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CORK Bibliography: Religiosity and Religious Groups

119 citations. January 2007 to present

Prepared: December 2009

Adamczyk A; Palmer I. Religion and initiation into marijuana use: The deterring role of religious friends. Journal of Drug Issues 38(3): 717-742, 2008. (61 refs.)

Over the last two decades researchers have begun to look at how personal religious beliefs and behaviors influence substance use, finding that more religious teens are less likely to drink, smoke, and use illegal drugs. This study builds on this previous research, combining it with work on religious contextual effects to develop a theoretical model that explains why friends' religion would influence teens' marijuana use, even if teens are not personally religious. Using two waves of data from the National Longitudinal Study of Adolescent Health, this study examines whether individual and friends' religiosity (e.g., religious participation and importance) or born-again identity influence marijuana initiation. Individual and friends' born-again identity appear to independently influence marijuana initiation, which is not significantly mediated by the proportion of in-school friends who have tried marijuana. Findings offer support for the role of micro religious contexts for explaining illegal substance use.

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.

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.

Atkins RG; Hawdon JE. Religiosity and participation in mutual-aid support groups for addiction. Journal of Substance Abuse Treatment 33(3): 321-331, 2007. (76 refs.)

Mutual-aid support groups play a vital role in substance abuse treatment in the United States. A national survey of mutual-aid support groups for addiction was conducted to identify key differences between participants in recovery groups. Survey data indicate that active involvement in support groups significantly improves one's chances of remaining clean and sober, regardless of the group in which one participates. Respondents whose individual beliefs better matched those of their primary support groups showed greater levels of group participation, resulting in better outcomes as measured by increased number of days clean and sober. Religious respondents were more likely to participate in 12-step groups and Women for Sobriety. Nonreligious respondents were significantly less likely to participate in 12-step groups. Religiosity had little impact on SMART Recovery participation but actually decreased participation in Secular Organizations for Sobriety. These results have important implications for treatment planning and matching individuals to appropriate support groups.

Azaiza F; Shoham M; Bar-Hamburger R; Abu-Asbeh K. Patterns of psychoactive substance use among Arab secondary school students in Israel. Substance Use & Misuse 43(11): 1477-1494, 2008. (55 refs.)

The current study examines patterns and trends in the use of psychoactive substances among Arab secondary school students throughout Israel. Data were collected in late 2004 using self-report questionnaires. The sample consisted of 2,944 students, Grades 7 through 12. Participants were sampled using a cluster method from schools throughout Israel. Results indicate higher use rates among males and among low-religiosity adolescents, as well as a strong link among attitudes, risk perception, behavioral intentions, and substance use. The study's implications and limitations, as well as possibilities for future research, are discussed. This study was funded by the Israel Anti-Drug Authority.

Baetz M; Bowen R; Jones G; Koru-Sengul T. How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population. Canadian Journal of Psychiatry 51(10): 654-661, 2006. (33 refs.)

Objective: Research into risk and protective factors for psychiatric disorders may help reduce the burden of these conditions. Spirituality and religion are 2 such factors, but research remains limited. Using a representative national sample of respondents, this study examines the relation between worship frequency and the importance of spiritual values and DSM-IV psychiatric and substance use disorders. Method: In 2002, the Canadian Community Health Survey obtained data from about 37 000 individuals aged 15 years or older. While controlling for demographic characteristics, we determined odds ratios for lifetime, 1-year, and past psychiatric disorders, with worship frequency and spiritual values as predictors. Results: Higher worship frequency was associated with lower odds of psychiatric disorders. In contrast, those who considered higher spiritual values important (in a search for meaning, in giving strength, and in understanding life's difficulties) had higher odds of most psychiatric disorders. Conclusion: This study confirms an association between higher worship frequency and lower odds of depression and it expands that finding to other psychiatric disorders. The association between spiritual values and mood, anxiety, and addictive disorders is complex and may reflect the use of spirituality to reframe life difficulties, including mental disorders.

Bahr SJ; Hoffmann JP. Religiosity, peers and adolescent drug use. Journal of Drug Issues 38(3): 743-770, 2008. (46 refs.)

In this paper we examined the relationship between religiosity, peer drug use, and adolescent drug use among 4,983 Utah adolescents and the 13,534 respondents from the National Longitudinal Survey of Adolescent Health. Adolescents who were religious were less likely to smoke, drink heavily, and use marijuana than adolescents who were not religious. Adolescents in highly religious schools were less likely to smoke than adolescents in schools low on religiosity. Individual religiosity tended to lessen the influence of peer drug use on respondent drug use for cigarettes, heavy drinking, and marijuana use but not for the use of other illicit drugs. The associations between individual religiosity and the four types of drug use were not affected by the level of school religiosity. The findings were consistent across the two different samples and three types of drugs: cigarettes, heavy drinking, and marijuana. Social learning and social control theories were used to explain these findings.

Bailey AR; Harvey DC; Brace C. Subscribed content disciplining youthful Methodist bodies in nineteenth-century Cornwall. Annals of the Association of American Geographers 97(1): 142-157, 2007. (62 refs.)

Discourses of Methodist temperance and teetotalism in Cornwall, U.K., show geographical relationships that link religious constructions of moral sanctity with specific forms of bodily performance. Understanding religious attitudes toward youthful spirituality and the histories of children informs theoretical debates concerning the embodied religious subject, citizenship, and public performance, expressed in the activities of Sunday schools and the Band of Hope (a temperance organization in which children took a pledge of total abstinence from alcohol). Methodist communities sought to regulate young people's behavior beyond the spaces of the chapel. Methodists' beliefs in autodidacticism, temperance, and social engagement have a spatiality as well as a history that demands attention.

Bard JA. Faith community nurses and the prevention and management of addiction problems. Journal of Addictions Nursing 17(2): 115-120, 2006. (22 refs.)

Faith Community Nurses can have a role in the prevention and management of problems associated with the use and abuse of psychoactive substances, prescription drugs, and over-the-counter medications. Religious perspectives of faith communities on the use of drugs vary considerably, as do the religious perspectives of addiction. Nevertheless, Faith Community Nurses work in these communities and understand the unique culture of these groups. The Faith Community Nurse has many functions including health educator, health advocate, personal health counselor, referral agent, coordinator of volunteers, developer of support groups, and integrator of health and faith. Consequently, the Faith Community Nurse is involved with individuals, families, and members of the community. These connections provide many opportunities for the Faith Community Nurse to institute programs to prevent addictions, help people understand the problems of addiction, help provide a caring community for people suffering from addictions, and guide people to the help they need. In addition, the nurse has opportunities to conduct research that would enhance the understanding of the topic.

Bartkowski JP; Xu XH. Religiosity and teen drug use reconsidered: A social capital perspective. American Journal of Preventive Medicine 32(6, Supplement S): S182-S194, 2007. (38 refs.)

Background: Although religiosity has often been shown to have a deterrent effect on teen drug use, noteworthy theoretic gaps and contradictory findings have left important questions unanswered. Methods: Conceptualizing religion as a measure of social capital and using cross-sectional data from Monitoring the Future (1996), a nationally representative sample of American high school seniors collected annually, this study is designed to shed new light on the relationship between religiosity and drug use among American youth. Levels of teen drug use for three different components of faith-based social capital-exposure to and internalization of religious norms, integration within religious networks, and trust in religious phenomenaare explored with respect to high school seniors' use of alcohol, marijuana, and other illicit drugs during the year prior to the survey. In addition, drug use associated with faith-based and secular forms of civic engagement among teens (e.g., participation in religious youth groups vs secular organizations such as sports and school clubs, theistic trust vs secular trust) are compared. Results: Among religiosity variables, integration within congregational networks (i.e., worship service attendance) exhibits the most consistent negative association with youth drug use. Theistic trust is not associated with teen drug use, but secular trust and civic participation in secular organizations are associated with less drug use. Conclusions: Elements of both religious and secular social capital are associated with lower reported drug use, thereby suggesting that multiple avenues for the prevention of teen drug use might be pursued. Implications and directions for future research are discussed.

Belcher JR. Protestantism and alcoholism: Spiritual and religious considerations. Alcoholism Treatment Quarterly 24(1/2): 21-32, 2006

This article provides an overview of Protestant perspectives on alcohol use and abuse. It discusses the dissimilar views of alcohol consumption among Protestant denominations. While there is a consensus that abuse of alcohol is morally wrong and spiritually debilitating, some denomination have theological positions that any alcohol use is harmful spiritually and psychologically. Some treatment implications of these positions are discussed.

Benda BB; Pope SK; Kelleher KJ. Church attendance or religiousness: Their relationship to adolescents' use of alcohol, other drugs, and delinquency. Alcoholism Treatment Quarterly 24(1/2): 75-88, 2006

The purpose of the study was to determine if religiousness, instead of church attendance, was related to alcohol consumption, other drug use, and delinquency after considering socio-demographic, familial and peer factors. Many researchers argue that religion only inhibits relative minor, or ascetic, offenses, such as underage consumption of alcohol. They also argue that religion ceases to be related to offenses when more important influences like peer associations are considered. This study consisted of a stratified random sample of 3,551 adolescents, grades seven through nine, from 66 public high schools in a southern state. The findings indicate that religiousness is significantly related to all three offenses studied when other study factors are simultaneously considered, whereas church attendance has a modest relationship to drug use. The treatment implications of these findings are discussed.

Benjamins MR; Buck AC. Religion: A sociocultural predictor of health behaviors in Mexico. Journal of Aging and Health 20(3): 290-305, 2008. (41 refs.)

Objective: Tobacco, alcohol, and physical inactivity are now among the top 10 risk factors for mortality in the Americas region. Subsequently, a more complete understanding of the various cultural factors that influence health behaviors such as these is needed. Method: This study investigates how religion influences the use of alcohol and cigarettes within a large, nationally representative sample of older adults in Mexico (Mexican Health and Aging Study, N = 10,399). Results: Religious salience and participation in religious activities are both significantly associated with smoking status, but not alcohol use. Discussion: This is one of the first studies to examine these associations in a developing country. Despite cultural differences, the negative relationship between religion and smoking in Mexico corresponds to associations seen in the United States and other Western countries. This type of information may be useful to health researchers, providers, and policy makers attempting to reduce deaths due to preventable causes.

Blay SL; Batista AD; Andreoli SB; Gastal FL. The relationship between religiosity and tobacco, alcohol use, and depression in an elderly community population. American Journal of Geriatric Psychiatry 16(11): 934-943, 2008. (40 refs.)

Objective: The objective of this study is to examine the religious characteristics of older subjects and the associations of these characteristics to the use of tobacco, alcohol, and depression. Methods: Data from a multistage random sample were used to examine associations between religiosity and health behaviors (tobacco use, alcohol) and depression among elderly house hold residents aged 60+ in Rio Grande do Sul, Brazil. Survey measures included sociodemographic characteristics, four aspects of religiosity, tobacco use, alcohol abuse and dependence, depression, life style, social context, functional status, and health conditions. Results: After controlling for demographic, social connections, health behavior, functional status, and health conditions, evangelical affiliation reduced the odds of being a current tobacco user by 51%. Those reporting affiliation as Afro-Brazilian and not having a religion had, respectively, a 74% and 124% increased risk. All other religious domains protect against tobacco use. Not having a religion affiliation and the experience of a religious change increased the risk of alcohol misuse by 88% and 31%, respectively. In contrast, orienting-motivating force increased the odds of depression by 38%. Participating in social religious activities had reduced the risk of depression by 16%. Conclusion: Several aspects of religiosity reduced the odds of being a tobacco user. Not having a religion and the experience of a religious change increased the risk of alcohol misuse. However, the domain orienting-motivating force increased the odds, and participating in social religious activities had reduced the risk of a depressive state.

Bradby H. Watch out for the Aunties! Young British Asians' accounts of identity and substance use. Sociology of Health & Illness 29(5): 656-672, 2007. (52 refs.)

This paper considers how young people able to trace their origins from Pakistan or India (henceforth Asians'), discuss their use of, or abstention from, alcohol and tobacco in terms of religious and cultural tradition. The role of religion, ethnicity, gender and generation in the uptake or avoidance of alcohol and tobacco was explored in 19 qualitative group and individual interviews with 47 Asians aged 16-26 years and analysed in terms of pioneering and conservative forms of tradition. Religious proscriptions on alcohol and tobacco were reported to be formally gender blind, but concerns about reputation and future marriage chances, sanctioned by gossip, meant that women's behaviour was consistently more constrained than men's. Muslims' abstinence from alcohol was tightly linked with an Islamic identity in that drinking jeopardised one's claim to being a Muslim, whereas cigarette smoking was tolerated among young men. Sikhs' and Hindus' avoidance of tobacco was strongly sanctioned, but smoking did not strongly jeopardise a religious identity. Sikh men's abstention indicated manly strength central to a devout identity Some experimentation was possible out of view of the older generation, especially the aunties, but the risk of gossip damaging young women's reputations was keenly felt. While damage to women's reputations was hard to undo, men's reputations tarnished by substance use, could be compensated for by their parents' honourable status. Discussion of tradition as innovation was rare and met with resistance. Tradition was largely experienced as a constraint to be circumvented.

Bradby H; Williams R. Is religion or culture the key feature in changes in substance use after leaving school? Young Punjabis and a comparison group in Glasgow. Ethnicity & Health 11(3): 307-324, 2006. (39 refs.)

Aims. To establish levels of use of tobacco, alcohol and illegal drugs among 18 - 20 year old men and women of Asian (Punjabi) and non-Asian origin compared with levels four years earlier and consider the role of religion and culture in abstinent behaviour. Design. Structured self-complete questionnaire used with 94% of pupils with South Asian names recorded by the Greater Glasgow education department in 1991 and a proportionate random sample of pupils in the same years who did not have South Asian names. Followed up in 1996 in an interviewer-led structured questionnaire in their own homes. Setting. Greater Glasgow, largest city in the west of Scotland. Participants. Eight hundred and twenty-four overwhelmingly British-born 14 - 15 year olds in 1992, 492 followed up aged 18 - 20 years in 1996. Measurements. Self-report measures of ever having tried alcohol, tobacco and drugs and the quantities consumed at age 14 - 15 and 18 - 20. Indication of reasons for abstinence from substance use at age 18 - 20. Findings. Asians were much more abstinent from all these substances at both ages (p < 0.001), except for smoking at 18 - 20. However, religiously specific patterns of abstinence were particularly strong for alcohol (Muslim odds ratio 7- to 9-fold lower at 14 - 15, 16- to 25-fold lower at 18 - 20) and smoking (Sikh/Hindu odds ratio 10-fold lower than Muslims, 20-fold than Christians at 18 - 20), though there is a shared Asian tendency for women to observe these patterns more than men at 18 - 20. Conclusions. At age 14 - 15 abstinence was high in the largely British-born generation of Asians mainly for cultural reasons common to religious groups. Four years later culturally determined abstinence has atrophied, and abstinence reflects the specific influence of ascetic religious traditions, though some cultural influence remains in that women are more affected. Intergenerational changes are similar. The erosion of constraints on smoking presents a threat to health.

Brechting EH; Giancola PR. A longitudinal study of coping strategies and substance use in adolescent boys. Journal of Child & Adolescent Substance Abuse 16(2): 51-67, 2006. (45 refs.)

The authors examined the extent to which religious coping predicted subsequent drug use in adolescent boys. Three hundred and twenty-six adolescent boys completed the Willy Coping Questionnaire (Wills, 1985) as well as a number of drug use inventories. Results showed that religious coping, measured at 12-14 years of age, predicted a significant reduction in number of drugs used, frequency of drug use, and problems associated with drug use measured at 15-16 years of age. These results were maintained even when controlling for age and other key coping variables. These findings may have implications for treatment and prevention efforts, specifically for populations who are amenable to "spiritual" interventions.

Brown AE; Whitney SN; Schneider MA; Vega CP. Alcohol recovery and spirituality: Strangers, friends, or partners? Southern Medical Journal 99(6): 654-657, 2006. (29 refs.)

Alcoholics Anonymous, with its steady but nonspecific promotion of belief in a higher power and its emphasis on the group process, long held a near-monopoly in the outpatient alcohol recovery field, but its hegemony has now been challenged by two very different perspectives. The first is a nonspiritual approach that emphasizes the individual's capability to find a personal pathway to sobriety, exemplified by Rational Recovery. The second is a faith-based method, built on a religious understanding of alcoholism, of which Celebrate Recovery is a prominent example, based upon Christianity. Most communities offer a variety of approaches, so clinicians who are aware of these differences are in a good position to help patients make intelligent choices among the competing recovery philosophies.

Brown DR; Scott W; Krim S; Blount J; Roman D; Brown D. Black churches in substance use and abuse prevention efforts. Journal of Alcohol and Drug Education 50(2): 43-65, 2006. (15 refs.)

In light of their historical role in African American communities, faith-based organizations are uniquely positioned to offer substance use prevention programs to urban African American youth. This article describes the efforts of a university-based program to provide training and technical assistance to faith-based organizations in the development and implementation of substance use prevention activities. Occurring over a three-year period, the activities were assessed using both qualitative and quantitative approaches. Results indicate that one-third of the faith-based participants had successfully implemented a substance use prevention program," another third were in the process of developing a program," and the final third had not begun to do so. Key characteristics associated with successful program development and implementation are discussed along with recommendations for future community efforts.

Brown EJ. The integral place of religion in the lives of rural African-American women who use cocaine. Journal of Religion & Health 45(1): 19-39, 2006. (35 refs.)

To understand the culture of rural African-American women who use cocaine, ethnographic research was conducted in rural North Central Florida using in-depth interviews and participant observations with 30 respondents. Fourteen major themes emerged from the data; however, this paper focuses on one theme, that of religion. Nine sub-themes about religion and spirituality emerged. Religion was viewed as a personal relationship with God, which is not dependent on socializing with other church members, but was helpful in sustaining the respondents. While religiosity was a stable and consistent place in the respondents' lives and some relied on their faith in God to replace their addiction, faith was not uniformly utilized by all respondents in this manner. Religiosity among African-American women who use cocaine cannot solely overcome the lack of drug treatment or treatment options and the stigma associated with drug use although it may be a resiliency factor, which warrants promoting.

Carrico AW; Gifford EV; Moos RH. Spirituality/religiosity promotes acceptance-based responding and 12-step involvement. Drug and Alcohol Dependence 89(1): 66-73, 2007. (57 refs.)

Background: Previous investigations have observed that spirituality/religiosity (SIR) is associated with enhanced 12-step involvement. However, relatively few studies have attempted to examine the mechanisms for this effect. For the present investigation, we examined whether acceptance-based responding (ABR) - awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses - accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode. Methods: Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline. Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time. Results: In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up. However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR. In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement. Conclusions: S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement.

Chawla N; Neighbors C; Lewis MA; Lee CM; Larimer ME. Attitudes and perceived approval of drinking as mediators of the relationship between the importance of religion and alcohol use. Journal of Studies on Alcohol and Drugs 68(3): 410-418, 2007. (80 refs.)

Objective: Previous research has consistently demonstrated that religiosity and personal importance of religion are associated with lower levels of alcohol use among both adolescents and college students. Although a number of different mechanisms have been proposed to account for this, few studies have empirically examined potential mediators of this relationship. Given the extensive literature on the impact of social norms on the drinking behavior of college students, the present study evaluates the role of perceived drinking norms as a mediator of the relationship between the importance of religion and alcohol use. Specifically, we examined both personal attitudes and perceived injunctive norms with regard to reference groups that vary in their proximity to students (i.e., close friends and typical college students). Method: Participants were 1,400 undergraduate students (60.6% women) who were assessed using self-report measures of alcohol consumption, importance of religion, attitudes, and perceived norms. Results: Results indicated that, consistent with the hypotheses, personal attitudes were the strongest mediator of the relationship between importance of religion and alcohol use, followed by the approval of close friends, and, to a lesser extent, the approval of typical college students. Conclusions: These findings suggest that importance of religion may have an indirect effect on alcohol use via personal attitudes and the perceived approval or disapproval of important others, and this relationship varies as a function of reference group. Implications for interventions that incorporate information on social norms are discussed.

Cheng TC; McElderry CG. How do drug use and social relations affect welfare participation? Social Service Review 81(1): 155-165, 2007. (17 refs.)

This study analyzes whether welfare use is longitudinally related to drug use and various measures of social relations. It conducts secondary analyses on data from a sample of 382 women. The data, which stem from the National Longitudinal Survey of Youth, were gathered between 1984 and 2002. The results suggest that use of marijuana or cocaine does not affect women's welfare participation to a statistically significant degree. Attending religious services and receiving low levels of child support are associated with statistically significant declines in welfare participation. Changes in marital status are linked to increases in welfare participation.

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.

Chitwood DD; Weiss ML; Leukefeld CG. A systematic review of recent literature on religiosity and substance use. (review). Journal of Drug Issues 38(3): 653-688, 2008. (128 refs.)

This paper contains a systematic review of articles about the relationship between religiosity/spirituality and alcohol and drug use that were published between 1997 and 2006. Summaries of methodological characteristics (e.g., study design, sample size and composition, specific dimensions of religiosity, and substances investigated) and general findings of 105 studies provide an overview of the field. The association between religiosity/spirituality and reduced risk of substance use is well established, but a well defined body of knowledge on this relationship has been slow to emerge. The development of more sophisticated instrumentation to measure religiosity and spirituality, the investigation of samples that include users of major drugs of abuse, and the integration of the study of religion and drug use into the broader literature on religion and health can help the field build upon the considerable work that has been published.

Chu DC. Religiosity and desistance from drug use. Criminal Justice System 34(5): 661-679, 2007. (79 refs.)

Recent research acknowledges an inverse relationship between religiosity and crime (though some claim it is a modest one), but no desistance theories to date include religiosity in their model to help explain desistance from drug use. A better understanding of how religiosity is related to the initiation of and desistance from drug use can lead to more effective preventive and rehabilitative interventions. Data derived from Wave 5 to Wave 7 of the National Youth Survey are employed to test whether religiosity exerts an effect on initiation of and desistance from drug use. The findings suggest religious behavior has a direct effect on individuals' desistance from marijuana and hard-drug use. On the other hand, religious salience has a significant deterrent effect only on the onset of drug use; it does not have a significant effect on individuals' desistance from drugs. Policy implications are discussed, and future research suggestions are offered.

Collins MA. Religiousness and spirituality as possible recovery variables in treated and natural recoveries: A qualitative study. Alcoholism Treatment Quarterly 24(4): 119-135, 2006

Treatment and natural recovered (TR/NR), current alcohol dependent (CAD), and non-alcohol-dependent (NAD) individuals were compared on the Brief Multidimensional Measure of Religiousness and Spirituality (Idler et al., 2003). For convenience, participants were sampled from the Greater Toronto Area for the retrospective study. The TR/NAD groups had higher overall spirituality levels including the domains of private religious practices and daily spiritual experiences than the NR/CAD groups. The TR, NR, and NAD groups had higher levels of the religiousness domain of religious commitment, and higher levels of the spirituality domains of values/beliefs and forgiveness than the CAD group. Fifty percent of the TR and 25% of the NR groups considered spirituality important for maintenance of recovery, even though the latter group had low levels of the construct.

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.

Conners NA; Whiteside-Mansell L; Sherman AC. Dimensions of religious involvement and mental health outcomes among alcohol- and drug-dependent women. Alcoholism Treatment Quarterly 24(1/2): 89-108, 2006

The current study examined ties between religious variables and mental health in a high-risk population: lower-income chemically dependent pregnant or parenting women participating in a residential treatment program. The primary goal of the study was to investigate the relationship between various facets of religiousness and mental health symptoms, including depression and post-traumatic stress. Negative religious coping was associated with greater PTSD symptoms, greater depressive symptoms, and greater syndromal depression after controlling for background demographic and addiction variables. Other aspects of religiousness, including positive coping and involvement with organized religion, were not associated with mental health outcomes. These results suggest that negative aspects of religiousness, particularly religious struggle, merit greater attention from clinicians and investigators.

Cook CCH. Alcohol, Addiction and Christian Ethics. Cambridge: Cambridge University Press, 2006

Addictive disorders are characterised by a division of the will, in which the addict is attracted both by a desire to continue the addictive behaviour and also by a desire to stop it. Academic perspectives on this predicament usually come from clinical and scientific standpoints, with the 'moral model' rejected as outmoded. But Christian theology has a long history of thinking and writing on such problems. The author reviews reviews Christian theological and ethical reflection upon the problems of alcohol use and misuse, from biblical times until the present day. Drawing particularly upon the writings of St. Paul the Apostle and Augustine of Hippo, a critical theological model of addiction is developed. Alcohol dependence is also viewed in the broader ethical perspectives related not only to consumption, but also production, marketing, and distribution.

Cook CCH. Alcohol, Addiction and Christian Ethics. Cambridge: Cambridge University Press, 2006. (Chapter refs.)

The Bible relates that Jesus instructed his disciples to drink wine in memory of him. Some Christians therefore see alcohol as a 'good creature of God', as the Puritan Increase Mather put it. Yet other key Christian writings portray drunkenness as a facilitator of all manner of sin, and emphasize that Christians must forego certain pleasures, even if they can handle them personally, for the sake of those who cannot. This volume traces how Christian thought has evolved and influenced the views of alcohol use, alcoholism and alcohol policy. The author, an Anglican priest, a psychiatrist and addiction specialist, begins this history of Christian views on alcohol with Augustine of Hippo, who initiated a stream of Christian thought that has been influential for over 15 centuries. To Augustine, self-indulgent drunkenness, rather than drinking or alcohol per se, was to be deplored because it separated the drinker from God. In Augustine's view (which, although Cook does not say so explicitly, parallels some ideas of Alcoholics Anonymous), God has the power to free a drunkard from the compulsion to drink, but only if the drunkard humbly asks for grace. These views are compared to other influential theologians, such as Thomas Aquinas and Martin Luther) These different perspectives are used to interpreted the same Biblical account, that of Lot's drunken incest with his daughters. There is also discussion of the anti-alcohol views which arose in the 19th century temperance movement. It is suggested that within the 19th century temperance movement, Biblical interpretation often followed current opinion more than guided it. The book concludes with discussion of the important role that Christianity has to play in alcohol treatment and policy, and efforts are made to distinguish what is proposed from the "moral model." Anticipating the most probable criticism of this position, Cook adroitly differentiates Christian understandings of alcoholism from the moral model. Cook's Christian conception of the struggle against the desire to drink as simply one instance of the universal struggle of all people.

Degenhardt L; Chiu WT; Sampson N; Kessler RC; Anthony JC. Epidemiological patterns of extra-medical drug use in the United States: Evidence from the National Comorbidity Survey Replication, 2001-2003. Drug and Alcohol Dependence 90(2/3): 210-223, 2007. (35 refs.)

Background: In 1994, epidemiological patterns of extra-medical drug use in the United States were estimated from the National Comorbidity Survey. This paper describes such patterns based upon more recent data from the National Comorbidity Survey Replication (NCS-R). Methods: The NCS-R was a nationally representative face-to-face household survey of 9282 English-speaking respondents, aging 18 years and older, conducted in 2001-2003 using a fully structured diagnostic interview, the WHO Composite International Diagnostic Interview (CIDI) Version 3.0. Results: The estimated cumulative incidence of alcohol use in the NCS-R was 92%; tobacco, 74%; extra-medical use of other psychoactive drugs, 45%; cannabis, 43% and cocaine, 16%. Statistically robust associations existed between all types of drug use and age, sex, income, employment, education, marital status, geography, religious affiliation and religiosity. Very robust birth cohort differences were observed for cocaine, cannabis, and other extra-medical drug use, but not for alcohol or tobacco. Trends in the estimated cumulative incidence of drug use among young people across time suggested clear periods of fluctuating risk. Conclusions: These epidemiological patterns of alcohol, tobacco, and other extra-medical drug use in the United States in the early 21st century provide an update of NCS estimates from roughly 10 years ago, and are consistent with contemporaneous epidemiological studies. New findings on religion and religiosity, and exploratory data on time trends, represent progress in both concepts and methodology for such research. These estimates lead to no firm causal inferences, but contribute to a descriptive epidemiological foundation for future research on drug use and dependence across recent decades, birth cohorts, and population subgroups.

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.

Dotinga A; van den Eijnden RJJM; Bosveld W; Garretsen HFL. Religious, cultural and social cognitive correlates of alcohol use among Turks and Moroccans in The Netherlands. Addiction Research & Theory 14(4): 413-431, 2006. (44 refs.)

This study examined religious, cultural and social cognitive predictors of alcohol use among second-generation Turks and Moroccans in The Netherlands. Data were obtained from an experimental study in which 189 Turks and 166 Moroccans responded to a mailed questionnaire and 111 Turks and 116 Moroccans responded to a face-to-face interview. Logistic and linear regression models examined religious, cultural and social cognitive correlates of alcohol use, adjusting for data collection mode and relevant sociodemographic factors. Additional regression models examined interaction effects with ethnicity. Both religious (practising Islam and having traditional religious beliefs) and cultural factors (not feeling accepted in Dutch society) were related to drinking. However, data seem to indicate that social cognitive factors i.e. the influence of family members and Turkish/Moroccan friends (both their drinking behaviour and their opinions about alcohol use) and alcohol expectancies were more important in predicting alcohol use among second-generation Turks and Moroccans.

Dulin PL; Hill RD; Ellingson K. Relationships among religious factors, social support and alcohol abuse in a western U.S. college student sample. Journal of Alcohol and Drug Education 50(1): 5-14, 2006. (11 refs.)

This study examined the relationship between college student alcohol consumption and self-reported level of religious activity. The level of religious activity accounted for most of the variance in alcohol abuse, 16%. It was more determinative of alcohol abuse (defined by a questionnaire drawing upon DSM-IV diagnostic criteria) than levels of social support, or grade point average. Of note is that students reporting the highest levels of religious activity were members of the Church of Latter-Day Saints, which prohibits alcohol use, the religious group of the majority of students at the University.

Duvall JL; Staton-Tindall M; Leukefeld C. Persistence in turning to faith as a predictor of drug use and ciriminality among drug court clients. Journal of Drug Issues 38(3): 911-928, 2008. (49 refs.)

Faith-based beliefs are associated with and considered to be a vital component in enhancing the efficacy of substance abuse treatment and recovery. However, relatively little empirical information has been accumulated on the temporal stability of individuals' use of faith and its importance before and following initiation of the therapeutic process. The current study examined persistence in turning to faith across time as a predictor of substance use, criminal behavior, and perceived addiction severity in a sample of 500 Kentucky Drug Court participants. Results suggest that when modeling variance in faith, which persists across the two-year span of Drug Court involvement as a latent construct, greater persistence in one's faith predicts decreases in substance use frequency measured at the final 24-month interview. The latent faith construct was marginally related to differences in 24-month criminal behavior and was not associated with perceptions of addiction severity. Results are discussed for substance abuse treatment needs and recovery.

Ellison CG; Bradshaw M; Rote S; Storch J; Trevino M. Religion and alcohol use among college students: Expoloring the role of domain-specific religious salience. Journal of Drug Issues 38(3): 821-846, 2008. (53 refs.)

A growing body of work examines links between religious involvement and alcohol use patterns. Most studies in this vein have relied upon generic measures of religion such as affiliation, service attendance, or overall salience. This study contributes to the literature by developing refined measures of domain-specific religious salience, and exploring their links with the frequency of alcohol use in a diverse sample of college students. Results confirm the importance of domain-specific religious salience in shaping alcohol choices, but at the same time, also show that overall levels of such salience in this sample are relatively low, indicating that other influences (e.g., peers, parents) are also important. The effects of other religious variables (e.g., religious tradition, attendance, prayer) on drinking frequency are largely indirect, serving primarily to heighten the salience of religious convictions in the domain of alcohol behavior. Implications, study limitations, and directions for future research are discussed.

Felt JN; Mcbride DC; Helm HW. Alcohol, tobacco, and marijuana use within a religious affiliated university. Journal of Drug Issues 38(3): 799-820, 2008. (37 refs.)

This study examines the prevalence of alcohol, tobacco, and marijuana use within a religiously affiliated, conservative Christian university to assess whether risk and protective factors for substance use, which have been found to function in general society, also apply within a unique context which prohibits use and has overall lower prevalence rates. Variables examined included perception of normative use, personal religious behaviors, and need for adult approval. Self-reported substance use was low, while perception of normative use was high. Perception of use was positively related to self-reported use while personal religiosity and need for adult approval were Inversely related to use. These data suggest that these risk and protective factors apply not only within general populations, but also within a specific subcultural context, supporting the importance of these models in a religious college context in understanding substance use patterns, variables related to those patterns, and possible prevention programs.

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.

Furst PT. Rock Crystals and Peyote Dreams: Explorations in the Huichol Universe. Salt Lake City: University of Utah Press, 2008

The Huichol people live in west Mexico's Sierra Madre Occidental. The most authentically "traditional" of all Mexican Indians, they have recently become famous for their vivid yarn paintings, their sacramental use of hallucinogenic cactus, and the peyote pilgrimages that take them three hundred miles east from their present homeland into the north-central desert. This collection of essays by one of the foremost experts on hallucinogen-induced vision seeking by Native Americans, explores aspects of the life and culture of the Huichol Indians of Mexico. The author, an anthropologist, weaves personal reminiscences of his early days among the Huichol with discussion of their pre-conquest history and post-conquest adaptation to Mexican society, and with a lively account of the famous pilgrimages Huichols make in search of peyote in distant deserts. The book discusses ritual and shamanism, concepts of soul, beliefs concerning the origins of the world, drawing upon a wealth of finely translated, analyzed myths and narratives, and texts from interviews he conducted with renowned shamans.

Gable RS. Risk assessment of ritual use of oral dimethyltryptamine (DMT) and harmala alkaloids. (review). Addiction 102(1): 24-34, 2007. (76 refs.)

To extend previous reviews by assessing the acute systemic toxicity and psychological hazards of a dimethyltryptamine and beta-carboline brew (ayahuasca/hoasca) used in religious ceremonies. A systematic literature search, supplemented by interviews with ceremony participants. No laboratory animal models were located that tested the acute toxicity or the abuse potential of ayahuasca. Separate animal studies of the median lethal dose of dimethyltryptamine (DMT) and of several harmala alkaloids indicated that a lethal dose of these substances in humans is probably greater than 20 times the typical ceremonial dose. Adverse health effects may occur from casual use of ayahuasca, particularly when serotonergic substances are used in conjunction. DMT is capable of inducing aversive psychological reactions or transient psychotic episodes that resolve spontaneously in a few hours. There was no evidence that ayahuasca has substantial or persistent abuse potential. Long-term psychological benefits have been documented when ayahuasca is used in a well-established social context. A decoction of DMT and harmala alkaloids used in religious ceremonies has a safety margin comparable to codeine, mescaline or methadone. The dependence potential of oral DMT and the risk of sustained psychological disturbance are minimal.

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.

Gilman SL. Alcohol and the Jews (again), race and medicine (again): On race and medicine in historical perspective. Patterns of Prejudice 40(4-5): 335-352, 2006. (29 refs.)

The question of why or whether Jews have a resistance to alcoholism is now the subject of genetic research. Parallel to investigations into such perceived resistance in other groups (such as 'Asians'), the recent work makes global claims that can be shown to have very specific social and historical origins. The accusation that the Jews abused alcohol was rebutted in the eighteenth century as Jews entered into the German-speaking public sphere. The key to such access was adherence to rules of 'decorum', and the public consumption of alcohol was central to this project.

Gnadt B. Religiousness, current substance use, and early risk indicators for substance abuse in nursing students. Journal of Addictions Nursing 17(3): 151-158, 2006. (41 refs.)

Nursing students have been targeted by the American Nurses' Association (ANA) for efforts focused on the prevention of substance abuse. This study surveyed 241 nursing students enrolled in their first year of nursing courses at seven faith-based colleges and universities. The purposes were to investigate the prevalence of current substance use and the number of early risk indicators for substance abuse and dependence among nursing students, and to examine the relationships among religiousness, current substance use, and early risk indicators for substance abuse. Efinger's Alcohol Risk Survey, the CAGE Questionnaire, and the Intrinsic/Extrinsic Revised Scale were used to collect data. Twenty-four percent of respondents reported current substance use, 15% scored in the probable abuse/dependence category: those who were more religious tended to have lower prevalence rates of substance use as well as fewer numbers of early risk indicators.

Grehan J. Smoking and "early modern" sociability: The great tobacco debate in the Ottoman Middle East (seventeenth to eighteenth centuries). American Historical Review 111(5): 1352-1377, 2006. (99 refs.)

Walking around Middle Eastern towns today, it is difficult to imagine that tobacco was once a matter of controversy. Upon its first arrival in the Ottoman Middle East at the end of the sixteenth century, tobacco ignited intense debates about its legality and morality. Why? As contemporaries could not have fully realized, the spread of smoking was a major cultural watershed that was both profoundly liberating and unsettling. It helped to accelerate cultural transformations. Of concern were its hedonistic overtones. In the long term, smoking would help to redefine patterns of social interaction, promoting more relaxed attitudes about pleasure and opening up new avenues for leisure and escapism. In coming to grips with these seductions, the Ottoman Middle East would acquire some of the most salient characteristics of an "early modern" culture. One likely catalyst was the worldwide diffusion of new commodities that, winning almost instant favor, would later be integral to the creation of a modern consumer culture. This history of early modern consumption is still being reconstructed, but what seems certain is that throughout much of Eurasia growing numbers of consumers were indulging a taste for entirely new luxuries. In the Middle East, as in Europe, tobacco first attracted interest among physicians, and was appearing in medical manuals by the last years of the sixteenth century. Ottoman physicians were soon applying packs and poultices of tobacco leaves for ailments such as bites and burns. In tribute to its emetic properties, they even recommended drafts of tobacco juice as an antidote for poisons or prescribed it as an abortifacient. The jump to recreational smoking took place very quickly. By the first decades of the seventeenth century, tobacco was being smoked openly in "gathering places of the people, like the markets and streets." By 1700, the Ottoman market was producing most of its own tobacco, so, the price of tobacco steadily declined. One of the great difficulties concerning tobacco, carried over from the earlier wrangling about coffee, was that jurists could not count on any explicit guidance from scriptural sources. One common strategy was to argue by analogy, casting tobacco as an intoxicant and equating it with wine, which the Qur'an unequivocally banned. Some classified tobacco as a source of "fatigue" that perceptibly undermined physical vigor. Others focused on the foul odor that it left on the breath. Emotions ran highest in discussions of tobacco's immorality. Some viewed tobacco as deeply menacing to spirit and character. Fearful critics saw smoking as an inducement to idleness and profligacy. In exposing the evils of smoking, the most persistent critics pointed to the connection with Christian Europe. Some saw tobacco as a Christian plot against Islam. It was even suggested that as an import there were endless opportunities for mischief. It was suggested bales of tobacco were being soaked in wine or pig lard, to violate Muslim taboos against alcohol and pork and left believers in a state of ritual impurity.

Gureje O; Degenhardt L; Olley B; Uwakwe R; Udofia O; Wakil A et al. A descriptive epidemiology of substance use and substance use disorders in Nigeria during the early 21st century. Drug and Alcohol Dependence 91(1): 1-9, 2007. (30 refs.)

Background: Several studies have examined the use of psychoactive substances among selected groups in Nigeria. Here, we extend the description to include the features of substance dependence. Method: A stratified multi-stage random sampling of households was used to select respondents in 21 of Nigeria's 36 states (representing 57% of the national population). In-person interviews with 6752 adults were conducted using the World Health Organization Composite International Diagnostic Interview, Version 3. Lifetime history and recent (past year) use, as well as features of dependence on, alcohol, tobacco, cannabis, sedatives, stimulants, and other drugs were assessed. Results: Alcohol was the most commonly used substance, with 56% (95% confidence interval, CI = 54, 58%) ever users and 14% (95% CI = 13, 15%) recent (past year) users. Roughly 3% were recent smokers (3%, 95% Cl = 2.6, 4.2%). Next most common were sedatives, 4% (95% CI = 2.3, 4.5%), and cannabis smokers, 0.4% (95% CI = 0.1, 0.6%). Males were more likely than females to be users of every drug group investigated, with male preponderance being particularly marked for cannabis. Prevalence of both alcohol and tobacco use was highest among middle aged adults. Moslems were much less likely to use alcohol than persons of other faiths, but no such association was found for tobacco, non-prescription drug use, or illegal drug use. Features of abuse and dependence were more common at the population level for alcohol; but among users, these features were just as likely to be experienced by alcohol users as they were by other drug users. Conclusion: Alcohol is the most commonly used psychoactive drug in Nigeria. Features associated with drug dependence and abuse are less prevalent but may require attention by public health authorities.

Hill TD; McCullough ME. Religious involvement and the intoxication trajectories of low income urban women. Journal of Drug Issues 38(3): 847-862, 2008. (39 refs.)

Although prior research has made significant contributions to our understanding of the risk factors associated with increased alcohol consumption in disadvantaged urban neighborhoods, very little is known about the resources that help residents to resist the countless circumstances and conditions that sustain these systems of alcohol abuse. Building on prior research, we use data from the Welfare, Children, and Families project, a probability sample of 2,402 lowincome women with children living in low income neighborhoods in Boston, Chicago, and San Antonio, to test whether religious involvement is protective against intoxication. Results obtained from ordered logistic regression models indicate that regular religious attendance is associated with lower levels of intoxication over two years.

Hodge DR; Andereck K; Montoya H. Spiritual/religious life-style profiles and community substance abuse perceptions: An exploratory study among a predominantly Hispanic sample in the American southwest. Journal of Social Service Research 34(1): 43-54, 2007. (44 refs.)

This study explored the relationship between various spiritual/religious life-style profiles and community trends in the areas of: alcohol and other drug abuse, physical safety, and in the community or neighborhood as a whole. A cluster analysis yielded three spiritual/religious life-style profiles among the predominantly Hispanic sample (N = 249): spiritual and religious, neither spiritual nor religious, and spiritual but not religious. The latter profile was associated with the most optimistic perceptions regarding community trends. In other words, respondents in the spiritual but not religious life-style profile perceived the community to be trending more positively in the four areas surveyed, relative to the other two profiles. Some tentative implications are drawn from the findings and the manuscript concludes by offering suggestions for future research.

Hodge DR; Andereck K; Montoya H. The protective influence of spiritual-religious lifestyle profiles on tobacco use, alcohol use, and gambling. Social Work Research 31(4): 211-219, 2007. (53 refs.)

The costs associated with the use of addictive substances and practices underscore the need for research on protective factors that inhibit use. In this study, the protective influences of various spiritual-religious lifestyle profiles on tobacco smoking, alcohol use, and gambling frequency and expenditures are examined. Among the predominantly Hispanic sample used in the study (N = 249), cluster analysis produced three lifestyle profiles: neither spiritual nor religious, spiritual and religious, and spiritual but not religious. Of these three, the spiritual and religious lifestyle profile exhibited the strongest protective influence across all four dependent measures. Although the exploratory nature of the study precludes definitive recommendations, a number of tentative implications from the findings are drawn.

Holt JB; Miller JW; Naimi TS; Sui DZ. Religious affiliation and alcohol consumption in the United States. Geographical Review 96(4): 523-542, 2006. (68 refs.)

Levels of alcohol consumption are a major public health issue. This study aims to gain a better understanding of how geographical patterns of religious affiliation in the United States relate to geographical patterns of alcohol consumption. We explored state-level correlations between alcohol consumption and religious adherence. Although we found no statistically significant correlation between overall religious adherence rates and current or binge drinking rates, states with higher adherence rates were significantly more likely to have high proportions of binge drinking among current drinkers. Yet, regionally, we found a strong inverse correlation in the Southeast and a strong positive correlation in the Midwest and Northeast between adherence rates and current and binge drinking rates. These geographical differences were largely explained after stratifying by major religious denominational groupings. States with high Catholic adherence rates tended to have higher drinking rates, whereas states with high Evangelical Protestant adherence rates tended to have lower drinking rates. These findings suggest that the relationship between religion and alcohol may be denomination-specific and challenge the lay perception that religious adherence per se is associated with less alcohol consumption and less excessive drinking among those who drink.

Holt MP, ed. Alcohol: A Social and Cultural History. Gordonsville VA: Berg Publishers, 2006. (Chapter refs.)

This edited volume deals with an array of topics that shed light on the social and cultural history surrounding alcohol. With 13 chapters it is organized into three sections. Alcohol has long played an important role in societies throughout history, and understanding its consumption can reveal a great deal about a culture. It examines how drink has evolved in its functions and uses from the late Middle Ages to the present day in the West. This book discusses a range of issues, including domestic versus recreational use, the history of understanding of alcoholism, and the relationship between alcohol and violence, religion, sexuality, and medicine. It looks at how alcohol sheds light on issue of class, gender and place. Drawing on examples from Europe, North America and Australia, this book provides an overview of the many roles alcohol has played over the past five centuries.

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.

Jenkins M; Moore B; Lambert E; Clarke A. DUI treatment programs and religious freedom: Does Cutter v. Wilkinson change the analysis? University of Maryland Law Journal of Race, Religion, Gender and Class 5(Fall): 351-384, 2005. (190 legal refs.)

SUMMARY: ... Legal commentators and scholars consistently argue that a compulsory mandate to attend Alcoholics Anonymous (A.A.), either as a condition of probation or as an inmate, violates the First Amendment. ... There exists a need to reevaluate A.A. as a condition of probation, in order to rehabilitate the offender and to free society from the dangers posed by alcohol-related driving incidents. ... Three years after Boerne, Congress, in yet another attempt to reassert the "compelling interest test' and the "least restrictive means" test, passed the Religious Land Use and Institutionalized Persons Act (RLUIPA). ... RLUIPA may impose burdens on prison administrators as they act to accommodate an inmate's right to free exercise. ... " Although deference to prison and probation authorities has been a consistent theme with the Court, it serves here as a warning not to read RLUIPA's compelling interest and least restrictive means tests too rigorously. ... And, coming closer to home, a parole officer could not recommend to a parolee who had a serious drinking problem that he enroll in Alcoholics Anonymous, even if the officer believed that this was the only alcoholic-treatment program that would keep the parolee from committing further crimes. ... If the state's purpose is to eradicate alcoholism and its harmful effects on society, the line should be drawn closer to society, requiring A.A. attendance for assistance to the alcohol-related offenders. ...

Johnson TJ; Sheets VL; Kristeller JL. Identifying mediators of the relationship between religiousness/spirituality and alcohol. Journal of Studies on Alcohol and Drugs 69(1): 160-170, 2008. (87 refs.)

Objective: Religiousness is known to be inversely related to alcohol use and problems, but few studies have attempted to identify mediators of this relationship. We examined beliefs about alcohol, social influences, well-being, and motives for drinking as potential mediators of the relationship between religiousness/spirituality and alcohol use and problems. Method: Participants were 315 female and 197 male college students who responded to a survey sent to a stratified (by gender and year in school) random sample. We used path analysis to test models specifying hypothesized mediators of the relationship between several religious/spiritual constructs (identified via factor analysis in previous studies) and alcohol use and problems. Models were tested in the full sample and a subsample consisting of alcohol users only. Results: The effect of religious/spiritual involvement on alcohol use was mediated by negative beliefs about alcohol, social influences, and spiritual well-being. The effect of religious struggle on alcohol problems was mediated by spiritual well-being. Search for meaning had both direct and indirect (via negative beliefs about alcohol) effects on use and problems. Negative beliefs about alcohol and social influences were related to alcohol use via enhancement motives and, in some models, social motives for drinking. Spiritual well-being was related to alcohol problems via coping motives. Social influences also had direct effects on alcohol use. Conclusions: Although future studies using longitudinal designs are needed the study identified several plausible mechanisms by which religiousness/spirituality could causally impact alcohol use and problems. Results also provide further support for the motivational model of alcohol use.

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.

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.

Kerr-Correa F; Igami TZ; Hiroce V; Tucci AM. Patterns of alcohol use between genders: A cross-cultural evaluation. (review). Journal of Affective Disorders 102(1-3): 265-275, 2007. (101 refs.)

Introduction: Alcohol use by men and women is very much influenced by social habits and customs. Cultural peculiarities and biological differences between the sexes require more focused and standardized studies. The objective was to systematize information on patterns of alcohol use between the sexes. Method: A literary review (1972-2004) identified 96 publications (Lilacs, Scielo, Medline) and some related books. Results and conclusions: Men drank more and presented more problems (legal, family, social, clinical, traumas and mortality) associated with alcohol use; the consequences of alcohol use in developing countries with low death rates is even higher. Women can face more discrimination by using alcohol as well as worse health problems when they abuse drinking (liver, pancreas, and central and peripheral nervous system problems, psychiatric comorbidity, etc.); sexual abuse is more commonly associated with women than discussing the different responses to treatment. As for social roles/responsibilities exercised by women, there are indications that marriage, employment, and children have a good influence, discouraging alcohol use, while divorce, unemployment, and no children contribute to higher consumption. For both sexes, religion was a protective factor for alcohol use; acculturation was a strong influence in the pattern of alcohol use, and alcohol worsened the evolution of existing psychiatric disorders.

Klein H; Elifson KW; Sterk CE. The relationship between religiosity and drug use among "at risk" women. Journal of Religion and Health 45(1): 40-56, 2006. (52 refs.)

This study focuses on the interplay between religiosity and drug use in a sample of 250 adult women from the Atlanta, Georgia metropolitan area who were interviewed between August 1997 and August 2000. The research addresses two principal questions: (1) Is there a relationship between the level of religiosity and the amount of illegal drug use reported? (2) If so, is this relationship maintained in multivariate analysis when the eects of other potentially relevant factors like demographic characteristics, childhood maltreatment experiences, psychosocial traits, and substance user-related measures are taken into account? We found that religiosity is related to the amount of drugs women used. Four variables were retained in the final multivariate drug use prediction model: religiosity, coping with everyday stresses, number of family members who are substance abusers, and amount of oral sex. Greater amounts of drugs were used by women who were less religious, less capable of coping with stress, had more drug-abusing family members, and reported having more oral sex. Together, these items explained nearly one-fifth of the variance in the dependent variable. The implications for substance abuse prevention and intervention efforts are discussed.

Kliewer W; Murrelle L. Risk and protective factors for adolescent substance use: Findings from a study in selected Central American countries. Journal of Adolescent Health 40(5): 448-455, 2007. (25 refs.)

Purpose: To identify the prevalence of substance use and problems with use, and risk and protective factors at different levels of the adolescent's ecology associated with substance use among adolescents in selected Central American countries. Methods: Results of a survey of 17,215 students from Panama, Costa Rica, and Guatemala conducted in 2000-2001 served as the basis for the analyses. Lifetime use of alcohol, tobacco, marijuana, and five other drugs (inhalants, tranquilizers, cocaine, crack, and ecstasy), and problems with drugs and alcohol were the outcome variables. Risk factors included dysregulation, family problems with drugs/alcohol, negative family interactions, school disengagement, peer deviance, and exposure to community violence. Protective factors included a personal belief in God, positive family interactions, parent religiosity, and positive student-teacher interaction. Both hierarchical linear regression and logistic regression analyses were used to model main and interaction effects of risk and protective factors. Results: There was a linear association between number of risk and protective factors and substance use, however, risk factors were more strongly associated with substance use than were protective factors. There were significant risk-by-protective-factor interactions for alcohol and marijuana use, and for problems with drugs and alcohol. Risk interacted most consistently with a personal belief in God, but also with parent religiosity and with student-teacher communication. Conclusions: It is important to consider risk and protective factors at different levels of an adolescent's ecology. Prevention and intervention efforts should focus on interactions adolescents have in different microsystems (e.g., with parents, teachers, and peers).

Knight JR; Sherritt L; Harris SK; Holder DW; Kulig J; Shrier LA et al. Alcohol use and religiousness/spirituality among adolescents. Southern Medical Journal 100(4): 349-355, 2007. (37 refs.)

Background: Previous studies indicate that religiousness is associated with lower levels of substance use among adolescents, but less is known about the relationship between spirituality and substance use. The objective of this study was to determine the association between adolescents' use of alcohol and specific aspects of religiousness and spirituality. Methods: Twelve- to 18-year-old patients coming for routine medical care at three primary care sites completed a modified Brief Multidimensional Measure of Religiousness/Spirituality; the Spiritual Connectedness Scale; and a past-90-days alcohol use Timeline Followback calendar. We used multiple logistic regression analysis to assess the association between each religiousness/spirituality measure and odds of any past-90-days alcohol use, controlling for age, gender, race/ethnicity, and clinic site. Timeline Followback data were dichotomized to indicate any past-90-days alcohol use and religiousness/spirituality scale scores were z-transfonned for analysis. Results: Participants (n = 305) were 67% female, 74% Hispanic or black, and 45% from two-parent families. Mean +/- SD age was 16.0 +/- 1.8 years. Approximately 1/3 (34%) reported past-90-day alcohol use. After controlling for demographics and clinic site, Religiousness/Spirituality scales that were not significantly associated with alcohol use included: Commitment (OR = 0.81, 95% CI 0.36, 1.79), Organizational Religiousness (OR = 0.83, 95% CI 0.64, 1.07), Private Religious Practices (OR = 0.94, 95% CI 0.80, 1.10), and Religious and Spiritual Coping-Negative (OR = 1.07, 95% CI 0.91, 1.23). All of these are measures of religiousness, except for Religious and Spiritual Coping-Negative. Scales that were significantly and negatively associated with alcohol use included: Forgiveness (OR = 0.55, 95% CI 0.42-0.73), Religious and Spiritual Coping Positive (OR = 0.67, 95% CI 0.51-0.84), Daily Spiritual Experiences (OR = 0.67, 95% CI 0.54-0.84), and Belief (OR = 0.76, 95% CI 0.68-0.83), which are all measures of spirituality. In a multivariable model that included all significant measures, however, only Forgiveness remained as a significant negative correlate of alcohol use (OR = 0.56, 95% CI 0.41, 0.74). Conclusions: Forgiveness is associated with a lowered risk of drinking during adolescence.

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.

Lam D. The influence of religiosity on gambling participation. Journal of Gambling Studies 22(3): 305-320, 2006. (87 refs.)

Gambling is now a popular legal activity among people around the world. Despite numerous studies on individuals' gambling behavior, few researchers examine the influence of religiosity on gambling participation. This study investigated the effect of religiosity, measured in terms of frequency of religious participation and importance of faith, on gambling participation across four different types of games: casino, track, lottery, and bingo. Using data collected by the National Gambling Impact Study Commission in 1999, the study found that there was indeed a significant difference in the frequency of religious participation between gamblers and non-gamblers. Moreover, it seemed like the more types of games one played, the lower was their frequency of religious participation. The importance of faith, however, did not seem to have a significant impact on gambling participation. The implications of these findings to businesses and public policy makers were discussed.

Laudet AB; Morgen K; White WL. The role of social supports, spirituality, religiousness, life meaning and affiliation with 12-Step fellowships in quality of life satisfaction among individuals in recovery from alcohol and drug problems. Alcoholism Treatment Quarterly 24(1/2): 33-74, 2006

Many recovering substance users report quitting drugs because they wanted a better life. The road of recovery is the path to a better life but a challenging and stressful path for most. There has been little research among recovering persons in spite of the numbers involved, and most research has focused on substance use outcomes. This study examines stress and quality of life as a function of time in recovery, and uses structural equation modeling to test the hypothesis that social supports, spirituality, religiousness, life meaning, and 12-step affiliation buffer stress toward enhanced life satisfaction. Recovering persons (N = 353) recruited in New York City were mostly inner-city ethnic minority members whose primary substance had been crack or heroin. Longer recovery time was significantly associated with lower stress and with higher quality of life. Findings supported the study hypothesis; the 'buffer' constructs accounted for 22% of the variance in life satisfaction. Implications for research and clinical practice are discussed.

Laudet AB; White WL. Recovery capital as prospective predictor of sustained recovery, life satisfaction, and stress among former poly-substance users. Substance Use & Misuse 43(1): 27-54, 2008. (85 refs.)

Many recovering persons report quitting their drug use because they are "sick and tired" of the drug life. Recovery is the path to a better life, but that path is often challenging and stressful. There has been little research on the millions of recovering persons in the United States, and most research has focused on substance use outcomes rather than on broader functioning domains. This study builds on our previous cross-sectional findings that recovery capital (social supports, spirituality, religiousness, life meaning, and 12-step affiliation) enhances the ability to cope with stress and enhances life satisfaction. This study (a) tests the hypothesis that higher levels of recovery capital prospectively predict sustained recovery, higher quality of life, and lower stress one year later, and (b) examines the differential effects of recovery capital on outcomes across the stages of recovery. Recovering persons (N = 312), mostly inner-city ethnic minority members whose primary substance had been crack or heroin, were interviewed twice at a one-year interval in New York City between April 2003 and April 2005. Participants were classified into one of four baseline recovery stages: under 6 months, 6-18 months, 18-36 months, and over 3 years. Multiple regression findings generally supported the central hypothesis and suggested that different domains of recovery capital were salient at different recovery stages. The study's limitations are noted and implications of findings for clinical practice and for future research are discussed, including the need for a theoretical framework to elucidate the recovery process.

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."

Lillis J; Gifford E; Humphreys K; Moos R. Assessing spirituality/religiosity in the treatment environment: The Treatment Spirituality/Religiosity Scale. Journal of Substance Abuse Treatment 35(4): 427-433, 2008. (42 refs.)

There has been much interest in measuring and evaluating the role of spirituality/religiosity in substance use disorder (SUD) treatment. This study presents the initial evaluation of a new measure of spirituality/religiosity in the treatment environment: the Treatment Spirituality/Religiosity Scale (TSRS). This Scale has 10 items and can be completed by both patient and staff to measure the emphasis on spirituality/religiosity in a given treatment program, which may have important implications for patient-program fit. Data on the Scale results were gathered from 3,018 patients and 329 staff members from 15 residential SUD treatment programs within the Department of Veterans Affairs Health Care System. The Scale showed good internal consistency (alpha = .77), a single-factor structure, close agreement between patients and staff members (r = .93), and good discriminant validity. The TSRS appears to be a brief, easily administered, and potentially useful measure of the emphasis on spirituality/religiosity in residential SUD treatment programs.

Longest KC; Vaisey S. Control or conviction: Religion and adolescent initiation of marijuana use. Journal of Drug Issues 38(3): 689-716, 2008. (53 refs.)

Much research on adolescent deviance has supported a theory of social control, asserting that the lack of ties to institutions (such as school and parents) increases an adolescent's likelihood of using illicit substances. Researchers in this tradition often posit religion as one among many sources of norm enforcement. Yet religion may impact adolescents' behavior more directly through its ability to create beliefs and identities that are incompatible with illegal substance use. This paper uses a nationally representative, longitudinal data set of adolescents, the National Study of Youth and Religion, to examine the influence of traditional measures of social control, religious social control, and a new measure of religious salience on the probability of adolescents' first marijuana use. Results demonstrate that religious salience is more predictive of this initiation than are measures of involvement with religious organizations and several common social control indicators. We also find substantial interactions between different forms of religiosity. In the conclusion, we consider broader implications for understanding religion's influence on deviance.

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.

McGovern TF; Benda BB. Themes and patterns of spirituality-religiousness and alcohol/other drug problems:

McGovern TF; McMahon T. Spirituality and religiousness and alcohol/other drug problems:

Michalak L; Trocki K; Bond J. Religion and alcohol in the US National Alcohol Survey: How important is religion for abstention and drinking? Drug and Alcohol Dependence 87(2/3): 268-280, 2007. (51 refs.)

Objective: This paper examines the relative importance of three religion variables (religious preference, religiosity, and alcohol proscription) and eight demographic variables (gender, ethnicity, education, income, marital status, age, region, and employment status) as statistical predictors of drinking versus abstention and moderate versus heavy drinking. Method: Data from 7370 telephone interviews from the 2000 National Alcohol Survey are analyzed using bivariate cross-tabulations and multiple logistic regression. Results: When analyzed by religious preference groups, the NAS showed diverse patterns of abstention and drinking that suggest that religion variables are important for drinking behaviors. It was found that the religion variables are strongly associated with abstention. For statistical prediction of heavy versus moderate drinking, religion variables significantly improve model fit but are secondary to gender and age. Conclusions: Religion variables are important for drinking patterns, especially abstention. The relationship of religion to lower levels of alcohol abuse merits further study, such as investigating religious denominations with healthy patterns of abstention and moderate drinking, to learn how these norms are initiated and maintained. Such knowledge has promise of application in programs for prevention and treatment of alcohol problems.

Miller WR; Bogenschutz MP. Spirituality and addiction. Southern Medical Journal 100(4): 433-436, 2007. (27 refs.)

This article explores the relationship between spirituality and addiction along several dimensions. Historically drug use and spirituality are intertwined, in some instances religions prohibit use while in others substances are used as a vehicle in the search for the devine. The authors distinguish between the religious and the spiritual, and comment upon the role of spirituality in self-help groups, specifically Alcoholics Anonymous and the related programs. The research, while limited, sheds some insights into the relationhip beween addiction and spirituality. Consistently religious participation protects against the emergence of substance abuse/dependence. However, the nature of these correlation findings is unclear. There is brief discussion of the role of spiritual interventions, spirituality over the course of recovery, and important research questions that can better clarify the relationship.

Mohr S; Gillieron C; Borras L; Brandt PY; Huguelet P. The assessment of spirituality and religiousness in schizophrenia. Journal of Nervous and Mental Disease 195(3): 247-253, 2007. (29 refs.)

To assess religious coping in schizophrenia, we developed and tested a clinical grid, as no validated questionnaire exists for this population. One hundred fifteen outpatients were interviewed. Results obtained by 2 clinicians were compared. Religion was central in the lives of 45% of patients, 60% used religion extensively to cope with their illness. Religion is a multifaceted construct. Principal component analysis elicited 4 factors: subjective dimension, collective dimension, synergy with psychiatric treatment, and ease of talking about religion with psychiatrist. Different associations were found between these factors and psychopathology, substance abuse, and psychosocial adaptation. The high prevalence of spirituality and religious coping clearly indicates the necessity of addressing spirituality in patient care. Our clinical grid is suitable for this purpose. It proved its applicability to a broad diversity of religious beliefs, even pathological ones. Interjudge reliability and construct validity were high and specific training is not required.

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.

Morjaria-Keval A. Religious and spiritual elements of change in Sikh men with alcohol problems: A qualitative exploration. Journal of Ethnicity in Substance Abuse 5(2): 91-118, 2006

The research presented aimed to explore and elucidate religious and spiritual elements involved in the change process for South Asian men overcoming alcohol problems. In-depth interviews with 15 Sikh men who had either accessed counselling services, and/or used religious/spiritual strategies to overcome an alcohol problem were carried out. A grounded theory approach was used to analyse the data. Change was seen to occur within a holistic framework, impacting on many levels of the person and their context. A model of behaviour change was developed identifying 3 phases of change labelled as catalyst, commitment, and maintenance within which specific religious and spiritual change processes took place. The findings have important implications for the provision of culturally appropriate alcohol treatment services.

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.

Nasim A; Utsey SO; CoronaR; Belgrade FZ. Religiosity, refusal efficacy, and substance use among African-American adolescents and young adults. Journal of Ethnicity in Substance Abuse 5(3): 29-49, 2006

Research points toward multiple pathways (i.e., psychosocial domains) through which religiosity influences substance use behaviors. This study examined whether refusal efficacy mediated the relationship between religiosity and substance use in African-American adolescents and young adults. Four hundred thirty-five urban and rural African-Americans, aged between 12 and 25, completed measures of private and public religiosity, refusal efficacy, and substance use (i.e., tobacco, alcohol, marijuana, and other illicit drug use). Tests for mediation were computed with private and public religiosity as independent variables, drug refusal efficacy as mediator, and substance use as the criterion. Results show that drug refusal efficacy mediated the relationship between private religiosity and tobacco, marijuana, and other illicit drug use, but not for alcohol use. Refusal efficacy also mediated the relationship between public religiosity and alcohol use, but not for other licit and illicit substances. The findings provide support for the unique impact of public religiosity when considering its role in preventive intervention. Future research should consider examining other psychosocial domains which may mediate the effect of religiosity on substance use behaviors among African-American adolescents.

Nasim A; Utsey SO; CoronaR; Belgrade FZ. Religiosity, refusal efficacy, and substance use among African-American adolescents and young adults. Journal of Ethnicity in Substance Abuse 5(3): 29-49, 2006

Neff JA. A new multidimensional measure of spirituality-religiosity for use in diverse substance abuse treatment Populations. Journal for the Scientific Study of Religion 47(3): 393-409, 2008. (42 refs.)

Extant measures of spirituality-religiosity, not developed specifically with substance abuse treatment populations in mind, may not be culturally appropriate in regard to either: (1) the 12-step "culture" found in many treatment programs; or (2) racial-ethnic minority populations overrepresented in publicly funded programs. A 40-item four-dimensional measure was developed, which differentiates "religiosity" (religious practices) from "spirituality, " (an individual's relationships with God/higher power, others, and self). Instrument development involved: qualitative focus groups with individuals in seven diverse Texas treatment programs; quantitative exploratory and confirmatory (CFA) analyses to test the four-factor model conducted using data from 237 diverse clients in treatment programs in Tennessee and Virginia. Confirmatory analyses indicate acceptable fit indices (>0.90)for the four-factor model, and acceptable reliability, estimates for all subdimensions (>= 0.70) provide further support for the measures. Results support the potential usefulness of the measures.

Neff JA; Shorkey CT; Windsor LC. Contrasting faith-based and traditional substance abuse treatment programs. Journal of Substance Abuse Treatment 30(1): 49-61, 2006. (36 refs.)

This article (a) discusses the definition of faith-based substance abuse treatment programs, (b) juxtaposes Durkheim's theory regarding religion with Simpson's (2004) treatment process model to highlight key dimensions of faith-based and traditional programs, and (c) presents results from a study of seven programs to identify key program dimensions and to identify differences/similarities between program types. Focus group/Concept Mapping techniques yielded a clear "spiritual activities, beliefs, and rituals" dimension, rated as significantly more important to faith-based programs. Faith-based program staff also rated "structure and discipline" as more important and "work readiness" as less important. No differences were found for "group activities/cohesion" and "role modeling/mentoring," "safe, supportive environment," and "traditional treatment modalities." Programs showed substantial similarities with regard to core social processes of treatment such as mentoring, role modeling, and social cohesion. Implications are considered for further research on treatment engagement, retention, and other outcomes.

Newman IM; Shell DF; Li TD; Innadda S. Buddhism and adolescent alcohol use in Thailand. Substance Use & Misuse 41(13): 1789-1800, 2006. (24 refs.)

A sample of 2019 Thai secondary school students in grades equivalent to U.S. 10 through 12 completed a 43-item alcohol expectancy questionnaire in June 2000. Factor analysis revealed four factors: (a) positive expectancies, (b) negative expectancies, (c) sex and power expectancies, and (d) religious expectancies. Practicing Buddhists were less likely to drink than nonpracticing Buddhists and had fewer positive and more negative expectancies about alcohol. Among students who did drink, Buddhist beliefs did not appear to influence whether or not they were binge drinkers. Buddhist beliefs may influence decisions to drink but not decisions related to drinking patterns.

Nonnemaker J; McNeely CA; Blum RW. Public and private domains of religiosity and adolescent smoking transitions. Social Science & Medicine 62(12): 3084-3095, 2006. (47 refs.)

We used data from a nationally representative sample of US adolescents in school grades 7 through 12 to explore the effects of public and private religiosity on initiation, escalation, and cessation of smoking. We found that adolescents' decisions to experiment with smoking are influenced by both their individual practice of their faith and by participation in a larger faith community. However, the effects of private and public religiosity are specific to different decision points on the smoking uptake process. Private religiosity was protective against initiation of regular smoking among nonsmokers. It also was protective against initiation of experimental smoking but only when the young person frequently attended religious services or a religious youth group. Although private religiosity appeared to discourage the uptake of smoking, it was unrelated to reduction or cessation once a young person has become addicted to cigarettes. In contrast, public religiosity did predict reduction and cessation of cigarette use among regular smokers. Taken together, these findings demonstrate that the domains in which religiosity are important extend beyond the individual and include religious institutions.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Religious Involvement and Substance Use Among Adults. (March 23, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (6 refs.)

In 2005, about 168 million adults aged 18 or older (78.1%) reported that religious beliefs are a very important part of their lives, 75.1% reported that religious beliefs influence how they make decisions in their lives and 30.8% attended religious services 25 times or more in the past year. Adults who attended religious services 25 times or more in the past year were less likely to have used cigarettes, alcohol, or illicit drugs in the past month than those who attended religious services fewer than 25 times. About 6.1% of the adults who reported that religious beliefs are a very important part of their lives used illicit drugs in the past month compared with 14.3% of adults who reported that religious beliefs are not an very important part of their lives.

Public Domain

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.

Petry NM; Lewis MW; Ostvik-White EM. Participation in religious activities during contingency management interventions is associated with substance use treatment outcomes. American Journal on Addictions 17(5): 408-413, 2008. (20 refs.)

Many drug abuse treatment programs encourage participation in religious activities, yet there is scant research regarding their effectiveness. Contingency management (CM) interventions sometimes reinforce the completion of non-drug related activities, and church attendance is a popular activity. Cocaine abusers (n = 184) randomized to CM interventions were categorized based on whether or not they engaged in three or more religious activities. Engagers in religious activities (n = 34) remained in treatment longer, were abstinent for longer durations, and submitted more substance-negative samples than non-engagers (n = 150), even after controlling for number of activities completed overall. Thus, encouraging religious involvement during CM treatment may improve during treatment outcomes.

Petts RJ; Knoester C. Parents' religious heterogamy and children's well-being. Journal for the Scientific Study of Religion 46(3): 373-389, 2007. (48 refs.)

This study considers the impact of having parents of dissimilar faiths on children's well-being. Using data from the National Survey of Families and Households, we examine the hypothesis that parents' religious heterogamy has both direct and indirect negative effects on children's well-being. First, we find evidence that religious heterogamy is positively associated with marital conflict and negatively associated with religious participation. Second, our results suggest that children with religiously heterogamous parents are more likely to engage in marijuana use and underage drinking than children with religiously homogamous parents. However, these associations occur only in families where parents' religious heterogamy is a product of greater religious distance (e.g., one parent is not religious or both parents identify with different religions). Religiously heterogamous parents who affiliate with different Protestant groups report similar levels of marital conflict and religious participation as same-faith parents. In addition, the children of these parents report similar levels of delinquency as children of same-faith parents. We find no evidence that religious heterogamy is associated with children's self-esteem, life satisfaction, or grades in school.

Piderman KM; Schneekloth TD; Pankratz VS; Maloney SD; Altchuler SI. Spirituality in alcoholics during treatment. American Journal on Addictions 16(3): 232-237, 2007. (49 refs.)

The purpose of this study was to measure spiritual wellbeing (SWB), private religious practices (PRP), positive religious coping, abstinence self-efficacy (AASE), affiliation with AA (AAA), and their associations with alcoholics in treatment. Seventy-four adults in a three-week outpatient addiction treatment program were assessed at admission and discharge. Wilcoxon signed rank and t tests demonstrated significant increases in all variables. Spearman correlation coefficients detected significant associations between the spiritual variables, SWB and AASE, as well as PRP and AAA. Findings suggest that spiritual variables can change during treatment and that there may be connections between spiritual variables and variables associated with longer-term recovery.

Pozdnyakova ME; Moiseeva VV. The role of religious communities in countering drug abuse. Herald of the Russian Academy of Sciences 78(4): 390-396, 2008. (4 refs.)

In the authors' opinion, religion and confessional affiliation can and must act as a deterrent to taking psychoactive substances and thus become a significant resource in preventing various deviant behaviors. The role of religious institutions in drug interdiction is based on an analysis of special literature and expert opinions.

Regnerus M; Burdette A. Religious change and adolescent family dynamics. Sociological Quarterly 47(1): 175-194, 2006. (46 refs.)

Much more has been documented about the influence of religion on parenting practices than on how the former may shape family life from the perspective of adolescents. Building a conceptual model of religion and changing family relations, we assessed the particular influence of adolescent religious change on the dynamics of their relationships with their parents, and overall satisfaction with their families. Employing data from two waves of the National Longitudinal Study of Adolescent Health (Add Health), results suggested that growth in personal religious salience -- how important religion is in adolescents' lives -- is uniquely and consistently related to better family relations, even after accounting for behavioral changes -- such as excessive drinking and drug abuse -- that are detrimental to both religiosity and family relations.

Robinson EAR; Cranford JA; Webb JR; Brower KJ. Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample. Journal of Studies on Alcohol and Drugs 68(2): 282-290, 2007. (51 refs.)

Objective: This descriptive and exploratory study investigated change in alcoholics' spirituality and/or religiousness (S/R) from treatment entry to 6 months later and whether those changes were associated with drinking outcomes. Method: Longitudinal survey data were collected from 123 outpatients with alcohol use disorders (66% male; mean age = 39; 83% white) on 10 measures of S/R, covering behaviors, beliefs, and experiences, including the Daily Spiritual Experiences and Purpose in Life scales. Drinking behaviors were assessed with the Timeline Followback interview. Alcoholics Anonymous (AA) participation and attendance were also measured. Results: Over 6 months, there were statistically significant increases in half of the S/R measures, specifically the Daily Spiritual Experiences scale, the Purpose in Life scale, S/R practices scale, Forgiveness scale, and the Positive Religious Coping scale. There were also clinically and statistically significant decreases in alcohol use. Multiple logistic regression analyses showed that increases in Daily Spiritual Experiences and in Purpose in Life scores were associated with increased odds of no heavy drinking at 6 months, even after controlling for AA involvement and gender. Conclusions: In the first 6 months of recovery, many dimensions of S/R increased, particularly those associated with behaviors and experiences. Values, beliefs, self-assessed religiousness, perceptions of God, and the use of negative religious coping did not change. Increases in day-to-day experiences of spirituality and sense of purpose/meaning in life were associated with absence of heavy drinking at 6 months, regardless of gender and AA involvement. The results of this descriptive study support the perspective of many clinicians and recovering individuals that changes in alcoholics' S/R occur in recovery and that such changes are important to sobriety.

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. Is religiosity a protective factor against substance use in young adulthood? Only if you're straight! Journal of Adolescent Health 40(5): 440-447, 2007. (40 refs.)

Purpose: Previous research has documented that substance use peaks during young adulthood and that religiosity provides a protective effect against binge drinking, marijuana use, and cigarette smoking. The majority of these studies do not examine sexual identity as it relates to these factors. Drawing on social influence and developmental theories, we tested the hypothesis that religiosity would provide a protective effect for heterosexual but not sexual minority young adults. Method: Waves 1 and 3 of the National Longitudinal Study of Adolescent Health provided data for the study. Three young adult sexual identity groups were formed: sexual minorities who did not report same-sex attraction at Wave 1 (NA), sexual minorities who did report same-sex attraction at Wave 1 (SSA), and heterosexuals (HET) (sample n = 764). Results: Religiosity measured at baseline had no significant effect on past-year substance use, measured six years later in sexual minority young adults. For heterosexual young adults, each unit increase in religiosity reduced the odds of binge drinking by 9%, marijuana use by 20%, and cigarette smoking by 13%. Conclusions: Religiosity was not protective against substance use in sexual minority young adults, cautioning against over-generalizing previous findings about the protective effects of religiosity. Future studies that 1) consider the social context for sexual identity development, 2) model both risk and protective factors, and 3) use multidimensional measures of religiosity (and spirituality) and sexual identity are needed to build the necessary knowledge base for effective health promotion efforts among sexual minority youth and young adults.

Rostosky SS; Danner F; Riggle EDB. Religiosity and alcohol use in sexual minority and heterosexual youth and young adults. Journal of Youth and Adolescence 37(5): 552-563, 2008. (54 refs.)

Despite interest in the role of religiosity in youth development and health behavior, few studies have examined these associations in sexual minority youth. Participants (n = 11,699) who were adolescents (wave 1) and young adults (wave 3) in the Add Health survey were used to examine proximal and distal religiosity by sexual identity group and to test group differences in associations between religiosity and alcohol use. Sexual minorities were less likely than heterosexuals to report a current religious affiliation. In young adulthood, heterosexual females reported significantly higher distal and proximal religiosity than heterosexual males and sexual minority young adults. From adolescence to young adulthood, religiosity in all three sexual identity groups (heterosexual, bisexual, gay/lesbian) significantly declined, with the largest effects found for the sexual minority groups. Distal and proximal religiosity scores were significantly associated with less alcohol use and less binge drinking among heterosexuals, but not among sexual minorities. Future studies of sexual minority youth and their religious contexts are suggested.

Sanchez ZVDM; De Oliveira LG; Nappo SA. Religiosity as a protective factor against the use of drugs. Substance Use & Misuse 43(10): 1476-1486, 2008. (27 refs.)

Although many studies have suggested that risk and protective factors are related to the use of drugs, their role has not been given due importance. More attention to protective factors could make them a fundamental tool in prevention programs. Since low socioeconomic level and adolescence are known as risk factors, the aim of this study was to identify which factors would prevent Brazilian adolescents from low-income families from using drugs. A qualitative method and an intentional sample selected by criteria were adopted for this investigation. During 2003, sixty-two youngsters, ages 16 to 24 years old, 30 drug users, and 32 nonusers were administered a semistructured interview. The subjects perceived family and religiosity as important protective factors in their lives. With regard to religiosity, 81% of nonusers believed in and practiced a religion, whereas only 13% of users considered themselves as being religious. The belief in and practice of a religion were also more evident among family members of nonusers (74%) than those of users (33%). These results indicated that religion may be a relevant protective factor for the sample studied, helping the family unit in keeping youth away from drugs. The study's limitations were noted.

Saunders SM; Kuras L. Measuring the discrepancy between current and ideal spiritual and religious functioning in problem drinkers. Psychology of Addictive Behaviors 21(3): 404-408, 2007. (28 refs.)

The idea that spiritual and religious functioning (SRF) is associated with alcohol misuse is generally supported, but problems with typical research methods limit the utility of findings. Problems in SRF were conceptualized as discrepancies between current and ideal SRF. Two separate studies were conducted to develop and evaluate a scale to measure the subjective importance and adequacy of aspects of SRF that seem to be associated with alcohol problems. The 1st study suggested that a questionnaire developed to evaluate self-reported ratings of current and ideal SRF is both internally consistent and temporally stable. In the 2nd study, the questionnaire was administered to persons seeking treatment for alcohol problems and persons who indicated that they had never sought treatment for an alcohol problem. Results indicate that those with a drinking problem were more likely to report substantial discrepancies between current and ideal SRF, supporting the validity of the measure as an indicator of problems in SRF. The usefulness of this method for treatment and research is discussed.

Schiff M. Living in the shadow of terrorism: Psychological distress and alcohol use among religious and non-religious adolescents in Jerusalem. Social Science & Medicine 62(9): 2301-2312, 2006. (63 refs.)

This study examines the effects of prolonged exposure to terrorism in 600 religious and non-religious Jewish adolescents living in Jerusalem, particularly post-traumatic stress (PTS) symptorns, depressive symptoms, alcohol use, coping strategies and social support. The youth in Jerusalem reported high exposure to terrorist acts. This exposure was associated with high PTS, depressive symptoms and alcohol use. Despite an apparently greater exposure to terrorism, religious adolescents reported lower levels of PTS and alcohol consumption, but similar levels of depressive symptoms to non-religious adolescents. Problem-solving coping predicted higher depressive symptoms for religious adolescents exposed to terrorism but not for similarly exposed non-religious adolescents. In contrast, emotion-focused coping predicted more alcohol consumption among highly exposed non-religious adolescents, while emotion-focused coping predicted more alcohol consumption among religious adolescents with low exposure. The overall findings suggest that religiosity may buffer the negative consequences of exposure in other ways than through coping or support.

Scott LD Jr; Munson MR; McMillen JC; Ollie MT (1). Religious involvement and its association to risk behaviors among older youth in foster care. American Journal of Community Psychology 38(3/4): 223-236, 2006. (61 refs.)

This study examined religious involvement and its association to risk behaviors (sexual behavior, marijuana use, alcohol use, and cigarette use) among older youth in foster care (N = 383). Three dimensions of religious involvement were assessed--church or religious service attendance, religious practices, and religious beliefs. Findings showed that gender, ethnic group membership, sexual abuse history, and placement type were significantly associated with older foster care youth's religious involvement. Hierarchical logistic regression analyses showed that religious service attendance was associated with reduced odds of youth's engagement in sexual behavior in the past 2 months and current use of cigarettes. In addition, greater religious beliefs were associated with a reduction in odds of youth's use of alcohol in the past 6 months and current use of cigarettes. The consideration of religious involvement as a positive influence and resource that may reduce unhealthy risk behaviors among older youth in foster care is discussed.

Sekulic D; Kostic R; Miletic D. Substance use in dance sport. Medical Problems of Performing Artists 23(2): 66-71, 2008. (25 refs.)

Very few studies have been conducted on substance use (SU) in performing sports. In the current study, we analyzed SU and factors related to SU in dance sport. The sample subjects consisted of 21 female and 22 male dancers, all > 19 years of age, who were given an anonymous questionnaire developed for this study. The questionnaire consisted of questions about 1) social, cultural, educational, and sport-related factors, and 2) SU, including alcohol, opiates, cigarettes, and doping consumption, and personal opinions. The chi-square test was used to define the differences between male and female dancers. To identify the relationships between the studied factors and SU, the Pearson's correlation coefficient was calculated separately in males and females. We found a relatively low incidence of cigarette smoking (<10%) and significant differences between males and females in opinions regarding doping issues. The level of the sport achievement in females and religiousness in male dancers was significantly related to SU. Although not frequent, the consumption of alcohol was more common in more successful and experienced dancers. The use of pain killers was related to age in female dancers (all at P < 0.05). Based on these results, we recommend educational programs regarding SU, especially about doping problems, in sport dance.

Sexton RL; Carlson RG; Siegal H; Leukefeld CG; Booth B. The role of African-American clergy in providing informal services to drug users in the rural South: Preliminary ethnographic findings. Journal of Ethnicity in Substance Abuse 5(1): 1-21, 2006

To date, no ethnographic studies of the role of African-American clergy in providing informal services to drug users in the rural South have been reported. We use qualitative interviews with 15 African-American ministers and 26 African-American drug users in Arkansas' Mississippi River Delta region to explore this issue. All drug users reported significant religiosity, and 9 had discussed drug problems with clergy. Every minister had provided assistance to at least one drug user or their family during the previous year, including: direct counseling; referrals to treatment programs; aiding negotiations with formal institutions; and providing for basic needs. Ministers stated that clergy are not well-prepared to address drug problems, and most acknowledged a need for professional training. They also discussed barriers to education. The findings contribute to understanding rural informal drug treatment resources. They suggest that professional treatment providers should investigate the potential benefits of improving outreach efforts to assist African-American ministers engaged in drug abuse issues.

Sharma M. Religiosity and substance abuse: Need for systematic research. (editorial). Journal of Alcohol and Drug Education 50(1): 1-4, 2006. (9 refs.)

Sherbine EL. Comment: Does Cutter v. Wilkinson change the analysis of mandated DUI treatment programs? A critical response. University of Maryland Law Journal of Race, Religion, Gender and Class 6(Spring): 223-249, 2006. (182 legal refs.)

This is a reponse to the article by Jenkins et al in Fall 2005 which argued that mandatory attendance at Alcoholics Anonymous(A.A.) as a condition for probation or incarceration did not violate the First Amendment, despite A.A.'s "somewhat religious" nature, given A.A.'s unique effectiveness in treating alcoholism and the strong societal interest against negative alcohol-related conduct. Further, the A.A. proponents argued that the prospect for mandatory A.A. attendance, in the face of a First Amendment challenge, improved significantly following the Supreme Court's decision in Cutter v. Wilkinson, given the Court's supposedly less restrictive view of the Establishment Clause in that case. ... " Thus, in the dissenters' view, some "reconciliation with the Lemon terminology" was necessary for accommodation statutes because state alleviation of government-imposed burdens on religious exercise was permissible. ... Second, the A.A. proponents argued that mandatory A.A. attendance passes the compelling interest tests established by Congress in RFRA and RLUIPA and by state governments in similar legislation because the Court has relaxed the meaning of these tests in Cutter. ... The A.A. proponents argued that mandatory participation in A.A. does not violate the Free Exercise Clause because of the state's compelling interest in preventing alcohol-related conduct, the unique effectiveness of A.A. in treating alcoholism, and an alleged softening of the compelling interest standard for prison and penological authorities in Cutter. ... When Cutter is considered within the appropriate context as a question of religious accommodation, however, the arguments for mandatory A.A. attendance fail to withstand scrutiny. ...

Shields JJ; Broome KM; Delany PJ; Fletcher BW; Flynn PM. Religion and substance abuse treatment: Individual and program effects. Journal for the Scientific Study of Religion 46(3): 355-371, 2007. (59 refs.)

The relationship between personal religiousness and substance abuse treatment outcomes has emerged as an important issue in the public health arena. Using the " moral community" perspective, a conceptual framework developed by Stark, Kent, and Doyle (1982) to analyze the contextual effects of religion, we explore the degree to which religion influences two drug treatment outcome measures - critical retention and commitment to treatment. The data are derived from the Drug Abuse Treatment Outcome Studies (DATOS), a national study of 10,010 clients enrolled in 70 drug treatment programs. Three research questions were addressed: (1) What is the relationship between an individual's level of religiosity and retention in treatment and commitment to treatment? (2) How does the ecological context of treatment programs shape the individual-level relationships? (3) To what extent are program practices and characteristics directly linked to outcome level? The findings are supportive of the literature that shows a weak to moderate relationship between religiosity and treatment outcomes. However, the findings did not show strong support for the "moral community" hypothesis. Although there was a wide variation in the size of the individual-level religiosity - treatment correlations, the variation could not be conclusively attributed to the overall religious emphasis of the programs. The findings suggest that further research is needed in order to understand fully the role of religion in substance abuse treatment.

Sinha JW; Cnaan RA; Gelles RJ. Adolescent risk behaviors and religion: Findings from a national study. Journal of Adolescence 30(2): 231-249, 2007. (57 refs.)

Too few studies have assessed the relationship between youth risk behaviors and religiosity using measures which captured the varied extent to which youth are engaged in religion. This study applied three measures of religiosity and risk behaviors. In addition, this study ascertained information about youths' participation in religious activities from a parent or caretaker. Based on a national random sample of 2004 teens (ages 11-18), this study indicates that youth perceive religion as important, are active in religious worship and activities, and further shows that perceived importance of religion as well as participation in religious activities are associated with decreased risk behaviors. Looking at ten risk behaviors, religiosity variables were consistently associated with reduced risk behaviors in the areas of smoking, alcohol use, truancy, sexual activity, marijuana use, and depression. In the case of these six risk variables, religiosity variables were significantly associated with reduced risk behaviors when controlling for family background variables and self-esteem. The study highlights the importance of further understanding the relationship between religious variables, background variables, self-esteem, and youth risk behaviors

Stahler GJ; Kirby KC; Kerwin ME. A faith-based intervention for cocaine-dependent black women. Journal of Psychoactive Drugs 39(2): 183-190, 2007. (45 refs.)

The purpose of the present study was to obtain preliminary data on the effectiveness of a faith-based treatment adjunct for cocaine-using homeless mothers in residential treatment. The Bridges intervention utilizes various Black church communities to provide culturally-relevant group activities and individual mentoring from volunteers. Eighteen women who were recent treatment admissions were randomly assigned to receive Standard Treatment plus Bridges or Standard Treatment with an Attention Control. Participants were assessed at intake and three and six months after intake. Bridges treatment resulted in significantly better treatment retention (75% vs. 20% at six months) than standard residential treatment alone. In addition, Bridges produced superior outcomes at the six month follow-up assessment on a secondary measure of cocaine abstinence. Creating a community of social support through Black churches appears feasible and promising, and may be a cost-effective means of providing longer-term post-treatment support for cocaine-addicted women.

Staton-Tindall M; Oser CB; Duvall JL; Havens JR; Webster JM; Leukefeld CG et al. Male and female stimulant use among rural Kentuckians: The contribution of spirituality and religiosity. Journal of Drug Issues 38(3): 863-882, 2008. (55 refs.)

This study describes gender-specific patterns of drug use among active rural stimulant users and examines religiosity and spirituality as factors that may be related to stimulant use among males and females. The study includes a sample of 225 active rural stimulant users from Kentucky who were recruited using respondent driven sampling and completed face-to-face interviews. Findings suggest gender specific patterns among active rural stimulant users, with females reporting more amphetamine use. In addition, bivariate findings indicate that there is an inverse relationship between spirituality, religiosity, and stimulant use (specifically methamphetamine and amphetamine use), particularly for males. However, when further examining this relationship in multivariate models controlling for age and race, few significant findings were noted for spirituality and religiosity in predicting gender-specific stimulant use patterns. These findings suggest that treatment interventions that incorporate spirituality and religiosity should not only be gender specific, but should also target clients differentially. Findings on the degree of reported spirituality and religiosity also suggest that religious and/or faithbased organizations could be utilized for drug use interventions for rural stimulant users.

Steinman KJ; Ferketich AK; Sahr T. The dose-response relationship of adolescent religious activity and substance use: Variation across demographic groups. Health Education & Behavior 35(1): 22-43, 2008. (72 refs.)

This article addresses two inconsistent findings in the literature on adolescent religious activity (RA) and substance use: whether a dose-response relationship characterizes the association of these variables, and whether the association varies by grade, gender, ethnicity, family structure, school type, and type of substance. Multinomial logistic regression analyses of a large, diverse data set of high school students in metropolitan Columbus, Ohio (n = 33,007), found marked differences in alcohol, marijuana, and cigarette use among youths who never, occasionally, or regularly participated in RA. Weekly RA was consistently associated with less substance use, yet occasional RA sometimes was associated with greater use. Four groups accounted for variations in the RA-substance use relationship: African American youths, younger White youths, 12th-grade White males, and 12th-grade White females. Researchers should avoid assuming the RA-substance use relationship is dose-response and consider the implications of this complexity for theory and practice.

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.

Timberlake DS; Rhee SH; Haberstick BC; Hopfer C; Ehringer M; Lessem JM et al. The moderating effects of religiosity on the genetic and environmental determinants of smoking initiation. Nicotine & Tobacco Research 8(1): 123-133, 2006. (35 refs.)

Although a number of studies have shown that various measures of religiosity are inversely correlated with smoking behavior, none of these studies have used genetically informative samples to test for a gene-environment interaction between the determinants of smoking initiation and religiosity. We tested the moderating effects of three measures of religiosity (religious affiliation, organizational religious activity, and self-rated religiousness) on the genetic and environmental determinants of smoking initiation in 237 monozygotic twin pairs, 315 dizygotic twin pairs, 779 full-sibling pairs, and 233 half-sibling pairs in young adults surveyed from the third wave of the National Longitudinal Study of Adolescent Health. Primary analyses incorporated all sibling pairs, irrespective of whether they were concordant or discordant for the environmental moderator, in models designed to account for the confounding effects of a gene - environment correlation. High levels of self-rated religiousness attenuated the additive genetic component for smoking initiation and were associated with a lower prevalence of smoking initiation. Although all three measures of religiosity were associated with lower rates of smoking initiation, only self-rated religiousness moderated genetic influences on the liability for smoking.

Tupper KW. The globalization of ayahuasca: Harm reduction or benefit maximization? International Journal of Drug Policy 19(4): 297-303, 2008. (62 refs.)

Ayahuasca is a tea made from two plants native to the Amazon, Banisteriopsis caapi and Psychotria viridis, which, respectively, contain the psychoactive chemicals harmala alkaloids and dimethyltryptamine. The tea has been used by indigenous peoples in countries such as Brazil, Ecuador and Peru for medicinal, spiritual and cultural purposes since pre-Columbian times. In the 20th century, ayahuasca spread beyond its native habitat and has been incorporated into syncretistic practices that are being adopted by non-indigenous peoples in modern Western contexts. Ayahuasca's globalization in the past few decades has led to a number of legal cases which pit religious freedom against national drug control laws. This paper explores some of the philosophical and policy implications of contemporary ayahuasca use. It addresses the issue of the social construction of ayahuasca as a medicine, a sacrament and a "plant teacher." Issues of harm reduction with respect to ayahuasca use are explored, but so too is the corollary notion of "benefit maximization."

van der Meer Sanchez Z; Nappo SA. Religious treatments for drug addiction: An exploratory study in Brazil. Social Science & Medicine 67(4): 638-646, 2008. (38 refs.)

The main objective of the present work is to understand the processes used in emerging Catholic and Protestant religious interventions for recovery from drug dependence, from the vantage point of individuals subjected to them. A qualitative method and an intentional sample selected by criteria were adopted for this investigation, which was conducted in Sao Paulo, Brazil. An in-depth semi-structured interview was conducted with 57 predominantly male former drug users who fit the criteria: they had been submitted to non-medical religious treatments to treat dependence and were abstinent for at least 6 months. Crisis was found to be the main reason leading interviewees to seek treatment; this includes, losing family, losing employment, and experiencing severe humiliation. Evangelicals most used religious resources exclusively as treatment, showing strong aversion to the role of doctors and to any type of pharmacological treatment. A common feature of Catholic and Protestant groups is the importance ascribed to praying and talking to God, described by subjects as strongly anxiolytic, and a means to control drug craving. Confession and forgiveness, through faith conversion or penitences, respectively, appeal strongly to the restructuring of life and increase of self-esteem. Religious interventions were considered effective by the individuals who underwent them and were seen as attractive for the humane, respectful treatment they delivered. The key aspects of this type of treatment are social support provided by the receiving group, equal treatment, and instant, judgment-free acceptance. The success of these actions, then, is not only due to some "supernatural" aspect, as might be assumed, but also more to the unconditional dedication of human beings to their peers. Given the difficulty in treating drug dependence, religious interventions could be used as a complementary treatment for conventional therapies.

Walker C; Ainette MG; Wills TA; Mendoza D. Religiosity and substance use: Test of an indirect-effect model in early and middle adolescence. Psychology of Addictive Behaviors 21(1): 84-96, 2007. (52 refs.)

The authors tested hypothesized pathways from religiosity to adolescent substance use (tobacco, alcohol, and marijuana) with data from samples of middle school (n = 1,273) and high school students (n = 812). Confirmatory analysis of measures of religiosity supported a 2-factor solution with behavioral aspects (belonging, attendance) and personal aspects (importance, value, spirituality, forgiveness) as distinct factors. Structural modeling analyses indicated inverse indirect effects of personal religiosity on substance use, mediated through more good self-control and less tolerance for deviance. Religiosity was correlated with fewer deviant peer affiliations and nonendorsement of coping motives for substance use but did not have direct effects on these variables. Parental support and parent-child conflict also had significant effects (with opposite direction) on substance use, mediated through self-control and deviance-prone attitudes. Implications for prevention research are discussed.

Wallace JM; Yamaguchi R; Bachman JG; O'Malley PM; Schulenberg JE; Johnston LD. Religiosity and adolescent substance use: The role of individual and contextual influences. Social Problems 54(2): 308-327, 2007. (28 refs.)

For more than three decades scholars have debated about if, when, and under what circumstances religiosity deters delinquency. The present study uses multilevel modeling data analytic techniques (i.e., hierarchical linear model [HLM]) and large nationally representative samples of American public high schools (N = 227) and high school seniors ( N = 16,595) to examine various unresolved issues in the ongoing debate, with a specific focus on the relationships between individual- and contextual-level (i.e., school) religiosity and adolescent's use of tobacco, alcohol, and marijuana. The results indicate first, that the higher adolescents' level of religiosity, the less likely they are to be current tobacco users, to engage in binge drinking, or to have used marijuana in the past year; second, that as the level of religiosity in a school increases, adolescents' frequency of cigarette use, binge drinking, and marijuana use decreases; third, that the religiosity of the school influences students' substance use, over and above their individual religiosity, but that this relationship exists only for marijuana; and fourth, that the strength of the relationship between individual- level religiosity and individual-level substance use varies depending upon the religiosity of the context, such that adolescents who are highly religious and in highly religious contexts are less likely to engage in binge drinking or marijuana use than those who are equally religious but in less religious contexts. Future research should seek to understand the mechanisms through which individual- and contextual-level religiosity influences young people's use of substances and other delinquent behaviors.

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.

Weiss ML; Chitwood DD; Sanchez J. Religiosity, drug use , and HIV-related risk behaviors among heroin injectors. Journal of Drug Issues 38(3): 883-888, 2008. (63 refs.)

The association between religiosity and reduced alcohol and drug use in the general population is commonly recognized, but research about the relationship between religiosity and drug-related risk behaviors among illicit drug users has received considerably less attention. This study explores the role of religiosity in explaining heavy polydrug use and other HIV-related risk behaviors among a tri-ethnic sample of 600 male and female active heroin injectors who were recruited from the streets of Miami-Dade County, Florida. The effects of three dimensions of religiosity on heavy alcohol use, daily crack-cocaine use, and five HIV-related injection and sex risk behaviors were assessed using multivariate logistic regression techniques that controlled for demographics and self-reported HIV serostatus. The majority of heroin injectors reported some degree of religiosity as expressed by religious intentionality, worship attendance, and religious self-perception. Strong religious intentionality was associated with a decreased likelihood of reusing needles/syringes, but the regression results suggest that religiosity for the most part did not influence heavy polydrug use or other HIV-related risk behaviors of active heroin injectors.

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.

Yu M; Stiffman AR. Culture and environment as predictors of alcohol abuse/dependence symptoms in American Indian youths. Addictive Behaviors 32(10): 2253-2259, 2007. (16 refs.)

This study utilizes Bronfenbrenner's ecological model (1979) to examine multiple and interactive environmental (familial, social, and cultural) predictors of adolescent alcohol abuse/dependence symptoms. A stratified random sample of 401 American Indian youths was interviewed in 2001. The findings showed that family members' substance problems, peer misbehaviors, and participation in generic cultural activities positively predicted adolescent alcohol symptoms. Conversely, cultural pride/spirituality predicted fewer alcohol symptoms, and, importantly, religious affiliation moderated the effects of problematic peers and family members on adolescent alcohol symptoms. The findings suggest further study of intervention and prevention efforts regarding the benefits from consideration of the complex relationships among multiple environmental variables.

Conceptual framework. Alcoholism Treatment Quarterly 24(1/2): 7-20, 2006Spirituality and religiousness are multidimensional concepts in their philosophical, theological and healthcare connotations. Both concepts have been discussed extensively in the literature describing the origins, diagnosis and treatment of alcohol and other drug problems. Recovery communities, especially Alcoholics Anonymous, have been studied in terms of their ongoing conversations about spirituality and religiousness in the process of recovery. The contributions of authors, such as James, Tiebout, Kurtz, Whitfield, Brown, Miller, Morgan and White to an understanding of those concepts are highlighted.

Treatment and recovery perspectives. Alcoholism Treatment Quarterly 24(1/2): 1-6, 2006The themes and patterns of spirituality-religiousness are explored, in their relevance to the treatment and recovery from alcohol other drug problems, in this volume. The findings of the various authors are summarized, including descriptions of the populations studied across the life cycle, as they experience treatment and recovery.