Ethical and spiritual frameworks in U.S. substance use prevention: A narrative review of faith-informed approaches

Substance use disorders (SUDs) have proven to be a long-standing public health issue in the United States and are therefore leading to a resurgence of interest in faith-based prevention and recovery. This review is a narrative discussing the ethical and spiritual models, processes, efficacy, and constitutional factors that form the bases of faith-based interventions. Practice is organized in three major styles: 12-step mutual aid focuses on personal spirituality and higher power qualities; faith-based organizational programs that combine religious teaching and community practice; and spirituality-focused clinical counselling that views spirituality as an instrument of therapy. There is even some evidence that culturally sensitive and truly voluntary faith-based programs can be used to improve the engagement and recovery process, especially in people with substantial levels of identification with their religious affiliations. Spirituality seems to work in mechanisms such as meaning-making, moral development, social support, and identity formation. Despite this, some major issues still prevail in the areas of coercion, church-state separation, constitutional compliance, and the boundary of the ethics of the profession, particularly when publicly funded. Other weaknesses that reduce the evidence base include methodological weaknesses, small samples, and limited comparative research in terms of effectiveness. The potential of faith-informed approaches is meaningful, yet to progress the field, it is necessary to conduct rigorous assessment, ethical protection, and adherence to the evidence-based practice of public health.