Addiction & At-Risk Behavior Among Muslims! Solution Anyone?

By addiction, we mean "out of control, compulsive dependence on a substance" (e.g., alcohol or drug) or a behavior (e.g., gambling, sex or superstitious divination). Astrology is not viewed as a problem in non-Muslim societies even when it is compulsive.

Muslims have had a temporally and spatially successful system of addiction curtailment for over 1400 years. It is a true and tested system unlike any other in the history of mankind. It has aspects of bilateral interdiction: behavior change to impact demand as well as supply. Here, we are interested in altering preferences in order to impact demand.

Addiction, theologically, is forbidden among Muslims. While evidence of pockets of addiction exist, its incidence among Muslims is scantily recorded. In 2011-12, there were about 23,573 registered heroin addicts in Malaysia in a population of 29.5m in 2012, making it a 0.001% incidence. Of them 71% were Malays, presumably Muslims. It also seems to be the case that Muslim addicts either do not know enough about Islam or do not practice it as much as they should^[1].

"Countries with Muslim majorities have the lowest (<2.5 pure alcohol liters) or near lowest (2.50 - 4.99 liters) consumption per capita in the world. However, they have a higher proportion of alcohol consumed being unrecorded (alcohol outside the official regulatory system; WHO, 2015). Although alcohol consumption has been reported to be stable in most Muslim-majority countries, in a few countries (such as Turkey) it appeared to be increasing (WHO, 2015)"^[2].

As to the US, for a brief comparison, below is one report^[3] summarizing the addiction scene. Incidentally, the US population in 2017 was 326m.

1. According to the National Survey on Drug Use and Health (NSDUH), 7 million American adults (aged 12 and older) battled a substance use disorder in 2017.
2. Almost 74% of adults suffering from a substance use disorder in 2017 struggled with an alcohol use disorder.
3. About 38% of adults in 2017 battled an illicit drug use disorder.
4. That same year, 1 out of every 8 adults struggled with both alcohol and drug use disorders simultaneously.

Drug abuse and addiction cost American society more than $740 billion annually in lost workplace productivity, healthcare expenses, and crime-related costs.

According to Counseling Muslims: Handbook of Mental Health Issues and Interventions and the Handbook of Arab American Psychology, there are certain considerations that could be looked into when Muslim individuals seek addiction treatment^[4]. Foremost, it appears:

1. It is crucial to incorporate aspects of Islam into the treatment program. For example, specialized 12-Step groups should focus on Islamic adoptions of the 12 Steps, such as using the Islamic conceptualization of Allah.
2. There should be an emphasis on Islamic principles. Counselors and therapists should be individuals the client can identify with. Most often, male counselors should work with male clients, and female counselors should work with female clients, although this may not always be the case.

There are other problems in the Muslim Community with respect to identification of and treatment for addiction problems. Viewing it as yet another misfortune that has descended upon a once mighty, well put together community, Muslims are essentially clueless. In reality, as has been true about numerous other issues, having assumed a defensive posture the community has been lackadaisical, slow to anticipate or recognize, make corrections and rise up to the challenge. So, there is little or no empathy, scarce resource, limited concrete data, and little if any institutional response. Predominantly, it is not viewed as a disease^[5] but as a self-inflicted, fool-hardy wound and as an act that totally disrespects Islam and is oblivious of the historic context in which Islam initially blossomed. Yet these are our people, our children. We want them to get well and be addiction free. It is a desire of their kith and kin and a duty incumbent on the rest of us. Also, the community has to protect itself from multiple sides: An increase in this group will introduce huge problems down the line. So, it must be addressed right away. Non-Muslims more handy with such issues are going to enter the picture and become the celebrated saviors. That may lead to other better unsaid problems. Yet Muslim society could do a far better job of helping its own addicts and rehabilitating them instead of watching from the sidelines. There are exceptions. One such undertaking is the US-based program addressing Sex Addiction among Muslims: www.purifyyourgaze.com.

So, to see what may be done to assist fellow Muslims in such a predicament, we have initially displayed the 12 step program developed in the US in the 1930s and directed at Alcoholics. Over time, the same model began to be used for other types of addiction.

This element of the approach is a fertile ground for the Muslims, if only they walked the beat and wrote down their analysis and thoughts. Be as it may, it would constitute the long run or strategic template. The short-run or tactical template involves psychological and medical analysis and intervention. The 12 Steps is value-based. It does not address the tactical details that also scream to be taken into consideration. That would be true for a Muslim 12 Steps, too. There is an immense amount of hard work involved in fusing these two strands for a successful therapeutic endeavor^[6],[7],[8].

Muslims literally struggle with new problems

The inability to respond to addiction issues in Muslim countries is not an isolated responsiveness problem. Morocco has been straddled with a devastating unwed motherhood problem. As of 2015, there were 153 babies born out of wedlock daily, 24 of whom were abandoned. "Aicha Chenna of Solidarite Feminine Association reports from a study that between 2003 and 2009, there were 200,000 unwed mothers with 500,000 births - that is 13.46 percent of total births in the kingdom."^[9] Aicha thinks "a lack of sex and preventive education in schools plus societal hypocrisy" regarding illegal sexual practices, especially among young people as the cause behind this rise.

What could she have possibly meant by 'hypocrisy'? Is it pointing out that while claiming to be Muslims, these young people are violating one of the most important moral laws? Also, who is being hypocritical, men or women? In this case, both since both are Muslims. The hypocrisy can only be removed by turning toward Islam, and not farther away from it. Providing condoms and birth control pills along with sex education will sanitize the problem and improve the numbers, but it will do little to mitigate hypocrisy. Could it be like giving alcohol and drugs to alcoholics and drug addicts? She thinks the prayer leaders must be more proactive and open their horizon, saying "Islam is very advanced in terms of sex education."

The question is, "Who is behind times?" The Ulema or people like Aicha? Strangely, back in the 1930's when all else had failed, the addiction alleviation fighters in the West mounted a moral and spiritual rehabilitation campaign. Aicha's approach is an ancient secular approach just as it is now current in western schools, and in keeping with the secular lifestyle of reported unwed Moroccan parents. This approach has not worked in the West in quelling either pregnancy or abortion. So, how does she expect the ulema to be on the same page as her? Then, in the Muslim world context, who is behind times - the Ulema or people like Aicha? Even if it is Aicha who is lacking, the Ulema are not doing a good enough job selling their wares. In fact, Aicha should have called for moral and spiritual outreach and related activities to counter this problem, blaming the Ulema for their ineffectiveness in fielding morality and spirituality.

What Are the Twelve Steps of Alcoholics Anonymous?

The Twelve Steps are a set of guiding principles in addiction treatment that outline a course of action for tackling problems including alcoholism, drug addiction and compulsion^[10].

Step 1: We admitted we were powerless over alcohol-that our lives had become unmanageable.

Step 2: Came to believe that a Power greater than us could restore us to sanity.

Step 3: Made a decision to turn our will and our lives over to the care of God as we understood Him.

Step 4: Made a searching and fearless moral inventory of ourselves.

Step 5: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

Step 6: Were entirely ready to have God remove all these defects of character.

Step 7: Humbly asked Him to remove our shortcomings.

Step 8: Made a list of all persons we had harmed, and became willing to make amends to them all.

Step 9: Made direct amends to such people wherever possible, except when to do so would injure them or others.

Step 10: Continued to take personal inventory and when we were wrong promptly admitted it.

Step 11: Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

Step 12: Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Where Did the Twelve Steps Originate?

"Bill Wilson and Dr. Bob Smith, the two men behind AA, drew their inspiration for the Twelve Steps from the Oxford Group who advocated that all problems rooted in fear and selfishness could be changed through the power of God by following the "Four Absolutes," a moral inventory of "absolute honesty, purity, unselfishness and love," and through public sharing/confession. The Oxford Group also believed in the work of American psychologist William James, particularly his philosophy of pragmatism and "The Will to Believe" doctrine (by changing the inner attitudes of the mind, we can change the outer aspect of life), and William Silkworth, MD, one of the first medical professionals to characterize alcoholism as a disease."

"When AA was founded in 1935 by Bill W. and Dr. Bob as a fellowship of alcoholics working together to overcome their drinking problems, the 12 Steps acted as a set of guidelines for spiritual and character development-a blueprint for recovery. The Twelve Steps serve the same purpose today. As described by Alcoholics Anonymous, following these guidelines "as a way of life, can expel the obsession to drink and enable the sufferer to become happily and usefully whole.""

Now, programs promoting relief from Drug Addiction^[11], Gambling Addiction^[12] and Sex Addiction^[13] also produce the same 12 Steps. That makes sense. After all, the psycho-social ground, the moral ground and the spiritual ground are common in these afflictions.

Further, the 12 Steps above is content hollow from spiritual and moral points of view thereby allowing an individual recovering addict to plug in however much he knows about his faith and however intensely he interacts with it. As a result, the outcomes are uneven. Different addicts from different religions and with different levels of studiousness and religiosity are likely to attain different outcomes. Incidentally, the 12 Steps has been adopted by secular groups who gutted the concept of God from their version^[14].

Composing Muslim experience driven universal 12 steps

Needless-to-say, the Islamic moral and spiritual bases are very thorough and well-tested. They are not the product of any subsequent Muslim scholars through the ages. They are either direct from the Quran or the Sunnah. There is no known controversy. The objective and the game plan are crystal clear.

In writing up a 12 Step approach from the Muslim society's point of view, we incorporated a known therapeutic step as the first point and lowered the traditional Step 1 to Step 2. Also, since the Muslim experience has been holistic, we make the point at the outset that such a model is for all forms of addiction. So, the recovery foreseen here is in the spirit of entering submission wholeheartedly: udkhulu fis silmi kaffa (2:208).

The Steps 8, 9 and 10 are replaced in our version with Steps 7 and 8. In Steps 8 and 9, one will notice a combination of "Istighfar" and Tawba". After all, a genuine repentance needs both of them. Also, in Step 8, we make clear that any mandated confession is to Allah alone, As-Sitteer, and not to any other human being. The original form carries a Catholic confessional element. However, a voluntary admission to a trustable, concerned person has values other than that of expiation.

In Step 11, we felt that the opportunity had to be taken to flesh out relationship with God regarding the highest station of faith, 'Ihsaan' - the original, spiritual definition of mindfulness. The Step 12 is about finding something useful to do upon recovery that is likely to keep the former addict in recovery. In our version, it reflects Suratul 'Asr. Since Muslim addicts have a reduced knowledge base and habit of practice, our version of 12 Steps seeks a spiritual reintroduction. Overall, in our rendition, while there are certain aspects of creed (aqida) - Tawhid and Akhirah, the presence of elements of character (akhlaq) is significant.

Using the concept of "la ikraha fiddeen" - there is no compulsion in religion (2:256) and the knowledge that the Islamic approach is holistic, our drafted version of 12 Steps is dubbed 'Totally Personal Total Choice 12 Steps'.

Totally Personal Total Choice 12 Steps

1. Disaster Awareness. Situational awakening about the utterly pathetic, painful, abusive and injurious futility of unmitigated, morbid, singular dependency on alcohol, drugs, gambling, sex, or divination as a safe, secure, balanced, happy, long-lived, stable, promising lifestyle.
2. Helplessness. Feeling inadequate, of being less than self-sufficient, powerless in face of a dark monstrosity that has overtaken normalcy creating umpteenth hazard, strewing random hurdles and "leading from light into darkness".
3. Hope. Recognizing that there is redemption and hope, "despair and sadness" can be a thing of the past regardless of "the evil whispering of the evasive whisperer, non-human and human, who whispers into the human chest".
4. God Comprehension. For a direct flight out of chaos and danger into harmony and peace, connecting and forming alliance with "the Supreme Arbiter" of this life and the next, the Composer of the operating manual governing man's life and destiny, the Hope of the hopeless, "the One and Only, the Self-Sufficient, the Beginning and the End, the Apparent and the Hidden, the Almighty and the Wise, the Forgiving and the Loving, the Thankful and the Forbearing, the Discounting and the Generous, the Oft-Returning and the Merciful".
5. Active Obedience. Fully functional submission to God, "the Knower of All Things Covert and Overt, the Knower of All Things Subtle, the Inventor, the Maker and the Shaper (of man)" for forgiveness and guidance for a permanent resolution that brings immediate as well as long lasting, confidence building relief as it uplifts the spirit, heals the heart, educates and calms the mind by separating right from wrong, and kind from harsh, spelling out rights and duties, and the do's and the don'ts for a wholesome, dynamic private and public life.
6. Intentional-Incremental-Consistent. Making all good work intentional and remembering that the job best done in God's eyes is the one done with regularity even if it is as small as giving an M&M, or failing which "owing to poverty giving a simple smile", and that failures are designed to test quality of faith and make us stronger through reflection and humility as we pull our act together once again and get back into thick of things. Only then failures will be temporary. One thing to take note: a believer never puts his hand in the same hole twice.
7. Inventory. Taking stock - continually, now and on an everyday or fixed period basis, meaningfully recalling the excesses and the follies, the victims and the spoils of a life however imprudent, arrogant, mendacious, treacherous, lecherous, boorish, or wanton it may have been. Getting ready to make amends now and into the future.
8. Repentance and Reparation. Voluntarily atoning to "the Concealer of Sins": by being transparent and accountable to God Alone for having produced every trash that has blighted own and others' lives. However, sharing with one other sympathetic, listening, privacy conscious, fellow human in a non-confessional setting appears to carry a significant practical value of unburdening or relief. Also, whenever possible, making direct or indirect admission and/or material amends to those hurt or harmed.
9. Redirection and Courage of Conviction. With a finality of commitment to follow the Divine guideline for a life well lived, and adhering to "Fair Play and Goodness" as a part and parcel of life and steering clear of "lewdness, wickedness and disorderliness".
10. Heart Welfare. For "a sound heart" - the visa to enter Paradise, giving a wide berth to "hypocrisy, vanity in submission, lying and betrayal and standing well clear of slander, backbiting, pride and jealousy".
11. God is Number One. Continuing the lifelong mission of remembering that we have been created only to worship God. So, everything we do, we should do on account of and for God: "my prayer, my sacrifice, the way I live and the way I die are for the Lord of the Worlds". "No doubt, I am close, responding to the call of every caller when he calls upon Me. So, let them respond to Me and believe in Me so that they may be guided". True mindfulness is "being able to see God while praying; else, knowing that He sees you when you turn toward Him in submission"!
12. Serving Self and Others. Upon recovery, assuming dual responsibilities by first dutifully continuing with the commitment to "belief and goodness" and then "joining others to promote truth and patience". This allows leading a life absent a losing account. Sharing the obnoxious truth about addiction and its inevitable defeat via hope in God as well as patiently pursuing His commands would be an example.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450010/ [Iran J. Public Health. 2015 Jan; 44(1): 22-27.

[2] https://quod.lib.umich.edu/j/jmmh/10381607.0010.103/--ten-years-of-substance-use-research-in-muslim-populations?rgn=main;view=fulltext [Cynthia L. Arfken and Sameera Ahmed, "Ten years of substance use research in Muslim populations: Where do we go from here?" J. of Muslim Health, Vol. 10, Issue 1, Summer 2016

[3] https://americanaddictioncenters.org/rehab-guide/addiction-statistics

[4] https://americanaddictioncenters.org/faith-based-addiction-recovery/islam

[5] Even in the West, when the response began, it began at the hands of recovering addicts. The disease classification arose either from them or from the professionals serving them. Incidentally, the incidence of mass, multiple addictions in multiple countries simultaneously appears to be a modern day phenomenon. It is also likely to have affected the economically advanced nations first. Thus, Muslims nations, placing largely at the back of the bandwidth, are facing these problems more acutely only recently.

[6] Dianne Doyle Pita, "Addictions Counseling", The Crossroad Publishing Co., NY, 2004; ISBN: 0-8245-2262-1

[7] Robert Weiss. "Sex Education 101", Health Communications, Inc., Deerfield Beach, FL 33442-8190, 2015; ISBN: 13-978-07573-1843-6

[8] Wexler, Arnie and Sheila, "All Bets Are off", Central Recovery Press, Las Vegas, NV 89129; ISBN: 978-1-937612-75-7

[9] www.Moroccoworldnews.com "13.4%of Moroccans are Born Out of Wedlock", March 12, 2015

[10] https://www.hazeldenbettyford.org/articles/twelve-steps-of-alcoholics-anonymous

[11] https://www.drugrehab.com/recovery/narcotics-anonymous/

[12] https://www.choosehelp.com/topics/gambling-addiction/gamblers-anonymous-12-steps-of-recovery.html

[13] https://www.recovery.org/support-groups/sexaholics-anonymous/

[14] https://aaagnostica.org/alternative-12-steps/