“I’m Ready to Go.”

Lines, no, cracks
in the walls—
all of them,
and the ceiling too;
the kind that morph
while you stare,
unaware,
drifting back and forth
from what was and
what can be.

I started packing
this morning, slowly,
still rigid with fear
that it will all start
folding in on me again,
drowning my voice,
shackling me to the past
like a stake and chain
for a dog.

It’s not that I want
to stay—I don’t;
The air here smells
like sweat and sick
and just a hint of desperation;
sunlight barely pushing
itself through five years
of rain scum
on the window panes.

Now there’s a curious
metaphor for sure,
the half-decade-old
film of forgotten responsibility
and lost opportunity
weighing me down,
causing the clown of bloodshot eyes and
rotten flesh to reappear,
a thick blanket of fear
wrapping around me, squeezing,
trapping my breath.

Last month, last year,
the last thousand years,
packed full of regrets
so heavy I spent most days
in bed or in my broken recliner.
If my vision were clearer back then
maybe I could’ve
recognized where I was—
then I would’ve been
(at least a little) more
likely to head to the door,

and flinging it open,
giving the sunshine at least
half a chance of falling on
my emaciated body, warming
my bones and clearing
my brain—which is, frankly,
a prerequisite to
freedom—victory from
the bondage of
self-deprecation.

No bother, though, because
I’ve been flexing my
heart lately, strengthening
my muscle of
hope now that I’m off dope;
shocked yet relieved that
I’m done with all that and
ready for this, whatever
this is—
I’m ready to go.

©2020 Steven Barto

Mental Health and Addiction

The first section of this post is taken from the blog of Sophia Majlessi,
National Council for Behavioral Health
Released January 8, 2020

Voters More Likely to Support a Candidate Who Promises to Address Mental Health and Addiction, According to New Polling from the National Council for Behavioral Health Released Ahead of December 16 New Hampshire 2020 Presidential Candidate Forum

WASHINGTON, D.C. (December 11, 2019)—New polling released today by the National Council for Behavioral Health shows strong bipartisan agreement among registered voters in New Hampshire that the federal government is not doing enough to address mental health (84% of Democrats and 72% of Republicans) and addiction (77% of Democrats and 53% of Republicans) in America. The National Council released the new polling in advance of the Unite for Mental Health: New Hampshire Town Hall, a public forum for 2020 presidential candidates to discuss mental health and addiction policies. The National Council for Behavioral Health, Mental Health for US and the NH Community Behavioral Health Association will host Unite for Mental Health: New Hampshire Town Hall on December 16 at the Dana Center at Saint Anselm College in Manchester, N.H.

“The message is clear: candidates who want to win New Hampshire need to tell voters they have a plan to address the mental health and addiction crisis, one of the most important health issues facing the nation,” said Chuck Ingoglia, president and CEO of the National Council for Behavioral Health. “The Unite for Mental Health: New Hampshire Town Hall will provide an important opportunity for presidential candidates to engage with New Hampshire families, mental health professionals and local policymakers to discuss the issues and share solutions voters—and the nationare eager to support.”

This statewide poll comes on the heels of new national data from the U.S. Centers for Disease Control and Prevention (CDC) confirming that suicide is the second leading cause of death among teenagers in the U.S. The suicide rate among people ages 10 to 24 years old climbed 56% from 2007 to 2017, according to the CDC report. These findings, compared with high rates of death nationwide from drug overdose, are leading to calls for the 2020 presidential candidates to engage communities across the country in order to better meet the needs of millions of Americans.

“Mental health and addiction continuously poll as key issues for many Americans, yet our leaders rarely prioritize prevention, treatment, and recovery strategies,” said former U.S. Rep. Patrick J. Kennedy, founder of The Kennedy Forum and Mental Health for US co-chair. “This new polling data from New Hampshire is the catalyst we need for change. The Mental Health for US coalition is proud to stand with the National Council and the NH Community Behavioral Health Association as we call on policymakers and candidates to walk the walk for the those with mental health and addiction challenges.” “The results of this poll are compelling. The need to invest in caring for those with mental illness is clear, and the voters want to see candidates for public office at all levels address these important issues,” said Roland Lamy, executive director of the NH Community Behavioral Health Association.

Results from the full survey have a margin of error of +/-6%. Click here for full polling results.

My Thoughts

The struggle to break free from active addiction is among the hardest undertakings a person can face in his or her lifetime. Putting the drug down is more difficult depending on the substance, amount used, and duration of use. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, has sequestered substance abuse under the new heading Substance Use Disorder (SUD). The substance-related disorders encompass 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens; inhalants; cocaine (powder or rock); opioids; sedatives and hypnotics; stimulants (amphetamine-type, cocaine, and other stimulants; tobacco; and other (or unknown) substances. It is important to note that all drugs (when taken in excess) have a common direct activation of the brain reward system, typically leading to dependency and addiction.

Mental health issues can become a complicating factor; this is often referred to as dual-diagnosis, or, in the vernacular, “double-trouble.” Moreover, individuals with poor self-control may be particularly vulnerable to substance abuse. Accordingly, the roots of substance abuse for some individuals can be seen in behaviors long before the onset of actual substance use itself. It is also important to note that substance-related disorders are divided into two groups: substance use disorders and substance-induced disorders. These secondary issues can include intoxication, withdrawal, psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders.

Features of substance use disorders include a rather important element: change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders. The behavioral results of such changes may manifest in repeated relapses and intense craving for the individual’s favorite drug. This craving is often set in motion through a mere drug-related stimuli, which is referred to in the addictions field as a trigger. Typically, the longer an addict remains clean the easier it is to recognize and defeat such cravings. A craving is likely rooted in classical conditioning, and is associated with activation of specific reward structures in the brain. These structures are rather individualized; not every addict is triggered by the same thought or stimulus. Instead, triggers are established by what the individual is agitated or distressed by, and inversely related to the ability to properly handle such stimuli.

Not surprisingly, treating co-occurring substance abuse and mental illness calls for simultaneously addressing two critical and sometimes confounding problems. In fact, double-trouble can often complicate differential diagnosis—the comparison of symptoms from multiple likely mental or physical conditions. From a personal perspective, it was quite difficult for me to clearly determine what was “wrong” with me. Severe anxiety, constant ruminations, insomia, and underlying depression crippled me for decades. In addition, I felt powerless and helpless, unable to relax or sleep. This is likely what initially led to my substance abuse. I started drinking alcohol and smoking marijuana the summer following my high school graduation. My use was extensive from the beginning, but I was able to calm down, stop my thoughts from racing, and finally get some sleep. Unfortunately, I was not “sleeping” as much as I was passing out. It did not take long for my substance use to become excessive, leading to a decades-long season of poor choices and serious consequences.

Reasons for drug and alcohol abuse by individuals with mental illness varies by individual. Substance abuse could be primary or secondary to psychiatric issues, or may even in some cases be independent of mental illness. The association between mental disorders and substance abuse is complex. The relationship of substance abuse to onset, course, and severity of mental issues, and problems in the evaluation of dual-diagnosis patients, is often complex. Adding to this difficulty is the likelihood that the individual often engages in self-medication to alleviate troublesome symptoms for which they have no explanation. This psychodynamic perspective must also include neurochemical considerations. Affective disorders (those impacting mood, often including depression, bipolar disorder, anxiety disorder) are particularly difficult to manage. I found welcome relief through drug and alcohol us—albeit only temporarily.

Unfortunately, chronic substance abuse can also lead to the development of organic conditions, such as psychosis, mania, and mental confusion. Other disorders can include chronic apathy and dysphoria, and personality disorders such as Antisocial Personality Disorder and Borderline Personality Disorder. Again, there is often confusion regarding co-morbity. For example, addicts quite frequently use, abuse, manipulate, and disrespect friends, family, and other acquaintances in order to get what they need, whether it be money, shelter, or (at times) the drug itself. These traits are also typical of several key personality disorders.

As these traits become routine, the addict often slides down the slippery slope to criminal behavior—theft, embezzlement, forgery, kiting checks, burglary, armed robbery. A serious, unfortunate end-result for the dually-diagnosed addict can lead to suicide. I have personally considered taking my own life on many occasions during active addiction. I would become remorseful for the way I treated family and friends. The disconnect between my Christian worldview and my behavior haunted me. It seemed suicide was the only option. As my uncle once told me, I was unable to see the horizon. Truly, I have not faced a more difficult situation in my life than suffering from mental illness while in active addiction.

In my review of the diagnostic criteria for Borderline Personality Disorder, I determined I’ve displayed eight of the nine criteria for making such a diagnosis. I’ve demonstrated a pervasive pattern of instability in my interpersonal relationships, self-image, affect (mood swings), impulsivity (sexual behavior, drug and alcohol abuse, risk-taking, excessive impulse spending, reckless driving), recurring thoughts of suicide, chronic feelings of emptiness, and recurrent anger. Thankfully, I have seen a vast improvement in the lion’s share of these symptoms. However, I still deal with poor self-image at times, tend to “sanitize” the truth, occasionally manipulate others, and remain rather impulsive in areas such as impulsive spending.

Given the pervasive nature of dual-diagnosis, it is critical to identify when you are suffering from mental or emotional symptoms, and more importantly to recognize if you are using or abusing drugs or alcohol to dampen or defeat uncomfortable thoughts or feelings. Depression, anxiety, and insomnia tend to “respond” initially to substance use. However, the need for one’s drug of choice to “treat” these types of symptoms increases as use leads to abuse; abuse leads to tolerance; and tolerance leads to dependency. Consequently, self-medication of emotional or psychiatric difficulties by consuming drugs or alcohol is doomed to fail—often with quite devastating results. If you, or someone you know, is caught in the vicious cycle of addiction (with or without a co- occurring mental condition), it is vitally important to seek professional intervention.

It is impossible to “go it alone” and achieve anything like helpful results. In fact, it is likely your situation will deteriorate. I was told years ago by an addictions counselor that because I had an underlying mental illness, treating my addiction without addressing my psychiatric problem is like having two broken legs but only putting a cast on one of them.

If you or someone you know is struggling with substance use disorder and want more information or help quitting, please contact your local AA or NA chapter, or click here to visit the National Institute on Drug Abuse official website. You can also scroll back to the top of this post and click on the COMMENT bar to open an dialog with me. I will be glad to speak with you any time.

References

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th edition (Washington, DC: American Psychiatric Publishing), 2013.

 

Recovery 2019: The Year in Review

From the Recovery Advocacy Update blog of the Hazelden Betty Ford Foundation originally posted on January 7, 2020.

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As Americans reflect on the past decade, the much more defining story, of course, was the opioid crisis, which fueled an unprecedented overdose epidemic that has barely begun to abate. Drug overdoses claimed a mind-boggling half-million lives in the 2010s and devastated countless others, while exposing the inadequacy of our nation’s overall approach and commitment to preventing and treating addiction, and supporting long-term recovery.

Amid the tragedy, we saw the beginning of positive change in addiction-related public attitudes, perceptions, policies, practices and systems. Hazelden Betty Ford has helped lead the way with many changes of its own. They began using opioid-addiction-treatment medications in 2012, and became a strong advocate for comprehensive care that includes medication options, psychosocial therapies and peer support. They emerged as a leading voice for breaking down barriers between the medical and Twelve Step communities.

Hazelden Betty Ford also transitioned to an insurance model so more people could access care; evolved away from the 28-day residential standard to a more individualized approach that enables people to stay engaged longer over multiple levels of care; launched a new era of aggressive collaboration with the broader healthcare field; made the evidence-based therapy “motivational interviewing” core to a more patient-centered clinical approach; initiated a new, innovative system for capturing and acting upon patient feedback throughout the treatment experience; developed new recovery coaching options; and much more. In addition, the foundation spoke up vigorously about the need for ethical and quality standards in recovery, and continued to support related industry reform efforts. It was a decade of big change for them, and they will likely evolve a great deal more in the 2020s, as they have consistently done since 1949.

Broader changes to the many systems that affect people with addiction are coming more slowly, but things seem to be pointed in the direction of progress. Indeed, most addiction specialists want addiction prevented and treated, rather than stigmatized and criminalized. The question arises, though: Does that mean it is wise to fully legalize and commercialize more addictive substances? Or are there policies and approaches in between that promote public health better than either extreme?

In the new decade, marijuana will be a case study and likely a defining story. The experiment with full legalization looks troubling so far. State-level data from the National Survey on Drug Use and Health finds that marijuana use in “legal” states among youth, young adults, and the general population continued its multi-year upward trend in several categories. New data and studies come in weekly, it seems—consistently showing cause for greater public health concerns. One of the foundation’s 2020 resolutions is to help ensure the facts about marijuana and the risks of expanded use get more attention.

One big concern, for example, is that marijuana vaping by teens surged in 2019, signaling that more adolescents are using the drug and consuming highly potent vape oils, according to new government data and drug-use researchers. Federal regulators are paying attention. They shut down 44 websites advertising illicit THC vaping cartridges, part of a crackdown on suppliers amid a nationwide spate of lung injuries tied to black-market cannabis vaping products.

The outbreak of severe lung injuries may have peaked, but cases are still surfacing, and the agency is urging doctors to monitor people closely after hospitalization, due to the risk of continued vaping. One Harvard graduate student writes, “I nearly died from vaping THC, and you could too.” Marijuana and vaping are both among the issues coming up on the campaign trail, and recent polling released by the National Council for Behavioral Health shows strong bipartisan agreement among registered voters in New Hampshire that the federal government is not doing enough to address mental health and addiction in America. Mental Health for US, a coalition trying to raise more awareness in the campaign, held a recent forum in New Hampshire. Watch the livestream replay here.

In Washington, the White House hosted a summit of its own on efforts to deliver mental health treatment to people experiencing homelessness, violence and substance use disorder. Watch Part 1 of the event, Part 2, and the President’s remarks. The Administration also issued its long-awaited vaping policy last week, with the FDA banning fruit, mint and dessert-flavored vaping cartridges but continuing to allow menthol- and tobacco-flavored cartridges as well as all flavored e-cigarette liquids. Many worry the guidelines don’t go far enough.

Since the foundation’s last update, the President also signed a $1.4 trillion spending package passed by Congress, averting a government shutdown. The package maintains funding levels for most areas relevant to the field of addiction counseling, with modest increases in a few SAMHSA grants as well as at the CDC and at the National Institutes of Health. Most notably, the legislation gives states more flexibility in spending State Opioid Response (SOR) grant funds; specifically, they’ll now be able to use the money to also address the growing problems associated with addiction to meth, cocaine and other stimulants. Here’s a thorough overview from our friends at the National Association of State Alcohol and Drug Abuse Directors.

If you are interested in more information about these topics or the Hazelden Betty Ford Foundation, please visit their website by clicking here.

If you or someone you know is struggling with substance use disorder and want more information or help quitting, please contact your local AA or NA chapter, or click here to visit the National Institute on Drug Abuse official website. You can also scroll back to the top of this post and click on the COMMENT bar to open an dialog with me. I will be glad to speak with you any time.

Make Me

The following is a poem I wrote in late December 2019 as I contemplated decades of  bondage to addiction; powerless, struggling but never changing; telling myself the same false reality day after day.

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At times I’m
Just a step away—
One bad choice, ya know?
Leave or stay?
It’s a long journey back
To what’s true. 

Every year
I see what you took,
But the hook is
I played a part too. 

My song, unsung,
Choked me,
Held me back;
Kept me there
Instead of here,
Year after year. 

But your power
Is an illusion—
A trick to make me stay;
Pushing, pulling, shoving me
Into
A box.

Wherever I look, I
See black;
You attack hope and
I answer with affirmations
That fall to the floor.

No more,
Please!
Tired of my own voice,
Exhausted by endless choice,
After choice,
After choice,
Everything staying the same.

© 2019 Steven Barto

Why Can’t I Follow My Heart?

“The good man out of the good treasure of his heart produces good, and the evil man out of his evil treasure produces evil; for out of the abundance of the heart his mouth speaks” (Luke 6:45, RSV).

Written by Steven Barto, B.S., Psych.

LATELY, I HAVE BEEN obsessed with whether I have a heart for God. It is a critical question for all of us. Unbelievably, there are many Christians in the church today who don’t question their heart. An assumption is made: “I go to church. I believe in God. I trust in Jesus Christ. I’m saved so I’m good.” There is a huge danger to having this illogical thought. Whenever we assume anything when it comes to our salvation or our theology, we risk loosing our way. It’s as if we’ve decided to “think” of ourselves as “Christian,” and then walked out the door to go about our lives.

This thought started pestering me in 2009 when my sponsor in a 12-step program told me, “You need to get God out of your head and into your heart.” I was puzzled. It made absolutely no sense. But I’m “saved,” I thought. How can God not be in my heart? When I became a young Christian at thirteen, I was told that Jesus had “come into my heart.” So if He did this, then He must still be there, right? I was later told by my then-current pastor in 2011, “I don’t think you have a heart for God.” Whoa, what? Rather than see a pattern, I became defensive. I was so mortified that I cannot remember the rest of the conversation. It’s as if I decided on the spot that my pastor was wrong. He wasn’t!

What it Means

What does it mean to have God in our hearts? It is important that we know and understand this if we hope to grow in Christ. First, to grow in Him involves allowing Him in us; but this means to allow Him to become greater while we become less. Yeah, I know; that sounds ridiculous, right? Why would we think less of ourselves? It is a matter of humility. Something I have never come to naturally. I am one of those who, for whatever the reason, has to build myself up. Make myself worth something. In doing so, I have led a life of duplicity. Lacking the power to overcome, and the “armor” with which to protect myself, I chose to lie about my feelings of inadequacy. I hid my failures. I permitted life-limiting habits to rule over me. The moment I did that, I chose to live the life of a hypocrite. 

If we’re going to live according to a Christian worldview, we must decide to surrender all of our heart and let God have access to every room in our “house.” This should be an exciting proposition because something greater is coming. It presents us with the opportunity to “clean” our house. Jesus warns us, however, that if we clean house (ask Jesus to come into our heart), but let the rooms remain empty, we are putting ourselves at great risk. Matthew wrote in his Gospel that Jesus said, “But if it is by the Spirit of God that I cast out demons, then the kingdom of God has come upon you. Or how can one enter a strong man’s house and plunder his goods, unless he first binds the strong man? Then indeed he may plunder his house” (Matt. 12:28-29). Jesus then adds, “When the unclean spirit has gone out of a man, he passes through waterless places seeking rest, but he finds none. Then he says, ‘I will return to my house from which I came.’ And when he comes he finds it empty, swept, and put in order. Then he goes and brings with him seven other spirits more evil than himself, and they enter and dwell there; and the last state of that man becomes worse than the first. So shall it be also with this evil generation” (Matt. 12:43-45).

Can you imagine someone choosing a life of failure on purpose? Does that make any sense at all? What could possibly be at the root of deciding, time after time, to fail? To make choices that risk your life, your health, or your career? That destroys marriages and breaks the hearts of everyone in your family? That costs you countless tens-of-thousands of dollars in lost income and other financial losses? That shuts you off from the very God you claim to love and worship? Why would a “Christian” who is born-again and has invited God into his heart willfully disobey the God he loves? Why choose to be cut off from the Sunlight of the Spirit, going it alone? Why would a theist, especially a Bible-believing Christian, risk (or maybe unconsciously choose) to spend eternity in Hell? The answer to these questions is both complex and simple. Complex because we make it so; simple because the Word of God is clear about why. These were difficult questions to ask myself, but I could no longer put off asking them.

Where Your Treasure Is

I am sure most Christians have heard Matthew 6:21: “For where your treasure is, there will your heart be also.” One reason I rejected the comments of my sponsor and my pastor is because I did not think about this verse for one second. I responded intellectually and pridefully, taking “offense” rather than advice. A huge part of my reaction had to do with a complete lack of humility. I was clueless how prideful I was being. Humility, after all, does not mean thinking less of ourselves; it means thinking of ourselves less often. Throw in a pinch of IQ and an ounce of denial, stir in two-parts manipulation and one-part of shifting blame, and you’ve got a recipe for the most sour peach pie you’ve ever tasted. Metaphor aside, it’s a plan for ultimate failure and self-destruction. My self-destruction came in the form of addiction.

One of my most favorite biblical study tools is Matthew Henry’s Concise Commentary on the Whole Bible. Regarding the section of Matthew 6:19-24, He says, “Worldy-mindedness is a common and fatal symptom of hypocrisy, for by no sin can Satan have a surer and faster hold of the soul, under the cloak of a profession of religion.” [1] If we confess Christ with our mouths, yet take no action to assure we are walking as He has called us to walk, we become the very hypocrites He warned about. Our soul chooses what it will look upon as the “best thing,” and then go after that thing with our whole heart! This “object” of our heart will most likely have intense pleasure, and, perhaps, offer us some reward we find most appealing above all else. It becomes the very thing we’re living for. Perhaps more accurately, it is something we’ve become dependent upon to live. This is what Christ refers to as a “master.” Jesus said, “No one can serve two masters; for either he will hate the one and love the other, or he will be devoted to the one and despise the other” (Matt. 6:24). Trust me, when it comes to serving a master that delivers great fleshly rewards, we will not even realize we are enslaved!

Matthew 6:20-21 discusses the “treasures in heaven,” indicating they are forever exempt from decay and theft. Luke tells us, “For life is more than food, and the body more than clothing” (Luke 12:23). This is what Matthew is discussing in chapter six. Whatever is of good and eternal significance comes out of what we do here on earth. Doing righteous deeds, suffering for Christ’s sake (which includes denying ourselves and taking up the cross), dealing truthfully and faithfully with one another, forgiving one another, being kind, willing to share—all of these things have the promise of reward. These become the treasures stored in heaven. Conversely, consistent unrighteous, disobedient behavior stores up much judgment and wrath. For the unbeliever, it ultimately leads to damnation. For the believer, Paul says, “So whether we are at home or away, we make it our aim to please him. For we must all appear before the judgment seat of Christ, so that each one may receive good or evil, according to what he has done in the body” (2 Cor. 6:9-10).

When we fail to see the basic biblical truth of Matthew 6:22-23, as I did for decades, we see life with “bad eyes,” walking in darkness. These verses tell us such darkness is all the more disastrous and defeating because we fail to recognize it for what it is. This has metaphorical implications; the “eye” can be considered equal to the “heart.” Psalm 119:10-11 says, “With my whole heart I seek thee; let me not wander from thy commandments! I have laid up thy word in my heart, that I might not sin against thee.” Here we see the tremendous benefits of Scripture. Jesus came not to abolish the Law but to fulfill it. When we hide Him in our heart, we hide that which He embodies, including the commandments of God the Father. Doing this allows us to watch our feet; the path we’re on. Christ becomes the Light by which we walk.

The psalmist says in Psalm 119:9-16 that we are to pray and meditate on God’s Word. When we do this, we are able to participate in the judgment and discernment of God. Colossians 3:16 says, “Let the word of Christ dwell in you richly, teach and admonish one another in all wisdom, and sing psalms and hymns and spiritual songs with thankfulness in your hearts to God.” Matthew 6:24 is saying the results of our choices are being stored in Heaven for the day we stand before Christ. We have to ask ourselves if we are storing up treasures in Heaven. That depends on our actions, which are directly influenced by where we decide to set our eyes. How we see the world, ourselves and others, and what we choose to do. It’s really that simple.

Jesus said to the Pharisees, “For judgment I came into this world, that those who do not see may see, and that those who see may become blind” (John 9:39). When church leaders challenged Jesus, asking “Are we also blind?” He said, “If you were blind, you would have no guilt; but now that you say, ‘We see,’ your guilt remains” (9:41). In other words, knowing the truth, they chose to ignore it and decide for themselves what was true. This is what Jesus referred to when He said we cannot serve God and mammon (John 6:24). This is a rather strange phrase. In the Greek, mamona, which is a literal translation of the same word in Aramaic, can refer to virtually anything of value: “wealth,” “property.” The root in both Aramaic and Hebrew (mn) means that in which one has placed their confidence or reliance. Both of these are compared—God and “other than God”—not as employers but slave owners. In other words, either God is served or “other than God” is served.

A Hard Lesson to Learn

We now see clearly the vital importance of Matthew 12:22-30. When we’re under Satan’s power and led captive by sin, we are blind to the things of God. Divided loyalty does not merely lead to a partial commitment to discipleship; it is an indication of deeply-rooted commitment to idolatry. Admittedly, this has been a very hard lesson for me. It made no sense during my active addiction that I was actually choosing to serve “other than God.” In this instance, my “god” or “idol” was alcohol, oxycodone, cannabis, cocaine, benzodiazepines. Because we “see” out of the abundance of the heart, my life of active addiction amounted to a continual walk in darkness, even while attending church, reading Scripture, teaching Bible study at two county prisons, sharing at 12-step meetings—sadly, even during much of the early years of this blog. Pride and fear has kept me from admitting this those of you who follow my blog, or anyone else. Walking in darkness also caused me to mistake the path I was on. This is precisely why my sponsor and my former pastor were absolutely correct. I did not have God in my heart. More tragically, my siblings were correct when they said I was being a hypocrite. I could be nothing less at that time, for I was putting on the appearance of being a Christian while walking in denial and disobedience.

What I was failing to see is that when we meet Christ, at a time predestined by God Himself, we will be held accountable to Him (from the day of our salvation) for every word and deed. Take a second and read that last sentence again. Yeah, I know! So let’s get this straight. Becoming “born-again” is not a get-out-of-judgment-free card. I have grown in Christ considerably over the past five or six months. Still, it was not until God put this lesson on my heart this morning that I was able to get to this moment, right now, when I saw a glimpse of what it’s going to feel like staring at His scars, remembering what the last twelve hours of His life were like, having to give an answer for every sad, dirty, low-down, manipulative, deceitful act I’ve done from the moment of my salvation, when I was given the power to dwell in the Holy Spirit and grow in the righteousness of Christ, until the day I draw my last breath. And there is nothing I can do to escape it.

So Now What?

First, anyone in this position must realize that when we finally decide to stop, drop, and roll, putting out the fire that is consuming us, we need to repent and turn over to Christ everything we’ve done. But that’s not the end of it. I have come to see the importance of “letting it go” (allowing the past be the past) and forgiving myself as I have been forgiven. If we fail to do this critical step, we will never be able to consistently see ourselves as a new creation. We will not be capable of seeing ourselves as God the Father sees us: clothed in the righteousness of Christ. Of course, the true “180” must come first or any degree to which we “shine” in Jesus will be dulled by sin and guilt. It is impossible to change if we live in shame. We’ll talk to ourselves with condemnation, forgetting there is no condemnation for those who are in Christ (Rom. 8:1).

After settling the matter in our hearts that we are regenerated in Christ, we must then pray and meditate on God’s Word, learning everything we can about who we’ve become. It is crucial to remember a fairly universal warning: Satan will not let go willingly. The finest example we have regarding resisting temptation is presented to us in Matthew 4:1-11. Satan appeared to Christ in the dessert and essentially attacked His “Sonship.” This is quite accurate to what Satan tries to throw in our faces, but he is far more subtle and crafty with us. He challenged Jesus by saying, If you truly are the Son of God then change stone to bread; throw yourself down from the top of the temple and let the angels save you; renounce God and the universe is yours. Does this not sound a lot like what happens in our lives once we accept Christ and confess we are the sons and daughters of God?

There is only one way to defeat these challenges, which is exactly what Christ did. He knew the Scriptures because He had them hidden in His heart. Yes, He was part man and part God, likely giving Him a greater moral infrastructure than we have; however, He defeated temptation by saying what the Scriptures say. Then, standing firmly on the Word of God, He told Satan who He truly was and shouted, “Away from me, Satan! For it is written, serve the Lord your God, and serve Him only” (Matthew 4:10). Decide for yourself who you believe you are, seek proof in the Scriptures, turn from your old path, and walk toward the Light of the World. The only way to change our sinful behavior is to see the path we’re on with open eyes and decide to go in an entirely new direction.

***

 I want to start encouraging more feedback so we can open a dialog. Presently, in order to leave a comment you need to scroll back to the header and click on LEAVE A COMMENT, but I’m in the process of figuring out how to move the COMMENT bar to the end of each post. Thanks for reading. God bless.

Footnotes

[1] Matthew Henry, Matthew Henry’s Concise Commentary on the Whole Bible (Nashville: Thomas Nelson, Inc., 1997), 868.

 

U.S. Surgeon General’s Advisory: Marijuana Use and the Developing Brain

Steven Barto, B.S., Psych.

I am reposting this information from a link to the U.S. Department of Health and Human Services (HHS.gov) provided by the National Institute on Drug Abuse (NIDA) website.

I, Surgeon General Jerome Adams, am emphasizing the importance of protecting our Nation from the health risks of marijuana use in adolescence and during pregnancy. Recent increases in access to marijuana and in its potency, along with misperceptions of safety of marijuana endanger our most precious resource, our nation’s youth.

Background

Marijuana, or cannabis, is the most commonly used illicit drug in the United States. It acts by binding to cannabinoid receptors in the brain to produce a variety of effects, including euphoria, intoxication, and memory and motor impairments. These same cannabinoid receptors are also critical for brain development. They are part of the endocannabinoid system, which impacts the formation of brain circuits important for decision making, mood and responding to stress.

Marijuana and its related products are widely available in multiple forms. These products can be eaten, drunk, smoked, and vaped. Marijuana contains varying levels of delta-9-tetrahydrocannabinol (THC), the component responsible for euphoria and intoxication, and cannabidiol (CBD). While CBD is not intoxicating and does not lead to addiction, its long-term effects are largely unknown, and most CBD products are untested and of uncertain purity.

Marijuana has changed over time. The marijuana available today is much stronger than previous versions. The THC concentration in commonly cultivated marijuana plants has increased three-fold between 1995 and 2014 (4% and 12% respectively). Marijuana available in dispensaries in some states has average concentrations of THC between 17.7% and 23.2%. Concentrated products, commonly known as dabs or waxes, are far more widely available to recreational users today and may contain between 23.7% and 75.9% THC.

The risks of physical dependence, addiction, and other negative consequences increase with exposure to high concentrations of THC and the younger the age of initiation. Higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis. Edible marijuana takes time to absorb and to produce its effects, increasing the risk of unintentional overdose, as well as accidental ingestion by children and adolescents. In addition, chronic users of marijuana with a high THC content are at risk for developing a condition known as cannabinoid hyperemesis syndrome, which is marked by severe cycles of nausea and vomiting.

This advisory is intended to raise awareness of the known and potential harms to developing brains, posed by the increasing availability of highly potent marijuana in multiple, concentrated forms. These harms are costly to individuals and to our society, impacting mental health and educational achievement and raising the risks of addiction and misuse of other substances.  Additionally, marijuana use remains illegal for youth under state law in all states; normalization of its use raises the potential for criminal consequences in this population. In addition to the health risks posed by marijuana use, sale or possession of marijuana remains illegal under federal law notwithstanding some state laws to the contrary.

Marijuana Use during Pregnancy

Pregnant women use marijuana more than any other illicit drug. In a national survey, marijuana use in the past month among pregnant women doubled (3.4% to 7%) between 2002 and 2017. In a study conducted in a large health system, marijuana use rose by 69% (4.2% to 7.1%) between 2009 and 2016 among pregnant women. Alarmingly, many retail dispensaries recommend marijuana to pregnant women for morning sickness.

Marijuana use during pregnancy can affect the developing fetus.

  • THC can enter the fetal brain from the mother’s bloodstream.
  • It may disrupt the endocannabinoid system, which is important for a healthy pregnancy and fetal brain development.
  • Studies have shown that marijuana use in pregnancy is associated with adverse outcomes, including lower birth weight.
  • The Colorado Pregnancy Risk Assessment Monitoring System reported that maternal marijuana use was associated with a 50% increased risk of low birth weight regardless of maternal age, race, ethnicity, education, and tobacco use.

The American College of Obstetricians and Gynecologists holds that “[w]omen who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use. Women reporting marijuana use should be counseled about concerns regarding potential adverse health consequences of continued use during pregnancy”. In 2018, the American Academy of Pediatrics recommended that “…it is important to advise all adolescents and young women that if they become pregnant, marijuana should not be used during pregnancy.”

Maternal marijuana use may still be dangerous to the baby after birth. THC has been found in breast milk for up to six days after the last recorded use. It may affect the newborn’s brain development and result in hyperactivity, poor cognitive function, and other long-term consequences. Additionally, marijuana smoke contains many of the same harmful components as tobacco smoke. No one should smoke marijuana or tobacco around a baby.

Marijuana Use during Adolescence

Marijuana is also commonly used by adolescents, second only to alcohol. In 2017, approximately 9.2 million youth aged 12 to 25 reported marijuana use in the past month and 29% more young adults aged 18-25 started using marijuana. In addition, high school students’ perception of the harm from regular marijuana use has been steadily declining over the last decade. During this same period, a number of states have legalized adult use of marijuana for medicinal or recreational purposes, while it remains illegal under federal law. The legalization movement may be impacting youth perception of harm from marijuana. 

The human brain continues to develop from before birth into the mid-20s and is vulnerable to the effects of addictive substances. Frequent marijuana use during adolescence is associated with:

  • Changes in the areas of the brain involved in attention, memory, decision-making, and motivation. Deficits in attention and memory have been detected in marijuana-using teens even after a month of abstinence.
  • Impaired learning in adolescents. Chronic use is linked to declines in IQ, school performance that jeopardizes professional and social achievements, and life satisfaction.
  • Increased rates of school absence and drop-out, as well as suicide attempts.

Risk for and early onset of psychotic disorders, such as schizophrenia. The risk for psychotic disorders increases with frequency of use, potency of the marijuana product, and as the age at first use decreases. 

  • Other substance use. In 2017, teens 12-17 reporting frequent use of marijuana showed a 130% greater likelihood of misusing opioids.

Marijuana’s increasingly widespread availability in multiple and highly potent forms, coupled with a false and dangerous perception of safety among youth, merits a nationwide call to action. 

You Can Take Action

No amount of marijuana use during pregnancy or adolescence is known to be safe. Until and unless more is known about the long-term impact, the safest choice for pregnant women and adolescents is not to use marijuana.  Pregnant women and youth–and those who love them–need the facts and resources to support healthy decisions. It is critical to educate women and youth, as well as family members, school officials, state and local leaders, and health professionals, about the risks of marijuana, particularly as more states contemplate legalization.

Science-based messaging campaigns and targeted prevention programming are urgently needed to ensure that risks are clearly communicated and amplified by local, state, and national organizations. Clinicians can help by asking about marijuana use, informing mothers-to-be, new mothers, young people, and those vulnerable to psychotic disorders, of the risks. Clinicians can also prescribe safe, effective, and FDA-approved treatments for nausea, depression, and pain during pregnancy. Further research is needed to understand all the impacts of THC on the developing brain, but we know enough now to warrant concern and action. Everyone has a role in protecting our young people from the risks of marijuana.

Overcoming Temptation (The Jesus Way)

“Let no one say when he is tempted, ‘I am tempted by God;’ for God cannot be tempted with evil and he himself tempts no one; but each person is tempted when he is lured and enticed by his own desire. Then desire when it has conceived gives birth to sin; and sin when it is full-grown brings forth death” (James 1:13-15, RSV).

By Steven Barto, B.S. Psych.

PERHAPS YOU’VE HEARD IT SAID “sow a thought, reap an action; sow an action, reap a habit; sow a habit, reap a character; sow a character, reap a destiny.” There is a basic concept at work here which involves obsession and compulsion. Watchman Nee (1903-1972) was a Christian leader and teacher who worked in China during the 20th century, helping to establish numerous churches in that region of the world. Nee wrote, “It is a pitiful and tragic thing to be obsessed. Those who are obsessed are in a very abnormal condition.” He said obsession encompasses lying and deception. The obsessed Christian lies to himself, pretending there is no problem with his behavior. This self-deception becomes thick like fog, making it nearly impossible to see beyond obsessive thought and habitual action.

What is Obsession?

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I have been prone to obsessions throughout my life. Psychology teaches us that obsessions are “recurring thoughts, urges, or images that are experienced as intrusive and unwanted and, for most people, cause anxiety or distress. The individual tries to ignore them, suppress them, or neutralize them with a different thought or action.” The specific details of obsessions can vary widely. For example, they might include thoughts about contamination, a desire for order, taboo thoughts related to sex or religion, or a compulsion to harm oneself or others. Obsessions can revolve around activities that provide pleasure or escape, especially relative to alcohol, drugs, gambling, shopping, watching pornography, or eating.

At this stage, the brain is typically focused on the so-called benefits of a particular action or habit rather than the negative consequences. One hallmark of an obsession involves what some addictions counselors refer to as euphoric recall. At first blush, this might sound “warm and fuzzy.” Relative to substance abuse, however, this is associated with remembering past drinking and drugging experiences in a positive light, while overlooking negative experiences associated with it. I heard someone at a 12-step meeting say, “Play the tape all the way through.” Huh? He expounded: “Look past the high and the fun and the escape, seeing the eventual consequences of taking that first drink or drug.” In other words, remember the ugly results. 

What is Compulsion?

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Compulsions are “repetitive behaviors or mental acts that one feels compelled to do in response to an obsession or based on strict rules.” Typically, such behaviors are meant to counter anxiety or distress or to prevent a feared event or situation, but they are not realistically connected to these outcomes, or they are excessive. Although rare, obsessive thoughts and compulsive actions can lead to Obsessive-Compulsive Disorder (OCD), as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). A person suffering from OCD is often plagued by obsessions or compulsions that take up more than one hour a day or cause clinically significant distress or impairment for the individual. In order for this diagnosis to stand, all other potential disorders involving similar symptoms must be ruled out. Psychiatrists and psychologists call this procedure differential diagnosis.

The Book of James

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James 1:13-15 explains the process of obsessive thoughts in the believer that lead to temptation and sin. The apostle gives us a few key points to think about.  We must remember that James said when we’re tempted, not if we’re tempted. It is inevitable that we’ll be coaxed or seduced (essentially “baited”) to disobey God’s Word. The foundation of such temptation can be demonic or fleshly. It can have physical or psychological roots, or, frankly, both. For example, the enticement to take a drug or to watch pornography has a physical component of pleasure and escape, but it might also have an emotional or psychological component. Depending on your circumstances, such as severe physical pain, the enticement can be nearly impossible to resist. From a psychological viewpoint, the inducement can be pride, anxiety, depression, or boredom. In my experience, both physical and psychological enticement can be equally compelling. The perfect storm, especially for me, is when both mechanisms are at play!

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James is quick to tell us that temptation is a solicitation from the devil to do wrong, and is never directed by God (1:13). Satan doesn’t want us to think about the how of our temptation. Instead, he wants us to obsess over the temporary pleasure to be gained when we give in to what is baiting us. The devil will deceive us about the results of taking the bait. Perhaps we’ll buy into this action as having some type of relief or benefit. That’s why deception is his “go-to” device. Our habitual sin is rooted in automatic (compulsive) behavior, focused only on temporary pleasure or escape. Hand-in-hand with the thought that God does not tempt us to sin is the fact that temptation is strictly an individual matter (1:14).

Eugene Peterson places verses 2 through 18 under the heading “Faith Under Pressure.” In his translation The Message, he writes, “Don’t let anyone under pressure to give in to evil say, ‘God is trying to trip me up.’ God is impervious to evil, and puts evil in no one’s way. The temptation to give in to evil comes from us and only us. We have no one to blame but the leering, seducing flare-up of our own lust. Lust gets us pregnant, and has a baby: sin! Sin grows up to adulthood, and becomes a real killer.” It’s critical that we see what James is teaching us on temptation. He is saying we are lured away from God in the midst of trials by our own desires. It is my experience that temptation is specific to that which I personally find pleasurable. Not everyone is prone to finding relief at the bottom of a bottle or from a handful of opiate painkillers, as I have been. Not all men or women are enticed by pornography. These wiles are specific to each of us, which makes them harder to resist.

On one level, we simply want to sin. Paul taught us this in the seventh chapter of Romans. He says, “But sin, seizing the opportunity afforded by the commandment, produced in me every kind of coveting. For apart from the law, sin was dead” (7:8, NIV) [italics mine]. He reminds us that the law is spiritual, but at our core, that is in the flesh, we are not spiritual. We’re sold as a slave to sin (7:14). Prior to giving his life to the Way of Jesus, Paul was a “Pharisee among Pharisees,” well-educated at the feet of the renowned rabbi Gamaliel. He knew the Law front-to-back. He felt justified in persecuting and murdering Christians as members of a heretical sect of Judaism. No doubt he believed he was helping to protect Israel from the wrath of God.

It is important to note that Paul, a highly-educated Jew who was called to preach the Good News to the Gentiles, and had undergone spiritual conversion on the road to Damascus, still recognized his struggle in the flesh. Exasperated, he said, “I do not understand what I do. For what I want to do I do not do, but what I hate I do. And if I do what I do not want to do, I agree that the law is good. As it is, it is no longer I myself who do it, but it is sin living in me. For I know that good itself does not dwell in me, that is, in my sinful nature. For I have the desire to do what is good, but I cannot carry it out” (7:15-18, NIV).

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Be careful, though, for it is possible to allow Paul’s struggle to become a loophole with which you will excuse your own wilful sin. I’ve been there, thinking, If even Paul can’t resist the flesh, then how can I? (See my blog article Do You Look for Loopholes as a Christian?) Wilful sin, however, is anathema to repentance, which literally means “to turn away from.” To repent is to do a 180 and never look back.

So Now What?

Repentance involves having the will to change; to never be the same again. If temptation is so difficult to resist, then what is its purpose in the life of the Christian? We know that sin occurs when we yield to enticement and make a wrong decision regarding our behavior. The dynamics of that mental and emotional process is complex. Although we’ve been freed from being a slave to sin (see Romans 6), we haven’t completely lost our taste for sin. Desires will remain in our flesh for as long as we live in a physical body. What we cannot excuse, however, is the practice of sin. Paul notes this problem in Romans 1:32, using the Greek word prasso to describe wilful sin. This refers to performing sin repeatedly or habitually. One definition specifically states, “to exercise, practice, to be busy with, carry on.”

If we are aware of a particular desire personal to us that entices or lures us into sinful behavior, we are responsible for addressing that behavior. Instead, many of us (me included) agree to be tempted, and we get on with practicing the sin. Looking at it this closely truly exposes the mechanism (the “come-on” if you will) and the chronic, repeated behavior associated with that temptation. Let’s be real: We simply “give in” once again and fail to resist the devil.

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Temptation that leads to sin always follows the same process.  There are four steps involved in giving in to temptation:  (1) the bait is dropped, (2) our inner desire is attracted to the bait, (3) sin occurs when we yield to temptation, and (4) sin results in tragic consequences.  To be aware of these principles is to be armed in the face of struggling with temptation. But can a true Christian habitually sin? Many believers wrestle with this question, and often give up and give in, thinking they must not be saved if they cannot stop sinning. Some will even teach that if you have habitual sin in your life you are not really a Christian. One pastor put it to me this way a few years ago: “You don’t have God in your heart.” Ouch! But unfortunately we can have head knowledge about God and Jesus, yet not have the required heart knowledge needed to act according to our beliefs or our intention to do that which is right.

Thankfully, the Bible takes no steps in hiding the sins of key Old Testament figures. Abraham, Isaac, Moses, and David were not super heroes. They were normal men who sinned as Adam did. There is no question that David is one of the Bible’s more prominent figures. Jesus Christ came from the House of David. We are easily inspired by his youthful willingness to fight Goliath, his tender friendship with Jonathan, his worshipful Psalms, and his enduring patience under wicked King Saul. It’s almost hard to believe that this beloved character who’s spoken so highly of in more than half of the Bible’s books would also be guilty of breaking half of God’s commandments. David coveted Uriah’s wife, Bathsheba (2 Samuel 11:2-3), committed adultery with her (11:4) effectively stealing her from Uriah (12:9), lying to him (11:12–13), and eventually having him murdered (12:9).

Others come to mind as well. Noah was a drunk (Genesis 9:20-21). Sarah doubted God and allowed Abraham to have sex with her maidservant in order to help fulfill God’s promise of a son (Genesis 16). Jacob was a pathological liar (Genesis 25, 27, 30). Moses had a bad temper (Exodus 2, 32:19; Numbers 20:11) and killed an Egyptian. Solomon was said to be the wisest man in the world, but he was a sex addict who took over 1,000 sexual partners (1 Kings 11). The prophets, even as they spoke for God, struggled with impurity, depression, unfaithful spouses and broken families. Looking to the New Testament men of God, we see Peter’s denial of Christ (John 18:13-27). Paul persecuted Christians, often sending them to death, before God chose him to lead the Gentile world to Christ (Acts 22:1-5).

Handling Temptation the Jesus Way

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Paul said God intends for us to work out our salvation daily with fear and trembling (Philippians 2:12). Unfortunately, the importance of this verse is lost on many Christians today. It is often used by certain teachers and preachers to instill fear into people, wrongly warning them that they can lose their salvation. (I am working on a blog article on this subject, which will be based on diligent exegesis, to be published at a later date.) Paul was certainly not encouraging believers to live in a continuous condition of nervousness and anxiety. That would contradict his many other exhortations of peace of mind, courage, and confidence in Jesus, the author of our salvation. The answer lies in the Greek word phobou (from phebomai) which Paul uses for the word fear, meaning “to be put to flight.” Paul was likely telling the believers at Philippi to work out their deliverance (salvation) from sin by fleeing from it or, in the alternative, by telling it to flee. This dovetails nicely with James’s admonition, “Submit yourselves, then, to God. Resist the devil, and he will flee from you” (James 4:7, NIV).

The Greek verb for “work out” (katergazesthe) refers to continually working to bring something to completion or fruition. This sounds a lot like the ongoing process of sanctification by which we are “set apart” from our sinful nature for God. Paul describes himself as straining and pressing on toward the goal of becoming like Christ (Philippians 3:13-14).  He teaches that the very essence of salvation is holiness—what he calls sanctification of the spirit. He says good works find their only root in salvation and sanctification. In other words, we are not saved by our good works, but rather we are saved for our good works. It is true that genuine Christians are identified by their fruits. Jesus reminds us that He is the Vine, and God is the Vinedresser (John 15:1). The Vinedresser cuts off every branch that bears no fruit, while pruning the ones that do, making them more fruitful (15:2). This is a great description of the process of sanctification through being pruned and made fruitful.

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The means by which we are able to work out our salvation and resist temptation is grounded in Jesus. If we want to participate in the salvation and restoration of the world, we must live in a manner that works toward that end. We follow Jesus. This includes coming to understand the power in the Name of Jesus: power to break chains, heal minds and bodies, build the Body of Christ, and rely on the Holy Spirit to clarify the truth of the Gospel. Accordingly, we must not cherry-pick the Gospel. We cannot decide to follow Jesus in some aspects of our lives, but go our own way (or, worse, the way of the devil) in others. If we are going to follow Jesus, we must learn the ways in which He leads. Moreover, we need to examine His relationship with the Father. We have to lock on to these methods and follow them with consistency and completeness. Paul reminds us that this is not easy, and James tells us it can only be accomplished by resisting Satan.

Concluding Remarks

The ways and the means promoted and carried out in the world today are designed to take God completely out of the equation. It is no coincidence that America is suffering at the hands of gun violence, murder, terrorism, hatred, bigotry, increased rates of abortion, brokenness (especially regarding the home), addiction, deception, selfishness, illness, and heartache. Surely, wars are fought and won, wealth is accumulated, elections are won, diseases are cured, and victories are posted, but at what cost? The means by which these ends are achieved leaves a hole in the soul of our country. Many people are killed, others are impoverished, marriages are failing apart, addicts are dying at an alarming rate, our schools and other venues have become soft targets for violence, children are being abandoned and neglected, and worldly churches are hawking their watered-down message in the name of Christ. As a result, we’re not moving toward spiritual maturity.

Simply stated, Jesus said, “I am.” He is the way, the truth, and the life. He is the Word in the flesh. The salvation of the world. The Head of the Body of Christ. He said we must repent, believe, and follow Him. We repent by making a decision to turn away from everything we were in the flesh and walk toward Jesus. This must include a change of heart and mind, which is the first step in becoming a new creation in Him. This requires a personal, trusting participation in the reordering of our reality. Lastly, we must follow the Way of Jesus. This involves every aspect of our daily lives, including what we think, how we speak, the manner in which we behave, and how we pray and interact with Christ. To follow the Way of Jesus implies that we enter into a brand new reality that necessarily shapes our character. We cannot separate what Jesus says from what Jesus does and the manner by which He does it, nor can we fail to walk in that same manner.

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Publishing, 2013.

Nee, Watchman. The Holy Spirit and Reality. Hatfield, South Africa: Van Schaik Publishers, 2001.

Peterson, Eugene. The Jesus Way: A Conversation on the Ways That Jesus is the Way. Grand Rapids, MI: Wm. B. Eeardmans Publishing, 2007.