Sources of Care for Alcohol and Other Drug Problems: The Role of the African American Church

Programming Provided by Religious Congregations in the United States to Address Mental Illness and Substance Use Disorder

Mental health conditions, including substance use disorders, are one of the most commonly occurring yet least commonly treated health ailments in the United States. Religious congregations serve as important providers of mental health services, as they can fill this gap with accessible care. This study provides an up-to-date accounting of mental health service provision by religious congregations, using a nationally representative survey of U.S. congregations collected in 2012 and 2018-19. Half of all congregations in the U.S. provided a program or service targeting mental illness or substance use disorder in 2018-19, and rates of provision increased among Christian congregations between 2012 and 2018-19.

Prevalence and Predictors of Substance Use Support Programming Among U.S. Religious Congregations

We conducted a cross-sectional secondary analysis of data from the 2012 National Congregation Study, a nationally representative survey of religious congregations in the United States ( N = 1,331). Multivariate logistic regression was used to identify congregational characteristics associated with providing substance use support programing. Nearly one-third (38%) of U.S. congregations indicated that they provided substance use support programming; approximately half (52%) of all congregational attendees were in a congregation that provided some type of substance use support. The internal factors associated with a congregation providing substance use programming include having members who are unemployed and younger, being conservative Protestant, engaging in the practice of speaking in tongues, and having the resources to support social services. The analysis also identifies external factors (i.e., assessing community needs and hosting social service speakers) as being associated with a congregation’s likelihood of providing substance use programming. Findings identify factors associated with congregations providing substance use support.

Access to psychosocial support for church-going young people recovering from drug and substance abuse in Zimbabwe: a qualitative study

BACKGROUND

The church and other religious-affiliated organizations have promising yet underexplored potential to provide social support services for young people recovering from substance abuse in communities where drug and substance rehabilitation services are limited. This study aimed to establish the barriers and facilitators of accessing psychosocial support, the role of the church, and strategies to promote access to psychosocial support for youths recovering from drug and substance abuse.

METHODS

This was a qualitative cross-sectional study, and semi-structured interviews of 18 church-going youths and three youth pastors were conducted in eastern Zimbabwe. Data were collected using recorded telephone interviews. Data were transcribed and analyzed using the thematic network analysis technique of producing basic themes, which build into organizing themes. Organizing themes produces one overarching global theme. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for reporting on qualitative research were used in reporting the study findings.

RESULTS

The interviews produced the following basic themes under organizing theme barriers: stigma and discrimination, parental/guardian denial, radical religious beliefs, and negative role models. Under the organizing theme facilitators, the basic themes were acceptance, confidentiality, peer and parental support, and an organized support program. The church acted as the bridge between the barriers to access to services and support seeking through innovative, inclusive projects and activities, as well as a pillar of social support.

CONCLUSIONS

Acceptance of one's addiction problem is critical to initiate seeking psychosocial support. Confidentiality, support from trustworthy relationships, and the availability of a well-coordinated recovery program enable young people to seek support. We recommend formal training church-based counselors in the ethical aspects of psychotherapy to reduce the preconceived social stigma associated with drug and substance abuse.

Inquiry into faith-based social reintegration programs for recovering drug addicts in Nigeria

Purpose

The purpose of this study is to subject faith-based organizations (FBOs)-operated social reintegration programs for recovering drug addicts to scrutiny to understand their effectiveness in addressing the three-pillar social needs.

Design/methodology/approach

Using concurrent mixed methods research design, a sample size of 156 respondents, 15 in-depth interviewees and 12 key informants was selected purposely from three FBOs and three National Drug Law Enforcement Agency (NDLEA) State Command Areas in Nigeria. Data were collected using questionnaire survey, interviews, observation and document review, and then analyzed using descriptive and content analyses.

Findings

Findings showed nine different noncore social reintegration programs for recovering drug-addicts with different required rates of participation and diverse purposes. Also, the results showed that the three-pillar social needs of recovering drug addicts for successful reintegration into the society were not provided for by the FBOs. Finally, findings showed that majority of the respondents were only slightly satisfied with the overall services rendered at the selected FBOs, and these services were not properly monitored by relevant government agency.

Social implications

Appropriate regulations that will check and balance the activities of treatment providers involved in social reintegration is recommended to achieve optimal level of physical, psychological and social health for recovering drug addicts.

Originality/value

To the best of the authors’ knowledge ,this is a pioneer study that investigated faith-based social reintegration programs for recovering drug addicts in Nigeria.

Clergy's Viewpoint Change Toward Mental Health and Stigma on Mental Illness: A Short Course Training

BACKGROUND

As stigma is one of the main barriers in promoting the mental health, the present study was designed with the purpose of reviewing clergy's viewpoint regarding the effect of mental health workshops on these barriers.

METHODS

For this study, by order of Iran's Health Ministry, a questionnaire was designed to examine the clergy's viewpoint related to mental illnesses and the consequent stigma. Ten faculty members and psychiatrists confirmed the questionnaire's validity after some modifications. In this research, 30 members of the clergy from the main religious city in Iran's "Qom" Seminary attended the training workshops for 2 days. The data obtained from the clergy's responses were analyzed using the SPSS software (ver.16) and descriptive and analytical tests. Also, the significance level was considered p < 0.05 in all tests. The results exhibited that the mean and standard deviation (Mean ± SD) of the clergy's attitude domain and awareness before the workshop was 1.90 ± 26.30 and 8.31 ± 1.64, respectively. Also, average and standard deviation (Mean ± SD) of their attitude domain and awareness after the workshop was 1.95 ± 29.73 and 1.18 ± 10.70, respectively.

DISCUSSION

The present study, which was designed to examine the clergy's viewpoint toward mental illnesses and the consequent stigma in the most considerable religious base in the country, illustrated that one strategy for reducing mental illness stigma in religious communities can be by holding training sessions to promote the clergy's awareness of and attitude toward mental health.

CONCLUSION

There was a significant statistical difference between their awareness and attitude scores before and after the workshop (p < 0.01). In the present research, the awareness and attitude of clergy toward mental health and stigma due to mental illness was relatively good and significantly increased by holding the workshop.

Clergy Perceptions of Mental Illness and Confronting Stigma in Congregations

Mental illness and stigma are key concerns in congregations and represent important threats to community health. Clergies are considered influential in how congregants think about and respond to mental health issues, especially in African American congregations. In-depth interviews with 32 African American and White clergies were conducted to understand their unique perspectives on mental health and how they interact with their congregations based on those perspectives. Findings include six themes related to mental health stigma, namely, holistic definitions of health; African Americans and different conceptions of mental health (only reported by African American clergies); code words and language; depression as a special case; perceptions of mental health counseling and treatment; and clergy strategies for addressing mental health stigma. The clergies in this study recognized their influence on ideas related to mental health in their congregations, and most expressed active efforts toward discussing mental health and reducing stigma.

Saving Grace? Religious ecology and deaths of despair

Since the late 1990s, deaths related to drug and alcohol abuse and suicide have increased substantially in the United States. Religious ecology is an important community attribute with theoretical links to these "deaths of despair." This study uses spatial autoregressive models to explore the relationship between religious ecology and deaths of despair, analyzing 2,992 US counties. Analyses focus on the effects of four American religious traditions (Mainline Protestant, Evangelical Protestant, Black Protestant, and Catholic), and how religious ecological effects interact with structural community disadvantage. Mainline Protestantism is protective in communities of low to medium disadvantage, while Black Protestantism is protective at high levels of disadvantage. Catholicism is positively associated with death rate at high levels of disadvantage. These denominational differences are likely linked to social processes of organizational support and norms about alcohol, which vary in efficacy and salience by community disadvantage. Overall, findings highlight the importance of religious ecology to understanding community health and mortality, as well as nuance in where and how religious ecology matters.

Faith Communities' Improvements in Readiness to Engage in Addictions Resilience and Recovery Support Programming

Spirituality and religion are well-documented components of prevention, treatment and recovery of substance use disorders. Faith communities are in a distinct position to support recovery and resilience regarding substance use disorders-not only in times of crisis, but every day. We conducted an exploratory study of congregational (i.e., organizational) "levers" that can drive change readiness in implementing recovery and resilience programming for substance use disorders within faith communities. Findings point to enhanced effectiveness post-intervention and the importance of developing awareness of resources to help with someone who has an alcohol or other drug problem.

Religious service attendance typologies and African American substance use: a longitudinal study of the protective effects among young adult men and women

PURPOSE

This study sought to identify variation by gender in the associations between religious service attendance from adolescence to young adulthood and seven measures of lifetime and short-term substance use.

METHODS

To conduct this nationally representative study, data from the Add Health Surveys was abstracted from Waves I and IV (N = 3,223) to construct four types of service attendance (non-attenders, attenders only as adolescents, attenders only in young adulthood, and consistent attenders). A series of logistic regressions were conducted to identify the independent effects of each pattern of service attendance on each substance among all black young adults, as well as male and female sub-samples.

RESULTS

Analysis revealed consistent attenders were generally less likely to use substances, with the effects being strongest among females. Among young adult only attenders, males recorded lower odds across all three short-term measures whereas females reported lower odds only for monthly cigarette use.

CONCLUSION

The protective effects of religious service attendance are more robust for African Americans who consistently attend in adolescence and young adulthood, especially among females.

"An undercover problem in the Muslim community": A qualitative study of imams' perspectives on substance use

BACKGROUND

Mainstream Islam prohibits alcohol and other drugs, yet substance use is prevalent in Muslim-American communities. Previous studies have not examined how imams, leaders of mosques, address substance use in their communities. This study aimed to explore imams' perspectives and approaches toward Muslim Americans with substance use disorders (SUD).

METHODS

Qualitative study of imams in New York City recruited by convenience sampling. We conducted one-on-one semi-structured interviews to address how imams perceive and address substance use. Using an inductive thematic analysis approach, we created an initial coding scheme which was refined iteratively, identified prominent themes, and created an explanatory model to depict relationships between themes.

RESULTS

All imams described substance use within a shared underlying framework of religious prohibition of alcohol and other drugs. Their perceptions of individuals with SUD diverged between a focus on sin, shame, and social disruption vs. a focus on acceptance and forgiveness. Furthermore, imams diverged between conceptualizing their communities as comprising mosque-going individuals without SUD vs. broader communities that include individuals with SUD. While imams acknowledged how some imams' judgmental language toward SUD may perpetuate stigma, they also identified therapeutic approaches toward SUD: non-judgmental engagement, encouragement of recovery, prayer, and referral to resources.

CONCLUSIONS

This study is among the first to illustrate the range of perceptions and approaches to substance use among Muslim American imams. These perceptions have potentially divergent impacts- shaming or assisting individuals with SUD. An understanding of these complexities can inform provision of culturally competent care to Muslim-American patients with SUD.

Attitudes About Mental Illness Among Seminary Students: a Qualitative Analysis

Tragically, a majority of people with mental illness never seek treatment; however, people may be more likely to seek help from religious clergy than from mental health professionals. In the current study, 25 Protestant seminary students were interviewed. The majority of students considered there to be biological, spiritual, and environmental causes of mental illness and favored psychological, medication, or spiritual treatments. Some participants reported stigma of mental illness, including avoidance and "dangerous" stereotypes. Religious clergy are frontline mental health providers, and their attitudes about mental illness are critical in reducing stigma and increasing treatment seeking among people with mental illness.

Size Matters: Addressing Social Determinants of Health Through Black Churches

Congregational size has been most consistently linked with offering health-related programs. However, few studies have examined the unique contribution of congregational size when considering other factors and across a range of health topics including those identified as social determinants of health. The current study sought to fill this gap. Eighty-eight faith leaders from 63 Christian churches in Baltimore, Maryland, provided information about themselves, their congregations, and the programs offered in their congregations. Over half of the sample were Baptist, and 60% were women. Logistic regression analyses were conducted to examine the extent to which congregational size was associated with the likelihood of having health programs. Results showed that faith leaders from larger congregations are significantly more likely to report having more programs overall and programs that specifically target health/health care and education, even after accounting for faith leader characteristics and denomination. However, both large and small churches had an equal likelihood of offering programs related to economic stability and social/community contexts. Our findings extend previous research and suggest important next steps for researchers and practitioners to consider on how best to involve congregations in health promotion and well-being among urban communities of color.

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

BACKGROUND

Psychosocial factors have rarely been studied to understand racial differences in opioid use disorders (OUD). We investigate religious involvement and Black-White differences in OUD risk between 2004-05 and 2012-13.

METHODS

We use Non-Hispanic Black and White adults from the National Epidemiologic Survey on Alcohol and Related Conditions (wave 2, N = 26,661 and NESARC-III, N = 26,960) (NESARC). We conducted survey-weighted logistic regression to examine whether race moderates the association between religious involvement and lifetime DSM-IV and -5 OUD and whether those differences change (i.e., are modified) by time, adjusted for covariates such as age, education, and urbanicity. Religious involvement measures were service attendance, social interaction, and subjective religiosity/spirituality.

RESULTS

The prevalence of lifetime DSM-IV (3.82 vs 1.66) and DSM-5 (2.49 vs 1.32) OUD in NESARC-III was higher among White compared to Black respondents. Never attending services declined for both races over time. Race moderated the association between service attendance (F(4,65) = 14.9, p = 0.000), social interaction (F(4,65) = 34.4, p = 0.000) and subjective religiosity/spirituality (F(2,65) = 7.03, p = 0.000) on DSM-IV OUD in wave 2 and using DSM-5 OUD in NESARC-III (F(1,113) = 2.79, p = 0.066). Race differences in religion and DSM-IV OUD risk was modified by time (i.e., survey year) (all p < 0.000). For instance, higher service attendance was associated with lower DSM-IV risk for Black respondents in wave 2 but higher risk in NESARC-III. There were no changes in regression slopes among White respondents.

CONCLUSIONS

Religious involvement may be important for prevention and treatment practices that respond to racial differences in risk of OUD. Replicate studies should examine other religious factors and specific types of opioids.