Religious Institutions as a Link to Substance use Treatment: Characterizing the Potential Service Population through National Survey Data

Abstract

Background: Relatively few Americans with current alcohol or drug use disorders receive outpatient or residential treatment. Outreach initiatives at local places of religious worship have been proposed as a way of facilitating such service use, but the number and characteristics of adults who may be reached in this way has not been studied. Methods: Data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative cross-sectional survey of U.S. adults were used to estimate the number of and proportion of adults with substance use disorders (SUDs) who attended monthly religious service and did not receive SUD treatment in the past year and used multinomial logistic regression to compare them to three SUD groups who did or did not receive treatment and/or attend religious services. Results: A total of 5,795 respondents representing 35.8 million Americans met criteria for a past-year SUD, of whom 8.3 million (23.1%) attended religious services monthly and did not receive substance use treatment. This more often African-American group had substantially fewer socio-demographic disadvantages (e.g., unemployment), behavioral problem indicators (e.g., police involvement), a higher quality of life score and less likelihood of an illicit drug use diagnosis than those who received treatment and either did or did not attend religious services. Conclusion: Almost one quarter of adults with a SUD attend religious services monthly and do not receive SUD treatment. Although they have fewer adversities than people who receive treatment, outreach to this population may link this substantial group of people to needed services.

Highlights/review

National survey data suggest 8 of 36 million Americans with substance use diagnoses’ (23%) do not receive specialized SUD treatment, but they do attend religious services monthly or more.

This group, notably, has less numerous problems, such as unemployment, police involvement, and drug use disorder, and have higher quality of life scores than those who receive treatment for SUD.

Outreach and linkage initiatives with religious institutions may facilitate use of services by this population.

Keywords

Alcohol use disorder (AUD)drug use disorder (DUD)substance use disorder (SUD)religion addiction treatment health services research outreach

Get full access to this article

View all access options for this article.

References

US Burden of Disease Collaborators. The State of US Health, 1990-2016: burden of diseases, injuries, and risk factors among US states. JAMA. 2018;319(14):1444–1472.

National Institute on Drug Abuse. Overdose death rates. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. 2020. Accessed April 14, 2020.

Yuodelis-Flores

, Ries

RK.

Addiction and suicide: a review. Am J Addict. 2015;24(2):98–104.

Callaghan

, Gatley

, Veldhuizen

, Lev-Ran

, Mann

, Asbridge

Alcohol- or drug-use disorders and motor vehicle accident mortality: a retrospective cohort study. Accid Anal Prev. 2013;53:149–155.

Smith

, Homish

, Leonard

, Cornelius JR.

Intimate partner violence and specific substance use disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Addict Behav. 2012;26(2):236–245.

National Institute on Drug Abuse. Trends & statistics. https://www.drugabuse.gov/related-topics/trends-statistics. 2020.

Center for Behavioral Health Statistics and Quality. Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.htm. Accessed August 26, 2020.

Mackey

, Veazie

, Anderson

Evidence Brief: Barriers and Facilitators to Use of Medications for Opioid Use Disorder. Washington, DC: Department of Veterans Affairs (US); 2019. https://www.ncbi.nlm.nih.gov/books/NBK549203/.

Mcginty

, Barry

. Stigma reduction to combat the addiction crisis – developing an evidence base. N Engl J Med. 2020;382(14):1291–1292.

10.

Volkow

ND.

Stigma and the toll of addiction. N Engl J Med. 2020;382(14):1289–1290.

11.

Romo

, Ulbricht

, Clark

, Lapane

KL.

Correlates of specialty substance use treatment among adults with opioid use disorders. Addict Behav. 2018;86:96–103.

12.

Andrews

, Humphreys

, Grogan

CM.

How Medicaid work requirements could exacerbate the opioid epidemic. Am J Drug Alcohol Abuse. 2020;46(1):1–3.

13.

James

, Jordan

The opioid crisis in black communities. J Law Med Ethics. 2018;46(2):404–421.

14.

Novak

, Feder

, Ali

, Chen

Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness: evidence from a national survey. J Subst Abuse Treat. 2019;98:47–52.

15.

Priest

, Englander

, McCarty

“Now hospital leaders are paying attention”: a qualitative study of internal and external factors influencing addiction consult services. J Subst Abuse Treat. 2020;110:59–65.

16.

Blevins

, Rawat

, Stein

. Gaps in the substance use disorder treatment referral process: provider perceptions. J Addict Med. 2018;12(4):273–277.

17.

Campbell

, Hudson

, Resnicow

, Blakeney

, Paxton

, Baskin

Church-based health promotion interventions: evidence and lessons learned. Annu Rev Public Health. 2007;28(1):213–234.

18.

Bielefeld

, Cleveland

WS.

Defining faith-based organizations and understanding them through research. Nonprof Volunt Sec Q. 2013;42(3):442–467.

19.

Grim

, Grim

ME.

Belief, behavior, and belonging: how faith is indispensable in preventing and recovering from substance abuse. J Relig Health. 2019;58(5):1713–1750.

20.

Cuadrado

Roman Catholic priests as referral sources and treatment aides for Hispanics with substance misuse/abuse problems. J Relig Health. 2018;57(2):609–621.

21.

Wong

, Derose

, Litt

, Miles

JNV.

Sources of care for alcohol and other drug problems: the role of the African American church. J Relig Health. 2018;57(4):1200–1210.

22.

Castaldelli-Maia

, Bhugra

. Investigating the interlinkages of alcohol use and misuse, spirituality and culture - Insights from a systematic review. Int Rev Psychiatry. 2014;26(3):352–367.

23.

Rover

A study in innovation: reinventing substance use disorder intervention. https://medicine.yale.edu/news/yale-medicine-magazine/a-study-in-innovation-reinventing-substance-use-disorder/. 2019.

24.

Innovations in compassion. The faith-based and community initiative: a final report to the armies of compassion. https://georgewbush-whitehouse.archives.gov/government/fbci/pdf/innovation-in-compassion.pdf. 2008. Accessed April 5, 2020.

25.

National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). 2019. https://www.niaaa.nih.gov/research/nesarc-iii.

26.

National Institute on Alcohol Abuse and Alcoholism. 2017. National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

27.

Grant

, Goldstein

, Saha

et al. Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757–766.

28.

National Institute on Alcohol Abuse and Alcoholism. National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III): Source and accuracy statement National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD; 2018.

29.

U.S. Census Bureau. American Community Survey Edited by U.S. Census Bureau. U.S. Department of Commerce, Suitland, MD; 2012.

30.

Kelly

, McCrady

BS.

2008. Twelve-step facilitation in non-specialty settings. In: Kaskutas

, Galanter

, eds. Recent Developments in Alcoholism. Recent Developments in Alcoholism. vol 18. New York, NY: Springer.

31.

Ware

Jr. , Kosinski

, Keller

SD.

A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233.

32.

Ferguson

CJ.

An effect size primer: a guide for clinicians and researchers. Professional Psychology: Research and Practice. 2009;40(5):532–538.

33.

Cohen

Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New Jersey: Lawrence Erlbaum Associates; 1988.

34.

SAMSHA. Facing addiction in America: the surgeon general's report on alcohol, drugs, and health - full report. https://store.samhsa.gov/product/Facing-Addiction-in-America-The-Surgeon-General-s-Report-on-Alcohol-Drugs-and-Health-Full-Report/SMA16-4991. 2016. Accessed August 26, 2020.

35.

Evashwick

Creating the continuum of care. Health Matrix. 1989;7(1):30–39.

36.

SAMSHA. Prevention of substance use and mental disorders. https://www.samhsa.gov/find-help/prevention. 1999. Accessed August 26, 2020.

37.

Gorsuch

RL.

Religious aspects of substance abuse and recovery. Soc. Issues. 1995;51(2):65–83.

38.

Miller

WR.

Researching the spiritual dimensions of alcohol and other drug problems. Addiction. 1998;93(7):979–990.

39.

Cheney

, Curran

, Booth

, Sullivan

, Stewart

, Borders

TF.

The religious and spiritual dimensions of cutting down and stopping cocaine use: a qualitative exploration among African Americans in the south. J Drug Issues. 2014;44(1):94–113.

40.

Ransome

, Gilman

SE.

The role of religious involvement in black-white differences in alcohol use disorders. J Stud Alcohol Drugs. 2016;77(5):792–801.

41.

Escobedo

, Allem

, Baezconde-Garbanati

, Unger

JB.

Cultural values associated with substance use among Hispanic emerging adults in Southern California. Addict Behav. 2018;77:267–271.

42.

Warner

Temperance, alcohol, and the American evangelical: a reassessment. Addiction. 2009;104(7):1075–1084.

43.

Probst

, Manthey

, Rehm

Understanding the prevalence of lifetime abstinence from alcohol: an ecological study. Drug Alcohol Depend. 2017;178:126–129.

44.

Ransome

, Haeny

, Mcdowell

, Jordan

Religious involvement and racial disparities in opioid use disorder between 2004–2005 and 2012–2013. Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend. 2019;205:107615.

45.

Johnson-Lawrence

, Bailey

, Sanders

The church challenge: a community-based multilevel cluster randomized controlled trial to improve blood pressure and wellness in African American churches in Flint, Michigan. Contemp Clin Trials Commun. 2019;14:100329.

46.

Campbell

Brief interventions and brief therapies for substance abuse 34 treatment improvement protocol (TIP) series center for substance abuse treatment substance abuse and mental health services administration. https://www.academia.edu/25734993/Brief_Interventions_and_Brief_Therapies_for_Substance_Abuse_34_Treatment_Improvement_Protocol_TIP_Series_Center_for_Substance_Abuse_Treatment_Substance_Abuse_and_Mental_Health_Services_Administration. n.d. Accessed August 26, 2020.

47.

Rashid

, Kamali

, Habil

, Shaharom

, Seghatoleslam

, Looyeh

MY.

A mosque-based methadone maintenance treatment strategy: implementation and pilot results. Int J Drug Policy. 2014;25(6):1071–1075.