I love this paper for a lot of reasons.
It’s the first meta-analysis on this topic, by the way.
Here’s the link and citation for this open access paper: 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. 2026;83(4):363–378. doi:10.1001/jamapsychiatry.2025.4816
Below, I’ll present a few quotes from the overview/abstract of the paper. Then I’ll mention a few of my favorite portions.
Objective To synthesize findings from independent studies about spirituality and AOD use and to produce a comprehensive estimate of the overall effect size of the associated risk reduction.
Study Selection From an initial retrieval of more than 20 000 articles, a total of 55 spirituality studies (as defined by Puchalski and colleagues) that were (1) published 2000-2022 in the English language, (2) used validated measures of spirituality, (3) examined longitudinal associations between spirituality and AOD use, and (4) were either prospective cohort studies with sample sizes of 1000 or more or randomized clinical trials (eg, public health interventions) with sample sizes of 100 or more, were captured.
Main Outcomes and Measures The primary outcome was the association between spiritual or religious involvement and AOD. Subgroup analyses examined differences by AOD use type (alcohol, tobacco, marijuana, and illicit drugs) and exposure type (spiritual or religious attendance vs broader spiritual exposures).
Results Results from the 55 studies, which collectively included 540 712 participants, documented a significant protective association related to both prevention and recovery between spirituality and AOD use outcomes.
What definition of spirituality do the authors use?
The authors use the following definition of spirituality from Puchalski and colleagues: “…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.”
They then state: “Although spirituality encompasses religion as part of established faith institutions, it also broadly includes other ways people find meaning, purpose, and connection to something greater than themselves.”
What kinds of studies did they examine?
48 studies looked at prevention, 4 looked at recovery, and 3 looked at both prevention and recovery. There were 41 US studies and 14 international studies published from 2001-2022. The total number of subjects was 540,712 people, with different studies in the meta-analysis ranging from 1045 to 68,376 participants.
What results did this meta-analytic study find?
The primary finding was that broad spiritual practices provided a significant protective effect related to AOD use outcomes. The effectively protective practices included “community involvement”.
The protective efficacy of spiritual practices did not differ across alcohol and other drug types.
When the authors only examined recovery studies, the size of the impact looked similar to that found for prevention.
Adding involvement in a spiritual or religious social community to ones personal spiritual practices contributed an additional 8.5% reduction in risk.
Discussion points included:
Involvement in a spiritual community of others might confer its benefit at least in part from factors such as: “social support, abstinence or non-intoxication social norms or moderation social norms, meaning and purpose, and moral beliefs.” And its influence upon “brain regions associated with stress regulation, reward processing, and social connection.”
In spite of the separation of church and state in the US constitution, the public health benefits of these protective factors could be a point of education for parents. Such as with practices like exercise.
The authors discuss “choice architecture” and “rewards” such as joy, connection, and meaning while gaining social disapproval on decisions to use.
Clinical applications and related factors are discussed.
One barrier is that the “educated professional class” might underestimate the benefit of spiritual practices and a spiritual community.
Clinicians may not be able to relate to engaging in spiritual practices or involvement in a spiritual community, but they can acknowledge the value of these regardless.
Addiction training modules can include these topics.
Targeting the “chronic stress, social isolation, and loss of meaning proposed to be root causes of ‘deaths of despair'” can be achieved by community-level spiritual resources.
Authors: Howard K. Koh, MD, MPH; Donald D. Frederick, PhD; Tracy A. Balboni, MD, MPH; Samantha M. O’Reilly, MPH; John F. Kelly, PhD; Keith Humphreys, PhD; Michael Botticelli, MEd; Maya B. Mathur, PhD; Constatine S. Psimopoulos, MBE, PhD; Katelyn N. G. Long, DrPH; Tyler J. VanderWeele, PhD.
During my years (1989-2008) working in the inner city with people experiencing severe, chronic, complex addiction illness mainly with crack and heroin, I watched many recover. And they did so in a way that included what I came to call “switching teams”.
This article really does remind me of exactly that kind of change.
