Race, Drugs, and the Church: Moral and Theological Considerations from a Qualitative Research Case Study
Alejandra Salemi, MTS, MPH, PhD student, Duke University; Brett McCarty, Assistant Research Professor of Theological Ethics and Assistant Professor Population Health Sciences, Duke University; Charles Lynch, Jr., MTS student, Theology, Medicine and Culture Fellow, Duke University; and Emmy Yang, MD, University of North Carolina Hospitals
Substance use issues are continuing to ravage people and communities across the nation. In 2021, it was estimated that over 100,000 people died from overdoses, a nearly 15% increase from the overdose deaths in 2020–which had seen a 30% increase from the year prior [1]. Within these staggering numbers, there are startling demographic changes, as the racial makeup of these overdose deaths has begun to shift. The COVID-19 pandemic has overshadowed these disturbing developments while simultaneously exacerbating contributing factors to substance use issues.
To describe and understand these overdose deaths (along with deaths due to suicide and alcoholic liver disease), the language of deaths of despair has been invoked [2]. “Despair” and its existential overtones invite religious responses. And yet both the discourse of “deaths of despair” and the religious responses it has evinced are marked by an implicit and largely unrecognized racial imaginary. In both popular press and academic publications, deaths of despair have been associated with rural, middle to lower class white communities, even as the actual racial dynamics are drastically different [3]. Within the recent surge in overdose deaths in the U.S, death rates within communities of color have skyrocketed. For the first time since 1999, the overdose mortality rate for Black individuals was higher than that among white individuals in 2020 [4]. And while overdose death rates within Latinx communities are not as high, they have increased at a disturbing rate; for example, overdose death rates for Latinx men are two and a half times higher in 2020 than they were in 2015 [5].
Efforts to understand religious responses to substance use issues likewise have failed to attend adequately to racial diversity. This panel explores this phenomenon through the lens of one such recent effort, a project that sought to understand and respond to the needs of faith leaders seeking to address substance use issues within their communities. The mixed methods needs assessment included a statewide survey of faith leaders, and respondents were strikingly and disproportionately White relative to the state population. To partially address this inequity, the project then conducted eight listening sessions, half of which were focused on faith leaders in predominantly Black and Latinx communities.
The panelists all were involved with the project at various stages, and in this panel, they will seek to build upon its efforts by interrogating the undertheorized racial dimensions of religious responses to substance use issues. Through critical reflection on this qualitative research project, the panel hopes to pursue the conference theme through examining questions that expose the limits of medicine in relation to a public health crisis and the limits of religious responses that do not sufficiently attend to contemporary racial realities.
The panel moderator, an internal medicine resident who researched religious responses to substance use issues during her theological studies, will begin with a snapshot of where this project sits within the wider landscape of substance use issues.
The first speaker, a theological ethicist and qualitative researcher who served as the project’s PI, will provide an overview of the research project before turning to findings from the predominately White survey respondents. Survey results revealed denominational differences among viewing substance use issues as primarily related to sin or disease, with evangelicals more prone to the former and mainline Protestants tending to appeal to the latter. These differences correlate with divergent support for harm reduction practices such as Medication-Assisted Treatment (MAT) and syringe exchange programs; those who view substance use issues as primarily associated with disease are more likely to support harm reduction practices than those who view it as primarily associated with sin. The first panelist will set these survey findings in relief by putting them in conversation with themes uncovered in the listening sessions with faith leaders of predominantly Black and Latinx communities. As theological reasoning from some of these listening session participants suggests, the contrast between sin and disease may be a false dichotomy for understanding substance use issues; a more complex account of the relationship between the needs for personal and social transformation is needed.
The second speaker, a masters student researching at the intersections of theology, addiction, and race, will explore the experiences of addiction and the opioid epidemic within Black communities. This will include an overview of the history and contemporary landscape of substance use issues within Black communities, and an analysis of barriers to treatment and support for those struggling with substance use. They will highlight impacts from the War on Drugs and the overcriminalization of substance use in communities of color and examine the ways societal narratives around Black individuals struggling with addiction has contributed to stigma and stereotypes focused on the Black community, before shifting to address the responses of religious communities to the experiences of these groups. The panelist will explore the role shame around addiction may have within Black communities, particularly in religious spaces, and how Black clergy have led and taught their congregations around substance use. Finally, they will offer potential ways forward for clergy and clinicians engaging with racially diverse populations in hopes that they can better attend to the experiences of Black persons dealing with substance use issues.
The third speaker, a doctoral student from Duke University focusing on the intersection of public health and religion, will focus on the impacts of the opioid epidemic among the Latinx community and highlight the specific barriers that the Latinx diaspora faces when wrestling with addiction. This speaker will use demographic-specific data to contextualize the urgency of addressing the gaps in theology and efficacy held by religious communities in close proximity to Latinx persons. They will address the ways in which the diaspora creates complexities when dealing with Latinx patients because of the vast intersectionalities within the community and focus mostly on the ways in which public narrative at the Border and around immigration bolster harmful stereotypes and create shame for Latinx persons. They will also focus on the specific communities within Latinidad, such as those who are undocumented or those who are of low English-proficiency, that leave persons at a higher risk for negative health outcomes.
Through considering the theological and moral implications of Christian approaches to substance use issues, the panel will conclude with an invitation for more sustained attention to political theology in research at the intersection of religion and health care. Considering the limitations of medicine through the one-on-one model most familiar to those in the medical field, the panel utilizes an intersectional lens to explore the importance of solidarity efforts which work to break down barriers to the care provided by medical professionals. How might lessons learned from cross-racial and cross-class solidarity represented through social movements such as the contemporary Poor People’s Campaign reshape the pursuit of questions at the limits of medicine today? Faith leaders responding to substance use issues are well positioned to take these lessons forward in their efforts, and researchers seeking to understand religious responses to substance use issues do well to attend to these wider dynamics in their research.
[1] “U.S Overdose Deaths in 2021 Increased Half as Much as in 2020–But Are Still Up 15%.” CDC National Center for Health Statistics. October 14, 2022.
[2] Cf. Anne Case and Angus Denton, Deaths of Despair and the Future of Capitalism (Princeton, NJ: Princeton University Press, 2020).
[3] Friedman, Joseph, and Helena Hansen. "Far From a “White Problem”: Responding to the Overdose Crisis as a Racial Justice Issue." American Journal of Public Health 112, no. S1 (2022): S30-S32.
[4] Joseph R. Friedman and Helena Hansen. "Evaluation of Increases in Drug Overdose Mortality Rates in the US by Race and Ethnicity before and during the COVID-19 Pandemic." JAMA psychiatry 79, no. 4 (2022): 379-381.
[5] John Gramlich. “Recent surge in U.S. drug overdose deaths has hit Black men the hardest.” Pew Research Center. January 19, 2022. https://www.pewresearch.org/fact-tank/2022/01/19/recent-surge-in-u-s-drug-overdose-deaths-has-hit-black-men-the-hardest/
To describe and understand these overdose deaths (along with deaths due to suicide and alcoholic liver disease), the language of deaths of despair has been invoked [2]. “Despair” and its existential overtones invite religious responses. And yet both the discourse of “deaths of despair” and the religious responses it has evinced are marked by an implicit and largely unrecognized racial imaginary. In both popular press and academic publications, deaths of despair have been associated with rural, middle to lower class white communities, even as the actual racial dynamics are drastically different [3]. Within the recent surge in overdose deaths in the U.S, death rates within communities of color have skyrocketed. For the first time since 1999, the overdose mortality rate for Black individuals was higher than that among white individuals in 2020 [4]. And while overdose death rates within Latinx communities are not as high, they have increased at a disturbing rate; for example, overdose death rates for Latinx men are two and a half times higher in 2020 than they were in 2015 [5].
Efforts to understand religious responses to substance use issues likewise have failed to attend adequately to racial diversity. This panel explores this phenomenon through the lens of one such recent effort, a project that sought to understand and respond to the needs of faith leaders seeking to address substance use issues within their communities. The mixed methods needs assessment included a statewide survey of faith leaders, and respondents were strikingly and disproportionately White relative to the state population. To partially address this inequity, the project then conducted eight listening sessions, half of which were focused on faith leaders in predominantly Black and Latinx communities.
The panelists all were involved with the project at various stages, and in this panel, they will seek to build upon its efforts by interrogating the undertheorized racial dimensions of religious responses to substance use issues. Through critical reflection on this qualitative research project, the panel hopes to pursue the conference theme through examining questions that expose the limits of medicine in relation to a public health crisis and the limits of religious responses that do not sufficiently attend to contemporary racial realities.
The panel moderator, an internal medicine resident who researched religious responses to substance use issues during her theological studies, will begin with a snapshot of where this project sits within the wider landscape of substance use issues.
The first speaker, a theological ethicist and qualitative researcher who served as the project’s PI, will provide an overview of the research project before turning to findings from the predominately White survey respondents. Survey results revealed denominational differences among viewing substance use issues as primarily related to sin or disease, with evangelicals more prone to the former and mainline Protestants tending to appeal to the latter. These differences correlate with divergent support for harm reduction practices such as Medication-Assisted Treatment (MAT) and syringe exchange programs; those who view substance use issues as primarily associated with disease are more likely to support harm reduction practices than those who view it as primarily associated with sin. The first panelist will set these survey findings in relief by putting them in conversation with themes uncovered in the listening sessions with faith leaders of predominantly Black and Latinx communities. As theological reasoning from some of these listening session participants suggests, the contrast between sin and disease may be a false dichotomy for understanding substance use issues; a more complex account of the relationship between the needs for personal and social transformation is needed.
The second speaker, a masters student researching at the intersections of theology, addiction, and race, will explore the experiences of addiction and the opioid epidemic within Black communities. This will include an overview of the history and contemporary landscape of substance use issues within Black communities, and an analysis of barriers to treatment and support for those struggling with substance use. They will highlight impacts from the War on Drugs and the overcriminalization of substance use in communities of color and examine the ways societal narratives around Black individuals struggling with addiction has contributed to stigma and stereotypes focused on the Black community, before shifting to address the responses of religious communities to the experiences of these groups. The panelist will explore the role shame around addiction may have within Black communities, particularly in religious spaces, and how Black clergy have led and taught their congregations around substance use. Finally, they will offer potential ways forward for clergy and clinicians engaging with racially diverse populations in hopes that they can better attend to the experiences of Black persons dealing with substance use issues.
The third speaker, a doctoral student from Duke University focusing on the intersection of public health and religion, will focus on the impacts of the opioid epidemic among the Latinx community and highlight the specific barriers that the Latinx diaspora faces when wrestling with addiction. This speaker will use demographic-specific data to contextualize the urgency of addressing the gaps in theology and efficacy held by religious communities in close proximity to Latinx persons. They will address the ways in which the diaspora creates complexities when dealing with Latinx patients because of the vast intersectionalities within the community and focus mostly on the ways in which public narrative at the Border and around immigration bolster harmful stereotypes and create shame for Latinx persons. They will also focus on the specific communities within Latinidad, such as those who are undocumented or those who are of low English-proficiency, that leave persons at a higher risk for negative health outcomes.
Through considering the theological and moral implications of Christian approaches to substance use issues, the panel will conclude with an invitation for more sustained attention to political theology in research at the intersection of religion and health care. Considering the limitations of medicine through the one-on-one model most familiar to those in the medical field, the panel utilizes an intersectional lens to explore the importance of solidarity efforts which work to break down barriers to the care provided by medical professionals. How might lessons learned from cross-racial and cross-class solidarity represented through social movements such as the contemporary Poor People’s Campaign reshape the pursuit of questions at the limits of medicine today? Faith leaders responding to substance use issues are well positioned to take these lessons forward in their efforts, and researchers seeking to understand religious responses to substance use issues do well to attend to these wider dynamics in their research.
[1] “U.S Overdose Deaths in 2021 Increased Half as Much as in 2020–But Are Still Up 15%.” CDC National Center for Health Statistics. October 14, 2022.
[2] Cf. Anne Case and Angus Denton, Deaths of Despair and the Future of Capitalism (Princeton, NJ: Princeton University Press, 2020).
[3] Friedman, Joseph, and Helena Hansen. "Far From a “White Problem”: Responding to the Overdose Crisis as a Racial Justice Issue." American Journal of Public Health 112, no. S1 (2022): S30-S32.
[4] Joseph R. Friedman and Helena Hansen. "Evaluation of Increases in Drug Overdose Mortality Rates in the US by Race and Ethnicity before and during the COVID-19 Pandemic." JAMA psychiatry 79, no. 4 (2022): 379-381.
[5] John Gramlich. “Recent surge in U.S. drug overdose deaths has hit Black men the hardest.” Pew Research Center. January 19, 2022. https://www.pewresearch.org/fact-tank/2022/01/19/recent-surge-in-u-s-drug-overdose-deaths-has-hit-black-men-the-hardest/