Embodiment and somatic modes of attention in the evangelical care model in drug rehabilitation centers (Tijuana,Mexico)

Abstract

This article identifies how beliefs, practices, and religious communities converge in the structuring of the evangelical drug rehabilitation model (ERM). Based on a qualitative study, we propose that the ERM shapes the ways of interpreting emotions and sensations based on a beliefs system that conceives the body as a battle field between good and evil. Sensations produced through ritual experience and symptomatic manifestations relative to withdrawal syndrome constitute key points of the culturally shaped somatic modes of attention (SMA) that are produced and transmitted within the evangelical rehabilitation centers (ERCs). This procedure grounds in prayer, cathartic emotive rituality, belief in forgiveness and God’s calling; in testimony; and in the community of believers. We conclude that religious practices and beliefs constitute essential tools of the ERM and can be efficacious for users who are engaged in a spiritual quest.

Introduction

In the face of increased drug abuse, Latin America has experienced a rise in the number of rehabilitation centers (RCs) for drug-dependent individuals, structured as therapeutic communities or mutual aid groups, with little regulation by governmental public health authorities. In Mexico, as in the rest of Latin America, RCs are primarily religious, and, within that category, primarily evangelical with a Pentecostal orientation. This is true of the centers analyzed by Algranti and Mosqueira (2018), Güelman (2018a, 2018b), and Miguez (2007) in Argentina, Mendes Lages Ribeiro and De Souza Minayo (2015) in the case of Brazil, Talavera (2016) in Perú, Castrillón Valderruten (2008) in Colombia, and even in the case of Nicaragua (Morales Alfaro, 2013), although in Nicaragua, the treatment models advanced by Catholic and evangelical churches do not require residency.

In the Mexican state of Baja California, the number of RCs, which had been estimated at 91 in 2001 (González Reyes, 2009), reached 233 in 2013 (Instituto de Psiquiatría del Estado de Baja California (IPEBC), 2013). A telephone survey carried out in 2013 in Tijuana, site of the majority of the RCs in the state, revealed the scant availability of non-religious therapy. A 64.5% majority of the RCs follow the Twelve-Step model that, while not religious in the strict sense of the word, is based on the ‘need to rely on a Higher Power’ (Humphreys et al., 2004), while 28% identify as Christian evangelical religious institutions, and only 8.5% follow a lay model of service delivery (Galaviz and Odgers, 2014). ¹

These data would not be of great importance if there were parallel sources of addiction treatment provided by the state that were of a secular nature. In fact, the state offering is limited to (1) a school-based prevention program focused on identifying children and adolescents with risk factors predisposing them toward drug addiction, followed by psychological advice to reinforce protective factors; pupils found to be at risk for addiction are directed to the psychological centers run by FORMA; (2) a clinic associated with the network of Centros de Integración Juvenil, treating heroin addiction via methadone replacement; and (3) a rehabilitation program for drug users known as Reconstrucción Personal (Personal Reconstruction) serving persons under detention and, as outpatients, ex-prisoners as well. Indeed, Given the scarce services offered by the state and its inability to meet the treatment needs generated by substance abuse, the Health Department advises the public – through its web page and through medical consultation services – to have recourse to the mutual aid centers provided by civil society which form part of an official list (Odgers-Ortiz and Olivas-Hernández, 2019).

Despite the prevalence of religious models – and the scarcity of secular alternatives – studies of the role of spirituality in their praxis are practically nonexistent. Therefore, the goal of this article is to identify the form in which religious beliefs, practices, and communities converge in the structuring of the treatment model provided by evangelical rehabilitation centers (ERCs), making use of a qualitative study carried out in Tijuana between 2013 and 2018. The idea is to offer entry points to understanding actually existing therapeutic resources (Zolla and Sánchez-García, 2010) and to contribute to the development of the best public health strategies.

It is important to emphasize that the aim of this study in not either to assess the efficacy of the ETM or to compare it with other models, nor to make recommendations, but to understand the way it functions.

Methods

This qualitative study made use of participant observation, semi-structured interviews, and narrative analysis of testimony. ²

Three ERCs (two for men and one for women) were selected on the basis of their longevity, the degree of stability in their manner of operation, and their leaderships’ willingness to the participate in the study. Two of the centers are related because they are led by a couple; the Pastor is the director of the male center, and his wife leads the female center. Despite following the same treatment model, the one for men was founded over 20 years ago, while the other has been in operation for less than half that time. The size and infrastructure development also vary from one to another. For example, the one for men can receive more than 100 people, while the one receiving women has a capability for 40 people. Of all the evangelical centers we visited, the center for males was the one with the most stable model, with clear protocols and well-defined strategies. Because of its size, it allowed us access to a greater number of experiences, both of current residents, as well as of former ones who continue visiting the premises. The third center branched out from an in-prison program for drug users. To respond to the difficulties that former inmates faced to maintain abstinence after being discharged, in 2005, the program’s directives decided to found a halfway house. Eventually, they started to receive people seeking treatment for drug use even if they had not been in prison. When fieldwork was conducted, most of the people in treatment in this center did not have experience in prisons. However, the center kept the open-door model, unlike the other ERCs in the region.

Observation included recurring visits (a minimum of once a week) over a period of 18 months, as well as two periods of prolonged, uninterrupted immersion. The first of these was for a duration of 6 days in a women’s ERC, and the second for 1 week in an ERC for men. During the immersion periods, the researchers (one in each case) resided in the ERC, sharing space (dormitories, dining halls, sanitary facilities, chapel, etc.) and daily activities with the other residents, so as to achieve an understanding of 24-hour daily life within the facilities throughout the week. Even though residents knew that the researchers were not there for a detoxification process, daily interaction generated trust between researchers, the people in treatment, and administrative staff, favoring later researchers to conduct in-depth interviews.

Interviewees included the centers’ directors, volunteer administrative staff, and former residents who had completed treatment at selected ERCs (N = 69). Additional interviews were conducted with directors and administrators of other established ERCs within the municipality (N = 6). Researchers attended closed religious services (exclusively for residents) and open ones (intended for local community members and residents’ families during visiting days). Interviews as well as Testimonies of graduates (N = 14) of the centers under study were recorded, transcribed, and analyzed. Finally, informal conversations were carried out with families of the residents and with regular visitors, most commonly missionaries and preachers from evangelical congregations in the region, on both sides of the border.

The material so obtained was analyzed toward the end of identifying the model of treatment that was provided, focusing on the place of religious beliefs, practices, and communities in praxis. As a result, some other elements present in the ERCs were omitted, such as vocational training or the psychological attention provided to residents in complementary but sporadic fashion.

It is relevant to point out that there are fewer RCs for women, and they are usually smaller in comparison with the ones for men. The existent ERCs for women were founded recently, and their structure is weaker due to the difficulty of having a stable group of women volunteering and steady financing. The ERC we analyzed was not the exception. In comparison with our observation in men’s centers, the protocols in the one for women were more flexible, the transmission of experience among them was less effective, and improvisation happened more often. Even though the ERC for women follows the same model as the one for men (Kozelka, 2018, 2020; Velázquez Fernández, 2016, 2018), in the former, this is not as clear as in the latter.

All the study procedures were reviewed and approved by the Ethics Committee of El Colegio de la Frontera Norte and adhered to the principles of the Helsinki Declaration and other guidelines for the protection of human subjects. All participants read and signed an informed consent letter.

Bodily experiences in the evangelical care model in drug rehabilitation

The observed ERCs are self-managed institutions that operate with minimal resources and low admission fees. ³ Fees are waived for individuals who personally request admission and are lacking in resources. Two of the ERCs under study accept compulsory admissions of those affected by drug dependencies, at the request of families. ⁴ The majority of ERCs are confinement centers that residents may leave only after a previously determined period varying from 3–6 months.

Due to the laxity of ties to local religious institutions, the ERCs can benefit of an important autonomy in Biblical interpretation and ritual practices, reproduced through Bible study schools within the facilities, which serve to educate the future founders of new RCs. This logic encourages fluidity and rapid reproduction of the interpretive and ritual model, shaped around a healing process that stresses the holistic nature of health (soul, body, and spirit). Thus, what we are calling here the ‘evangelical treatment model’ (ETM) is the result of empirical knowledge transmitted by former residents to new ones, where the symbolic reinterpretation of the personal experience of rehabilitation constitutes at once a heuristic resource and a source of legitimization. As we will discuss later, bodily experiences in the rehabilitation process are a fundamental part of this treatment model.

Empirical observation confirms that the ERCs are self-help therapeutic communities that arise from the will of the converts, rather than facets of the expansion strategies of previously constituted churches.

According to regional patterns of religious change (Galaviz et al., 2009), the ERCs participating in this study refer to themselves simply as Christian, but can be classified as evangelical-Pentecostal. In Latin America, the accelerated development of Pentecostalism represents an important break from the evangelical currents linked to historical Protestantism, so that the former now outnumber the latter. The most distinctive characteristics of Pentecostal congregations are the centrality of belief in the gifts of the Holy Spirit, religious healing, and highly emotional rituals (Garma, 2000; Moulián, 2017). All these traits were observed in the ERCs studied, where ritual emotional practice is induced through music, dance, and recounting of liminal experiences, among others, that may result in trance states interpreted in that context as the Baptism of Fire or the incorporation of the Holy Spirit. Nevertheless, directors and administrators of ERCs do not identify themselves as Pentecostals, nor have a formal relationship with Pentecostal churches in the region.

In the ERCs, illness and suffering are understood as an expression of the presence of Evil in individual lives. The suffering of the body is indivisible from the suffering of the soul and spirit, which means that spiritual recovery is considered necessary for cure. Thus, drug addiction is conceptualized as a moral problem. It is one more expression of the struggle between good and evil, within which the body is a battleground:

. . . somebody who is not spiritually reborn doesn’t understand anything. But once they come into the spiritual area, they realize: ‘But who brought me to this?! Who brought me here, robbing, killing?!’ . . . because it’s the devil who came to kill, rob, and destroy, but Jesus came to give overflowing life. The struggle is spiritual, and man – his body – is the terrain, the battlefield. And there’s free will . . . Then, when man understands, ‘Ah, I was blind, I didn’t understand, but now I see, but I see with spiritual sight’, then he begins to grow stronger, and then comes temptation, and struggle . . . but now he knows he has the power to say no. (Interview, President of Coccera (Network of rehabilitation centers), ⁵ 20 November 2013)

To get well, the individual has to turn to God, in the form of Christ, and in that way, acquire the moral strength to fight against the evil dwelling within. The Enemy is seen as powerful and clever and skilled in deception. As reported for Pentecostal contexts elsewhere in Latin America by Marín Alarcón (2010), the representation of the devil in the ETM includes four attributes: (1) deception and lie; (2) enemy and adversary in the spiritual warfare; (3) the evil that guides toward evil actions; and (4) destruction. ⁶ Thus, a consumer of substances is not viewed as a bad person – there is no categorical judgment of him or her as a person – but as someone who has sinned because the Enemy is a master in deception and destruction. The sinner requires forgiveness and the spiritual support of the community toward the goal of overcoming the evil dwelling within, as a part of the Spiritual Warfare that every Christian most fight against Evil. Therefore, a central objective of ETM consists of getting the resident to take Christ into his or her heart – that is, for a religious conversion to take place – so as to obtain moral strength, to be cured and to avoid relapses. On the other hand, those who do not receive Christ in their hearts will leave with a ‘spiritual vacuum’ that can be occupied, once again, by evil.

Unlike the biomedical model, the objective of the ETM is not to overcome addiction but to reach the moral restoration that will eventually lead to quitting drug use. This fundamental difference is at the base of religious and medical specialist disagreements – for instance, the use of substitute drugs like methadone. While for the latter, this is an effective treatment (Saxon et al., 2013; Tobin, 2019), for the former, it is only a distraction.

Regardless of the remarkable differences in their understanding of the addiction problem and its treatment, the ERCs and sanitary authorities in Baja California have developed agreements allowing the former to function without conflicts. This situation does not necessarily mean that a real dialogue between them exists (Cf. Odgers-Ortiz and Olivas-Hernández, 2019). However, there are exceptions worth mentioning. Such is the case of Esperanza, a psychologist providing therapeutic services in one of the ERC analyzed. She refers that after some months of interacting with pastors and people in treatment within the ERC; she received God’s call and decided to join the evangelical community. After her religious conversion, she continues providing psychological services at the center, but integrating her practice with the idea of promoting a spiritual rebirth in her patients:

more than addiction rehabilitation, is a complete personal restoration. That is how I see it when I come in [to the therapeutic office], I do not see an addict, I see a brother in Christ, and I see a purpose of lord Jesus.

Toward the goal of promoting spiritual rebirth, a rigorous routine is imposed, one in which daily life activities are accompanied by specific rituals, like: personal prayer waking up, personal hygiene, community religious service, breakfast, building’s maintenance and cleanliness, prayer before lunch, resting, sport and recreative activities or biblical school, dinner and prayer before sleeping. On Sundays, religious activities occupy still more time, incorporating people from outside the ERC, especially families, converted ‘ex-addicts’ who come to present their testimonies, and preachers from the churches of the area.

Although belief freedom supposedly exists in the ERCs – conversion should be an individual voluntary act – participation in religious services is mandatory. For people not feeling identified with evangelical practices and beliefs, whether they have another religion or are not believers, being forced to attend the services is disturbing, and occasionally has resulted in disagreements within the centers (Cf. Galaviz, 2018). Despite the tension this imposition cause to people in treatment, there are few cases of openly expressed conflicts or disagreements related to religious beliefs in the three ERCs studied. However, some frequent tensions are observed. For instance, those not having an engaged attitude or being sleepy and bored are asked to remain standing up during the religious service. Occasionally they are asked to recite a Bible verse before getting into the dining room, and those who reject the request should get in the line again. Although grudgingly, people in treatment accept the sanctions, and the conflict does not go further. It is also possible that those who are less willing to submit to the religious discipline are more likely to abandon the ERCs before treatment completion. Longitudinal quantitative research conducted as part of this study showed that those without a religious affiliation were less likely to remain in the center for the 3-month treatment period than those who reported a religious affiliation (Bojorquez et al., 2018). ⁷

Interviews allow the identification of non-confrontational resistance, like Luz’s case shows: she identified herself as a practicing Catholic, and when the preacher requested them during the prayer asking God to send an angel to take care of their children, she, in silence, prefers to commend them to the maternal figure of Virgin Mary.

Given the belief in the manifestation of good and evil within the bodies of believers, somatic semiotics are central: the faithful are invited to pay attention to the sensations and emotions experienced during the liturgy and to re-semanticize them within the symbolic universe established by doctrine (Moulián, 2009), considering the body as battlefield between good and evil, and interpreting emotions and sensations as the presence of either God or the Enemy. Terms such as ‘the devil’ or ‘demon’ are not generally used in the ERCs. Rather, they employ a generic figure of evil, in contrast with more particular figures such as the Devil or Demon whose rhetorical/symbolic effect could be to imply the use of exorcisms, which the ERCs emphatically reject.

Embodiment as a methodological stance invites us to focus on the immediacy of sensory experience, and, in this instance, on how the rigorous ritual routine not only establishes the body as a battlefield in a semiotic sense but also cultivates a day-to-day production of somatic modes of attention (SMA): culturally constituted dispositions to and practices of attending to and with the body (Csordas, 1993). In the case of those following a religious based treatment, this is reflected in the attention devoted to personal care – hygiene, diet, and exercise. Both the sensations produced through ritual experience and the symptomatic manifestations relative to recovery from substance addiction constitute key points of the culturally shaped SMA that are produced, learned, and transmitted within the ERCs. The SMA central to the experience of residence in an ERC can constitute lasting aptitudes that the residents carry with them after their treatment discharge and is also a significant component in the elaboration of relationships with transcendent entities. ⁸

We identify six main facets of the functioning of the ETM: prayer, ritual cathartic practice, belief in forgiveness, testimony, belief in God’s Plan and a divine call, and the community of believers. We will discuss each of these briefly.

Prayer as an introspective experience

Each day involves a rhythm of periods of prayer carried out in silence, punctuating daily life with times and places that encourage introspection. The private nature of this practice gives the subject freedom to, if he or she so desires, carry out an exercise oriented toward communication with God, Christ, or other transcendent entity. As a religious practice, this personal – intimate – experience can give the opportunity to perform other religious non-evangelical rituals, as invoking catholic Saints or Virgins. These practices are tolerated, as far as they are not performed in an ostensibly visible way. They are interpreted as a positive – though mislead – effort to a spiritual revival.

For those not willing to look for a communication with a transcendent entity, the instruction is to carry out a reflective exercise about his or her experience in the ERC, previous life stages, or plans for the future. ⁹ This exercise of memory and projection, in the context of a process of substance-abuse detoxification and recovery, can be accompanied by intense bodily sensations that are interpreted as mystical experiences that demand individual reflection to make sense of them. Thus, for example, a rise in body temperature or an episode of sweating can be interpreted as the presence of the fire of the Holy Spirit, while the ‘projection of an internal white light within the prefrontal visual area’ can be associated with the divine mantle (Moulián, 2009), in opposition to the figure of the ‘black sheet’, a frequently repeated metaphor in one of the liturgical chants most popular with the ERCs, referring to the disturbing effect of drug consumption.

Although the literature on the anti-anxiety potential of prayer is inconclusive (Boelens et al., 2012; Ellison et al., 2014), empirical evidence suggests that, in the case of those in a process of spiritual quest, or who are involved in Pentecostalism, prayer could, in effect, contribute to diminishing anxiety. In the interviews conducted with people that have concluded the treatment, the reference to experiences of calm and serenity through prayer are common and opposed to the anxiety related to physiological cravings:

. . . when I cannot sleep and get up during the night to pray . . . that is, for me, my most intimate moment with God. I feel peace inside. I take this as a gift from God to go on building my life . . . (Testimony of a volunteer who previously used drugs and received treatment as an ERC resident, 12 March 2014)

. . . here [in the chapel] is where we come to leave, we come to drop down all our load, all our afflictions. (Testimony of a volunteer who previously used drugs and received treatment as an ERC resident, April 2015)

Rather than a recitation of a previously learned prayer, to pray in this context lies in a monologue in which the person narrates his problems, sensations, and emotions to God. Occasionally, people in treatment talk about hearing God’s voice answering them, either in dreams or through visions. Oneiric experiences, namely sacred dreams, which are relevant in Pentecostal practices (Algranti, 2004), are meaningful in the introspection process and act as a strategy for paying attention to emotions and sensations experienced during the treatment. Those experiences influence the healing process directly:

I remember that in that time I was here, in the night, a little bit desperate for a cigarette, I had quit heroin and cocaine [. . .] and I used to smoke hiding me here. But a 20 years old young man saw me, and with a calm and peaceful aspect told me with assertiveness, ‘hey you, aren’t you ashamed of being smoking here in a Christian Center?’ [. . .] the anger made me feel like attacking and biting him, but I left, because I was feeling something inside of me, the heat of those words were hurting me . . . nonetheless, I managed to sleep and I started to dream that I was getting a cigarette into my mouth, but (then) I heard God telling me ‘didn’t you told me that you want to quit smoking?’ and in that moment I smashed the cigarette and woke up frightened thinking that my hand was burning, and everything was a dream, but I took it as a dream from God. Since then I don’t smoke, I don’t even want to smoke.

As we can see in this experience, the SMA produced and learned in this treatment model carry over into dream experience. Putting the cigarette into his mouth, then smashing it and feeling his hand burning are oneiric elements that rhetorically define a therapeutic locus in vivid sensory experience.

Ritual cathartic practice and breaking

Pentecostal collective ritual involves pursuit of powerful emotional experiences. The church ‘offers itself a space for administration of the emotions’, in which the distinct moments of religious ceremony – praising God, testimonies, invitation to conversion, activation of gifts, outpouring of the holy spirit – orient toward ‘weakening the defense mechanisms of the ego to make room for free expression of the emotions, revealing the affective states of the congregants’ (Moulián, 2009).

In contrast to what has been observed in Pentecostal churches in the region, speaking in tongues is not a frequent part of the ritual trance. Instead, ‘breaking’ is the recurrent theme.

Breaking (quebrantamiento in Spanish) is described as a combination of sensations such as an expanding internal fire, profound repentance, and uncontrollable sobbing, followed by the sensation that the body becomes light and its contours blur (García, 2014; Olivas and Odgers, 2015). To an observer, breaking manifests as sudden and uncontrolled crying during which the person lies down in front of the altar or on the floor and is overcome by spasmodic movements. This cathartic experience tends to occur during collective observances, but in exceptional cases, it can also occur in solitude.

Although breaking is neither a requirement for cure nor a guarantee of cure, its extraordinary character leads to its interpretation as an epiphany, and it is seen as a sign within the process of rehabilitation and spiritual renewal:

. . . tears come to my eyes, because of the song I am hearing and singing . . . and I feel like what’s happening is that my body is healing . . . because with these tears I feel the Holy Spirit is cleansing me . . . I don’t really know why, but that’s how I feel it, I feel very light and I listen to the message . . . (Testimony of a volunteer who previously used drugs and received treatment as an ERC resident, November 2014)

God’s forgiveness and identity redefinition

Since the consumption of drugs is perceived as a sin induced by Evil, the ETM does not follow the Twelve-Step model ¹⁰ in conferring the identity of ‘addict’ on the users, but rather labels them as sinners who are capable of repentance and beginning a new life in Christ.

The belief in forgiveness and the perception of a convert as having been ‘born again’ open up the possibility of resignifying the past and redefining one’s identity: rather than being hidden, the past should be proclaimed, because forgiveness would allow ‘the worst sinners’ to change into good Christians who will live good lives. This interpretation of forgiveness and rebirth in Christ allows for reversal of stigma: yesterday’s sinner is today’s new child in Christ who testifies in the name of God; ‘the farther the fall’, the greater the strength and effectiveness of one’s testimony.

Belief in forgiveness also functions as a resource for freeing oneself from guilt. As the following testimony from one person in treatment shows:

In this afternoon I want to thank God for getting me out of drug addiction, for putting away of that black sheet covering me [. . .] for the opportunity of making up my life [. . .] because you are my savior, you are my answer [. . .] Thanks for the August 9^th when you have rescued my soul, cleaned me, getting me up, forgave my sins and made me a new creature. (Testimony of a volunteer who previously used drugs and received treatment as an ERC resident, April 2014).

Conversion permits a change in how the convert is viewed, both by others and by himself or herself. Even among Pentecostalism’s critics, the image of the ‘born-again’ enjoys a certain moral legitimacy in comparison with that of the addict. Also, this revalidating image allows access to new spaces of socialization and new employment niches.

Testimony and narrative identity

The process of testifying, a central feature of evangelical tradition Da Costa et al. (2020) is a repeated practice within the ERCs, but if these accounts of transformation serve as an important resource for ETM, that does not stem from the repetitive character of the message, but rather from its offering a practical strategy, a concrete methodology for beginning the work of personal reconstruction through narrative. Thus, residents are constructed through their narration of themselves (Andrews, 2002).

In the ERCs, the testimonies are life stories of people that have quit drug use after experiencing a religious conversion process or spiritual revival. In this context, testimony always adheres to the same pattern, consisting of three sections: the past, the encounter with God, and the current life in Christ. They begin with such expressions as, ‘I was a sinner, my soul was lost because I didn’t know Jesus’, immediately followed by a narrative of bad deeds committed – delinquency, addictions, the suffering of loved ones (especially family), and life on the streets or in jail. Then comes the encounter with Jesus and the conversion, presented in dramatic form, frequently linked to a liminal experience. Finally, there is the new meaning of the testifier’s life, acquired through forgiveness and through a new life project understood as God’s Plan.

The narrative force of these stories is captivating, sometimes accompanied by outbreaks of weeping on the part of both teller and listeners. Within the ETM, its importance lies in the fact that it constitutes an invitation to the new residents to construct new narratives of themselves. During their residence, individuals ‘learn’ to tell their stories following a pre-made model. To achieve this, they have the necessary time and attentive listeners, so they can practice and repeat their stories as many times as needed, in order to improve their testimony little by little and to put it to the test before an audience.

This exercise implies conferring meaning on lived experience, and coherence on its narration, so as to legitimate the present and the projects for the future. Usually, testimonies incorporate the bodily experience lived during conversion processes, through the metaphor of God taking off the burden from an addict’s shoulders, cleaning the body from sins, or standing up the fallen.

In empirical terms, the practice of testimony, as preformed in ERCs has a number of similarities with the technique of narrative therapy (Seo et al., 2015).

The call, God’s plan, and life projects

In the work of building life narratives, the individual projects into the future by imagining alternatives. Following evangelical doctrine, program residents will frequently hear that God has a plan for every person in the world, so they must receive Jesus in their hearts and ‘identify’ the overriding purpose of their lives. In the ERC, this principle constitutes an invitation to reflect on the path to follow once they are discharged.

In some cases, the identification of Gifts and Charismas is part of this process. However, due to the lack of church supervision, the ERCs offer a space of autonomy for each individual to choose what he or she will do. So, for instance, in the case of the ERC for women, the life projects do not necessarily mesh with the conventional model of the virtuous woman. It is possible to see that some women do not center their attention on the care of others (spouse, children, parents), but rather put themselves first, trying to resume their studies, achieve economic self-sufficiency, and so on (Velázquez Fernández, 2016).

The religious community and the replacement of social networks

In the context of the ETM, the ex-ERC residents who have gone through a process of religious conversion join a community of believers and therefore receive support from their congregation for the realization of their life projects. Although that religious community has limited number of members, joining it still signifies a certain replacement of social networks. One expression in the life of the convert is support for finding a job – even a poorly paid and provisional one – or an offer of a place to live. For those who decide to leave the city and begin a migratory project, or to return to their place of origin, an attempt is made to contact ‘sister churches’ there, so that that the ERC graduate can count on a community of reference. For those who stay in the city, there is an attempt to maintain constant contact via the network of ex-residents, inviting them to testify or hear testimony and offering specific forms of material support when needed.

Conclusion

Empirically, it is possible to observe that, while the RCs arising from civil society are heterogeneous, the prevalence of a religious and/or spiritual discourse in their treatment models places a priority on understanding the way in which religious beliefs, practices, and communities converge in the structuring of therapeutic models of rehabilitation for drug-dependent people.

In particular, in the evangelical treatment centers of a Pentecostal bent, it was possible to identify a specific model of treatment, within which therapeutic effectiveness can only be understood through comprehension of the way in which the subject lives and re-signifies the bodily experiences (the ways of giving attention to and with the body) of addiction and of detoxification and recovery. This occurs by way of a belief system that is previously structured but of a shifting nature.

Specifically, the factors we have discussed constitute an ensemble of bodily practices and forms of engagement critical to the therapeutic process. Because of this, we find the embodiment perspective especially useful in order to understand the evangelical model for addiction treatment. This framework complements previous ones (Algranti and Mosqueira, 2018; Castrillón Valderruten, 2008; Güelman, 2018a, 2018b; Mendes Lages Ribeiro and De Souza Minayo, 2015; Miguez, 2007; Talavera, 2016) describing the devices employed in other ERCs.

Prayer induces intense bodily experiences, and collective ritual facilitates somatically powerful emotional experience. Being ‘born again’ has more than a metaphorical significance in transforming one’s bodily being in the world from stigmatized sinner to new child in Christ. Testimony is a bodily technique, sonorous speech with the narrative force for personal reconstruction leading to purposeful action in the world. The religious community is not an abstract group but a site of bodily being in proximity to like-minded others, and even when former residents move to other cities, they seek both material and spiritual support from sister churches.

Each of these devices contributes to the interpretation of emotions and sensations experienced in the body, setting up the SMA characterizing the evangelical addiction therapeutics.

The religious character of therapeutic techniques constitutes, simultaneously, the greatest strength and the major weakness of this model. Our observation found that the interpretive systems in use constitute a resource for rehabilitation on the part of those who identify with Pentecostalism or are in a process of spiritual quest. On the other hand, for those who identify with a different religious tradition or who identify as non-believers, the ERCs’ therapeutic model is invasive, limits freedom of religion, and generates conflict situations on a daily basis. Under such conditions, it is unlikely to be successful.