What 540,000 Participants Teach Us About Spirituality and Substance Use

A newly published meta-analysis in JAMA Psychiatry examined more than 540,000 participants across 55 longitudinal studies and found something significant: spirituality is associated with a measurable reduction in harmful alcohol and drug use.

Across studies, spiritual engagement was linked to a 13 percent reduction in risk of hazardous substance use. For individuals attending religious services more than weekly, the reduction increased to approximately 18 percent. In addiction treatment, where single-digit percentage improvements in retention or relapse reduction are often celebrated, these findings are clinically meaningful.

Why This Conversation Gets Polarized

Within behavioral health, professionals often divide into camps. On one side are advocates of harm reduction, emphasizing overdose prevention, syringe services, and medication-assisted treatment. On the other are clinicians rooted in abstinence-oriented or spiritually integrated models.

Too often, the discussion becomes ideological rather than clinical. But the data do not support ideological rigidity. They support expanding options.

Harm reduction strategies have significantly reduced mortality in the era of fentanyl and synthetic opioids. Organizations like SAMHSA continue to emphasize the lifesaving value of medication-assisted treatment (MAT), naloxone distribution, and evidence-based behavioral interventions.

At the same time, longitudinal data now show that spirituality—broadly defined—is associated with lower rates of harmful substance use across alcohol, tobacco, cannabis, and other drugs.

We do not need ideology. We need evidence-informed options.

Spirituality Is Broader Than Religion

One critical nuance in the research is the definition of spirituality. It extends beyond institutional religion and includes meaning, purpose, connection, transcendence, and relationship to community or something larger than oneself.

That distinction matters in clinical settings.

It would be inappropriate to assume every client should enter a faith-based program. For some individuals—particularly those with histories of religious trauma—strictly dogmatic environments may be countertherapeutic. Client autonomy and treatment fit remain central ethical obligations.

However, avoiding spiritual assessment altogether because clinicians are uncomfortable discussing it is equally problematic. If we claim to provide whole-person care, we must be willing to assess and explore meaning, values, and purpose when relevant.

Integrating Spiritual Assessment Responsibly

Incorporating spirituality into addiction treatment does not require proselytizing or endorsing a particular belief system. It requires thoughtful assessment:

What gives your life meaning?

What connects you to something larger than yourself?

Have spiritual or religious practices supported your recovery before?

Have spiritual experiences caused harm?

Treatment centers can responsibly expand services to include optional spiritual support groups, chaplaincy access, mindfulness practices, or partnerships with community leaders—while equally maintaining secular, trauma-informed, cognitive-behavioral, and medication-based pathways.

Choice is not compromise. It is ethical care.

Harm Reduction and Spirituality Are Not Opposites

One of the most damaging dynamics in addiction treatment is the false dichotomy between harm reduction and spirituality.

Harm reduction keeps people alive. It reduces overdose deaths, infectious disease transmission, and medical crises. The World Health Organization recognizes harm reduction strategies as critical public health interventions.

Spiritual engagement, when client-directed and voluntary, can increase resilience, strengthen social networks, enhance motivation, and deepen long-term recovery commitment.

There is no inherent contradiction between offering naloxone and exploring purpose. There is no conflict between medication-assisted treatment and discussing transcendence.

Addiction is biopsychosocial—and often existential. Neurobiology, trauma history, social determinants, medication, community, and meaning all intersect. Effective treatment requires layered, individualized approaches.

Expanding the Menu of Care

The responsible clinical stance is not to defend a camp. It is to defend options.

The research does not mandate faith-based programming. It does not diminish secular approaches. It does not override client autonomy. What it does is add to a growing body of evidence that spirituality may function as a protective factor in substance use prevention and recovery.

At the same time, mortality reduction through medication, overdose prevention, and harm reduction services is well documented and non-negotiable.

Addiction treatment is not a purity contest. It is life-and-death care.

If we are serious about reducing suffering, we must expand access to evidence-informed pathways: faith-integrated care for those who seek it, secular trauma-informed treatment, medication-assisted treatment, peer recovery support, and meaning-centered therapy.

Citation

Koh HK, Frederick DE, Balboni TA, et al. Spirituality and Harmful or Hazardous Alcohol and Other Drug Use: A Meta-Analysis of Longitudinal Studies. JAMA Psychiatry. Published online February 18, 2026. doi:10.1001/jamapsychiatry.2025.4816

About the Author

Carmichael McKinley Finn, MA, LMFT, LADC, AADCR-MN, is Executive Director of Recovering Hope Treatment Center, a Minnesota-based residential and outpatient program serving women and families affected by substance use disorders. He writes and teaches on leadership, ethics, supervision, and evidence-based addiction treatment.