The Religious and Spiritual Dimensions of Cutting Down and Stopping Cocaine Use: A Qualitative Exploration Among African Americans in the South

Using societal conditional regard to cope with drug use in the ultraorthodox community and the unintended consequences

Introduction

A developing theoretical framework for the investigation of tight cultures' reaction toward members who violate communal norms is societal conditional regard (SCR).

Methods

Using a qualitative interpretive approach, in the current study we investigated the way the Ultraorthodox Jewish community uses SCR to cope with substance use disorders (SUDs), which considered to be a norms violation in closed religious communities. We did so by drawing on in-depth interviews with 14 young men from the Ultraorthodox community in Israel who were diagnosed as having an SUD and were in recovery.

Results

(a) The community's socialization process, educating its members to lead a life that is the only right one; (b) The community's use of God as the one whose love and regard are conditional; (c) The SCR emotional and behavioral practices used by the community toward individuals who violate norms, and (d) How, paradoxically, the use of SCR may eventuate in the initiation of drug use, and within the community itself.

Discussion

Findings are discussed in the context of self-determination theory and SCR, and shed light on how tight cultures cope with the threat of deviation of communal norms. Implications for intervention and policy are outlined.

Understanding the preference for receiving mental health and substance use support in African Americans 50 and older

OBJECTIVE

This study aims to determine whether current tobacco and/or alcohol use is associated with setting preferences for seeking support for substance use (SU) and mental health (MH) services to African Americans ages 50 and older.

METHODS

Data from 368 African American individuals (aged 50+) who participated in a community-based needs assessment survey were used. Preferences included community-based (e.g., health centers) and traditional settings (e.g., doctor's office). SU was measured as a categorical variable detailing past-month use of conventional cigarettes and alcohol graded by risk levels. Logistic regression models tested the associations between SU and setting preference before and after adjusting for the influence of self-reported MH diagnoses.

RESULTS

Prior to adjustment for the influence of MH outcomes, high-risk use of tobacco and alcohol in the past month was associated with a lower odds of preferring MH/SU support in traditional settings (OR = 0.23, 95% CI = 0.06-0.85) compared to participants engaged in no-/low- risk substance use. This association was no longer significant after accounting for the influence of mental health symptoms and covariates.

DISCUSSION

These results provide preliminary evidence that mental health outcomes mediate the association between substance use and setting preference for seeking MH/SU support in traditional settings.

TRANSLATIONAL SIGNIFICANCE

This exploratory study encourages additional investigation of the association between substance use, setting preferences, and the likelihood of seeking treatment in community health centers using larger sample sizes. Additional opportunities to offer mental health/substance use support to African American older adults within clinical settings should be explored.

The Journey From Drug Addiction to Drug Withdrawal: A Christian Gospel Rehabilitation Program in Taiwan

BACKGROUND

World Drug Report estimates the number of opioid users at 53 million and identifies opioids as responsible for two thirds of the 585,000 people who died as a result of drug use in 2017.

PURPOSE

The purpose of this study was to analyze the testimonies of 30 people regarding their journeys from drug addiction to drug withdrawal in Taiwan.

METHODS

This was a qualitative research design. The sample inclusion criteria were as follows: (a) being a drug abuser, (b) completed the Christian Gospel Drug Withdrawal Program or church-sponsored program, and (c) shared their related testimony on the Good TV television channel in Taiwan. The participants' stories were posted in Chinese, transcribed by the author, and translated from Chinese into English. Content analysis was used to identify the major themes.

RESULTS

Of the 30 participants, 24 were male (80%) and six were female (20%). The major themes identified in their testimonies were: (a) Using illegal drugs related to peer recognition, lack of knowledge, and temptations; (b) drug addiction was an endless pain cycle; (c) turning points related to love, repentance, and hope; (d) drug withdrawal was related to avoiding temptation and overcoming the drug withdrawal syndrome through the Holy Spirit; and (e) outcomes were faith and new life.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

In this study, people who received the gospel drug withdrawal programs expressed that their lives had changed, they had withdrawn from drugs successfully, they had become volunteers to help others, and interactions with their family had improved. These programs may be applied in the mental health nursing profession.

The intergenerational persistence of opioid dependence: Evidence from administrative data

To address the opioid crisis, it is crucial to understand its origins. We provide descriptive evidence for the intergenerational persistence of opioid dependence. Our analysis is based on administrative data covering the universe of Austrian births from 1984 to 1990. We consider prescription opioids and a new proxy for addiction to illicit opioids. We find that, if at least one parent is using illicit opioids, the likelihood of the child using increases from 1% to 7%. For prescription opioids, we observe an increase from 3.6% to 6.7%. Both associations are stable and do not change when controlling for environmental variables.

"They didn't have any idea what drugs were": Pathways to substance use disorders among ultraorthodox Jewish males

BACKGROUND

Substance use disorders (SUDs) are a worldwide phenomenon with very negative consequences, and belonging to a religious community is considered to be a protective factor against them. The pathways to SUDs have been investigated in many studies with the aim of helping us better understand this phenomenon and promoting effective intervention programs to prevent and manage it. However, there is a lack of knowledge regarding SUDs in closed religious communities such as the Ultraorthodox Jewish community.

METHOD

To fill this gap, in the current study we investigated the pathways to SUDs among 14 young men from the Ultraorthodox Jewish community in Israel who were diagnosed as having an SUD in the past and who had been in sustained remission for at least a year. Semi-structured, in-depth interviews consisting of open-ended questions were conducted.

RESULTS

The findings highlighted two main themes: (a) A lack of support and attention from various systems, where participants reported sense of otherness or lack of belonging to family, educational institutions and community; a lack of responsiveness from those systems; a sense of rejection or exclusion; and a longing for belonging, and (b) A light in the darkness - someone who cares, in which the interviewees received some assistance, either in the period before or during drug use.

CONCLUSION

Findings point to the unique experience of Ultraorthodox young men in their addiction process and shed light on the failure of the abovementioned systems to help these young men cope. Findings are discussed in the context of the theoretical perspectives of social capital theory and exclusion. Implications for intervention and policy are outlined.

Spirituality and religiosity expressed by relatives of drug users: contributions to health care

OBJECTIVE

to analyze the expressions of spirituality and religiosity of relatives of people who abuse or are dependent on psychoactive substances.

METHODS

exploratory-descriptive research that dialogues with the spirituality and religiosity conceptual framework. It was performed at an outpatient clinic specialized in drug treatment in southern Brazil. Semi-structured interviews conducted with 11 relatives of patients undergoing treatment were analyzed by content analysis.

RESULTS

the findings were grouped into two categories: forms of expression of spirituality and religiosity practices; and their influence on relatives' lives. Spirituality and religiosity almost always serve as a protective factor against feelings of anguish, conflicts and loneliness.

FINAL CONSIDERATIONS

despite the important role of expressions of spirituality and religiosity for many relatives, not everyone seems to benefit from them. Health professionals should consider these expressions in the construction of comprehensive health care for relatives.

Espiritualidade e religiosidade expressas por familiares de usuários de drogas: contribuições ao cuidado em saúde

RESUMO Objetivo: analisar as expressões da espiritualidade e da religiosidade de familiares de pessoas com uso abusivo ou dependente de substâncias psicoativas. Métodos: pesquisa exploratório-descritiva dialogando com o marco conceitual da espiritualidade e da religiosidade, realizada em ambulatório especializado no tratamento de drogas no sul do Brasil. Foram realizadas entrevistas semiestruturadas com 11 familiares de pacientes em tratamento, sendo analisadas pela análise de conteúdo. Resultados: foram agrupados em duas categorias: formas de expressão de práticas de espiritualidade e religiosidade e influência delas na vida dos familiares. A espiritualidade e religiosidade quase sempre servem como fator de proteção diante de sentimentos de angústia, conflitos e solidão. Considerações Finais: as expressões da espiritualidade e religiosidade têm papel importante para muitos familiares, no entanto nem todos parecem se beneficiar delas. Os profissionais de saúde devem considerar essas expressões na construção do cuidado integral em saúde dos familiares.

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.

A Qualitative Exploration of Women's Lives and Resilience in Substance Use Disorder Recovery

OBJECTIVE

This study sought to explore constructs of the Whole Health resilience model to identify potential intervention and local research opportunities as a precursor to intervention development, as well as to describe women's resilience in Substance Use Disorder (SUD) recovery including current strengths, coping, self-care, needs and priorities in the context of their everyday lives.

METHODS

Qualitative data were collected from December 2018 to January 2020 in the Mid-South United States. In-depth interviews of 17 women age 25 to 65 years in SUD recovery for 2 weeks or longer were conducted in 9 different settings including a Medication Assisted Treatment (MAT) hospital setting, a MAT pilot program in a community corrections setting, an incarceration re-entry residential program, community-based peer support organizations (eg, Narcotics Anonymous, Alcoholics Anonymous), a residential SUD treatment facility and a yoga teachers' online group. These data were analyzed with a hybrid approach (inductive and deductive coding).

RESULTS

The major themes that emerged from the analysis included social support, individual-level cognitive and spiritual strategies; self-care; stressors, priorities, needs, and self-care barriers and trauma. In this context, women needed a wide range of support including treatment of severe physical injuries, professional psychological support, help with restoring relationships, SUD treatment and recovery services, job training and coaching, health insurance advice, transportation, intimate partner violence (IPV) counseling and housing. Peer-support groups and faith communities were instrumental in many (but not all) of these women's lives in recovery-a gap was identified for women who did not have social support from these groups.

CONCLUSION

These data highlight the need for developing interventions for women in SUD recovery that take a holistic view of resilience life areas, as well as integrate professional services, family support, community support and approach care as wrap-around support that includes integration of social services to meet women's basic needs.

A feasibility study providing substance use treatment in the Black church

BACKGROUND

Black adults with substance use disorders (SUDs) experience health care disparities, including access to and retention in treatment. The Black church is a trusted institution in the Black community and could be a novel setting for providing SUD treatment.

METHOD

We conducted a nonrandomized feasibility study evaluating (1) whether it was possible to conduct a clinical trial of SUD treatment in this setting, (2) whether an adequate number of individuals with SUDs would participate in technology-based treatment in this setting, and (3) whether an adequate number of individuals would be retained in this setting. We evaluated computer-based training for cognitive behavioral therapy (CBT4CBT), with modifications that the church-based health advisors (CHAs), who delivered the intervention within the church, made.

RESULTS

Participants were 40 Black adults, all of whom met DSM-5 criteria for a current SUD, (55% severe). The mean number of sessions completed was 6.8 and 31 completed all 7 sessions of CBT4CBT. Both self-reports and weekly urine toxicology screens indicated reduction in substance use over time.

CONCLUSION

We demonstrated feasibility, as we were able to (1) collect weekly data and protect participant confidentiality, (2) recruit an adequate number of individuals with SUD, with (3) high uptake and retention of an adapted CBT4CBT in the Black church. If demonstrated to be effective in a future randomized clinical trial, delivery of technology-based treatments in the Black church may prove a promising, easily disseminable strategy to provide evidence-based interventions to an underserved and undertreated population.

Critical Literature Review on the Definition Clarity of the Concept of Faith, Religion, and Spirituality

The critical review of the literature describes the definition clarity of spirituality, religion, and faith. These three terms are interchangeably used in the literature. However, each of these terms has its own definitions. For example, the term spirituality has more than 13 conceptual components. It is abstract and subjective and is different from religion and faith. Spirituality can be a connection to God, nature, others, and surrounding. Spirituality is associated with quality and meaning in life. Conversely, religion is attributed to traditional values and practices related to a certain group of people or faith. Religion is guided by tradition, rules, and culture. Religion is defined as a personal set or institutionalized system of religious attitudes, beliefs, and practices. Religion is the service or worship of God or the supernatural. Faith is often associated with religion and spirituality. Faith is more personal, subjective, and deeper than organized religion and relates to the relationship with God. The concept of spirituality lacks a professional understanding. It is imperative that the holistic view of nursing must strive to understand the definition of spirituality.

Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse

This study reviews the voluminous empirical evidence on faith's contribution to preventing people from falling victim to substance abuse and helping them recover from it. We find that 73% of addiction treatment programs in the USA include a spirituality-based element, as embodied in the 12-step programs and fellowships initially popularized by Alcoholics Anonymous, the vast majority of which emphasize reliance on God or a Higher Power to stay sober. We introduce and flesh out a typology of faith-based substance abuse treatment facilities, recovery programs, and support groups. This typology provides important background as we then move on to make an economic valuation of nearly 130,000 congregation-based substance abuse recovery support programs in the USA. We find that these faith-based volunteer support groups contribute up to $316.6 billion in savings to the US economy every year at no cost to tax payers. While negative experiences with religion (e.g., clergy sex abuse and other horrendous examples) have been a contributory factor to substance abuse among some victims, given that more than 84% of scientific studies show that faith is a positive factor in addiction prevention or recovery and a risk in less than 2% of the studies reviewed, we conclude that the value of faith-oriented approaches to substance abuse prevention and recovery is indisputable. And, by extension, we also conclude that the decline in religious affiliation in the USA is not only a concern for religious organizations but constitutes a national health concern.

Comorbidity of Lifetime Alcohol Use Disorder and Major Depressive Disorder in San Juan, Puerto Rico

OBJECTIVE

The purpose of this study was to update estimates of comorbidity between lifetime alcohol use disorder (AUD) severity and lifetime major depressive disorder (MDD) in San Juan, Puerto Rico.

METHOD

Data are from a household random sample of 1,510 individuals (816 female) 18-64 years of age in San Juan, Puerto Rico. AUD and MDD identification follow criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and Fourth Edition, respectively, both implemented with the Composite International Diagnostic Interview (CIDI). It is possible to implement DSM-5 AUD identification with the CIDI, but only DSM-IV criteria can be applied to identify MDD.

RESULTS

The prevalence of lifetime MDD was 11% among men, 17% among women, and 14% for both genders; the prevalence of lifetime AUD was 38% among men, 16% among women, and 26% for both genders. Among those with AUD, the rate of MDD was 17% among men and 35% among women. Among those without AUD the rate of MDD was 7% among men and 15% among women. Results of multiple logistic regression analysis controlling for gender, illegal drug use, age, level of family cohesion, religion, employment status, marital status, education, and family annual income showed that AUD severity was positively associated with the likelihood of MDD, as follows: mild AUD, adjusted odds ratio [AOR] = 1.78 (95% CI [1.09, 2.91], p < .05); moderate AUD, AOR = 2.58 (95% CI [1.33, 5.01], p < .01); and severe AUD, AOR = 3.34 (95% CI [1.70, 6.56], p < .01).

CONCLUSIONS

MDD frequently occurs as a comorbid condition with AUD in San Juan, Puerto Rico. The frequency of occurrence increases as AUD severity increases. AUD treatment providers should therefore be equally prepared to treat these two comorbid conditions.

Order in The Court? The Association Between Substance Use, Exposure to Violence, Risky Sexual Behaviors & Observed Court Behaviors Among Women Involved in the Criminal Justice System

Drug courts, therapeutic justice programs for individuals charged with drug offenses, have sub-optimal completion rates. The Courtroom Behavior Checklist (CRBCL), an assessment that quantifies readiness for drug court and drug court behaviors, was developed to predict female offenders who may be at-risk for non-compliance and termination. Data derived from 264 mainly urban women recruited from a Municipal Drug Court System in St. Louis, MO, were used to evaluate the association between substance use, victimization, HIV/AIDS risk behaviors, and observed drug court behaviors. Results showed that women who reported recent substance use or were categorized as at risk for HIV/AIDS were significantly more likely to have scores indicative of unfavorable drug court behaviors, while women who experienced victimization had scores indicative of favorable drug court behaviors. Other factors significantly associated with unfavorable drug court behaviors included greater lifetime arrests, lower education, and being less religious or spiritual. Our findings suggest that the CRBCL may have added utility in identifying women in drug court with recent substance use and risky sexual behaviors. However, further studies on other samples of offenders are needed to support these findings.

Sociodemographic, neighborhood, psychosocial, and substance use correlates of cocaine use among Black adults: Findings from a pooled analysis of national data

OBJECTIVE

Cocaine use (CU) is serious a public health issue affecting U.S. adults, including Blacks. Cocaine-related overdose deaths have also trended upwards among this population. However, there remains a lack of research on correlates of CU among a nationally representative sample of Black adults.

METHODS

The current study examines the prevalence and correlates of past-year CU among Black adults aged 18 and older (N = 9,821). Data from the National Survey on Drug Use and Health (2015-2016) were used and a weighted logistic regression model was estimated.

RESULTS

Findings showed 2.4% of Black adults reported past-year CU-significantly higher than rates of CU among other assessed racial groups. Opioid use/misuse, encounters with drug dealers, easier access to cocaine, unemployment, and being 35 or older were associated with increased odds of CU. Greater risk perception of CU and religiosity were associated decreased odds of CU.

CONCLUSION

Results identified several correlates associated with past-year CU among Black adults. Findings suggest addressing CU among this population will likely require the development of multilevel prevention and intervention strategies and an increased focus on opioid use/misuse as opioids have been recently implicated in cocaine-related overdose deaths.

Narrating the journey of sustained recovery from substance use disorder

Background

The reported high rate of relapse in the context of an ever-increasing rate of substance abuse internationally and in South Africa together with the fact that the topic of sustained recovery from Substance Use Disorder (SUD) appears to be totally neglected in extant literature and research agendas motivated the researchers to conduct this investigation. The aim was to obtain an in-depth understanding of how individuals recovering from a SUD experience and sustain their recovery in order to fill the gap in the knowledge base.

Methods

A qualitative research approach was followed, employing a narrative and phenomenological research design alongside an explorative, descriptive and contextual strategy of inquiry. Fifteen participants were purposefully recruited; and data were collected by means of individual, face-to-face interviews. Schlossberg’s Transition Process Model (1981) (Schlossberg NK, The Counselling Psychologist 1981;9(2):2-18, Schlossberg NK, Journal of Employment Counselling 2011;48:159-162, Anderson ML et al., Counselling adults in transition: linking

Schlossberg’s theory with practice in a diverse world., 2012) served as a theoretical framework and provided the backdrop to, and foundation for, the presentation of the research findings.

Results

Participants’ entry into recovery was triggered by an internal or external crisis caused by chemical substance abuse. They had to embrace a psychological mind set change, involving commitment to a new way of life in order to sustain their recovery. This, among others, was facilitated by participants’ acceptance of the concept of ‘disease of addiction’ or finding a new faith-based identity. The 12-Step programme and further education and development were found to spiritually support sustained recovery. Strong ongoing support from specialised substance abuse support and/or religious groups, interpersonal relationships with family, spouses and sponsors as well as supportive work environments played a major role in sustaining recovery. The act of helping others further helped the participants to sustain their own recovery.

Conclusion

Regardless of the pathway of recovery, there are key aspects that appear to aid sustained recovery. In grouping these according to the four S’s in Schlossberg’s Transition Process Model (Schlossberg NK, The Counselling Psychologist 1981;9(2):2-18, Journal of Employment Counselling 2011;48:159-162, Anderson ML et al., Counselling adults in transition: linking

Schlossberg’s theory with practice in a diverse world., 2012): self, situation, strategies and support, they seem to facilitate the adaptation to transition from addiction to sobriety. Internal psychological and spiritual resources in terms of self; support (from family, church and support groups); strategies to combat cravings and deal with life problems; and avoiding and managing risk-inducing situations to strengthen recovery.

The Association Between Religiosity and Substance Use Patterns Among Women Involved in the Criminal Justice System

A growing body of research is exploring the association between religiosity and drug use. Thus, this analysis examines the association between religiosity and substance use patterns among females in the criminal justice system. Data derived from 318 women recruited from a Municipal Drug Court System in St. Louis, Missouri, were used to determine the association between religiosity and substance use patterns. Results indicate that religiosity decreased the odds of cocaine use, observed for both crack/cocaine (CC) use alone (adjusted odds ratio [AOR] = 0.41) and crack/cocaine + marijuana (CC + MJ) (AOR = 0.32). Interestingly, this association was not found for MJ use alone. Other variables that were significantly associated with CC + MJ use included being non-Black (CC + MJ: AOR = 0.46; MJ: AOR = 0.28), 4+ arrests (CC + MJ: AOR = 4.66; CC: AOR = 2.64), and <30 years of age (CC + MJ: AOR = 0.37; CC: AOR = 0.16; MJ: AOR = 2.84). Future drug prevention and interventions should consider the potential protective effects of religiosity on substance use.

Illegal drug use and its correlates in San Juan, Puerto Rico

BACKGROUND

Data on the prevalence and correlates of illegal drug use in Puerto Rico are now almost 20 years old.

OBJECTIVES

This study sought to estimate the 12-month prevalence of illegal and non-prescribed medical drug use in San Juan, Puerto Rico and identify sociodemographic correlates of use.

METHODS

Data are from a random household sample of 1510 individuals, 18-64 years of age in San Juan, Puerto Rico.

RESULTS

The 12-month prevalence of any illegal or non-prescribed drug use was 16.5%. Prevalence among men (20.7%) was higher than among women (12.9%; chi² = 16.308; df = 1; p < .01). Prevalence for specific drugs ranged from 11.2% for marijuana to 0.2% for methadone.

RESULTS

of the multiple logistic regression analysis showed that male gender (OR = 1.67, 95CI = 1.21-2.3; p < .01), age 18-29 (OR = 2.39; 95CI = 1.35-4.23; p < .01), age 30-39 (OR = 1.93; 95CI = 1.01-3.69; p < .05), low (OR = 2.03; 95CI = 1.36-3.02; p < .001) and medium (OR = 1.50; 95CL = 1.01-2.23; p < .05) family cohesion/pride, and no religious preference (OR = 1.99; 95CI = 1.23-3.22; p < .01) increased the odds of drug use. Annual family income of $40,000-$60,000 (OR = 0.45; 95CI = 0.21-0.93; p < .05) and $60,001 and more (OR = 0.35; 95CI = 0.13-0.94; p > .05) were negatively associated with drug use compared to annual income up to $10,000.

CONCLUSIONS

As in many other places in the U.S., drug use in San Juan, Puerto Rico is high, affecting about 1 in 6 adults in the population. The highest prevalence is for marijuana use, which cannot be medically prescribed and of which recreational use is illegal on the island.

The Criminal Justice Experience of African American Cocaine Users in Arkansas

BACKGROUND

African Americans are incarcerated at rates much higher than other racial and ethnic groups in the United States.

OBJECTIVES

We sought to qualitatively explore the relationships between ongoing involvement in the criminal justice system and continued drug use in a population of urban and rural African American cocaine users in a southern state.

METHODS

Semi-structured qualitative interviews were conducted among African American cocaine users in Arkansas between 2010 and 2012. Participants resided in both rural (two counties located in the eastern Arkansas Mississippi delta region) and urban (the county including the capital city of Little Rock) areas.

RESULTS

Numerous important themes emerged from participants' narratives, including chronic involvement with the criminal justice system (being a "career criminal"), continued access to drugs while incarcerated, relapse, and reincarceration and lack of access to effective drug treatment. Conclusion/Importance: The themes which emerged from our data speak to the collective experience that many substance using populations in the United States face in dealing with the criminal justice system. Our findings highlight the need to better, more holistic ways of engaging African American substance users in community based substance use treatment and supportive services.

Gender Differences in the Association Between Religion/Spirituality and Simultaneous Polysubstance Use (SPU)

While religion/spirituality strongly protects against drug use (Cheney et al. in J Drug Issues 44(1):94-113, 2014), little is known about gender differences in the association of religion/spirituality on simultaneous polysubstance use (SPU) among those who use prescription opioids. Data come from a community-based study that recruited community members from the St Louis area (N = 632). Participants were asked whether they used prescription opioids when not prescribed for them or in ways other than prescribed in the past 12 months. Religion/spirituality was categorized as high, medium, or low based on personal views on the importance of religion and spirituality, attendance at religious services, and advice seeking from religious leaders. SPU was defined as non-medical use of opioids simultaneously with use of cocaine, alcohol, ecstasy, or marijuana. Multivariate logistic regression determined the association between religion/spirituality, demographic variables, and SPU. Men with high levels of religion/spirituality had 63 % decreased odds of SPU compared with men with low levels. Other variables associated with SPU in men were four or more arrests (AOR 2.21), multiple sex partners (AOR 2.11), and opioid use without a prescription (AOR 3.04). Women with high or medium levels of religion/spirituality had 58 and 62 % decreased odds of SPU compared with women with low levels. Variables that predicted SPU in women also included 4+ arrests (AOR 5.00) and never being married (AOR 2.13). Being African-American was associated with decreased odds of SPU in women (AOR 0.32). Overall, a high level of religion/spirituality was associated with lower odds of SPU. Gender differences in this association were evident, whereas women with even a medium level of religion/spirituality had significantly decreased odds of SPU. Future drug prevention and interventions should consider the relevance of religion/spirituality in SPU.

Associations Between Religiosity, Perceived Social Support, and Stimulant Use in an Untreated Rural Sample in the U.S.A

BACKGROUND

Religiosity and perceived social support (SS) may serve as protective factors for more severe substance use in adults.

OBJECTIVES

This study sought to examine whether aspects of religiosity and SS are associated with longitudinal reductions in stimulant use over three years in an untreated sample of rural drug users.

METHODS

Respondent-driven sampling was used to recruit stimulant users (N = 710) from Arkansas, Kentucky, and Ohio. Follow-up interviews were conducted at 6-month intervals for 36 months.

RESULTS

Our bivariate findings indicate that higher religiosity was associated with lower odds and fewer days of methamphetamine and cocaine use. After controlling for covariates, higher religiosity was associated with fewer days of crack cocaine use, but more days of methamphetamine use among a small sample of users in the two final interviews. Higher SS from drug-users was also associated with higher odds and days of methamphetamine and powder cocaine use, while higher SS from nondrug users was associated with fewer days of methamphetamine use.

CONCLUSIONS/IMPORTANCE

Our bivariate findings suggest that higher levels of religiosity may be helpful for some rural individuals in reducing their drug use over time. However, our multivariate findings suggest a need for further exploration of the potential effects of religiosity on longer-term drug use, especially among those who continue to use methamphetamine and/or remain untreated. Our findings also highlight the potential deleterious effect of SS from drug users on the likelihood and frequency of methamphetamine and powder cocaine use over time among untreated rural drug users.

The Role of Social Capital in African Americans' Attempts to Reduce and Quit Cocaine Use

BACKGROUND

Research examining substance users' recovery has focused on individual-level outcomes while paying limited attention to the contexts within which individuals are embedded, and the social processes involved in recovery.

OBJECTIVES

This paper examines factors underlying African American cocaine users' decisions to reduce or quit cocaine use and uses practice theory to understand how lifestyle changes and shifts in social networks facilitate access to the capital needed to change cocaine use patterns.

METHODS

The study, an in-depth analysis of substance-use life history interviews carried out from 2010 to 2012, included 51 currently not-in-treatment African American cocaine users in the Arkansas Mississippi Delta region. A blended inductive and deductive approach to data analysis was used to examine the socio-cultural and economic processes shaping cocaine use and recovery.

RESULTS

The majority of participants reported at least one lifetime attempt to reduce or quit cocaine use; motivations to reduce use or quit included desires to meet social role expectations, being tired of using, and incarceration. Abstinence-supporting networks, participation in conventional activities, and religious and spiritual practices afforded access to capital, facilitating cocaine use reduction and sobriety.

CONCLUSIONS

Interventions designed to increase connection to and support from nondrug using family and friends with access to recovery capital (e.g., employment, faith community, and education) might be ideal methods to reduce substance use among minorities in low-income, resource-poor communities.

Rural/urban residence, access, and perceived need for treatment among African American cocaine users

OBJECTIVE

To examine how rural/urban residence, perceived access, and other factors impede or facilitate perceived need for drug use treatment, a concept closely linked to treatment utilization.

STUDY DESIGN

Two hundred rural and 200 urban African American cocaine users who were not receiving treatment were recruited via Respondent-Driven Sampling and completed a structured in-person interview. Bivariate and multivariate analyses were conducted to test the associations between perceived need and rural/urban residence, perceived access, and other predisposing (eg, demographics), enabling (eg, insurance), and health factors (eg, psychiatric distress).

PRINCIPAL FINDINGS

In bivariate analyses, rural relative to urban cocaine users reported lower perceived treatment need (37% vs 48%), availability, affordability, overall ease of access, and effectiveness, as well as lower perceived acceptability of residential, outpatient, self-help, and hospital-based services. In multivariate analyses, there was a significant interaction between rural/urban residence and the acceptability of religious counseling. At the highest level of acceptability, rural users had lower odds of perceived need (OR = 0.21); at the lowest level, rural users had higher odds of perceived need (OR = 3.97) than urban users. Among rural users, the acceptability of religious counseling was negatively associated with perceived need (OR = 0.65). Ease of access was negatively associated (OR = 0.71) whereas local treatment effectiveness (OR = 1.47) and the acceptability of hospital-based treatment (OR = 1.29) were positively associated with perceived need among all users.

CONCLUSIONS

Our findings suggest rural/urban disparities in perceived need and access to drug use treatment. Among rural and urban cocaine users, improving perceptions of treatment effectiveness and expanding hospital-based services could promote treatment seeking.

The pew versus the couch: relationship between mental health and faith communities and lessons learned from a VA/clergy partnership project

The history of the relationship between religion and mental health is one of commonality, conflict, controversy, and distrust. An awareness of this complex relationship is essential to clinicians and clergy seeking to holistically meet the needs of people in our clinics, our churches, and our communities. Understanding this relationship may be particularly important in rural communities. This paper briefly discusses the history of this relationship and important areas of disagreement and contention. The paper moves beyond theory to present some current practical tensions identified in a brief case study of VA/Clergy partnerships in rural Arkansas. The paper concludes with a framework of three models for understanding how most faith communities perceive mental health and suggests opportunities to overcome the tensions between "the pew" and "the couch."