An interview with Darv Smith, M.D.
Darv Smith is a physician, a certified addictionologist and a member of the American Society of Addiction Medicine. He also serves as Vice President of the International Substance Abuse and Addiction Coalition (ISAAC). He and his wife, Carol, have led many Addictive Behavior Counseling (ABC) schools for Youth With A Mission. We interviewed Darv on Jeju Island, South Korea, where he was leading the most recent ABC school.
STEPS: When did you become interested in working with addicts? It wasn’t a focus for you in medical school, was it?
Darv: Not really. Like many new physicians in 1969, I volunteered time in the emergency room of a local hospital, in addition to starting my medical practice. It was in that emergency room that I saw many alcoholics and drug addicts. I enjoyed working with them, and very soon the hospital asked me to be the medical director for several halfway houses in the area.
STEPS: What was it like to work at the halfway houses?
Darv: I didn’t know much about addictions then. Medical schools provided very little training about addictions. So I did a lot of listening. I went to open A.A. meetings. My first impression was, I’m no different from these folks. But I don’t have an alcohol or drug problem. How can that be? I didn’t understand at the time what this familiarity was about. It took me years to figure out how the addictive process manifested itself in my own life. But I knew that I felt comfortable working with addicts.
I worked mostly with alcoholics until I also became involved in a local free clinic, the People’s Clinic, which had a program for heroin addicts–mainly a methadone program. I enjoyed getting to know the addicts, but I observed that very few of them got off drugs. Most of them just added methadone to the list of drugs they abused. Maybe they would use methadone all week and then use their preferred drugs on the weekend. Often clients would be dealing drugs at the methadone clinic because it was understood that the police couldn’t interfere with the operation of the clinic or arrest anyone on clinic property. So I started early in my medical practice to learn a lot about addictions.
I also started a hospital-based treatment program for alcoholics with psychiatric disorders, dual-diagnosis patients. We did groups every day and sent people to local A.A. meetings and the usual things you do in hospital treatment programs. It was a wonderful resource for the local Twelve Step community because they had a place to send people to detox and to be evaluated. Prior to this time no resources of this kind were available in the area. I also did psychiatric evaluations and addiction evaluations for the county as part of the criminal justice system. So I got to know something about addictions in the context of incarceration.
STEPS: You started one of the first day-treatment programs in the country, didn’t you?
Darv: That’s right. After a patient in detox at a private psychiatric hospital jumped out a window, the hospital staff realized they needed help from someone who understood addictions. So they hired me to develop a treatment program and to train the staff. I was interested in holistic health, so I kept trying to include nutrition, exercise, stress management, spirituality and things like that in the treatment process. It doesn’t seem that radical today, but back then it was fairly ambitious.
When it became clear after a few years that a holistic approach was not a good fit for that hospital, I resigned and took some time to pray about where I was and where I needed to go next. A colleague of mine, a Catholic priest who left that treatment program about the same time that I left, joined me in forming a new treatment program in our community. All the staff members were Christians, and most of them were themselves recovering from addictions. Special training programs for addiction treatment professionals were very limited then, so all of us on staff went to many places trying to learn how to do this well.
We opened the Whole Person Health Center in 1980. It was a day-hospital program, now also called a partial hospitalization program. We were accredited as a psychiatric hospital without beds, which was unusual for that time. Clients were on site from nine in the morning until four in the afternoon, Monday through Friday. To the best of my knowledge it was the first community-based day hospital for alcoholics in the country.
People didn’t think at the time that you could treat alcoholism without a 24-hour residential program. It took a while to gain acceptance. One of the key events was when the wife of the president of a large multinational corporation who lived in the area was admitted for abuse of prescription drugs, mostly sedatives. She had been through several psychiatric hospitalizations, with little or no benefit. But she did very well in our program. Her whole family got help. Her husband’s comment to me was, “You can’t just do this here. You need to do this internationally.”
STEPS: This is the first time you’ve used the word international in our conversation. Was this the beginning of your interest in addictions from that perspective?
Darv: Well, it was part of it. We were also being encouraged by a friend to participate in a discipleship training program offered by Youth With A Mission (YWAM). The program was called Crossroads, and it was well optimized for people in mid-career. It was a very positive experience for us. During the program we decided to participate also in the outreach component of the program, which involved 12 weeks of work in Thailand, Singapore, Malaysia, Hong Kong and China. Not long after that, we went back for three more months to another YWAM program: their introduction to counseling. These were both multicultural experiences, so we got a lot of international experience just from the courses.
I suppose there were parts of my family background that helped me to be open to international work. Although we didn’t travel much as a family outside the U.S., my father traveled a lot internationally. And my sister and her husband served as missionaries in a Christian school in Guatemala. We had visited them on several occasions, and two of our kids went to school down there. So gradually our family became relatively comfortable in cultures different from our own.
STEPS: It does sound like the YWAM experiences created a turning point for you.
Darv: They did. We thought at first that we might go to China and work as missionaries. But when we shared this vision with some trusted friends, one of them said, “I think it might be better for you to train others to be missionaries.” That made a lot of sense to me.
STEPS: So what did that look like?
Darv: I kept working as a physician for some time, but not long after that, YWAM asked us to consider setting up an Addictive Behavior Counseling school. They saw the need, both in their students and in the communities they had been called to serve, and they knew that missionaries would be a lot better off with a basic understanding of the addictive process. So our first school, in 1989, was attended by students from five countries. I modeled it after the kind of program we had developed for alcoholics in the day hospital, but with a lot more teaching. We had process groups and support groups, and we required that students attend Twelve Step groups in the community. There was a lot of resistance to this by some in leadership positions, but in general it was accepted.
STEPS: It seems like a stroke of genius to decide to train missionaries by doing the same things you do to treat alcoholics.
Darv: Well, yeah. We didn’t tell them, of course, that we were treating them as if they were addicts. We just did it. And I think it worked well; for some it was a life-changing experience. We did the outreach component of the first school in India, Singapore and Malaysia, and we learned a lot.
There was resistance, of course. One student in that first school, a medical professional, thought the whole thing was not biblical. He was always quoting Scripture and saying we were doing “secular” things. Some students agreed with him, and we were pretty discouraged by the end of the first school. I think I was ready to quit and go back to work as a physician. But in praying about it we felt we should move ahead and also involve some other people as co-leaders in the training program so that the burden wouldn’t fall so heavily on us.
STEPS: A lot of people reading this article will understand what it feels like to develop a recovery ministry in the Christian community and to be met with this kind of resistance.
Darv: You have to expect resistance. Most people do not understand the addictive process. But we also made some mistakes. For example, we made some poor choices in who to invite as guest speakers. We had a lot to learn, and the learning process was painful for us. But learning is often like that.
STEPS: So it took some time to adjust to the culture in which you were working. But you kept at it. You’ve done quite a few of these schools now, right?
Darv: Yes. This is the twelfth Addictive Behavior Counseling school that YWAM has sponsored. We had five in Hawaii, then several in Amsterdam, then one in Switzerland with an outreach to Mongolia and Russia, and last spring we did one in Kiev, Ukraine, and this is our first in Korea. In most cases we have experienced resistance of various kinds, and in all cases we have learned more.
STEPS: A theme is emerging here. The tone of your voice reflects the persistence that must have been required to continue these schools. You meet resistance, but you persist.
Darv: Yes. For example, in Amsterdam a leader of a local coffee-house ministry was dead-set against the Twelve Steps. He thought they were demonic, certainly unbiblical in some way, and when we arrived in Amsterdam he circulated some anti-A.A. literature. So it was not entirely a welcoming environment. But persistence was important.
STEPS: What’s the long-term vision?
Darv: We would eventually like to see Addictive Behavior Counseling schools available on every continent, every year. Recently Carol and I have changed our focus to mentoring younger leaders for these schools rather than organizing the schools ourselves.
STEPS: In addition to setting up the Addictive Behavior Counseling schools through YWAM, you have been involved in several other interesting projects. Tell us about the Mongolian project.
Darv: In 1993 a Swiss missionary nurse applied to our school but didn’t actually come because she decided instead to go to Mongolia. While she was there she learned that the national Ministry of Health was interested in doing something more helpful for alcoholics. Their only approaches to treatment used Russian methodologies that didn’t work. So she helped put together a joint project between the Ministry of Health and a ministry called Joint Christian Services to train medical doctors in Twelve Step methods of rehabilitation. Absolutely nothing of that sort was available at the time in Mongolia.
Initially we trained only five doctors. I became the main consultant for the program, partly because the Mongolian doctors could not hear anything unless it came from another doctor. That was a cultural reality we had to deal with. We were basically teaching the Twelve Step model, and it was not an easy sell. The doctors wanted to use group time to teach. And the program was only three hours a day because the doctors didn’t want to work in the afternoon. In addition, the doctors wanted to lead the A.A. meetings themselves.
I had to teach them the most basic things, all the A.A. guidelines. We were really starting from scratch. I think gradually the doctors started to understand the program. And some meetings began in the community. Our goal was to train a small number of doctors to become trainers. But we also had workshops for all the doctors who had been trained in the Russian method. That was 50 people, mostly women, because most Mongolian doctors are women. We managed to help start both A.A. and Al-Anon. And now one of our Korean colleagues is working to expand the program into some of the poorer parts of Mongolia. So we will be going back. Several medical doctors in the program have become Christians, and I think a good start has been made on developing recovery resources for the country.
STEPS: You have also been involved with the International Substance Abuse and Addiction Coalition (ISAAC). Tell us something about that.
Darv: ISAAC is a networking organization for Christians who work in the field of addictions. It is relatively new, but it is also very interested in developing international training programs for addiction workers. It has sponsored training programs in Egypt and in Russia. I think the main goal for ISAAC is to help people working in the addiction field, all addictions, worldwide.
STEPS: It seems to me like an unbelievably wonderful thing that God has done. Fifteen years ago nobody had a passionate commitment to train Christians internationally to do recovery ministry, and now at least two organizations are headed in this direction. And there are others as well. I know there’s still a long way to go, but this seems like really hopeful stuff to me.
What is it about leading recovery groups that you’ve found to be the most difficult to communicate to people in various cultures?
Darv: The basic guidelines are sometimes very difficult to communicate. The idea that you can just listen. Not teach, not give advice. That is a shock to people. And of course, the idea that shame doesn’t help. People in many places still think that increasing shame is part of the solution. I call it shame induction therapy. Part of the miracle of A.A. and the whole Twelve Step movement is that it understands that shame is part of the problem and not part of the solution. That truth is so powerful and so simple, but it often is not easy to communicate to people who have not directly experienced it themselves.
I remember when we first went to an A.A. meeting in Siberia we found that they had someone teaching. People sat in rows and there was lots of cross-talk going on while the teacher taught! It was really more of a seminar or class than an A.A. meeting as we understand it. In another place we observed a treatment program. They said “Oh yes, we have groups every day.” But when we actually looked at what they called groups it was people sitting around playing games or watching television. They weren’t working on issues or feelings or sharing any experience, strength and hope. So when it’s appropriate, we offer to demonstrate what it’s like to do a group without cross-talk. I think it was important to actually do a group with them so that they could see it in practice.
STEPS: In the U.S. you can often go to a dozen local groups and observe group process and how leadership functions. But in many parts of the world there’s no place to go to learn these dynamics.
Darv: That’s true. It is important to start by finding out everything that’s available. Sometimes I’m surprised by what we find. Also, we make it a priority, when we are working in a new area, to translate some basic materials, usually at least The Big Book of A.A. and the Twelve Steps and Twelve Traditions. A.A. World Services was very helpful in getting the Mongolian materials printed and providing free copies of materials for our use. And where we have conducted ABC schools we’ve translated the materials. For this current school in Korea we’ve been working for almost three years to get books translated into Korean for use by our students.
STEPS: I have a kind of Is-the-glass-half-empty-or-half-full question: What is your overall assessment of the state of the Christian recovery movement in the world?
Darv: In most parts of the world there is the feeling that alcoholism and drug addiction are hopeless problems. People see very little possibility for recovery. This is true even in places that have some resources. In the Christian community the attitude is not so much hopelessness but a form of denial. What we hear is, “Well, we will just pray for deliverance and everything will be okay.” So hopelessness and denial are pretty much what’s out there. On the other hand, we have seen a gradually increasing openness to recovery. You can find programs all over the world now where Christians are starting to make progress on this front. Betel, which started in Spain, for example, is now in 10 countries, working with mostly late-stage street addicts. That’s just one example of reasons for hope. It seems that God doesn’t give in to hopelessness as quickly as we do.
STEPS: I go back and forth between feeling that we’re starting to make progress and feeling that the resources are few and that hopelessness is always at the door. But so much has happened in the last decade or so. Fifteen years ago, when I started working in this area, it was very difficult to find other Christians interested in doing recovery ministry in the U.S. Now there are Christians all over the world trying things, making mistakes, learning from their mistakes and moving forward. That’s a huge difference.
What would you suggest to STEPS readers who are interested in doing recovery work internationally?
Darv: Well, first I’d encourage them to visit the population group they’re interested in, especially visit the alcoholics and addicts. If the region has Twelve Step groups, visit those; if not, visit prisons. Many areas don’t have programs or treatment facilities of any kind but might have places where people are held until their families can pick them up the next day.
Also, try to talk to people in various positions in the country. Learn as much as you can. Talk to government officials and health workers. Listen to their perspectives on the problem, and find out what kind of help they might want.
STEPS: It sounds like, in addition to knowing something about recovery, it would be helpful to have some cross-cultural skills.
Darv: Absolutely. Any kind of cross-cultural training is helpful. Get as much as you can. Addiction is pretty much the same everywhere. That’s why we can carry the message to others cross-culturally. But building a sensitivity for cultural differences is also helpful, because those differences can easily get in the way of carrying the message effectively.