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When I Get Low, I Get High: Integrating Spirituality and Counseling for African American Clients with Mental Illness and Substance Use Disorders, Part 3

December 21, 2023

By: Kisha Freed and Mark Sanders 

Ella Fitzgerald’s 1938 blues song, “When I Get Low, I Get High,” eloquently summarizes the medicinal role alcohol and other drugs have played for African Americans experiencing oppression, isolation, and depression (Sanders, Sanders and White, 2006). The first article of this three-part series discusses the cultural importance of spirituality for many African Americans, especially in dealing with the effects of historical trauma and oppression, and describes how spirituality is often an important ingredient of culturally-responsive mental health and substance use services for African Americans. Part 2 focuses on methods of integrating spirituality and counseling with African Americans seeking mental health and substance use disorder (SUD) recovery services.

In this third installment, we focus on the role of the church in supporting mental health and SUD recovery in African American communities. During the holiday season, it’s common for people to struggle with stress, past trauma, and personal loss associated with the holidays, and we discuss how feeling spiritually low can increase the risk of getting high. This blog post also addresses what spirituality can look like for African Americans seeking recovery who are not a part of a religious community and strategies to help African American clients cultivate inner peace.

Kisha: What role has the church played in SUDs and mental health treatment and recovery in African American communities?

Mark: In 1986, crack cocaine replaced marijuana as the number one street drug. Addictions Studies and Research Consultant, William White, says the “best” day to have a SUD in America was September 13, 1978. On that date, First Lady Betty Ford went on national television and said, “My name is Betty Ford; I'm an alcoholic” (White, 2017). By normalizing SUDs on a national platform, the public stigma associated with SUDs was greatly reduced and folks began to see SUD as a disease that should be treated.

Perhaps the worst day to have SUD when it comes to public opinion and stigmatization was June 15, 1986. On that date, basketball star Len Bias was drafted number one by the Boston Celtics. He went to a party that night to celebrate, snorted some cocaine, had a heart attack, and died. Congress was so angry about his death they intensified the war on drugs. In 1985, there were 400,000 incarcerated individuals in our nation's prisons. By 1995, the population had grown to 1,000,000, and by 2005, that number had doubled, with a disproportionately large percentage of those individuals being African Americans (White, Kurtz and Sanders, 2006). As stigma increased, insurance companies went from covering addiction treatment at a rate of approximately 90% to 10%, and many African Americans who needed treatment suddenly could not afford it (White, Kurtz and Sanders, 2006).

During the time period of 1986 to 1996, every denomination of African American churches formed their own church-based drug ministries to help support the recovery efforts of their members and the wider African American community. One of the most famous African American drug ministries, Glide Memorial Church in San Francisco, was established during this time of need. In addition to drug ministries, African American communities across the nation have helped countless people by further establishing HIV ministries, prison ministries, and mental health ministries through local churches.

Mark: Kisha, what are your thoughts about the Black church forming ministries to help with community healing?

Kisha: I'm excited to hear there are programs in place to support African Americans with SUDs, mental health needs, and those who lack housing. As you mention the stigma of SUDs, I think you really touched on something important when you mentioned shame. I think any time we are in spaces of recovery and wellbeing, having an awareness of the impact and influence of shame, guilt, and anxiety in the process of recovery is going to be paramount.

I appreciate the research of Dr. Peter Breggin on this trio of emotions—shame, guilt, and anxiety.  He calls them “negative legacy emotions.” Breggins explains that shame, guilt, and anxiety have served as “internal emotional inhibitions or restraints”—a type of biological evolutionary mechanism—to protect and preserve familial and interpersonal relationships against the impulsive, violent human nature. So, these three emotions have played a huge role in human preservation and natural selection.

However, Breggins continues to explain that negative legacy emotions, being rudimentary in nature, have continued to hinder rather than help individuals to emotionally and psychologically progress. Instead, shame, guilt, and anxiety perpetuate emotional repression, which can eventually lead to unintended adverse effects, such as impulsive violence or the breaking down of restraints. My personal conclusion and perspective are that shame, guilt, and anxiety (being rudimentary in nature) stunts the awareness of the deeper repressed and suppressed emotions and as a result, this repression might be a hindrance to the progress of a client’s mental health or SUD recovery.

My point is, I think it would be helpful to integrate an educational program on mindful compassion in church recovery programs. Mindful compassion exercises can not only support both peer support specialists and patrons to cultivate a self-awareness to enable the recognition of negative legacy emotions and access the repressed emotions behind them, but also practice compassion and empathy and reduce the stigma of shame, guilt, and anxiety. I think this would be foundational for any church recovery program’s success and could have a significant impact on the surrounding community.

Mark: There is a movement where churches are receiving formal training on how to work with people who have SUDs and mental illness. When George W. Bush was President of the United States, he funded a program called Access to Recovery. This program provided funding to churches that offer recovery support for their communities. Since then, Barack Obama and Joe Biden have both increased funding for the Access to Recovery program during their terms as president.

Kisha: It is good that these services are available in the community with the support of federal funding. I’d also like to recount; the power is in the community and peers. However, I love the way Kurtz and White define “community” in their 2015 article entitled “Recovery Spirituality”:

Everyone needs a sense of ‘community’—the deep experience of being in some way at one with [some] others. Unlike other communi­ties that one may join, ‘home’ is a place where we belong because it is where our very weaknesses and flaws fit in and are in fact the way we ‘fit in.’

Reflecting on the second article of this series, we touched on the reasons 12-Step programs are still successful to this day. The peers’ ability to leverage both mirroring the client’s mental and emotional experiences and modeling new behavior and attitudes are the factors that make peers strong assets to community recovery programs. Compassion, empathy, and connection will come naturally for peer specialists. So, as role models they also have great influence. Continuing to incorporate partnerships with peers in community-based or church affiliated programs is a very powerful approach for substance use recovery.

Mark: There have been surveys of African American women’s recovery journeys. Many of them begin their recovery in traditional 12-step groups like Narcotics Anonymous or Alcoholics Anonymous. Follow-up surveys taken in the fifth year of participating in recovery services show that many of the women transitioned from 12-step groups into church-based groups to maintain their recovery.

Kisha: Ah, yes! Peers who have navigated their own “hero’s journey” of recovery can provide guidance and support to others in a religious environment.

Mark: For African Americans who are not a part of a religious community, how can they pursue spirituality in therapy or recovery?

Kisha: You and I have been writing collaboratively about this topic in the last few articles. We have explored music therapy as an approach, and in part 2 of this series, I mentioned mindfulness-based art therapy and spiritually-modified cognitive behavioral therapy as additional approaches. So, I would suggest finding behavioral healthcare providers who specialize in these approaches.

Joining a program that includes mindful self-compassion, such as the Mindfulness Self-Compassion (MSC) Program, is another option that can help individuals increase their emotional awareness and endurance when experiencing difficult emotions. The founders of the MSC Program, Kristin Neff and Christopher Germer, developed their 8-week curriculum to help clients process difficult emotions that come up while practicing mindfulness.

A 2007 study by Neff, Kirkpatrick, and Rude, found that therapy patients who were struggling with some mental health disorders were responsive to the practice of self-compassion. Over a one-month interval, participants’ self-compassion levels increased and reported incidents of self-criticism, depression, rumination, thought suppression, and anxiety decreased. Similar studies also suggest that self-compassion may be a causal agent of therapeutic change.

Mark: Self-compassion is medicine for self-judgment and negative self-talk. I was thinking about the early years in my career teaching new counselors. I discouraged them from asking clients “why” questions. Often, the answer to these questions conjure up memories for the client of when they were judged and criticized as kids. Taking a self-compassion approach instead would be much more helpful. Can you tell us about your Seven Day Self-Compassion Challenge?

Kisha: Yes, and as coaches we avoid ‘why’ questions as well. They can keep us stuck in the past with self-judgment. Self-compassion helps us to get unstuck.

Earlier this year, I initiated a Seven Day Self-Compassion Challenge on my YouTube channel, Unlimited for Life – Coaching. I challenge leaders to practice self-compassion by taking up seven days of practice with a breath and self-compassion mindfulness meditation practice. As I use the word “leaders,” I'm referring to self-leadership. Leadership begins on the inside, and as of today, this world needs many authentic leaders in all places.

I encourage people to listen to and practice this meditation for seven consecutive days and observe how many times during the day self-criticism and judgment arise. We all do it! The three negative legacy emotions are ingrained in us!  As Breggin suggests, it is time to modify how we use these emotions. This seven-day practice gradually trains the mind to respond differently in those moments and enables us to make different choices and tell ourselves a different story.

Mark: Inner peace is a term used to describe spirituality. How can a person cultivate inner peace in recovery?

Kisha: I’m glad you asked this question, Mark. In our introduction, we mention Fitzgerald’s blues song, “When I Get Low, I Get High” and how it summarizes the culture of self-medicating with alcohol and other substances to deal with loneliness, isolation, and oppression. As we enter into the holiday season, many people are trying to cope with loneliness and isolation during a season of spiritual meaning and uplifting spirits. Peace is the essence of the season, yet peace can be elusive for someone who is not tapped into a life of spiritual meaning.

Quieting the mind is a practice of allowance. The mind is a noise maker. Allowance draws you into your inner sanctum of peace. Practicing a quiet mind, releasing perfectionism, eventually segues into confronting the turbulence of oneself. As we become mentally and emotionally stronger, we react less and make choices that are in alignment with our values and needs. Just taking the first step is an invitation to align with the greater part of ourselves that we call Spirit or God.

Mark:  Kisha, your advice has me reflecting on my first decade working in SUD treatment facilities. We would begin the day with a meditation. One of the 12 steps is meditation. I'm curious about your thoughts on people in recovery practicing daily meditation.

Kisha: I recommend daily mindfulness practices. There is a subtle difference between meditation, contemplation, and mindfulness. Mindfulness is mobile, and it requires attention on the here and now without judgement. There are various types of mindfulness practices—so many that I think it would be difficult to not find a practice that works for someone.

One example might be utilizing the five senses to cultivate stillness and presence. When you are cooking, take time to smell the aroma of the spices, feel the textures of different foods, observe the variety of colors, listen to the sounds of boiling water or sizzling oil. There are many opportunities each day to practice mindfulness this way!

If you’d like to incorporate religious principles into your mindfulness practice, an interesting article to read and discover examples of application is by Yvette Latunde who writes about practicing Christian mindfulness as a means of self-care and wellbeing in hostile work environments.

Mark: I also think of practicing mindfulness by being really present in a conversation with a friend.

Kisha: Being present and listening with the heart. And it becomes easier to do the more you practice it. One of my favorite Bible scriptures is, “Be still and KNOW God” (Psalms 46:20 NIV). Whether you practice spirituality in meditation, in mindfulness practices, or in contemplation on scripture or profound words of wisdom, these approaches in recovery therapy can be beneficial.

Mark: It has been a joy to spend this time with you to discuss the integration of spirituality and counseling for African Americans seeking recovery.

Kisha: And the same to you, Mark! May you encounter and enjoy inner peace and stillness this holiday season.

Mark Sanders, LCSW, CADC  Mark Sanders is the Illinois state project manager for the Great Lakes ATTC, MHTTC and PTTC. He is an international speaker and behavioral health consultant whose presentations and publications have reached thousands throughout the United States, Europe, Canada, West Indies, Lithuania, and Guam. Mark is the recipient of four lifetime achievement awards, including NAADAC’s prestigious Enlightenment Award, the National Association for Addiction Professionals’ 50th Anniversary Legends Award, the Illinois Certification Board's Professional of the Year Award and Jessica Hayes Lifetime Achievement Award, and the Barbara Bacon Award for outstanding contributions to the social work profession as an alumnus of Loyola University of Chicago.      Kisha Freed, BA  Kisha serves as an outreach program coordinator with CHESS BHE-TAC and has co-authored multiple blog series with Mark Sanders for the Great Lakes ATTC’s Counselors Corner blog. She is a certified professional coach with a special emphasis in emotional intelligence and mindful leadership. Utilizing her Bachelor of Arts in English from the University of Alabama-Birmingham, Kisha has worked in her community helping people to get in touch with suppressed emotions through the creative arts, such as poetry writing, storytelling and hip hop and emotional intelligence online workshops. She is also an event host, public speaker, and performing spoken word poetry. She resides in Huntsville, AL with her two sons and two-year old granddaughter.


Breggin P. R. (2015). The biological evolution of guilt, shame and anxiety: A new theory of negative legacy emotions. Medical hypotheses85(1), 17–24.

Germer, C., & Neff, K. (2019). Teaching the Mindful Self-Compassion Program. Guilford Publications.

Held, P., Owens, G. P., Thomas, E. A., White, B. A., & Anderson, S. E. (2018). A pilot study of brief self-compassion training with individuals in SUD treatment. Traumatology, 24(3), 219–227.

Kurtz, E. and White, W., (2015) Recovery spirituality. Religions 2015, 6, 58–81; doi:10.3390/rel6010058.

Latunde, Y. C. (2022). Deep Like the Rivers: Black Women’s Use of Christian Mindfulness to Thrive in Historically Hostile Institutions. Religions13(8), 721. MDPI AG. Retrieved from

Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007). Self-Compassion and Adaptive Psychological Functioning. Journal of Research in Personality, 41, 139-154.

Sanders, T., Sanders, M. and White, W. (2006). The Portrayal of Addiction and Recovery in African American Music. Counselor. 7(6), 30-35.

White, W. Recovery Rising. (2017). CreateSpace Independent Publishing. Scotts Valley, California

White, W., Kurtz, E. and Sanders, M. Recovery Management. (2006). Great Lakes ATTC. Chicago, IL.

(1938). When I Get Low, I Get High. [Recorded by Ella Fitzgerald with The Chick Webb Orchestra]. Performed on The Early Years - Part 1 (1935-1938)

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