But I can’t do it all myself. I need others with the same commitment to help in areas I’m weaker or simply because I am one person. I have come to appreciate the body of Christ and the gifts that others can bring to the table. At the church I serve as one of the pastors, we have a couple that has served alongside those battling addictions for years. They have opened their home and spent significant time with those trying to put their addiction to death. They are a vital part of counseling addictions at our church.  More people are served well when the whole body of Christ joins together.

It’s also important here for pastors to consider their own limitations when it comes to specific areas. How well have you thought through applying the Scriptures to addiction? Is there someone who may be more skilled to meet with and help when it comes to a specific issue? This isn’t abdicating your responsibility but rather utilizing the body of Christ to help. There have been many times where I’ve encouraged someone to meet with a person who is more skilled in a particular area or, for various reasons, may be able to commit more time than I am in a particular season. 

This is also where the strengths of a residential program can be very helpful. For the last decade I have probably counseled over 100 different cases of addiction. There are many things I’ve learned over the years through this experience. If, as a pastor, I am aware of a program with that kind of experience and the gospel is central to their care, I want to tap into them in any way I can.

Consider the individual

Pastors should also consider the individual person they are working with. Perhaps you begin meeting with a person and they show signs of wanting to change but then repeatedly fall back into their addiction. There are many reasons to explore as to why this happens but sometimes a change in their counseling plan or environment is needed. This is a major strength of gospel-centered residential programs. Programs can provide safe, supervised living that limits the amount of temptation a person faces so they can focus on the heart of their addiction and their relationship with Christ in a more intentional way. Many churches don’t have the resources to provide housing and practical needs that can assist in counseling. 

Some helpful questions to consider are: Is a once per week meeting enough? Are they unable to gain traction in pursuing sobriety and could they use a higher level of care?

No matter how gifted we are at counseling, the Scriptures are clear that God’s people are sanctified “from one degree of glory to another” (2 Corinthians 3:18). Residential programs don’t fix addiction but they can provide a significant jumpstart for the person in ways that a once a week, hourly counseling session cannot. A change in environment is never enough to change the heart, but sometimes removing someone from a toxic living situation can be really helpful to help them prioritize the heart.

In addition, if a person has caused significant damage to the relationships around them, giving space and time for others to heal can also be very helpful for the individual and those whom their addiction has impacted. At Redemption House, we have seen this often. A wife will express much gratitude for the program and for their pastor for encouraging the men to come to our program because it brings a measure of peace to their home and now she can more easily focus on what she is called to. Again, this isn’t the heart of change but it assists in the change process.

Consider where you send them

If, when considering your own limitations and the needs of the individual you are counseling, you decide a residential program is best, where do you send them? 

The challenge pastors who care deeply about their people getting solid biblical counsel is that many programs lack a gospel-centrality. On one hand, there are many programs that undermine the work of pastors by teaching unbiblical, worldly theories about addiction. On the other hand, there are many programs that rightfully call addiction a sin but have a behavioristic approach and fail to address the heart. Or there are programs that provide housing but don’t take the time to enter into the difficult work of counseling the individual. 

Addiction, in one sense, is very complex and in another sense, it is pretty common to all of us. A good program understands both of those realities. We have tried to hit that balance in our teaching, “A Biblical View of Addiction” found here.

Ultimately, Redemption House exists because we want to see people set free from addiction. We have a heart for those struggling with addiction. And we want to serve churches by partnering with them as they care for their members. We pray this helps you consider if it is time to refer the person you are working with to a residential program. 

Is Your Pastor Competent To Counsel Addiction?

Justin Lakemacher, Program Director

A young man sits down for counseling. He admits to a recent methamphetamine binge, clearing out his bank account and abandoning his family for weeks. He proceeds to inform you he can’t share everything because the FBI is listening to the conversation. He looks like he hasn’t slept in days and regularly looks at the door as if at any moment the authorities will burst through and take him to prison. 

You are his pastor. What do you say to him?

As a bi-vocational pastor working in a biblical counseling addiction program, I’ve had the privilege of counseling hundreds of such cases. And while I am often prayerfully considering what I might say in each situation, I am more convinced than ever that as pastors, physicians of the soul, we not only have something to say that is hopeful and helpful in a generic way but we can offer words that speak to the particular details of the addict’s life. We are competent to counsel addiction. 

What I intend to offer here is not an exposition of key texts related to the sufficiency of Scripture, but rather 3 simple principles to guide the counseling process, with addiction primarily in my mind. I want to show pastors what it might look like to counsel an addict utilizing the following principles. 

1. Don’t be intimidated by addiction

This is often the first hurdle to get over. Unfortunately, many pastors hear addiction and their impulse is to send them to treatment or Alcoholics Anonymous.¹ To be clear, I run a residential program where we encourage pastors to send men battling addiction and in a separate post I will address when it is appropriate to do so in the counseling process.  But I also want to say very loudly here, do not be intimidated by addiction. Enter in with confidence because the problem driving addiction is one that the pastor is not only competent to address but must provide counsel from God’s Word.

Underneath addictive behavior is a heart that is driven by two dominating desires: The addict wants to minimize pain and  maximize pleasure. That’s what drugs do for them. They help them escape their present reality and give them a euphoria that is addictively pleasurable. In this, we have found common ground already. For what human being living in a world under the curse of sin cannot relate to those desires? Press the addict a bit further and you will find that instead of turning to God who is a “refuge and strength, a very present help in trouble” (Psalm 46:1) they turn to their drug of choice. The addict lives according to this belief, “[Drug of choice] is my refuge and strength, a very present help in trouble.” The addict has replaced God as the object of their affection with another ‘god,’ a god that cannot provide true refuge for their soul and instead brings slavery and  death. As we begin to counsel those battling addiction, we find the addict is guilty of idolatry and being enslaved to their own passions. This is the problem all sinful human beings face living after the Fall and there is nothing to be intimidated about counseling idolatrous lusts. Sure, idol worship comes with a lot of pain and darkness. Sometimes the stories we hear are so dark it seems as if the devil himself is in the counseling room. But we cannot let the ugliness of a particular sin intimidate us and hinder us from our task of entering in with gospel hope.

2. Listen, reframe, and proclaim

Counseling begins by listening. When we sit down with a struggling person, the first thing we do is listen and understand their problem accurately so that we can provide the right type of care. 1 Thessalonians 5:14 makes it clear that different types of people need different counsel, “And we urge you, brothers, admonish the idle, encourage the fainthearted, help the weak, be patient with them all.” Patience is required for every counselee but there are clearly different types of counsel.

When we have listened to a person’s story and asked a significant amount of questions, we can begin to reframe what we hear according to the Word which is ultimate reality. I often find when counseling addiction, that my counselees have adopted the language and definitions of our psychologized culture. So one of my goals after listening is to try to help them define their struggle biblically. If they don’t learn biblical language and categories, the Bible will seem irrelevant to them.

One passage I refer to often in addiction counseling is Exodus 32. Narratives in Scripture can be incredibly helpful in illustrating deep truths about the human heart and hope-filled truths about the way God relates to his people. Exodus 32 can also be extremely helpful in helping those battling addictions to redefine their experience with biblical language.

In Exodus 32, the Israelites have been delivered from slavery in the land of Egypt and find themselves in the testing period of the wilderness filled with many difficult trials along the way. When Moses delays coming down the mountain (Exodus 32:1), the people become “irritable, restless, and discontent.”² Instead of turning to God in this moment of testing, they turn to an idol which brings temporary relief and security. No longer are they concerned that Moses is gone and instead  are dancing and rejoicing at the base of the mountain (Exodus 32:6; 18-19). The idol has given them a temporary sense of security and relief. But of course it’s a false security, just like addictions. Meanwhile at the top of the mountain, the all seeing God is aware of this blatant idolatry. He identifies them as a “stiff-necked people” signifying that the people have become spiritually like the object they worshiped.³ Moses, standing as a mediator between the people and God, intercedes for them, not asking for another chance, but pleading God’s own covenantal love and faithfulness. God’s mercy is seen by not destroying the entire nation and staying faithful to his promise, even though many are killed for their sin that day.

The connections to addiction are numerous. The addict, like the Israelite, lives in a wilderness of sorts and is looking for a sense of relief and security in a deeply broken and dangerous world. They struggle to trust God and turn to Him. The addictions they turn to are like the golden calf. Their idols temporarily give them pleasure and a sense of security, yet in the end, are destroying them. Talk with addicts and they will often admit that addictions they love are not only changing them but are slowly killing them. And all of this reveals that a physical deliverance from addiction, i.e. sobriety, is not enough. The addict needs to be delivered from the desires of their own heart. 

Exodus 32 is a doorway into the themes of suffering, temptation, worship, slavery, repentance, and faith. And when we have reframed their story with these biblical categories, the door is wide open to proclaim Christ and his promises to their specific needs. We can proclaim Christ as the mediator between God and man who atones for sin and therefore can truly and completely  take away the guilt and shame addiction brings and reconcile us to God. We can proclaim Christ in all his glory that captures  hearts and woos us away from idols. We can proclaim Christ as a Sympathetic High Priest who understands temptation yet never sinned. We can proclaim Christ as the way out of every temptation (1 Cor. 10:13) so the addict can have hope to change through Him

God’s Word resonates with the addict because their problem, like all sinful problems, is a worship problem. And when we help them see their problem with biblical categories, the Bible is not merely an add on to counseling, it becomes the centerpiece of counseling and the means by which we proclaim Christ.

3. Remember biblical goals for counseling

The Bible describes the chief motive of the converted as the glory of God. 2 Corinthians 5:14-15, “For the love of Christ controls us, because we have concluded this: that one has died for all, therefore all have died; and he died for all, that those who live might no longer live for themselves but for him who for their sake died and was raised.” 

Most treatment programs define their success according to sobriety and aim primarily for sobriety. To aim only for sobriety is symptom management. As pastors, the Scriptures must shape our counseling at every level. Particularly, our goals when sitting down with an addict ought to match God’s revealed will in the Scriptures. Of course, we want sobriety for the addict. But we believe that sobriety is the fruit of properly ordered worship. Knowing that difference is crucial. We help them pursue sobriety, not as an end in itself, but by aiming at worship. A heart satisfied in Christ is a heart that doesn’t need what addiction attempts to offer. The glory of God is our goal in all things.

The question for the addict, now redeemed in Christ, is the same every Christian should be asking each day: “How can I bring glory to the One who has paid for my sin and made me His?”

Again, we aren’t aiming at merely staying  sober here. We want to help the person battling addiction to evaluate every aspect of their life and bring it all  under the lordship of Christ so they might bring him glory in all they do. The irony here is that when the addict stops living for himself and is set free by Christ to live for his glory, they find the true satisfaction they were looking for. Moses, in Hebrews 11:25, chose “to be mistreated with the people of God than to enjoy the fleeting pleasures of sin.” He did this because “He considered the reproach of Christ greater wealth than the treasures of Egypt for he was looking to the reward.” The reproach of Christ was worth more than anything in Egypt. In a nutshell, our goal when counseling addicts is to help them find Christ of greater worth than all the pleasures of addiction, not just because of what he does for us, but who He is in and of himself. We want to help addicts have the same experience as Asaph who said, “Whom have I in heaven but you? And there is nothing on earth that I desire besides you” (Psalm 73:25). Help addicts know, enjoy, and glorify God in all they do and the fruit of sobriety will begin to grow.

A final word

We live in a world that is constantly trying to redefine all sinful problems, including  addictions, in a way that directs people away from pastors, the church, and the Word of God. What a shame it is when pastors and counselors adopt the language and understanding of the culture. We must push back against this and defend our ground. Addictions, when seen carefully through the lens of Scripture, are on the Bible’s ground and the Scriptures are sufficient to address them.

So what might you say to that young man who comes in addicted to drugs and hearing voices? I would encourage you:  Don’t be intimidated. Listen to what the voices are telling him. But then offer a much more certain Word, the Word of the living God. Then proclaim Christ and help him respond to the Lord and bring Him glory.

What did I end up saying to that man? I listened to him describe the voices he was hearing and said plainly to him, “I’m not sure all the things you are hearing are accurate. But can we open the Bible and hear a certain word.” We read Psalm 46 together and heard God’s call from uncertainty to certainty, from fear to faith, from false refuge to true refuge. And God’s Word made an impact on that man’s life and began to transform him from one degree of glory to another (2 Cor. 3:18).

Pastors are competent to counsel addiction. 

1 Alcoholics Anonymous is an organization that dates back to the 1930’s utilizing a 12-step program to help alcoholics recover from their addiction. While at times offering helpful principles, at its core, the beliefs of A.A. contrast significantly with a biblical view of God, the heart, and change.

 2 This is a common term in Alcoholics Anonymous. While Alcoholics Anonymous groups often shy away from using biblical language this is a good phrase that describes the effects of sin. Sin makes us irritable, restless, and discontent. As Augustine said, “Our hearts are restless until they rest in You.”

 3 For an excellent treatment of this theme see G.K. Beale’s book, We Become What We Worship: A Biblical Theology of Idolatry.