Faith-Based Treatment for Addiction in Puerto Rico

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. 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. Furthermore, between 2000 and 2003, Puerto Rico’s drug-related homicide rate was 3 times the US average. 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. 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. 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. Much of the illicit drug trade, such as sex work, is related to economic pressures. 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. In fact, one third of all island Puerto Ricans reportedly identify themselves as Protestant. 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. 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, 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 drugusing behaviors of Hispanics. However, in a crosssectional 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. 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. 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. Residential programs that these ministries administer are actually underenrolled, while partial hospital and methadone maintenance programs are often overenrolled. This suggests that, despite continued growth in faith-based initiatives for addiction treatment, current levels still do not meet treatment demand.