by Dr. Michael Smith

Presented at NADA Annual Conference in New York City, 1995.

The Serenity Prayer
God, grant me the serenity to accept the things
I cannot change,
Courage to change the things I can,
And wisdom to know the difference.
~ Reinhold Niebuhr

When I do the training program at Lincoln, I point out to students that we’re really training them in two abilities, each one expanding upon the other. The first is the ability to put needles in appropriately and correctly, and to run the group setting and so on. The other is the ability to integrate what acupuncture is about with what substance abuse recovery, and substance abuse treatment, is about. This isn’t easy — it has to grow out of personal experiences. It has become clear to me as time goes on that when people ask what acupuncture is about, it’s quite a bit different than what some people might understand, though many of us already do understand what I am teaching.

I use the word “spiritual” because I think it is so commonly used in the drug and alcohol recovery field that we are not frightened by the term. First of all, you have the idea of enlightenment in spiritual development. In the Buddhist sense of enlightenment, your body is lighter, your stress is lighter. I believe acupuncture is very much about enlightenment. Things move quicker, Qi moves more easily.
Enlightenment means you are lighter in regards to all the associations therapists like to bring up. Your memories are lighter, your experience of trauma is lighter, your burdens are lighter. Life is not holding you down as much. Enlightenment also has a lot to do with the 12-step phrase, “Let go.” If you let go of authority and control, you will, in turn, gain it. But first you must let go. Acupuncture helps people do this. Acupuncture is productive therapy and helps therapists be more effective in what they already do.

Secondly, acupuncture relates to spiritual development through the awareness or experience of solitude and privacy. Even in settings like 12-Step groups, spiritual development is still essentially a personal and private matter. You are able to affirm, “I’m not only lighter, but I’m within my own space. I can have solitude and privacy even when other people are around.”

I remember one time in the midst of one of our many administrative harassments, our director wanted to drill a hole in the cement floor of the acupuncture room. Workers brought in an air hammer at 10 in the morning with about 20 patients sitting around. I was quite annoyed. It was insulting and contrary to what our program was about. So the air hammer started, and I turned around and looked at the patients. They were sitting there quietly. Generally, if you are in a setting like that and the person of authority shows annoyance, people get riled up. In this case, that did not happen. No one moved or made a sound. Later, I understood their behavior, realizing that many people have a mental air hammer going all the time, and, therefore, have learned to tolerate merely external noises. Quiet is something we develop — it can’t be measured in decibels. Privacy, lightness and solitude belong to us — and not to the sound system.

Another aspect of spiritual development is that people can learn to be in the present — one day at a time, one minute at a time, one second at a time. If you are meditating or relaxing, you need to be where you are and not bring in the past or jump to the future. Acupuncture easily accomplishes this present-ness.

We should also consider the question, “What is spiritual development about?” Many of us think, “Well, yeah, I meditate, I do this, I do that.” But when we’re talking about drug and alcohol treatment or severe trauma, that’s not the kind of spirituality we’re talking about. We’re talking about walking out in the desert – about feeling lost and without clear direction or guidance. We’re talking about the spirituality of adolescence, which is without question the most spiritual time we live through. Without question because there is always challenge there: “Who am I? Where am I? What is my essence? What is going on?” The challenge is there because Nature puts it there.

Ask people who are using drugs something like, “What do you want to do next month?” and they will just tell you “stuff.” It won’t be true or useful, it will just be stuff. But if you ask people who are one-week clean the same question, it’s not a sympathetic question because there are too many unknowns. At this point, it feels like you’re harassing them. You’re saying, “Let’s pretend all these things are known, because I don’t want to deal with your spiritual crisis. I want you to be part of this particular clinical or social plan.” Then they hear all those other questions from their prior life: “Who’s going to like me?” “Where do I fit?” That is the essence of recovery, the essence of survival of trauma, the essence of many things. Acupuncture helps with these issues a great deal, particularly if we can accept the silence, the need for privacy and the unpredictability of the situation.

If you ask 7-year-olds what they want to be when they grow up, they usually feel complimented, and they lose themselves in their future visions as if they already were the president or an athlete. Their answer has nothing to do with who they are right at this moment. It’s a game. Conversely, if you ask 13-year-olds what they want to be, they’ll dislike the question, and they’ll often feel like you’re harassing them. And unless they’ve invented a reply for funny-sounding adults at this point, they won’t answer.

Now a 13-year-old knows more about “what’s going on” than a 7-year-old. At 13, the question is no longer, “What do you want to be when you grow up?” but “What will you look like?” “Will you be alive when you grow up?” “Will you work?” “Are you there?” “What place is there in the world for you?” And how can a 13-year-old even begin to answer those questions? They don’t even know what how tall they’ll be, and they’re just now realizing that the world doesn’t really care about the deeper things. At this realization, it becomes clear that this is when they need spiritual help.

We in health care have the illusion that we provide structure, that we provide peace, that we provide choices — both with our own teenage children and with our patients. People need harmony. They need structure. They need choices. But these things have to come out of the organic process of becoming who they are. That is a painful process. It might not be one that’s fun to remember, but it’s the one we as therapists have lived through ourselves and have all chosen to work with.

If one day you’re feeling healthy and someone tells you that you’re HIV-positive, you will automatically be faced with the issue of spiritual growth. Now you’re once again asking, “Who am I now?” “What am I going to be like later?” “What’s going on?” Answering these questions requires privacy, enlightenment, time and space, not verbal suggestions or talk therapy.

In Chinese medicine, teachers talk about the growth energy being a seed. What do we do with the seed? Well, first we plant it (though often the seeds will plant themselves). The seed is planted, and it disappears in the ground. At this point we might think, “The farmer seems lazy, just hanging out for a while, right?” No, farmers are hard-working people, but there are times when they must wait and times when they can work. For instance, if we wanted to diagnose this seed, to dig it up and make a diagnosis in the middle of winter, what would be the diagnosis? A dead seed. Every time we dig up a hidden seed, the diagnosis is always the same. The seed is dead. This inevitability means we have to wait.

We are taught that change occurs because, somehow, the clients have to prepare to make things better. They have to make the weather “warmer.” We try to create a lot of “almosts”: almost ready, almost ripe, almost this, almost that. Everything is almost OK. The process is called “case management.” However, this is not how seeds grow in Nature. Seeds develop and grow in the coldest, darkest, hardest space with the least amount of support. It may seem counter-intuitive, but we need roots in our own private space before entering the outside world. Before spiritual growth occurs, specific goal-oriented preparations have little value and much possible negativity – fatigue, stress and a loss of hope. As new and creative parts of adult life sprout, only those specific parts can be nurtured. Good parents and therapists wait — they don’t diagnose or probe, they don’t guess or predict or even hope. They distinguish the small real sprouts from complex formulations or parental expectations.

We’ve come back around to spiritual development — where and how seeds grows. They grow downward first, upward second — this private process, the process of hitting bottom and developing up, is how new things develop. They don’t develop by artificially warming a seed. We should know by now that new things emerge from cold seeds. The private process is private, underground, and it’s best not to be a snowbound therapist trying to dig up a bunch of underground seeds. Not because you are not well-meaning, but because it doesn’t work. So what else do you do? You wait. But wait in the right way — using nurturing, nonjudgmental support like acupuncture — and wait for the right time.

Spring is here when the seed sprouts. Spring is not a month. Seeds grow continually and each seed has its own Spring. Now is the time when you can give direction. You can put that little stick in the ground for support. And later on, that plant will be stronger because of the direction you pointed it in. You can trim it so it grows better. You can do many things, but only if you know how to be a farmer and you know in what season to work.

All of us are made of different seeds. Some things sprout quickly, but others that are hidden might take a longer time to blossom. If we are working with people who have hidden seeds, and they sense that we want/need to find them, their first instinct is to run away. And the intelligent, healthy thing for them to do is to run away. One of the very few, if not only, methods of nurturing a hidden seed is through acupuncture, because you can nurture and relate to something that is private. So be a good farmer. Know in which season to rest and know in which to work. Know what part of a person can be given guidance and what part is private. Privacy is special — good things develop from it.

I want to mention one other thing which, in many ways, is the real mechanism of what we do. This is another spiritual issue, but it is cast in terms of cognitive therapy. It is called the Serenity Prayer. The Serenity Prayer has three parts to it: two parts and a tail. The first part says that if I can’t change something, then I should just accept it. The second says that if I can change something, I should try. And the last part says, rather confusingly, to let me have the wisdom to know the difference. Not the support system, not the faith, not the prior knowledge or anything like that—just the wisdom, the evidence to know the difference. Wisdom and the Serenity Prayer are the pure essences of cognitive therapy.

The issue of wisdom is implicit in spiritual development. For a client in therapy, the agenda every morning, in every situation, and at every point of danger becomes: “Is it possible to improve or is this something I can’t change? How do I decide what is possible in a relationship? Should I accept it and move on, or is it possible to improve? In myself, can I reach out and do that new skill, or am I limited and broken?”

When people who are using drugs come into your program, you might ask yourself if they’re applying the Serenity Prayer. They will come in and be in what we call denial, saying that it’s impossible to improve. They are on the first half of the Serenity Prayer—denial is nothing but that. We may complain about their denial, but the fact is that the police chief agrees with it. The mayor agrees with it. Most of their family agrees with it. And, if they’ve had seven or eight experiences with treatment, the evidence of those prior treatments agrees with it.

Well, what if we just told the client, “You’re a good person. You have goodness inside you. You can improve.” If you say these things to people who are using or maybe who are two weeks clean, they’ll figure you’re a goof or that there’s something wrong with you. If a person is depressed or paranoid or escaping or feeling disenfranchised, they are not interested in that kind of compliment. It makes no sense. So a good counselor doesn’t say that.

So, how do people ever figure out that they should try? Ordinarily, they will slowly perceive that you actually care about what’s going on, and that you think they can improve. Then they see that other people in the group and in the program feel that way too. This is a slow process, made more so by a foggy brain and lots of slip-ups along the way. And this is not unreasonable. Look at the Serenity Prayer. Have the wisdom to know the difference, otherwise you’ll be in denial. Have the wisdom to know the difference, not that “somebody told me something,” but have your own wisdom and evidence. Acupuncture changes the situation a great deal, particularly if we understand the process. People take drugs because they think, “I’m lousy. Something outside me must be good. I need that stuff that’s outside me.”

The basic addiction posture is: “I’m no good, something outside me must be better.” So, you have people sit down for their first acupuncture treatment. Many of these people come in angry and feeling terrible. Then during treatment, they become calm, settled and relaxed. At the end of the session, they ask, “What’s in the needle? There must be something in the needle.” Some people get very intense about this because they are struck by the notion that “if there is nothing good in the needle, then there must be something good in me.”

That’s the biggest lesson in the clinic—the biggest lesson in anybody’s life. And because acupuncture can take the most panicked person and show them a peaceful side of themselves in about 30 seconds, you are able to reveal this important human and spiritual lesson right away. “There nothing in that needle, so there must be something good in me—something good, something peaceful, something quiet, something forgiving, something optimistic.”

You can come into the clinic thinking, “I don’t deserve to be relaxed. What I did last week … blah blah blah.” But the needles don’t care. Your body doesn’t care. It forgives you every day. It’s been forgiving you for 20 years. You just don’t realize it. And you become lighter.

What if, on the other hand, when that person says there must be something in the needle, someone steps out and says, “Well, I’m a pretty smart therapist and you’re getting better because of our really fancy therapy technique.” Now you just went south. That is not the basic issue. Acupuncture is not a dominant process. It is supportive and integrative. Everything we do is. The basic issue is the question: “Is there something good in me?” And the answer is, “There is some value in me. So I’m going to be on the other half of the Serenity Prayer, and now I’m going to try.” Now, you as the therapist have the most important partner you could ever have—the patient’s Qi and their own process.

When I look at some of the results we’ve had with chronic schizophrenics, it seems to me that this mechanism then says, “There is something good in you. There is something good in you that is not broken. You should try.” If you ask how much value is there in a few minutes of peace, there’s not a whole lot of value. But turning around your whole life has a tremendous amount of value. This is something that is useful to tell people about.

There are many therapists out there who told their pre-adolescents all about adolescence. I’m not sure that provided a lot of benefit. Adolescence, and recovery, has to do with self-discovery, privacy and being lighter—not with being parented or diagnosed. When self-discovery occurs, then people can see something and say, “Wow, here’s a reason to do something,” and then one part of denial goes away and the process changes.

Acupuncture gives us as therapists a unique privilege. We are able to work with a partner – the living human body – that has much more capability than we do. Most health care methods focus on substances or activities that act on the body. Practitioners of these methods must rely only on their own knowledge to determine the appropriateness and limitations of the treatments being provided. This leads to the obsessive need for control that dominates most health care. Acupuncture transcends these limitations. The patient comes to us for help, but the treatment only makes sense if the patient’s Qi – the patient’s becoming – is more vital than ours. Healing occurs through relationship not action. To develop our relationship with the patient’s Qi, we must be comfortable with the vast and complex character of bodily Qi. It is indeed a Higher Power. And we need to accept our subordinate role in this relationship.