This Article  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Complementary and Alternative Medicine  • Substance Abuse/ Alcoholism  • Alert me on articles by topic  Social Bookmarking   What's this?

Helena Hansen, PhD
Yale University School of Medicine, New Haven, Conn

JAMA. 2004;291:2882.

In 1997 the US Drug Enforcement Administration identified Puerto Rico as the Caribbean epicenter of illicit cocaine and heroin trade between Latin America and the United States and in 2001 designated it as a zone of high-intensity drug traffic.^1-2 In 1998 a household-based survey of Puerto Rican adults aged 15 to 64 years found that 5.6% of the population was in need of substance abuse treatment.³ Furthermore, between 2000 and 2003, Puerto Rico's drug-related homicide rate was 3 times the US average.⁴ At that time, the Puerto Rican legislature voted to define drug dependence as a spiritual and social problem, rather than simply a mental health disorder.⁵ The resolution reflected the high prevalence of faith-based programs for addiction treatment. Indeed, the Puerto Rican Mental Health and Anti-Addiction Services Administration found that as of 1998, faith-based residential addiction treatment centers comprised 75% of all state-registered drug treatment programs.⁶

This convergence of faith-based initiatives and drug treatment facilities has been due to a number of factors. As of January 2003, Puerto Rico had an unemployment rate twice the US median.⁷ Much of the illicit drug trade, such as sex work, is related to economic pressures.⁸ Concomitant with this trend over the past few decades, evangelical Protestant churches have risen to prominence in a region that historically has been dominated by Catholicism.⁹ In fact, one third of all island Puerto Ricans reportedly identify themselves as Protestant.¹⁰ Low-income, urban converts to evangelical Protestantism in Latin America often cite the church's antialcohol and antidrug stance as a reason for their conversion.¹¹

In an atmosphere of both active evangelism and drug trade, Puerto Rican addiction ministries have multiplied and claimed a professional niche as providers of faith-based residential addiction programs. Largely founded by ex-addicts who mirror mainland US Christian drug treatment models such as Teen Challenge,¹² Puerto Rican addiction ministries offer peer and pastoral counseling, prayer, and bible study as methods toward recovery.

In a review of ongoing drug abuse studies evaluating the interaction of social support systems with drug addiction among Hispanics, the authors reported that involvement with religious institutions had a significant impact on the drug-using behaviors of Hispanics.¹³ However, in a cross-sectional survey from an Alcoholics Anonymous group in Los Angeles, several interventional models, some of which did not emphasize spirituality, were found to be equivalent in effectiveness.¹⁴

Despite their frequent lack of medication and clinical staff, faith-based ministries continue to thrive as a main option for drug addiction treatment, in part due to policies the Puerto Rican government has pursued in the last decade. Starting in 1994 the government began privatizing the health care system, causing most public addiction treatment programs and mental health centers to close.¹⁵ This compounded an existent problem of diminishing funds for drug abuse recovery in Puerto Rico, which has fewer subsidies for addiction treatment than any of the 50 US states.¹⁶ Residential programs that these ministries administer are actually underenrolled, while partial hospital and methadone maintenance programs are often overenrolled.⁶ This suggests that, despite continued growth in faith-based initiatives for addiction treatment, current levels still do not meet treatment demand.

Funding/Support: Dr Hansen received funding for this research from an NIH MSTP training grant (GM07205), from the Social Science Research Council, and from Yale University's Center for International and Area Studies, Yale Council on Latin American Studies, and Yale's John Perry Miller Fund.

REFERENCES
1. US Drug Enforcement Administration. DEA Congressional Testimony before the Subcommittee on National Security, International Affairs and Criminal Justice, July 17, 1997. Available at: http://www.usdoj.gov/dea/pubs/cngrtest/ct970716a.htm. Accessed November 12, 2003. 2. National Drug Intelligence Center. Puerto Rico and the US Virgin Islands Drug Treatment Assessment. July 2003. Available at: http://www.usdoj.gov/ndic/pubs3/3950/index.htm#Contents. Accessed May 17, 2004. 3. Colon H, Canino G, Robles R, Toro C, Lopez C, Orraca O. Household Study: Needs Assessment Program for Substance Abuse Services. Commonwealth of Puerto Rico: Mental Health and Anti-Addiction Services Administration; 1998. 4. Goodnough A. Two-front battle in Puerto Rico: crime and apathy. New York Times. December 28, 2003:20. 5. Legislative Assembly of Puerto Rico. Mental Health Law of Puerto Rico: Law 408, Articles 1.04, 13.01 and 13.02. October 2, 2000. 6. Melendez I, Colon H, Robles R, et al. Puerto Rico Substance Abuse Needs Assessment Program: Treatment Capacity Survey Final Results. Commonwealth of Puerto Rico: Mental Health and Anti-Addiction Services Administration; 1998. 7. Central Intelligence Agency. The World Factbook, 2003. Available at: http://www.cia.gov/cia/publications/factbook/geos/rq.html. Accessed May 17, 2004. 8. Alegria M. Hispanic women. In: Wetherington A, Roman C, eds. Drug Addiction Research and the Health of Women: Executive Summary. Washington, DC: US Dept of Health and Human Services; 1998:123-126. 9. Martin D. Pentecostalism: The World Their Parish. Oxford, England: Blackwell Publishers; 2001. 10. Cleary E, Stewart-Gambino H. Power, Politics, and Pentecostals in Latin America. Boulder, Colo: Westview Press; 1997. 11. Brusco E. The Reformation of Machismo. Austin: University of Texas Press; 1995. 12. National Center on Addiction and Substance Abuse at Columbia University. So Help Me God: Substance Abuse, Religion and Spirituality. Available at: http://www.casalibrary.org/CASAPublications/Spirituality.pdf. Accessed June 6, 2003. 13. De La Rosa M, White M. A review of the role of social support systems in the drug use behavior of Hispanics. J Psychoactive Drugs. 2001;33:233-240. WEB OF SCIENCE | PUBMED 14. Hoffman F. Cultural adaptations of Alcoholics Anonymous to serve Hispanic populations. Int J Addictions. 1994;29:445-460. 15. Alegría M, McGuire T, Vera M, et al. The impact of managed care on the use of outpatient mental health and substance abuse services in Puerto Rico. Inquiry. 2001;38:381-395. PUBMED 16. National Center on Addiction and Substance Abuse at Columbia University (CASA). Shoveling Up: The Impact of Substance Abuse on State Budgets. Available at: http://www.casacolumbia.org/pdshopprov/files/47299a.pdf. Accessed on June 6, 2003.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?