Can Churches Bring Addiction Treatment to Rural Areas?
Effective treatment for substance use disorders (SUDs) is scarce in much of the United States. People with SUDs in rural counties have a high risk of overdose and face steep barriers to accessing treatment. These communities need accessible and culturally sensitive treatment options tailored to their populations.
One promising yet underexplored approach to bring SUD treatment to their communities is partnering with faith-based organizations. The overlap of high mortality, low treatment availability, and religious attendance in rural communities highlights the potential success of these partnerships.
Why Is This So Promising?
Rural areas in the US have been hit hard by the opioid crisis. Research has found that people with opioid use disorders who reside in Appalachia, the Midwest, and the Rocky Mountain region are at an elevated risk of overdose. This is due to many factors, including the difficulty in bringing effective treatment to geographically dispersed counties, often because of physician shortages. In 2017, Americans in more than half of all counties in the United States lacked access to medical providers that could prescribe medications for opioid use disorder—the majority in the regions above.
Bringing treatment for SUDs to these communities has been identified by researchers and providers as particularly challenging. Innovation will be crucial as cultural norms in rural America can influence how and why people seek medical attention, and how treatment is perceived by the community.
A comparison of the data collected by the US religious census in 2010 (exhibit 1) and the 2019 National Survey of Substance Abuse Treatment Facilities (N-SSATS) (exhibit 2) shows that counties with high rates of religious adherence (affiliated with a congregation) frequently lack treatment for substance use disorders.
Four hundred and twelve counties (13.1 percent of total US counties) had more than 60 percent of the population identified as religious adherents and lacked any substance use treatment services. These disparities increase when you narrow in on specific services such as medication for addiction treatment (MAT). Churches in these communities serve as a hub for social connection, dissemination of information, and influence attitudes—all of which are key to addressing the opioid crisis.
How Would This Work?
There is already an infrastructure in place to provide religious organizations with the resources they need to implement addiction treatment in their communities. In 1996, Congress passed “charitable-choice” laws to allow faith-based organizations to apply for federal grant funding. With those laws in place, the George W. Bush, administration created the Office of Faith-Based and Community Initiatives in 2001, which fosters partnerships between federal agencies and religious organizations engaging in public interest activities. This program was later renamed the White House Faith and Opportunity Initiative by the Trump administration, which further solidified religious organizations’ ability to receive federal funding.
Through this structure, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers support through faith-based community initiatives including partnership and grant funding to underserved communities with inadequate resources to treat addiction. These funding opportunities hold tremendous promise; in some black communities, where religious participation is high, these grants have been used to increase treatment avenues and improve social attitudes toward treatment. But despite these efforts, these mechanisms remain underused and difficult to navigate.
Facilitating Faith-Based Community Partnerships
Many churches are not strangers to the opioid crisis. Churches are often eager to provide support to families impacted by addiction through self-help groups and counseling. Despite controversy among addiction medical professionals, evidence shows that religious participation can be a protective factor in recovery. While that may be a proxy for increased community and social support, it is well founded that faith-involved treatment delivery can have positive impacts on community prevention and treatment of substance use disorders.
Robust research shows that delivering treatment that honors and respects the beliefs of the population is important to treatment retention, building relationships, and improving outcomes. SAMSHA even developed an online toolkit to help walk religious institutions through providing care to their communities.
The sections below briefly describe how these partnerships can positively impact a community and provide examples of how these partnerships have proven successful in the past; particularly for efforts around harm and stigma reduction, social support, and medication delivery.
Harm Reduction Services
Rural counties struggle to provide key harm reduction strategies such as Narcan distribution and needle exchanges, but religious organizations have helped implement programs around both with success. There are numerous reports of churches partnering with harm-reduction programs to provide clean needles to the benefit of their community. These exchanges are a key resource to people who use drugs; they reduce the risk of transmissible diseases such as HIV and hepatitis c and reduce injection-related infections.
Narcan is a nasal spray that reverses opioid overdoses and saves lives. It can be administered by anyone and is especially valuable in the hands of those in the same social network as people using opioids. Churches may be an ideal place to distribute overdose rescue kits and educate members of the community on how to use this lifesaving medication. Like needle exchanges, many churches already do this.
Reducing Stigma And Providing Social Support
Bias and community stigma can discourage people with SUD from seeking life-saving medication treatment or engaging with harm reduction efforts, leaving them isolated, and thwart treatment centers from entering communities. This can be especially true in rural areas where the communities are small and there is little refuge from the opinions of others. Churches can serve as places to address those misconceptions and educate community members on the reality of addiction. Church leaders can help foster a culture of understanding and support of evidence-based care; some already have.
Churches have long hosted support groups for people and families struggling with addiction. Many people in recovery rely on both spiritual and secular support groups such as Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery to provide structure and community while facing the cyclic nature of addiction. These groups are designed to be anonymous and often operate subtly and away from the general parish, for the comfort and privacy of the attendees. But it is also important that there are ways a community outwardly supports, recognizes, and values people with SUD.
Medications For Addiction Treatment
While providing MAT in a church setting may be complicated and challenging, this approach could still serve as a critical space to encourage and motivate people to initiate medications. The Imani Program, an innovative pilot program funded by SAMSHA, provides group classes, cognitive behavioral therapy, and wellness coaching in churches while also connecting interested participants to medication for opioid use disorder. Building relationships through and with churches can open important lines of communication.
The Controversy Behind Faith-Based Approaches
Faith-based initiatives have been controversial since the passage of charitable choice laws, in particular around exclusionism. Increasing treatment services at churches will likely exclude unaffiliated members of the community. However, harm reduction and education have secondary benefits that expand beyond the individual receiving the services. For example, the person given Narcan as a precaution may not be the person revived by it. In a small town, where information is likely to spread quickly—and beyond the bounds of the initial group—a hub of distribution by any means can be impactful. Partnering with churches should be considered one way to do this although should not be seen as a comprehensive solution to a fractured treatment infrastructure.
Effective solutions to the opioid crisis rely on culturally sensitive care that engages communities and patients. This is particularly true in rural areas. Due to the relatively high rates of religious participation in many rural communities, faith-based community initiatives may be a respectful and impactful approach to providing addiction treatment. Unease about relying on religious organizations is not a good enough reason to dismiss these options; the devastation of the opioid crisis is too great to discard any avenue for success.