Faith-Based ProgrammesAcross the world, many programmes that aim to prevent youth drug abuse or to treat youth with drug problems promote specific religious beliefs and practices. This approach is especially the case in the Middle East and in developing countries. In Western countries religion is less prominent in drug abuse prevention and treatment, but religion-based programmes do have a presence.In the USA, President George W. Bush recently introduced legislation to increase federal support for religious programmes involved in substance abuse prevention and treatment and to remove some controls on their activities. This is not unwelcome news to some professionals but others have raised concerns about civil liberties, the quality of religious programmes and the qualifications of staff in programmes run by religious organizations (Drug Policy Alliance, 2003; National Association of State Alcohol and Drug Abuse Directors, 2000). The move does, however, signify that, at least in the USA, religion is emerging as an issue of significance in substance abuse programmes and there is a need to monitor trends and to evaluate new initiatives. Proponents of prevention programmes that emphasize specific religious beliefs and practices find support in evidence from surveys and a few prospective studies showing that adults and teens who consider religion to be important and who attend religious services weekly tend to be less likely than others to smoke, drink or use drugs (Kutter and McDermott, 1997; De la Rosa and White, 2001; National Centre on Substance Abuse, 2001). There are many reasons why this might be the case, including: (1) adherence to religious proscriptions against the use/excessive use of particular substances; (2) the satisfaction, through religion, of needs that can lead to drug use (e.g., finding a meaning in life); and (3) involvement in time-filling activities that do not involve drug use (e.g., services or youth groups). It is also possible that people who choose to involve themselves in religious institutions have other characteristics that reduce their vulnerability to substance abuse, like supportive families. There are many anecdotal accounts and case studies of religion-based initiatives that have contributed to positive changes in communities and groups where drug abuse and other problems are prevalent (Wilkerson and Sherrill and Sherrill, 1986; O'Connor, Ryan and Parikh, 1998; Hartmen, 2003). One currently unpublished cohort study (Saunders, 1999) showed that youth involved in a 120-day religion-based substance abuse prevention programme had lower levels of depression and perceived stress and an increase in self-esteem following the programme. However, no controlled studies of religion-based initiatives have been reported, so we do not know if these prevention programmes are inherently more or less effective than others.Religiosity and involvement in religious institutions may, however, contribute to resilience against substance abuse (Rolf and Johnson, 1999) and some effective prevention programmes involve components designed to enhance these and other protective factors (Johnson et al, 1996). Professionals should, therefore, consider involving religious groups or institutions in planning and implementing new prevention programmes in communities where they are likely to be respected. However, it would be important to protect young people from religious cults (Myers, 1991) or aggressive religious proselytizing and to promote alternative routes to religious or spiritual fulfillment. It would also be important to be aware that heavy binge drinking has been observed among adolescents involved with religions that prohibit the use of alcohol (Kutter and McDermott, 1997). This may reflect rebelliousness or a lack of exposure to social drinking. Proponents of religion-based treatments for youth who have significant drug problems find support from anecdotal reports by recovering addicts (Zimmer, 2002). Religion-based treatments emphasize prayer, the study of religious texts and participation in religious ceremonies. There is no research showing that religion-based programmes are more effective than others. Rather the research indicates that the most effective treatment programmes for youth are flexible and holistic and emphasize skill building, recreation, nutrition, relapse prevention and peer support (Health Canada, 2001). Religion-based programmes that have these characteristics may be as effective as others and have the advantage of being able to provide religious instruction to those who might benefit. However, there is no evidence that this is the case and there are concerns that some religion-based programmes are ideologically poorly equipped to address the complex issues presented by many clients (National Mental Health Association, 2000).Substance abuse prevention and treatment are complex issues and there is still much to be learned about what works best and for whom. Religion may have a role to play, but religious convictions and practices are neither necessary nor sufficient for effective prevention or treatment initiatives, and there is some concern that religion-based activities can be inconsistent with best practices. Like all prevention and treatment programmes, those based on religion need to be carefully evaluated by independent researchers using objective indicators of success. Anything less would be a disservice to those in need.The growing interest in 'spirituality' in substance abuse prevention and treatment might also be noted in this context. This term has different, and sometimes idiosyncratic, meanings. For some people, spirituality is clearly associated with religious beliefs and practices. For others, it concerns a sense of purpose and meaning associated with nature or relationships or self-knowledge. In substance abuse treatment programmes, spirituality tends to be used in connection with the notion of the higher power as understood by Alcoholics Anonymous. Many recovering people report that spirituality plays an important role in the recovery process (Pardini et al., 2000), and spirituality (variously defined) is associated with the decreased likelihood of substance abuse. Many prevention and treatment programmes now have 'spirituality' components. However, research has not clearly demonstrated the effectiveness of these components and there is a need for more rigorous evaluations, especially for programmes that target youth. In addition to the need to evaluate all prevention and treatment initiatives, the following should be considered when these initiatives involve religion or spirituality:1. The need to respect those with different beliefs and those who do not accept religious teachings. 2. The need to recognize that religious convictions and related personal experience do not in themselves qualify those involved as experts in substance abuse prevention or treatment.3. The need to ensure that governments do not reduce funds for substance abuse services on the assumption that such services can be provided by religious charities.4. The need to recognize that young people with substance abuse problems may be vulnerable to manipulation by religious cults.5. Religious proscription against the use of alcohol has been associated with binge drinking among adolescents.
