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CORK Bibliography: Religiosity and Religious Groups

74 citations. January 2009 to present

Prepared: December 2011

Agrawal A; Lynskey MT. Correlates of later-onset cannabis use in the National Epidemiology Survey on Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence 105(1/2): 71-75, 2009. (44 refs.)

Background: Much of the research surrounding correlates of cannabis initiation has focused on adolescent and young adult populations. However, there is growing evidence that cannabis onset occurs later in life as well and little is known of the risk and protective influences that are associated with late-onset cannabis initiation. Methods: We used data on 34,653 individuals that participated in both the first wave and the 3-year follow-up (3YFU) of the National Epidemiologyogical Survey on Alcohol and Related Conditions (NESARC). Univariate and multivariate logistic regression was used to examine the association between cannabis initiation at 3YFU and socio-demographic, religious/pro-social and psychiatric measures. Analyses were also conducted in age bands to further distinguish across the lifespan. Results: of the 27,467 lifetime abstainers at wave 1509 had initiated cannabis use at 3YFU. Consistent associations between divorce, religious attendance, volunteer/community service, alcohol abuse/dependence, nicotine dependence and cannabis initiation were noted in the full sample and across age-bands. Conclusions: Religious and pro-social activities are negatively associated with late-onset cannabis onset while divorce and alcohol and nicotine-related problems are positively associated with later onset.

Allamani A. The relationship between addiction and religion and its possible implication for care. (editorial). Substance Use & Misuse 45(14): 2375-2377, 2010. (2 refs.)

Allen TM; Lo CC. Religiosity, spirituality, and substance abuse. Journal of Drug Issues 40(2): 433-459, 2010. (76 refs.)

With data from the 2004 General Social Survey, the study examined effects of religiosity and spirituality on substance abuse. Also explored was whether and how social bonding mediates religiosity's effects on substance abuse. The results show that religiosity was negatively associated with substance abuse and, further, that social bonding variables did somewhat mediate this negative relationship between the two. Additionally, and as expected, with religiosity controlled, the likelihood of substance abuse increased along with increasing spirituality, in the models. Policy implications and further research needs are discussed.

AlMarri TSK; Oei TPS. Alcohol and substance use in the Arabian Gulf region: A review. (review). International Journal of Psychology 44(3): 222-233, 2009. (79 refs.)

Despite cultural, social, religious, and legal constraints on Muslim Arab nationals living in the Arabian Peninsula against the consumption of alcohol or drugs, usage and dependence do exist. The aim of this paper is to provide a systematic review, compiling and critiquing the literature in this interesting yet neglected area. Information about the current status of alcohol and substance abuse research and knowledge in the Arabian Gulf region will be presented, providing an accessible synopsis of available papers. A systematic review of English and Arabic language literature was conducted by searching electronic databases (1975-2007) and conducting hand searches of Arab published journals. Only studies investigating alcohol and/or substance use or abuse issues with participants (1) of Arab nationality, (2) living in an Arabian Gulf country, and (3) of Muslim faith were included. Within this literature, the majority of research has been conducted with clinical male participants. The most commonly abused drugs are alcohol, heroin, and hashish. Literature investigating the substance use domain with people who are not seeking treatment for addiction is extremely limited. Although the research is largely in its infancy, it does however confirm alcohol and substance abuse in Muslim, Gulf Arab nationals. We strongly urge that further research into substance use and abuse in this region is conducted. Community investigations assessing the prevalence, magnitude, and associated problems with alcohol and substance abuse and also research into valid and reliable measurements in these countries are warranted.

Aten JD; Mangis MW; Campbell C. Psychotherapy with rural religious fundamentalist clients. Journal of Clinical Psychology 66(5): 513-523, 2010. (19 refs.)

Successful psychotherapy with rural fundamentalist Christians requires psychologists to understand the clients' culture and world-view. They often rely heavily on religious authorities, interpret Scriptures literally, adhere to strict moral codes of behavior, and believe that they should evangelize those around them. Common therapeutic challenges include: spiritualizing problems, relational conflicts related to gender role expectations, addiction problems, and the religious agendas of family and clergy. We recommend that psychotherapists evaluate their own attitudes, collaborate with community gatekeepers, sensitively address clients' rigid beliefs, address religious differences, and take a holistic approach to treatment. A case example illustrates this approach.

Aveyard P; Begh R; Sheikh A; Amos A. Promoting smoking cessation through smoking reduction during Ramadan. (editorial). Addiction 106(8): 1379-1380, 2011. (20 refs.)

Bahr SJ; Hoffmann JP. Parenting style, religiosity, peers, and adolescent heavy drinking. Journal of Studies on Alcohol and Drugs 71(4): 539-543, 2010. (24 refs.)

Objective: The purpose of this research was to examine whether authoritative, authoritarian, indulgent, and neglectful parenting styles were associated with adolescent alcohol use and heavy drinking, after controlling for peer use, religiosity, and other relevant variables. Method: Structural equation modeling was used to estimate direct and indirect associations of parenting style with alcohol use and heavy drinking among 4,983 adolescents in Grades 7-12. Results: Adolescents whose parents were authoritative were less likely to drink heavily than adolescents from the other three parenting styles, and they were less likely to have close friends who used alcohol. In addition, religiosity was negatively associated with heavy drinking after controlling for other relevant variables. Conclusions: Authoritative parenting appears to have both direct and indirect associations with the risk of heavy drinking among adolescents. Authoritative parenting, where monitoring and support are above average, might help deter adolescents from heavy alcohol use, even when adolescents have friends who drink. In addition, the data suggest that the adolescent's choice of friends may be an intervening variable that helps explain the negative association between authoritative parenting and adolescent heavy drinking.

Bohnert ASB; Perron BE; Jarman CN; Vaughn MG; Chatters LM; Taylor RJ. Use of clergy services among individuals seeking treatment for alcohol use problems. American Journal on Addictions 19(4): 345-351, 2010. (29 refs.)

This study examined the prevalence and characteristics of adults with an alcohol use-related problem who receive clergy services. Data come from the National Epidemiologic Survey on Alcohol and Related Conditions. Among persons who sought any services for alcohol-related problems (n = 1,910), 14.7% reported using clergy services. In a multivariable logistic regression model, factors associated with increased likelihood of service use included being Black, aged 35-54 years, a lifetime history of alcohol dependence, major depressive disorder, and personality disorder. Clergy may benefit from training to identify alcohol use problems and serve an important role in making treatment referrals.

Borders TF; Curran GM; Mattox R; Booth BM. Religiousness among at-risk drinkers: Is it prospectively associated with the development or maintenance of an alcohol-use disorder? Journal of Studies on Alcohol and Drugs 71(1): 136-142, 2010. (38 refs.)

Objective: This study examined whether particular dimensions of religiousness are prospectively associated with the development or maintenance of an alcohol-use disorder (AUD) among at-risk drinkers or persons with a history of problem drinking. Method: A prospective cohort study was conducted among at-risk drinkers identified through a population-based telephone survey of adults residing in the southeastern United States. The cohort was stratified by baseline AUD status to determine how several dimensions of religiousness (organized religious attendance, religious self-ranking, religious influence on one's life, coping through prayer, and talking with a religious leader) were associated with the development and, separately, the maintenance or remission of an AUD over 6 months. Multiple logistic regression analyses were conducted to estimate the odds of developing versus not developing an AUD and maintaining versus remitting from an AUD while adjusting for measures of social support and other covariates. Results: Among persons without an AUD at baseline, more frequent organized religious attendance, adjusted odds ratio (ORadj) = 0.73, 95% CI [0.55, 0.96], and coping through prayer ORadj = 0.63, 95% CI [0.45, 0.87], were associated with lower adjusted odds of developing an AUD. In contrast, among persons with an AUD at baseline, no dimension of religiousness was associated with the maintenance or remission of an AUD. Conclusions: The findings of this study suggest that religious attendance and coping through prayer may protect against the development of an AUD among at-risk drinkers. Further research is warranted to ascertain whether these or other religious activities and practices should be promoted among at risk drinkers.

Bourgois P; Hart LK. Science, religion and the challenges of substance abuse treatment. (editorial)18. Substance Use & Misuse 45(14): 2395-2400, 2010. (18 refs.)

Brechting EH; Brown TL; Salsman JM; Sauer SE; Holeman VT; Carlson CR. The role of religious beliefs and behaviors in predicting underage alcohol use. Journal of Child & Adolescent Substance Abuse 19(4): 324-334, 2010. (25 refs.)

Religious beliefs have consistently emerged as significantly and inversely related to alcohol use. This article seeks further understanding of this relationship by exploring the role of religious behaviors in this relationship in three ways. First, we aim to determine whether the relationship between religious beliefs and alcohol use differs with regard to frequency of participation in religious behaviors. Next, we seek to explore the role of religious behavior as a moderator of the relationship between religious beliefs and alcohol use. We find support for the hypothesis that individuals who possess strong religious beliefs but do not frequently take part in religious practices (e.g., attend services, engage in prayer) would report more frequent alcohol use than those who profess similar beliefs but more frequently participate in religious practices.

Burazeri G; Kark JD. Alcohol intake and its correlates in a transitional predominantly Muslim population in southeastern Europe. Addictive Behaviors 35(7): 706-713, 2010. (44 refs.)

Objective: Our aim was to assess alcohol consumption and its correlates in Albania, a predominantly Muslim though largely secular Southeast European republic in transition from rigidly structured socialism to a market-oriented system. Methods: A population-based sample of Tirana residents aged 35-74 years was interviewed and examined in 2003-2006 (450 men and 235 women with data on alcohol intake. 65.5% response). Multivariable-adjusted logistic regression was used to assess the association of drinking frequency, quantity and type of drink with socioeconomic, psychosocial and coronary risk characteristics. Results: 30.6% (95%CI = 26.3%-34.9%) of men, age-standardized to the 2005 census, and 5.6% (95%CI = 2.6%-8.6%) of women reported almost daily intake of alcohol, whereas 17.0% (95%CI = 13.4%-20.5%) of men and 46.6% (95%CI = 40.2%-53.1%) of women abstained. In men, frequent drinking was positively associated with age and not receiving financial support from close family emigrants, and was strongly inversely related to religious observance in both Muslims and Christians. In women it was associated with smoking and upward social mobility. Alcohol intake was not associated with religious affiliation in either sex. In men, intake of spirits (predominantly raki) and beer were associated with lower socioeconomic indices, smoking and obesity (beer only), whereas wine intake was associated with financial security, being secular, and not smoking. Among men, 11.3% (95%CI = 8.3%-14.3%) reported high intakes (>= 210 g of pure alcohol/week) and 6.0% (95%CI=3.8%-8.3%) very high intakes (>= 420 g/week). High intakes were associated with frequent, rather than episodic, drinking. Conclusions: Our study may be the first to provide information on alcohol intake and its characteristics in an Albanian population sample, one of the few predominantly Muslim countries in Europe. Alcohol consumption in women was extremely low. However, consistent very heavy intake of alcohol appears to be more frequent among Albanian men than in many former communist countries in Europe, and is cause for concern.

Burris JL; Sauer SE; Carlson CR. A test of religious commitment and spiritual transcendence as independent predictors of underage alcohol use and alcohol-related problems. Psychology of Religion and Spirituality 3(3): 231-240, 2011. (58 refs.)

Religiousness exerts a protective effect against underage alcohol use, but it is largely unknown whether its protective quality extends equally to alcohol-related problems. It is also unclear to what extent spirituality, which is related to religiousness, exerts a similar protective effect. The current study examined whether facets of religiousness and spirituality-religious commitment and spiritual transcendence-were differentially related to alcohol use and alcohol-related problems among an underage sample of young adults. Despite being underage, most participants (n = 344; 61% female) reported having an alcoholic drink at least once a month and having at least two to three drinks per occasion. Results of hierarchical linear regression analyses that controlled for demographics, positive alcohol expectancies, and impulsivity found unique associations between religious commitment and spiritual transcendence and alcohol use. Specifically, religious commitment operated as a protective factor, while spiritual transcendence operated as a risk factor for alcohol use. Neither religious commitment nor spiritual transcendence predicted alcohol-related problems. Results of this study inform future research by highlighting the importance of studying religiousness and spirituality as unique constructs with the potential for differential predictive utility.

Button TMM; Hewitt JK; Rhee SH; Corley RP; Stallings MC. The moderating effect of religiosity on the genetic variance of problem alcohol use. Alcoholism: Clinical and Experimental Research 34(9): 1619-1624, 2010. (31 refs.)

Background: Previous studies have demonstrated that the heritability of alcohol-related phenotypes depends upon the social background in which it is measured (e.g., urbanicity, marital status, and religiosity). The aim of the current study was to identify whether religiosity moderated the genetic variance of problem alcohol use in men and women at two time points: adolescence and early adulthood. Method: Participants were 312 male MZ pairs, 379 female MZ pairs, 231 male DZ pairs, 235 female DZ pairs, and 275 opposite sex DZ pairs participating in the University of Colorado Center on Antisocial Drug Dependence. Religiosity was measured using the Value on Religion Scale (Jessor and Jessor, 1977), and problem alcohol use was measured using the Composite International Diagnostic Interview-Substance Abuse Module (Cottler et al., 1989). Data were analyzed using a model-fitting approach to the twin data. Results: In adolescence, genetic variance of problem alcohol use decreased significantly with increasing levels of religiosity in both men and women, whereas in early adulthood, religiosity did not moderate the genetic variance of problem alcohol use in either men or women. Conclusion: Religiosity appears to moderate the genetic effects on problem alcohol use during adolescence, but not during early adulthood. The reduced genetic variance for problem alcohol use in adolescence may be the consequence of greater social control in adolescence than in young adulthood.

Chi FW; Kaskutas LA; Sterling S; Campbell CI; Weisner C. Twelve-Step affiliation and 3-year substance use outcomes among adolescents: Social support and religious service attendance as potential mediators. Addiction 104(6): 927-939, 2009. (78 refs.)

Twelve-Step affiliation among adolescents is little understood. We examined 12-Step affiliation and its association with substance use outcomes 3 years post-treatment intake among adolescents seeking chemical dependency (CD) treatment in a private, managed-care health plan. We also examined the effects of social support and religious service attendance on the relationship. We analyzed data for 357 adolescents, aged 13-18, who entered treatment at four Kaiser Permanente Northern California CD programs between March 2000 and May 2002 and completed both baseline and 3-year follow-up interviews. Measures at follow-up included alcohol and drug use, 12-Step affiliation, social support and frequency of religious service attendance. At 3 years, 68 adolescents (19%) reported attending any 12-Step meetings, and 49 (14%) reported involvement in at least one of seven 12-Step activities, in the previous 6 months. Multivariate logistic regression analyses indicated that after controlling individual and treatment factors, 12-Step attendance at 1 year was marginally significant, while 12-Step attendance at 3 years was associated with both alcohol and drug abstinence at 3 years [odds ratio (OR) 2.58, P < 0.05 and OR 2.53, P < 0.05, respectively]. Similarly, 12-Step activity involvement was associated significantly with 30-day alcohol and drug abstinence. There are possible mediating effects of social support and religious service attendance on the relationship between post-treatment 12-Step affiliation and 3-year outcomes. The findings suggest the importance of 12-Step affiliation in maintaining long-term recovery, and help to understand the mechanism through which it works among adolescents.

Conner BT; Anglin MD; Annon J; Longshore D. Effect of religiosity and spirituality on drug treatment outcomes. Journal of Behavioral Health Services & Research 36(2): 189-198, 2009. (12 refs.)

This study empirically tested one component of a comprehensive model of the role of religiosity and spirituality (R/S) in drug treatment that is presented as a companion article in this special issue. Data collected from individuals dependent on heroin receiving narcotic replacement therapy were used to assess the effects of R/S on drug treatment outcomes. Based on their R and S scores, participants were assigned to one of four groups: those whose scores remained consistently high across the 12-month study period were compared to those whose scores were consistently low, increased, or decreased across the same period. Results indicated that at both study completion (12 months after admission) and 6 months after that participants in the consistently high and increasing spirituality groups self-reported significantly fewer days of heroin and cocaine/crack use than those in the consistently low group (p < 0.05). There were no significant differences among the religiosity groups on self-reported heroin or cocaine/crack use. Results from chi(2) analyses indicated that at 12 months the results of urinalysis for the presence of opiates, but not cocaine/crack, were dependent on spirituality group membership (p < 0.01) but not religiosity group membership. Results also indicated that at the 6-month follow-up, there were significantly more participants in the decreasing group who were not in maintenance treatment who had a positive urinalysis and fewer in the increasing group than would be expected if the two variables were independent (p < 0.05). Implications for addictions health services are discussed.

Dennis DL; Cox W; Black A; Muller S. The influence of religiosity and spirituality on drinking behaviors: Differences between students attending two southern universities. Journal of Drug Education 39(1): 95-112, 2009. (56 refs.)

The purpose of this study was to determine if-students (n = 431) from two southern universities -- one in the "buckle" of the Bible-belt, the other a southern "border" state -- have different drinking behaviors depending on their religiosity and spirituality. Approximately 95% of students indicated that they had at least one drink of alcohol during their lives, with almost 82% reporting that they used alcohol in the past 30 days. Binge drinking among underage students increased every year (approximately 43% to almost 70%). Students from the buckle university had higher degrees of religiosity and spirituality and reported fewer unhealthy drinking behaviors than those from the border university. By creating a learning environment where students are encouraged to increase the spiritual dimension of health, health educators may alleviate potentially deadly consequences of alcohol.

Desmond SA; Soper SE; Purpura DJ; Smith E. Religiosity, moral beliefs, and delinquency: Does the effect of religiosity on delinquency depend on moral beliefs. Sociological Spectrum 29(1): 51-71, 2009. (52 refs.)

Does the effect of religiosity on delinquent behavior depend on moral beliefs? For example, will religious adolescents refrain from using marijuana, even if they do not believe using marijuana is wrong? We addressed this question using data from the third and fourth waves of the National Youth Survey. The results indicated a significant interaction between religiosity and moral beliefs for marijuana use and getting drunk, but not for hitting or property offenses. Religiosity has a stronger effect on marijuana and alcohol use when adolescents also believe these behaviors are wrong. Conversely, when it is not accompanied by strong moral beliefs, religiosity has less of an effect on marijuana use and drinking.

Dollinger SJ; Malmquist D. Reliability and validity of single-item self-reports: With special relevance to college students' alcohol use, religiosity, study, and social life. Journal of General Psychology 136(3): 231-241, 2009. (20 refs.)

The authors tested the assumption that single-item measures have unacceptably low reliability and validity. On 2 occasions 11 weeks apart, college students reported on the frequency and quantity of alcohol consumption, 2 religious behaviors, time of study and of socializing (focal items), and other qualities and characteristics. Most test-retest reliabilities were good to excellent; objective facts were more reliable than subjective evaluations; and target items had good validity when correlated with 2-week nightly log records of corresponding behaviors in a multimethod multitrait matrix. The exception was self-reported study, with relatively low reliability and validity, suggesting the non-trait-like quality of this behavior. Single-item measures may be better than commonly thought.

Drerup ML; Johnson TJ; Bindl S. Mediators of the relationship between religiousness/spirituality and alcohol problems in an adult community sample. Addictive Behaviors 36(12): 1317-1320, 2011. (34 refs.)

Johnson et al. (2008b) reported that, in a college student sample, the effect of religiousness on alcohol use was mediated by negative beliefs about alcohol, social influences, and spiritual well-being, and that these variables in turn impacted alcohol use and problems both directly and indirectly via motives for drinking. This study attempted to replicate those findings in a sample of community dwelling adults (N = 211). The effect of Religious/Spiritual Involvement was mediated by Negative Beliefs about Alcohol, Social Modeling, and Spiritual-Well-Being. However, Social Modeling had stronger relationships with motives for drinking and alcohol consumption than the other two mediators. The effect of Religious Struggle on Alcohol Problems was mediated by Spiritual Well-Being and coping motives for drinking. Results provide further support for the motivational model of alcohol use and suggest plausible mechanisms by which religiousness could causally impact alcohol use and problems. Religious struggle may be a clinically significant correlate of alcohol problems.

Edlund MJ; Harris KM; Koenig HG; Han XT; Sullivan G; Mattox R et al. Religiosity and decreased risk of substance use disorders: Is the effect mediated by social support or mental health status? Social Psychiatry and Psychiatric Epidemiology 45(8): 827-836, 2010. (60 refs.)

The negative association between religiosity (religious beliefs and church attendance) and the likelihood of substance use disorders is well established, but the mechanism(s) remain poorly understood. We investigated whether this association was mediated by social support or mental health status. We utilized cross-sectional data from the 2002 National Survey on Drug Use and Health (n = 36,370). We first used logistic regression to regress any alcohol use in the past year on sociodemographic and religiosity variables. Then, among individuals who drank in the past year, we regressed past year alcohol abuse/dependence on sociodemographic and religiosity variables. To investigate whether social support mediated the association between religiosity and alcohol use and alcohol abuse/dependence we repeated the above models, adding the social support variables. To the extent that these added predictors modified the magnitude of the effect of the religiosity variables, we interpreted social support as a possible mediator. We also formally tested for mediation using path analysis. We investigated the possible mediating role of mental health status analogously. Parallel sets of analyses were conducted for any drug use, and drug abuse/dependence among those using any drugs as the dependent variables. The addition of social support and mental health status variables to logistic regression models had little effect on the magnitude of the religiosity coefficients in any of the models. While some of the tests of mediation were significant in the path analyses, the results were not always in the expected direction, and the magnitude of the effects was small. The association between religiosity and decreased likelihood of a substance use disorder does not appear to be substantively mediated by either social support or mental health status.

Francis SA; Lam WK; Cance JD; Hogan VK. What's the 411? Assessing the feasibility of providing African American adolescents with HIV/AIDS prevention education in a faith-based setting. Journal of Religion and Health 48(2): 164-177, 2009

This study examines African American faith based leaders' attitudes and beliefs about providing HIV prevention education and services to adolescents. Using a convenience sample, we identified priority adolescent health issues, attitudes about abstinence messages, and willingness to provide and participate in HIV prevention. Leaders identified drugs, gangs, alcohol, sex, and pregnancy as priority health issues affecting youth in their institutions. Leaders' strongly preferred to emphasize abstinence messages. Although leaders were willing to provide youth with health education, they were not willing to discuss specific behaviors associated with HIV transmission. African American churches provide a venue to reach African American youth; however, there are limitations to relying on faith-based HIV prevention services. HIV prevention education should continue to be supplemented via parents, schools, and public health agencies.

Ghandour LA; Karam EG; Maalouf WE. Lifetime alcohol use, abuse and dependence among university students in Lebanon: Exploring the role of religiosity in different religious faiths. Addiction 104(6): 940-948, 2009. (41 refs.)

To examine alcohol consumption and the role of religiosity in alcohol use disorders in Christian, Druze and Muslim youth in Lebanon, given their distinct religious doctrines and social norms. Using a self-completed anonymous questionnaire, data were collected on 1837 students, selected randomly from two large private universities in Beirut. Life-time abuse and dependence were measured as per the Diagnostic and Statistical Manual version IV. Alcohol use was more common in Christians, who started drinking younger and were twice as likely to be diagnosed with abuse and dependence. However, among ever drinkers, the odds of alcohol use disorders were comparable across religious groups. Believing in God and practising one's faith were related inversely to alcohol abuse and dependence in all religious groups, even among ever drinkers (belief in God only). The associations were sometimes stronger for Muslims, suggesting that religiosity may play a larger role in a more proscriptive religion, as postulated by'reference group theory'. Students belonging to conservative religious groups may be shielded from the opportunity to try alcohol. Once an ever drinker, however, religion is not related to the odds of an alcohol use disorder. Religiosity (i.e. belief in God and religious practice) is, nevertheless, related inversely to alcohol-related problems, even among drinkers. Findings from this culturally and religiously diverse Arab country corroborate the international literature on religion, religiosity and alcohol use, highlighting potential differences between Christians and Muslims.

Gillum F; Obisesan TO; Jarrett NC. Smokeless tobacco use and religiousness. International Journal of Environmental Research and Public Health 6(1): 225-231, 2009. (19 refs.)

Although smoking shows a strong negative association with religiousness, no studies have appeared of use of smokeless tobacco (ST) and religiousness. To assess an association of use of ST and religiousness, data from 9,374 men aged 17 years and over with complete data on self-reported frequency of attendance at religious services and use of smokeless tobacco were analyzed. Among men aged 17-29 years, 4.9% of frequent attenders (>= 24 times/y) and 9.4% of others (< 24 times/y) were current users of ST (p=0.002). After adjusting for multiple confounders by logistic regression, infrequent attenders were twice as likely as frequent attenders to be ST users: odds ratio 2.09, 95% confidence limits 1.12-3.92, p=0.02. This negative association suggests a protective effect of early-life religiousness on ST use, which might be taken into account in planning ST prevention efforts.

Godlaski T. Dialogue on the relationship between addiction and religion and its possible implications for care. (editorial). Substance Use & Misuse 45(14): 2393-2395, 2010. (2 refs.)

Godlaski TM. Osiris of bread and beer. (editorial). Substance Use & Misuse 46(12): 1451-1456, 2011. (14 refs.)

Harden KP. Does religious involvement protect against early drinking? A behavior genetic approach. Journal of Child Psychology and Psychiatry 51(7): 763-771, 2010. (45 refs.)

Background: Adolescent involvement in religious organizations has been hypothesized to protect against early age at first drink. However, the correlation between adolescent religiosity and later age at first drink may be confounded by environmental or genetic differences between families. This study tests whether, after controlling for shared environmental and genetic confounds using a behavior genetic design, the association between individual levels of religiosity and earlier age at first drink is still evident. Method: Twin and sibling pairs were drawn from the National Longitudinal Study of Adolescent Health, a nationally-representative sample of US adolescents. Age at first drink was measured as how old adolescents were when they first had a drink of beer, wine, or liquor. Religiosity was measured using four items concerning frequency of religious activities and importance of religious beliefs. Using twins and siblings who were discordant for religiosity, analyses tested whether religious adolescents had a later age at first drink than their non-religious co-twins/co-siblings. Results: Religious adolescents did not differ from their non-religious siblings in their mean age at first drink. Results from survival models indicate that environmental differences between families completely account for the correlation between religiosity and later age at first drink. Conclusions: Results suggest that individual religious involvement is a proxy variable for family or cultural environments that are salient for when adolescents initiate alcohol use. Future research is needed to identify specific protective environments in religious families. These results have implications for both public policy and etiological theory.

Heinz AJ; Disney ER; Epstein DH; Glezen LA; Clark PI; Preston KL. A focus-group study on spirituality and substance-user treatment. Substance Use & Misuse 45(1/2): 134-153, 2010. (52 refs.)

Focus groups were conducted in 2005-2006 with 25 urban methadone-maintained outpatients to examine beliefs about the role of spirituality in addiction and its appropriateness informal treatment. Thematic analyses suggested that spirituality and religious practices suffered in complex ways during active addiction, but went "hand in hand" with recovery. Participants agreed that integration of a voluntary spiritual discussion group into formal treatment would be preferable to currently available alternatives. One limitation was that all participants identified as strongly spiritual. Studies of more diverse samples will help guide the development and evaluation of spiritually based interventions in formal treatment.

Hemphill SA; Heerde JA; Herrenkohl TI; Patton GC; Toumbourou JW; Catalano RF. Risk and protective factors for adolescent substance use in Washington State, the United States and Victoria, Australia: A longitudinal study. Journal of Adolescent Health 49(3): 312-320, 2011. (40 refs.)

Purpose: To compare the levels of risk and protective factors and the predictive influence of these factors on alcohol, tobacco, and cannabis use over a 12-month follow-up period in Washington State in the United States and in Victoria, Australia. Method: The study involved a longitudinal school-based survey of students drawn as a two-stage cluster sample recruited through schools, and administered in the years 2002 and 2003 in both states. The study used statewide representative samples of students in the seventh and ninth grades (n = 3,876) in Washington State and Victoria. Results: Washington State students, relative to Victorian students, had higher rates of cannabis use but lower rates of alcohol and tobacco use at time 1. Levels of risk and protective factors showed few but important differences that contribute to the explanation of differences in substance use; Washington State students, relative to Victorian students, reported higher religiosity (odds ratio, .96 vs. .79) and availability of handguns (odds ratio, 1.23 vs. 1.18), but less favorable peer, community, and parental attitudes to substance use. The associations with substance use at follow-up are generally comparable, but in many instances were weaker in Washington State. Conclusions: Levels of risk and protective factors and their associations with substance use at follow-up were mostly similar in the two states. Further high-quality longitudinal studies to establish invariance in the relations between risk and protective factors and substance use in adolescence across diverse countries are warranted.

Hofstetter CR; Ayers JW; Irvin VL; Sim DEK; Hughes SC; Reighard F et al. Does church participation facilitate tobacco control? A report on Korean immigrants. Journal of Immigrant and Minority Health 12(2): 187-197, 2010. (76 refs.)

Background: This study explores hypotheses linking church attendance to smoking prevalence, cessation, exposure to environmental tobacco smoke (ETS), and household smoking bans among Korean immigrants in California. Methods: Data were drawn from telephone interviews with Korean adults (N = 2085) based on a probability sample during 2005-2006 in which 86% of those contacted completed interviews. Results: Koreans who reported that they had attended church were less likely to be current smokers and to be exposed to ETS, and more likely to have quit smoking and to have a complete smoking ban than non-attenders after statistical controls for behavioral covariates. Discussion: Whether or not participants reported attending church was associated with increased tobacco control practices. Public health interventions may profit by seeking to expand cooperation with religious congregations to facilitate efforts to promote healthy lifestyles among immigrant populations beyond the influences of church attendance.

Hook JN; Worthington EL; Davis DE; Jennings DJ; Gartner AL; Hook JP. Empirically supported religious and spiritual therapies. Journal of Clinical Psychology 66(1): 46-72, 2010. (74 refs.)

This article evaluated the efficacy status of religious and spiritual (R/S) therapies for mental health problems, including treatments for depression, anxiety, unforgiveness, eating disorders, schizophrenia, alcoholism, anger, and marital issues. Religions represented included Christianity, Islam, Taoism, and Buddhism. Some studies incorporated a generic spirituality. Several R/S therapies were found to be helpful for clients, supporting the further use and research on these therapies. There was limited evidence that R/S therapies outperformed established secular therapies, thus the decision to use an R/S therapy may be an issue of client preference and therapist comfort.

Huguelet P; Borras L; Gillieron C; Brandt PY; Mohr S. Influence of spirituality and religiousness on substance misuse in patients with schizophrenia or schizo-affective disorder. Substance Use & Misuse 44(4): 502-513, 2009. (27 refs.)

Substance misuse represents a major issue in the treatment of schizophrenia patients. Spirituality and religiousness have been shown to reduce substance misuse and to foster recovery among substance misusers in the general population. One hundred and fifteen stabilized outpatients with schizophrenia (mean age 39; 70% male) were selected in 2004 for an interview about religious coping. Religious involvement was significantly inversely correlated to substance use and abuse. A content analysis showed that religion may play a protective role toward substance misuse in 14% of the total sample, especially for patients who had stopped substance misuse (42%). It played a negative role in 3% of cases. Religion may play a role in the recovery of schizophrenia patients with substance misuse comorbidity.

Jones SC; Rossiter JR. Social and religious factors in adolescents' drug use. Journal of Child & Adolescent Substance Abuse 18(1): 85-92, 2009. (12 refs.)

The original purpose of this study was to test several types of anti-cannabis messages. Analysis of the results led to a second, post hoc purpose: to explain why pre-intervention substance usage rates varied so greatly between the sampled schools. Participants were Australian ninth-grade students at a state government high school and a non-denominational Christian high school. Analysis of the open-ended responses indicated that attending a school that has a strong moral prohibition on substance usereinforced by peers, families, and churchacts as a protective factor in preventing substance use. Studies such as this suggest that providing adolescents with supportive environments will encourage them to make sensible choices about drugs, with long-term benefits for the individual and the community.

Kamal SMM; Islam MA; Abu Raihan M. Differentials of tobacco consumption and its effect on illicit drug use in rural men in Bangladesh. Asia-Pacific Journal of Public Health 23(3): 349-362, 2011. (23 refs.)

This study examined socioeconomic differentials of tobacco consumption and its effect on illicit drug use among rural men, extracting data from the 2004 Bangladesh Demographic and Health Survey. Overall, 58.4% of the respondents consumed tobacco either by smoking or chewing. Smoking bidi (33.9%) and cigarette (23.6%) were the most prevalent forms of tobacco use. The prevalence of illicit drug use was 3.5%. The predominant illicit drug used was ganja (2.3%). Socioeconomic and behavioral factors such as age, education, religion, marital status, premarital and extramarital sexuality, and having STDs were found to be significantly (P < .001) associated with tobacco consumption. Multivariate logistic regression analyses yielded significantly (P <.001) increased risk of illicit drug use for different forms of tobacco consumption, for young age, premarital and extramarital sexuality, and non-Muslims. Appropriate measures should be undertaken to prevent smoking and illicit drug use for a healthy Bangladesh.

Keinan-Boker L; Kohn R; Billig M; Levav I. Smoking behaviour under intense terrorist attacks. European Journal of Public Health 21(3): 355-359, 2011. (19 refs.)

Background: Smoking is one of the varied psychological reactions to stress. This study examined the rate and changes in cigarette smoking among former Gaza and current West Bank Jewish settlers subjected to direct and indirect terrorist attacks during the Al-Aksa Intifada. The relationship with degree of religious observance and emotional distress was explored as well. Methods: In this cross-sectional study, the respondents were settlers randomly selected and interviewed by telephone (N = 706). The interview schedule included socio-demographic items, information on direct exposure to terrorist attacks (e.g. threat to life or physical integrity, personal losses, property damage) and on steady and changes in smoking habits, and a scale to measure emotional distress. Results: In contrast with the country population, a larger percentage of settlers who smoked increased the number of cigarettes consumed with exposure to terrorism (10 and 27%, respectively). Respondents who were injured or had their home damaged reported a higher rate of smoking during the preceding year (30 and 20%, respectively). Emotional distress was related to cigarette smoking, but not in the controlled analysis. Religious observance had no effect. Conclusion: Direct or indirect exposure to terrorist attacks had an impact on smoking prevalence rates and on changes in smoking habits. Studies investigating reactions to traumatic events should include a detailed section on smoking while mental health interventions should address the needs of smokers.

Kendler KS; Myers J. A developmental twin study of church attendance and alcohol and nicotine consumption: A model for analyzing the changing impact of genes and environment. American Journal of Psychiatry 166(10): 1150-1155, 2009. (36 refs.)

Objective: Church attendance is one of the most consistent predictors of alcohol and nicotine consumption. The authors sought to clarify changes in the role of genetic and environmental factors in influencing church attendance and the interrelationship between church attendance and alcohol and nicotine use from early adolescence into adulthood. Method: The authors used data from two interview waves 6 years apart of 1,796 male twins from a population-based register, in which respondents were asked about current and past church attendance and psychoactive drug use. Structural twin models were fitted and tested using the Mx software program. Results: As twins developed from childhood through adulthood, the influence of shared environmental factors on church attendance declined dramatically while genetic factors increased. In early and late adolescence, the negative correlations between church attendance and alcohol and nicotine consumption resulted largely from shared environmental factors. In adulthood, the inverse relationship between church attendance and substance use became stronger and arose largely from genetic factors. Conclusions: As individuals mature, they increasingly shape their own social environment in large part as a result of their genetically influenced temperament. When individuals are younger and living at home, frequent church attendance reflects a range of familial and social-environmental influences that reduce levels of substance use. In adulthood, by contrast, high levels of church attendance largely index genetically influenced temperamental factors that are protective against substance use. Using genetically informative designs such as twin studies, it is possible to show that the causes of the relationship between social risk factors and substance use can change dramatically over development.

Khallad Y. Health risk behaviors among college youths: A cross-cultural comparison. Journal of Health Psychology 15(6): 925-934, 2010. (41 refs.)

The present study examined the frequency of smoking, seatbelt use, and vehicular speeding among American and Jordanian college students, and assessed the relationship between these risk behaviors and gender, socioeconomic status, and religiosity. Significantly more Jordanian students were smokers. Jordanian students were less likely than American students to buckle up, but American students were more likely to engage in vehicular speeding. Female students, especially among Jordanians, were less likely than male students to engage in risky behaviors. Among Jordanian participants, smoking and passenger seatbelt use were positively associated with indices of socioeconomic status, and smoking was negatively associated with religiosity.

Koenig LB; Haber JR; Jacob T. Childhood religious affiliation and alcohol use and abuse across the lifespan in alcohol-dependent men. Psychology of Addictive Behaviors 25(3): 381-389, 2011. (36 refs.)

The current study examined the relationship between childhood religious affiliation and alcohol use across the life span. A sample of 931 men (average age of 51) from the Vietnam Era Twin Registry, which includes an overrepresentation of alcohol-dependent men, completed the Lifetime Drinking History interview, which assessed drinking across the life span. Childhood religious affiliation was obtained from the men's spouse/partner. Affiliations were subdivided into four categories: nonreligious, accommodating (religions that are relatively more accepting of the larger culture), differentiating (religions that set themselves apart from the larger culture), and Catholic. Differences in a variety of alcohol use variables by religious affiliation were examined, as well as the protective effect of childhood religious affiliation on three alcohol use variables at 5-year intervals from age 20 to age 50. Significant differences were found for abstinence, regular drinking, and current quantity-frequency (QFI) scores, with individuals in differentiating religions having the highest rates of abstinence/nonregular drinking and the lowest consumption levels. When examining QFI and alcohol dependence symptoms and diagnoses over time, the nonreligious group had more alcohol use than the religious groups, with the differentiating affiliations showing the least alcohol use. The differences between affiliations were not always significant, but the consistent pattern suggests that childhood religious affiliation may continue to affect alcohol use even into adulthood.

Koenig LB; Vaillant GE. A prospective study of church attendance and health over the lifespan. Health Psychology 28(1): 117-124, 2009. (21 refs.)

Objective: The objective of the current study was to help clarify the previously ambiguous results concerning the relationship between church attendance and later physical health. Design: The current study examined the effect of church attendance on 4 different indicators of later health in a sample of inner city men followed throughout their lifecourse. Measures of previous health status, mood, substance abuse, smoking, education, and social class were used as covariates in regression analyses predicting health at age 70 from church attendance at age 47. Main outcome measures: Health at age 70 was assessed by 4 indicator: mortality, objective physical health, subjective physical health, and subjective well-being. Results: Though church attendance was related to later physical health, this was only through indirect means, as both physical health and church attendance were associated with substance use and mood. However, findings do suggest a more direct link between church attendance and well-being. Conclusion: Indirect effects of church attendance on health were clearly observed, with alcohol use/dependence, smoking, and mood being possible mediators of the church attendance-health relationship. The effects of church attendance on more subjective ratings of health, however, may be more direct.

Lewis M. Keeping sin from sacred spaces southern evangelicals and the socio-legal control of alcohol, 1865-1915. Southern Cultures 15(2): 40-60, 2009. (54 refs.)

Historically, and still today, southerners have attempted to maintain a strict separation of "items" deemed sinful and "spaces" deemed pure. White southerners have also been unusually concerned with separating "persons" deemed sinful or tempting from "pure" spaces or persons, as the long sad history of laws designed to prohibit intimate cross-racial fraternization illustrate. While many Americans might view an inebriated churchgoer as an ill person who has inappropriately entered a sacred place, southern evangelicals then and now would characterize the person as a victim of Satan's machinations. Initially southern evangelicals attacked the saloon, creating laws that would ensure "decreasing drinking and drunkenness by removing temptation farther from men. " Evangelicals worried that these measures did nothing to prevent the movement of liquor from areas that still permitted its sale into those that had outlawed it. Historians who have investigated the shift away from prohibition sentiment and practice generally explain it by referring to different social changes. These include urbanization and upward mobility, another is the acceptance of the medical model of the alcoholic as someone who is suffering from a genetic or biologically-based disease. Those who are genetically or biologically ill represent less threat of contagion, making a spatial separating strategy less necessary. Some evangelical groups have once again begun to question the wisdom of the medical model, arguing instead for a return to a legal and moral solution to the liquor problem. In 2006 the Southern Baptist Convention passed Resolution #5: "Resolved that the messengers to the SBC express our total opposition to the manufacturing, advertising, distributing, and consuming of alcoholic beverages ... and be it further that we commend organizations and ministries that treat alcohol-related problems from a biblical perspective."

Longshore D; Anglin MD; Conner BT. Are religiosity and spirituality useful constructs in drug treatment research? Journal of Behavioral Health Services & Research 36(2): 177-188, 2009. (81 refs.)

Religiosity and spirituality (R/S) have been shown to be related to better outcomes in many health service areas, including drug abuse treatment. The latter area, however, lacks a fully emergent empirical framework to guide further study. Moreover, although scientists have tested isolated hypotheses, no comprehensive process model has been designed and validated, limiting conceptual development as well. This paper reviews the relevant R/S and health research literature with a primary focus on drug treatment processes. Then a conceptual model is suggested to guide future incremental study of R/S assessment and intervention development. Implications for addiction health services include increased efforts to empirically validate R/S interventions, to increase practitioner competencies in this area, and to disseminate relevant research findings.

Lorencova R. Religiosity and spirituality of alcohol and marijuana users. Journal of Psychoactive Drugs 43(3): 180-187, 2011. (34 refs.)

This study focuses on measuring the spirituality of alcohol and marijuana users, using the new and exclusively Czech measuring tool, the Prague Spiritual Questionnaire (PSQ). The data from 155 respondents shows that users of both marijuana and alcohol scored significantly higher in the mysticism dimension of spirituality than those who only drank alcohol. People who mentioned that the specified spiritual feelings resulted from drug use are significantly more spiritual than those who do not associate their experiences with any drugs. The gender, age, education and professions of respondents show no significant effect on spirituality, while there is a significant difference between religious and nonreligious drug users in the specific dimensions of spirituality. Various implications of these findings, as well as the limitations of the PSQ, are further discussed.

Magura S. A few thoughts on addiction and religion. (editorial). Substance Use & Misuse 45(14): 2400-2402, 2010. (5 refs.)

Mason SJ; Deane FP; Kelly PJ; Crowe TP. Do spirituality and religiosity help in the management of cravings in substance abuse treatment? Substance Use & Misuse 44(13): 1926-1940, 2009. (39 refs.)

The purpose of this study was to examine the relationship of spirituality, religiosity and self-efficacy with drug and/or alcohol cravings. A cross-sectional survey was completed by 77 male participants at an Australian Salvation Army residential rehabilitation service in 2007. The survey included questions relating to the participants' drug and/or alcohol use and also measures for spirituality, religiosity, cravings, and self-efficacy The sample included participants aged between 19 and 74 years, with more than 57% reporting a diagnosis for a mental disorder and 78% reporting polysubstance misuse with alcohol most frequently endorsed as the primary drug of concern (71%). Seventy-five percent of the clients reported that spirituality and religious faith were useful components of the treatment program. A multivariate multiple regression analysis identified that spirituality and self-efficacy have significant relationships with cravings. Self-efficacy mediated the relationship between spirituality and drug and/or alcohol cravings. The limitations of this study included its cross-sectional design and a sample that was drawn from a faith-based program. Future research would benefit from the longitudinal examination of the relationship between spirituality, self-efficacy, and cravings: the exploration of a broader range of client-specific and interpersonal variables; and the inclusion of a control group from a secular treatment facility.

Masters KS; Knestel A. Religious orientation among a random sample of community-dwelling adults: Relations with health status and health-relevant behaviors. International Journal for the Psychology of Religion 21(1): 63-76, 2011. (47 refs.)

This empirical study was designed as the first to describe the distribution of the four religious orientation types in the general population, based on Allport and Ross's Intrinsic/Extrinsic typology, and to test whether differences in health status and health relevant behaviors based on religious type exist. Throughout 2005-2006 individuals (N = 157) were randomly telephoned and administered a measure of religious orientation. They reported health status, height/weight, use of tobacco and alcohol, and engagement in aerobic exercise. All four religious orientation types were represented (Intrinsic = 19.1%, Extrinsic = 22.3%, Pro-religious = 36.9%, Non-religious = 21.7%). Intrinsic and Non-religious types reported the most favorable health perceptions and lowest body mass indexes. Intrinsic and Pro-religious types were least likely to smoke tobacco or drink alcohol. Religious orientation is a useful construct pertaining to health status and health relevant behaviors and further demonstrates the multidimensional nature of religion.

McFadden D; Croghan IT; Piderman KM; Lundstrom C; Schroeder DR; Hays JT. Spirituality in tobacco dependence: A Mayo Clinic survey. Explore: The Journal of Science and Healing 7(3): 162- 167, 2011. (23 refs.)

Context: With widespread interest in natural remedies and "wholistic" treatments, there has been a renewed focus on the impact of spirituality related alternative therapy for many current chronic diseases. Objective: To assess the potential impact of spiritual beliefs on lifestyle choices such as tobacco use, we conducted a patient survey. Design:/Setting: This cross-section study was conducted using a 27-question survey of patients seen at the Mayo Clinic over a 14-week period. Patients: We invited all patients (smokers and nonsmokers) seen in several Mayo Clinic divisions to participate in this voluntary survey. Interventions: The survey included demographic information, history of tobacco use or nonuse, and assessment of spirituality. Main Outcome Measure: Among the 501 patients who participated, 370 were nonsmokers and 131 were smokers. Compared with smokers, nonsmokers more often participated in religious activities such as regular weekly church attendance (48% vs. 24%), daily prayer, and Bible study (49% vs. 24%; P < .001). Current smoking was negatively correlated with religious activities. However, after adjustment for demographic facdtors, there was no significant difference in intrinsic spirituality (importance of religion) between the two groups (P < .130). Result: Nonsmokers are more likely to engage in religious activities such as prayer, Bible study, and regular church attendance. Further studies may be helpful to clearly define the potential impact of spirituality on smoking cessation.

Mellor JM; Freeborn BA. Religious participation and risky health behaviors among adolescents. Health Economics 20(10): 1226-1240, 2011. (26 refs.)

Previous studies have shown that adolescent religious participation is negatively associated with risky health behaviors such as cigarette smoking, alcohol consumption, and illicit drug use. One explanation for these findings is that religion directly reduces risky behaviors because churches provide youths with moral guidance or with strong social networks that reinforce social norms. An alternative explanation is that both religious participation and risky health behaviors are driven by some common unobserved individual trait. We use data from the National Longitudinal Study of Adolescent Health and implement an instrumental variables approach to identify the effect of religious participation on smoking, binge drinking, and marijuana use. Following Gruber (2005), we use a county-level measure of religious market density as an instrument. We find that religious market density has a strong positive association with adolescent religious participation, but not with secular measures of social capital. Upon accounting for unobserved heterogeneity, we find that religious participation continues to have a significant negative effect on illicit drug use. On the contrary, the estimated effects of attendance in instrumental variables models of binge drinking and smoking are statistically imprecise.

Miller ML; Saunders SM. A naturalistic study of the associations between changes in alcohol problems, spiritual functioning, and psychiatric symptoms. Psychology of Addictive Behaviors 25(3): 455-461, 2011. (31 refs.)

The study evaluated how spiritual and religious functioning (SRF), alcohol-related problems, and psychiatric symptoms change over the course of treatment and follow-up. Problem drinkers (n = 55, including 39 males and 16 females) in outpatient treatment were administered questionnaires at pretreatment, posttreatment, and follow up, which assessed two aspects of SRF (religious well-being and existential well-being), two aspects of alcohol misuse (severity and consequences), and two aspects of psychiatric symptoms (depression and anxiety). Significant improvements in SRF, psychiatric symptoms and alcohol misuse were observed from pretreatment to follow-up. Although SRF scores were significantly correlated with psychiatric symptoms at all three time points, improvement in the former did not predict improvement in the latter. When measured at the same time points, SRF scores were not correlated with the measures of alcohol misuse. However, improvement in SRF (specifically in existential well-being) over the course of treatment was predictive of improvement in the alcohol misuse measures at follow-up. These results suggest that the association between SRF, emotional problems, and alcohol misuse is complex. They further suggest that patients who improve spiritual functioning over the course of treatment are more likely to experience improvement in drinking behavior and alcohol-related problems after treatment has ended.

Moiseeva VV; Pozniakova ME. Can religion counteract the spread of narcotics abuse among young people? Russian Education and Society 51(3): 25-43, 2009. (4 refs.)

Empirical data show that religious organizations have no influence in preventing people from becoming drug addicts or in attempts to give up drug abuse.

Moos R. Spirituality and religiosity in context. (editorial). Substance Use & Misuse 45(14): 2386-2388, 2010. (5 refs.)

Nakhaee N; Divsalar K; Jadidi N. Religious involvement and cigarette smoking among Iranian university students. International Journal of Psychiatry in Medicine 39(2): 189-198, 2009. (19 refs.)

Objectives: To find out the prevalence of cigarette smoking in a group of Iranian Muslim students and also to find out if there is a relationship between religious practices and cigarette smoking. Methods: In this cross-sectional study, 950 university students in Kerman, Iran were asked to fill out a self-administered questionnaire consisting of questions on demographic data, cigarette smoking, and religious practices. It was explained that the study was anonymous and voluntary, and confidentiality was assured. Results: All 833 subjects who participated in the study were Muslims, 54.1% of whom were female and 89.3% were single. Approximately 40% of male students and 5.8% of the female ones were smokers. Based on bivariate analysis, some differences were noted in the prevalence of smoking according to gender, marital status, income, average university scores, close friend's smoking, parental smoking, reading the Quran, saying prayers, mosque attendance, and fasting. Using multivariate analysis, male gender, higher income, lower average exam scores, and close friend's smoking being associated with the likelihood to smoke cigarettes. The odds ratio for cigarette smoking in the upper tertile compared with those in the lower tertile of religious activity was 0.53 (CI 95% 0.33-0.84). Conclusion: Religious activities may have a protective role against cigarette smoking among Muslim college students in the country.

Nencini P; Grant KA. Psychobiology of drug-induced religious experience: From the brain "locus of religion" to cognitive unbinding. Substance Use & Misuse 45(13): 2130-2151, 2010. (79 refs.)

The recent interest in the psychopharmacological underpinnings of religious experiences has led to both the laboratory characterizations of drug-induced mystical events and psychobiological models of religious experiences rooted in evolution and fitness. Our examination of this literature suggests that these theories may be congruent only within more modern religious and cultural settings and are not generalizable to all historical beliefs, as would be expected from an evolutionarily conserved biological mechanism. The strong influence of culture on the subjective effects of drugs as well as religious thoughts argues against the concept of a common pathway in the brain uniquely responsible for these experiences. Rather, the role of personal beliefs, expectations and experiences may interject bias into the interpretation of psychoactive drug action as a reflection of biologically based religious thought. Thus, psychobiological research proposing specific brain mechanisms should consider anthropological and historical data to address alternative explanations to the "fitness" of religious thought. A psychobiological model of the religious experience based on the concept of cognitive unbinding seems to accommodate these data better than that of a specific brain locus of religion.

Ningombam S; Hutin Y; Murhekar MV. Prevalence and pattern of substance use among the higher secondary school students of Imphal, Manipur, India. National Medical Journal of India 24(1): 11- 15, 2011. (17 refs.)

Background. Substance use often begins in adolescence. We did a study to describe substance use and its associated factors among adolescent students in Imphal. Methods. We defined substance use as the use of licit and illicit substance other than when medically indicated. Using a WHO self-administered questionnaire, we collected information about substance use from 61 randomly selected students of 17 government/private higher secondary schools. We calculated the prevalence of substance use according to selected characteristics. Results. We surveyed 1020 students, 551 of whom reported prior substance use (prevalence of ever use: 54%, 95% confidence interval [CI] 42%-67%). Prevalence of recent and current user was 35% (95% CI 28%-43%) and 22% (95% CI 17%-28%), respectively. Among ever users, tobacco (46%) was used most commonly, followed by alcohol (29%), cannabis (14%) and opiates (12%). On multivariate analysis, substance use was significantly higher among boys (adjusted odds ratio [AOR] 2.6, 95% CI [2.0-3.4]), whose father (AOR 2.0, 95% CI 1.6-2.7) or sibling (AOR 2.1, 95% CI 1.5-3.0) used substance. It was significantly lower among children of Hindu/Jain religion (AOR 0.5, 95% CI 0.4-0.7). Conclusion. Prevalence of tobacco and alcohol use was high among students. Familial use of substances was associated with the behaviour of adolescents. Friends were the key proximal determinant. We recommend introducing a substance use prevention policy in schools to educate students about various adverse effects and to impart refusal skills.

Page RL; Ellison CG; Lee J. Does religiosity affect health risk behaviors in pregnant and postpartum women? Maternal and Child Health Journal 13(5): 621-632, 2009. (58 refs.)

Objectives: We examined the association between religious involvement and health risk behaviors such as smoking, drinking, marijuana use, and having multiple sex partners among a multiethnic sample of pregnant and postpartum women. Methods: Using data from the National Survey of Family Growth, we estimated multivariate logistic regression models to determine the association between various aspects of religious involvement (e.g., attendance, salience, and denomination) and certain behaviors known to be risky for pregnant women and their offspring. Results Frequent (more than once a week) and regular (once a week) attenders at religious services had 80% and 60% (respectively) lower odds of drinking alcohol compared to women who attended less than once a week. Similar patterns surfaced with regard to smoking tobacco with the odds of smoking roughly 85% lower (OR = 0.146, P < 0.001) among frequent attenders, and nearly 65% lower among regular attenders (OR = 0.369, P < 0.001). For smoking marijuana, religious attendance again emerges as a strong predictor. The odds of marijuana smoking are nearly 75% lower for women who attend services frequently (OR = 0.260, P < 0.05) and more than 65% lower for those who attend regularly (OR = 0.343, P < 0.01), as compared with their counterparts who attend services less often. Conclusions: Religious attendance emerged as an important correlate of less-risky health behaviors among this nationwide sample of pregnant and postpartum women. Future research should include an examination of the links between religious involvement and other important lifestyle factors that may influence maternal and child health.

Rasic D; Kisely S; Langille DB. Protective associations of importance of religion and frequency of service attendance with depression risk, suicidal behaviours and substance use in adolescents in Nova Scotia, Canada. Journal of Affective Disorders 132(3): 389-395, 2011. (58 refs.)

Purpose: We examined relationships of measures of personal importance of religion and frequency of attendance at religious services with risk of depression and risk behaviours in high school students in Cape Breton, Canada. We examined the impact of confounding and explanatory factors on these relationships. Methods: Data were drawn from self-report surveys of adolescents aged 15-19 (N=1615) at three high schools in May, 2006. We used logistic regression to assess associations of religious importance and religious service attendance with risk of depression, suicidal behaviour, binge drinking and frequent marijuana use, controlling in multivariate models for sociodemographic factors, family structure and social capital. Results: Among females, higher personal importance of religion was associated with decreased odds of depression, suicidal ideation, drinking and marijuana use, while more religious attendance was protective for substance use behaviours and suicidal ideation. In males, both measures of religiosity were associated with decreased substance use. In multivariate models, religious importance had weak protective effects for depression and suicidal thinking in females, which were respectively modified by social trust and substance use. Attendance was protective for suicidal thinking in females, and was modified by depression. These associations were not seen in males. Attendance was consistently associated with less substance use in females, while importance was not. Importance was consistently protective for marijuana use and attendance was protective for binge drinking in males. Limitations: This was a cross-sectional self-report survey and causality cannot be inferred. Conclusion: Protective associations of measures of religiosity are seen in Canadian adolescents, as they are elsewhere.

Robertson AA; Xu XH; Stripling A. Adverse events and substance use among female adolescent offenders: Effects of coping and family support. Substance Use & Misuse 45(3): 451-472, 2010. (86 refs.)

This study examined a stress-coping model for substance use among female adolescents (N = 305, 69% African American) involved in the Mississippi juvenile justice system. Participants were interviewed in 2006, regarding exposure to adverse and traumatic events, and they completed self-administered measures of social support from relatives, coping strategies, and questions on frequency of alcohol and other drug use. Results from nested regression models revealed that stressors are associated with drug, but not alcohol use. The use of supportive kinship ties and religion to cope were protective factors. The implications and limitations of the study are discussed.

Robinson EAR; Krentzman AR; Webb JR; Brower KJ. Six-month changes in spirituality and religiousness in alcoholics predict drinking outcomes at nine months. Journal of Studies on Alcohol and Drugs 72(4): 660-668, 2011. (48 refs.)

Objective: Although spiritual change is hypothesized to contribute to recovery from alcohol dependence, few studies have used prospective data to investigate this hypothesis. Prior studies have also been limited to treatment-seeking and Alcoholics Anonymous (AA) samples. This study included alcohol-dependent individuals, both in treatment and not, to investigate the effect of spiritual and religious (SR) change on subsequent drinking outcomes, independent of AA involvement. Method: Alcoholics (N = 364) were recruited for a panel study from two abstinence-based treatment centers, a moderation drinking program, and untreated individuals from the local community. Quantitative measures of SR change between baseline and 6 months were used to predict 9-month drinking outcomes, controlling for baseline drinking and AA involvement. Results: Significant 6-month changes in 8 of 12 SR measures were found, which included private SR practices, beliefs, daily spiritual experiences, three measures of forgiveness, negative religious coping, and purpose in life. Increases in private SR practices and forgiveness of self were the strongest predictors of improvements in drinking outcomes. Changes in daily spiritual experiences, purpose in life, a general measure of forgiveness, and negative religious coping also predicted favorable drinking outcomes. Conclusions: SR change predicted good drinking outcomes in alcoholics, even when controlling for AA involvement. SR variables, broadly defined, deserve attention in fostering change even among those who do not affiliate with AA or religious institutions. Last, future research should include SR variables, particularly various types of forgiveness, given the strong effects found for forgiveness of self.

Rodek J; Sekulic D; Pasalic E. Can we consider religiousness as a protective factor against doping behavior in sport? Journal of Religion and Health 48(4): 445-453, 2009. (26 refs.)

Religiousness is rarely studied in relation to doping behaviors in sport. In this study, we sampled 27 weightlifting/powerlifting athletes from Bosnia and Herzegovina. Using the originally developed questionnaire and by means of Spearman's correlation, we interpreted data and discussed relationships between (a) social, religious, sport, and educational factors, and (b) substance use criteria, including cigarettes, alcohol, analgesics, nutritional supplementation, and doping behaviors. In conclusion, we found (1) that religiousness can be considered as a potential protective factor against doping, but also (2) that religious subjects tend to deny and underestimate the doping behaviors in their sport. Both of these findings should be extensively studied in future investigations.

Rostosky SS; Danner F; Riggle EDB. Religiosity as a protective factor against heavy episodic drinking (HED) in heterosexual, bisexual, gay, and lesbian young adults. Journal of Homosexuality 57(8): 1039-1050, 2010. (28 refs.)

Although religiosity has been shown to be associated with positive outcomes in studies of general population samples, few studies have considered the potential differential effect of religiosity on those who are consolidating gay, lesbian, or bisexual (GLB) identities. Logistic regression analyses using a sample of 13,038 emerging adults from the National Longitudinal Survey of Adolescent Health (Add Health) revealed main effects for religiosity and a significant religiosity x sexual identity interaction in women. Specifically, religiosity was protective against alcohol use and heavy episodic drinking (HED) in heterosexual women, but not lesbian women. In bisexual women, higher religiosity increased the odds of alcohol use and HED. Among men, religiosity was protective, with no differential effects based on sexual identity. Prevention efforts should consider that individual religiosity may be a risk, rather than protective factor for some young adults.

Salmoirago-Blotcher E; Fitchett G; Ockene JK; Schnall E; Crawford S; Granek I et al. Religion and healthy lifestyle behaviors among postmenopausal women: The Women's Health Initiative. Journal of Behavioral Medicine 34(5): 360-371, 2011. (47 refs.)

Worship attendance has been associated with longer survival in prospective cohort studies. A possible explanation is that religious involvement may promote healthier lifestyle choices. Therefore, we examined whether attendance is associated with healthy behaviors, i.e. use of preventive medicine services, non-smoking, moderate drinking, exercising regularly, and with healthy dietary habits. The population included 71,689 post-menopausal women enrolled in the Women's Health Initiative observational study free of chronic diseases at baseline. Attendance and lifestyle behaviors information was collected at baseline using self-administered questionnaires. Healthy behaviors were modeled as a function of attendance using logistic regression. After adjustment for confounders, worship attendance (less than weekly, weekly, and more than weekly vs. never) was positively associated with use of preventive services [OR for mammograms: 1.34 (1.19, 1.51), 1.41 (1.26, 1.57), 1.33 (1.17, 1.52); breast self exams: 1.14 (1.02, 1.27), 1.33 (1.21, 1.48), 1.25 (1.1, 1.43); PAP smears: 1.22 (1.01, 1.47-weekly vs. none)]; non-smoking: [1.41 (1.35, 1.48), 1.76 (1.69, 1.84), 2.27 (2.15, 2.39)]; moderate drinking [1.35 (1.27, 1.45), 1.60 (1.52, 1.7), 2.19 (2.0, 2.4)]; and fiber intake [1.08 (1.03, 1.14), 1.16 (1.11, 1.22), 1.31 (1.23, 1.39), respectively], but not with regular exercise or with lower saturated fat and caloric intake. These findings suggest that worship attendance is associated with certain, but not all, healthy behaviors. Further research is needed to get a deeper understanding of the relationship between religious involvement and healthy lifestyle behaviors and of the inconsistent patterns in this association.

Sanchez ZM; Opaleye ES; Chaves TV; Noto AR; Nappo SA. God forbids or mom disapproves? Religious beliefs that prevent drug use among youth. Journal of Adolescent Research 26(5): 591-616, 2011. (37 refs.)

Researches have emphasized religiosity as a protective factor against drug use although the mechanism through which it occurs is still unknown. This article aims to explore religious beliefs that could prevent drug use among youth. Three sources of qualitative data were used: participant observation in 21 religious institutions, semistructured interviews of 37 religious leaders, and 6 focus groups comprised of 55 religious drug-naive youths. The young people's discourses and the sermons of religious leaders revealed that conceptions about drugs were based on media content, with little religious or scientific context. Catholics and Spiritists considered the consumption of licit drugs less harmful than that of illicit ones and were especially tolerant of the use of alcohol. Protestants were more emphatic when describing all drugs as being harmful to one's health. Findings suggest that young people who practice a religion invoke several religious concepts to justify their choice for not using drugs, and they attribute this position more to the family legacy than to their own religiosity. Thus youths' antidrug position was more reflective of family values than religious beliefs.

Stimpson JP. Smoking by frequency and type of social contact. American Journal of Health Behavior 34(3): 322-327, 2010. (30 refs.)

Objectives: To compare smoking by frequency and type of social contact. Methods: Respondents aged 20 years or older from NHANES III were analyzed using multivariate logistic models (N=15,499). Results: Among the levels and types of social contact, frequency of church attendance was the only type of social contact associated with lower likelihood of smoking (OR=0.68, 95% CI=0.64, 0.72). Other types of contact were either not associated or were associated with higher probabilities of smoking. Conclusions: Frequent church attendance appears to protect the most from smoking relative to other types of social contact.

Sung HE; Chu D; Richter L; Shlosberg A. Treatment philosophy and service delivery in a network of faith-based substance abuse treatment. Families in Society 90(4): 390-398, 2009. (54 refs.)

This research examines how the treatment philosophy and clinical practice of the Teen Challenge USA (TC) -- a national network of faith-based recovery services -- differ from secular substance abuse treatment programs. Using survey data from 80 TC administrators and counselors and 68 non-TC counterparts randomly selected from secular providers of substance abuse treatment, TC and non-TC providers were compared on these dimensions: views on human nature and morality perspectives on substance abuse and its treatment, structural capacity of the program and facilities, characteristics of the treatment population, service availability and utilization, and staff profiles. Findings revealed important differences as well as interesting similarities between TC and non-TC programs. Recommendations based on these findings are offered to both faith-based and secular service providers.

Sussman S. Addiction, religion, spirituality, treatment. (editorial). Substance Use & Misuse 45(14): 2383-2386, 2010. (15 refs.)

Tenorio KA; Lo CC. Social location, social integration, and the co-occurrence of substance abuse and psychological distress. American Journal of Drug and Alcohol Abuse 37(4): 218-223, 2011. (37 refs.)

Background: In the United States, social stratification has generally led individuals occupying lower social locations to have more health problems than other individuals, even acknowledging that social groups are distinguished by their particular manifestations of health problems. Objectives: This study examined whether two social integration factors, marriage and religiosity, mediate the relationship between social location and co-occurrence of substance abuse and psychological distress and the nature of this relationship. Methods: Multinomial logistic regression was conducted on data from a national sample of 34,650 adults mostly between the ages of 18 to 35, collected through the 2007 National Survey on Drug Use and Health. Results: White males who were lesser educated and living in poverty were more likely to exhibit co-occuring substance abuse and psychological distress than their demographically similar counterparts. Additionally, being married and religious appeared to be protective factors within the overall study cohort with fewer co-occurring behaviors reported. Conclusion: The data generally confirm the hypothesis concerning mediating roles for religiosity and marriage. Scientific Significance: Confirmation that marriage and religiosity can protect adults against co-occurring substance abuse and psychological distress potentially provides the information necessary to better target health policy and interventions that serve to further enhance the population's mental health.

Vaughan EL; de Dios MA; Steinfeldt JA; Kratz LM. Religiosity, alcohol use attitudes, and alcohol use in a national sample of adolescents. Psychology of Addictive Behaviors 25(3): 547-553, 2011. (24 refs.)

The purpose of this study was to investigate alcohol use attitudes as a mediator of the relationship between religiosity and the frequency of past month alcohol use in a national sample of adolescents. Data were drawn from 18,314 adolescents who participated in the 2006 and 2007 National Survey on Drug Use and Health. Variables included religiosity, alcohol use attitudes, and past month frequency of alcohol use. Structural equation modeling was used to test alcohol use attitudes as a mediator of the relationship between religiosity and frequency of alcohol use and to test model invariance across 4 racial/ethnic groups. Results suggest that alcohol use attitudes partially mediate the relationship between religiosity and frequency of alcohol use. Furthermore, while the pattern of these relationships is similar across racial/ethnic groups, the magnitude of alcohol use attitudes on frequency of alcohol use differed. Implications for prevention programs include targeting alcohol use attitudes in a variety of settings.

Warner J. Temperance, alcohol, and the American evangelical: A reassessment. (review). Addiction 104(7): 1075-1084, 2009. (109 refs.)

Abstinence from alcohol is a way of life for many American evangelicals, with rates of abstention running at over 70% among some Pentecostal denominations. This paper examines the religious beliefs that, historically, have supported teetotalism. The most notable of these is Christian perfection, a doctrine that originated in 18th-century England, that was then radicalized in America in the early 19th century. Abstinence from alcohol is highest among denominations that make Christian perfection the cornerstone of their teachings, and lowest among those that discount human agency. The paper also argues that 19th-century American evangelicals were by no means committed uniformly to temperance as a way of life, and that this was especially true of the various Methodist churches.

Webb JR; Brewer K. Forgiveness and college student drinking in southern Appalachia. Journal of Substance Use 15(6): 417-433, 2010. (62 refs.)

Methods: As such, cross-sectional associations between dimensions of forgiveness (Fetzer) and drinking (AUDIT) were examined among college students (n = 721; female = 516; M-age = 23) from the rural southern Appalachian region of the United States. Results: Using multiple regression analyses and independent of demographic variables and religiousness, while no forgiveness dimension was predictive of drinking in the first place (yes/no), Feeling Forgiven by God predicted a decreased likelihood of problematic drinking (Non/OK drinking vs. problematic drinking). Further, among problematic drinkers (n = 126; female = 75; M-age = 22), Feeling Forgiven by God predicted fewer alcohol-related problems and Forgiveness of Self predicted lower HALT scores, all with medium effect sizes. Forgiveness of Others was not associated with the alcohol-related variables. Conclusions: Of the dimensions of forgiveness measured, it appears that Feeling Forgiven by God may be most important in the context of drinking and problems therewith, while Forgiveness of Self may be most important in the context of relapse prevention.

Webb JR; Robinson EAR; Brower KJ. Mental health, not social support, mediates the forgiveness-alcohol outcome relationship. Psychology of Addictive Behaviors 25(3): 462-473, 2011. (77 refs.)

Religiousness and spirituality are important to most Americans, and evidence suggests that they may contribute to both addiction and recovery. Forgiveness is a specific dimension of religiousness and spirituality that may enhance recovery, but the mechanism(s) through which it operates is unknown. We hypothesized that higher levels of forgiveness would be associated with higher levels of mental health and social support, which, in turn, would be associated with improved alcohol-related outcomes. Baseline and 6-month longitudinal data from a sample of 149 individuals with alcohol use disorders seeking outpatient substance abuse treatment were analyzed through multiple-mediation statistical techniques. While previous research has shown direct associations among forgiveness, alcohol-related outcomes, mental health, and social support, this study found that the direct associations between forgiveness and alcohol-related outcomes were no longer significant when mental health and social support were analyzed as mediator variables. At baseline, for each alcohol-related outcome measured (alcohol-related problems, percent heavy drinking days, percent days abstinent, and drinks per drinking day), mental health individually played a role in the relationship with both forgiveness of self and forgiveness of others, fully mediating or operating through an indirect-only pathway. For alcohol-related problems only, mental health fully mediated the relationship with forgiveness of self at follow-up and operated through an indirect-only pathway with forgiveness of others longitudinally. Social support and feeling forgiven by God were nonsignificant variables at baseline, follow-up, and longitudinally.

Wells GM. The effect of religiosity and campus alcohol culture on collegiate alcohol consumption. Journal of American College Health 58(4): 295-304, 2010. (24 refs.)

Religiosity and campus culture were examined in relationship to alcohol consumption among college students using reference group theory. Participants and Methods: College students (N = 530) at a religious college and at a state university complete questionnaires on alcohol use and religiosity. Statistical tests and logistic regressioxn were utilized to examine alcohol use, religiosity, and campus environment. Results: Alcohol consumption was significantly higher among students at the university (M = 26.9 drinks) versus students at the religious college (M = 11.9 drinks). University students also had lower religiosity scores (M = 23.8) than students at the religious college (M = 26.5). Students who attend a secular university are 4 times more likely to be moderate or heavy drinkers compared to students attending a religiously affiliated college. Students with the least religiosity were 27 times more likely to be a heavy alcohol user and 9 times more likely to be a moderate alcohol user compared to students with greater religiosity.

Yeung JWK; Chan YC; Lee BLK. Youth religiosity and substance use: A meta-analysis from 1995 to 2007. Psychological Reports 105(1): 255-266, 2009. (50 refs.)

In this meta-analysis, the magnitude of the protective effects of religiosity on Youth involvement in substance use was investigated. Based on 22 studies in peer-reviewed journals published between 1995 and 2007, the average weighted mean correlation was Z(r) = .16, significant regardless of the definitions of religiosity. The homogeneity test of variance showed consistent protective effects of religiosity on four types of substance use, namely, alcohol, cigarette, marijuana, and other illicit drugs.

Yong HH; Hamann SL; Borland R; Fong GT; Omar M. Adult smokers' perception of the role of religion and religious leadership on smoking and association with quitting: A comparison between Thai Buddhists and Malaysian Muslims. Social Science & Medicine 69(7): 1025-1031, 2009. (18 refs.)

In recent years, attempts have been made to incorporate religion into tobacco control efforts, especially in countries like Malaysia and Thailand where religion is central to the lives of people. This paper is a prospective examination of the perceived relevance and role of religion and religious authorities in influencing smoking behaviour among Muslims in Malaysia and Buddhists in Thailand. Data were collected from 1482 Muslim Malaysian and 1971 Buddhist Thai adult smokers who completed wave 1 (early 2005) of the International Tobacco Control Southeast Asia Survey (ITC-SEA). Respondents were asked about the role of religion and religious leadership on smoking at Wave 1 and among those recontacted, quitting activity at Wave 2. Results revealed that over 90% of both religious groups reported that their religion guides their day-to-day behaviour at least sometimes, but Malaysian Muslims were more likely to report that this was always the case. The majority (79% Muslims and 88% Buddhists) of both groups believed that their religion discourages smoking. About 61% of the Muslims and 58% of the Buddhists reported that their religious leaders had encouraged them to quit before and a minority (30% and 26%, respectively) said they would be an influential source to motivate them to quit. Logistic regression models suggest that these religious factors had a clear independent association with making quitting attempts in both countries and this translated to success for Malaysian Muslims but not for the Thai Buddhists. Taken together, results from this study indicate that religion and religious authorities are both relevant and important drivers of quitting, but whether this is always enough to guarantee success is less clear. Religion can be a culturally relevant vehicle to complement other tobacco control efforts.

Yu M; Stiffman AR. Positive family relationships and religious affiliation as mediators between negative environment and illicit drug symptoms in American Indian adolescents. Addictive Behaviors 35(7): 694-699, 2010. (38 refs.)

The present study tests how positive family relationships and religious affiliation mediate between negative familial and social environments, and adolescent illicit drug abuse/dependence symptoms. The theoretical framework is based on an integration of two theories: the ecological model of human development (Bronfenbrenner, 1979) and the social development model (Hawkins & Weis, 1985). We used a stratified random sample of 401 American Indian adolescents. A path analysis tested the integrative theoretical model. Findings showed that positive family relationships mediated the negative impact of addicted family members, violence victimization, and negative school environment on illicit drug abuse/dependence symptoms. Religious affiliation mediated the negative effect of deviant peers on positive family relationships. Intervention and prevention efforts may benefit from promoting positive family relationships and religious affiliation to reduce the impact of complex familial and social problems on illicit drug symptoms.

Zigon J. "A disease of frozen feelings": Ethically working on emotional worlds in a Russian Orthodox Church drug rehabilitation program. Medical Anthropology Quarterly 24(3): 326-343, 2010. (30 refs.)

In a Russian Orthodox Church drug rehabilitation program in St. Petersburg, drug addiction was often described as a disease of frozen feelings. This image suggests that rehabilitation is a process of thawing emotional worlds and, thus, allows the emotions to flow once again. In this article I argue that "frozen feelings" is better understood as the unsocial emotional worlds many drug users experience, and that rehabilitation in this church-run program particularly focuses on the cultivation of an emotional world that supports sociality. This is done, I argue, by means of ethically training rehabilitants to learn how to control and manage their emotional worlds, and in so doing, rehabilitants become new moral persons better able to live in the social world.