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| Faith-Based Treatment |
| Columns - Policy | ||||||||||||||||||||||||||||||||
| Sunday, 30 September 2001 | ||||||||||||||||||||||||||||||||
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Nothing was more controversial in the early months of the new administration as the President's plan to increase support for faith-based treatment initiatives. Launched at a presidential press conference on January 29, 2001, the new White House Office of Faith-Based and Community Initiatives is intended to expand partnerships between faith organizations and government in addressing a range of social problems, including alcohol and other drug abuse. President George W. Bush has great confidence in this approach: "We will look first to faith-based organizations because private and religious groups are effective. Because they have clear advantages over government."John DiIulio, the Princeton professor who Bush appointed to head the new White House office, underscores this statement: "Churches do a great deal of good for considerably less resource investment than we pay via other institutional means." John Walters, the newly appointed drug czar and a former colleague of DiIulio, shares the view that addiction is more a moral issue than a disease. According to a nationwide Pew opinion poll taken in April, three in four Americans support the President's plan. However, this strong public support is not unqualified, but depends on three conditions: 1) that the groups receiving federal funds must be Christian or Jewish; 2) that they do not proselytize the poor; 3) and that they do not use religious guidelines in deciding whom to hire. Religious organizations are themselves split between the prospect of increased funding and the possibility of governmental interference with their activities. Moreover, constitutional scholars are concerned that the president's initiative threatens the constitutional guarantee of separation between church and state. In the midst of the controversy, however, very little attention has been focused on effectiveness. Do faith-based treatment services really produce better results than secular programs? Unfortunately, the research is largely silent on this question. What we do know is that spirituality and/or religious involvement seems to be inversely related to alcohol and other drug abuse. For example, one study of high-risk students who had failed at traditional schools and had been placed in alternative schools, found that those who reported stronger commitment to religion were more likely to associate with drug-free friends. Other studies show that those who have a strong personal commitment to church or other faith organizations are generally less likely to use drugs or be involved in crime. As many treatment experts note, the 12-Steps approach, which has helped millions of people, is itself based on faith in a "higher power." But experts also are concerned that faith and spiritual approaches should not necessarily replace other, more formal treatment opportunities. Teen Challenge, which has 150 centers around the country and treats 3,000 addicts each year, is one of the few faith-based programs that has been studied, although on a very limited basis. In 1995, a group of 59 Teen Challenge graduates of the one-year residential program was compared to a similar group of addicts who had spent one or two months in a hospital treatment program. The study found that Teen Challenge graduates reported returning to drug use less often than the hospital program graduates, but not less often than the hospital program graduates who continued attending Alcoholics Anonymous support groups. Teen Challenge posted a simplified version of the study on its web site, which claimed the program had an 86 percent success rate. Unfortunately, this figure has been used in the increasingly heated debate over the President's initiative. Critics point out that Teen Challenge has a high drop-out rate; about 30 percent leave in the first four months, and an additional 10 percent leave in the remaining eight months. The program also selects its clients, rather than accepting all newcomers. Several decades of extensive evaluation, involving follow-up studies of thousands of addicts who have participated in various treatment programs, have established the critically important truth that treatment works. The single most important variable for successful outcome is length of time in treatment, regardless of the modality. Whether the faith-based focus of a program increases overall effectiveness, we simply do not know. Nonetheless, the apparent lack of solid research will probably not be an impediment to the President's initiative. The key question for the treatment community is whether the President's focus on faith-based treatment will erode the standards of training and care that are currently required of programs that receive federal funds. This new legislation allows religious organizations to discriminate on the basis of religion in their hiring practices and exempts them from state licensing and training requirements that apply to secular providers. These provisions may encourage a proliferation of faith-based programs that operate outside the professional requirements so central to effective treatment. It must be noted that the public clearly does not understand the full implications of giving preferential status to faith-based programs. It is critically important that treatment professionals make their voices heard so that the advances that have been built on research in the past thirty years are not lost.             
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