Chapter 8: The Clergy’s Role In A Government Program Of Prevention Of Alcoholism by Lawrence A. Purdy
What has been the experience of a government addiction program in its use of clergy as members of the professional team? The program of the Ontario Addiction Research Foundation illustrates one approach.
The Foundation is an agency of the Province of Ontario and receives most of its budget through the Department of Health. In turn, it is accountable for its program to the government and people of the province.
A multi-million-dollar research and clinical institute is under construction in Toronto, and plans for joint appointments of senior staff with the University and the Institute are underway; a great portion of the Foundation’s current program is dispersed throughout the province. Programs in thirty cities and towns seek to serve the nearly 7,000,000 population with treatment, education, research, and community development resources. These services range from highly sophisticated diagnostic and treatment centers to smaller community clinics and one-man information and development programs.
Among the more than 200 professional staff members, 10 clergy representing the major denominations are at work side by side with psychiatrists, physicians, social workers, psychologists, nurses, and others. There is common consent -- perhaps in this field the one area of real consensus -- that there will never be enough services and professionals to meet all the needs of the alcoholics and the drug addicts. In recognition of this, a great deal of the emphasis on the role of clergy to be detailed here refers to the development and mobilization of concern, competence, and care-giving capacity on the part of the community as a whole. This is based on direct service experience and demonstrated skill at the secondary and tertiary (treatment and rehabilitation) levels of prevention. Its ultimate objective, however, goes beyond the proliferation of specialized services to the improvement and ultimate change of the community climate which produces the problems. The method is to move to the level of secondary prevention by providing more skilled early intervention by community helpers in the health and social services. Ultimately the aim is to achieve the primary level of prevention by effecting the kinds of social change necessary to reduce the problems of alcoholism or drug dependency.
In all these efforts, hard questions continue to be asked, program achievement is assessed and evaluated, new directions are identified and new emphases explored. This research base is balanced by the need to share our experience with others through programs of training, consultation, undergraduate, graduate, and continuing professional education.
Let us, then, describe briefly what the clergy do and endeavor to fit these activities and experiences into the total rationale for their involvement.
The first full-time appointment for clergy in the Foundation was that of the pastoral counselor. The primary task, five years ago, was to identify and validate the role of the pastor in a multi-professional therapeutic milieu. Given the more than forty-year history of clinical pastoral training in North America, this was hardly a pioneering effort. It was, however, a "first" for the Foundation and included responsibilities not only in the treatment field but in the areas of professional education and consultation as well.
The validation of the role of the clergy in a multi-professional treatment setting is challenging to both the personal and professional relationships involved. However, it is even more difficult to duplicate in the community outside. While a great deal has been said about the interprofessional team, it is inevitably more successful when relationships are sustained, visible, and viable within the closed circuit of an institution. The so-called community team has a long way to go to establish and improve its effectiveness. There is still abundant evidence of tendencies among the health and social service professionals to close ranks against the clergy. Priests and ministers are often the victims of stereotyping by other professionals and seen as irrelevant, untrained, even highly suspect in their motivation. As sources of referral and prospects for ongoing supportive care, they are often overlooked or only reluctantly given gestures of approval by the "professionals."
To overcome this state of affairs, one of the major tasks of the Foundation’s clergy is not only to meet the needs of individual patients in treatment, and to contribute to the case conferences in consultations with other staff. The pastoral counselor must also continually work to bridge the gap between the community -- including the clergy -- and the treatment resources. To this end then, he aims not only at the needs of the patients, but at the needs of professionals with whom he works, to whom he relates both within and beyond the therapeutic setting.
A major deficiency in recognizing the spiritual component in the field of addictions has been the lack of clearly defined criteria, based on hard data, that measure up to social, psychological, and medical standards. The Foundation’s pastoral counselor, a member of the staff of Toronto’s medical unit, has contributed to the overall design of a measuring instrument providing total medical records by computer. The instrument has a religious and spiritual portion, along with medical, psychiatric, psychological, and social histories. Ultimately, this research will answer 6,000 questions of more than 1,200 patients each year. We see this making an important contribution to a clearer definition of what we mean by the "spiritual component" in the cause, course, and consequences of alcoholism. As experience in this field develops and further research is undertaken, we look for clearer guidelines in measuring the role of religion -- as asset and liability -- in developing effective treatment and rehabilitation programs.
As suggested earlier, the direct service of our treatment resources to alcoholics and other addicted persons is limited numerically by the staff and facilities available. However, we believe these services can be multiplied effectively if the existing resources in the community are motivated, mobilized, and supported by specialized experience. Background information, training resources, and the ongoing coordination of services is undertaken by agents or field representatives of the Foundation engaged in community development.
In several communities professionals have been appointed to such tasks. In three such communities the person selected is a clergyman. The qualities sought in such an individual represent not only the traditional trust and expectations of the community, but also the very special flexibility and skills that the persons have demonstrated in providing a focus for joint action on the part of the community’s professional and volunteer helpers. This "agent" role appears to work best in communities of 25 to 50,000 where the visibility and competence of one individual can be reinforced by frequent and informal contacts with professionals in the community care-giving services.
While Foundation clergy in this role are full-time appointees, there is no reason why partnership programs of more modest scale should not provide for part-time appointments to the same end.
Two of the Foundation’s clergy serve important and demanding roles as directors of pilot projects. The Foundation’s Bon Accord Farm is a rural rehabilitation project located at a splendid century-old farm northwest of Toronto. Here the hard-core alcoholic is brought for long-term (six- to ten-month) rehabilitation. A choice of activities is available including routine farm maintenance, woodworking and metal working shops, and regular domestic and household chores.
In the city, the Foundation’s Halfway House program is also supervised by a clergyman. Responsibilities for this work include not only the administration of the large residential center in Toronto, but a consulting role with church and community-sponsored halfway houses throughout the province. When caring, flexible, and diligent staff persons were needed to get these programs off the ground, the church provided them. Not only the leadership, but the rationale and philosophies of the reinforced family, the supporting community, the corrective living experience, come through with theological as well as sociological bases in these programs.
To many in the field of addictions, the history and the role of the temperance movement remains a curious and increasingly irrelevant phase in society’s attempt to cope with alcoholism. To the Foundation it represents an authentic and legitimate attempt to meet a problem head-on. One of the Foundation’s clergy, for some years deeply involved in the temperance movement in Canada, is writing a history to be published under our auspices.
The information being gathered, both anecdotal and statistical, represents a major and significant contribution to the field. It is, moreover, a task being undertaken barely in time to avoid the irretrievable loss of direct contact with some of the few remaining great personalities identified with this phase of social change.
The largest regional program for professional education and training in the province is under the direction of a clergyman. This involves the development of seminars, workshops, professional internships, and community consultations, together with the ongoing flow of information and experience to the agencies and organizations serving the community.
Two of the Foundation’s clergy are responsible for the direction of comprehensive regional programs embracing the three thrusts of treatment, education, and research. One of the regions thus directed represents the largest portion of the province s population and the greatest single program investment in terms of manpower and money.
It must be said that only part of the multi-faceted involvement of the clergy in our program is the Foundation’s recognition of individual and professional competence. A good portion of the involvement must also be attributed to the ferment and change within the church and the current search for new and relevant ministries. In discussions with the Foundation clergy it has been agreed that the object of this search is not to establish an elite cadre of specialists. Nor is it simply to suggest a rejection of the church and its traditional systems and structures. Rather it is a reconnaissance -- perhaps too a renaissance -- a rediscovery of’ the role of the church in society with a particular and urgent emphasis on the cure of souls. The task will not be complete with the discoveries, the identification of roles, the development of
skills and insights, or even with the clarification of status and relationships with the other professions in partnership programs and community care-giving services. This is only the beginning.
The task approaches a useful point of measurement when the experience gained is interpreted and relayed back to the church to effect modifications in its attitude, structure, and service. The introduction of courses at the undergraduate level in colleges and seminaries, the promotion of graduate seminars, together with more than a decade of specialized training for clergy sponsored by the Foundation, reinforce this experience of ours by adding to the experience of others.
Major shifts in church policy and programming will come, however, only when the religious community, historically opposed to tyrannies of all kinds, recognizes the nature of one of the more subtle and insidious tyrannies of our time -- the tyranny of the chemical age. Those of us who are privileged to be on the firing line with our professional partners have a duty to help the church community articulate a message that meets this need.
What has been described thus far has largely been functional -- the way the clergy work in a government addictions program as counselors, administrators, educators, consultants, teachers, and field workers. Perhaps our greatest role is still being shaped by our experience -- that of the prophet -- to be spokesmen out of our experience, insight, and concern, to "tell it the way it is" to the church and, through the church, to the world.