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Legacy Behavioral Health Services

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Cherokee/Forsyth County Mental Health Resources

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Cherokee/Forsyth County Mental Health Resources

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CHOA Recommended Mental Health Provider List

Cherokee Rose Counselling and Consulting

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Alpharetta/John's Creek Mental Health Resources

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Alpharetta/John's Creek Mental Health Resources

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LifeStance Health Therapists & Psychiatrists in Johns Creek

Embark Behavioral Health

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Grow Counseling

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Free Your Feels - Mental Health Initiative for Youth and Adults

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Free Your Feels - Mental Health Initiative for Youth and Adults

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SPEAK.

LISTEN.

CONNECT.

Launched by Voices for Georgia's Children and Georgia's Department of Behavioral Health, along with incredible partners, the Free Your Feels campaign helps Georgia's children, teens, and young adults stay mentallyhealthy by expressing their feelings with peers, parents, teachers, and most importantly, themselves.

​

Through customized awareness materials, curated educational resources, and signature events and programs like the Free Your Feels Teen Summit and school-based peer-to-peer wellness groups, we aim to increase mental health awareness, reduce stigma, and encourage Georgia's youth to express their real feelings and seek support, while guiding caregivers and adults to listen and help.

@FREEYOURFEELSGA

We provide digital resources, tips, and tools that anyone with a young person in their life can use. Check out our Instagram feed to see our most recent posts!

Follow us on all of our social media platforms!

@FreeYourFeelsGA

THIS MONTH'S RESOURCE TOOLKIT

To play, press and hold the enter key. To stop, release the enter key.

Download the
Free Your Feels Blueprint

Contribute your mental health story or journey, messages of hope and encouragement,

self-care tips, mental health resources, and more to this #FreeYourFeels storywall!

Use the hashtag #FreeYourFeels on any social media posts.

​

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Free Your Feels | Mental Health Campaign

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Free Your Feels is a mental health awareness campaign encouraging Georgia's young people to explore their real feelings and share them fearlessly.

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Muslim Mental Health Initiative of Atlanta (MMHIA) Community Resource Guide

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Muslim Mental Health Initiative of Atlanta (MMHIA) Community Resource Guide

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MMHIA Community Resource Guide (12/2024)

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If you need mental health support call 988.

In a crisis, contact a professional immediately, or reach out to NAMI's Crisis Text Line by texting 'NAMI' to 741741.

Georgia Crisis & Access Line: (800) 715-4225. Georgia offers a statewide toll-free call center for individuals to access services.  The call center operates 24/7 and has the capacity to screen and assess callers for intensity of service response.

Naseeha: Helpline: 1 (866) 627-3342
Available  24 hours a day, 7 Days a week

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More than half of school-age Muslim students reported being bullied at school because of their religion (that is twice the reported national average for all students)

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Resources: Muslim Mental Health Organizations

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Resources: Muslim Mental Health Organizations

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Muslim Mental Health Organizations

Mental Health Provider Directories

Mental Health and Wellness Resources

Savannah Mental Health Resources

Fayette/Coweta Mental Health Resources

Valdosta Mental Health Resources

Alpharetta/Johns Creek Mental Health Resources

Cherokee/Forsyth County Mental Health Resources

Augusta Mental Health Resources

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Resources: Muslim Mental Health Counselors and Therapists 

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Resources: Muslim Mental Health Counselors and Therapists 

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Muslim Mental Health Provider Directories

Muslim Therapists: Healing with Counseling 360

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Resources: Mental Health and Substance Misuse Toolkits

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Resources: Mental Health and Substance Misuse Toolkits

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Young Adult American-born Muslims and Mental Health

Addressing Religious Based Bullying of Muslim Kids

Meeting the Needs of Muslim Youth: Growing Up Safe and Positively Engaged Online

Counseling Muslims

Free Your Feels - Mental Health Initiatives for Youth and Adults

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The Islamic Perspective on Substance Use

Talking to Teens about Drugs and Alcohol: A Quranic Approach

Meeting the Needs of Muslim Youth: Preventing and Treating Drug Use

A Qualitative Study on Imams' Perspective on Substance Use

Islam and Harm Reduction

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Support Strategies and Crisis Intervention

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Support Strategies and Crisis Intervention

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Support Strategies SAMSHA

Crisis Management SAMSHA

Self-help Strategies for Cutting Down or Stopping Substance Use

Screening & Assessment

Georgia's Good Samaritan Law

Self Harm Awareness Toolkit

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Defining Substance Misuse

Causes and Risk Factors

Substance Misuse Data

Understanding Drug Use and Addiction

Prescription Pain Pills-Opioid Use

5 Effects of Alcoholism on Family

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Understand the Core of Who You Are - Muslim Mental Health

Importance of Mental Health in Islam

Islamic Psychology and Muslim Mental Health- Dr. Rania Awaad

Toolkit for Providing Mental Health to Muslim Patients Launched

Mental Wellness and Depression- Sheikh Dr. Yasir Qadhi

Healing Through Faith. The Role of Spiritual Leaders to provide Psychosocial Support

Suicide Attempts of Muslims Compared with Other Religious Groups in the US

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Support Strategies and Crisis Management

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Support Strategies and Crisis Management

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Caring for your Mental Health

Mental Health Wellness Tips

Crisis Management

Mental Health Hotline

Suicide Prevention

Coping Mechanisms: Everything You Need to Know

Comorbidly Guidelines: Do's and Don'ts of Managing Clients with Mental Health Conditions

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Georgia District 4 Health Equity Navigator Program at Mercer University School of Medicine

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Comorbidity Guidelines: Dos and Dont's of Managing Clients with Mental Health Conditions

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Comorbidity Guidelines: Dos and Dont's of Managing Clients with Mental Health Conditions

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Muslim Therapists: Healing with Counseling 360

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Muslim Therapists: Healing with Counseling 360

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Experience convenient and confidential virtual therapy services from our experienced therapists here at Counseling 360. Get the support you need from the comfort of your home.

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Coping Mechanisms: Everything You Need to Know

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Coping Mechanisms: Everything You Need to Know

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Coping mechanisms are strategies that help people deal with stress and uncomfortable emotions. Whether you realize it or not, you are using coping mechanisms regularly. These behaviors can help you cope with stress in a positive way or can sometimes be harmful.

This article discusses different coping styles, types of coping mechanisms, and ways to improve your coping skills.

Why Do We Use Coping Mechanisms?

Coping mechanisms help decrease the side effects of stress. The stress response is triggered by the "flight or fight" role of your sympathetic nervous system. This causes changes in your body to help you prepare to run away from or face potential danger head-on.

Side effects of the stress response include:

Increased heart rate

Increased breathing

Higher blood pressure

Increased alertness

Heightened senses

Release of glucose (sugar) into your bloodstream for energy

These physiological changes are helpful when you are in a dangerous situation. However, they are also meant to be temporary.

Unfortunately, your body doesn't know the difference between actual danger and emotional stress. And chronic stress can lead to problems, such as:

Difficulty sleeping

Changes in appetite

Headaches

Stomach pain

Body aches

Rashes

Sadness

Anxiety

Depression

Lack of interest in activities

Active vs. Avoidant Coping

Coping Styles

Two common ways that people cope with stress are problem-focused coping and emotion-focused coping.

Problem-Focused Coping

Problem-focused coping aims to change or eliminate the source of your stress. This type of coping works if you have some control over the situation that is causing you stress.

Examples of problem-focused strategies for specific situations could include:

Situation: You frequently fight with your partner, which causes a stressful relationship.

Possible responses:

Seek counseling.

Set boundaries.

End the relationship.

Situation: Your job requires you to do presentations, but public speaking causes you stress.

Possible responses:

Practice in front of family or friends.

Hire a public-speaking coach.

Take a public-speaking course.

Find a different job that does not require public speaking.

Situation: You are diagnosed with high blood pressure.

Possible responses:

Talk to your healthcare provider about medication options.

Exercise regularly.

Reduce your salt intake.

Emotion-Focused Coping

Unfortunately, it's impossible to avoid stress completely, particularly in situations in which you have no control over the source of your stress. Emotion-focused coping strategies can help you change the way you respond to your stress.

Examples of emotion-focused strategies for specific situations could include:

Situation: Your partner is diagnosed with cancer, causing you fear and anxiety.

Possible responses:

Gather information and focus on the facts.

Join a support group.

Journal about your feelings.

Situation: You are attending a party, but being around a group of people makes you anxious.

Possible responses:

Practice deep breathing.

Arrive with a friend for social support.

Plan topics of conversation.

Coping Mechanisms vs. Defense Mechanisms

Types of Coping Mechanisms

Not all coping mechanisms are helpful. In fact, some can even be harmful. Adaptive coping mechanisms are positive coping skills, while maladaptive coping mechanisms are negative coping skills.

Adaptive Coping Mechanisms

Adaptive coping mechanisms empower you to change a stressful situation or adjust your emotional response to stress.

Examples include:

Deep breathing

Meditation

Exercise

Journaling

Talking with a friend

Positive thoughts

Taking a bath

Reading a book

Aromatherapy

Maladaptive Coping Mechanisms

Maladaptive coping mechanisms are negative ways of dealing with stress. Maladaptive coping commonly occurs in people who have experienced childhood trauma or abuse. Though these behaviors might temporarily distract you from your stress, they can eventually lead to physical and emotional harm.

Examples include:

Drinking excessive amounts of alcohol

Using drugs

Anger outbursts

Denying/ignoring the problem

Self-harm

Negative thoughts

Isolating yourself

How to Improve Your Coping Skills

If you find that your coping skills need some improvement, try these tips:

Identify your stressors: Positive coping mechanisms are most effective when you can identify the cause of your stress.

Take note of current coping skills: Notice how you respond to your stressors and determine whether you are currently using positive or negative coping mechanisms.

Try something new: You might need to try several different coping skills to find the one that works best for you.

Make it a habit: Incorporate your coping skills into your daily schedule. For example, take five minutes during your workday to do some deep breathing or meditation, even if you aren't feeling stressed.

Get some help: If you find it particularly difficult to build positive coping skills or get rid of negative ones, consider talking to a therapist.

Coping mechanisms are behaviors that aim to avoid stress or unpleasant emotions. These behaviors can be positive (adaptive) or negative (maladaptive). Problem-focused coping aims to eliminate or change the source of your stress, while emotion-focused coping helps you change the way you react to your stressors.

A Word From Verywell

Everyone experiences stress, but not everyone handles stress in a beneficial way. It can take time to unlearn negative coping mechanisms. At first, you'll need to be intentional about incorporating positive coping strategies into your daily life. With time, these responses will become more automatic.

Frequently Asked Questions

What are unhealthy coping mechanisms?

Unhealthy coping mechanisms often distract a person from their stress. These behaviors can cause physical and emotional harm. Examples include substance abuse, self-harm, anger outbursts, and isolation.

Is eating a coping mechanism?

Eating can be a coping mechanism, particularly if a person is eating to avoid feeling sad or stressed. Consuming sugar releases chemicals in your brain called neurotransmitters that make you feel good. This has an immediate but temporary effect on your mood.

How can I improve my coping skills?

You can improve your coping skills by first identifying your stressors and your current responses to these situations. Try a variety of positive coping behaviors including deep breathing, meditation, positive thoughts, and journaling. Then begin to incorporate these skills into your daily life.

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Coping mechanisms are strategies for avoiding unpleasant emotions. Discover the different types of coping mechanisms and identify them in your life.

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SAVE | Suicide Prevention | Suicide Information | Suicide Awareness

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The mission of SAVE is to prevent suicide through public awareness and education, reduce stigma and serve as a resource to those touched by suicide.

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A demo video to help navigate through our Online Toolkit

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Accessing Professional Help and Resources through our Online Toolkit

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Building a Supportive Community and a Faith-Based Support Network

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Various types of mental illness have been discussed by Muslim scholars for centuries. Contemporary scholars recognize the need for both spiritual and clinical treatments to address mental health struggles.

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While terms such as "meditation" may evoke certain images and connotations that are not Islamic, Muslims are encouraged (and in some cases obligated) to engage in practices and cultivate inwards states and qualities that could be described as meditative.
These practices include prayer as well as other mindfulness practices such as tafakkur (deliberate contemplation), dhikr (remembrance of God), silence, and muraqaba (mindfulness), among others.
With respect to prayer, Prophet Muhammad ﷺ himself stated that, of all things made beloved to him in life, "the coolness of [his] eyes" or "[his] tranquility" has been placed in prayer. When he felt overwhelmed or troubled, he instinctively and routinely sought refuge in God through prayer.
On one specific occasion, the Prophet ﷺ asked his Companion, Bilal, to call the people to prayer by saying, "give us comfort by it, oh Bilal..."

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Mental Health & Wellness | Yaqeen Institute for Islamic Research

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An Islamic research institution dedicated to dismantling doubts and nurturing conviction by addressing relevant topics affecting today's society.

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Best Practices in Providing Support

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Identifying Mental Health and Substance Misuse

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Introduction to Substance Misuse

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Introduction to Mental Health

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Online screening is one of the quickest and easiest ways to determine whether you are experiencing symptoms of a mental health condition. Take a mental health test here.

Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based approach to identify individuals who use alcohol and other drugs (substances) at risky levels. The goal of SBIRT is to prevent or reduce use of substances to prevent related health consequences, disease, accidents and injuries through an early intervention approach.

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Connect with others

Advocate for yourself

Get the care you need

Plan your sleep schedule

Watch what you eat

Manage stress

Exercise

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What are mood disorders? Four basic forms of mood disorders are major depression, cyclothymia (a mild form of bipolar disorder), seasonal affective disorder and mania (euphoric, hyperactive, over inf

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Defining Mental Health

Signs of Mental Illness

Causes and Risk Factors

Mental Health Data

Mental Health Demographics

How to Improve Mental Health

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Alcoholism Is A Family Disease, But Help Is Available For All

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Alcoholism Is A Family Disease, But Help Is Available For All

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When someone is battling alcoholism and is ready to get help, getting help for the entire family is crucial to bringing about full healing and lasting change.

Alcoholism risk factors: peer pressure, high levels of stress, family history with alcohol.

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Alcohol causes more than just trouble for the person drinking, especially with prolonged alcohol misuse. Because addiction can negatively affect several areas of a person's life, often alcoholism has profound effects on family and friends as well. However, alcohol addiction treatment can make a difference.

The Effects of Alcohol Addiction on Loved Ones

1. Damaged Family Relationships

One way in which alcoholism affects families is in damaged relationships. Families of people affected by alcohol misuse often struggle to create strong emotional bonds, even within their family unit. This starts with the parents. In one study from the University at Buffalo, heavy drinking was connected to lower marital satisfaction. The study also found that alcoholism increased the risk of negative interactions, especially among couples. In addition, people battling alcoholism tend to lie about their condition, minimizing its effect on the family. This destroys trust and makes it difficult for other family members to build strong relationships with the individual.

2. Developmental Issues in Neglected Children

Children of parents who struggle with alcoholism are at higher risk for cognitive, behavioral, and emotional problems. Since an estimated 6.6 million children live in households where alcoholism is present, this is a significant concern. Sadly, parents who are struggling with alcohol addiction are often neglectful of both the physical and emotional needs of their children. This leads to serious developmental issues for the kids. Some of the problems children experience in homes where alcoholism is present include:

Academic problems

Anxiety and depression

Poor emotional development

Difficulty with intimate relationships as adults

A tendency to be dishonest

3. Domestic Abuse

One of the most sobering effects of alcoholism is an increased risk for domestic abuse within the family. Abuse tied to alcoholism can be either emotional or physical in nature. People battling alcoholism may insult their family members, manipulate them, or humiliate them. These are all forms of emotional abuse. Physical violence is also a serious issue. The World Health Organization reports that 55 percent of physical assault cases between intimate partners occurred when the perpetrator had been drinking. Because alcohol use lowers their self-control levels by affecting cognitive and physical functioning, people who drink are more prone to acting violently when frustrated.

4. Drained Family Finances

The habit of consuming alcohol on a regular basis is expensive. While the total amount spent on alcohol will vary depending on the frequency and type chosen, the costs add up. It is not uncommon for someone battling this addiction to spend over $1,000 a month on alcohol. That is money that the family could use in other ways, and this financial cost takes a toll on the family's overall well-being.

5. Physical and Mental Health Issues

Finally, a battle with alcoholism affects the physical and mental health of most members of the family. The individual fighting addiction will deal with physical health issues because of the impact of excessive alcohol consumption. Some common problems include liver disease, digestive system problems, damage to the brain, and risk for stroke. Mental health problems are also a risk for these families. The anxiety and stress of alcoholism for a family will wear down the emotional health of all involved. Family members of those fighting alcoholism may also struggle with guilt and feelings that they somehow are the cause of their loved one's disorder.

Why So Many U.S. Families Are Affected By Alcoholism

Between 2002 and 2013, drinking rates among US adults rose substantially, with more people reaching problem drinking levels as a result. High-stress levels in modern society increase the demand for today's adults, and as a result, more and more are turning to alcohol to self-medicate. It doesn't take long for occasional alcohol misuse to turn into binge drinking, and binge drinking to turn into an addiction. Unfortunately, when addiction develops, it's the families that suffer.

Alcoholism Is A Family Disease, But Help Is Available For All

Alcoholism is a disease that affects all members of the family. When someone is battling alcoholism and is ready to get help, getting help for the entire family is crucial to bringing about full healing and lasting change. At Vertava Health Mississippi, we offer alcohol addiction treatment to help people overcome addiction, but we don't stop there. Because addiction is a family disease, we also have a family support program that ensures everyone, not just the person suffering from addiction, gets the help they need. This family addiction counseling can help the whole family heal, change, and begin rebuilding healthy relationships. Reach out today at 844.470.0410 to learn more about how we can help.

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The effects of alcoholism on family can be serious, but alcohol addiction treatment can help. Call 844.481.0331 for addiction recovery in Mississippi today.

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According to Georgia's Good Samaritan law immunity is granted to the person overdosing and the person calling when seeking medical help.

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1 in 7 people who get a refill are still using opioids a year later. We all get injured, but we must manage our pain responsibly—especially when it comes to prescription pain pills like opioids. See how.

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Talking to Teens about Drugs and Alcohol: A Qur’anic Approach

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Talking to Teens about Drugs and Alcohol: A Qur’anic Approach

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In a 2001 study based on the 2001 Harvard School of Public Health College Alcohol Study database, 47% of American Muslim college students reported alcohol use in the past year. In Europe, where the issue has been studied in greater detail, the rates of use amongst Muslim adolescents are higher or lower depending on the drug: lower for alcohol, similar for cannabis, and higher for tobacco and sedative hypnotics.

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Talking to Teens about Drugs and Alcohol: A Qur’anic Approach | Yaqeen Institute for Islamic Research

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Dr. Jibran Khokhar provides guidelines from the Qur’an on how talk to your teens about drugs and equipping teens to make the right decisions.

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There should be an emphasis on Islamic principles. Counselors and therapists should be individuals the client can identify with. Most often, male counselors should work with male clients, and female counselors should work with female clients, although this may not always be the case.

Family counseling with an Islamic-based approach to treatment can be extremely helpful.

Development of goals and helping the person to invest their energy in goals associated with the afterlife as conceptualized by Islam may be useful.

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A young female client presents with anorexia nervosa and believes that her problem has its roots in magic; parents are helpless in the face of their son's substance abuse issues; an interracial couple cannot agree on how to discipline their children.
How would you effectively help these clients while balancing appropriate interventions that are sensitive to religious, cultural, social, and gender differences? This handbook answers these difficult questions and helps behavioral health practitioners provide religio-culturally-competent care to Muslim clients living in territories such as North America, Australia, and Europe.
The issues and interventions discussed in this book, by authoritative contributors, are diverse and multifaceted. Topics that have been ignored in previous literature are introduced, such as sex therapy, substance abuse counseling, university counseling, and community-based prevention. Chapters integrate tables, lists, and suggested phrasing for practitioners, along with case studies that are used by the authors to help illustrate concepts and potential interventions.
Counseling Muslims is also unique in its broad scope, which reflects interventions ranging from the individual to community levels, and includes chapters that discuss persons born in the West, converts to Islam, and those from smaller ethnic minorities. It is the only guide practitioners need for information on effective service delivery for Muslims, who already bypass significant cultural stigma and shame to access mental health services.

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A young female client presents with anorexia nervosa and believes that her problem has its roots in magic; parents are helpless in the face of their son's substance abuse issues; an interracial couple cannot agree on how to discipline their children.How would you effectively help these clients while balancing appropriate interventions that are sensitive to religious, cultural, social, and gender differences?

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The preservation and protection of the dignity of man, and steering mankind away from harm and destruction are central to the teachings of Islam. When viewed through the Islamic principles of the preservation and protection of the faith, life, intellect, progeny and wealth, harm reduction programs are permissible and in fact provide a practical solution to a problem that could result in far greater damage to the society at large if left unaddressed.

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Abstract

Although drugs are haram and therefore prohibited in Islam, illicit drug use is widespread in many Islamic countries throughout the world. In the last several years increased prevalence of this problem has been observed in many of these countries which has in turn led to increasing injecting drug use driven HIV/AIDS epidemic across the Islamic world. Whilst some countries have recently responded to the threat through the implementation of harm reduction programmes, many others have been slow to respond. In Islam, The Quran and the Prophetic traditions or the Sunnah are the central sources of references for the laws and principles that guide the Muslims' way of life and by which policies and guidelines for responses including that of contemporary social and health problems can be derived. The preservation and protection of the dignity of man, and steering mankind away from harm and destruction are central to the teachings of Islam. When viewed through the Islamic principles of the preservation and protection of the faith, life, intellect, progeny and wealth, harm reduction programmes are permissible and in fact provide a practical solution to a problem that could result in far greater damage to the society at large if left unaddressed.

Introduction

It might be thought that adherence to Islamic tenets could theoretically provide protective benefits against the risk of HIV. Strict adherence to these tenets which include prohibition of extra-marital sex and homosexuality which could reduce the risks of unprotected anal sex could theoretically confer protective benefits against the sexual transmission of HIV. Circumcision which must be practiced by all Muslim males and which has recently been shown to reduce the probability of HIV transmission from an infected female to her uninfected male partner provides further benefits against the acquisition of HIV via sexual transmission (Weiss, Hankins, & Dickson, 2009). Furthermore prohibition against alcohol and drugs may reduce risky sexual behaviour that is associated with these intoxicants. In the only analysis of its kind, Gray observed that the percentage of Muslims within a given country negatively and significantly predicts the prevalence of HIV amongst sub-Saharan African countries (Gray, 2004).

From the perspective of shariah, khamar an Arabic term which literally means "to shroud" or "to cloud" refers to any substance that intoxicates the mind causing the person to lose self-control as a result of the effects of the substance. Aside from alcoholic-based substances, khamar may also include drugs. Contemporary Islamic scholars have now agreed that any kind of substance that causes intoxication is haram (not permissible) from the perspective of Islam as the preservation and protection of the mind is one of ad-dharuriyat al-khams; the preservation and protection of the faith, life, intellect, progeny and wealth, the fundamental principles governing the Islamic shariah law (Al-Ghazali, 1937, Kamali, 1991).

Unfortunately Islamic teachings and Muslim beliefs alone are not enough to prevent against the spread of HIV as can be seen by the rates of HIV infection in many Muslim majority countries outside sub-Saharan Africa where risks other than heterosexual transmission of HIV exist. We examine the extent of the HIV epidemic in relation to drug use in the Islamic world and the role that Islamic teachings and principles have played in the response to this twin problem.

Section snippets

Epidemiology of illicit drug use in Islamic countries

The Islamic world is home to over 1 billion people which spans across three continents. Within this, approximately 40% or more of the populace practices some form of Islam on a background of differing histories and cultures (Kelley & Nicholas, 2005). Despite being haram and prohibited, illicit drug use is widespread in many predominantly Islamic countries throughout South, South East and Central Asia and increasingly in North Africa and the Middle East (Mathers et al., 2008, UNODC, 2009a,

Injecting drug use and the HIV epidemic in Islamic countries

Unsafe injecting practices associated with illicit drug use have in turn led to an explosion of HIV infections in several of these countries. Concentrated HIV epidemics amongst PWID are emerging from Libya, Uzbekistan, Tajikistan, and Pakistan whilst Indonesia, Malaysia, Bangladesh, and The Islamic Republic of Iran have large established epidemics (UNAIDS, 2008, Mathers et al., 2008). In Indonesia, approximately half of the cumulative reported HIV cases are associated with injecting drug use (

Harm reduction in Islamic countries

Injecting drug use is regarded as a challenging issue in many countries. The attitudes of leaders of diverse religions to the issue of injecting drug use and the HIV/AIDS epidemic have been important in most countries around the world and this has also been true in many Islamic countries. The responses of the governments in Islamic communities to IDU-driven HIV epidemics vary from the public health approach that has been undertaken in The Islamic Republic of Iran, Malaysia and Indonesia to the

Islamic countries' responses to harm reduction

Several factors played a role in the shift of harm reduction policies in countries such as The Islamic Republic of Iran, Malaysia and Indonesia where both needle exchange programmes and opiate substitution therapy have been implemented. In these three countries this included the important role that non-governmental organisations and civil society played in advocacy and the implementation of successful programmes that reached vulnerable groups (Mesquita et al., 2007, Razzaghi et al., 2006, Reid

Conclusion

Many countries with large Muslim populations are threatened by the escalation in illicit drug use and related HIV epidemics. Harm reduction programmes including opioid substitution therapy and needle exchange programmes are permissible in Islam in line with the maqasid al-shariah framework where faith, life, intellect, progeny and wealth threatened by drug use and HIV/AIDS must be preserved and protected. The reluctance to implement harm reduction programmes by many Muslim governments and

Y.A. Abdullah
The Holy Quran: Text and translation

A.M. Abu Bakar
AIDS and religion
Making the best of both worlds, volume one: Faith and science

Al-Bukhari. (1995). In M. M. Khan (Translator), The translation of the meanings of Sahih al-Bukhari (Vol. 7). Medina:...

A.H.M. Al-Ghazali
Al-Mustasfa min Ilm al-Usul

Cook, C., & Kanaef, N. The Global State of Harm Reduction. (2008). Mapping the response to drug-related HIV and...

Coverage to curb the emerging HIV epidemic among injecting drug users in Pakistan: Delivering prevention services where most needed

International Harm Reduction Association. The Global State of Harm Reduction. (2008). Mapping the response to...

View full text

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Although drugs are haram and therefore prohibited in Islam, illicit drug use is widespread in many Islamic countries throughout the world. In the last...

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“An undercover problem in the Muslim community”: A qualitative study of imams’ perspectives on substance use

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“An undercover problem in the Muslim community”: A qualitative study of imams’ perspectives on substance use

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Creating an environment which perpetuates stigma may lead to missed opportunities for mosques and other Muslim faith-based organizations from acknowledging, recognizing, and addressing SUD.

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J Subst Abuse Treat. Author manuscript; available in PMC 2022 Apr 1.

Published in final edited form as:

Abstract

Background:

Mainstream Islam prohibits alcohol and other drugs, yet substance use is prevalent in Muslim-American communities. Previous studies have not examined how imams, leaders of mosques, address substance use in their communities. This study aimed to explore imams' perspectives and approaches toward Muslim Americans with substance use disorders (SUD).

Methods:

Qualitative study of imams in New York City recruited by convenience sampling. We conducted one-on-one semi-structured interviews to address how imams perceive and address substance use. Using an inductive thematic analysis approach, we created an initial coding scheme which was refined iteratively, identified prominent themes, and created an explanatory model to depict relationships between themes.

Results:

All imams described substance use within a shared underlying framework of religious prohibition of alcohol and other drugs. Their perceptions of individuals with SUD diverged between a focus on sin, shame, and social disruption vs. a focus on acceptance and forgiveness. Furthermore, imams diverged between conceptualizing their communities as comprising mosque-going individuals without SUD vs. broader communities that include individuals with SUD. While imams acknowledged how some imams' judgmental language toward SUD may perpetuate stigma, they also identified therapeutic approaches toward SUD: non-judgmental engagement, encouragement of recovery, prayer, and referral to resources.

Conclusions:

This study is among the first to illustrate the range of perceptions and approaches to substance use among Muslim American imams. These perceptions have potentially divergent impacts- shaming or assisting individuals with SUD. An understanding of these complexities can inform provision of culturally competent care to Muslim-American patients with SUD.

Keywords: Muslim, imams, alcohol use, substance use, substance use disorder

1. Introduction

Islam is the second largest religion in the world. Since early Islamic civilizations, the consumption of alcohol and other substances has been broadly prohibited, both scripturally and socially ( Ali-Northcott, 2013; M. Ali, 2014). Much of the research to date on substance use among Muslim populations focuses on the prevalence of substance use in Muslim-majority countries ( Benjamin, 2018; Çelen, 2015; French, Purwono, & Rodkin, 2014; Manickam, Abdul Mutalip, Abdul Hamid, Kamaruddin, & Sabtu, 2014; Matthee, 2014; Mauseth, Skalisky, Clark, & Kaffer, 2016; Yaqub, 2013). While substance use disorder (SUD) may be stigmatized in Muslim-majority countries, research characterizing their provision of SUD treatment is emerging ( Bassiony, 2013; Batool et al., 2017; Ghazal, 2019; Ibrahim, Hussain, Alnasser, Almohandes, & Sarhandi, 2018; Khalil et al., 2008; Maehira et al., 2013; Mutlu et al., 2016; Sarasvita, Tonkin, Utomo, & Ali, 2012; Stengel et al., 2018).

Within the United States, Islam is the fastest growing religion, with over three million Muslim Americans ( Ghani et al., 2015; Pew Research Center, 2016). Despite religious prohibitions on substance use, and stigma-related challenges to collecting data about SUD ( Arfken & Ahmed, 2016), studies have shown that substance use is also prevalent among Muslims living in Muslim-minority countries ( Attarabeen et al., 2019; Jamil, 2017; Pannu, Zaman, Bhala, & Zaman, 2009; Williams, Ralphs, & Gray, 2017), and may increase as Muslims acculturate into cultures which are less prohibitive of substance use ( Arfken & Grekin, 2015; Mir, 2014). Among Muslim-American undergraduate students, 46% report drinking alcohol and 25% report illicit drug use ( Ahmed, Abu-Ras, & Arfken, 2014). In a separate national survey, 14% of Muslim Americans reported binge drinking ( Gallup Muslim West Facts Project, 2009).

Christian faith-based interventions are widely utilized in the prevention and treatment of SUD in the USA. Twelve-step programs, which are rooted in the protestant Christian tradition ( Mullins, 2010), are used at least some of the time by 72% of US SUD treatment centers ( Substance Abuse and Mental Health Services Administration, 2018). Millati Islami, an organization that has adapted the twelve-step model for Muslims, has been conducting groups to address SUD within Muslim-American communities since 1989 ( Millati Islami World Services). Though the organization has been described in a theological analysis ( M. Ali, 2014), its outcomes have not been evaluated. Culturally and religiously tailored interventions may be necessary to facilitate effective care for Muslims with SUD ( Ali-Northcott, 2013; Arfken, Berry, & Owens, 2009; Senreich & Olusesi, 2016; Tahboub-Schulte, Ali, & Khafaji, 2009). Muslim-American individuals with SUD may seek help in a variety of settings, including their own religious communities ( Ali-Northcott, 2013). However, aside from Millati Islami, approaches to substance use and SUD within the Muslim-American community have not been described.

Mosques are centers of worship for Muslims. Imams play a central role in mosques, leading prayer and giving sermons ( O. M. Ali, Milstein, & Marzuk, 2005). Imams may also encourage healthy behavior through religious teachings ( Islam et al., 2017), advocate for Muslim patients in healthcare settings ( Padela, Killawi, Heisler, Demonner, & Fetters, 2011), and provide formal or informal counseling to community members ( Abu-Ras, Gheith, & Cournos, 2008; Bagby, Perl, & Froehle, 2001). In a survey of US imams inquiring about the counseling needs of congregants, a majority reported counseling Muslim Americans on anxiety, depression, financial burdens, and discrimination related to Islamophobia. Forty-one percent of imams reported counseling on SUD, though this was not substantively described ( O. M. Ali et al., 2005). In another survey of US Muslim worshippers, a minority reported seeking help from an imam specifically because of problems related to drugs or alcohol use ( Abu-Ras et al., 2008). While some research has explored how other American faith leaders address substance use within their communities, such as within African American churches ( Wong, Derose, Litt, & Miles, 2018), there is scant research on how imams address substance use within Muslim-American communities.

To address these gaps in the literature, we conducted a qualitative study to characterize how imams in New York City perceive and address substance use in their communities. The objectives of this study were to 1) understand the perspectives of imams on how substance use affects their communities and 2) describe imams' approaches toward Muslim Americans with SUD.

2. Methods

2.1. Study design

For this qualitative study, we conducted semi-structured interviews and used an inductive thematic analysis approach. The study was approved by the Institutional Review Board at Albert Einstein College of Medicine.

2.2. Research team

The study was designed by SM, JS and SN. All interviews were conducted by a female, Muslim physician (SM). Prior to study commencement, members of the research team had no relationship with any of the interviewees.

2.3. Setting and participants

We recruited imams from two sections of New York City, the Bronx and upper Manhattan. Almost 10% of New York City residents are Muslim, representing all racial groups and migrant and non-migrant backgrounds ( Muslims for American Progress, 2018). We selected these regions because they have both relatively high populations of Muslim Americans, and a high prevalence of SUD. We focused on imams because of their accessibility and leadership role in the Muslim community. Individuals were eligible to participate if they self-identified as an imam, were fluent in English, and were at least 18 years of age.

2.4. Recruitment

We recruited imams using convenience sampling and snowball sampling. From June 2015 to June 2016, we searched publicly available contact information for all mosques in the selected geographical area and contacted them by phone. All phone numbers without an initial response were contacted at least twice. Given the modest response with this approach, we also introduced the study to two Muslim Americans active in the New York City Muslim community, one an imam in a Manhattan mosque and one a board member of a Manhattan mosque. They were not included as participants in the study but provided contact information for three imams who became research participants for the study. Interviewed imams provided contact information for other imams who were then recruited in a snowball sampling approach.

2.5. Data collection

The interviewer (SM) contacted imams initially by phone and described the project. In this initial conversation, she disclosed her occupation, place of employment, and religious affiliation (Muslim). If the imam was interested in participating, an in-person interview was scheduled at the participant's mosque. Written informed consent was obtained and a brief questionnaire was verbally administered to ascertain demographic characteristics. A semi-structured interview using an interview guide was conducted and audio recorded. Interviews were professionally transcribed and de-identified. Transcripts were reviewed by the interviewer for errors and to verify de-identification of all personal information.

Because little is known about US imams' perspectives, an open-ended interview guide was developed. The interview guide was broadly informed by Ali's exploration of theoretical models of addiction in Islam, including addiction as crime, addiction as spiritual disease and a description of the Millati Islami 12-step approach to SUD recovery ( Ali, 2014). Interview guide questions asked imams to describe how they perceived and addressed substance use in their communities. Example questions included: "Think about the last person who came and talked to you about substance use. What was the conversation like?", "What does Islam say about drugs?," "What suggestions or help do you offer?," and "What goals do you emphasize?" To more deeply explore differences in how imams view substance use in individuals vs. communities, after three interviews, the guide was refined to ask imams explicitly how they define their communities and how appropriate it is for mosques to address substance use and substance use disorder in their communities. We use the term substance use disorder throughout this manuscript with the recognition that imams are not making clinical diagnoses, but rather are addressing problems related to substance use.

2.6. Analysis

Data analysis was conducted using an inductive thematic analysis approach ( Merriam & Tisdell, 2015). Using Dedoose software (version 4.12), an initial coding scheme was created based on open coding of the first three interviews (SM, SN, and JS) to identify topic areas and conceptual themes that arose. The coding scheme was refined iteratively with review of additional interviews by SM, CS, JS and SN, using constant comparison methods to consolidate similar concepts or distinguish dissimilar ones. Two coders (SM and CS) independently coded all transcripts, and all disagreements in coding were reconciled through consensus. Prominent themes were identified, and an explanatory model was created to depict relationships between themes. The explanatory model was refined by reviewing themes and codes iteratively.

3. Results

3.1. Participant characteristics

We contacted 46 phone numbers of imams, available either through publically listed contact information for mosques or snowball sampling. Of those, 22 were not reachable and did not have a voicemail option, 12 were left voicemails and did not reply, and two declined to participate. Five participants were recruited via phone call recruitment, and five were recruited via snowball sampling. Ten interviews were completed.

Of the ten participants, all were male, all identified as Sunni, and nine were born outside of the USA. Seven had completed an undergraduate degree and nine had received specialized training in Islamic studies either in the US or abroad. Six of the imams worked in mosques in the Bronx and four worked in mosques in Manhattan. Mosques served communities from different ethnic and racial backgrounds, including congregations that were predominantly African (four), African American (one), South Asian (one), European (one) and mixed congregations (three). All mosques provided a range of services to the community, including Sunday School, Qur'an classes, and formal and informal counseling to individuals. None of the mosques were formally affiliated with a SUD treatment program.

3.2.1. Major themes

We developed an explanatory model to present the major themes that describe how imams perceived and addressed substance use in their communities and to illustrate the relationship between themes ( Figure ). All imams described a shared underlying framework that substance use is prohibited in Islam. Imams expressed divergent perceptions of individuals with substance use. Specifically, while some imams emphasized negative spiritual, psychological and social consequences for individuals who use substances, other imams embraced a positive outlook toward these individuals, focusing on acceptance and forgiveness. Imams also expressed divergent perceptions of substance use inside their community; some conceptualized their community as limited to mosque-going individuals without SUD while other imams emphasized their obligations to a broader, more inclusive community, which includes individuals with SUD. Imams' perceptions about individuals with SUD and concepts about community influenced how they address SUD. Some described other imams using judgmental language that can distance individuals with SUD and perpetuate stigma. In contrast, imams also identified therapeutic approaches to help those with SUD, including non-judgmental and motivational language, encouragement of recovery, prayer, and referral to community resources.

3.2.2. Underlying framework

All imams grounded their discussions of substance use within a framework of Islam, making several references to God, the Quran (the holy book for Muslims) and Muhammad (the final Prophet of Islam). Unanimously, they agreed that alcohol is haram, the Arabic term for forbidden or prohibited. Prominently, they explained that alcohol and other drugs are prohibited because they induce intoxication or a mind-altered state. They agreed that substance use is a sin in Islam. For example, one imam said,

'The [teaching] of the Prophet [is], "every intoxicant is an alcohol and every alcohol is haram."'

Another said,

"Anything that interferes with your intellect is an illegal substance to Muslims ... crack cocaine and K2 and certainly alcohol ... Once a person becomes a slave of all these substances then your life is over."

3.2.3. Divergent perceptions of individuals with substance use: Emphasis on negative consequences vs. acceptance and forgiveness

Some imams emphasized the negative consequences of substance use, including spiritual harms (i.e., sin), psychological harms (i.e., shame) and social harms. In contrast, other imams emphasized acceptance and forgiveness of individuals who use substances.

Regarding spiritual harms, imams discussed how when one uses substances that are haram, they are engaging in sinful acts which prevent the individual from worshipping God and maintaining a connection to God. For example, one imam said:

"[Alcohol] is going to prevent you from worshipping with the prayer. It will prevent you from remembrance of God ..."

Imams also discussed how substance use is associated with shame and stigma in the community, causing individuals to hide their bad habits.

"It could be that they do whatever is not good to their bodies ... Not only is it [i.e., substance use] not good for them, it is not good for the society. That is why they hide. They hide themselves. They don't want people to know that they are smoking and they are drinking because they know that is a bad habit. It is forbidden in Islam. It is haram."

Finally, imams associated substance use with social disruptions such as crime.

"Everybody knows [alcohol is] haram, but people still drink it and themselves, they know it's affecting them. People drink and drive, get in an accident and kill themselves, kill other people and they go to jail and they mess up their record ..."

In contrast, other imams emphasized acceptance and forgiveness of individuals who use substances and focused less on the negative consequences of substance use. They described the importance of being understanding, and they normalized sin in an effort to promote hope for recovery. They discussed how God's forgiveness is more powerful than human beings' sins.

"You know, [God] is a load of forgiveness. His first aim is not to punish and he also can give a lot of second chances. We do not see a sinner as a cursed person. You have to love them... As long as they are alive, they have a chance to overcome [substance use] and have a chance for God to forgive them. We make the things easy for them, to tell them that everybody commits sin..."

"We cannot cut the hope of people and say ... you are weak ... We have to say to them, you are strong, you are good..."

3.2.4. Divergent perceptions of community: mosque-going community without SUD vs. inclusive community with SUD

Some imams perceived their communities to be limited to mosque-going Muslims who they encountered regularly. Imams described these community members as frequently performing good deeds and rarely using substances or facing addiction. They contrasted members of their congregations with people outside the mosque suggesting that the people outside may engage in substance use.

"We don't have many in our community who do alcohol or drugs."

"The hard substances... me or my colleagues or imams that I've spoken to haven't come across it in such a way that we could say it's an actual problem within the community."

"The drugs, alcohol, there are not much in Islam. They always stay outside when they do these things."

In contrast, other imams had a much broader definition of community, which included mosque-going Muslims and non mosque-going Muslims who may have SUD. Imams identified an obligation toward serving all people who seek help, including those who use substances.

"... [substance use] is an undercover problem in the Muslim community ... people know it but nobody wants to acknowledge it ..."

"There are no boundaries [of the community]. Anybody who needs help at any time, in any shape or form and I can be of assistance. That is my duty ... I am willing to speak to anybody..."

"And we love them [those who use substances]. We let them know that they are not out, they are in. [We] are inclusive."

"We say no, even though you do something which is not good, we need you in our community..."

3.2.4. Perpetuation of stigma vs. therapeutic approaches focused on abstinence

Imams varied in how they addressed substance use within the community. Imams described how leaders of mosques who use judgmental or harsh language distance themselves from community members who use substances, preventing the problem from being addressed and perpetuating stigma.

"Some of them [imams] tell the people, "stop it or you will find yourself in the hell fire." [In contrast, God] says when approaching people, treat them with respect and dignity for them to listen to you."

"Unfortunately, [in] a lot of religious places, the judgment is too heavy and people are so prejudiced against what they don't like -- to a point where there can never, ever be a relationship built because people would be afraid to talk to you about their shortcomings."

Other imams advocated for open, non-judgmental communication and encouragement in a welcoming environment to support individuals dealing with problems related to substance use. All emphasized abstinence as an end goal.

"The first thing is, let's talk. No judgment, let's talk ... Because once people begin to talk to you, you talk to them ... you drink tea ... I don't care what you do or who you are or whatever, I don't even want to know. Let's just talk ..."

"It's not easy to leave it [substance use]. It's a big fight with yourself ... Sometimes you may find yourself defeated, so that's an example of the weakness but that doesn't mean that actually a human being will always be weak. Of course if he stands back, with the help of God, you can stop."

Imams used religious teachings in their conversations about substance use, specifically describing a stepwise approach to recovery. Religious teachings regarding alcohol became more restrictive over a period of time in the early Islamic period. Early on, alcohol was prohibited for certain occasions like prayer but allowed in other circumstances; later on, it became prohibited in all situations. This imam makes an analogy between the gradual, stepwise prohibition of alcohol over time and the gradual stepwise recovery from using substances, with abstinence as the end goal.

"We have verses from the Quran talking about alcohol, addressing it from the beginning to the end, how the Quran treated the people stage by stage. You know, because when you are involved in something [like substance use], it's very hard to take you out of it at one time. So the Quran [addressed people who use substances] stage by stage until the end stage, [when you] finish and [you] never, ever go back to it."

Other imams discussed prayer as a therapeutic approach.

"Praying and being close to him. Talk to him directly... When you prostrate your forehead down, that is the place that you will be [most] close to God. You are praying and he knows what you want to ask him before you even ask him. So you try to sit and show ... that you need [God] completely..."

Finally, other imams made referrals to community resources.

"... what we do is we developed a directory of service providers, whether it is ... because of substance abuse [an individual] completely lost their home, lost their family, lost everything and wants to reconnect with that... we have referrals.

"If they came to us and if they were wanting to change their life from negatively to positively, what can we do? We refer them ... to the hospital and then the hospital pushes them and encourages them to go to this rehabilitation [center]."

4. Discussion

This study is among the first to illuminate how imams perceive and address substance use within Muslim-American communities. Within a shared framework that assumes prohibition of substance use, imams diverged in their perspectives on individuals with SUD, whether they are part of the Muslim community, and approaches to address substance use. Taken together, these findings highlight a range of perspectives and approaches to substance use among Muslim American imams: while they could result in shaming and ostracizing individuals with SUD, they could also result in welcoming and assisting these individuals. There may be unseized opportunities to develop collaborations with imams to help support people with SUD by reducing stigma and facilitating treatment engagement.

Some imams in this study emphasized that because substance use is prohibited and considered a sin, there are negative consequences for individuals with SUD both in their spiritual life and socially within their Muslim communities. The spiritual and social impact of substance use among Muslims was similarly reported in a qualitative study of British South Asian young men and women ( Bradby, 2007). In that study, participants reported that drinking alcohol could lead to rejection by God, an inability to access spiritual rewards in the afterlife and, because drinking alcohol is considered shameful, ostracism from the Muslim community. The expectation of substance use leading to both spiritual and community consequences aligns with a theory posited by a contemporary Muslim theologian ( M. Ali, 2014). He describes traditional Muslim societies as "shame-based" cultures, in which fear of both God's and community members' knowledge of wrongdoing prevents an individual from transgressing. He argues that in Muslim cultures an individual with SUD represents a failure of the entire community. This serves as an explanation for imams, as community leaders, reiterating social narratives of the negative consequences of substance use.

Those imams with negative perceptions of individuals with SUD, who emphasized sin and shame and who perceived the community as unwelcoming to those who use substances, may perpetuate stigma against Muslims with SUD. Similar to processes described among Jewish-Americans ( Loewenthal, 2014) and West African-American immigrants ( Senreich & Olusesi, 2016), some imams in this study identified substance use as a problem which lies outside their community. The stigma surrounding substance use among Muslim populations has been described ( Ali-Northcott, 2013; Arfken & Ahmed, 2016; Arfken & Grekin, 2015; Badr, Taha, & Dee, 2014). Moreover, the detrimental effects of stigma on the psychological well-being of individuals with SUD are well described ( Kulesza, Watkins, Ober, Osilla, & Ewing, 2017). Creating an environment which perpetuates stigma may lead to missed opportunities for mosques and other Muslim faith-based organizations from acknowledging, recognizing, and addressing SUD.

In contrast, other imams in this study focused on de-stigmatizing SUD by encouraging forgiveness and open communication; this approach may help to reduce stigma and facilitate treatment engagement. In a Christian context, measures of forgiveness, including forgiveness of self, forgiveness of others, and perceived forgiveness by God have been shown to predict decreased patterns of alcohol use among individuals entering SUD treatment ( Webb, Robinson, Brower, & Zucker, 2006). In a qualitative study at a Canadian Muslim community services agency that provided SUD outreach and counseling, case workers reported that their work helped to reduce community stigma around SUD ( Jozaghi, Asadullah, & Dahya, 2016). Similarly, in a qualitative study of Muslim faith healers in the UK, respondents described empathy for people with SUD, invoked religious teachings of Islam to assist those with SUD in their recovery, and advocated for referrals to community resources and drug counselors ( Rashid et al., 2014). Health campaigns building on Islamic religious norms and disseminated through imams and mosques have potential to promote health behavior ( Islam & Patel, 2018; Islam et al., 2017; Killawi, Heisler, Hamid, & Padela, 2015). One example is a pilot program in Malaysia, in which a methadone maintenance program was implemented in a mosque, and local imams delivered religious counseling services. Imams brought forward motivational verses from the Quran, taught individuals how to use their faith to maintain their sobriety and discussed the importance of religious community in overcoming addiction ( Rashid et al., 2014). Taken together, these findings suggest that open attitudes among imams and faith-based organizations may facilitate treatment of SUD.

Our findings are consistent with other studies which highlight the complexities of addressing substance use within religious communities: while people with SUD may experience stigmatization within religious communities, these communities may also provide support for those who value religion and spirituality as part of their treatment for SUD. In a survey of 169 African American churches, 71% reported caring for persons with SUD often, but half reported that individuals' shame related to SUD served as a barrier to treatment referral ( Wong et al., 2018). Similarly, stigmatization within the Jewish community may prevent help-seeking, yet Jews may also feel more comfortable in seeking treatment in programs sensitive to their religious and cultural values ( Loewenthal, 2014). Finally, in a study population demographically similar to congregants served by imams in our study, Muslim and Christian West African immigrants report stigmatization of SUD yet still identify spirituality as an essential resource ( Senreich & Olusesi, 2016).

Our findings highlight an opportunity for primary care and SUD treatment providers. Patients report wanting to engage in conversations about spirituality and health with their providers ( Best, Butow, & Olver, 2015). Our findings highlight reasons for providers caring for patients with SUD to engage in conversations about religion and spirituality. Understanding the complexity of perceptions of SUD among faith leaders in mosques and other religious settings allows clinicians to provide religiously and culturally competent care. For example, if a Muslim patient with SUD relays concerns related to stigma and marginalization from the Muslim community, the provider may attempt to address these concerns by offering psychosocial support and additional mental health services as needed. Conversely, if the patient expresses support from the Muslim community or wishes to seek assistance there, the provider might partner with a faith-based provider to optimize a treatment plan for the patient.

There are several limitations to this study. We are unable to quantify the impact of having a Muslim woman physician conducting study recruitment and interviews on enrollment and participant responses. The sample size was small, but did allow for exploratory analyses of salient themes. In our sample, imams belonged to mosques with congregants from fairly diverse backgrounds, but the ethnicities represented were not proportionately reflective of the US Muslim population, which includes large populations of Arab Americans, South Asian Americans and African Americans ( Gallup Muslim West Facts Project, 2009). This sampling limitation, coupled with the modest sample size, precludes analysis of the impact of factors that may impact imam's approaches to SUD; these include imams' and congregants' gender, race, ethnicity, country of origin, number of years spent in the USA, and sect within Islam (e.g., Sunni vs. Shi'a); imams' formal chaplaincy education; and prevalence of SUD within imams' communities. In addition, the results of the study may have been impacted by social desirability bias. The past two decades have seen the Muslim-American identity change dramatically, with the Muslim community regularly facing discrimination and stigma ( Samari, 2016). Imams in this study may have wanted to reinforce how individuals in their communities are respectful, law-abiding citizens who do not engage in activities (like substance use) which may be associated with social disruption and legal problems.

Our findings highlight several opportunities for future study. First, what strategies can be used to best leverage spiritual supports to facilitate engagement, support and treatment of SUD? How can interventions be designed to minimize SUD-related stigma, within a Muslim-American context, and more broadly? How can clinicians best collaborate with spiritual leaders to facilitate access to and engagement in treatment of SUD?

5. Conclusion

This study is among the first to illustrate the range of perceptions and approaches to substance use among Muslim American imams. An understanding of the complex, divergent responses to SUD within the Muslim-American community can inform provision of culturally competent and comprehensive care to Muslim American patients with SUD.

​

Imams have divergent perceptions of and approaches to substance use disorder (SUD).

Some imams focused on negative consequences; others focused on acceptance.

Approaches to SUD ranged from stigmatization to provision of therapeutic resources.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Declarations of interest:

This work was supported by the National Institutes of Health [grant numbers R01 DA039046 and K24 DA046309 (JS); and R01 DA042813 (SN)]; and the Department of Family and Social Medicine, Montefiore Medical Center. Dr. Starrels receives consulting fees from Venebio Group, LLC; research and travel support from the Opioid Post-Marketing Requirement Consortium (for work on an FDA-required observational study of the risks of opioids); and royalties from Wolters Kluwer Health (to author a review on UpToDate.com). Dr. Nahvi receives investigator-initiated research support from Pfizer.

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# data[].attributes.attachment_link.title
"An undercover problem in the Muslim community": A qualitative study of imams' perspectives on substance use

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Mainstream Islam prohibits alcohol and other drugs, yet substance use is prevalent in Muslim-American communities. Previous studies have not examined how imams, leaders of mosques, address substance use in their communities. This study aimed to explore ...

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Meeting the Needs of Muslim Youth: Preventing and Treating Drug Use

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Meeting the Needs of Muslim Youth: Preventing and Treating Drug Use

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Suicide Attempts of Muslims Compared With Other Religious Groups in the US

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Suicide Attempts of Muslims Compared With Other Religious Groups in the US

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Suicide Attempts of Muslims Compared With Other Religious Groups in the US

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This study compares the prevalence of suicide attempts among Muslims compared with other faith communities in the US.

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Healing Through Faith: The Role of Spiritual Healers in Providing Psychosocial Support to Canadian Muslims

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Healing Through Faith: The Role of Spiritual Healers in Providing Psychosocial Support to Canadian Muslims

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Introduction

Muslims are one of the fastest-growing minority groups in Canada, comprising 3.2% of the country's population ( Statistic Canada, 2015). Demographic studies also project an increase in the growth of this population ( Pew Research Centre, 2015). Even though Muslims are a heterogeneous group with diverse cultural, ethnic, linguistic, and sociological backgrounds, they are connected by common Islamic themes ( Riley, 2011). The persistent geo-political crisis, war, and instability in parts of the Middle East, Asia, and Africa have been a major cause for massive population displacement in the past several years; forcing many people to take refuge in Western countries, including Canada ( Silove, Ventevogel, & Rees, 2017). Some refugees from war-torn countries deal with specific mental health challenges, such as Post-Traumatic Stress Disorder (PTSD) and depression due to their exposure to conflict, displacement, and loss of lives and properties ( Fazel, Wheeler, & Danesh, 2015). These vulnerable group's mental health challenges can become more compounded with their post-immigration struggles as they render efforts to settle in their new society (Hansson, Lurrie, & Mckenzie, 2008; Hossain, Ross-Sheriff & Tirmazi, 2010).

Despite the dearth of research on this topic, a few studies have revealed that imams play a significant role in addressing the mental health needs of their congregants. This particular role became dramatically important after the events of September 11, 2001, when Muslims across North America and other Western countries suddenly became the targets of public and media backlash, state security harassment, and discrimination at all levels (Ali, & Marzuk, 2012; Jisrawi & Arnold, 2018). Considering the contemporary political climate, Muslim immigrant communities in Western countries have become particularly vulnerable in terms of mental health struggles by enduring the challenges of resettlement and renegotiation of identity in a new land ( Islam & Campbell, 2014). Due to lack of research in this area, this exploratory study attempted to illuminate the experiences of imams in the provision of psychosocial support to Canadian Muslims. The study also explored the meanings imams attribute to their role as religious support, while also casting light on the psychosocial needs of Muslims accessing faith-based support to deal with their mental health struggles.

Refugee and Immigrant Mental Services in Canada

The increase of Muslim immigrants in the Western world, and specific violent attacks on Western soil associated with armed radical groups, have accentuated the public's prejudice against Muslim communities ( Disha, Cavendish, & King, 2011). It is plausible to argue that discrimination on various social levels can further jeopardize the mental health of the Muslim refugee populations in Canada. In the Canadian context, it has been generally noted that new immigrants and refugees are less likely to seek mental health services due to language difficulties, lack of awareness of existing health services, and other structural barriers such as institutionalized racism ( Hansson, Lurrie, & Mckenzie, 2009). Furthermore, psychotherapeutic service, as an effective non-medical approach, is financially expensive and often not readily accessible within diverse communities, including immigrants and refugees in Canada ( Bartram, 2019). Accessing the mainstream services is also compounded by a non-biomedical explanatory understanding of mental illness among some Muslim communities. Therefore, many Muslims may prefer to seek help outside of the mainstream mental health care system ( Hansson, Lurrie, & Mckenzie, 2009).

Help Seeking Behavior

In the context of mental health, help seeking relates to the need for reaching out and verbalizing one's concerns and need for external assistance to address pressing psychosocial or mental health problems. Seeking help externally could mean reaching out to families, friends, faith-based institutions such as imams and mosques, or the formal health care system ( Rockwood & Thomas, 2012).

Current studies among Muslims across the Muslim world and in Western countries reveal that the majority identified both bio-psychosocial and spiritual causes for mental illness, and that a significant number will first seek faith-healing before seeking medical help while others may seek both concurrently (Rozario, 2009; Eneborg, 2012). In the Western world, studies on Muslim mental health issues and practices were barely available prior to the tragic events of September 11, 2001. This paucity in research was attributed to the lack of interest by Western researchers and inaccessibility of Western journals to researchers in Muslim countries due to language barriers ( Ahmed & Amer, 2012).

Despite the shortage of research on Islamic healing practices among Muslims in Western countries, available studies point out that the majority of respondents in these studies believe in spiritual causality, and, hence, prefer accessing the available faith-based community healing resources ( Abu-Ras, Geith & Cournos, 2008; Dein, Alexander & Napier, 2008; Ahmed & Amer, 2012). In fact, in a study conducted in New York, where the majority (70%) of the respondents had some college education, a staggering 84% believed in spirit possession, and that their primary support would be a religious healer ( Abu-Ras, Geith & Cournos, 2008). In Britain, Muslims tend to underutilize the mainstream mental health system, and there are numerous reports of thriving spiritual healing services among the Muslim population, often advertised in local community newspapers. Although some of these healers ask for exorbitant fees, people still pay for it, choosing to bypass the free National Health Services ( Mullick, Khalifa, Nahar & Walker, 2012; Dein, Alexander & Napier, 2008). These studies in the United States and Britain suggest the importance of spiritual healing traditions among Muslim communities across the Western world, and the role of imams and mosques as community institutions in the provision of psychosocial-related support. Based on these studies, it is plausible to argue that there is an essential need for a concerted effort by the mainstream mental health providers to collaborate with spiritual leaders to bridge the gap and improve services to this vulnerable minority population ( Abu-Ras, Geith, & Cournos, 2008). Furthermore, while imams are increasingly encountering individuals with complex social and psychological problems, they may lack the educational and professional training necessary to effectively deal with such issues. In fact, in some instances, imams are new immigrants, and so the lack of language proficiency and knowledge of available community resources further handicaps their effectiveness in providing essential psychosocial services to their congregants ( Abu-Ras, Geith, & Cournos, 2008).

Review of the Muslim Religious Literature

Islam is a way of life and primarily guides Muslims in many aspects of their lives. Islamic laws and guidelines consist of the following four main sources in hierarchal format: the Qur'an, which Muslims believe to be the words of God revealed to the Prophet Muhammad; Hadiths, which are the sayings and deeds of the Prophet Mohamed; Qiya or Analogy; and Ijma or Consensus ( Pasha & Pridmore, 2004).

The Qur'an states, "We reveal from the Qur'an that which is healing and a mercy for the believers" (Qur'an, 17:82), and the prophet was quoted stating, "Allah does not send any disease but he also sends down a cure for it" (Al-Saheehyn as quoted by Ameen, 2005). There are numerous verses in the Qur'an and Hadiths that communicate themes on the notions of health and wellness, including mental health. The use of Qur'anic and prophetic healings by the prophet and his followers is also detailed in the scriptures ( Ameen, 2005).

The scriptures explain some of the causes of mental illness as spirit possession ( Jinn), witchcraft ( Sihr), and evil eye. The scriptures also explain how treatment constitutes recantation ( ruqya) and recitation of verses of the Qur'an by either the individual, family members, or imams and other religious healers ( Dein, Alexander & Napier, 2008; Ahmed & Amer, 2012). This metaphysical understanding of mental illness profoundly impacts the way some individuals and families seek therapeutic help. In general, many factors such as level of education, gender, and age may play a significant role in shaping this spiritual understanding of mental illness ( Islam & Campbell, 2014).

Methods

This qualitative study was undertaken in a major Canadian metropolitan city with a sizeable Muslim population. The focus of the research was to understand the important role of imams and or spiritual healers within the Muslim community in the context of psychosocial and spiritual support systems.

The study was exploratory in nature. The lead author conducted 1:1 in-depth interviews, and the ethics approval was granted by the Simon Fraser University Ethics Board. The study sample consisted of six imams purposively selected from several mosques across a Canadian metropolitan city. Semi-structured study guides were used, and the interviews were conducted in English. The interviews were tape-recorded with full consent and confidentiality assured. The tape-recorded data was transcribed, thematically analyzed, summarized, and used to make conclusions.

Results

The interviews with the imams support the existing literature regarding the cardinal role of imams in the provision of psychosocial support to their congregants in local Muslim communities (Rozario, 2009, Eneborg, 2012). The emergent themes from this study were in the following specific domains: Marital and Family Problems; Help Seeking; Psychosocial Problems; and Post-9/11 Society's Negative Attitudes, Stereotyping, and Stigma.

Marital and Family Problems

Imam 1 stated, " Also, my role is to deal with issues related to marriage, as you mentioned marriage conflict between husband and wife. It happens very often, so we prefer that issues do not go to courts or to police, so we try to intervene and to give them advices and consultations. Basically, I have to play the role of marriage counsellor." The role of imams in family counseling has been so central that some have trained and obtained legal licenses as marriage officers. Imam 1 explained about the prevalence of family conflicts as a significant challenge within the local community and the cardinal role of imams in mitigating this social problem.

He further claimed that imams utilize culturally acceptable unique styles to solve family conflicts through faith-based resolution processes and adjudications, to which most couples related spiritually and culturally. He elaborated that imams are helping the government in terms of financial responsibility and human resources burden by resolving these conflicts amicably at the community level and preserving families. This spared the time and efforts of the police and justice departments, Ministry of Children and Family, foster care, and related departments where some of the children from these troubled families could have potentially been admitted.

In addition, the participants explained that individuals and families who have resettled as refugees from war-torn countries tend to struggle mostly with family conflicts, including youth delinquency as one of the main psychosocial challenges. In other words, this study revealed that providing services in the areas of psychosocial healing and couple or family interpersonal conflict resolution has been a core function of the imams in their communities.

Help Seeking

According to the imams that participated in the study, the choice of spiritual healing by some families and individuals is in line with their belief systems around the causes of psychosocial distress. While research studies support the existence of such cultural explanations of psychosocial and spiritual illnesses, they also point to the cultural complexities and diverse demographic of the Muslim world ( Ahmed & Amer, 2012). However, for others, the utilization of spiritual healing in combination with mainstream health services reflects their option for holistic biopsychosocial and spiritual care.

Imam 5 stated, " In the Islamic literature, that we believe in, there is a treatment for mental illness because you need to connect these people spiritually to the creator and when you connect them to the creator, their confidence level will be stronger, and they feel good about themselves, and when they feel good about themselves, they feel the supreme power, which is the power of God is with them and it will help them to overcome this weakness that they feel..." It is this strong belief that endears the faithful to seek help from their spiritual healers for their psychosocial needs. In England, for example, Muslims bypass the free National Health Services (NHS) to see their spiritual healers for various health-related needs, including mental health ( Dein, Alexander & Napier, 2008). Similar stories came out of this study as well, where very ill individuals did not even attempt to visit their primary care physicians or psychiatrists and only did so after their imam's advice.

Imam 1 was called to treat a very sick female patient who never consulted her family physician or psychiatrist for her condition. Imam 1 stated, " We went to the home and the wife was possessed by Jinn, so we went in their living room, she was completely gone, she was frightened from long time ago, and we started reading Qur'an on the lady, and we continued reading for about two hours."

Imam 2 further endorsed this by stating that in his mosque, they had to set aside specific days of the week for spiritual healing when many people would come to seek healing. Imam 2 said, " The mosque had specific days for Ruqyas. The numbers of patients were so many with the entire room filled. It is the people's perception. They feel cured when Qur'an is read upon them and their situation."

Psychosocial and Mental Health Problems

Imam 2 stressed the myriad of psychosocial and family issues that came to his attention all the time. Imam 2 stated, " ... marital issues, spousal abuse, cultural conflicts, issues with police, families in court, child custody happens a lot. Divorce rate is very high, also unstable parents and children relations. Conflict between kids and parents' cultural divide, financial difficulties also adds because I was dealing with a lot of spouses' issues and a lot of abuses, a lot of adolescence problems, a lot of kids, social issues, and it was too much. It was a lot ..."

Due to the lack of culturally appropriate counseling services, Imam 2 was obliged to do further studies in counseling psychology to fill the void. Imam 2 decided to enroll in a Master of Psychology degree program to obtain some relevant skills to help in these psychosocial problem areas. These examples demonstrate the awareness of imams and their commitment to deal with these psychosocial challenges by developing their individual professional capacity with specialized trainings to act as competent frontline social service providers.

Regarding mental health problems, the interviewed imams indicated that while some Muslims struggling with mental health challenges would initially resort to faith-based healing traditions, others would utilize the mainstream health care system as well as the institution of the mosque. In this problem domain, all the imams emphasized the paramount importance of belief in God (Allah). Imam 3 said:

"We have many people who have mental illness in the community, so we sit with them, we examine these issues from a religious perspective, and, many times, we help them through, you know, through supplication, through prayers, because our religion teaches us to connect us to Allah. We know that whatever happens, happens due to the will of God; so he's the one who causes all of these things and he's the one who heals mental issues, mental problems, and many other problems, so we try to motivate these people to be patient and to connect themselves to Allah; and many times it helps them a lot."

Imam 1 endorsed similar religious understanding and said, "... among Muslims, there is acceptance of Qadar (the will of God) and so we generally accept illness and other misfortunes ... so if someone is depressed, it's seen as the Qadar of Allah." Indeed, all the participating imams endorsed the importance of the will of Allah or Qadar, and remarked that illnesses are caused by the will of Allah. Therefore, praying would be a profoundly important spiritual way to address them by attending the local mosque and participating in ruqya (supplications). These accounts support the existing literature's findings about the role of imams and the institution of the mosque as the preferred points of contact and site for psychosocial and mental health support among many Muslim communities.

Post-9/11 Society's Negative Attitudes, Stereotyping, and Stigma

Two of the interviewed imams discussed the negative impact of the political discourse after September 11, 2001, which gradually destabilized the mental health of many Muslims in North America, and particularly increased their vulnerability to the development of depression and anxiety disorders ( Disha, Cavendish & King, 2011). They also discussed the powerful role of the media in the stigmatization of Muslims by depicting them as terrorists through stereotypes and scapegoats. Imam 4 said, " So after September 11... so every Muslim is a suspect. So every Muslim woman who is wearing hijab is a suspect. Every Muslim who has a beard or goes to the mosque is a suspect. So that really put the Muslims in a tremendous pressure where they are not so comfortable with themselves, about their identity, and how and when to pray." He provided an example of many Muslims, under social and psychological pressures, that made efforts to change their names to avoid being the subject of discrimination and victimization in society.

Discussion

This qualitative study, using in-depth interviews with the imams, revealed five major areas where imams were the main sources of help. According to the study, the emergent themes were: Marital and Family problems; Help Seeking; Psychosocial and Mental Health Problems; and Post-9/11 Negative Attitudes, Stereotyping, and Stigma. In summary, the study showed the significance of understanding diverse explanatory models of health and wellness, especially regarding the provision of culturally appropriate services for individuals with mental illness among the racialized communities. The study also highlighted the importance of closely collaborating with cultural brokers, the significance of alternative and faith leaders in addressing the issues of mental health service provision, psychosocial support, and addressing inequities. The need to enhance the capacity of community agents so that they can effectively address and mitigate various psychosocial needs of their respective immigrant communities cannot be understated, especially since individuals and families from such communities have strong faith and trust in their cultural institutions and rely heavily on them for their psychosocial needs. In addition, the imams are considered the primary resource of guidance for immigrant Muslim communities and have had high levels of trust and expectations thrust on their shoulders. Thus, imams must possess the right knowledge and tools to sufficiently and effectively assist those seeking help from them, or be able to direct or refer them to the proper channels if the presenting problems are beyond their expertise. Supporting their capacity and providing tools to enhance their knowledge in counseling, awareness of available resources, language proficiency, and active communication with health care services, police, and social services will ease their work, reduce barriers, and increase access to services for vulnerable communities. Such capacity-building activities could include workshops for imams by the local health and social services providers to provide an overview of the services available and referral pathways. Also, placing brochures and flyers of local mental health services at local mosques could further enhance the awareness of existing services.

References

Abu-Ras, W., Gheith, A., & Cournos, F (2008). The Imam's role in mental health promotion: a study at 22 Mosques in the York City's Muslim community. Journal of Muslim Mental Health, 3:155-176.

Ali, O. M., & Milstein, G (2012). Mental illness recognition and referral practices among imams in the United States. Journal of Muslim Mental Health, 6(2).

Ameen, A. (2005). The Jinn and Human Sickness. Remedies in the Light of the Qur'an and Sunnah. King Fahd National Library.

Amer, M. & Ahmed, S (2012). Counselling Muslims. Handbook of mental health issues and interventions. Routledge Taylor & Francis Group, London, New York.

Bartram, M (2019). Expanding access to psychotherapy in Canada: Building on achievements in Australia and the United Kingdom. Healthcare Management Forum, 32(2), 63-67.

Dein, S., Alexander, M & Napier, A (2008). Jinn, psychiatry and contested notions of misfortune among East London Bangladeshis. Transcultural Psychiatry. Sage Publications.

Disha,L., Cavendish, J. C., & King, R. D (2011). Historical events and spaces of hate: hate crimes against Arabs and Muslims in post-9/11 America. Society for the Study of Social Problems, 58 (1), 21-46.

Eneborg, Y. M (2012). Ruqya Shariya: Observing the rise of a new faith healing tradition amongst Muslims in east London. Mental Health, Religion and Culture, 16(10), 1080-1096.

Fazel, M., Wheeler, J., & Danesh, J. 2005. Prevalence of serious mental disorder in 7000 refuges resettled in Western countries: A systematic review. Lancet, 365, 1309-14.

Hansson, E., Tuck, A., Lurie, S., & McKenzie K (2009). Improving mental health services for immigrant, refugee, ethno-cultural and racialized groups: Issues and options for service improvement. Mental Health Commission of Canada

Hussain, A., Ross-Sheriff. & Tirmazi, M (2010). Mental Health of Muslim Refugees and Forced

Migrants: Practice, Theory, and Research. Journal of Muslim Mental Health, 5:3-7.

Islam, F., & Campbell, R. A (2014). "Satan has afflicted me!" Jinn Possession and mental illness in the Qur'an. Journal of Region and Health, 53, 229-243.

Jisrawi, A., & Arnold, C. 2018. Cultural humility and mental health care in Canadian Muslim communities. Canadian Journal of Counselling and psychotherapy, 52(1), 43-64.

Mullick, M., Khalifa, N, & Walker, D (2012). Beliefs about Jinn, Black Magic and the Evil Eye in Blangladeshi: The effects of gender and level of education. Mental Health, Religion and Culture, 1-11.

Pew Research Center. (2015). The future of world religions: Population growth projections, 2010-2050. Retrieved from http://www.pewforum.org/2015/04/02/religious-projections-2010-2050/

Pridmore, S., & Pasha, M (2004). Psychiatry and Islam. Religion and Spirituality. Australian Psychiatry. Vol. 12, No 4.

Riley, K. (2011). Violence in the lives of Muslim girls and women in Canada: Creating a safe space for dialogue, research and reflection. London, ON: Centre for Research & Education on Violence Against Women and Children.

Rickwood, D., & Thomas, K. (2012). Conceptual measurement framework for help-seeking for mental health problems. Psychology research and behavior management, 5, 173.

Rosario, S. 2009. Allah is the scientist of all scientists: Modern medicine and religious healing among Bangladeshis. Religion and Technology, 1092), 177-199.

Silove, D., Ventevogel, P., & Rees, S. (2017). The contemporary refugee crisis: An overview of mental health challenges. World Psychiatry, 16, 130-139.

Statistics Canada (2015). 2011 National household survey: Immigration and ethnocultural (Catalogue no. 99-010-X). Ottawa, ON: Retrieved from. http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-010-x/99-010-x2011001-eng.pdf.

Notes

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Healing Through Faith: The Role of Spiritual Healers in Providing Psychosocial Support to Canadian Muslims

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Studies have documented on the role of religious leaders in providing psychosocial support to their members. However, there is a dearth of research in understanding the role imams play among Muslim communities in the Canadian context.

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https://www.islamicpsychology.org/database

https://therapyformuslims.com

https://khalilcenter.com/contact/

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American Muslim Health Professionals (AMHP)

The Family & Youth Institute (FYI)

ICNA Relief

Institute for Muslim Mental Health

Islamic Social Services Association

Khalil Center

Michigan State University’s Muslim Mental Health Consortium

Muslim Wellness Foundation

Stanford Univ School of Medicine’s Muslims & Mental Health Lab

Stones to Bridges

Maristan

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Meeting the Needs of Muslim Youth: Growing Up Safe and Positively Engaged Online

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Meeting the Needs of Muslim Youth: Growing Up Safe and Positively Engaged Online

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Addressing Religous-Based Bullying of Muslim Kids

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Addressing Religous-Based Bullying of Muslim Kids

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Young Adult American-Born Muslims and Mental Health: An Exploration of Attitudes, Challenges, and Needs

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Young Adult American-Born Muslims and Mental Health: An Exploration of Attitudes, Challenges, and Needs

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The Islamic Perspective on Substance Use

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The Islamic Perspective on Substance Use

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Islam prohibits the consumption of intoxicants, which impair the mind and harm the body. Education and community support play important roles in prevention and recovery within Muslim communities.

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Mental Wellness & Depression | Shaykh Dr. Yasir Qadhi

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Mental Wellness & Depression | Shaykh Dr. Yasir Qadhi

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Khuṭbah: Mental Wellness & Depression | Shaykh Dr. Yasir Qadhi

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Toolkit for providing mental health care to Muslim patients launched

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Toolkit for providing mental health care to Muslim patients launched

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MDedge: news and insights for busy physicians

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Toolkit for providing mental health care to Muslim patients launched

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Islamic Psychology and Muslim Mental Health- Dr. Rania Awaad

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Islamic Psychology and Muslim Mental Health- Dr. Rania Awaad

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Islamic Psychology and Muslim Mental Health | Dr. Rania Awaad

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Understand the Core of Who you Are- Muslim Mental Health

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Understand the Core of Who you Are- Muslim Mental Health

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ln islam mental health is recognized as an integral part of overall health. The community and faith-based support, along with seeking professional guidance, are encouraged for those facing mental health challenges.

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Understand The Core of Who You Are |  Muslim Mental Health | Inside Out Outside In

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Self-help Strategies for Cutting Down or Stopping Substance Use

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Self-help Strategies for Cutting Down or Stopping Substance Use

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Overview

Substance use problems can arise as a result of acute intoxication, regular use or dependence - and from the way in which substances are used.This guide is part of the ASSIST packaged and is designed for people above 18 years of age who are at moderate risk of substance related problems but do not have severe substance related problems or dependence.

If you think your substance use is putting you at risk of experiencing health, social, legal, psychological, work or family problems then this guide will help you to weigh up your substance use behavior and give you some ideas about how to change it.

If you experience severe withdrawal symptoms or serious discomfort when you stop using alcohol, tobacco or other drugs, you should seek medical help from your doctor, health care worker or someone from a specialist drug and alcohol service.

Related publications:

The WHO ASSIST project aims to support and promote screening and brief interventions for psychoactive substance use by health professionals to facilitate prevention, early recognition and management of substance use disorders in health care systems with the ultimate goal of reducing the disease burden attributable to psychoactive substance use worldwide.The ASSIST package is part of the WHO ASSIST project and was developed to help the primary health professionals to detect and manage substance use and related problems in primary and general medical care settings.

The package includes three different manuals;
(1) The Alcohol, Smoking and Substance involvement Screening Test (ASSIST);
(2) The ASSIST-linked brief intervention for hazardous and harmful substance use; and
(3) Self-help strategies for cutting down or stopping substance use: a guide (this publication).

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The ASSIST-linked brief intervention for hazardous and harmful substance use

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a guide for cutting down or stopping substance use

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In an emergency situation involving substance misuse, SAMHSA's National Helpline at 1-800-662-HELP (4357) provides confidential, free help from public health agencies.

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Suicide and crisis helpline open 24/7 – just call or text 988. SAMHSA also has a helpline for disaster help, and a helpline for treatment referral.

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SAMHSA advocates for evidence-based interventions including detoxification, rehabilitation, and long-term follow-up to prevent relapse.

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If you're having trouble with mental health, drugs, or alcohol, it can help to talk about it with someone you trust. They can give you support, ease your burden, and help you find a path to feeling better.

As you think about who to talk to-and what you might say-it's normal to feel a lot of emotions. Asking for help is hard and might seem scary, so here are some tips for preparing yourself. A little planning can make the conversation easier, and you're likely to get better results.

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If you're having trouble with mental health, drugs, or alcohol, it can help to talk about it with someone you trust. They can give you support, ease your burden, and help you find a path to feeling better. As you think about who to talk to-and what you might say-it's normal to feel a lot of emotions.

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If you need mental health support call 988.

Click here to learn more about 988.

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In a crisis, contact a professional immediately, or reach out to NAMI's Crisis Text Line by texting 'NAMI' to 741741.

Georgia Crisis & Access Line: (800) 715-4225. Georgia offers a statewide toll-free call center for individuals to access services.  The call center operates 24/7 and has the capacity to screen and assess callers for intensity of service response.

For individuals with less intense needs, the call center staffs are able to offer individuals choice of providers and to schedule appointments for services.

A Portable Treatment Record from the Crisis Guide is available for download and use to begin creating your personal crisis plan.

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5 Tips for Starting a Conversation About Mental Health

Five Tips for Nonjudgmental Listening

What Not to Do: Seven Things to Keep in Mind When Helping Someone with a Mental Health Challenge

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Tailored support such as therapy, medication, peer support, and self-care as key strategies for managing mental health.

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National Institute of Mental Health (NIMH)

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Overview

Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, act, make choices, and relate to others. Mental health is more than the absence of a mental illness-it's essential to your overall health and quality of life. Self-care can play a role in maintaining your mental health and help support your treatment and recovery if you have a mental illness.

About Self-Care

Self-care means taking the time to do things that help you live well and improve both your physical health and mental health. When it comes to your mental health, self-care can help you manage stress, lower your risk of illness, and increase your energy. Even small acts of self-care in your daily life can have a big impact.

Here are some tips to help you get started with self-care:

Get regular exercise. Just 30 minutes of walking every day can help boost your mood and improve your health. Small amounts of exercise add up, so don't be discouraged if you can't do 30 minutes at one time.

Eat healthy, regular meals and stay hydrated. A balanced diet and plenty of water can improve your energy and focus throughout the day. Also, limit caffeinated beverages such as soft drinks or coffee.

Make sleep a priority. Stick to a schedule, and make sure you're getting enough sleep. Blue light from devices and screens can make it harder to fall asleep, so reduce blue light exposure from your phone or computer before bedtime.

Try a relaxing activity. Explore relaxation or wellness programs or apps, which may incorporate meditation, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy activities you enjoy such as journaling.

Set goals and priorities. Decide what must get done now and what can wait. Learn to say "no" to new tasks if you start to feel like you're taking on too much. Try to be mindful of what you have accomplished at the end of the day, not what you have been unable to do.

Practice gratitude. Remind yourself daily of things you are grateful for. Be specific. Write them down at night, or replay them in your mind.

Focus on positivity. Identify and challenge your negative and unhelpful thoughts.

Stay connected. Reach out to your friends or family members who can provide emotional support and practical help.

Self-care looks different for everyone, and it is important to find what you need and enjoy. It may take trial and error to discover what works best for you. In addition, although self-care is not a cure for mental illnesses, understanding what causes or triggers your mild symptoms and what coping techniques work for you can help manage your mental health.

For other ideas for healthy practices for your mind, body, surroundings, and relationships, see the National Institutes of Health (NIH) Wellness Toolkits .

When to Seek Professional Help

Seek professional help if you are experiencing severe or distressing symptoms that have lasted 2 weeks or more, such as:

Difficulty sleeping

Appetite changes that result in unwanted weight changes

Struggling to get out of bed in the morning because of mood

Difficulty concentrating

Loss of interest in things you usually find enjoyable

Inability to perform usual daily functions and responsibilities

Don't wait until your symptoms are overwhelming. Talk about your concerns with your primary care provider, who can refer you to a mental health professional if needed. If you don't know where to start, read the National Institute of Mental Health (NIMH) Tips for Talking With a Health Care Provider About Your Mental Health. Learn more about how to get help or find a provider on the NIMH's Help for Mental Illnesses webpage.

What to Do in a Crisis

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org . This service is confidential, free, and available 24 hours a day, 7 days a week. In life-threatening situations, call 911.

For additional information about suicide prevention, please see NIMH's Suicide Prevention webpage.

Featured Videos

Learn More

Federal Resources

Other Resources

Note: This list of non-federal resources is provided for informational purposes only. It is not comprehensive and does not constitute an endorsement by NIMH, NIH, the U.S. Department of Health and Human Services, or the U.S. government.

Last Reviewed: December 2022

Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

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Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, act, make choices, and relate to others.

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According to the National Institute of Mental Health:

In 2021, there were an estimated 14.1 million adults aged 18 or older in the United States with Serious Mental Illness (SMI). This number represented 5.5% of all U.S. adults.

The prevalence of SMI was higher among females (7.0%) than males (4.0%).

Young adults aged 18-25 years had the highest prevalence of SMI (11.4%) compared to adults aged 26-49 years (7.1%) and aged 50 and older (2.5%).

The prevalence of SMI was highest among AI/AN adults (9.3%), followed by adults reporting two or more races (8.2%). The prevalence of SMI was lowest among Asian adults (2.8%).

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According to NAMI, 1 in 5 U.S. adults experience mental illness each year, and 1 in 20 experience serious mental illness.

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Causes can be complex and a combination of variable factors such as genetics, brain and bodily function, occupational factors and life experiences.

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Genetic predispositions, life experiences, and family history can all contribute to mental health issues.

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World Health Organization defines mental health as a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in.

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Highly Addictive Drugs (YouTube Videos)

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Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease-people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

It's common for a person to relapse, but relapse doesn't mean that treatment doesn't work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient's changing needs.

Video: Why are Drugs So Hard to Quit?

What happens to the brain when a person takes drugs?

Most drugs affect the brain's "reward circuit," causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug-an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.

Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include:

Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

Why do some people become addicted to drugs while others don't?

No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example:

Biology. The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.

Environment. A person's environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person's likelihood of drug use and addiction.

Development. Genetic and environmental factors interact with critical developmental stages in a person's life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.

Can drug addiction be cured or prevented?

As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn't a cure. However, addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients. Treatment approaches tailored to each patient's drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery.

More good news is that drug use and addiction are preventable. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective for preventing or reducing drug use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drug use as harmful, they tend to decrease their drug taking. Therefore, education and outreach are key in helping people understand the possible risks of drug use. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Points to Remember

Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.

Brain changes that occur over time with drug use challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.

Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.

Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy activities, leading people to repeat the behavior again and again.

Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug-an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high.

No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction.

Drug addiction is treatable and can be successfully managed.

More good news is that drug use and addiction are preventable. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Learn more

For information about understanding drug use and addiction, visit:

For more information about the costs of drug abuse to the United States, visit:

For more information about prevention, visit:

For more information about treatment, visit:

To find a publicly funded treatment center in your state, call 1-800-662-HELP or visit:

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Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse

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Provides an overview of drug use and addiction, including what happens in the brain during drug use, why some people become addicted while others don't, and the importance of prevention.

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Factors such as genetics, mental health disorders, peer pressure, and stress can lead to substance misuse.

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Drug addiction (substance use disorder) - Symptoms and causes

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Drug addiction affects your brain and behavior to the point where you can’t control your use of legal or illegal drugs, even when you know they cause harm.

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Substance misuse involves the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.

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SAMHSA reports that in 2018, 20.3 million people aged 12 or older had a substance use disorder.

Georgia has also consistently dropped in the rankings of mental healthcare over the last several years. At the beginning of 2020, Georgia ranked 36th overall, by early 2021, the state had dropped to 37th. While this ranking does take into account the total number of adults and adolescents struggling with mental illness, these numbers have remained fairly consistent over the years. The drop in rankings comes from a consistent lack of access to healthcare, insufficient care, and a very small number of mental healthcare workers compared to the relatively large population of Georgia.

Number of overdose deaths from fentanyl in the U.S. from 1999 to 2021