Brief Introduction
Pastoral care providers are often challenged by having to provide care for individuals who find themselves in situations involving drug abuse. Issues of substance abuse may develop over a prolonged period due to exposure to different traumatic events or occur suddenly as a consequence of a crisis period. Persons with drug addiction in pastoral care often present with a diverse range of emotions: pain, frustration, exasperation, and even resignation. Thus, the purpose of this research project is to provide extensive information on substance abuse as a pastoral care challenge and to develop a response that encompasses both the person and their immediate family and friend network.
Effect on the Individual and Their Family Network
The female presenting to the pastoral care context has reported abusing heroin for four years, with her mental and physical health deteriorating alongside the relationships with her family. The physical challenges have become highly prevalent in the last year, with the person being diagnosed with liver damage and coronary heart disease. The mental health issues that she had experienced before engaging in drug use include anxiety and depression, and they were exacerbated during the period of using opioids.
Regarding relational challenges, the person’s family reported that her relationship with her changed significantly. They have noticed a drastic shift in her behavior, can no longer trust her with financial matters, and say they do not trust her judgment on many issues. The person lost her job because her productivity decreased exponentially, leaving her unable to fulfill her daily responsibilities. Nevertheless, the financial strain kept increasing because the individual spent her savings on purchasing heroin, and with the absence of a job, she started borrowing money from friends and family.
The emotional and spiritual challenges have manifested through persistent feelings of anxiety, shame, guilt, and frustration, as well as the inability to express these feelings to anyone. The increased occurrence of conflict and stress in her deteriorating relationship with the family caused her to consider finding support groups to fulfill their spiritual needs; however, she did not know whether she would be welcomed due to her addiction. The social stigma associated with substance abuse is a significant deterring factor in individuals seeking help (Amaro et al. 2021). The interplay between physical, relational, emotional, and spiritual challenges creates a context in which the person feels hopeless and does not know how to act to overcome the challenge.
Statistical Data on Substance Abuse in Australia
From the healthcare perspective, the burden of drug use is considered significant in Australia as it can lead to hospitalization due to injury, disease, mental health issues, complications in pregnancy, injection-related harms, as well as overdose and mortality (AIHW 2023). In 2019 alone, around 3.4 million Australians acknowledged using an illicit drug in the past year, with cannabis being the most common, followed by ecstasy, prescription medication being misused, and cocaine (Australian Government 2022). In terms of addiction, one in six Australians was found to have an addiction to drugs, while one in ten has an alcohol addiction (Addiction Help 2023).
Among the entire population, around 280,000 Australians are addicted to opioids, while about 240,000 people use amphetamines and 115,000 use cocaine regularly (Carberg 2023). Moreover, in 2019, around 250,000 individuals aged fourteen and older reported using opioids in the previous year (Carberg 2023). With heroin specifically, hospitalization linked to the drug more than doubled between 2008 and 2018, with 3,527 heroin-related hospital admissions recorded in 2018 alone (Carberg 2023).
The number of deaths resulting from heroin overdose is also on the rise, as aligned with the general trend of the increase in the rate of the drug’s use. It must be noted that opioids are considered Class A drugs in the country, which entails that it is illegal to possess, use, and sell them, which presents further legal challenges for individuals with addiction.
In Australia, criminal drug laws are put in place to manage the possession and use of drugs by the population and to punish individuals who break the laws. There are four levels (schedules) of criminal offenses that illustrate the variability in the extent of offenses and the punishments associated with them. For example, Schedule 1 is the most severe level with strict penalties for individuals who possess or use the drugs listed in this category. In contrast, Schedule 4 is the least serious, and it generally has no offenses associated with it.
Reports from entities like the Australian Bureau of Statistics (ABS), the Australian Institute of Health and Welfare (AIHW), and the Penington Institute employ the term “drug-induced deaths” to specifically refer to fatalities directly linked to drug use. Deaths where a drug contributed to the outcome, however, are not encompassed in this classification of drug-related deaths. In particular, in 2022, there were 1,693 (1,082 males and 611 females) drug-induced cases of mortality, with the sex ratio for the deaths calculated at 1.9 males to females (ABS 2023). The median age for individuals dying from drug-related issues was 47.4 years, and opioids were the most widespread drug class identified in toxicology reports for drug-induced deaths (ABS 2023).
Over two-thirds of the reported deaths were ruled accidental, while a third were considered intentional (AIHW 2023). The effect of drugs has been differentiated into acute and chronic, with the most prevalent acute effects including overdose and the chronic effects including cardiac conditions induced by drugs (AIHW 2023). In Australia, the most deaths occurred due to the use of benzodiazepines. Refer to Figure 1 below for statistics on drug- and alcohol-induced deaths in Australia.
Essential statistics on the issue were provided by the National Drug and Alcohol Research Centre, showing that age, sex, and socioeconomic characteristics influence drug-induced death rates. The highest rate of drug-induced deaths occurred in individuals between the ages of 45 and 54, which is a change since the end of the 1990s and the beginning of the 2000s, when the death rate was the largest for adults between ages 25 and 34 (AIHW 2023). Furthermore, the most significant proportion (32%) of deaths occurred among the persons living in the most disadvantaged areas (AIHW 2023).
In contrast, the deaths that were recorded in more advantaged areas affected people aged 15-24 years old (AIHW 2023). This contrast suggests the age-associated differences in the perception of drug use, the type of drugs being used, and their implications. Importantly, cocaine was the type of drug that caused more deaths among persons living in more advantaged areas (Chrzanowska et al. 2023). Unintentional and intentional fatalities exhibited a higher prevalence within populations residing in disadvantaged areas.
The geographical distance from one’s usual residence (Figure 2) emerges as a sociodemographic factor contributing to drug-induced deaths. The majority of such incidents (73%) occur in major cities, followed by 15% of fatalities in inner regional areas, 7.1% in outer regional areas, and 1.5% in remote and very remote locations (Chrzanowska et al. 2023). The statistical evidence is reinforced by the shift in patterns from 2009 to 2019, showcasing an overall increase in drug-induced fatalities in major cities, as well as in both inner and outer regional areas (Chrzanowska et al. 2023). The ability of an individual to access illicit substances depends on their availability in different areas.
Opioids and benzodiazepines have been the most commonly identified single drugs that cause both intentional and unintentional deaths among the population. The statistics from Australia’s National Mortality Database showed that opioids were present in almost three in five drug-induced deaths, with an age-standardized rate of 3.8 per 100,000 population (AIHW 2021). Opioids comprise various drug categories, including both natural and semi-synthetic opioids like heroin.
They also encompass opiate-based analgesics, such as morphine, codeine, and oxycodone, along with synthetic prescription opioids like fentanyl and tramadol (AIHW 2021). Even though benzodiazepines were found in over two in five death cases, this drug type may not have been recorded as “an underlying cause of death” and is more commonly reported as associated causes of death as a result of other types of drugs, such as depressants and antidepressants(Chrzanowska et al. 2023, 23) (Figure 3).
Pastoral Care Plan
The Scripture does not provide an explicit explanation of how to handle drug use and addiction. However, many of the fundamental principles explored in the Bible apply to the case in question. Specifically, obeying the law, not being mastered by anything, and maintaining purity are messages relevant to the present pastoral care plan. For instance, purity is expressed through the quote from 1 Corinthians 6:15-20: “Our body is the temple of the Holy Spirit, whoever defiles the body sins against the Holy Spirit.” Thus, the purpose of the following pastoral care plan is to provide spiritual, emotional, and practical support for addressing the individual’s overall well-being.
The first step of the plan is the assessment of the individual’s specific situation, including her history and family background, the reasons and circumstances for beginning substance use, and any attempts at recovery. To build a close connection with the client, the pastor will employ active listening as a strategy that goes beyond mere hearing and seeks the meaning and intent behind the words. It means to “listen fully, with an active body and mind, in response to the speaker’s message […] it’s a way of getting through to others that begins with understanding their needs” (Leonardo 2020, 3). The skill of active listening is essential to employ within the pastoral care plan because it is one of the qualities of a leader (Hoppe 2018, 8).
As noted by (159), “few things shut down a person in pain faster than quoting the Bible at them.” The author means that even though the Bible can guide a person toward better decision-making, it should not be used to silence someone’s pain and struggles. Thus, through active listening, the pastor will be more effective at understanding the person’s needs and adjusting the spiritual guidance plan accordingly.
Building trust and connection is an integral part of the pastoral care plan because the client’s family reported difficulties maintaining a good relationship with her; thus, she may feel isolated and guilty, with no one to rely on. It is crucial to find a balanced position and not take sides with the substance abuser’s family or judge the person for resorting to heroin use (Harris 2021). The person-centered approach is necessary because it enables the pastor to offer support that focuses on the individual rather than their behaviors. Mindfully and gently attending to the spiritual disconnect between the person and God is a point in the care plan that will recognize and affirm the emotional underpinning of drug abuse.
The pastor will serve as a spiritual guide, encouraging the client to discuss their spiritual beliefs and practices openly. Specific recommendations for providing compassionate guidance include approaching the individual with love and assurance of ongoing support and emphasizing the availability of assistance for as long as necessary. The clergy member will also offer comfort and guidance in exploring solutions for self-care and recovery, which may involve seeking support from mental health professionals, physical health providers, and local community resources, such as twelve-step support groups. Additionally, fostering a collaborative environment within the family will encourage identifying points of compromise, breaking negative communication patterns, and restoring broken connections. The clergy member will further advise on steps for the individual’s spiritual development, potentially facilitating a deeper connection with Scripture as a tool for self-improvement and renewal.
Conclusion
Finally, educating the client’s family on the importance of fostering supportive connections during recovery is another key part of the plan. As she works on re-establishing her relationship with God, she will also work on mending her connections with the people closest to her. For instance, the family can meet for prayer or read passages from the Bible about guilt and forgiveness in the spiritual sense (Githuthu and Gicheru 2022).
The sense of community and mutual trust created during such meetings will provide the person struggling with drug abuse the reassurance that she is not alone on this path. It may be challenging for the family to accept the problem without judging their relative for her choices. Through active listening, the pastor will learn more about the family’s frustrations, dynamics, feelings, and concerns. It is essential to set expectations that the person will move at her own pace and that her emotional and physical needs will be the focus of the care plan.
Bibliography
ABS. 2023. “Causes of Death, Australia.” Australian Bureau of Statistics.
Addiction Help. 2023. “Addiction Statistics in Australia.” Addiction Help.
AIHW. 2023. “Alcohol, Tobacco & Other Drugs in Australia.” Australian Institute of Health and Welfare.
Amaro, Hortensia, Sanchez, Mariana, Bautista, Tara, and Robynn Cox. 2021. “Social Vulnerabilities for Substance Use: Stressors, Socially Toxic Environments, and Discrimination and Racism.” Neuropharmacology 118.
Australian Government. 2022. “Drug Trends and Statistics.” Australian Government Department of Health and Aged Care.
Chrzanowska, Agata, Man, Nicola, Akhurst, Jane, Sutherland, Rachel, Degenhardt, Louisa, and Amy Peacock. 2023. “Trends in Overdose and Other Drug-Induced Deaths in Australia, 2002-2021.” National Illicit Drug Indicators Project.
Githuthu, Florence Wamahiga, and Esther N. Gicheru. 2022. “Engaging Dispositional Forgiveness: A Structure for Consistent Forgiveness Praxis.” Journal of Pastoral Care & Counseling 76 (4): 285-293.
Hoppe, Michael H. 2018. Active Listening: Improve Your Ability to Listen and Lead. Greensboro: Center for Creative Leadership.
Leonardo, Nixaly. 2020. Active Listening Techniques: 30 Practical Tools to Hone Your Communication Skills. Oakland: Callisto Media, Inc.
McHugh, Adam S. 2015. The Listening Life: Embracing Attentiveness in a World of Distraction. Downers Grove, Illinois: IVP Books.