CLERGY AND FAITH-BASED GROUPS

A Guide for Religious and Spiritual Leaders to Help People With Substance Use Disorders

Substance use disorders affect a large portion of the population. As many as 74 percent of Americans say that addiction to alcohol has had some impact on them at some point in their lives, whether it was their own personal addiction, that of a friend or family member, or any other experience with addiction.¹ For many, spirituality and religion have been instrumental to successful treatment and recovery, yet they are often overlooked as relevant in preventing and treating substance use disorders.²

I grew up in the projects in a tough, poor section of Brooklyn. As a "light-skinned" black kid I was always justifying that I belonged. I started drinking at age 14 and almost immediately I felt like I belonged no matter where I was. From the beginning I drank to get drunk. Eventually, my drinking led to medical problems, lost jobs, and broken relations with my wife and family. While in the hospital a friend asked me to read the Bible. I opened to the Book of Romans that said, "Have joy in your suffering that will build perseverance, and perseverance builds character, and character builds hope." At that moment, hope was all I could hold on to. I started going to 12-step meetings and put God and recovery first in my life. God has taken me to jails, a detox center, treatment facilities, youth centers, wherever I can bring the message of hope in recovery. I know the work of serenity and I am truly blessed to be alive and sober. I pray every day that God keeps me sober, gives me strength and sends me somewhere to reflect His light of hope in recovery. David Jackson Recovery Outreach Minister		Clergy members are critical yet relatively untapped resources in preventing substance use disorders, helping people get treatment, and offering support for recovery.3 Clergy should be aware that treatment is effective and recovery is life-changing for people with substance use disorders. Substance use disorders are comprised of the dependence on or abuse of alcohol and/or drugs. Dependence on and abuse of alcohol and illicit drugs, which include the nonmedical use of prescription drugs, are defined using the American Psychiatric Association's criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Dependence indicates a more severe substance problem than abuse; individuals are classified with abuse of a certain substance only if they are not dependent on the substance.4 For more information on the criteria used in defining dependence and abuse, consult the 2004 National Survey on Drug Use and Health, which is available on the Web at www.oas.samhsa.gov/nsduh.htm. Much has been written about substance abuse, dependence, and addiction; many studies have used different terminology to explain their findings. To foster greater understanding and avoid perpetuating the stigma associated with these conditions, the phrase "substance use disorders" is used as an umbrella term to encompass all of these concepts. Clergy's Role in Addressing Substance Use Disorders Clergy understand the negative impact of substance use disorders on families, individuals, and children. Ninety-four percent of clergy members (e.g., priests, ministers, and rabbis) recognize that substance use is an important issue among families in their congregations. Among clergy members, 38 percent believe that alcohol use disorders are involved in half or more of the family problems they encounter.5 Clergy have a great desire to assist families, but are divided over whether to speak openly about substance use disorders with their congregations.

Nearly 37 percent of clergy report that they preach a sermon on substance use more than once a year, while almost 23 percent say they never do. Few clergy receive formal training on the topic, as only 12.5 percent of clergy have completed any coursework related to substance use while studying to be a member of the clergy. Furthermore, only roughly 26 percent of presidents of schools of theology and seminaries report that people preparing for the ministry are required to take courses on this subject.⁶

To effectively reach your congregation about substance use disorders, make the message hit home by sharing local information on the prevalence of substance use disorders, which can be found in the State Data on Alcohol, Tobacco, and Illegal Drug Use report available at oas.samhsa.gov/states.htm. Also contact the Single-State Agency (SSA) in your state, which is listed in the SSA Directory included in the "Resources" section of this planning toolkit. Inquire about both public and private patient census information.

Although some clergy members have shown hesitation to speak openly with their congregations about substance use, many take it upon themselves to learn more about substance use disorders. In one survey, two-thirds of clergy indicated that they had sought training on their own since their ordination to assist parishioners seeking help for substance use disorders. While many members of the clergy may know about substance use disorders, they may not disseminate this knowledge to their congregations, possibly because seminaries do not require training on the subject.⁷ Yet the need still exists for clergy to acquire the knowledge and skills to effectively address and share information about the following issues:

• The way a substance use disorder manifests itself and signs to watch for
• The effects of alcohol and/or drugs on thinking and reasoning
• The role alcohol and/or drugs may play in a person's life
• The way substance use disorders affect families, workplaces, and communities as a whole⁸

These issues became guidelines for clergy education in 2003 at a meeting supported by the Substance Abuse and Mental Health Services Administration (SAMHSA). This meeting developed key proficiencies to enable clergy and other pastoral ministers to encourage faith communities to actively help reduce substance use disorders and mitigate their impact on families and children. An outcome of this meeting was the publication Core Competencies for Clergy and Other Pastoral Ministers in Addressing Alcohol and Drug Dependence and the Impact on Family Members. For more information, please refer to the Web site with the full report at http://alt.samhsa.gov/grants/competency/css/menu.htm.

Educating Clergy About the Treatment of Substance Use Disorders

In addition to recognizing the problem, clergy members need to understand that, like other chronic disorders, substance use disorders are medical conditions that can be treated.⁹ A major study published in the Journal of the American Medical Association in 2000 is one of several studies demonstrating the success of treatment for substance use disorders.¹⁰ Treatment of both mental health and substance use disorders can help prevent the exacerbation of other health problems, including cardiac and pulmonary diseases, according to SAMHSA's Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Health Disorders in 2002.¹¹

Since many clergy members are not required to learn about substance use disorders during their seminary or educational training, it is important that they subsequently learn about the types of treatment options available should a member of their congregation seek their advice. Treatment is offered in different settings, and types of treatment greatly depend on the substance misused, as well as a person's individual needs and characteristics. Treatment is offered in residential and outpatient programs and can include counseling or other behavioral therapy, family therapy, medication, or a combination.^{12, 13}

Some people may require medical detoxification (detox), a process administered under the care of a physician that helps manage physical withdrawal symptoms. Brief interventions by counselors also provide more immediate attention to people waiting for specialized programs.¹⁴ Another option is the use of medications such as buprenorphine and methadone as a component of treatment for addiction to opiates.¹⁵ For more information about buphrenorphine, visit http://buprenorphine.samhsa.gov/index.html, a Web site through SAMHSA's Center for Substance Abuse Treatment (CSAT) that includes frequently asked questions and a physician locator.

Different populations often have distinct methods of treatment that may work better for them. For example, family-oriented treatment approaches can be most effective among adolescents with substance use disorders.¹⁶ Older adults with substance use disorders have been shown to respond well to age-specific, supportive, and non-confrontational group treatment that aims to build or rebuild self-esteem. Older adults work best with staff members who are interested and experienced in working with older adults.¹⁷ Clergy should be aware of the different options available for all members of their congregations. To refer someone to a treatment facility, please visit SAMHSA's Substance Abuse Treatment Facility Locator at www.findtreatment.samhsa.gov or call 1-800-662-HELP.

To help those in need of treatment, SAMHSA administers the Access to Recovery (ATR) grant program, an initiative announced by President Bush in 2003 to help people in need of treatment to secure the best treatment options available to meet their specific needs. The competitive grant program gives recipient states, territories, the District of Columbia, and tribal organizations broad discretion to design and implement federally supported voucher programs to pay for a range of effective, community-based substance use disorder clinical treatment and recovery support services. By providing vouchers to people who need treatment, the grant program promotes individual choice for treatment and recovery services. It also expands access to care, including access to faith- and community-based programs, and increases substance use disorder treatment capacity.

As a minister and an executive director of a treatment program, I am blessed to be able to see the miracle we know as "recovery" occur daily. We work with the homeless, addicted, and mentally ill in the Seattle area, journeying with them as they seek healing, hope, and restoration. Our services are free, on demand, and delivered with hope and dignity. As the founding director of the Matt Talbot Recovery Center, I-along with the center itself-am celebrating 20 years of this work. The most amazing lesson for me in these two decades is this: the human spirit is more resilient than we can imagine. A family may give up on a person and people may give up on themselves. But if we woke up this morning, a power greater than ourselves believes in us. "May we find Him now." Our job is to help people begin to believe, and relationships are the key. Mother Teresa said, "The greatest poverty in the world is loneliness." If we will be present, the miracle can begin. Gregory K. Alex, M.A., CDC Executive Director The Matt Talbot Recovery Center		Spirituality as a Component of Treatment Since so many Americans have some religious or spiritual beliefs, it is no surprise that many people incorporate these ideas into their approach to health care. A Lancet study reported that 79 percent of Americans believe that spiritual faith can help people recover from disease and 63 percent think that physicians should talk to patients about their spiritual faith.18, 19 However, while more than 80 percent of physicians generally refer their patients to clergy and pastoral care providers, only 19 percent recommend this kind of referral when the patient suffers from a substance use disorder.20 Clergy members should know their local treatment providers, physicians, and other health care specialists and establish productive relationships with them. Physicians and substance use treatment specialists are in an excellent position to ask patients about their spiritual needs and, where appropriate, refer people to clergy members or spiritually based programs to support their recovery. This relationship can educate clergy about substance use disorders and help health care providers better respond to requests for a religious or spiritual element to be incorporated into a person's treatment.21 Addressing Stigma and Discrimination Despite the effectiveness of treatment, stigma and discrimination present a barrier for people with substance use disorders who wish to access treatment. They also inhibit the ongoing recovery process. Stigma detracts from the character or reputation of a person. For many people, stigma can be a mark of disgrace and a barrier to receiving treatment.22 In 2004, 21.6 percent of the 1.2 million people who felt they needed treatment but did not receive it indicated it was because of reasons related to stigma.23

Discrimination, on the other hand, is an act of prejudice. It can include denying someone employment, housing, accommodation, or other services based on the revelation that the person is receiving treatment or has previously been treated for a substance use disorder.²⁴ Discrimination ignores the fact that substance use disorders can strike people of any age, gender, race, ethnicity, education level, and geographic area.²⁵

Unfortunately, stigma and shame are a large part of why a person who needs treatment for a substance use disorder may not seek help. Overall, 37 percent of people in recovery say that when they first decided to seek help, they were either very or somewhat concerned that other people would find out about their substance use disorder.²⁶ Because many people trust the clergy, they are in a unique position to change this perception by creating a discussion in their congregations about the pervasiveness of substance use disorders and the need to address them.²⁷

While nearly all clergy acknowledge that substance use disorders are an important issue concerning their congregants and their families, 58 percent of clergy polled for one study admit that they avoid discussing alcohol use disorders with the people they counsel.²⁸ Though the reasons are unclear, it is possible that clergy may not be aware of the importance of engaging in an open dialogue about substance use disorders.

Some people with substance use disorders may not confide in their priest, rabbi, minister, or other spiritual leader because of a phenomenon called "the paradoxical user"-a person who has a substance use disorder who is a member of a religious group that prohibits the use of any substance.²⁹ Within a more conservative religious culture, people who have a substance use disorder may become further isolated, contributing to a downward spiral.³⁰ This demonstrates that substance use disorders can affect people regardless of their religious affiliation.³¹

Tools for Clergy to Help People With Substance Use Disorders

There are resources designed to specifically help clergy and faith-based groups create an open dialogue about substance use disorders. Twelve-step groups such as Alcoholics Anonymous and Narcotics Anonymous are spiritually based resources for people with these disorders. Another example of incorporating spiritual concepts into substance use disorder treatment is a treatment program at Hazelden. This program offers a variety of treatment components, including group and individual therapy, in either a residential or an outpatient setting. Hazelden broadens the concept of the 12-step program into a full course of therapy.³²

In addition, the Johnson Institute's Rush Center assists people of faith in developing caring communities that promote the prevention of alcohol, tobacco, and drug use, and that value and support recovery from substance use disorders.³³ Also, the Clergy Recovery Network is a resource for clergy who suffer from substance use disorders themselves. The Clergy Recovery Network supports, encourages, and provides resources to clergy in recovery, and can be reached at 406-292-3322 or on its Web site at www.clergyrecovery.com.

Another resource is the Non-Denominational Clergy Leadership Training Pilot Project, a collaboration between SAMHSA and the National Association for Children of Alcoholics (NACoA) that develops and repackages publications and videos for congregations of all denominations to use. Topics include understanding substance use disorders and their impact on the family, the importance of finding support, and empowering people to initiate and sustain steps toward recovery. For more information, contact NACoA at 301-468-0985.

There are other resources for faith-based organizations, which have a long history of meeting the critical needs of their communities, including those related to substance use and mental disorders. Some organizations form relationships with companies and private foundations to help provide better resources to people in need. Maximizing Program Services Through Private Sector Partnerships and Relationships:  A Guide for Faith- and Community-Based Service Providers, a SAMHSA publication, is a manual that explains how to develop these partnerships to benefit your organization.³⁴ It can be ordered free of charge through SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) by calling 800-729-6686.

Making a Difference:  What Can I Do?

1. As a member of the clergy, learn about the symptoms of substance use disorders, so you can respond to and support those who have them, their family members, and members of your congregation in recovery.
2. Get acquainted with people in your congregation who are in recovery and encourage them to share their positive treatment and recovery stories with others.
3. Learn about treatment facilities in your community so you can immediately assist someone who approaches you for help.³⁵
4. Educate health care professionals about the need to incorporate spirituality into a recovery plan. Clergy can give physicians and treatment specialists the tools they need, such as proper language about how to fulfill these requests.³⁶
5. Be aware of the stigma outside your religious community that exists about people with substance use disorders. Know that substance use disorders are a disease and should be treated as such, and those who come forward should be supported and not judged.
6. Organize a clergy training program in your community.

Making a Difference:  How Can I Contribute to Recovery Month?

Help celebrate National Alcohol and Drug Addiction Recovery Month (Recovery Month) this year and support the observance's 2006 theme: "Join the Voices for Recovery:  Build a Stronger, Healthier Community."

1. Incorporate information about substance use disorders, treatment, and recovery into your sermon during September.
2. Schedule Recovery Month events in your community, such as forums and educational workshops with speakers who are in recovery.
3. Offer space in your church, synagogue, or mosque for recovery groups (such as Alcoholics Anonymous) to meet.³⁷
4. Prepare a fundraiser, such as a bake sale, car wash, or clothing drive, to help assist congregants who are in need of treatment or who are in recovery.
5. Create a community network of congregants and clergy to offer support for people with substance use disorders and those in recovery.
6. Offer opportunities for members of the congregation to tell their personal recovery stories to help reach out to others who may need assistance.
7. Write a letter in your congregation's weekly or monthly bulletin to spread the word about Recovery Month events in your community and the resources that can help people in recovery.

For additional National Alcohol and Drug Addiction Recovery Month (Recovery Month) materials, visit the Recovery Month Web site at www.recoverymonth.gov or call 1-800-662-HELP.

For additional information about substance use disorders, treatment, and recovery, please visit SAMHSA's Web site at www.samhsa.gov.

Clergy and Faith-Based Resources

This list is not exhaustive of all available resources. Inclusion does not constitute endorsement by the U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration, or its Center for Substance Abuse Treatment.

SOURCES

¹  Rivlin, A., presentation at Community Anti-Drug Coalitions of America Science Writers' Briefing, Pittsburgh, PA, September 29, 2005, slide #4. Survey data collected August 2005 by Peter D. Hart Research Associates.
²  So Help Me God: Substance Abuse, Religion and Spirituality. New York: The National Center on Addiction and Substance Abuse at Columbia University, November 2001, pp. 1, 3.
³  Ibid, p. iii.
⁴  Results From the 2004 National Survey on Drug Use and Health: National Findings. DHHS Publication No. (SMA) 05-4062. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2005, pp. 155, 160.
⁵  So Help Me God: Substance Abuse, Religion and Spirituality, p. 3.
⁶  Ibid, pp. iii, 3.
⁷  Ibid, pp. 21, 22.
⁸  Core Competencies for Clergy and Other Pastoral Ministers in Addressing Alcohol and Drug Dependence and the Impact on Family Members, DHHS Publication No. [XXXX]. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2004, p. ii.
⁹  Pathways of Addiction: Opportunities in Drug Abuse Research. National Academy Press. Washington, D.C.: Institute of Medicine, 1996.
¹⁰  Kleber, H.D., O'Brien, C.P., Lewis, D.C., McLellan, A.T. "Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation." Journal of the American Medical Association, 284 (13), Chicago, IL: American Medical Association, October 4, 2000, p. 1689.
¹¹  Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Health. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2002, p. ix.
¹²  Treatment Improvement Protocol (TIP) 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. DHHS Publication No. (SMA) 04-3939. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2004, pp. 51 and 58-59.
¹³  Treatment Improvement Protocol (TIP) Series 39: Substance Abuse Treatment: Group Therapy. DHHS Publication No. (SMA) 04-3957. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Printed 2004, Chapter 1.
¹⁴  Treatment Improvement Protocol (TIP) 34: Brief Interventions and Brief Therapies for Substance Abuse. DHHS Publication No. (SMA) 99-3353. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 1999, p.1 of Executive Summary.
¹⁵  Treatment Improvement Protocol (TIP) 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, pp. 51, 58-59.
¹⁶  Rowe, C.L., Liddle, H.A. "Substance Abuse." Journal of Marital and Family Therapy 29(1), January 2003, pp. 97-120.
¹⁷  "Clinical Guidelines for Alcohol Use Disorders in Older Adults." The American Geriatrics Society Web site, November 2003: www.americangeriatrics.org/products/positionpapers/alcoholPF.shtml, section entitled "Features of preferred treatment options for abuse/dependence among older adults." Accessed September 26, 2005.
¹⁸  McNichol, T. "The new faith in medicine." USA Today. April 7, 1996, p. 4.
¹⁹  Sloan, R.P., Bagiella, E., and Powell, T. "Religion, spirituality, and medicine." The Lancet, 353, February 20, 1999, p. 664.
²⁰  Daaleman, T.P. and Frey, B. "Prevalence and patterns of physician referral to clergy and pastoral care providers." Archives of Family Medicine, Vol. 7. Chicago, IL: American Medical Association, November/December 1998, p. 550.
²¹  So Help Me God: Substance Abuse, Religion and Spirituality, p. 4.
²²  Faces & Voices of Recovery Public Survey. Washington, D.C.: Peter D. Hart Research Associates, Inc., and Coldwater Corporation, May 4, 2004, p. 2.
²³  Results From the 2004 National Survey on Drug Use and Health: National Findings, pp. 78-79.
²⁴  Concurrent Disorders: Beyond the Label, An Educational Kit to Promote Awareness and Understanding of the Impact of Stigma on People Living with Concurrent Mental Health and Substance Use Problems. Toronto, ON: Centre for Addiction and Mental Health, 2005, slide #7.
²⁵  Results From the 2004 National Survey on Drug Use and Health: National Findings, pp. 67-72.
²⁶  The Faces of Recovery. Washington, D.C.: Peter D. Hart Research Associates, Inc., October, 2001, p. 10.
²⁷  So Help Me God: Substance Abuse, Religion and Spirituality, p. iii.
²⁸  "Spirituality and Religion: New Enlightenment for Addiction Recovery." HopeNet Web site: www.hopenetworks.org/FaithNRecovery.htm, section entitled "Among the key findings of the study."
Accessed August 18, 2005.
²⁹  Bahr, S.J. and Hawks, R.D. "Systems-oriented prevention strategies and programs: Religious organizations." In R.H. Coombs and D. Ziedonis (Eds.), Handbook on drug abuse prevention: A comprehensive strategy to prevent the abuse of alcohol and other drugs. Boston, MA: Allyn and Bacon, 1995, pp. 159-179.
³⁰  Olitzky, K.M. and Copans, S.A. Twelve Jewish Steps to Recovery. Woodstock, VT: Jewish Lights Publishing, 1991.
³¹  So Help Me God: Substance Abuse, Religion and Spirituality, p. 16.
³²  Ibid, pp. ii, 28.
³³  "About the Rush Center." The Rush Center of the Johnson Institute Web site: http://rushcenter.org/. Accessed September 26, 2005.
³⁴  Maximizing Program Services Through Private Sector Partnerships and Relationships: A Guide for Faith- and Community-Based Service Providers. DHHS Publication No. (SMA) 05-4119. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2005, p. 1.
³⁵  "Recovery Celebration!" Recovery Ministries. The Episcopal Church Web site: www.episcopalrecovery.org, section entitled, "Support Recovery."
³⁶  "Spirituality and Religion: New Enlightenment for Addiction Recovery." HopeNet Web site: www.hopenetworks.org/FaithNRecovery.htm, section entitled "Among the key findings of the study."
³⁷  "Recovery Celebration!" Recovery Ministries. The Episcopal Church Web site: www.episcopalrecovery.org, section entitled, "Do This."