Religiousness, Spirituality, and Substance Use: A Genetically Sensitive Examination and Critique

• Published date: 01 July 2017
• Author: George Richardson,Ian A. Silver,Joseph L. Nedelec
• DOI: 10.1177/0022042617693382
• Date: 01 July 2017
• Subject Matter: Articles

https://doi.org/10.1177/0022042617693382

Journal of Drug Issues

2017, Vol. 47(3) 340 –355

© The Author(s) 2017

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DOI: 10.1177/0022042617693382

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Article

Religiousness, Spirituality, and

Substance Use: A Genetically

Sensitive Examination and Critique

Joseph L. Nedelec1, George Richardson1, and Ian A. Silver1

Abstract

A growing literature has linked religiousness and spirituality (R/S) to substance use and abuse.

However, it is not clear that R/S has causal effects on substance use. Currently, there is a

relative lack of genetically sensitive examinations in the literature attendant to R/S effects. Given

that behavioral genetic analyses have illustrated the influence of genetic factors on substance

use and adherence to R/S worldviews, genetic confounding is a concern. The current study

employed a sample of monozygotic twins discordant on religiousness, spirituality, and spiritual

transformation to assess effects on substance use and abuse. Bivariate and multivariate models

indicated a general lack of effect of R/S on substance use and abuse but did illustrate a dampening

influence of religiousness on general (but not problematic) alcohol use. The findings highlight

the importance of controlling for genetic and shared familial factors in examinations of the

religiousness–spirituality–substance use nexus.

Keywords

religiousness, spirituality, substance use, MZ discordance, genetic confounding

Introduction

Substance abuse among adolescents and young adults is a substantial national health concern.

According to Substance Abuse and Mental Health Services Administration (SAMHSA; 2014),

5.2% of youth aged 12 to 17 met the criteria for illicit substance abuse or dependence in 2013,

while the prevalence among young adults aged 18 to 25 was 17.3%. In addition, 2.5% of youth

aged 12 to 17 met the criteria for alcohol abuse or dependence, while 13% of young adults aged

18 to 25 met these criteria. More than 15 years ago, Miller (1998) called for studies of whether

religiousness and spirituality (R/S) were important protective factors for substance abuse. Since

then, a growing literature has linked R/S to substance use and abuse (as reviewed below).

However, it is not clear that the effects of R/S are causal in nature. The current study addresses

this issue using a monozygotic twin discordance approach and data derived from a nationally

representative study.

1University of Cincinnati, OH, USA

Corresponding Author:

Joseph L. Nedelec, School of Criminal Justice, University of Cincinnati, 660-E TDC, Cincinnati, OH 45221-0389, USA.

Email: joseph.nedelec@uc.edu

693382JODXXX10.1177/0022042617693382Journal of Drug IssuesNedelec et al.

research-article2017

Nedelec et al. 341

Religiousness and Substance Abuse

Burkhardt and Solari-Twadell (2001) defined religiousness as “an understanding of a particular

faith-based system or dogma, and the participation in the rituals and services provided by a faith

community” (p. 49). Similarly, Steger, Hicks, Krueger, and Bouchard (2011) defined the construct

as “adoption of a core set of previously established beliefs and practices concerning the ultimate

nature of life and existence” (p. 181). Religiousness seems to reliably predict lower levels of sub-

stance abuse (e.g., Brown et al., 2001; Wallace & Forman, 1998; Yonker, Schnabelrauch, &

DeHaan, 2012), and studies have begun to characterize the mechanisms that may explain this

effect. For instance, moral development theory suggests that religiousness facilitates moral devel-

opment (e.g., by instilling moral values or serving as a moral compass) and is therefore helpful in

addressing a broad suite of outcomes generally seen as unfavorable, including substance abuse

(Koenig, King, & Larson, 2012). Consistent with this argument, research suggests that self-control

(DeWall et al., 2014) and the view that substance use is sinful (D’Onofrio, Eaves, Murrelle, Maes,

& Spilka, 1999) mediate effects of religiousness on substance use. Stemming in part from evi-

dence linking religiousness and substance abuse, researchers have indicated that faith or religion-

based intervention can be helpful in substance abuse prevention (Koenig et al., 2012; National

Center on Addiction and Substance Abuse [CASA] at Columbia University, 2001; Wallace, Myers,

& Osai, 2004). Currently, however, it is not clear whether the association between religiousness

and substance use is causal in nature. This is largely because it is not feasible to randomly assign

people to levels of religiousness. As a consequence, studies employing approaches that can address

confounding in observational research are needed.

Spirituality and Substance Abuse

Spirituality is another factor that has been puported to protect against substance abuse. Burkhardt

and Solari-Twadell (2001) defined spirituality as “integration of meaning and purpose in life

through connectedness with self, others . . . nature, or a power greater than oneself” (p. 49).

Higher levels of spirituality (Hodge, Cardenas, & Montoya, 2001; Ritt-Olson et al., 2004), spiri-

tual importance (CASA, 2001), spiritual connectedness and coping (Cotton, Zebracki, Rosenthal,

Tsevat, & Drotar, 2006), and meaning or purpose in life (Miller, 1998) have been linked to lower

levels of substance use. Clinical studies of the effects of spiritual practices such as mindfulness,

in samples of individuals who present for substance use disorder (SUD) treatment, provide addi-

tional potential evidence that aspects of spirituality impinge on substance abuse. For instance,

Spiritually Modified Cognitive Behavior Therapy (SMCBT; Hodge, 2011), Mindfulness-Based

Cognitive Behavior Therapy (MBCBT), and Mindfulness-Based Stress Reduction (MBSR) all

appear to improve treatment outcomes (Hawley et al., 2014; Hodge, 2011). Research has even

identified some of the neurobiological alterations that mediate the effects of mindfulness (e.g.,

decreased gray matter in the amygdala; Taren, Creswell, & Gianaros, 2013). Finally, Kelly, Stout,

Magill, Tonigan, and Pagano (2011) found evidence suggesting increased spiritual practices may

partially mediate the effect of Alcoholics Anonymous (AA) participation.

Given the apparent promise associated with incorporating spirituality into treatment, the

United States Joint Commission recommended that behavioral health organizations providing

SUD treatment conduct a thorough spiritual assessment (Hodge, 2011). There is currently a

dearth of research examining the potential effectiveness of spiritual constructs in substance abuse

prevention (CASA, 2001). In 2001, practically no research was available to provide guidance on

how spirituality might be employed in effective prevention programs (CASA, 2001). Reviews of

the extant literature indicate that little has changed in this regard—it is currently unclear whether

the plausibly causal effects reported in studies of individuals who select to treatment for SUDs

generalize to the broader population.