Causation of Drug Abuse and Treatment Strategy

Abstract

Many offenders participate in drug abuse treatment programs while in prison or on probation or parole. Among other benefits, this treatment may lessen the risk of recidivism. Thus, understanding counselor treatment philosophy is important as their attitudes toward treatment can be influential in the strategies they use and ultimately affect treatment outcomes. Analyzing data from 110 drug abuse treatment counselors, this study compared counselors’ perceptions of causation of drug abuse and treatment strategy between faith-based and secular treatment programs. It was found that counselors from faith-based programs were more likely to endorse religious models and less prone to support disease models as an explanation of drug use. With regard to treatment strategy, counselor’s group affiliation was not predictive of a focus on either a client religious need or a medical treatment model. Nevertheless, the extent of counselor’s religiosity was correlated with tackling clients’ religious needs as a treatment strategy. On the other hand, certified (licensed) counselors were found to be more supportive of the medical model as a treatment approach. Limitations of the current study and policy implications are discussed.

Keywords

counselor counselors’ perception faith-based treatment religion-based treatment religiosity religion model disease model

Introduction

Nestled beneath every substance abuse treatment intervention is a theoretical model of problem behaviors. These models contain assumptions about human nature, beliefs about determinants of human behavior, and expectations about how various therapeutic strategies fit together to promote health and well-being. All clinical practices are supported by conscious and unconscious conceptual underpinnings that permeate the perceptions and attitudes of those delivering these services. Formalizing these underlying frameworks constitutes the first step toward the development of evidence-based practices in substance abuse treatment that are theoretically grounded and empirically validated (Perepletchikova & Kazdin, 2006; Sung & Gideon, 2011).

Recent developments in governmental strategy and thinking about how to address social problems have led to an increase in the funding of faith-based initiatives for health, social welfare, and behavioral problems (Longshore, Anglin, & Conner, 2009); however, research has not kept pace with this shift in policy. Increasing scholarly attention has been directed to examining the relationship between religion and mental and physical health, but little research has been devoted to understanding the treatment philosophies and strategies involved in faith-based treatment programs. Also lacking is an understanding of counselors’ perceptions of treatment strategies in religion or faith-based programs.

Criminal justice agencies are the major suppliers of substance abuse treatment clients in the United States, accounting for between 28% and 51% of all community-based substance abuse treatment admissions (Center for Behavioral Health Statistics and Quality, 2012). A recent survey of treatment facilities found that the proportion of criminal justice–referred clients averaged 22% among faith-based service providers and 41% among secular providers (Sung, Chu, Richter, & Shlosberg, 2009). A better understanding of the underlying perceptions and theoretical models that counselors bring to substance abuse treatment is important because counselors are key players in treatment and can be influential in treatment outcome (Humphreys, Noke, & Moos, 1996). This ideology–practice connection will ultimately affect drug use relapse among clients in general and criminal recidivism among criminal justice–referred clients in particular.

In recent years, psychologists have begun to emphasize the importance of taking a culturally sensitive approach with their clients, and this may include factors such as the religious beliefs and preferences of clients (Chu & Sung, 2009; Sue, 1999; Walker, Walker, Gorsuch, & Tan, 2004). Recent meta-analytic findings show that psychotherapists, regardless of their personal religious/spiritual preferences, attain better outcomes when they adapt or match their treatment strategy to a range of the individual characteristics of their clients such as a client’s preference for a male or female therapist, a client’s cultural heritage, or a client’s particular religion/spirituality (Norcross & Wampold, 2011). Worthington, Hook, Davis, and McDaniel (2011) who carried out the meta-analysis on religion/spirituality found that incorporating the particular religious/spiritual approach of clients into therapy was “demonstrably effective” and let to better psychological and spiritual outcomes. Given the importance of bringing a client’s particular religious/spiritual approach or way of making meaning into their treatment, it becomes all the more important to understand how the counselors’ religious/spiritual approach or way of making meaning influences their treatment strategy. This study examines how the religious/spiritual backgrounds of substance abuse treatment counselors affect their perceptions of the causes, solutions, and treatment strategies to substance abuse and how those perceptions and treatment strategies vary between counselors in faith-based and secular treatment programs.

Treatment Philosophy and Staff Beliefs

Existing studies of how counselor attributes affect substance abuse treatment include several dimensions or aspects of the counselor. Some studies examined whether the recovery status of counselors affects their beliefs about the nature and causes of addiction (e.g., Humphreys et al., 1996) or client perception of treatment effectiveness (e.g., Culbreth, 2000). Humphreys and colleagues (1996) found that staff’s recovery status is not correlated with endorsement of disease and psychosocial models of substance abuse; nevertheless, staff’s recovery status is associated with endorsement of an eclectic model in which staff view diverse treatments as appropriate as they can address the needs of the diverse population of illicit drug users. Culbreth (2000) found that counselors with or without a history of substance abuse tend to use different methods to achieve their treatment goals; nevertheless, the treatment outcomes and clients’ perceived effectiveness are similar regardless of counselors’ recovery status. Other studies assessed the influence of substance abuse counselor attitude on their support for harm reduction versus traditional interventions for injecting drug users (Bonar & Rosenberg, 2010). In a recent study, Bouffard and Smith (2005) compared counselor characteristics, such as age, racial composition, education level, years of work experience, and recovery status, in a rural and urban drug court setting. There is no research, however, that explores the differences in counselor treatment philosophies between faith-based and secular programs.

The institutional culture of any service provider nurtures specific beliefs and knowledge among staff; it also creates certain expectations among clients and rewards certain responses to treatment in a way that maintains a self-selection process. That is, the official narrative adopted by the organization is intended to shape the attitudes and behaviors of individual staff members and clients and thus trigger change and recovery. On the other hand, individual perceptions of treatment can also affect a program’s culture and goals as individual staff also convey their philosophies and perceptions to clients (Humphreys et al., 1996). Thus, the nature/culture of the treatment program and the individual beliefs and characteristics of the counselors influence, to some extent, the preferred treatment beliefs and strategies of the counselors.

Among all existing treatment approaches, the loosely labeled faith-based modality remains the least conceptually articulated and systematized. Several factors contribute to this deficiency. First, there has been very little effort at translating the religious constructs and language surrounding faith-based interventions into social and behavioral science categories susceptible to empirical testing. This lack of conceptual clarity around faith-based interventions is likely to fade quickly; however, because the scientific study of religious institutions and experience is advancing at an astonishing pace (e.g., Neff, Shorkey, & Windsor, 2006). Second, the methodological and substantive diversity within the faith-based treatment movement resists any unifying meta-narrative. Some interventions are known as faith-based because they are sponsored by religious groups but have very little religious content; others place religious material and content at the center of their treatment approach. Faith-based services also vary enormously because of their denominational backgrounds. The best way to approach this challenge of categorization is probably to recognize this heterogeneity and to theorize about the faith-based model of the particular program under review. Third, providers of faith-based services have traditionally not shown much interest in developing evidence-based practices, but this began to change, when the Clinton administration put forth several initiatives (e.g., Charitable Choice) to make religious organizations eligible for government funding (U.S. Department of Health and Human Services, 2004). The requirement of evidence-based practices has been slowly growing across funding sources and will continue to encourage faith-based programs to open up to external evaluations and consider how to integrate evidence-based practices into their work (Sung et al., 2009).

Theoretical Framework

All treatment practices are founded on determined assumptions about the causes of substance abuse and addiction; about human nature, free will, and responsibility; and about how various life factors can be manipulated to trigger and maintain abstinence. Neff et al. (2006) identified some characteristics in faith-based treatment programs and applied Durkheim’s (1915/1948) classic structural-functional model to explain the features of faith-based treatment. They proposed that religious organization can be viewed as an integrated system of beliefs and practices for the purpose of fulfilling collective social functions, such as enhancing self-discipline and social cohesion (Alpert, 1961; Neff et al., 2006). Alienation from God and a self-centered lifestyle are often offered as the root causes of substance abuse; recovery, therefore, represents a spiritual journey that reconnects the individual with God, a renewed purpose in life, and self-control. Neff and colleagues posit that the practices of religion, such as prayer, not only strengthen the belief system of individuals but also facilitate the integration of individual people into a collective community.

On the other hand, mainstream understanding of substance abuse is quickly shifting to viewing addiction as an attribute of genetic determinism and brain disease (Vohs & Baumeister, 2009). Addiction is now widely accepted as a compulsive disorder resulting from chemical imbalances in the reward system of the brain. Consequently, most non-faith-based treatment programs tend to be receptive to a medical discourse that welcomes pharmacological treatment as an adjunct or alternative to traditional cognitive, behavioral, or social interventions (Neff et al., 2006). In sum, the disease model that centers on the biological foundations of addiction prescribes a medical model of intervention that addresses the biological and behavioral needs of substance abusers (Leshner, 1997; Vrecko, 2010).

Based on the above delineation, we assume that counselors in faith-based programs would be more likely to endorse religious models as an explanation of causation of drug abuse and as their treatment strategy. On the other hand, counselors in non-faith-based programs would be more prone to endorse disease models as an explanation of drug abuse, and thus emphasize medications as their treatment strategy.

Method

Data Collection and Samples

We used an independent random sampling method to select a group of faith-based and secular treatment providers in the United State. One hundred and twelve faith-based counselors were randomly selected from the 232 facilities listed on the 2006 Teen Challenge Facility Directory (Teen Challenge USA, 2006). Teen Challenge USA is a network of more than 200 residential treatment centers affiliated with the Assemblies of God, the largest Pentecostal denomination in the country (Sung et al, 2009). Established as a ministry targeting street gang members in the late 1950s, Teen Challenge has become a provider of services to adult substance abusers: adult clients aged 18 or older form 88% of its treatment population (Sung & Chu, 2008). One hundred and five counselors of secular programs were randomly taken from the 4,435 community-based residential treatment providers listed on the National Directory of Drug and Alcohol Abuse Treatment Programs 2005 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2005). Eighty-seven percent of the client populations in the surveyed secular programs were adults aged 18 or older (Sung & Chu, 2008). Programs with observable religious connection, such as the Salvation Army and the Catholic Charities, were excluded from the pool of secular programs to make the most of secularity in the comparison group.¹

Survey instruments were constructed for this study. Questions regarding respondents’ attitudes toward religion and science were adopted and modified based on items pertaining to the religion, morality, and science domains of the General Social Survey by the National Opinion Research Center (2007). Drug treatment and drug policy preferences were measured with Likert-type scale questions specifically created for this study. The first section consisted of items measuring counselors’ background characteristics. The second, third, and fourth sections measured religious attitudes and behavior, perceptions of human nature and science, attitudes toward drug abuse, drug treatment, and drug policy preferences. The last section consisted of items measuring practice of counseling.

A pretest was conducted early in 2006 to solicit feedback through a small pilot survey among 12 counselors in Odyssey House, a secular substance abuse treatment provider in New York City. The counselors who participated in the pretest were then dropped out of the pool. The formal survey was conducted via mail between May and December of 2006. Two hundred and seventeen survey packages (112 to faith-based counselors and 105 to secular counselors) were sent out, each of which consisted of a copy of the questionnaire, a consent form, and a 3-dollar cash incentive. One hundred and ten (59 from faith-based [Teen Challenge] facilities and 51 were from secular [non-Teen Challenge] facilities) out of 217 surveys were returned, resulting in a 51% of response rate. The response rate for faith-based (Teen Challenge) counselors was 53% and the response rate for secular treatment providers (non-Teen Challenge) was 49%.

As shown in Table 1, 61% (n = 36) of the sampled counselors in the faith-based treatment programs are males; 39% (n = 23) of them are females. The percentage of male and female counselors in the secular programs differs somewhat (49% of males vs. 51% of females). Sixty-six percent of the respondents in the faith-based and about 75% of them in the secular programs are Whites; approximately 21% of the counselors in faith-based and secular programs are African Americans. About 9% (n = 5) of the sampled counselors in the faith-based treatment programs are Hispanics. There are no Hispanic counselors in the secular treatment programs. Approximately 32% of the sampled counselors in the faith-based programs are college graduates or hold a graduate degree. Compared with the counselors in the faith-based programs, the counselors in the secular programs tend to have a higher educational level. More than a half of them (53%) have either a bachelor’s or master’s degree. The proportion of certified (licensed) counselors is also higher in the secular programs (72% in the secular programs vs. 17% in the faith-based programs). About three quarters (76% in the faith-based vs. 77% in the secular programs) of the sampled counselors in both programs are in recovery. More than a half (56.9%) of the sampled counselors in the faith-based programs are Protestant; only 29% of the counselors in secular programs are Protestant. With regard to the extent of religiosity, about 83% of the sampled counselors in the faith-based programs claimed they were very religious, whereas about a half of them (51%) in the secular programs reported that they were very religious. About 17% of the sampled counselors in the faith-based programs reported that they were moderately religious; approximately 39% of the sampled counselors in the secular programs reported that they were moderately religious. Two percent of the respondents reported that they were not religious at all, and about 8% of the respondents in the secular programs stated that they were slightly religious.

Table 1.

Descriptive Statistics of Counselors’ Demographic Characteristics.

	Faith-based treatment program number (%)	Secular treatment program number (%)
	M (SD)	M (SD)
Sex
Male	36 (61.0)	25 (49.0)
Female	23 (39.0)	26 (51.0)
Total	59 (100.0)	51 (100.0)
Race
White	39 (66.1)	38 (74.5)
African American	12 (20.3)	11 (21.6)
Hispanic	5 (8.5)	0 (0.0)
Asian	0 (0.0)	1 (2.0)
Native American	2 (3.4)	0 (0.0)
Others	1 (1.7)	1 (2.0)
Total	59 (100.0)	51 (100.0)
Education
Less than high school	3 (5.1)	1 (2.0)
High school or GED	20 (33.9)	3 (5.9)
Some college or associate degree	17 (28.8)	20 (39.2)
Four-year college graduate	13 (22.0)	14 (27.5)
Graduate degree	6 (10.2)	13 (25.5)
Total	59 (100.0)	51 (100.0)
Certified counselor
Certified	10 (16.9)	36 (72.0)
Uncertified	49 (83.1)	14 (28.0)
Total	59 (100.0)	50 (100.0)
Counselor in recovery
Yes	44 (75.9)	39 (76.5)
No	14 (24.1)	12 (23.5)
Total	58 (100.0)	51 (100.0)
Religious preference
Protestant	33 (56.9)	14 (28.6)
Judaism	0 (0.0)	2 (4.1)
Hinduism	0 (0.0)	1 (2.0)
Catholicism	0 (0.0)	7 (14.3)
Islam	0 (0.0)	3 (6.1)
Buddhism	0 (0.0)	1 (2.0)
Agnosticism	0 (0.0)	2 (4.1)
Other	25 (43.1)	19 (38.7)
Total	58 (100.0)	49 (100.0)
Extent of religiosity
Not religious at all	0 (0.0)	1 (2.0)
Slightly religious	0 (0.0)	4 (7.8)
Moderately religious	10 (17.2)	20 (39.2)
Very religious	48 (82.8)	26 (51)
Total	58 (100.0)	59 (100.0)

In summary, there are differences between the two sets of counselors in our study that are important to control for. Compared with the counselors in the secular programs, the faith-based counselors in this study sample seem more likely to be male, Hispanic, Protestant, have a lower level of education, not be certified/licensed as a counselor, and say they are more religious.

Measures

Dependent variables

Two dependent variables (religious model and disease model) were created to measure the dimension of causation of drug abuse. Respondents were asked to assign a score from 1 to 12 to indicate the relative importance of 12 statements (Appendix A), which represent a particular view of causation of drug abuse. A score of 1 represents the best explanation for causation of drug abuse; a 2 represents the next best explanation for drug abuse, and so forth. To gauge our theoretical model for explaining the root causes of drug abuse, statements that tap religious and disease models were selected to create dependent variables. Religious model is based on a single item: “Drug abuse is caused by a consequence of separation from God.” The disease model is an additive measure that includes two items: “Drug abuse is a brain disease” and “People are genetically predisposed to drug abuse.” All items were reverse coded. A higher score indicates that the statement provides a better explanation for drug abuse. In other words, a score “12” was assigned if the respondent rated the specific statement as the best explanation among the 12 listed statements for drug abuse and a score “11” was assigned if the respondent rated the statement as the next best explanation for drug abuse. The disease model of causation is constructed by adding the scores of the two items stated above.

In the section of the survey on drug abuse treatment, each respondent was asked to rank 10 statements from 1 to 10 regarding treatment strategy/goal (see Appendix B). A score of 1 represents the strategy or goal of drug treatment that the respondent thinks is most important, a “2” represents the next most important strategy or goal, and so forth. To create dependent variables, we used two statements that gauge our religious and medication models as treatment strategy. The first variable “addressing religious needs” was based on a single item: “Treatment must address the spiritual or religious needs of clients.” The second variable, “medication,” was also based on a single item: “Treatment must include medications either as maintenance or during detoxification.” All items were reverse coded to ease interpretations. The higher the score, the more important the particular treatment strategy is.

Independent and control variables

The primary independent variable—group affiliation—was based on the counselor’s affiliation. It was coded as 1 if the counselor worked in a Teen Challenge affiliated substance treatment network. It was coded as 0 if the counselor worked for a non-Teen Challenge treatment programs. The control variables consist of gender, age, race, education level, certification, recovery status, years of experience, caseload, Protestant, and extent of religiosity. Gender is a dummy variable with 1 representing male and 0 as female. Age and years of experience are continuous variables. Race was coded as a dummy variable with 0 representing non-White and 1 representing White. Caseload is a continuous variable in which the counselor was asked, on average, how many clients do they have on his or her treatment caseload at any time? Protestant was coded as dummy with 0 representing non-Protestant and 1 representing protestant. Education level was an ordinal variable: 1 = less than high school, 2 = high school or GED, 3 = some college or associate degree, 4 = 4-year college graduate, and 5 = graduate degree. Certification was coded as a dummy variable with 0 representing uncertified or unlicensed and 1 representing certified or licensed. Recovery status is a dummy variable with 0 indicating that the counselor was not a recovered drug user and 1 indicating that the counselor was a recovered drug user. Previous research indicated that the personal beliefs of counselors who were in recovery may affect their preferred treatment strategy (Humphreys et al., 1996). Humphreys and colleagues (1996) indicated recovering counselors are more likely to endorse an eclectic approach that incorporates diverse treatments for clients. To examine whether individual religiosity had any impact on counselor perception of drug causation and their preferred treatment strategy, we also included religiosity as a control variable. The variable “extent of religiosity” was an ordinal variable: 1 = not religious or spiritual at all, 2 = slightly religious or spiritual, 3 = moderately religious or spiritual, and 4 = very religious or spiritual.

Initially, a composite of religious behavior that included frequency of religious attendance, Bible study, and seeking God for strength was created as a control variable. However, further examination of variance inflation factor (VIF) indicated a problem of multicollinearity between religious behavior and faith-based/non-faith-based program affiliation. Consequently, the only religious control variables retained in the regression model were “extent of religiosity” and “Protestant/non-Protestant.” Collinearity among all independent and control variables was examined by VIF values (results not shown). All of the VIF values are below 2.0, and there is no indication of collinearity.

Analytical Strategy

Mean comparison analyses focused on the mean differences between counselors in faith-based and secular programs across demographic characteristics, causation of drug use, and treatment strategy. In a multivariate analysis, we used ordinary least squares regression to examine the effects of independent variable (group affiliation) and control variables on the variables of “religious model,” “disease model,” “addressing religious needs,” and “medication.”

Mean Comparison

Table 2 presents the results from the t test on counselors’ demographic characteristics, causation of drug abuse, and preferred treatment strategy between counselors in faith-based and secular programs. Counselors in faith-based and secular programs differed significantly in some of their background characteristics. Compared with counselors in secular programs, counselors in faith-based programs were younger. The average age of faith-based counselors was about 41, whereas the mean age for counselors in secular programs was 48. In addition, counselors in secular programs were more likely to have a higher level of education and to hold a license. Counselors in faith-based programs were more likely to be Protestant and have a higher level of religiosity. Counselors in faith-based programs were also significantly more likely to prefer a religious model of drug abuse causation and a treatment strategy of addressing religious needs. In terms of gender, race, experience, recovery status, and caseload, there were no significant differences between counselors in faith-based and secular programs.

Table 2.

Descriptive Statistics and Mean Comparison of Variables.

	Faith-based			Secular
	M	SD	n	M	SD	n	t
Causation of substance abuse
Religious model	9.27	4.23	59	5.10	4.06	49	5.20***
Disease model	7.41	6.66	58	16.61	6.94	49	−6.98***
Treatment strategy
Addressing religious need	10.32	3.45	59	8.59	3.14	51	2.74**
Medication	4.41	3.01	59	6.73	3.29	51	−3.86***
Control variables
Gender (male = 1)	0.61	0.49	59	0.49	0.51	51	1.26
Race (White = 1)	0.66	0.48	59	0.75	0.44	51	−0.96
Age	40.73	9.56	59	48.35	10.76	51	−3.94***
Education	2.98	1.09	59	3.69	0.99	51	−3.52**
Certified counselor (yes = 1)	0.17	0.38	59	0.72	0.45	50	−6.91***
Years of experience	6.62	6.21	55	7.99	6.69	51	−1.10
Counselor in recovery (yes = 1)	0.76	0.43	58	0.76	0.43	51	−0.074
Caseload	15.60	12.75	53	12.01	7.98	51	1.72
Protestant (yes = 1)	0.57	0.50	58	0.29	0.46	49	3.04**
Religiosity/spirituality	3.83	0.38	58	3.39	0.72	51	4.00***

p <.05. **p < .01. ***p < .001, two-tailed.

Table 3 presents the results of mean comparisons of causation of drug abuse and treatment strategy that were significantly different between counselors in faith-based and secular programs. As displayed in the first part of Table 3, out of the 12 statements (see Appendix A) that reflect a particular view about the causes of drug abuse, the variations in four statements were statistically significant, suggesting that counselors between faith-based and secular programs differed in their attitudes toward the following explanations of drug abuse: “drug abuse is brain disease,” “drug abuse is a consequence of separation from God,” “drug abuse is caused by a lack of parenting and family bonding,” and “people are genetically predisposed to drug abuse.” In comparison with their counterparts in secular programs, counselors in faith-based programs were more likely to perceive that drug abuse is caused by a separation from God or a lack of parental monitoring/family bond. On the other hand, counselors in secular programs were more prone to conceive that drug abuse is a brain disease or caused by genetic propensity.

Table 3.

Mean Comparison: Causation of Drug Abuse and Treatment Strategy.

	Total (N = 110)		Faith-based (n = 59)		Secular (n = 51)
	M	SD	M	SD	M	SD	t
Causation of drug abuse
Brain disease	5.39	4.69	3.07	3.50	8.14	4.45	−6.65***
Separation from God	7.38	4.63	9.27	4.23	5.10	4.06	5.20***
Lack of parenting/bond	6.33	3.72	7.31	3.67	5.16	3.47	3.10**
Genetically predisposed	6.32	4.22	4.38	3.88	8.58	3.42	−5.92***
Treatment strategy
Positive self-concept	9.30	3.08	8.71	3.45	9.98	2.46	−2.19*
Reduce stress	8.18	3.04	7.41	3.18	9.08	2.61	−2.98**
Address religious needs	9.52	3.41	10.32	3.45	8.59	3.14	2.74**
Medications	5.48	3.34	4.41	3.01	6.73	3.29	−3.86***

Note: Statements of causation of drug abuse and treatment strategy that were not significantly different between faith-based and secular programs were not listed.

p < .05. **p < .01. ***p < .001, two-tailed.

The second part of Table 3 displays statements regarding perceptions of drug abuse treatment strategy that were significantly different between faith-based and secular treatment programs. Of the 10 statements (see Appendix B) that reveal a particular drug treatment strategy or goal, 4 of them produced a statistically significant difference. Counselors in faith-based programs were more likely to emphasize addressing clients’ religious needs as treatment strategy, whereas counselors in secular programs were more inclined to place importance on developing a positive self-concept, reducing stress, and using medication.

Multiple Regression Analyses

Tables 4 and 5 present the results of multiple regression analysis. As displayed in the first panel of Table 4, a counselor’s group affiliation was a significant predictor of the endorsement of a religious model as an explanation of drug abuse. Counselors in religion-based programs were more inclined to endorse the assumption that the drug abuse is caused by a separation from God. Among the control variables, only the variable “extent of religiosity” was positively and significantly associated with the endorsement of the religious model in explaining the causation of substance abuse. In other words, counselors with higher levels of religiosity were more likely to endorse the religious model. Combined, the independent and control variables explained 26% of the variance on the variable “religious model” as the causation of drug abuse.

Table 4.

Multiple Regression on Causation of Substance Abuse.

	Causation of substance abuse
	Religious model		Disease model
Variable	B	SE	B	SE
Program affiliation	2.867*	1.165	−5.684**	1.812
Gender (male = 1)	0.982	0.997	−0.235	1.517
Age	0.009	0.051	0.087	0.079
Race (White = 1)	−0.854	1.027	2.009	1.558
Education	−0.127	0.460	0.672	0.695
Certified counselor	−0.015	1.072	−0.351	1.684
Recovering counselor	0.084	1.115	2.138	1.729
Years of experience	0.012	0.082	−0.108	0.125
Caseload	−0.047	0.042	0.836***	0.090
Protestant	−0.038	0.955	−4.076**	1.477
Religiosity/spirituality	1.545*	0.791	−0.727	1.232
R ²	.262		.450

p < .05. **p < .01. ***p < .001.

Table 5.

Multiple Regression on Treatment Strategy.

	Treatment strategy
	Addressing religious needs		Medication
Variable	B	SE	B	SE
Program affiliation	0.911	0.933	−1.081	0.828
Gender (male = 1)	0.451	0.787	−0.335	0.699
Age	−0.024	0.041	−0.008	0.036
Race (White = 1)	−0.887	0.810	−2.838***	0.719
Education	−0.013	0.360	0.163	0.320
Certified counselor	0.707	0.852	1.602*	0.757
Recovering abuser	−0.423	0.883	0.060	0.784
Years of experience	0.064	0.065	0.040	0.057
Caseload	−0.037	0.033	−0.001	0.030
Protestant	0.804	0.760	−0.306	0.675
Religiosity/spirituality	1.590*	0.632	0.085	0.561
R ²	.171		.275

p < .05. **p < .01. ***p < .001.

Turning to the second panel, “disease model,” it was found counselor’s group affiliation was negatively and significantly correlated with endorsement of disease model. In other words, counselors in faith-based programs were less likely to endorse the disease model as an explanation of causation of substance abuse. Counselors in faith-based programs were less convinced by the explanations that drug abuse is a brain disease or is genetically predisposed. In addition, counselors of Protestant denomination were less likely to endorse the disease model. On the other hand, counselors with heavier caseloads were more likely to support the disease model. Taken together, those variables accounted for 45% of the variance on the dependent variable “disease model” as an explanation of drug use.

With regard to the dimension of treatment strategy, as shown in the first panel of Table 5, a counselor’s group affiliation had no effect on emphasizing tackling clients’ religious needs. On the other hand, the extent of a counselor’s religiosity seemed to override group affiliation, which was significantly and positively correlated with an emphasis on addressing clients’ religious needs as treatment strategy. In other words, counselors with higher levels of religiosity were more likely to stress addressing clients’ religious needs in the treatment process. Those independent and control variables accounted for 17% of the variance of the dependent variable.

Moving to the last panel of Table 5, “medication model,” it showed that race and certification were the only predictors of endorsement of the medication model among all of the independent and control variables. Group affiliation had no significant effect on endorsement of medical model. White counselors were less likely to endorse the medication model. On the other hand, counselors who were certified or licensed were more likely to be supportive of the medication model. About 28% of the variance was explained by those variables.

Discussion and Conclusion

Our study begins by asking the following questions. First, whether counselors in faith-based treatment were more likely to endorse a religious model of diagnosis and intervention for drug abuse. Second, whether counselors in secular programs were more prone to endorse a disease model as an explanation of drug abuse and advocate using medication as a treatment strategy. The findings corroborated our two hypotheses regarding the causation of drug abuse. Counselors in faith-based treatment programs were more likely to endorse the religious model, whereas counselors in the secular programs were more inclined to support the disease model as an explanation of substance abuse. In a way, the observed within-group ideological homogeneity and between-group ideological heterogeneity attest to the successful alignment of individual beliefs with institutional positions. The issue of empirical testability aside, this cognitive congruency within treatment modality can be taken as a partial indicator of ideological consistency.

Nevertheless, the other two hypotheses related to treatment strategy were not supported. In the dimension of treatment strategy, a counselor’s group affiliation was not a significant predictor of endorsement of a focus of clients’ religious needs as a treatment goal. Only a counselor’s individual religiosity was significantly correlated to endorsement of tackling clients’ religious needs as treatment strategy. This finding does not come as a surprise. It reveals reciprocal influence of institutional culture and a counselor’s individual identity (e.g., religiosity). Counselors in faith-based programs were more likely to endorse a religious model as an explanation of drug abuse. On the other hand, counselors with a higher level of religiosity were more likely to endorse a religious model as an explanation of drug abuse and advocate it as treatment strategy. As elaborated in the literature review, counselors’ personal beliefs influence their preferred treatment strategies (Humphreys et al., 1996). Although both counselors’ “group affiliation” (faith-based program) and “individual religiosity” are significant predictors of an endorsement of a religious model as an explanation of causation of substance abuse, individual religiosity overrides the influence of group affiliation on counselors’ preferred treatment practice. It suggests that counselors’ personal beliefs and perceptions (e.g., individual religiosity) are influential in their decisions for treatment practice. Future studies should incorporate in-depth interviews to further unravel why counselors’ individual religiosity is influential in determining their preferred treatment strategy. The salience of individual religiosity over institutional affiliation reveals the relatively strong religious inclination or involvement among substance abuse counselors serving in secular programs, which has been documented in the literature (Ringwald, 2002; Sung et al., 2009). Redemption from past failures, moral awakening, and spiritual revivals are known to be universal narratives used to reinforce the recovery journey of clients in treatment, within or without faith-based settings (Ringwald, 2002), and more than three quarters of the counselors in our study were in recovery.

With regard to using medication, neither counselor’s group affiliation nor individual religiosity had a significant effect on endorsing the medical model as a treatment strategy. However, if counselors were licensed or certified, they were more likely to endorse the medical model. The credentialing process emerged as a powerful and effective socialization mechanism through which the medical discourse is disseminated and internalized among clinicians seeking governmental and/or professional recognition.

Group-sanctioned worldviews shape perceptions and shared attitudes create identities. Performing substance abuse counseling is as a balancing act between providing the right kind of interventions to the right kind of people on one hand and preserving and enriching one’s own personal and professional identity on the other hand. It involves building up an occupational self-concept, acquiring a therapeutic discourse, developing therapeutic skills, and integrating all these tasks in an institutional context. However, to pursue this complex endeavor, a substance abuse counselor has to be not only a caregiver and helper but also something of a successful scientist and advocate.

Obviously, the key to success depends on the individual’s ability to effectively amalgamate institutional worldviews and individual beliefs to support an empowering professional identity (Clouder, 2003). The importance of regulation and control within the substance abuse treatment profession cannot be underestimated. There can be no mistaking that ultimately the accreditation is prescribed by the professional community of reference, and those who wish to join that community need to adapt accordingly to gain membership. In the course of daily interaction with clients and other help professionals, counselors’ very selves are subtly shaped around their own recovery experiences, their symbolic universe of reference, and the official discourse of their employers, secular or religious.

As explained in the presentation of our theoretical framework, secular and faith-based recovery programs represent two distinct schools in the treatment of substance abuse. One might expect that, in effect, newcomers to a particular school of recovery services gradually internalize the values and beliefs of members of that professional community; they therefore become subject to powerful social learning and control processes at conscious and unconscious levels. The individual is on one hand passively enveloped by the influence of various discourses that almost unconsciously shape his or her own identity, and yet, on the other hand, proactively maintains an internal dialogue that subtly shapes the institutional storyline. Neither institutional determinacy nor personal agency by itself provides a full account of the construction of counselors’ occupational identity. In other words, professional socialization is a process through which individual counselors are socially constructed, and social constructions of disease and cure are uniquely adopted and adapted by individual counselors.

As effective treatment attends to multiple needs of the individual, not just his or her drug use (National Institute on Drug Abuse, 1999, 2006), substance abuse counselors should tap into other resources available in the community to address their clients’ drug use and any associated medical, psychological, social, vocational, legal, and religious/spiritual problems. Informed openness to best practices from other traditions can only increase the professional competency of individual counselors. For counselors from faith-based groups, the extent and intensity of this cross-traditional learning can be carefully calibrated so that the religious core and identity of their work are not diluted in the process.

Recovery from substance abuse is a complex process. It is actually a long-term process in which substance abusers are to reestablish the biochemical functionality of their systems and to relinquish an old self and invent a new one. The individual is only truly recovered when he or she has acquired neural and endocrinal equilibrium, resilient life skills, new purposes, a fresh set of meanings, and a satisfying new social role (Erickson, 2007; Huguelet & Koenig, 2009; Kelly & White, 2011). Our findings and the new political and policy openness to faith-based interventions mean that vital clinical and policy questions regarding the relationship of addiction/recovery to faith-based treatment contexts and counselors can be raised concurrently and holistically in the formation of the next generation of substance abuse counselors.

The findings of the current study indicate that counselor’s group and individual religious/spiritual identities exert an important influence on understanding addiction and approaching treatment. It is important for future addiction research to account for these important variables. Old provincial truisms about the separation of church and state or the role of spirituality and recovery will be questioned, new territorial disputes across conventional disciplines will be stirred up, and seemingly awkward professional faith-based and secular identities will struggle for acceptance in the process. We should welcome and be prepared for this challenge.

Footnotes

Appendix A

Appendix B

Acknowledgements

We are grateful to the editor and anonymous reviewers for their very helpful comments on an earlier draft of this article.

Authors’ Note

An earlier version of this article was presented at the annual meeting of the 2011 Academy of Criminal Justice Sciences in Toronto.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study is supported by the Grant 2005012, awarded by the Religious Institutions Grant Program of the Louisville Institute.

Notes

References

Alpert

(1961). Emile Durkheim and his sociology. New York, NY: Russell & Russell.

Bonar

E. E.

Rosenberg

(2010). Substance abuse professionals’ attitudes regarding harm reduction versus traditional interventions for injecting drug users. Addiction Research & Theory, 18, 692-707.

Bouffard

J. A.

Smith

(2005). Programmatic, counselor, and client-level comparison of rural versus urban drug court treatment. Substance Use & Misuse, 40, 321-342.

Center for Behavioral Health Statistics and Quality. (2012, July). The TEDS—Treatment Episode Data Set report: A comparison of rural and urban substance abuse treatment admissions. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Chu

Sung

H.-E.

(2009). Racial differences in desistance from substance abuse: The impact of religious involvement on recovery. International Journal of Offender Therapy and Comparative Criminology, 53, 696-716.

Clouder

(2003). Becoming professional: Exploring the complexities of professional socialization in health and social care. Learning in Health and Social Care, 2, 213-222.

Culbreth

J. R.

(2000). Substance abuse counselors with a personal history of chemical dependency: A review of literature. Alcoholism Treatment Quarterly, 18(2), 67-82.

Durkheim

(1948). The elementary forms of the religious life: A study in religious sociology ( Swain

J. W.

, Trans.). Glencoe, IL: Free Press. (Original work published 1915)

Erickson

C. K.

(2007). The science of addiction: From neurobiology to treatment. New York, NY: W.W. Norton.

10.

Huguelet

Koenig

H. G.

(2009). Religion and spirituality in psychiatry. New York, NY: Cambridge University Press.

11.

Humphreys

Noke

J. M.

Moos

R. H.

(1996). Recovering substance abuse staff members’ beliefs about addiction. Journal of Substance Abuse Treatment, 13(1), 75-78.

12.

Institute of Behavioral Research. (2006). Survey of structure and operations (TCUSSO). Fort Worth: Texas Christian University.

13.

Kelly

J. F.

White

W. L.

(Eds.). (2011). Addiction recovery management: Theory, research and practice. New York, NY: Humana Press.

14.

Leshner

A. I.

(1997). Addiction is a brain disease, and it matters. Science, 278(5335), 45-47.

15.

Longshore

Anglin

M. D.

Conner

B. T.

(2009). Are religiosity and spirituality useful construct in drug treatment research? Journal of Behavioral Health Services & Research, 36, 177-188.

16.

National Institute on Drug Abuse. (1999). Principles of drug addiction treatment: A research-based guide [Revised April 2009]. (NIH Pub. No. 09–4180). Rockville, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse.

17.

National Institute on Drug Abuse. (2006). Principles of drug abuse treatment for criminal justice populations: A research-based guide (NIH Pub. No. 06–5316). Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse.

18.

National Opinion Research Center. (2007). The General Social Survey, 1972-2006: Cumulative codebook. Chicago, IL: Author.

19.

Neff

J. A.

Shorkey

C. T.

Windsor

L. C.

(2006). Contrasting faith-based and traditional substance abuse treatment programs. Journal of Substance Abuse Treatment, 30, 49-61.

20.

Norcross

J. C.

Wampold

B. E.

(2011). What works for whom: Tailoring psychotherapy to the person. Journal of Clinical Psychology, 67, 127-132.

21.

Perepletchikova

Kazdin

A. E.

(2006). Treatment integrity and therapeutic change: Issues and research recommendations. Clinical Psychology: Science and Practice, 12, 365-383.

22.

Ringwald

C. D.

(2002). The soul of recovery: Uncovering the spiritual dimension in the treatment of addictions. New York, NY: Oxford University Press.

23.

Substance Abuse and Mental Health Services Administration. (2005). National directory of drug and alcohol abuse treatment programs 2005. Rockville, MD: Author.

24.

Sue

(1999). Science, ethnicity, and bias: Where have we gone wrong? American Psychologist, 54, 1070-1077.

25.

Sung

H.-E.

Chu

(2008). The Assemblies of God and substance abuse: The teen challenge program. Final report submitted to the Louisville Institute. New York, NY: The National Center on Addiction and Substance Abuse at Columbia University.

26.

Sung

H.-E.

Chu

Richter

Shlosberg

(2009). Treatment philosophy and service delivery in faith-based residential treatment. Families in Society, 90, 390-398.

27.

Sung

H.-E.

Gideon

(2011). Major rehabilitative approaches. In Gideon

Sung

H.-E.

(Eds.), Rethinking corrections: Rehabilitation, reintegration, and reentry (pp. 71-96). Thousand Oaks, CA: Sage.

28.

Teen Challenge USA. (2006). 2006 directory. Springfield, MO: Author.

29.

U.S. Department of Health and Human Services. (2004). Charitable Choice. Washington, DC: Author. Retrieved from www.hhs.gov/fbci/choice.html

30.

Vohs

K. D.

Baumeister

R. F.

(2009). Addiction and free will. Addiction Research & Theory, 17, 231-235.

31.

Vrecko

(2010). Birth of a brain disease: Science, the state and addiction neuropolitics. History of the Human Sciences, 23(4), 52-67.

32.

Walker

D. F.

Walker

Gorsuch

R. L.

Tan

S. Y.

(2004). Therapists’ integration of religious and spirituality in counseling: A meta-analysis. Counseling and Values, 49, 69-80.

33.

Worthington

E. L.

Hook

J. N.

Davis

D. E.

McDaniel

M. A.

(2011). Religion and spirituality. Journal of Clinical Psychology, 67, 204-214.