Templeton Religion Trust
What if an overlooked way of addressing substance abuse isn’t some medicine or therapy program?
What if spirituality can decrease substance abuse?
What if religious communities matter more than we thought?
The numbers are staggering. According to government data, 48.5 million people in the United States alone have a substance use disorder. Nearly 180,000 die each year from excessive alcohol use. And during just one recent year, more than 100,000 died from an opioid overdose.
Substance abuse remains one of the biggest health challenges of our time. Isolation, political polarization, global unrest, fast-developing technologies, economic strains, and the constant churn of media are supercharging anxiety and stress levels. At the same time, vulnerability to the supposedly “easy escapes” of alcohol, tobacco, marijuana, and illicit drugs also grows.
The impacts are profound for individuals, families, and communities. Yet, despite decades of research and a stockpile of hypotheses, substance abuse remains largely a problem in search of solutions.
Discoveries from a recent study led by researchers at Harvard T. H. Chan School of Public Health are a significant breakthrough in this ongoing quest. A meta-analysis of 55 of the most rigorous longitudinal studies published in the 21st century, its findings mark an important step forward in understanding the intersection of religion and health. Templeton Religion Trust was the principal funder.
“JAMA Psychiatry,” the esteemed monthly journal of the American Medical Association, has published the study.
Overall, it found that spiritual practices — including spiritual and religious community involvement, attending services, meditation, and prayer — reduced individuals’ risk of dangerous alcohol and drug use by 13%. This reduction was even greater (18%) for individuals attending religious services at least once per week. The results were consistent across all substances studied (alcohol, tobacco, marijuana, and illicit drugs). Using longitudinal data, they are the strongest evidence to date that spirituality — particularly participation in a religious community — significantly lowers rates of substance use and abuse.
“Meta-analyses of such longitudinal studies on spirituality and health are rare. This is a sort of once-in-a-decade advance,” reports senior author Tyler VanderWeele, John L. Loeb and Frances Lehman Loeb Professor of Epidemiology and director of Harvard’s Human Flourishing Program. “The consistency of the results across all the studies was striking— including over a dozen studies conducted outside of the U.S.— with all but a few showing a protective, not neutral or detrimental, effect.”
Establishing causation is a difficult challenge. Many earlier studies of the connection between spirituality and health have relied on cross-sectional data – snapshots taken at a single point in time. That makes it hard to answer what causes what. For example, does attending religious services reduce smoking and drinking? Or are people who smoke and drink simply less likely to attend services because they feel ostracized?
In contrast to such cross-sectional studies, the 55 studies selected for this meta-analysis were painstaking longitudinal studies that followed large numbers of people over time, providing the strongest data from a pool of more than 20,000 previously published investigations on spirituality and health more generally.
This study is the first of its kind to synthesize and comprehensively estimate meta-analyzing longitudinal data how dangerous substance use is impacted over time by spirituality.
“Because we were trying to move towards knowledge – not just provide additional evidence – we also considered numerous alternative explanations for the results and used sensitivity analysis techniques to assess the possibility of a variety of biases,” VanderWeele reports.
Of course, the findings don’t suggest that spirituality is a universal cure or that it always protects against substance abuse. Also, because most of the included studies were done in Western world contexts, generalizations across cultures remain less certain. That said, the findings carry implications that can be broadly applied.
“Our findings indicate that spirituality may be protective against substance misuse, one of the biggest public health challenges of our time,” said lead author Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership.
“Evidence from a single study is rarely definitive,” VanderWeele emphasizes. “But by combining evidence across a large number of the most rigorous studies, it becomes difficult to find any other explanation than that various forms of spirituality and religion have a protective effect on substance use. We can say quite definitively that, in at least some contexts, certain spiritual practices — perhaps especially participation in religious communities — decrease substance use and abuse.”
The findings don’t warrant prescribing religious service attendance as a blanket solution. They do, however, highlight religion and spirituality as potentially powerful resources — particularly for people who already identify with a faith tradition.
For clinicians, counselors, and social workers, the message is clear: When patients value their religious or spiritual identity, encouraging engagement with supportive religious communities may be both appropriate and beneficial. Shared values and supportive networks can all play critical roles in prevention and recovery.
In today’s often troubling landscape, the resources available within spiritual traditions and religious communities deserve serious consideration — not as mandates, but as meaningful options. For those who aren’t religious, “other forms of community participation can be encouraged in a thoughtful, sensitive, and ethical manner,” VanderWeele notes.
Harvard’s new meta-analysis is more than another data point. It strengthens the evidence that spirituality and caring communities can shape lives in measurable ways. The findings invite us to look beyond clinical settings for ways to combat substance abuse.
“Spirituality and religious communities can contribute in profound ways. We should more often appreciate, make use of, and take seriously their extraordinary potential,” VanderWeele concludes.