The efficacy of spiritual/religious interventions for substance use problems: A systematic review and meta-analysis of randomized controlled trials

Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: A latent class approach

BACKGROUND

The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups.

METHODS

As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs.

RESULTS

Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months.

CONCLUSIONS

This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play.

The twisted path to sacredness: a grounded theory study of irrational religious orientation and its psycho-sociological implications

This research delves into the nuances, origins, and societal effects of irrational religious orientations within China's Generation Z, employing grounded theory methodology for a comprehensive analysis. The focus is on those born between 1995 and 2010, a demographic raised amidst rapid information technology growth and significantly influenced by digitalization and globalization. The study identifies three primary dimensions of irrational religious orientations in Generation Z: religious spiritual dependence, religious instrumental tendency, and religious uniqueness identity. These are shaped by factors such as the overwhelming influx of information via digital media, societal pressures and psychological dilemmas, conflicts in values and identity crises, as well as feelings of social isolation and the need for group belonging. To address these trends, the study suggests several interventions: enhancing multicultural and values education, implementing stricter online information regulation and literacy programs, boosting mental health awareness and support, and fostering engagement in social and cultural activities. These recommendations are essential for comprehensively understanding and effectively responding to the irrational religious orientations of Generation Z, ultimately contributing to their overall well-being and healthy development.

The impact of spiritual well-being and social support on substance use treatment outcomes within a sample of predominantly Black/African American adults

INTRO

Substance use and associated problems often return following treatment for substance use disorder (SUD), which disproportionally impact Black/African American (AA) individuals. Social support and spiritual well-being are sources of recovery capital identified as particularly important among Black/AA adults. Social support and spiritual well-being are also posited mechanisms in 12-step; thus, this study tested the effects of social support and spiritual well-being on substance use outcomes over time, distinct from 12-step involvement, among Black/AA adults post-SUD treatment. The study hypothesized that social support and spiritual well-being would demonstrate significant interactions with time, respectively, on substance use frequency and substance use consequences, above the effect of 12-step involvement.

METHOD

The study drew data from a study of 262 adults (95.4 % Black/AA) entering residential SUD treatment (NCT#01189552). Assessments were completed at pretreatment and at 3-, 6-, and 12-months posttreatment. Two generalized linear mixed models (GLMM) tested the effects of social support and spiritual well-being, above the effect of 12-step involvement, on substance use frequency and substance use consequences over the course of 12-months posttreatment.

RESULTS

Higher spiritual well-being predicted significantly less frequent substance use during recovery (β = 0.00, p = .03). Greater 12-step involvement predicted significantly fewer substance use consequences during recovery (β = 0.00, p = .02). In post hoc analyses the effect of spiritual well-being and 12-step involvement dissipated by 3.5- and 6.6-months posttreatment, respectively. The study found no significant effects of social support over time.

DISCUSSION

Spiritual well-being and 12-step involvement are associated with lower substance use and substance use consequences, respectively, in the early months of posttreatment recovery among Black/AA adults. These findings contribute to the growing recovery capital literature informing paths to recovery and sources of support outside of 12-step affiliation. However, these effects diminish over time.

Association between religiosity/spirituality and substance use among homeless individuals

BACKGROUND

Alcohol and illicit drug use are prevalent among homeless people. Religiosity and spirituality (RS) have been widely associated with lower consumption of substances. However, evidence of this relationship among homeless people is still scarce.

AIMS

To evaluate the associations between RS and alcohol and illicit drug consumption among homeless people in a large Brazilian urban center.

METHOD

This cross-sectional study was carried out in São Paulo city, Brazil. Aspects such as spirituality (FACIT-Sp12), religiosity (DUREL), spiritual-religious coping (Brief-RCOPE), and self-report questions concerning the current substance use (alcohol and illicit substances) were evaluated. Adjusted logistic regression models were used to assess the impact of RS beliefs on alcohol and illicit drug consumption.

RESULTS

A total of 456 homeless people were included, of an average age of 44.5 (SD = 12.6) years. More than half of the participants consumed alcohol (55.7%) weekly and 34.2% used illicit drugs weekly. Adjusted logistic regression models identified that aspects of RS were associated with lower likelihood factors for alcohol and illicit drug use; conversely, negative spiritual religious coping (SRC) strategies were associated with a higher likelihood to use both.

CONCLUSION

The prevalence of alcohol and illicit drug use among participants was high. RS and positive SRC were important protective factors for lower consumption of these substances. Conversely, negative SRC strategies were associated with risk factors.

A mixed methods experience sampling study of a posttraumatic growth model for addiction recovery

Problematic substance use and addiction is a growing crisis in the United States. As a result, identifying factors that effectively promote addiction recovery is, currently, of particular societal importance. Informed by evidence that-while addiction can be perpetuated by stress-related impulsivity and decreased self-regulation-perceived social support is protective against addiction, we test a model for addiction recovery as a form of posttraumatic growth (PTG), focused specifically on close relationships and personal strength-two domains of PTG. In an initial study, we found that perceived social support and impulsivity predicted number of relapses in individuals in a substance use disorder recovery program. Using experience sampling, we then observed that experiencing a stressful event predicted impulsive behavior. However, experiencing closeness with others-a domain of PTG-was directly associated with perceived social support, and both predicted positive emotional states, which were, in turn, inversely associated with experiencing a stressful event. Further, when experiencing a stressful event, personal strength-also a domain of PTG-was inversely associated with impulsive behavior and was predicted by both perceived social support and positive emotional states. Finally, in a follow-up experiment, we found that an ecological momentary intervention targeting perceived social support decreased impulsivity and increased self-regulation-an aspect of personal strength-in a dose-dependent fashion. Taken together, our findings: (1) support a PTG model for recovery; (2) provide evidence for processes by which close supportive relationships are protective against addiction and relapse; and (3) indicate that self-regulation is responsive to a short in-the-moment perceived social support intervention. We suggest that these findings support the theory that addiction is a social disease in the sense that close personal interactions and supportive relationships: (a) buffer against stress-related impulsivity, thereby protecting against addiction and relapse; and (b) increase personal strength, thereby decreasing the probability of impulsive-including addictive-behavior and promoting recovery.

Spirituality in Addiction Recovery: A Narrative Review

In the area of addiction, Canada has been in a public health crisis since 2016. Addiction takes a toll on an individual's self-worth and identity. In this narrative literature review, the distinct nature of spirituality was addressed. Next, individualized conceptualizations of spirituality were outlined. Subsequently, the importance of fellowship in addiction recovery was detailed. Next, the significance of being of service was presented. Meaningful and authentic spirituality were discussed in the context of recovery identity. Lastly, spirituality as a personal journey is described. A narrative literature review of 70 manuscripts published between 1999 and 2021 was undertaken to determine multiple approaches to treating addiction recovery in the context of spiritual development. An understanding of spirituality can inform counsellors regarding spiritual development in addiction recovery. Implications for counselling include a roadmap to support clients developing an individualized spiritual connection and operating as a functional system.

A Systematic Review of Interventions Based on Judeo-Christian Principles for Patients with Substance Dependence

Substance use disorders have significant consequences for patients and those around them. A qualitative systematic review was conducted to examine the effectiveness of religiosity and spirituality (R/S) interventions based on Judeo-Christian principles during the multidisciplinary treatment of patients with substance dependence disorder. Studies of patients of both sexes, at any age, of any nationality, and from any geographic location who were participating in treatment programs with religious elements explicitly tied to Christianity or Judaism were eligible for inclusion. Other religious interventions were excluded. Seven electronic databases were searched to identify eligible intervention studies published in English until August 2021. Two reviewers independently screened studies and extracted data. JBI tools were used to assess risk of bias. Of 146 articles retrieved for full text reading, five were ultimately included in this review published from July 2008 to August 2021. The R/S interventions used in the included studies were music therapy in a religious context, reading of the Bible or Torah, reflexive readings, personal prayer and reflection, and religiously integrated cognitive behavioral psychotherapy with or without a comparison group. Despite the broad search, there were found only a small number of studies and little homogeneity in the data of patients that reported positive impacts of treatments. Well-designed controlled studies are needed to truly investigate the efficacy of Judeo-Christian religious interventions for helping people with substance use problems, so as to strengthen the evidence of the benefits of these type of approaches in the treatment of drug addicts.

Religious status and addictive behaviors: Exploring patterns of use and psychological proneness

BACKGROUND

Previous studies have emphasized the role of religiosity as both a protective factor and a factor contributing to the success of recovery in the case of addictive beahaviors. However, the associations between religious status and the involvement in distinct addictive behaviors as well as the associations between religious status and psychological factors have not been comprehensively examined. Therefore, the aims of the present study were to extend the literature by examining the (i) relationship between religiosity and distinct addictive behaviors including substance use and behavioral addictions, and (ii) interactive effects of religious status and psychological factors on addictive behaviors.

MATERIAL AND METHODS

Data from two representative samples were analyzed (National Survey on Addiction Problems in Hungary [NSAPH]: N = 1385; 46.8% male; mean age = 41.77 years [SD = 13.08]; and Budapest Longitudinal Study [BLS]: N = 3890; 48.4% male; mean age = 27.06 years [SD = 4.76]). Distinct addictive behaviors and psychological factors related to the psychological proneness to addictive behaviors (impulsivity, sensation seeking, rumination, well-being, mentalization, and worry) were comprehensively examined in relation to religious status (religious, agnostic, and non-religious). Chi-square, Kruskal-Wallis and Mann-Whitney (MW) tests and multinomial logistic regressions were performed.

RESULTS

Religious individuals showed significantly lower involvement in addictive behaviors whereas agnostic individuals showed significantly higher involvement in addictive behaviors. With regards to psychological factors related to the proneness to addictive behaviors, agnostic individuals showed the highest level of psychological proneness. The results of multinomial regression models showed that religiosity was protective in the NSAPH sample. However, worry could overwrite the protective effect. In the BLS study, the protective role of religiosity was uncertain. It was not protective in itself, but through interaction with sensation seeking, rumination and uncertian mentalization, religiosity can also be protective.

DISCUSSION

The findings highlight the general protective role of religiosity in addictions. However, interaction with some psychological contructs can modify the protective role of religious status. The study also highlights the need to take into account agnostic religious status of individuals in future research. Consequently, further studies are needed to explore the causality and mediating roles between these variables.

Further Validation of the Religious Surrender and Attendance Scale-3 (RSAS-3)

Background: The Religious Surrender and Attendance Scale -3 (RSAS-3) is a very brief measure used to quantify religious commitment as a protective health factor.Methods: To provide evidence of criterion-related validity of the RSAS-3, 440 community members and undergraduate students completed a survey containing three religiosity measures: the RSAS-3, the Intrinsic/Extrinsic Orientation scale, and the Belief into Action scale (BIAC), and a measure of problematic substance use, Texas Christian University Drug Screen-5. It was hypothesized all religiosity measures would be positively interrelated, the measure of problematic use would be negatively related to all religiosity measures, and that the RSAS-3 would be strongly predictive of absence of problematic substance use. After data filtering and imputation, bivariate correlations were calculated to establish convergent validity.Results: All relationships were in the predicted directions. Specifically, BIAC had the strongest relationship with the RSAS-3, r (440) = .906, p < .001, followed by intrinsic religiosity, r (440) =.814, p < .001, and extrinsic religiosity, r (440) = .694, p < .001. The RSAS-3 was the strongest predictor of problematic use among the religiosity measures, r (440) = -0.230, p <.001. Criterion-related validity of the RSAS-3 was supported using logistic regression to explore intrinsic religiosity, extrinsic religiosity, BIAC, and RSAS-3 as predictors of the presence/absence of problematic substance use. The RSAS-3 was the only significant predictor (OR = .858 [95% CI .757 - .973], p = .017).Conclusion: All results provide further evidence for the validity of the RSAS-3 as a very brief measure of religious commitment useful in health settings.

Exploring the Contextual Factors of Religious Leader Participation in Health Communication: Evidence from a Qualitative Study in Sierra Leone

As there are many and sometimes ambivalent intersections of health and religion, strategic collaborations with religious opinion leaders in health campaigns have been increasingly explored. Despite the known influence of distinct contextual factors within emergency and non-emergency settings, existing research seldom distinguishes between those different factors and their impact on the inclusion of religious leaders as health messengers. To compare the contextual factors of religious leaders as health messengers during emergency and non-emergency situations in a setting with high religious affiliations, this study used a qualitative approach and triangulated the perspectives of three different samples, including (religious) opinion leaders, members of religious communities, and developers of health communication strategies in Sierra Leone. The results provide multifaceted insights into contextual factors applicable to emergency and non-emergency settings as well as the risks and opportunities. Recommendations for the incorporation of religious leaders in health promotion activities in consideration of different contextual factors are provided.

Spirituality/Religion and Self-Harm Among Patients With Alcohol/Substance Use Versus Other Disorders

ABSTRACT

Spirituality/religion (S/R) is clinically relevant to recovery from alcohol use disorders (AUDs)/substance use disorders (SUDs) and also associated with less self-injury; however, the interplay of these factors has not been adequately evaluated. Participants (n = 1443) were culled from a larger study among psychiatric patients. We assessed for S/R using self-report measures, and medical records were reviewed for demographics, clinical diagnoses, psychiatric medications, and self-harm engagement. Self-harm engagement was significantly higher among patients without AUD/SUD. S/R distress was higher among participants with AUD/SUD, but S/R community activity and importance of religion were lower. Interest in discussing S/R in treatment did not significantly differ across patients. Religious affiliation, importance of religion, and belief in God were associated with less self-harm, but effects were not moderated by presence of AUD/SUD. S/R factors are associated with lower self-harm, irrespective of the presence or absence of AUD/SUD. In contrast with clinical lore, S/R may be equally salient to psychiatric patients with AUD/SUD versus other disorders.

The Relationship between Religion, Substance Misuse, and Mental Health among Black Youth

Studies suggest that religion is a protective factor for substance misuse and mental health concerns among Black/African American youth despite reported declines in their religious involvement. However, few studies have investigated the associations among religion, substance misuse, and mental health among Black youth. Informed by Critical Race Theory, we evaluated the correlations between gender, depression, substance misuse, and unprotected sex on mental health. Using multiple linear regression, we assessed self-reported measures of drug use and sex, condom use, belief in God, and religiosity on mental health among a sample of Black youth (N = 638) living in a large midwestern city. Results indicated drug use, and sex while on drugs and alcohol, were significant and positively associated with mental health symptoms. Belief in God was negatively associated with having sex while on drugs and alcohol. The study's findings suggest that despite the many structural inequalities that Black youth face, religion continues to be protective for Black youth against a myriad of prevalent problem behaviors.

Religious and secular spirituality: Methodological implications of definitions for health research

The importance of spirituality as a research topic has been increasingly recognized, which has led to several studies on the topic. Areas including psychology, medicine, and nursing have produced studies on spirituality under a plurality of definitions and methods, which reveals the complexity of the theme. However, this has resulted in a range of potential problems, including: (1) the use of overlapping and contradictory terms between studies, or even within the same study, (2) research methodologies that do not fit the definitions (sometimes unreflectively) assumed by the authors, (3) difficulties, or even the impossibility, of comparing the results of studies, (4) controversies in respect of the inclusion/exclusion of secular groups in research on spirituality, and (5) ambiguous measurements, often being exclusively dependent on each participant's individual interpretation of what spirituality means. This article discusses these problems, recommends theoretical and methodological alternatives and presents taxonomy of definitions of spirituality.

A Systematic Review on Alcohol Consumption among Non-Religious and Religious Adults

Background: Research has suggested that religiosity is a protective factor in alcohol use, but this is an area that could be further explored. Objective: To undertake a systematic review of the literature on drinking patterns and their relationship with religiosity and non-religiosity in adult populations. Methods: We searched for relevant studies using the PubMed, LILACS, Web of Science, Scopus, and Psych-INFO databases. This review included only studies of people aged 18 and over which had a non-religious group as a comparison measure. Results: Fifty-one studies met the inclusion criteria. The present review showed that religious people tend to have lower alcohol consumption compared to those with no religion. However, this difference appears only when religions are analyzed together without differentiating between religious affiliations (Catholicism, Buddhism, Evangelicalism, etc.). Some religious affiliations, such as Buddhism, Catholicism and Lutheranism, appear to be risk factors for alcohol consumption. Definitions of risk consumption showed high heterogeneity, ranging from eight to 21 or more doses per week, a difference of 13 doses of alcohol between studies. Conclusions: The present review showed that religious people tend to have lower alcohol consumption compared to non-religious people. However, the results are contradictory when religious affiliations are analyzed separately and compared with non-religious participants. Adequately understanding which dimensions of religiosity and non-religiosity (e.g., group processes, engagement, meaning, rules of behavior) are protective in adulthood is fundamental to the construction of more effective interventions in this age group.

Effective Nursing Recovery-Oriented Interventions for Individuals With Substance Use Disorder: A Literature Review

ABSTRACT

Nurses support the recovery of individuals with substance use disorder. How they support individuals, however, may impact the effectiveness of their work. For example, there are various paradigms of recovery that alter interventions. In addition, negative attitudes adopted by clinicians discourage individuals who use substances from accessing healthcare services, experiencing further health deterioration. Alternatively, nurses can enact interventions that promote positive experiences, further supporting the recovery of individuals. Hence, it is beneficial to increase nurses' awareness of effective interventions that promote recovery. The purpose of this literature review is to examine effective nursing interventions that promoted recovery of those with substance use disorders from the perspective of nurses and individuals who received nursing care. The review identified that effective interventions were based on three major themes: person-centered care, empowerment, and maintaining supports and capability enhancement. In addition, literature revealed that some interventions were perceived to be more effective; this depended on whose viewpoint was examined-nurses or individuals with substance use disorders. Finally, there are interventions based on spirituality, culture, advocacy, and self-disclosure that are often disregarded but may be effective. Nurses should utilize the more prominent interventions as they offer the most benefit and integrate interventions that are often overlooked.

Spirituality: A Key Component of the Salvation Army's Bridge Programme Model of Treatment in Aotearoa New Zealand

Spirituality is vital to The Salvation Army's Bridge model of treatment for alcohol and drug addiction. Spirituality is expressed through Recovery Church, prayer, spirituality lifters, the 12-step programme, and focuses on meaning and purpose. We recruited participants from several regional centers throughout Aotearoa New Zealand and evaluated spirituality using the WHOQol-SRPB and open-ended questions. Most participants held broad understandings of spirituality, only a minority equating it with religion. Participants who completed the Programme had statistically significant increases in spiritual wellbeing at end-of-treatment. These increases were maintained at a 3-month follow-up. Increases in spiritual wellbeing were associated with decreases in severity of alcohol and drug use.

Linguistic predictors from Facebook postings of substance use disorder treatment retention versus discontinuation

Background: Early indicators of who will remain in - or leave - treatment for substance use disorder (SUD) can drive targeted interventions to support long-term recovery.Objectives: To conduct a comprehensive study of linguistic markers of SUD treatment outcomes, the current study integrated features produced by machine learning models known to have social-psychology relevance.Methods: We extracted and analyzed linguistic features from participants' Facebook posts (N = 206, 39.32% female; 55,415 postings) over the two years before they entered a SUD treatment program. Exploratory features produced by both Linguistic Inquiry and Word Count (LIWC) and Latent Dirichlet Allocation (LDA) topic modeling and the features from theoretical domains of religiosity, affect, and temporal orientation via established AI-based linguistic models were utilized.Results: Patients who stayed in the SUD treatment for over 90 days used more words associated with religion, positive emotions, family, affiliations, and the present, and used more first-person singular pronouns (Cohen's d values: [-0.39, -0.57]). Patients who discontinued their treatment before 90 days discussed more diverse topics, focused on the past, and used more articles (Cohen's d values: [0.44, 0.57]). All ps < .05 with Benjamini-Hochberg False Discovery Rate correction.Conclusions: We confirmed the literature on protective and risk social-psychological factors linking to SUD treatment in language analysis, showing that Facebook language before treatment entry could be used to identify the markers of SUD treatment outcomes. This reflects the importance of taking these linguistic features and markers into consideration when designing and recommending SUD treatment plans.

The INFINITE Study: Pilot Research Exploring Plant-Based Nutrition in Treatment for Substance Use Disorders

Standard treatment for substance use disorders (SUDs) rarely incorporates a dietary intervention. The purpose of this research is to explore how nutrition might influence early recovery outcomes. Participants (N = 33) self-selected into the 10-week treatment (whole food, plant-based diet) or control group (standard treatment center diet). Both received weekly nutrition education lessons to complement the diet. At baseline, week 3, and week 10, participants completed assessments to track mental health markers. Mean values were calculated for Healthy Eating Index-2015 (HEI-2015) and Plant-based Diet Indices (PDI). Semi-structured interviews were gathered and analyzed using grounded theory. The intervention group had significantly higher scores for HEI-2015 and PDI scores (all P’s < .001). For all psychosocial outcomes, there was a statistically significant effect of time ( P’s < .001-.02), but not by condition. A significant condition by time interaction was seen with the Rosenberg Self-Esteem outcome ( P = .043). Resilience at 10-weeks was significantly higher in the high PDI group ( P = .031). Qualitative data showed that all participants found meaning and value in the experience. Early addiction treatment outcomes show modest but important effects of whole food plant-based nutrition and suggest value in further exploration of its use in SUD treatment.

Significance of Self-Transcendence for Rehabilitation and Relapse Prevention among Patients with Substance Use Disorder: A Qualitative Study

A complex variety of restrictive and promoting factors are in play when people with substance use disorder face challenges concerning rehabilitation and relapse prevention. Self-transcendence sources are strongly associated with meaningfulness, and meaningfulness is found to be associated with less alcohol and drug use severity and relapse prevention. The aim of the present qualitative study was to investigate self-transcendence among patients with substance use disorders and to discuss its significance for treatment and relapse prevention. An exploratory qualitative research design was employed, with individual interviews in a strategic sample of four patients with substance use disorder recruited from a religiously founded rehabilitation clinic in Southeast Norway. The transcribed material was analysed through systematic text condensation. A search for objects beyond immediate needs through self-transcendence was revealed, related to generativity and an unselfish prosocial commitment to family and the surroundings, strengthening the participants’ self-efficacy, confidence, and safety. Spirituality and confidence in a higher power or destiny generated order in life. The use of rituals contributed to tranquillity. Values gave new directions, and private confession helped to start over in life. For patients in rehabilitation aiming at relapse prevention, self-transcendence seems to be significant as part of the recovery process. Possible implications for rehabilitation and relapse prevention are discussed.

Reconstructing Social Relationships in a Post-Lockdown Suburban Area of Southern Italy Using Pastoral Counselling

The growing interest in spirituality has enabled numerous avenues of pastoral counselling support, which can be a useful resource for improving quality of life in the context of significant social deprivation. The aim of this research was to investigate the role of the spiritual dimension of pastoral support interventions created to help the inhabitants of a strongly deprived territory in Southern Italy during the COVID-19 pandemic. Eight people between the ages of 28 and 67 took part in the study. A qualitative research design was applied via online interviews with the participants, who were operators of a pastoral counselling service located on the outskirts of a suburban town. The main emergent themes were the importance of religiosity and spirituality in the lives of the participants, the role that these two aspects play in the lives of those who carry out activities devoted to helping others, and the ways in which these dimensions are used within support programmes responding to the needs of an area characterized by socioeconomic and psychosocial problems. The interviews revealed how pastoral counselling can be useful in situations of stress in highly deprived areas.

Spirituality for Coping with the Trauma of a Loved One's Death During the COVID-19 Pandemic: An Italian Qualitative Study

Spirituality may be a key factor in reducing the negative psychological effects of traumatic events and a means by which the experience of grief can be processed. The objective of the present research is to assess whether and how spirituality provided concrete support in those who lost a loved one during the COVID-19 pandemic. The participants are 8 people from the most affected cities in northern Italy. They were interviewed in depth, the interviews were transcribed and the texts were analyzed through Interpretive Phenomenological Analysis. The results show that spirituality has been found to be a protective factor with regard to the processing of grief in crisis situations such as the COVID-19 pandemic, in particular with regard to the belief that the deceased loved one is now in an otherworldly dimension. In addition, the celebration of a funeral rite offers support to the grieving person in the early stages of mourning thus laying the foundation for a healthy grieving process. It is therefore important to support individual spirituality, which can be a useful tool for processing the traumatic experience, especially in difficult times such as the COVID-19 pandemic.

Effects of Sexual Orientation on Spiritual Psychotherapy for Inpatient, Residential & Intensive Treatment

Objectives

Spiritual psychotherapy addresses mental health concerns by integrating spirituality/religion into treatment. There is scant research on how such approaches interact with sexual minority status. We sought to identify and compare how sexual minority and heterosexual patients respond to spiritual psychotherapy.

Method

We collected data from heterosexual (n = 66) and sexual minority (n = 15) patients who self‐referred to participate in Spiritual Psychotherapy for Inpatient Residential & Intensive Treatment (SPIRIT), a spiritually‐integrated, group‐based, cognitive‐behavioral treatment.

Results

We did not find significant differences between heterosexual and sexual minority patients across demographic/clinical variables, spiritual/religious characteristics, or effects of SPIRIT. Both groups reported notable perceived benefit of SPIRIT.

Conclusions

Although not specifically tailored for sexual minority patients, or intended to reconcile spiritual/religious conflicts around sexual identity, programs like SPIRIT may benefit sexual minority patients by providing a safe space to explore both sexual orientation and religious identity. In turn, this may help sexual minority patients develop frameworks to recruit spirituality/religion in the process of coping with distress, as a catalyst for clinical change.

To our knowledge, this is the first study to examine responses to spiritually integrated therapy among sexual minority individuals.

Sexual minority and heterosexual patients were equivalent with regard to clinical severity, spiritual/religious characteristics, and spiritual distress.

Sexual minority and heterosexual individuals benefited equally from spiritually‐integrated therapy.

Spiritual/religious involvement and spiritual distress did not differentially predict perceived benefit from spiritually‐integrated psychotherapy among sexual minority or heterosexual patients.

Findings underscore the importance of clinicians being open to exploration of relevant spiritual/religious topics with all patients, without assumption that such themes may be inherently problematic for sexual minorities.

Mutual Help Group Participation for Alcohol and Drug Problems: Uncovering Latent Subgroups

Objective: This report aims to identify US mutual help group (MHG) participants' psycho-socio-behavioral profiles. Method: We used data from the 2015-2018 National Survey on Drug Use and Health and the sample included 1022 adults with past-year substance use disorders (SUD). We conducted a latent class analysis to identify subgroups of MHG participants and estimated multinomial logistic regression models to examine the associations between sociodemographic/intrapersonal characteristics and class membership. Results: Analyses identified three latent classes. Class 1 (Low-Risk group, 54%) reported low risks in all correlates except for serious psychological distress (SPD, 33%). Class 2 (Psychological Distress group, 30%) demonstrated high risks of major depressive episodes (86%) and SPD (93%). Class 3 (Criminal Justice System Involvement group, 16%) showed high involvement in arrests (100%) and drug-related arrests (67%) and moderate risks for SPD (54%) and behavioral problems, e.g., drug selling (46%) and theft (35%). Compared to Class 1, Class 2 was more likely to be female, out of the labor force, and to show high risk propensity, and Class 3 was more likely to have lower education and drug use disorders. Class 3 was also less likely to be older, belong to the "other" racial/ethnic category, have lower English proficiency, and report alcohol use disorder. Conclusions: The three subgroups of the US MHG participant population illustrate the complex and heterogeneous psycho-social-behavioral profiles of MHG participants with SUD. MHG referral's effectiveness may be augmented by tailoring it to the patient/client's specific psycho-socio-behavioral profile.

Pain Management and Risks Associated With Substance Use: Practice Recommendations

Assessing and managing pain while evaluating risks associated with substance use and substance use disorders continues to be a challenge faced by health care clinicians. The American Society for Pain Management Nursing and the International Nurses Society on Addictions uphold the principle that all persons with co-occurring pain and substance use or substance use disorders have the right to be treated with dignity and respect, and receive evidence-based, high quality assessment, and management for both conditions. The American Society for Pain Management Nursing and International Nurses Society on Addictions have updated their 2012 position statement on this topic supporting an integrated, holistic, multidimensional approach, which includes nonopioid and nonpharmacological modalities. Opioid use disorder is used as an exemplar for substance use disorders and clinical recommendations are included with expanded attention to risk assessment and mitigation with interventions targeted to minimize the risk for relapse or escalation of substance use. Opioids should not be excluded for anyone when indicated for pain management. A team-based approach is critical, promotes the active involvement of the person with pain and their support systems, and includes pain and addiction specialists whenever possible. Health care systems should establish policies and procedures that facilitate and support the principles and recommendations put forth in this article.

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.

The prevalence and correlates of substance use disorders among patients of two different treatment settings in Thailand

Background

Monk healers provide an accessible and popular service in Southeast Asia, but little is known on the substance use status of their clients. This investigation intended to assess and compare the rate and correlates of substance use disorders in two different treatment settings (monk healers = MH and primary health care = PHC) in Thailand.

Methods

In a cross-sectional study, 1024 patients (591 of MH and 613 of PHC) responded to screening measures of the “World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test Lite”, and two common mental disorders (major depression and generalized anxiety disorder) from November 2018 to February 2019. Logistic regression was used to estimate the determinants of any substance use disorder in the MH and PHC setting.

Results

The prevalence of substance use disorder was higher in MH clients than PHC patients: any substance use disorder 11.7% (95% Confidence Interval-CI: 9.3–14.5%) vs 5.4% (95% CI: 3.9–7.5%), tobacco use disorder 7.6% (95% CI: 5.7–9.9%) vs 2.5% (95% CI: 1.5–4.0%), alcohol use disorder 10.0% (95% CI: 8.4–13.6%) vs 4.3% (95% CI: 3.0–6.3%), any drug use disorder 4.2% (95% CI: 2.8–6.1%) vs 0.3% (95% CI: 0.08–1.3%), and any past three months drug use 8.2% (95% CI: 6.2–10.7%) vs 1.5, 95% CI: 0.8–2.8%). In adjusted logistic regression analysis, among MH clients, male sex (Adjusted Odds Ratio-AOR: 9.52, 95% Confidence Interval-CI: 5.06–17.92) was positively, and were married (AOR: 0.32, 95% CI: 0.16–0.61) and high social support (AOR: 0.40, 95% CI: 0.16–0.99) were negatively associated with any substance use disorder. Among PHC patients, male sex (AOR: 7.05, 95% CI: 2.99–16.63) was positively and age (AOR: 0.95, 95% CI: 0.92–0.98) was negatively associated with any substance use disorder.

Conclusion

The proportion of substance use disorders among MH attendees was more than twice that of PHC attenders in Thailand, calling for collaboration in controlling substance use disorders between the two treatment systems.

Effects of Spirituality, Knowledge, Attitudes, and Practices toward Anxiety Regarding COVID-19 among the General Population in INDONESIA: A Cross-Sectional Study

BACKGROUND

Currently, the determinants of anxiety and its related factors in the general population affected by COVID-19 are poorly understood. We examined the effects of spirituality, knowledge, attitudes, and practices (KAP) on anxiety regarding COVID-19.

METHODS

Online cross-sectional data (n = 1082) covered 17 provinces. The assessment included the Daily Spiritual Experiences Scale, the Depression, Anxiety, and Stress Scale, and the KAP-COVID-19 questionnaire.

RESULTS

Multiple linear regression revealed that individuals who had low levels of spirituality had increased anxiety compared to those with higher levels of spirituality. Individuals had correct knowledge of early symptoms and supportive treatment (K3), and that individuals with chronic diseases and those who were obese or elderly were more likely to be severe cases (K4). However, participants who chose incorrect concerns about there being no need for children and young adults to take measures to prevent COVID-19 (K9) had significantly lower anxiety compared to those who responded with the correct choice. Participants who disagreed about whether society would win the battle against COVID-19 (A1) and successfully control it (A2) were associated with higher anxiety. Those with the practice of attending crowded places (P1) had significantly higher anxiety.

CONCLUSIONS

Spirituality, knowledge, attitudes, and practice were significantly correlated with anxiety regarding COVID-19 in the general population.

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.