The Roles of Spiritually Oriented Organizations Delivering Services within the Addiction Continuum of Care

Background: Spiritually oriented organizations have provided critical needs in the lives of individuals, families, and communities affected by substance use. While studies demonstrate that there are varying degrees of spiritual and religious characteristics in these programs and services, there are very few studies that have provided an in-depth exploration of spiritual orientation among services within the substance use and addiction continuum of care. Using a census of 410 facilities providing substance-related services, we obtained information on facility-level spiritual orientation in addition to facility characteristics, substance use disorder (SUD) services, and non-SUD support services. Our aims were to describe service strengths and gaps related to: 1) how facilities characteristics and services differed by spiritual orientation, and 2) level of facility clustering by spiritual orientation and community demographics.

Methods: Using an academic-community research partnership, the research team obtained a comprehensive Census of agencies providing services along the addiction continuum of care by triangulating data from 4 sources of information. A total of 216 agencies comprising 410 facility locations were identified within a mix of urban and rural geographies. Facility spiritual orientation was rated from 1 (secular) to 6 (faith-permeated) based upon signage, mission and values, and self-reported practices (Sider and Unruh, 2004). Facilities were geocoded to point locations within the 10-county Midwestern metropolitan region (N = 209 5-digit ZIP Code Tabulation Areas). Exploratory spatial descriptive analyses were used to describe relationships between facility density by spiritual orientation level and community demographics. Multinomial logistic regression was used to examine the relationship between facility characteristics and services by spiritual orientation level.

Results: While only faith centered to permeated organizations indicated being legally designated as a faith-based organization (FBO), over 75% of these facilities reported being legally designated as private (for profit or nonprofit) or government organizations. Facility spiritual orientation level was significantly associated with facility service focus, gender-specific services, and transgender inclusivity. Multivariate analyses showed faith centered to permeated facilities offered more recovery-oriented services, case management, and employment and educational services compared to secular facilities, holding all else equal. Additionally, when examining the location of services, we found that the number of facilities in communities with predominately people of color was significantly higher compared to communities with predominantly white residents.

Conclusions: Facilities appear to have a distinct and complementary role in this service sector by level of spiritual orientation. Spiritually oriented organizations, within the substance use and addiction service delivery context, provided critical recovery-oriented services, basic needs, and workforce services. However, many of the spiritually oriented organizations did not identify as a faith-based organization; this is particularly relevant for individuals who do not identify with or desire Judeo-Christian services. There is a need for additional research that examines the special capabilities of spiritually oriented services, ways of identifying less visible organizations to better match client needs to facility orientation, as well as the role of location of these services to understand service access disparities. This research can inform social work practice and future faith-based and neighborhood partnership policy interventions.