Original Article

Alcohol Use and Religiousness/Spirituality Among Adolescents

Authors: John R. Knight, MD, Lon Sherritt, MPH, Sion Kim Harris, PhD, David W. Holder, MD, MPH, John Kulig, MD, MPH, Lydia A. Shrier, MD, MPH, Joy Gabrielli, BA, Grace Chang, MD, MPH

Abstract

Background: Previous studies indicate that religiousness is associated with lower levels of substance use among adolescents, but less is known about the relationship between spirituality and substance use. The objective of this study was to determine the association between adolescents’ use of alcohol and specific aspects of religiousness and spirituality.


Methods: Twelve- to 18-year-old patients coming for routine medical care at three primary care sites completed a modified Brief Multidimensional Measure of Religiousness/Spirituality; the Spiritual Connectedness Scale; and a past-90-days alcohol use Timeline Followback calendar. We used multiple logistic regression analysis to assess the association between each religiousness/spirituality measure and odds of any past-90-days alcohol use, controlling for age, gender, race/ethnicity, and clinic site. Timeline Followback data were dichotomized to indicate any past-90-days alcohol use and religiousness/spirituality scale scores were z-transformed for analysis.


Results: Participants (n = 305) were 67% female, 74% Hispanic or black, and 45% from two-parent families. Mean ± SD age was 16.0 ± 1.8 years. Approximately 1/3 (34%) reported past-90-day alcohol use. After controlling for demographics and clinic site, Religiousness/Spirituality scales that were not significantly associated with alcohol use included: Commitment (OR = 0.81, 95% CI 0.36, 1.79), Organizational Religiousness (OR = 0.83, 95% CI 0.64, 1.07), Private Religious Practices (OR = 0.94, 95% CI 0.80, 1.10), and Religious and Spiritual Coping – Negative (OR = 1.07, 95% CI 0.91, 1.23). All of these are measures of religiousness, except for Religious and Spiritual Coping – Negative. Scales that were significantly and negatively associated with alcohol use included: Forgiveness (OR = 0.55, 95% CI 0.42–0.73), Religious and Spiritual Coping – Positive (OR = 0.67, 95% CI 0.51–0.84), Daily Spiritual Experiences (OR = 0.67, 95% CI 0.54–0.84), and Belief (OR = 0.76, 95% CI 0.68–0.83), which are all measures of spirituality. In a multivariable model that included all significant measures, however, only Forgiveness remained as a significant negative correlate of alcohol use (OR = 0.56, 95% CI 0.41, 0.74).


Conclusions: Forgiveness is associated with a lowered risk of drinking during adolescence.


Key Points


* Multivariable analysis found that forgiveness was the only significant correlate of alcohol use.


* The association was in the negative direction (high forgiveness: lower risk of alcohol use).

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References

1. Grant JD, Scherrer JF, Lynskey MT, et al. Adolescent alcohol use is a risk factor for adult alcohol and drug dependence: evidence from a twin design. Psychol Med 2006;36:109–118.
 
2. Grant BF. Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the National Longitudinal Alcohol Epidemiologic Survey. J Stud Alcohol 1997;58:464–473.
 
3. Robins LN, Przybeck TR. Age of onset of drug use as a factor in drug and other disorders. NIDA Res Monogr 1985;56:178–192.
 
4. Amoateng YA, Bahr SJ. Religion, family, and adolescent drug use. Sociological Perspective 1986;29:53–73.
 
5. Foxcroft DR, Lowe G. Adolescent drinking, smoking and other substance use involvement: links with perceived family life. J Adolesc 1995;18:159–177.
 
6. Kent R. The religiosity and parent/child socialization connection with adolescent substance abuse. In: Barber B, Rollins B, eds. Parent-Adolescent Relationships. Lanham, MD: University Press of America; 1990:143–165.
 
7. Ritt-Olson A, Milam J, Unger JB, et al. The protective influence of spirituality and ‘health-as-a-value’ against monthly substance use among adolescents varying in risk. J Adolesc Health 2004;34:192–199.
 
8. Gallup GH, Bezilla R. The religious life of young Americans. Princeton: The George H. Gallup International Institute; 1992.
 
9. Miller L, Davies M, Greenwald S. Religiosity and substance use and abuse among adolescents in the National Comorbidity Survey. J Am Acad Child Adolesc Psychiatry 2000 Sep;39:1190–1197.
 
10. Wechsler H, Thum D, Demone HW Jr, et al. Religious-ethnic differences in alcohol consumption. J Health Soc Behav 1970;11:21–29.
 
11. Allport GW, Ross JM. Personal religious orientation and prejudice. J Pers Soc Psychol 1967;5:432–443.
 
12. Amey CH, Albrecht SL, Miller MK. Racial differences in adolescent drug use: the impact of religion. Substance Use Misuse 1996;31:1311–1332.
 
13. D’Onofrio BM, Murrelle L, Eaves LJ, et al. Adolescent religiousness and its influence on substance use: preliminary findings from the Mid-Atlantic School Age Twin Study. Twin Res 1999;2:156–168.
 
14. Francis LJ, Mullen K. Religiosity and attitudes towards drug use among 13–15 year olds in England.Addiction 1993;88:665–672.
 
15. Francis LJ. The impact of personality and religion on attitude towards substance use among 13–15 year olds. Drug Alcohol Depend 1997;44:95–103.
 
16. Bahr SJ, Hawks RD, Wang G. Family and religious influences on adolescent substance abuse.Youth and Society 1993;24:443–465.
 
17. Potvin RH, Lee CF. Multistage path models of adolescent alcohol and drug use: age variations J Stud Alcohol 1980;41:531–542.
 
18. Nonnemaker JM, McNeely CA, Blum RW. Public and private domains of religiosity and adolescent health risk behaviors: evidence from the National Longitudinal Study of Adolescent Health. Soc Sci Med 2003;57:2049–2054.
 
19. Fetzer Institute. Multidimensional Meaurement of Religiousness, Spirituality for Use in Health Research. A Report of a National Working. Kalamazoo, MI: Fetzer Institute, 1999.
 
20. Sobell L, Sobell M. Alcohol Timeline Followback User’s Manual. Toronto: Addiction Research Foundation; 1995.
 
21. Holder DW, DuRant RH, Harris TL, et al. The association between adolescent spirituality and voluntary sexual activity. J Adolesc Health 2000;26:295–302.
 
22. Mickey RM, Greeland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–137.
 
23. van Oyen Witvliet C, Ludwig TE, Vander Laan KL. Granting forgiveness or harboring grudges: implications for emotion, physiology, and health. Psychol Sci 2001;12:117–123.
 
24. Gisi TM, D’Amato RC. What factors should be considered in rehabilitation: are anger, social desirability, and forgiveness related in adults with traumatic brain injuries? Int J Neurosci 2000;105:121–133.
 
25. Mickley JR, Cowles K. Ameliorating the tension: use of forgiveness for healing. Oncol Nurs Forum 2001;28:31–37.
 
26. Romero C, Friedman LC, Kalidas M, et al. Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer. J Behav Med 2006;29:29–36.
 
27. Carson JW, Keefe FJ, Goli V, et al. Forgiveness and chronic low back pain: a preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress. J Pain 2005;6:84–91.
 
28. Witvliet CV, Phipps KA, Feldman ME, et al. Posttraumatic mental and physical health correlates of forgiveness and religious coping in military veterans. J Trauma Stress 2004;17:269–273.
 
29. Lin WF, Mack D, Enright RD, et al. Effects of forgiveness therapy on anger, mood, and vulnerability to substance use among inpatient substance-dependent clients. J Consult Clin Psychol 2004;72:1114–1121.
 
30. Lawler KA, Younger JW, Piferi RL, et al. A change of heart: cardiovascular correlates of forgiveness in response to interpersonal conflict. J Behav Med 2003;26:373–393.
 
31. Lawler KA, Younger JW, Piferi RL, et al. The unique effects of forgiveness on health: an exploration of pathways. J Behav Med 2005;28:157–167.
 
32. Adlaf EM, Smart RG. Drug use and religious affiliation, feelings, and behavior. Br J Addict 1985;80:163–171.
 
33. Hadaway CK, Elifson KW, Peterson DM. Religious involvement and drug use among urban adolescents. J Scientific Study of Religion 1984;23:109–128.
 
34. Pargament KI, Koenig HG, Tarakeshwar N, et al. Religious coping methods as predictors of psychological, physical and spiritual outcomes among medically ill elderly patients: a two-year longitudinal study. J Health Psychol 2004;9:713–730.
 
35. Pargament KI, Koenig HG, Perez LM. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol 2000;56:519–543.
 
36. Babor TF, Kranzler HR, Lauerman RJ. Early detection of harmful alcohol consumption: comparison of clinical, laboratory, and self-report screening procedures. Addict Behav 1989;14:139–157.
 
37. Winters KC, Stinchfield RD, Henly GA, et al. Validity of adolescent self-report of alcohol and other drug involvement. Int J Addict 1990;25:1379–1395.