Spirituality is associated with a 13% lower risk of harmful alcohol and other drug use

A meta-analysis of studies examining the link between spirituality and the harmful use of alcohol, tobacco, marijuana, and other drugs found that higher spirituality is associated with a 13% reduction in the risk of harmful use across the studied drugs. The risk reduction was 18% in individuals engaging in spiritual or religious communities, defined as those attending religious or spiritual services more than once a week. The paper was published in JAMA Psychiatry.

Harmful or hazardous alcohol and other drug (AOD) use refers to patterns of drinking or drug use that increase the risk of physical, psychological, social, or legal problems. Hazardous use means that a person’s level or pattern of use creates a significant risk of future harm, even if serious consequences have not yet occurred. Harmful use means that alcohol or drug use has already caused damage, such as health problems, accidents, relationship difficulties, or reduced ability to work or study.

AOD can include alcohol, tobacco, cannabis, stimulants, opioids, sedatives, and other psychoactive substances. The level of risk depends on factors such as the amount used, frequency, method of use, combinations of substances, and the person’s age and health. Binge drinking is one example of hazardous alcohol use because it increases the risk of injury, alcohol poisoning, and unsafe behavior.

Using drugs in situations such as driving, operating machinery, or caring for a child is also considered hazardous. Harmful or hazardous use does not necessarily mean that a person has a substance use disorder or addiction. However, it can develop into a more severe pattern if it continues.

Study author Howard K. Koh and his colleagues note that harmful or hazardous alcohol and other drug use is a health threat affecting 16.7% of U.S. individuals, imposing major societal burdens related to hospitalizations, deaths, and economic costs. On the other hand, they note that spirituality may present an avenue to lower AOD use risk and improve chances of recovery. They adopt a definition that states that spirituality is “a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred.”

Aiming to integrate the findings on the links between spirituality and AOD risk, these authors conducted a meta-analysis of longitudinal studies based on research identified in a previously published review. The studies listed in that review were identified using “spirituality,” “religion,” or “faith” (and variants) as search terms along with a long string of terms intended to capture possible health outcomes.

The studies were published between 2000 and 2022, in the English language, used a validated measure of spirituality, and examined longitudinal associations between spirituality and AOD use or related health outcomes. The studies were also either prospective studies involving 1,000 participants or more, or randomized controlled trials or public health interventions involving at least 100 participants.

In total, this meta-analysis was based on 55 articles that met the criteria for being included in the analysis. Of the effects examined, 87% were categorized as preventive, while 13% had to do with recovery. Fifty-four of the studies were longitudinal studies of specific groups (cohorts), and one was a randomized controlled trial. The sample sizes of the individual studies ranged from 1,045 to 68,376 participants. The total number of participants across all studies was 540,712.

Results showed that higher spirituality has a protective effect against AOD misuse. Higher spirituality was associated with a 13% lower risk of AOD misuse across all four drug categories studied. In individuals who participated in religious or spiritual services more than once a week, this reduction in AOD risk increased to 18%.

The study authors report that 60% of the reported effects implied at least a 10% lower risk of AOD in individuals higher in spirituality, while 17% of studies reported at least a 20% lower risk.

“This meta-analysis underscores the holistic potential of addressing spirituality, for those desiring to do so, as part of prevention and recovery. Further exploration is needed about how spirituality can represent a greater part of both community-based and clinic-based resources,” the study authors concluded.

The study contributes to the scientific understanding of the links between spirituality and the risk of harmful or hazardous substance use behaviors. However, it should be noted that the links between spirituality and AOD were relatively weak and mostly detectable because the examined studies had massive sample sizes. Additionally, only one of the studies was a randomized controlled trial, meaning that the designs of the remaining 54 studies included in this meta-analysis do not allow definitive causal inferences to be derived from their results.

The paper, “Spirituality and Harmful or Hazardous Alcohol and Other Drug Use A Meta-Analysis of Longitudinal Studies,” was authored by Howard K. Koh, Donald E. Frederick, Tracy A. Balboni, Samantha M. O’Reilly, John F. Kelly, Keith Humphreys, Michael Botticelli, Maya B. Mathur, Constantine S. Psimopoulos, Katelyn N. G. Long, and Tyler J. VanderWeele.