God forbid! Rethinking substance use, religion, and spirituality

In view of its importance in helping us to understand addiction, research on psychoactive substance use in relation to religion and spirituality is now recognized as an important endeavor. However, the vast majority of studies focus on major religions in Western Europe and in the United States, especially Christianity and Judaism, and on alcohol and cannabis consumption. There is also an overemphasis in the literature on pathologized and negative conceptualisations of substance use, WEIRD (western, educated, industrialized, rich, and democratic) participants, and addiction treatments that are inaccessible to the majority of the world’s population. In this editorial we offer constructive suggestions for broadening research in an inclusive agenda to advance our understanding of substance use globally and in diverse populations.

Excessive substance use as a problem of the body, mind, and spirit is a stronghold in much of the research that has been published, and more engagement is needed with alternative perspectives. Both the prohibition of substance use in Christian denominations (e.g. Baptist, Mormon) and in Buddhism and Islamism, and the relative condonement of excessive alcohol use in parts of other faiths (e.g. Catholicism and Judaism), continue to shape a narrative of incompatibility between substance use and religion and spirituality. Negative perceptions of substance use are also reinforced by the disease model of addiction in biomedicine and beyond (Heather et al. 2018, 2022), and the harm reduction goal of public health (Tupper 2008). In comparison, beneficial psychoactive substance use is marginalized in the literature (Engel et al. 2021; Nelson 2021; Thal et al. 2022), even though there are many examples worldwide and throughout history (alongside arguments that religion and even human consciousness might have even emerged in our ancestors’ substance use; e.g. Rush 2013). For example, Waldstein (2020) reported on the centrality of cannabis and tobacco in facilitating spiritual experiences among Rastafari people in the United Kingdom. In Rastafari smoking rituals, cannabis acts as a ‘plant teacher’ (Tupper 2008) and guides experienced smokers to become ‘spiritual bodies’ by embodying the divine through a heightened state of consciousness and sensory awareness, especially when combined with meditation and trance. Habitual ritualistic cannabis and tobacco smoking also helps to transmit Rastafari culture, social values, and language. These findings are countercultural to the literature’s Western-centric narrative of immorality, abnormality, and harm; indeed, even words such as ‘addiction’, ‘substance use’, and ‘substance use disorder’ are problematic for the Rastafari diaspora in the U.K. who distinguish between a plant (e.g. cannabis) that has divination and healing qualities and a drug (e.g. alcohol, cocaine, heroin, Prozac, Viagra, etc.; Waldstein 2020). Comparing the experiences of ethnic majority group members (i.e. Euroamericans) and minority group members (Waldstein 2020; Davey and Zhao 2021; Nelson 2021) clearly illustrates how an overly exclusive focus on Western conceptualisations of substance use—and the types of questions researchers routinely pose—runs the risk of perpetuating an incomplete picture of the behaviors and concepts we seek to understand.

More engagement with positive and beneficial uses of psychoactive substances will help to dispel the generalization in the literature that findings of negative statistical associations between substance use, especially alcohol and cannabis use, and religion or spirituality variables, regardless of how they have been measured (Gorsuch and Butler 1976; Miller 1998; Chitwood et al. 2008), hold for all populations and settings. Another simplification in previous work is an assumed protective function of religion or spirituality, as conjectured for instance in reports of their roles in aiding recovery from alcohol and other substance problems and in associations between addictive behaviors and irreligion or conflict with faith (e.g. Miller, 1998; Faigin et al. 2014; Kelly and Eddie 2020). Going against the grain of this narrative, Zhao et al. (in press) found that Chinese Buddhist adolescents with higher tendencies of tobacco use tended to engage more with religious activities and had better spiritual wellbeing, likely explained by religious and spiritual and social meanings of tobacco. This work thereby highlights the limitations of Eurocentric views of addiction and religion and spirituality, and cautions against parroting hypotheses predicting inverse statistical relationships between these variables or protective functions that privilege ethnocentric stereotypes over other social constructions of substance use and substance-induced sensory experiences. Oddly, previous reports of positive and non-significant relationships (e.g. Baldinger et al. 1972; Gregoire 1995; Chitwood et al. 2008; Yun and Lee 2017) have been buried away in the literature, along with their nuances and complexities. Another overlooked point in previous work is the involvement of substance use in prayer, ritual, and ceremony in major religions, such as the drinking of wine in Christian and Jewish traditions, and the use of alcohol in Buddhist ceremonies (Newman et al. 2006). In other words, our field needs to be sensitive to the possibility that religion and/or spirituality can endorse rather than protect against substance use, requiring more research on specific aspects of religions and cultural contexts.

WEIRD participants continue to be the mainstay of the literature even though there are differences in substance use and religion and spirituality in relation to demographic attributes such as ethnicity, gender, religion, sexual orientation, and social economic status (Morjaria and Orford 2002; Chitwood et al. 2008; Bliss 2009). Currently, people unaffiliated with a religion, such as atheists and agnostics and their variants (e.g. agnostic theists, theist Jews), are largely absent from the literature even though they might be religious or spiritual to some extent (or indirectly connected to religious events secularly). A focus on atheists could therefore further our understanding of substance use in countries with large numbers of atheists such as in East Asia. Similarly, non-secular moral teachings and forms of social control that might influence substance use, such as Confucianism, require further investigation (Yun and Lee 2017). Major religions such as Christianity are nonidentical across countries, for example, in South Korea it has fused with Confucianism and Shamanism (Yun and Lee 2017). Thus, the many instruments that have been developed to measure substance use, religion, and spirituality in Western countries might be unsuitable for non-WEIRD participants (Morgan 2002; Bliss 2007; Chitwood et al. 2008), and we urgently require the development of culturally appropriate measures. Another perennial measurement issue is ‘measurement imperialism’ whereby universal survey items are imposed on people who do not share the same meanings and worldviews: take, for example, adolescent smokers in China who do not self-identify as smokers even though they regularly consume cigarettes, as their smoker/non-smoker identities contrast to the definitions and labels employed in Western-developed surveys based on consumption and nicotine dependence levels (Davey and Zhao 2020).

Bottom-up approaches guided by the people under study, especially critical methods and indigenous psychology, can help to resolve some of these issues as well as draw attention to the biased nature of measurement. In particular, ethnographic research, although unfashionable in the substance use literature, is needed to gain detailed and micro-level emic perspectives of the religion/spirituality and substance under study, as exemplified in Waldstein’s (2016) awareness of becoming a spiritual body through her own engagement with Rastafari bodily rituals. Innovative approaches to documenting experiences of addiction in everyday life are also urgently needed (Pienaar et al. 2015). Reflexivity is particularly useful for researchers to interrogate how their own epistemological positions shape the research process. For example, in our recent work we found it useful to reflect on the inappropriateness of our tobacco control and addiction framework for understanding the emotional and social complexity of smoking in China (Davey and Zhao 2021).

More studies of addiction treatment that draws upon spiritual resources and respective epistemologies would also contribute to decolonizing the literature (Koram 2019; Daniels et al. 2021; Lasco 2022). While there are excellent examples of culturally sensitive approaches to recovery that incorporate religious and spiritual beliefs (e.g. Mohatt et al. 2008; Winkelman 2014), most studies have been conducted on white Christians (Morjaria and Orford 2002; Morjaria-Keval 2006), and are underpinned by the dominant biomedical rationale that is less relevant to the majority of the world’s population reliant on traditional healing. Even minority ethnic communities in Western industrialized and rich countries often bypass counseling services in favor of religious and spiritual services (Morjaria-Keval 2006). Furthermore, emphasis in the literature on the treatment of individual psychopathology might prioritize Euroamerican worldviews of the self (Markus and Kitayama 1991), and neglect social and political issues that shape addiction (Pienaar et al. 2015). It can even be argued that drug prohibition is racialised and upholds colonial power structures (Koram 2019; Daniels et al. 2021; Lasco 2022). We particularly like Tupper’s (2008) suggestion of reframing the harm reduction mindset as a ‘benefit maximization’ perspective, to recognize traditional purposes of substance use alongside protocols and policies to minimize risk (as is the case, for example, in the ceremonial use of peyote in the Native American Church in the U.S.A.). However, reconciling these competing perspectives on substance use is a delicate balancing act between human rights, public health, and criminal justice as well as ethical responsibilities in research and practice.

Where do we go from here? Although religious morals, abnormal psychology, and public health, as well as existing methods of inquiry, are undoubtedly useful for understanding aspects of substance use and addiction, the spectrum of perspectives in diverse societies and throughout the world can no longer be neglected. The cross-disciplinary nature of Addiction Research & Theory is particularly important in this call for action. A greater representation of diversity among researchers will also help to change what we regard as a somewhat oppressive literature. As we move forward at this critical juncture, we hope this editorial stimulates reflection on possible future directions in the years ahead.

Disclosure statement

No potential conflict of interest was reported by the author(s).