Abstinence Through Education and Faith

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Concepts such as spiritual disciplines have only become more pronounced as the life course broadens and the familiarity of youth begins to fade. Time wasted in youthful ignorance, however, is a friendly reminder that sobriety has brought more precise insights into how things of a spiritual nature have meaning.

According to (Hasin et al., 2022), the clinical insights that guide diagnoses for substance use challenges are found in the DSM-V and are as follows, presenting with at least two criteria that involve:

1. Drinking alcoholic beverages for periods longer than intended.
2. Periods of drinking are dedicated and are done to support the ability to acquire alcohol and or recover from drinking.
3. There is the presence of a persistent craving to drink.
4. Alcohol drinking impairs normal life functions, roles, and responsibilities.
5. Persistent alcohol use impairs interpersonal relationships.
6. Social activities and gatherings are disrupted secondary to increased alcohol use.
7. Drinking in such a way that becomes dangerous to self and others.
8. Drinking is continued despite knowing the adverse effects that have negatively shaped the self and others, both physically and psychologically.
9. Apparent tolerance is defined as needing more drinks to produce the desired effect and/or the desired effect not obtained by the same amount consumed.
10. Symptoms of withdrawal are defined as stopping drinking after a period of heavy consumption and, after stopping drinking, physical experiences of twitching and tremoring, nausea and vomiting, sweating, fast heart rate, agitation, anxiousness, and or seizure activity.

In addition, problems associated with drinking are a luxury for educated individuals. According to Schuckit (2018), most people struggle with drinking. It is common in those individuals with advanced education and those with family affluence and is more common in males than females. Chronic drinking can shave off roughly a decade of one's life.

Whiskey, wine, and beer are pleasurable to drink, easily absorbed on an empty stomach, and directly affect the body's brain, muscles, and feel-good receptor centers (Schuckit, 2018). A pint of IPA, two fingers of Garrison Brothers, and a glass of Merlot become dose-dependent when consumed regularly and consistently. Drinking will need to proliferate to achieve the desired effect of reduced stress symptoms, and drinking will eventually progress to the need to consume more or drink more substantial types of drinks with more potent alcohol content, for example, transitioning from beer to bourbon, also known as tolerance.

Unfortunately, as Schuckit (2018) points out, a negative cycle of attitude, cognitive, personality, and physical changes associated with anxiety-reducing effects and feeling of muscle relaxation, all positive desired reasons for drinking, are part of the brain pleasure-seeking loop and circuitry that are temporary and are followed and accompanied by feelings and experiences of depression and restlessness when the drinking is stopped.

Although some believe that consuming alcoholic beverages has physical benefits, the evidence supporting such claims continues to be debated as the effects of the chemistry-related changes on the brain, central nervous system, psychiatric disturbances, gastrointestinal effects, heart, and lungs, as well as the interpersonal, communal and societal disadvantages from chronic drinking are evident (Schuckit, 2018). The explicit goal is to recognize those with dependence, treat acute symptoms, and find sources and resources to support rehabilitation and recovery for long-term abstinence and sobriety.

Cutting Alcoholic Ropes and hanging on to God's Hopes

It is important to remember that as disciples, the efforts to help others are not in vain. Seeking ways to better another individual through helping and support is not unnoticed, and being neighborly is never wasted and always in season. The faith that Christians lean on is the hope of a savior who will make good on his promises as they exercise their faith in his actions on the cross.

Ultimately, God sees the good in us and seeks a relationship with all people. Those who strive to please, obey, and serve him through the appropriate use of our talents, abilities, and skills to bring about his ideas and concerns for the world are what discipleship resembles: a student relationship with Jesus, the teacher.

God wants his realm and kingdom to look and feel a certain way; what we think how the world should look and feel often does not align with his views unless they are exercised in faith-based organizations, communities of hope and healing, and in the helping and serving organizations locally, and globally. It does not require much effort to see God working in the lives of humanity, which is an ongoing struggle because practicing the spiritual disciplines is hard.

It can be challenging to believe this about oneself, especially when comparing oneself to the standards set in Scripture. The words in the Bible are sharp and penetrating; they serve as both warnings and encouragements. They bring life while also providing caution to those who earnestly try, knowing that we are way off course on our best days.

However, with persevering intention and, of course, the grace or the state of being in a position where one is shown kindness when it is not deserved, that is the concept of grace, forgiveness, and the gift from God is a cycle describing the life and journey of those who have begun the Christian walk.

The author of this blog, a Christian believer, also has a personal story of challenges with drinking and searching for spiritual connection through his relationship with Jesus and overcoming the need to drink beer or whiskey to manage stress, anxiety, and symptoms of depression, insecurity, and loneliness from a chronic and life-long struggle for the need to prove one's self, to feel appreciated and valued that stems from early childhood adverse events.

At the time of this writing, the total number of days of no drinking alcoholic beverages, including beer, whiskey, and wine, is one year, eight months, and three days. That began with the help of peer support and talk therapy grounded in the meeting rooms of Alcoholics Anonymous. Through that trial, through seeking assistance while also trying to be a faithful follower and Christian, new insight has come at the time of sobriety.

In contrast, before, under the influence of chemical manipulation of alcohol on the body, mind, and psyche, the blog writer was blinded from concepts and themes that are clear now, whereas before they were cloudy, fuzzy, and out of focus, to explain it precisely before sobriety and after being sober is complex and obscure to put into words.

Meanwhile, as a Christian, the blurriness of faith, incessant doubt, challenges in perseverance, and struggles with temptations are all part of the Christian walk, which was not self-evident at the point of conversion. How could if, as a follower of Jesus, we are instructed to be sober, self-controlled, worthy of respect, sensible, and sound in the faith (The Holy Bible, New International Version, 1999, Titus 1:2), struggle with living in general?

If living and dealing with essential trials of life can be handled with, coped with, and dealt with through active faith practices, if challenges and struggles in life can be met with and treated with therapeutic journaling, counseling, reading and writing, prayer, worship, and spiritual relationships, how did the author treat those challenges through passive consumption of beer and whiskey? The answer to that question became crystal clear one day after a nervous breakdown and, after a willingness to admit a problem, sought help to quit drinking. New insights only became revealed after an intentional year-long, weekly participation in peer group therapy and aligned with common principles discovered in the 1930's-Alcoholics Anonymous.

As Alcoholics Anonymous outlines (AA, 2001, p. 263), the six-phase methodology that all individuals must apply for the best outcomes is: First and secondly, one must puncture the Ego and allow God to perform CPR; third, look inside and face the skeletons in the closet; fourth, find someone who can be trusted and tell the secrets that way down the mind and heart; fifth, begin immediately to make repairs and finally put into practice all those mentioned above intentionally every single day and help someone else.

As part of the six-step process in this blog post, the author of the Palate and Pabulum actively works to help others who may be struggling. The steps are best done, practiced, and carried out in partnership because who other than a person who has struggled with drinking is best equipped to help another with the same ailments?

References:

Alcoholics Anonymous. (2001). Alcoholics Anonymous big book (4th ed.). Alcoholics Anonymous World Services Inc.

Hasin, D. K., Blanco, C., Bochner, D., Budney, A. J., Compton, W. M., Hughes, J. R., Juliano, L. M., Kerridge, B. T., Potenza, M. N., & Schuckit, M. A. (2022). Substance-Related and Addictive Disorders. In American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (5th ed., pp. 543–666). essay, American Psychiatric Association.

Schuckit, M. A. (2018). Alcohol and alcohol use disorders. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 2), Harrison's principles of internal medicine (pp. 3277–3283). McGraw-Hill Education.

The Holy Bible: New International Version. (1999). Cornerstone Bible Publishers. (original work published 1973)

Applications and benefits of Ho'oponopono?

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The ER television show, originally aired thirty years ago, has been revived in the HBO Max series "The Pitt" (Adarkwa & Lankwarden, 2025). Dr. Robinavitch, an ER attending physician, is portrayed by Noah Wyle, who is recognized as his younger role alongside George Clooney when the 90's sitcom first aired and brings back a familiar perspective on emergency room medicine. The setting is a modern-day trauma center in Pittsburgh, where Dr. Robinavitch demonstrates his medical expertise as a seasoned ER attending physician, leading a team of care team providers of nurses, medical students, residents, and other junior and tenured physicians, surgeons, and social workers. Each episode covers the life of the ER environment in just one hour of the shift per episode of the series.

Post Call Rounds: Horrible Night in the ED

In the first episode, the writers of the series Adarkwa & Lankwarden (2025) portray on screen the first hour of the morning shift. Dr. Robinavitch, the day shift oncoming doctor, receives a report from the night shift doctor as he hands the change of coverage to the incoming day doctor at the sign-out. In basic terms, communication occurs between ED doctors. It is the handoff and is a talk about what happened during the night, what needs to be completed, and what is currently happening so that the continuity of care for patients in the ER is seamless and continuous, all the while the next day shift brings new admissions, traumas and the peculiarities of the ER environment primarily as the waiting area becomes full.

The handoff and morning rounds take place in a somewhat nontraditional format—on the hospital's roof, where the night shift doctor is grappling with the aftermath of a horrific evening, taking care of a soldier and veteran of a recent deployment who survived two combat tours only to come home and pass away in the Pittsburgh emergency department. The ED physician is contemplating jumping off the roof as the morning discussion unfolds, and his colleague, Dr. Robinavitch, literally "talks him off the roof."

Patient from the SNF

In the most recent episode of The Pitt, Dr. Robinavitch has been grappling with the dilemma of a patient who was admitted from a skilled nursing facility with what appears to be an altered mental status and difficulty breathing. The patient's two surviving children are at odds with their father's POLST, or the document that defines how to proceed with medical therapy for those patients who have a grave illness and or are nearing death, such as whether or not to perform life-saving measures that could prolong the inevitable or incur more suffering than comfort during the last moments of life. The end-of-life process in the ED is never ideal for staff or the community.

The scene, filled with emotion from Dr. Robinavitch as he grapples with performing interventions to help a dying patient breathe and helping the surviving son and daughter understand what is at hand, that is, their father's active dying process, are also at odds with the decision to redact the instruction of the POLST and perform life-saving measures as they have yet to close the loop or come to terms with their father's relationship as his children.

The two grown adult siblings, both of whom appear to be middle-aged, debate whether to keep their father alive, not understanding the gravity of the dying process. For reference, during the dying process, Emanuel (2018) describes the experience of families and loved ones of shame, regret, and guilt at reversing the steps initiated, for instance, in the POLST. At the same time, Dr. Robinavitch tries to endear himself to them and, with a compassionate frame of mind, exercises empathy to help them understand what the dying process could look like, that is to say, peaceful and part of the human experience, or they could watch their father suffer more in the hours and days to come by keeping him alive with for instance a breathing machine impacting his current quality of life.

The scene unfolds into an experience that, at this point, is worth noting. It is often the case that professionals in the hospital environment frequently encounter and are sometimes faced with the fact that families are often not prepared or ready to have the conversation and accept the inevitable and the letting go process of loved ones. A concept that Dr. Atwul Gawande has described in his book Being Mortal (Gawande, 2014, p. 259) is that the reach of medicine has limits and that human biology will take its course at the end of life.

It is crucial here to acknowledge a concept that was highlighted during the most recent episode, where the adult children of a dying father were looking for an opportunity to find closure with their father as he is actively dying. Notably, the daughter's emotional response is visualized on-screen as her present anger, irritation, and unwillingness to let go of her dad. Elements of her and her father's past relationship indicate a rough history of trauma and discord, as evidenced by her on-screen emotional distress.

Therapeutic Conflict Resolution

Scholars have studied and pointedly identified the existential connections of forgiveness as it relates to hurt and injury and is an ethical, moral conflict that all humans experience. Enright & Song (2022) describe the REACH module of forgiveness in their scholarly writing. The first therapeutic technique is to help others recollect the situation that caused feelings of hurt; second, try to practice empathy with the person who performed the hurt situation; third, with a spirit of altruism mindset, navigate a forgiveness path; fourth, make a pledge and commit to forgiving the offenses, and lastly hang on to the forgiving.

In the scene, Dr. Robinavitch incorporated the REACH model of therapeutic forgiveness (Enright & Song, 2022), an element of spirituality in healthcare, by asking open-ended questions about religion/spirituality and God and guiding the adult siblings towards the forgiveness closure experience as time seems to be running out in the scene. The on-screen performance evolves, demonstrating care withdrawal as the standard practice during end-of-life care. This is evidenced by the monitoring being turned off, the oxygen being removed, and the agonal breathing demonstrated by the dying father. In the show, the dying patient receives a scopolamine patch and frequent airway management with the Yankeur suction device to manage secretions. 

As the conversation erupted, the two surviving adult children were apt to reply that they did not have a God and were searching for a spiritual direction, as Dr. Robinavitch could sense they needed spiritual guidance or a hunch. Dr. Robinavitch helps the adult siblings navigate the forgiveness path. He refers to his mentor, who taught him a strategy using virtuosity for times such as these. The strategy uses tribal methodologies and practices from Hawaiian traditions: the concept of the Ho'oponopono.

The Ho'oponopono

According to Hurdle (2002), the native Pacific Islander technique has elementary roots in helping native tribal Hawaiian families resolve interpersonal conflict and was traditionally performed by the tribal leader. To perform ho'oponopono means to help individuals work through a process to correct wrongs done to each other in a structured style with open communication. The ultimate goal is to settle disputes, disarm and neutralize feelings of hurt, resolve words of distress, ill-temper, and rage, and finally cope with the challenges of relationships elsewhere (Hurdle, 2002).

In the scene, Dr. Robinavitch describes ho'oponopono and guides the two siblings to four concepts they can practice with their dying father. In his own words, he announces the following: The first is, "I love you." The next is, "Thank you." Then, "I am sorry, and I forgive you." Finally, he verbalizes, "Forgive me" (Adarkwa & Lankwarden, 2025). As the moment presses forward with their father leaning on his final breaths, the daughter and the son work through their process of those above, talking to first their father and then to each other, reopening old childhood wounds as each has experienced their father differently and in separate ways seated next to their father in his bed. The ho'oponopono technique appears to help the daughter and son find resolving life moments with their father as he nears death.

What can be learned from native Pacific Islander traditional practices of the ho'oponopono conflict resolution practice? These techniques can be applied to any situation where conflict resolution is needed in schools, churches, places of work, and the like. One does not need to wait until one's loved ones are nearing the end of life before one tells them what one needs to say, and that is communicating in a manner that demonstrates and expresses the love one has for another, being able to express hurts and injuries, having the opportunity to own and share in the hurts by accepting one another and forgiving one another that healing and resolution can take place. Although hard to practice, can the healing agency of the island of the Pacific of the ho'oponopono method heal relationships of all sorts, optimistically and faithfully? Yes.  

References:

Adarkwa, C., & Lankwarden, M. (2025). 10:00 A.M. The Pitt. Episode, HBO Max. Warner Media Direct LLC, https://www.play.max.com

Emanuel, Ezekiel J. (2018). Palliative and end-of-life care.  In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 1), Harrison's Principles of Internal Medicine (pp. 47-63). McGraw-Hill Education. 

Enright, R. D., & Song, Jacqueline Y. (2022). Forgiveness therapy. In Christopher C. H. Cook and Andrew Powell (2nd ed.), Spirituality and Psychiatry (pp. 281–292). Cambridge University Press.

Gawande, A. (2014). Being mortal: medicine and what matters in the end. Picador.

Hurdle, D. E. (2002). Native Hawaiian traditional healing: Culturally based interventions for Social Work Practice. Social Work, 47(2), 183–192. https://doi.org/10.1093/sw/47.2.183

Lean into Connection-Not Control

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What can we learn from movies like The Boys in the Boat or Chik-Fil-A?

In 2023, a film directed by Goerge Clooney, The Boys in the Boat, about a group of young men who competed at the Berlin Olympics during the 1930s, demonstrates the importance of teamwork. The film suggests powerful motifs surrounding struggle, hardship, trials, and triumphs in the spirit of working together despite difficult odds and overcoming those challenges by helping each other become a single unit. Lessons from the movie are applicable today.

According to Day & Miscenko (2016), who articulate leadership styles, a few that manifest in multiple organizations are the archetype of a talisman or the transformational leader, also known as a style of leadership approach that activates institutional pride, a sense of allegiance to one another and capitalizes on zeal and devotedness (Haidt, 2012, p. 275). In addition, the altruistic or authentic styles of leader influence, or the unpretentious trait leadership style, and the servant as leader, visionary leader, including the rapid adoption of shared-collective leadership concepts, are noticeable, evident, and commonplace in different sectors of the service industry for instance, fast food retail.

If the reader likes chicken sandwiches, the best bang for the dollar and restaurant experience is the too familiar "My Pleasure" response from the Chik-Fil-A friendly, indoctrinated staff that demonstrates in the sit-down dining experience or the long line drive-through culture of service to the guest franchise (Manko, 2022). The leader trait behavior, for example, the grand man theory or the hero archetype, are ways in which leaders show up to influence others (Day & Misenko, 2016) and are styles of leadership that, as scholars have pointed out, have to do with focus on the leader themselves or their character.

In contrast, the available research deals with the study of the leader's relationship with their direct reports, known as the theory of the leader/member exchange. In simple terms, the LMX acronym identifies the study of leader-follower relationships. The available scholarly literature does not restrain the information and articles ready for reading and analyzing leader and follower interactions and connections.

Examples of those character traits for leaders, corresponding to Day and Miscenko (2016), are mindfulness, interpersonal benevolence, a keen sense of awareness of the surroundings or fixated on the environment, open to innovation, and extroverted. Also, as reported by scholars, those work environments that highly respect one another's atmosphere correlates to leaders that employees view as having a high organizational supportive disposition toward their staff.

Why is the interpersonal leader-follower relationship meaningful, and what does the motif of a boat rowing crew from the 1930s and chicken sandwiches have to do with leadership? It's all about the relationship.

We all live in a different time; for reference, when reading this blog post, we all are in the remarkable recovery of post-pandemic life. Furthermore, we still live in the VUCA environment (Sherman, 2024). Read here from an earlier post highlighting the VUCA world. The world and the places we work are volatile, uncertain at times, complex, confusing, and ambiguous.

In recent weeks, for context, the southern California residents and citizens of Los Angeles have been undergoing recovery efforts in their local communities from the devastation of the wildfires. The wildfires were broadcast unrestrained on national news forums and streaming incessantly on social platforms, exacerbating the aforementioned conceptualizations about how people work, especially in the healthcare sector. More than ever, relationships are essential, and the people who work in the service industry have needs that take priority, first and foremost, because they are the people we support, champion, and steward.

As other nursing professionals bring attention to the surface regarding relationships, according to Foster-Smith (2024), the social distancing and the six-foot-apart regulations, coupled with the no-eating-together rules and the mandated masking from the way people worked in the hospital, have brought out the individuality of our natures. A sense of no community and the remnants of social distancing may still impact staff, leaders, and their workplaces. For departments, units, and institutions to thrive, the goal of a relationship-style leadership approach to departmental unity and a team approach to achievement must take precedence over individual success.

As we take the lead from other authors, scholarly insights, practices, and principles, leaders and their teams can lean into relationships (Foster-Smith, 2024) for the benefit of the group, which in turn benefits their units, departments, and organizations. As one heartbeat, all thrive. One body, many parts.

References:

Day, David V., & Miscenko, D. (2016). Leader-member exchange (LMX): Construct evolution, contributions, and future prospects for advancing leadership theory. In Nathan, P. E., Bauer, T. N., & Edogan, B., The Oxford handbook of leader-member exchange (pp. 9-28). Oxford University Press. https://archive.org/

Foster-Smith, R. (2024). The significance of relational leadership. Nursing Management, 55(12), 56–56. https://doi.org/10.1097/nmg.0000000000000202

Haidt, J. (2012). The righteous mind: Why good people are divided by politics and religion. Random House Inc.

Manko, B. (2022). Analyzing an unconventional success story of Chick-fil-A fast food restaurants in the USA. Management, 26(1), 118–143. https://doi.org/10.2478/manment-2019-0087

Sherman, R. O. (2024). Upskilling your nurse leaders. Nurse Leader, 22(5), 484–485. https://doi.org/10.1016/j.mnl.2024.07.007