Finding Success When Counseling an Opioid Addict

May 29, 2017

Lucy Ann Moll

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Lucy Ann Moll

When Cecilia* scheduled a counseling appointment, she told our center’s secretary that she popped pain pills and needed help for addiction. This case sounded challenging, but with God I knew it would be a success, for “He who began a good work in you will carry it on to completion until the day of Christ Jesus” (Phil. 1:6). Becoming more like Christ is a primary goal of biblical counseling, isn’t it? But what if a counselee doesn’t grow in Christ-likeness? Then is counseling a failure? We will explore the answers to these questions through the case of Cecilia.

A semi-regular church attender, Cecilia claimed true belief in Jesus Christ on the Personal Data Inventory she completed. But, months after her initial counseling visit, and as she persisted in her opioid addiction and other sins, especially lying, I doubted her conversion. So did her husband and her pastor.

As you hear the story of Cecilia, ask yourself how you would counsel her. Chances are, as opioid addiction grows exponentially in the United States and worldwide, at some point you will counsel a “Cecilia.”

Gathering Data on Cecilia and Drugs   

Cecilia is married and a 40-year-old mother of an 8-year-old girl. Early in her career in finance she received good pay and earned promotions, spending money on nice cars, fun vacations, and classy clothes. But then she lost her job. Soon after, she reported to her doctor ongoing physical pain, and he prescribed one opioid and then a second.

Her pain persisted, her sleeping worsened, and she sometimes raged against her husband, tossing cuss words like grenades and even hitting him. She sought help from a psychiatrist who gave her the diagnoses of Bipolar 2, depression, and anxiety. (Cecilia did not initially list these diagnoses and all of her medicines on her Personal Data Inventory. Later I confirmed the information with her husband and her pastor.)

After three appointments with me, Cecilia began skipping sessions. Some excuses – an ill child – sounded reasonable; others didn’t. This stop-start pattern of our counseling interfered with progress and gave her multiple times to retell her story, looking for sympathy and avoiding discussing the changes she needed to make. Would it have been best for me to get a commitment early in counseling and make skipped sessions a reason for me to end counseling her?

As data gathering continued, I learned that her medicine regime included sleeping pills to fall asleep, an amphetamine to wake up, an antidepressant, a tranquilizer, and mood stabilizers. This medicine cocktail concerned her husband – and me as well. He said as long as she followed the doctor’s instructions perfectly, Cecilia seemed to do better. However, she often failed to follow his instructions. In fact, she liked the feeling of “checking out” when she took double doses of opioids. I filled out a consent form that Cecilia signed so that I might speak with the psychiatrist for additional data gathering.

The Husband Shares Concerns

Cecilia had said she believes in God, prays, reads the Bible, and is saved. However, on her Personal Data Inventory, she left the section “Why should I let you into my heaven?” blank. When I asked her about it, she gave what sounded like a sincere answer. But should I have asked more compelling questions to detect lying?

While her pastor was very concerned about Cecilia’s salvation, her husband said his concern was not her salvation as much as it was her abuse of pills. He feared for her well-being and their daughter’s. For example, he said Cecilia often woke up in the middle of the night and smoked a cigarette in the garage, falling asleep while it was lit.

As her husband helped fill in the blanks, I realized the extent of her lies to me. When I lovingly confronted her, she became angry and said she didn’t want her husband to join her in counseling any longer. Her husband’s presence in counseling helped her keep her appointments and tell the truth, though they often argued in the counseling office. A great disagreement was over their daughter, who Cecilia said was very ill from allergies; her husband said their child wasn’t sick. He accused her of sending emails to church members in order to buy more pills.

Identifying the Problem

Among Cecilia’s problems are extreme selfishness, idolatry (specifically, looking to drugs to meet her “needs”), rebellion, and lying. I helped her understand her heart idolatry. For example, I used a diagram of the heart, marking the middle with “desires, motivations, beliefs” and made arrows to show that thoughts, emotions, and actions flow from the heart. Among the Scriptures we looked up together were Proverbs 4:23, Luke 6:45, Matthew 15:18-19, Jeremiah 17:9, and Mark 7:18-23.

Cecilia appeared interested in identifying and ridding her heart idols. However, she rarely did the assigned homework. Instead, she had excuses and blamed her husband for her problems. We discussed godly and worldly repentance. My hope was for her to see her need for Christ, but the confusion and lies continued. Cecilia’s husband told me that she had taken their daughter to many doctors and they called the pediatrician, saying they would contact the Child Protective Services if she persisted.

Counseling Comes to a Halt

I also warned Cecilia and she later called her psychiatrist, who recommended that she stop counseling with me. The pastor spoke with the psychiatrist and confirmed that he wanted her to see a counselor at his own practice. And so biblical counseling with me stopped.

Reviewing her case, I concluded it was both a failure in one sense and a success in another.

Counseling was a failure in that Cecilia didn’t move toward Christ-likeness. But how could she? While she spoke “Christian-ese,” she was an unbeliever and thus did not have the indwelling Holy Spirit.

Counseling was a success in that while Cecilia remained in sin, her husband not only made a plan to keep their daughter safe (a family member moved in with them) but also now studies the Bible regularly with their pastor and other Christian men at church. And he prays: for their marriage, their little girl, and most importantly for Cecilia’s salvation. They pray that the psychiatrist or another medical doctor intervenes and, with God’s help, she is freed from her opioid addiction.

Questions for Reflection

How will you counsel a “Cecilia”? What have been your experiences with counseling opioid addicts?

* Names and identifying details have been changed.