Both my moral outrage and my desire to respect my patients have made me passionate about engaging with issues related to addiction. Addiction is a catastrophe of our time, with devastating consequences to individual persons, families, and communities. By every metric I am aware of, personal and community harms from addiction have continually worsened over the past thirty years. This is especially apparent when we consider addiction to drugs, such as fentanyl and other opioids. In my own region, the “Overdose Crisis” has been a declared public health emergency for almost a decade.² Despite hundreds of millions of dollars and thousands of people working on the problem, overdose deaths continue to rise. A recent study suggests that about a third of American adults know someone who has died of an overdose.³ Worldwide, it is estimated that ten thousand people die per day as a result of substance use.⁴ Each of these deaths is the loss of an irreplaceable person, the fracturing of a network of relationships, and the grievous wounding of a family and community.

Addiction is, of course, not just a problem in Vancouver’s Downtown Eastside or other areas where its tragic consequences are visible to anyone who drives down the street. Behavioral addictions, including those to gambling and pornography, are increasingly pervasive in our society. Studies estimate that a near-majority of men in the Western world regularly view pornography.⁵ Further, addiction to pornography is widespread, if frequently hidden, within our churches. The consequences to individuals and communities are often devastating.

It is, however, difficult to speak of addiction. First, because the stakes are so high. In my experience, most people who come to the conversation have deep personal investment. For example, the first time I spoke at an academic ethics conference about addiction, there was a lineup of people waiting to speak to me when I left the stage. I anticipated a series of conversations about how I interpreted Aristotle. The first individual, a distinguished physician colleague, led with: “My son is an alcoholic.” The next person had a brother who had died of an overdose; the next had a history of severe gambling addiction. And so it went, down the line. While each person had genuine intellectual interest, their commitments came from their guts: their deepest sorrows, wounds, and fears. My arguments about Aristotelian categories tugged on a thread that connected to the things that mattered most to them.

Simply put, conversations about addiction are bound to be personal and sensitive. Addiction is too common and too destructive for it to be otherwise. One potential response to such a sensitive dialogue is to avoid the conversation for fear of saying the wrong thing and grieving our conversation partners. Such a response is understandable and often well-motivated. But I believe that it is not the Christian response. Part of our responsibility to love and serve our vulnerable neighbors is to learn how to enter these sensitive conversations well. To avoid the issue is to abandon the people who need our attention the most. We should instead seek to develop the creativity and humility necessary to inspire trust in our conversation partners, to affirm their need to be understood, and to bring humanizing precision to a dialogue that so desperately needs it.

This suggests a second problem: speaking precisely about addiction is challenging because addiction has been notoriously difficult to define. What exactly are we are talking about when we use the term “addiction”? Most of us would instinctively recognize it in intense cases involving opioids, amphetamines, or alcohol. I suspect most of us would also agree that some behavioral patterns, including those related to gambling or pornography, can rightly be described as addictions. But we also hear frequently about addictions to social media and cell phones. We “bingewatch” our favorite television shows, and we speak casually about being addicted to work, potato chips, coffee, or running. Writers in the field of addiction research describe themselves or others as having addictions to classical music,⁶ romance novels,⁷ walks in the country, or love.⁸ Are all of these really addictions? If not, where and how do we draw the line?

This leads to a third, related, challenge: Is addiction a distinct problem that affects only some, or is it a universal human condition that simply expresses itself in different forms in different persons? We often hear addiction described as a particular brain disease or disorder, especially in medical settings. On the other hand, many writers in the field of addictions research present it as a spectrum on which everyone falls. Christian thinkers have recently written books asserting that “everyone is addicted to something,”⁹ and “we are all addicts in every sense of the word.”¹⁰ Who is right? Is addiction a particular disorder that only some people face, or a common experience we all share to some degree?

For Christians seeking to love and serve persons with addiction, there are also questions of how the Bible can inform and empower our approach. We do not find the term “addiction” in the Bible, nor do we encounter a single term or concept that has an obviously synonymous meaning. There are, however, notable passages in the Bible that describe experiences that seem to overlap significantly with those of addicted persons. Can you apply these texts to your own struggle with pornography or to your dear friend’s feeling of despair after yet another relapse? Can we apply them in neighborhoods like the Downtown Eastside? If so, how?

Finally, the question of biblical interpretation should naturally flow into conversations regarding the life of the church and the role it might play in caring for persons with addiction. As we will see in the coming chapters, we often hear that addiction is essentially a medical problem and, therefore, solutions are to be found via biomedical research and medical therapeutics. One (unintended, I think) consequence of such a situation is that cultural and religious groups with potential to help often end up on the sidelines. Church communities do not want to set themselves up as an alternative to medical care for those with addictions. As a result, they often recede from the conversation, not from apathy or ill intent, but rather from lack of understanding of how to apply the life of the church to situations involving severe addiction. But is that a sufficient response from the community that hopes to be the hands and feet of Christ?

I think not, primarily because I believe the church is called to be a place of hospitality, friendship, and sanctification for persons with addiction. Furthermore, both the overwhelming majority of personal accounts from persons with addiction, along with a growing body of research, suggest that certain kinds of human communities are necessary for healing addiction.¹¹ I believe that most Christians desire to contribute to the kind of social and religious spaces that produce grace-laden, mutual relationships capable of promoting healing for persons struggling with addiction. But how do we do so? Where do we start, if the problems of addiction are so overwhelming?

This book attempts to speak, from a Christian perspective, to our present addiction crisis, touching on each of the tensions and questions listed above. The first section addresses the foundational question: “What is addiction?” I will show how the most common contemporary answers, the choice and disease models of addiction, fail to say sufficiently precise and respectful things about human persons. It will then be possible to see, using the tools of philosophy and theology, how we might move towards a more nuanced and humanizing understanding of addiction. I will refer to this as the personal model of addiction. In the second section of the book, I will use two texts from the Gospels as examples of how we might bring our questions of addiction to biblical texts. In the book’s final section, I will apply the insights of the earlier sections to the life of the church, landing on the ways that Christian communities can engage these challenging issues with grace and hope.

In other words, the three sections of this book present ways Christians might engage this urgent issue with our whole selves: minds, spirits, and bodies. The care of our minds, to seek a precise and respectful definition of addiction. The wrestling of our spirits, bringing questions of addiction into our reading of the Bible and our church conversations around freedom and hope. Finally, the labor of our hands, believing in the power of the Holy Spirit to transform our communities through our compassionate hospitality. As poet Christian Wiman has written: “Christ may be in us. But ours are the only hands he has.”¹²