100,000 Americans died from April 2020 to April 2021 due to opioids, according to numbers released this week from the Centers for Disease Control and Prevention. The majority of the deaths have come via fentanyl, which accounted for more than 75 percent of all fatalities. Most of the time fentanyl has been used in combination with drugs like methamphetamine or cocaine.

Who were those who lost their lives? According to The New York Times:

The vast majority of these deaths, about 70 percent, were among men between the ages of 25 and 54. And while the opioid crisis has been characterized as one primarily impacting white Americans, a growing number of Black Americans have been affected as well.

There were regional variations in the death counts, with the largest year-over-year increases — exceeding 50 percent — in California, Tennessee, Louisiana, Mississippi, West Virginia and Kentucky. Vermont’s toll was small, but increased by 85 percent during the reporting period.

This week on Quick to Listen, we wanted to talk about the opioid crisis. What is our response as Christians who are in relationship with those affected? What is our responsibility when we are far away?

Andrea “Andi” Clements is professor and assistant chair of the psychology department at East Tennessee State University and is cofounder of Uplift Appalachia, which helps churches care for addicted people. She is on the leadership team of the Strong BRAIN Institute, which studies childhood resilience.

Clements joined global media manager Morgan Lee and executive editor Ted Olsen to discuss when she first realized that opioid addiction had entered her community, why churches are part of the solution to the crisis, and how being in relationship with the addicted has changed her faith.

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Music by Sweeps

Quick to Listen is produced Morgan Lee and Matt Linder

The transcript is edited by Faith Ndlovu

Highlights from Quick to Listen: Episode #289

Where do you live and how did you first notice opioid addiction entering it?

Andrea Clements: I live in Northeast Tennessee. We are about 20 miles from North Carolina and about 20 miles from Virginia, right up in the tip and the mountains. This is near the hub of the beginning of the opioid crisis.

If you followed any of the press on the pill mills and Appalachia and so forth, Southeast Kentucky, Southwest Virginia, Northeast Tennessee is ground zero, and also Southern West Virginia and so there was a lot of the initial OxyContin and overprescribing and things like that here.

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We moved here in the nineties and that was occasionally on the news. You would hear things about this, but it was not really on my radar. There was press around that, but it was usually in terms of crime or tabloid things.

But I got to notice it more heavily in early 2010, 2012, and 2014 and that is because I got involved in a program that is for high-risk high need felony offenders with addiction as a volunteer. So it’s like the last-ditch effort before you go to prison. It's like day jail. This was a ministry of our church. I wanted to help out a friend who started that program and she needed volunteers. I just got to see the other side of how common this is.

I ended up going to court with people and you just saw this revolving door of the same person with a different face all day long in the court system. It was that overlap that alerted me to just how common it was here.

It was getting common then, and it was already fairly common, but it was kind of in the shadows. I walked in and saw this whole subculture that I had no idea existed.

Morgan Lee: It sounds like it’s been very present in your community for about 20 years, and there have been some different milestones that have happened along the way.

I mentioned at the top of the show that OxyContin was something that many people first suffered from addiction with and more recently it's been fentanyl.

Can you talk a little bit about fentanyl and how that's changed how we think about the opioid crisis?

Andrea Clements: Fentanyl is remarkably strong. It's because it is so strong that it's so dangerous. When you take any kind of opioid, you gradually get tolerance to it so that it takes more and more to get the same effect. If you're using a Lortab or something like that, it's not very strong, OxyContin is much stronger, fentanyl is much stronger. It's the strength of it that is such a danger for overdose and death and so what has happened is that we have just recently gotten more of a fentanyl problem here and I can explain a little bit why I think that is true. It's a marketing thing because it's inexpensive and it gives a better effect to whatever you're using.

You mentioned at the beginning that it's with methamphetamine or it's with cocaine or something like that. It's almost like a little extra kick with what you're taking. It's a downer, meth and cocaine are uppers so if you mix them, you can do more of both if that makes sense.

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So people that think they are getting one thing, may also be getting fentanyl if they aren't tolerant already to opioids. That's when you so often see these overdose deaths. It's not that they were not intending to use drugs. They were intending to use drugs, but they were not intending to use that drug.

That’s where a lot of this danger of fentanyl itself comes from. Just like OxyContin, it’s another marketing tool. Someone is making money, it’s generally what promotes this and the person who is addicted ends up being exploited and maybe dead?

Ted Olsen: I appreciate what you just said about the intent, what’s intended, and what’s not intended.

Is there a typical journey on opioids especially fentanyl? We are talking about very specific physiological processes that happen that are different than some other addictions, like a process addiction or something like that.

Chemically what's happening and how does it go from someone getting a prescription for a painkiller to these massive numbers of deaths? I know everyone’s story is different. I don't want to lump everyone together, but is there a fairly common narrative that we're trying to interrupt?

Andrea Clements: There are a couple because it is different. Some people may get their wisdom teeth out. They then have some opiates for a little bit. It stops hurting. They stop taking them. They're fine and nothing ever happens. Some people have either injury surgery, chronic pain, they are prescribed and I don't know if you've heard the, “you gotta stay on top of that pain, don't let it get out of hand. So take these every four hours, even if you're not quite hurting that much.” That's been the status quo for a long time to not let anyone hurt.

You take it as prescribed and by the end’s a relatively quick dependence that you can develop physically. You do hurt when you stop because it increases your pain sensitivity just by taking it. That's one route and so you can accidentally get addicted to a substance through prescription pain medication.

You got other folks that you're a teenager you're playing with your friends and it's like, “oh, mom's got some pills. Let's try those. Oh, that's fun. Let's get some more.” You go to grandma's you get some out of the med ischemia so it's more recreational and you fall into it that way.

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I listened to another podcast and the fellow interviews people, most of whom are in recovery. I've also actually found a couple of research articles sets that have looked at this and it’s something that I'm working on that we'll talk about maybe a little bit, it’s that this feeling the first time you took whatever, say you took somebody's OxyContin and it's like, “that's the love I never felt. I want to feel this way for the rest of my life.” It's oftentimes that’s somebody that was either highly anxious or neglected and this is where that ACEs stuff begins to overlap. You have this tumultuous upbringing and then all of a sudden, a substance can calm you and make you feel good and warm and light. I’ve heard people say it’s like being in a warm blanket and that’s more of this instantaneous I’ve found my thing. All three of those are quite different routes but by the time your body gets dependent on it, it looks very similar.

Ted Olsen: A lot of people are familiar with 12 step programs like Celebrate Recovery and those kinds of things. A lot of those are oriented both to things that create some chemical dependencies like alcohol and also process brain chemistry, stuff like gambling or what have you.

Given this process, it seems like the third group that you mentioned may be especially helped by some of the stuff that 12 step programs address, but is this significantly different? Do we need a very specific program on opioids that would be different than putting someone who's struggling with opioid addiction in the same kind of church or community-oriented recovery program with someone who’s in with alcohol or in with some other things? How unique is the process for breaking the narrative?

Andrea Clements: I don't know that it is that different because one of the things that we know, like even meth, activates opioid receptors and lots of substances activate opioid receptors, love activates opioid receptors, running a marathon activates opioid receptors. If we’re re talking neurochemically, I wouldn't say that you needed something different.

Looking at human connection as a treatment for addiction and trying to replace whatever your substance is with that naturally occurring endorphins from connecting with other people and that is a lot of what is motivating what Uplift Appalachia is doing.

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That is one of the reasons I think that 12 step programs are as effective as they are, and they are effective. There is a lot of research that shows that 12 step programs are effective and I think a lot of that is it's tha place where you have a safe, caring set of humans with skin on that are filling some of that.

Can you give us a picture of some of the ways that opioids were being or opioid addiction was being treated before the pandemic and then how the pandemic interrupted, disrupted, or undermined these systems that have been set up?

Andrea Clements: The gold standard treatment for opioids at this point is medication. For a long time, it was medication and that's with replacement medicine. You've probably heard of methadone, we can go full agonist but it's like heroin except legal. It does all the things that heroin does and the time is a little different, things like that. But then it's controlled. Buprenorphine, which is a partial agonist opioid, which means it partly fills your opioid receptors and then there's what's called Vivitrol or naltrexone, which blocks them. So it won't have an effect. Those are the common treatment medications.

Buprenorphine is the most common these days and so that's usually over a month You get a month’s prescription and up until last year, there was a mandatory counseling element of that. You had to have behavioral health along with that and the American Society of Addiction Medicine ( ACM), who sort of rules this all said you got all medication and you might also provide, it was no longer, you have to have both.

One of the things that our particular town is fairly famous for in Tennessee is several years ago, we were at the point where we had met 1200% of our medication-assisted treatment here. That means we had lots of extra going out into the society that was not going to the person who needed.

We had a huge diversion problem and this was very much the model of the OxyContin’s prescribers back in the day. It was overprescribed, sell part, come back, do your cash. There was no insurance, it was just, you walk in with your dollar bills and I will hand you a prescription, and then you go get more money, however you need to.

So that's the way things were happening and that is still what is recommended. It’s like frontline let's give them some replacement medication because they're such a high risk of overdose. If they get stuff off the street, it may have fentanyl. Buprenorphine doesn’t have fentanyl, it's a prescription drug, so it is safer. I think that the reason we didn't have such a fentanyl problem here when the rest of the country was, was because we had such ample supplies of buprenorphine.

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We also have a lot of 12 step things, all the way from very faith-based like Celebrate Recovery and Regeneration to Smart Recovery, which is 12 steps with no God at all and everything in between. Then the pandemic hit and everyone scrambled because the immediate thought was, these people are dependent on these substances.

Cause if you're on buprenorphine, you are just as physically dependent on that as you would have been on heroin or whatever. You have to have your supply or you go into withdrawal. So there was this scrambling to make sure people were able to get their prescriptions, but their offices weren't open.

So it became just like a drive by get your script drive by get it filled with very little monitoring. So there was a lot of provision of the medication without any of the wraparound services that go with that. I don’t know if you’ve compared that 100, 000 to the previous year. I think in 2018, the national overdose death rate had gone down ever so slightly. Tennessee still went up, but the national rate had gone down like a point or something like that.

The next year it was back up, but it was around 72,000, I think. So we’re talking a 30% increase and far more than that later. Before that, it had crept up over years, but never at the rate, it did during that first year of the pandemic, it was just every month that that report came out and it lags a bit, you can see because the April numbers just came out, but it was even higher. You just see this curve going up, steeply and I think a lot of that is that there was that isolation thing, that lack of connection thing.

Ted Olsen: That’s a pretty medicalized response so I am kind of like, good luck doctors and good luck addicted folks, hope you are able to get the pills you need and I'm sorry that the pills aren't a whole lot better.

But for churches, for individual Christians, other than Christians in the medical community, is there any connection between the Christian community and the kind of medicalized drug-based response?

Andrea Clements: There was a previous organization before that you read about I'm sure in the Duke magazine. The whole friendship collaborative was sort of the precursor to Uplift Appalachia and I won't go into how one became the other, but we were trying to see how we could get the medical community and the faith community talking together about this.

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One of the things we found when we're asking people about what they thought about addiction and how it should be treated and so forth, a lot of people said, “oh, that's a medical thing. It should be handled by medical people.” I see that in a lot of things, not just medical things, it's like, “oh, let me get you to a resource. I'll make a referral go, now you've got a person.” It's almost like the church feels okay and what we at Uplift Appalachia are trying to say is, “yes, there may be medical things you need. There may be social service things you need, but have the person with you. Go with the person and then bring them back and keep them instead of just referring them away for someone else to take care of.” That's a lot more work, but I think that's, what's more effective and that's one of the things that I see missing in a lot of the church. I don't want to cast this version of the church, I was one of those people that didn't realize this was going on under my nose until I was out there.

You've mentioned Uplift Appalachia. What exactly is its model and why specifically does it see the church as an answer to opioid addiction?

Andrea Clements: Another organization was doing some of the training about addiction and things like that and we were a sister organization. When we started we were going to do a transportation program and that came out of a small church we had planted in a high need, high addiction, high poverty, high homelessness area of Johnson City. This was the population that we wanted to serve. One day my son, who was one of the pastors at that church, which has recently closed, had this light bulb go off cause we were talking about what can we do? What should we be doing?

So this well-equipped, well-grounded group of folks wanted to reach this neighborhood and we gradually reached it. We were between the VA hospital and the soup kitchen and so we got a lot of business. We had lunch every Sunday so people would come in and gradually became incorporated into the church and so forth but they didn't drive.

We had a college graduate driving a disabled veteran with an addiction history every Sunday. They got to be friends and we saw the veteran get better and better. By the way, he is employed, has a house and all that stuff now.

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It wasn’t that we set out to do a program. They just became friends. So we said, what if we try to help churches to do that as a ministry, but not just to give somebody a ride to get from point A to point B, they would get from point A to point B, but purposefully, like the person giving the ride has an ulterior motive. They have an agenda.

It's like, I want to love you into a healthy place, pull you into a community. One of the things we know about people, particularly with opioids, is they don't seek a connection with other people. It's like the opioid fills that and so they tend to isolate and don't readily connect with folks. You have to almost chase them down to make this connection and that's why we think it's so important that it's the church. Cause most people without a Holy Spirit love driving them to care for the least of these is not gonna take their afternoon off and go seek out someone that doesn't want to see them and take them to a probation appointment.

Ted Olsen: Yeah. If a hundred thousand people are dying and it's heavily concentrated in Appalachia, it’s like this is one of those areas where I would think people have much more direct family connections and friendship connections and a lot of those kinds of things.

I would think there'd be a high eagerness where churches would meet more directly asking what are we as a congregation doing about this? Is there that sense of urgency or is it still something where you're like, yeah, it's a problem and the church can be responsive.

And by here they mean like in our neighborhood, not in our congregation because I would imagine a lot of churches would say, “we don't have that problem in our congregation because drug addicts don't often show up.”

Andrea Clements: My sister was addicted to substances for years. She passed away from addiction in 1999. This was long before I took this on as a cause and I would love to say, “oh yes, it was for the love of my sister.” It wasn't, I was a terrible family member to an addicted sister. I know all the things not to do now, but I've lived as a family member and you just get done with it.

That's another place I think the church can step up and that is if you've got a family that has an addicted family member, they need your help. It's unavoidable. Others may think, “how did you raise them so wrong that they did this?” Even if people don't think that the person may take that on anyway and so there's burnout.

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The meals ministry thing, is that something that we're starting with to folks who are struggling with addiction and to their families? Is that a foot in the door? Is it just like, let's make sure we're including people who are addicted and their families in this care or that's good but what we need is something else?

Andrea Clements: One of the things that we found as we taught people adverse childhood experiences and this ability to try to give people the benefit of the doubt and give them a safe space to talk and things like that is once people understood, they came up with their creative things. They would just go do their own thing and they come back and say, this is a program. We taught the nurses at our St. Jude branch here and they said, “we were trying to look at what might be traumatizing to our kids” and they came up with a plan to address it.

We didn't even know how that happened nor would we have known how to address it, but they in their place looked at what they were doing and changed how they were doing it. So I think what we would like to do is help people in the church better understand just what's going on.

I taught a seminar in the spring of 2020, but some of what we went over was what people go through and what are the social supports, what's going on physically, but also the manipulation tactics.

People who are addicted to a substance can tell you, these are the ways he or she is manipulative. Cause you think about it, this is your lifeline and you're going to do what you have to do to get it. Understanding that and how to set boundaries with people and how to help them without enabling all those kinds of things. It's developing a relationship with the person warts and all.

Ted Olsen: You've mentioned two challenges. One is the, “I'm afraid I might do something wrong” and the other one is, “I’m just done.” Both of them have some similar source, which is, “I don't really understand what's happening here and it's hard.”

Are those the two barriers you mentioned that like this church that you were engaged with was so successful that it became a victim of its success in some ways?

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What have you learned through the hard parts of actually having a church that was highly motivated on this and having to learn hard lessons?

Andrea Clements: One of the things that we have that we learned and now even have taken to doing trainings is just the numerical balance. We were small and some of the people left because if you're in med school, then you go to residency. If you plant with four med students and their spouses, eight people are going to leave in four years.

That was unavoidable but we didn't do a good job of growing up more of us while we were doing that. So you get a little bit thinner and I think we were overconfident in our bandwidth. We started out thinking everybody's got their person. We're thinking more like a five to one or ten to one ratio makes more sense just so that you can tap out, almost a support network for each person who is either an active addict or new recovery. Once they get a little further on, then they can be part of the team but while they're still really fragile then we would need enough people to share that burden.

Ted Olsen: We carry each other's burdens, but when I say I'll pray for you during that hard meeting, you know that’s one level.

Are we talking full-time job style?

Andrea Clements: It depends. and I'll say this is not everybody’s cup of tea. I know that this is my passion. It’s also hard to say we need to have a ten to one ratio before we even began, while two people died of an overdose down the street.

I will say that people that came to our little church died of overdoses between services, between Sunday to Sunday. It was not uncommon to have someone there in the morning and they died that day.

So Jason is 44. He's been in and out of jail since he was 19. He was addicted to mostly opioids. He grew up in government housing and had a couple of mentors when he was younger, but he, his brother, and his sister have all struggled with opioid addiction, all have been incarcerated off and on, him mostly he has 42 felonies.

He says he was a bad guy. He stole a lot of cars. He wasn't violent, he just stole a lot of cars and used a lot of drugs and things like that. In prison in 2014, he made a profession of faith and since then, he's had a couple of little skirmishes when he was out briefly, but, nothing like he had been before.

I had been mentoring folks at this corrections program I talked about before and he came in. He was released from jail on probation in 2017, went into the office, and had been incarcerated for 18 years and had no idea what to do with himself.

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When he got out, he ended up having surgery. They gave him an opioid and so he was back on opioids and he went into this probation office at the program where I had been, in tears. And he said, “I don't know what to do. I don't know where to go” and they said, “we've got this lady's phone number why don't you call”. So he cold-called me one afternoon. I was here at work and he just spilled his guts. He said, “they let me out of jail and I’m back on opioids. I don't know what to do. I don't know how to work. I don't know how to live. I don't know what I'm supposed to do.”

Anyway, we started to bring him to church with us that summer of 2017 and we would pick him up and take him to church. It was maybe a month, six weeks and he disappeared completely. Didn't know where he was. I ended up speaking at a conference on campus here, trying to get the church to be aware of the opioid crisis. I was speaking on this and I just said, “let me tell you about this guy, everybody.” There were around 2000 people and I said, “would you just pray for this guy? I haven't heard from him, fell off the face of the map.”

The next afternoon, he called me on the phone and said, “Ms. Sandy, I'm at the jail. I'm going to turn myself in. I'll call you when I do it.” He called me back in about an hour and said, “okay. I am in”. So anyway, he got out again the next year, for a little while bombed again. We were trying to get him sent to treatment and all of this.

Anyway, they said he was going to have to do his ten-year sentence, but that was fall of 2018 and he just found out last week that he's going to get paroled in May, which is great because he's in a little jail in a little county, one of the top five poorest counties in the country.

But they have a great program where he goes out, works during the day and he works. He goes to recovery meetings, he gets to go to church, he gets to direct traffic for parades and things like that and is doing fantastic. He's gonna stay and live there instead of coming back here, which is wonderful.

Morgan Lee: Because of this long-term relationship that you've had with him, you've probably reflected on things that were healthy about how you approached him and things that were not so healthy.

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What have been some of those things?

Andrea Clements: I can tell you when he was out in 2018, he did come to church all the time. He did get into that program that I was talking about and we got to know each other much better.

He had an apartment and I would pick him up. I would take him and his mom to church. She lived in a different place time. I got to know their whole family and the whole church just embraced him. That's what he calls his church and he still calls it his church, even though we don't exist.

But during that time he relapsed, he was doing yard work and somebody paid him Suboxone instead of money. He said he kept it for about four days, I think and he finally just couldn't stand it anymore and he used it, he just went off the rails and he ended up driving without a license.

He's never had a license and so he got pulled over. He was using more then and he disappeared again. He was like family by that point and I can remember driving around in the middle of the night, looking for him crying, thinking he's gotta be somewhere.

It's a thing to be prepared for because your heart will get broken, but I would rather that than have not known him and not been instrumental in his life.

I am his safe person. I have to be on call 24 hours a day and it's like, “no, you can't.”

Ted Olsen: Yeah. You can't. Just in this conversation, that's weighing pretty heavy because how do you mobilize the shepherds who leave the 99 to go follow the one. The assumption here is that you've got the sheep, that's the one that you go grab and you bring it back to the fold and it stays in the fold.

Recovery health is not a straight line. You need people walking with folks over and over and over again and creating systems where the caregivers have space to breathe. There's a sacrifice here, but it's a sacrifice that still needs to depend on God's energy, but also at the same time, there is Sabbath rest. In that caregiving, some communities need to come around folks so that it's not just one person that's always getting the same call at three in the morning, but at the same time, that's where friendship is.

It seems to me after this conversation that what we're talking about is, forget your metrics, forget trying to plan, our church is going to get super involved in rescuing people from opioids. We need to go find our person and most churches are small churches.

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What kind of community do you need that’s going to be intimate enough to do the real love and caregiving and be a family to someone who's walking through this but is big enough so that it's not completely tanking the one or two caregivers?

Andrea Clements: I wish I knew. I think a lot of it is like having a well-layered community if that makes sense. One of the things that we found, even though we were against the us and them thing at church, we realized that sometimes those of us who were trying to intentionally care for others needed to pow-wow together and retrain and recalibrate. There has to be some of that staffing, retraining, discussion, focus, group, etc.

Before we planted the church, one of the med students and I would just go walking and take a bottle of water and give it to people or something like that and we would talk to somebody. Sometimes we would pray and then we walk away and we go, “Ooh, that went terribly, what can we do next time? All right, let's try this.” It was very much a trial and error and, “okay God, what are we doing next?” pow-wow a planner. I do statistics, but even when somebody or something comes up, it's like, okay, Lord, I don't even know how to address this. Do I answer them? Do I not? Do I present this thing? I just have to trust that he can figure it out better than I can.

So I don't have a hard and fast do it this way. We've been looking for funding for three years now, to try to find a human being staff person to orchestrate best practices for us and we still don't have that.

How are we going to train churches? Will they want transportation etc. because we get a lot of requests to go speak somewhere, or our church wants to do this, but we don't have. Everybody has other jobs right now and that sounds so unscientific and unstatistical.

Ted Olsen: We are all in pretty different contexts for finding folks who are struggling with opioid addiction but one thing on prayer, that I've encountered a number of times is if you hear podcasts like this, or you read that Times article or something like this, and you feel there's an action I need to take here, praying that God would bring someone into your life that you can be part of their health results in God answering those prayers. Start praying and keep your eyes open and God will bring that person. But in addition to that in suburban contexts, places where people keep some of these things under wraps, we're in a COVID period where people have disappeared from our churches. We're like, did they move away? Or are they struggling at home?

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How would you advise someone to open their eyes a little bit more to ways that they can start being part of the solution for people who are trapped?

Andrea Clements: I still come back and it sounds so simple and it's not always is, being a safe person that someone can talk to. I guess not treating somebody like a science project and not expecting them to have everything together, but just having conversations. There are people that love to be on a stage and speak to the crowds. I am not that person. I do it sometimes, but that's not me, but I am all about going and plopping down on the curb beside somebody and talking to somebody just sitting there. If nobody else is talking to them. I'm going to talk to that person and not about are you using and what milligrams and are you afraid of fentanyl, but where did you grow up, something just like people's conversations. That’s just being able to treat people like equivalent, valuable human beings and you can do that anywhere.

So let me tell you one other story real quick, there's a girl I think she's 26. She came to church three years ago. She's so bright. I've watched her just spiral deeper and deeper. She has a lot of baggage from the past and things like that, but she has been in, I would say in the last year and a half 30 treatments facilities, maybe. She'll go to a treatment facility, she'll make it four to six days. She made a couple of weeks once and it's like, “nope, I want to go use it.”

It's like the pull of using is so much stronger and so much easier to her than it is to face the demons that she has to face to not use. She's found ways to always be able to get drugs and always to be able to get to the treatment place and if she bails from one, she can always find another one and it's almost like she goes to get a shower and get some food, and then she's out again.

But we were talking about these human connections treatments for addiction and we were talking on the phone one day and she said, “aren't you supposed to be able to love me enough that I don't do this?” I said, “I thought so, but I am rethinking that."

It’s so hard and she professes faith. One time she went to a church here and she said “they prayed over me and I'm healed and I'm done and it's good. And I'm all good.” That lasted three days. She goes from one day thinking, I'm just going to die this way. I don't see any option to. She came a couple of weeks ago and sat in my office for a couple of hours and talked about, she would love to do the kind of research that I do and she would love to, and she's smart enough to do it. She said she would love to be on my side, looking out, helping rather than being the one that needs it, but then she was going to visit somebody else down the street where she was walking to because she doesn't drive or anything and used on the way.

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I don't know if she got arrested there. I know she got kicked out. It's not an easy fix problem. It's not here's the formula; that does not exist.

How has doing your work and being in relationship with people who are struggling with addiction shaped your faith in ways that it's made it tougher and also ways that it's made it more beautiful?

Andrea Clements: I know it has forced me to be far more reliant on God. I've had a Ph.D. for 30 years and so we can easily say I know a bunch of stuff. I can fix things and so forth. It seems like such an insurmountable problem. It's like moving a mountain and I know that I cannot myself do that.

The things that I've gotten to do, the things that I've learned and the successes along the way is all God showing me that, there's no other explanation. I have a friend and we meet about once a week, we go to coffee or lunch and we talk about what we're both doing. We'll be praying about something and say we can't wait to see how this works out. It's not that it's not going to, we know it’s going to we've got enough history. We're both old women. and you look back and you see all of these things and it just makes it that much easier to rely on him, to give you the answer you need.

And if you're not getting one you don't need it yet.