A Deacon Who Won’t Go to AA and Drinks Kratom Daily
Robert, 58, was referred by the court after his second DWI in three years and has been abstinent from alcohol for 30 days. He attends your 12-step facilitation group but has not gone to a single AA meeting. He tells you, “AA is for weak people. I’m a deacon, and my pastor says addiction is a sin, not a disease. I just need to pray harder.” On the importance and confidence rulers he rates importance 8 and confidence 3. He describes drinking as his answer to a divorce two years ago and to chronic low back pain, and he has no primary care provider and no insurance. He also uses kratom powder, 8 to 10 grams a day, bought at a gas station, “to keep the cravings away and get energy for work.” He asks you, “That’s natural, right? It’s fine?”
1. How do you work with his refusal of AA without triggering a power struggle?
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The high importance score and the low confidence score tell you the work is not motivation, it is self-efficacy and fit. Arguing about AA spends the session on the wrong target.
- Roll with the resistance. Reflect it instead of correcting it: “AA feels like the opposite of what you believe about strength.” Every rebuttal you make gives him something to push against.
- Separate the requirement from the route. If the court requires mutual-help attendance, that is a real constraint, and you say so honestly. Then ask what kind of support he would actually use: SMART Recovery, Celebrate Recovery, LifeRing, or Recovery Dharma, several of which are available online and free.
- Use the confidence ruler. “You said three out of ten. What would move it to a four?” That answer is his plan, not yours.
- Mine the values he already has. Being a deacon means service, consistency, and responsibility to a community. Those are recovery assets if you connect them to behavior rather than to doctrine.
- Ask about the pain. Low back pain with no prescriber is a relapse engine. A referral is more useful than another meeting list.
- Document his preference and the alternatives offered in the plan, because “noncompliant with AA” is not a clinical finding.
2. What do you say about the kratom, and what has to be accurate?
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He is asking a factual question with a leading answer already attached, so give the facts plainly and without shaming.
- Ask permission and ask about the function first. “Can I tell you what I know about it, and can you tell me what it does for you?” He is using it for cravings and energy, which tells you what it is treating.
- The accurate picture: kratom is a plant containing mitragynine and 7-hydroxymitragynine, compounds that act on opioid receptors. It is not FDA-approved for any use. It carries dependence and withdrawal, has been linked to liver injury and seizures, and is not a benign herbal tea. Product potency varies widely from package to package, and it can interact with other sedating substances.
- Do not overclaim. It is not the same as a prescribed opioid, and it is not nothing. Avoid both “it’s harmless” and “it’s basically heroin.”
- Connect it to the relapse question. Any opioid-active substance used daily to manage cravings is relevant to his recovery plan, particularly if he might be started on a medication later.
- Suggest he write it down and bring it to whatever prescriber he eventually sees, and note the conversation, his response, and his stated intent in the record.
3. How do you address the pastor’s “sin, not disease” framing so that treatment remains possible?
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Debating theology in a counseling session loses the client and changes no minds, so the task is to find room inside his framework.
- Ask before interpreting. “What does your faith say about people who are struggling?” and “Does your pastor know the whole story?” Many clients hold a version of a doctrine stricter than their own lived experience.
- Present the disease model as a description, not a competing religion. Alcohol use disorder is a chronic condition with relapse risk and effective treatment; that claim can sit alongside moral responsibility, which the disease model does not remove.
- Name shame as a clinical risk. If every lapse is proof of spiritual failure, the likely response to a slip is concealment, and concealment is what turns a lapse into a relapse. Say that to him directly.
- Offer collaboration, not confrontation. With his written consent, ask whether he wants his pastor involved in a family or support meeting, and let him decide. His congregation may also be the strongest resource he has.
- Build the plan around his supports: faith community, a same-faith recovery group if he prefers one, the pain referral, and a concrete confidence-building step. Write it down and review it next session.