Drug abuse control and the Salvation Army

Sections

ABSTRACT
Background
Social causes
Remedial action: specialized centres
Hostels for the homeless
Other social action
The spiritual ministry of the Salvation Army
An experimental programme based on an old concept
Objectives
Rehabilitation programmes
Developing countries
Prevention

Details

Author: S. L. GAUNTLETT
Pages: 17 to 27
Creation Date: 1991/01/01

Drug abuse control and the Salvation Army

S. L. GAUNTLETT International Alcohol and Drug Rehabilitation Co-ordinator, Salvation Army, London, United Kingdom of Great Britain and Northern Ireland

ABSTRACT

The Salvation Army has been involved in the control of drug abuse since it was founded over 120 years ago, when alcohol was the predominant concern. Today, alcohol is still the most commonly abused substance, but the Salvation Army is increasingly tackling other forms of substance abuse as well.

High priority is given to prevention of all levels and by all means through a network of over 200 specialized rehabilitation centres throughout the world, in addition to programmes within hostels for the homeless, where there is a high proportion of alcohol and other substance abusers.

The Salvation Army endeavours to help drug-dependent persons to abstain from using drugs and achieve a healthy and happy life. It is of the view that, as drug dependence is usually a manifestation of deeper needs, the spiritual component is vital in dealing with drug abuse of all types.

Background

Ever since the founder of the Salvation Army, William Booth, established a Christian mission for socially deprived persons living in the slums of the East End of London, the Salvation Army has been involved in seeking to help and reclaim "chronic drunkards", as alcohol-dependent persons were referred to over 100 years ago.

Booth recognized that there was little hope of spiritual redemption for the people in the slums without tackling the problem of alcohol dependence, which affected a high percentage of that area's population. Although he was by training and vocation a Christian minister, he was a remarkably able sociologist and a visionary. He estimated that there were at least 500,000 victims of alcohol abuse in the United Kingdom of Great Britain and Northern Ireland at the time. Today, the figure usually quoted is twice that, but because the population has also doubled since Booth made his estimate, the percentage of alcohol abusers is about the same.

Booth's definition of what is today referred to as dependence corresponds fairly well to more recent experience gained from clinical and social work and can be applied to non-alcoholic drugs as well:

"Whilst in one case drunkenness may be resolved into a habit, in another it must be accounted a disease as much as stone or ophthalmia.

What is wanted in the one case, therefore, is some method of removing the individual from the sphere of temptation, and in the other treating the passion as a disease and bringing to bear upon it every agency, hygienic (medical) and otherwise, calculated to effect a cure."

It is impossible for the Salvation Army to consider alcohol abuse separately from other forms of substance abuse. In most countries in which the Salvation Army is active, there is an increasing incidence of other substances being abused in conjunction with alcohol, which is by far the most commonly abused substance.

Social causes

Although, in the earliest days of the Salvation Army, one of its main objectives was to provide a service to help people to achieve sobriety, there was an awareness of the importance of prevention. The Salvation Army's commitment to prevention took the form of education and efforts to strengthen family life and to develop inner emotional and spiritual resources that would enable people to cope with crises in their lives without resorting to chemical props. In addition, William Booth joined with others to campaign for improvement of the appalling social conditions of those whom he described as the "submerged tenth", persons-predisposed to the abuse of alcohol as a means of escaping from misery. At that time, liquor was cheap and within the reach of even the poor, albeit often at the expense of essential nutrition. It was said that a person could get drunk on gin for a penny and dead drunk for twopence. Many small children did so, even if only to create a feeling of warmth. Also at that time, Dr. Barnardo, who later established a famous network of children's homes and, for a time, worked in cooperation with William Booth, discovered that over 70 per cent of the children he had found abandoned or cruelly neglected had come from homes where one or both parents had been drunkards. It was evident that alcohol was both the cause and the result of extreme social misery. It was the opiate of the poor.

Remedial action: specialized centres

The first home for "inebriate women" was established by William Booth in London in 1896; later a home for men was also established. At the homes, alcohol-dependent persons were removed from "the sphere of temptation"; in a simple but often effective rehabilitation programme, they learned useful skills and regained their self-respect, physical health and self-confidence. Many were so influenced by the lives of those providing care in the homes that they were converted to Christianity. A few years later, the Government of New Zealand, in formulating new legislation to deal with a growing alcohol problem, asked the Salvation Army, which had become active there and in other countries, to set up a refuge on an offshore island near Auckland where it might accommodate and rehabilitate alcoholics. The rehabilitation programme has been functional for, over 80 years, but it is likely to end soon, as the appropriateness of keeping alcoholics in a refuge isolated from the real world and subsequently returning them to an urban environment is being questioned. In most countries where the Salvation Army operates programmes, the emphasis has been upon curing people; the increasing incidence of alcohol dependence despite these and other treatment centres, however, together with the limited success that has been achieved, has led. to a, reappraisal of policy. Much greater priority has to be given to all aspects of prevention.

In most Western countries, the abuse of substances other than alcohol has emerged during the past three decades, with alarming consequences, such as social disruption and human suffering. The potential for making quick profits by smuggling illicit drugs, often through international crime rings, has led to much publicity. While the resulting government action is, in itself, justified, it has often resulted in lower priority being given to, and fewer funds being available for, tackling the problem of alcohol abuse. And yet, in many Western countries, alcohol abuse is by far the greater problem: in Australia, for example, some 370 people die each year as a result of illicit drug abuse, compared with the over 3,000 persons who die annually as a result of alcohol abuse; in the United Kingdom, 14,688 drug-dependent persons were registered in 1985, compared with an estimated I million alcohol-dependent persons. The same is true of most developing countries.

In all the countries in which it operates, the Salvation Army reappraises its programme and policy from time to time, in the light of changing circumstances and new knowledge and techniques. It recognizes that social problems are also being tackled by others, but it believes that there needs to be spiritual input to therapy as well. The Salvation Army has a special contribution to make, as evidenced by the fact that it has received strong government support, as well as requests to undertake new initiatives, in many countries.

The Salvation Army does not have separate programmes for alcohol and drug addiction. It has been increasingly dealing with multiple substance abusers in its programmes. Reports from countries where the Salvation Army has a network of programmes, such as Australia, Canada, New Zealand, Sweden, the United Kingdom and the United States, indicate that centres that were previously admitting solely alcohol-dependent persons are now admitting multiple substance abusers as well, and in increasing numbers. In most countries where there is multiple substance abuse, it is primarily alcohol abuse. Most programme participants are dependent only upon alcohol. In some countries, such as in the United Kingdom, however, alcohol often becomes the primary source of dependence only when other substances are not available. In Australia, where the Salvation Army has a network of 23 centres called the Bridge Programme, 50 per cent of those admitted are dependent on more than one substance.

In New Zealand the situation is similar. An analysis made by the Salvation Army of substances abused by those entering rehabilitation centres operated in that country is provided in the table. Substance abuse is most common among persons aged 20-30. Persons under 19 and over 50 have a similar pattern of misuse, consisting of predominantly alcohol, though cannabis and glue and other volatile solvents are used much more frequently by members of the younger age group. Until two or three decades ago, substance abuse was virtually limited to alcohol, which remains the most commonly abused substance across all age groups. While the abuse of volatile solvents and other related substances has long been a feature among teenagers, there appears to be a growing number of them who continue such abuse into adulthood, as reflected in the figures provided in the table.

New Zealand: substances abused by persons entering substance abuse rehabilitation centres operated by the Salvation Army, by age group

(Percentage)

 

Age group

Substance

Under 19 (N = 11)

20-30 (N = 84)

30-40 (N = 71)

40-50 (N = 56)

Over 50 ( N=24 )

Beer
100 89.3 88.7 83.9 87.5
Spirits
100 88.1 78.6 82.1 70.8
Wine
60 46.4 53.5 60.7 45.8
Prescription drugs
9.1 11.9 11.3 8.9
-
Illicit drugs
         
Cannabis
63.6 64.3 35.2 7.1 8.3
Cocaine
-
10.7 5.6 7.1 8.3
Heroine
-
9.5 5.6
-
-
Others
9.1 17.9 7.0
-
4.2
Volatile solvents
         
Glue
9.1 2.4
-
-
-
Petrol
9.1
-
-
-
-
Others
9.1
-
-
-
-

In general, developing countries follow the pattern of evolution of substance abuse in the West (with certain variations due to availability, regardless of cultural and religious constraints. For example, the Salvation Army has a network of health-care clinics in Pakistan, an Islamic country where there should be no alcohol and, therefore, no alcohol-related problems. Increasing Western influence, however, has resulted in many Pakistanis making use of facilities that provide alcohol to non-nationals. There is evidence that the alcohol problem in Pakistan, though not yet serious, is growing. Much more serious is the rapidly escalating narcotic problem, especially in some of the major towns, resulting from the smuggling of opiates into Pakistan by Afghan refugees fleeing their war-torn country. The Salvation Army provides medical service in two of the large refugee camps in Pakistan near the border between that country and Afghanistan and there does not appear to be any drug problem among the population there. The primary health-care clinics, which are strategically located throughout Pakistan, provide health education regarding all forms of substance abuse.

Within the 90 countries in which the Salvation Army is working, there are well over 200 special centres for the rehabilitation of substance abusers. In some countries, it is felt that alcohol-dependent persons and those dependent on other substances do not get along well with one another. In Australia, about half of those admitted to the Bridge Programme also abuse substances other than alcohol, and it has been found that difficulties arise when the ratio of substance-dependent persons to alcohol-dependent persons exceeds 1:5. This is, in part, the result of age differences between the two groups, different lifestyles, the need to screen constantly for drugs among the non-alcoholics and, more recently, the emergence of human immunodeficiency virus (HIV) infection.

In Switzerland, a successful centre for the rehabilitation of over 100 alcohol- dependent persons has a small percentage of non-alcoholic substance abusers. Most of the non-alcoholic abusers are women who were on heroin for some years; some are still on a methadone regime. Another centre provides a residential rehabilitation programme that includes detoxification solely for nine non-alcoholic substance abusers. There is also a medically oriented alcohol detoxification centre in the country.

In the majority of Western countries, the emphasis of rehabilitation programmes is on the degree of motivation and level of psychological disturbance rather than on the drug or drugs producing dependence. Traditionally, the Salvation Army seeks to accept all who genuinely want help, and this often means the most socially and spiritually damaged, the alcohol- dependent person from "skid row". In more structured programmes involving small groups, however, there needs to be some selectivity. In some countries, such as Norway, the Salvation Army operates hostels for persons who are chronically dependent on alcohol and who have no desire to achieve sobriety, though some do. It is not possible in such situations to accept persons dependent on other substances because of the risk of drug dealing. In Norway, however, there is an effective day centre for drug-dependent persons, the "Door of Hope", in the heart of the drug area of Oslo, where such persons can come and find rest, a bath, meals, counselling and, above all, acceptance and friendship. Staff patrol the streets during the day and evening in order to make contact with drug-dependent persons, to build up relationships with them and to inform them of the facilities of the centre, which is always filled to capacity. Efforts are made to persuade the drug-dependent persons, many of whom are young, to accept referral for treatment. There are similar centres in other countries, such as the Bahamas.

The Salvation Army operates substance abuse rehabilitation centres in the following countries and areas:

Country or area

Number of centres

Australia
23
Canada
11
Finland
11
Japan
1
Netherlands
9
New Zealand
9
Norway
7
South Africa
1
Sweden
8
Switzerland
4
United Kingdom
8
United States
140
Central America
5

In many of these centres, a concept has been followed that was originally set out by William Booth in his book In Darkest England and the Way Out [ [1]] : providing two linked elements within a programme, one element in an urban setting for admitting clients to the programme and the other for longer-term stays in a rural or semi-rural setting, away from the drug milieu. In Norway, for example, in addition to the centre at Oslo, there is a small holding in a forest 50 kilometres outside the city with an intensive rehabilitation programme for six drug-dependent persons. In some countries, the concept has proved less effective, as clients have found it difficult to cope with the isolation of a rural area and the subsequent return to the urban area to be integrated into the community and to find work. With drugs, the need for Booth's principle of removing dependent persons from "the sphere of temptation" is even greater, as ruthless drug pushers are all too ready to exploit them.

Hostels for the homeless

The substance abuse problem is dealt, with in the specialized centres described in the previous section, but also in the many hostels for the homeless in the countries in which the Salvation Army operates. In some of the hostels, up, to 50 per cent of the residents are dependent on alcohol and there is a growing number of other substance abusers with multiple social problems. In many of the hostels, elementary programmes are operated, in close cooperation with medical services, social workers and specialized centres for dependence, to help those Willing to stop abusing substances, including alcohol. Not infrequently, all that is needed is to keep the substance abusers away from their, substances of choice and to provide systematic social work and counselling, together with spiritual help, at the appropriate time.

Other social action

Within the social programme of the Salvation Army, centres for problem families, refuges for women and children and community homes for delinquent adolescents often provide support for victims of substance abuse. In the process it is hoped that some of the children and young people can be prevented from resorting to substance abuse later in their lives. In the 1960s and 1970s, the Salvation Army and the Anglican Church operated a programme for young drug-dependent persons in London. Most were severely dependent on heroin, amphetamines or lysergic acid diethylamide (LSD). A study was undertaken to ascertain possible causative factors. The main factor, common to 75 per cent of the young drug-dependent persons, was a broken home. Primary prevention in the form of effective support provided to families under stress may prevent the emergence of substance abuse among the children in those families later on. The rehabilitation of drug-dependent parents often serves as prevention for their children. As William Booth wrote in 1890:

"[People] think the present race of drunkards must be left to perish, that, every ... effort having proved vain, the energies expended in the endeavour to rescue parents will be laid out to greater advantage upon the children. There is a great deal of truth in this" [ [1]] .

Nevertheless, Booth still made an effort to rescue the parents. Today the Salvation Army recognizes that, in the intervening years, there has been a lack of awareness of the needs of the children and spouses of substance-dependent persons. In recent years, much more emphasis has been given in many of its substance abuse programmes to families, in the form of either general support and counselling or more structured family therapy. Part of the problem with such programmes is that, in most instances, the participants are homeless or their families live too far away to participate in the programmes. Within the Salvation Army, there has been some rethinking of William Booth's views related to whether control of substance abuse is not better served by concentrating on the various forms of prevention and on those who are not yet chronically dependent on substances. In the Philippines, and in other countries, there is a large social problem involving "street children". In Manila, for example, many, of the street children are volatile solvent abusers. In December 1987, it was estimated that 1,500 children had been rehabilitated at a home established by the Salvation Army for them.

The spiritual ministry of the Salvation Army

It is not unusual for an alcohol-dependent person, or even an abuser of some other substance, to appear at the Sunday service of a Salvatian Army church. Usually, however, such persons are interested more in material help, such as money or food, than in spiritual help. Though they are not given money, they are often provided with food. In subsequent visits, counselling and spiritual help may be offered. Such visits often lead not only to increased sobriety, but to spiritual conversion and significant change. Individual members of the Salvation Army may provide follow-up support, including practical social work and help in finding a job. This may involve daily contact and, above all,, friendship, which sometimes lead to reconciliation with the family. In the earlier years of the Salvation Army, its success in helping "notorious drunkards" to become sober caused quite a sensation. It was achieved not with a structured programme or professionally trained staff but with a great deal of faith, patience, love and common sense. The same still happens today in most of the countries in which the Salvation Army operates, though perhaps not as frequently or spectacularly.

An experimental programme based on an old concept

In New Zealand, an experimental programme for the treatment of adolescent substance abusers that was established two years ago is being restructured because the population of abusers of volatile solvents and other drugs did not show much change in their behaviour patterns. A more physically based programme was required not only to deal with the problem of substance abuse, but also to challenge the youths' conception of themselves, which was often warped by years of negative reaction due to their ethnicity (mostly Maori or Polynesian), sex (increasingly, disadvantaged adolescent girls) or social circumstances (family violence, educational failure, dysfunctional parenting).

The plan being followed involves staff and young persons living closely as a family concentrating on good relationships to enhance self-esteem and security and to bring out each individual's true potential.

There is a lively programme of outdoor pursuits, some education and an acceptance that everyone does his or her share of the chores around the house. Non-professional staff assist those in charge of each unit. Young people are selected as house-parents, based on their personalities and their ability to relate and communicate well with adolescents. The units, which have proved successful with disturbed young substance abusers, are accountable immediately to a local supervisory group and, ultimately, to the Salvation Army administration, together with the social welfare department.

The programme seems to have been inspired by Booth's original concept involving a situation that is secure, loving and challenging, but without highly professional social work; a situation in which each individual's worth is recognized. It treats substance abuse as a mere symptom or surface manifestation of much deeper disturbances often arising from long-standing trauma and deprivation. This accurately describes the majority of cases in Salvation Army programmes. It also gives a clue to important approaches to prevention.

Objectives

The objectives of the Salvation Army programmes, which have been worked out based on over 90 years of experience, follow those set out by Brissett and others [ [2]] :

  1. Abstinence from all mood-altering chemicals;

  2. Improvement of lifestyle.

To objective (b) above, the words "and the quality of life" might be added. Whereas substance-dependent persons seeking help have the right to choose the pattern of life they will follow in relation to the substance abused, Salvation Army programmes do not include teaching controlled drinking, though it is advocated by many. Most clients of the Salvation Army are physically dependent upon alcohol; for them, a controlled drinking regime would not be safe and the dividing line between so-called safe drinking and excess is too ill-defined. In addition, the Salvation Army believes that an important aspect of prevention in any society is the acceptance of abstinence from "all mood- altering chemicals" as a lifestyle.

Rehabilitation programmes

Salvation Army rehabilitation programmes vary in different parts of the world, but most follow the Minnesota/Hazelden model, the components of which are as follows:

  1. Medical treatment;

  2. One-to-one counselling;

  3. Group therapy;

  4. Work or occupational therapy;

  5. Recreational or physical therapy;

  6. Spiritual counselling;

  7. Social skills training;

  8. Didactic lectures.

Anderson [ [3]] , in describing the model, stressed that, in addition to the physical, psychological and social components, the spiritual component is essential.

Many centres include in their programmes the concepts of Alcoholics Anonymous and Narcotics Anonymous. The emphasis in different programmes varies, depending upon the situation and culture, as well as experience. In some programmes, heavy emphasis is placed upon work therapy. In others, the counselling element, including group therapy, is stressed. In still others, the spiritual approach is the main aspect, although it is always accompanied by friendship and counselling support and various types of practical help. In all programmes there is an awareness of the need to help clients both to cope with stress and to reduce it. This often means improvement of social conditions or family therapy in various forms. In Western countries, it is often not poverty that has to be dealt with but affluence: how to manage money and time.

Work therapy in programmes may take the form of industrial work, as in adult rehabilitation centres in the United States, which refurbish, recycle and resell unwanted goods acquired from the public. The reselling of the goods has become a big operation. The refurbishing has become a valuable part of the therapy in that the clients turn old items of furniture, for example, into new ones, a symbol of what is happening to them. In programmes in Norway and in the United Kingdom, for example, textiles of all kinds are collected, baled and exported for recycling. In other countries, the programme is based on farming or a horticultural project. In programmes in Central America, there is a mixture of industrial and agricultural activity. All such activity serves not only as therapy but as training for re-employment, often after long periods of unemployment. In many programmes, the activity may take the form of community service; in Harbour Light centres, this feature is combined with a structured programme involving self-awareness, counselling and social work.

All such structured programmes are staff-intensive and many employ a large number of professionally trained personnel. In most centres recovered drug-dependent persons are employed. In some, the officers-in-charge, as well as some of the Salvation Army officers (ordained ministers), are recovered substance-dependent persons. Structured programmes are expensive to operate. In some countries, such as Australia, Canada, New Zealand and Switzerland, there is substantial government support. In others, there is little or none. Many programmes in the United States are able to support themselves by their industrial activity.

Developing countries

In many developing countries, substance abuse has become a serious problem, threatening to disrupt national economies and imposing a heavy burden on the limited medical and social services available, not to mention the human suffering involved. The shortage of financial and human resources makes work therapy programmes virtually impossible.

In Zambia, the major medical problem was once malnutrition. Gradually, the situation was improved and in some areas the results were dramatic. Then, with increased affluence and development, together with the emergence of breweries and drug dealers, there was a marked increase in the consumption of alcohol and the development of other forms of substance dependence. Almost overnight, malnutrition increased sharply, as limited, family incomes were spent on alcohol and other substances.

The Salvation Army, in conjunction with other international and national agencies, is currently seeking to develop low-cost programmes in developing countries that call for less highly skilled staff than programmes in developed countries. It is hoped that services for those who have become chemically dependent can be developed in developing countries. The Salvation Army regards this as an integral part of its existing spiritual and social ministry. Its successes in this field, together with recent research, suggest that more basic approaches can prove as successful in developing countries as those used in more sophisticated residential programmes. Moreover, the Salvation Army recognizes that preventing drug dependence is not only better than curing it, it is also less expensive.

Family programmes are being developed in many countries to counter numerous moral and social problems, including substance abuse. Some of these emphasize the role played by dysfunctional families in the development of addiction problems.

Salvation Army officers are being taught about chemical dependence, its causes and prevention so that they can make a useful contribution through their ordinary church work, with the help of their congregations.

Throughout its history, the Salvation Army has made an effort to avoid any affiliation with political parties. In its early years, however, William Booth and his associates were active in exerting pressure upon Governments for social reform. In a number of countries, this led to remarkable achievements despite fierce opposition. This was true in the United Kingdom and elsewhere in campaigns against alcohol and the exploitation of the poor by the liquor industry. It was true in Japan and elsewhere in the opposition to the exploitation of women by brothel owners and pimps. Then, for many years, as the Salvation Army became more widely respected, this kind of political action subsided and was even felt by many to be unwise. Today, however, the Salvation Army, alone or together with others, is seeking legislative reform in many countries that will result in greater control over the availability of alcohol and other substances through licensing laws and curbs on advertising. It has also pressed for increased taxation on alcohol with a view to reducing consumption.

Prevention

Early on in the history of the Salvation Army, the decision was made that, for the sake of alcohol-dependent persons whose lives had been changed and who had achieved sobriety but who did not dare to drink again, all members of the Salvation Army should desist from drinking alcohol. This standard of abstinence has been maintained as a condition for membership ever since. Later, members were required to abstain from smoking as well. Today, those who wish to become members of the Salvation Army must promise that they will abstain from the non-medical use of all dependence-producing drugs. The purpose of this is to establish abstention from smoking nicotine, drinking alcohol or taking other dependence-producing substances as a reasonable and attainable standard. Although many educational programmes aimed at preventing chemical abuse are proving less effective than expected, setting an example can be quite effective, as evidenced by the dramatic reduction of cigarette smoking among doctors and others in high-profile positions in the United Kingdom and elsewhere.

In many countries, the Salvation Army is developing educational programmes for prevention, starting within its own ranks and often concentrating on young people in youth clubs, schools etc. In Australia, for example, the Salvation Army is obtaining professional advice on an educational programme that utilizes the mass media. Often, its programmes are implemented in cooperation with other churches and agencies. In Mizoram, a territory in north-eastern India, for example, young members of the Salvation Army cooperated with young persons from other churches in printing and distributing leaflets warning of the dangers of drug abuse. In many countries, seminars to educate the public are being held.

The Salvation Army regards the growing incidence of all forms of substance abuse worldwide, together with its consequences for human life, individual communities and whole nations, as so serious that its General has instituted a coordinated effort at the international level aimed at making Salvation Army programmes for prevention and rehabilitation more effective and at extending such efforts to include developing countries, where little has been possible until now.

References

01

William Booth, In Darkest England and the Way Out (Croydon, United Kingdom, Charles Knight, 1970).

02

D. Brissett and others, "Drinkers and non-drinkers at three and a half years after treatment: attitudes and growth", Journal of Studies on Alcohol, 1980, pp. 945-952.

03

D. J. Anderson, Perspectives on Treatment (Center City, Minnesota, Hazelden Foundation, 1981).