Journal of Alcoholism Drug Abuse & Substance Dependence Category: Medical Type: Case Report
Substance Use among Muslims Residing in the United States: A Literature Review
- Sarah Ahmed1, Nick Doukas2*
- 1 Pediatric Department, Centro Hospitalar Barreiro Montijo, Avenida Movimento Das Forças Armadas, Barreiro, , Portugal
- 2 Department Of Concurrent Addiction Inpatient Treatment Service, Centre For Addiction And Mental Health, White Squirrel Way, Toronto, Ontario, Canada
*Corresponding Author:Nick Doukas
Department Of Concurrent Addiction Inpatient Treatment Service, Centre For Addiction And Mental Health, White Squirrel Way, Toronto, Ontario, Canada
Received Date: Jun 22, 2016 Accepted Date: Sep 20, 2016 Published Date: Oct 04, 2016
As one of the most rapidly growing religions in the world, there is a major lack of information on substance use among Muslims. This paper reviews the literature to retrieve and examine research available on substance use and the Muslim population. The review is divided into subsections based on the different areas of interest among researchers (college students, acculturation, Islamic countries, and treatment services). The paper discusses the findings and then makes recommendations for future research. The review located a total of 13 studies of which 5 were from the Middle East and the other eight were conducted in the USA.
Islam is the world’s fastest growing religion . The Muslim population is forecasted to grow at 1.5% annually, which is twice the rate of the non-Muslim population at a 0.7% growth rate. Globally, the muslim population is expected to leap 35% from 1.6 billion in 2010 to 2.2 billion by 2030, comprising 26.4% of the world’s total projected population of 8.3 billion in 2030 . In the United States (US) it is expected to triple by 2030, from more than 3 million as of 2010 to more than 10 million . Among the many sub-groups belonging to the Muslim population who choose to reside in the US, there will be varying degrees in their decision to acculturate to a western way and many will succumb to substance use regardless of the prohibition indicated in Islam [4-6]. This would be viewed as a form of acculturation, in where the individual goes through the process of adapting to the majority or new host culture, which can have positive or negative mental health outcomes .
As one of the most rapidly growing religions in the US, there is a major lack of information on substance use among Muslims . This growing population and the concern for the concerning rates of substance use has fostered an accumulation of research in this area, but there has yet to be a comprehensive review of the literature that focuses on substance use among Muslims in the United States.
This paper reviews the literature to retrieve and examine information available on substance use and the Muslim population. The review is divided into subsections based on the different areas of interest among researchers (college students, acculturation and treatment services). The paper ends with a discussion that describes the findings and makes recommendations for future research.
LITERATURE REVIEW SEARCH METHOD
Cultural differences in the Islamic world
Islam involves peoples of many different races, ethnicities and cultures, many literatures and languages, with many histories and a myriad of interpretations some of which may conflict with each other. Islamic practices and beliefs are those that have roots in the Quran (which Muslims believe to be the last and unchanged revelation from God) and the Sunnah (traditions) of Prophet Muhammad (peace be upon him). Despite the multitude of cultural differences in Muslim majority countries, one rule is universal - any practice among Muslim-majority countries, which does not go back to the Quran or the Sunnah, is not considered to be an Islamic practice. It is for this reason that substance use among Muslims is a very controversial topic and one that is often avoided.
Islamic teaching on substance use
Substance use among Muslim college students
Although alcohol consumption among US Muslim college students was lower compared to other faiths , the US Muslim rates are higher when compared to students in predominantly Muslim countries, specifically Egypt  and Jordan . In Egypt, Refaat  conducted a descriptive cross-sectional survey-based study among a randomly selected sample of 687 college students in Ismailia to examine awareness and practice of risk behavior among Egyptian university students. Their results found that 121 students (18%) engaged in risk behavior such as tobacco, substance and unprotected sexual activity. In Jordan, Suleiman, Shareef, Kharabsheh and Danoon  conducted a cross-sectional randomized survey-based study of 5064 university and college students to examine the impact of substance use among students and their attitude towards substance use. Twelve percent of students reported using alcohol and 29% reported using tobacco. It was observed that substance use was significantly higher among males. Risk factors that contributed towards drug use, as reported by the students, were acceptance of substance use, peer pressure and lack of communication with family. Despite having a lower consumption rate by US standards, in 2001, the rate of alcohol consumption among this population was still higher than that reported by students in the predominantly Muslim countries of Egypt  and Jordan .
In the second study from the US, Ahmed et al.,  and colleagues used secondary analysis to look at discouraged or prohibited Islamic behaviours, such as substance use, gambling, tobacco use and non-marital sexual intercourse. These researchers reviewed data collected from 10,401 students who completed the U.S. 2001 national college survey. Of this sample, 135 (1.7%) were identified to be Muslims. Among this sub-group, 46.2% of the students reported to use alcohol, 24.6% engaged in illicit drug use, 37.3% smoked cigarettes, 30.4% gambled and 53.8% of students engaged in pre-marital sex. This study reports that 58.5% of Muslim students engage in at least one risk behavior of which 77.6% engaged in two or more risky behaviors .
In the third study that shows a continued trend in examining the risk and protective factors of Muslim students, Abu-Ras et al.,  conducted a respondent-driven, survey-based study that was completed by 156 self-identified Muslim students in one university. Results of this study showed that 91.6% of this sample associated religiosity, negative experiences of alcohol use and proscriptive social influences with lifelong abstinence. Out of this sample 65% of life long abstainers identified religious beliefs to play a strong component in their life.
The three US studies found in this review that focus on college students-suggest that any prevention services geared towards Muslim students must address the entire family and diversity must be taken into account as Muslims can vary in levels of acculturation, socioeconomic backgrounds and degree of religious practice. When one considers that US Muslim students are a religious minority who may also have to navigate through a myriad of social, religious and cultural expectations in addition to other stressors such as discrimination , it is of no surprise that acculturation is another topic that has received attention among scholars.
Substance use and acculturation in the United States
Several writers exploring US acculturation assert that substance use can be problematic among individuals who identify with prohibitive cultures, such as that of most Arab countries [19-22]. Researchers have observed that individuals belonging to ethnic groups which prohibit the consumption of drugs and alcohol may have their protective factors reduced against substance use if acculturating in an alcohol and drug tolerant culture . Arfken, Kubiak and Farrag  state that increased substance use among Arab Americans increases with acculturation possibly because of increased access to substances over time, more acceptance of substance use, or the use of substances to cope with discrimination.
The literature in this area has produced two studies that investigate correlations among Arab Americans and substance use. In the first study, Arfken  reviewed medical charts on 156 Arab American male clients, in one Michigan clinic, which showed that increased US acculturation was correlated with polysubstance abuse. The results also uncovered that de-acculturation from origin and home country cultures were also associated with substance use. Individuals in the sample with strong ties to their families, cultural and religious practices reported to experience more discrimination from the society leading to greater acculturation stress . A reason for this could be due to the conflicting practices with mainstream culture, thereby increasing risk of alienation .
In the second study, Arfken, Arnetz, Fakhouri, Ventimiglia and Jamil , conducted a secondary data analysis on existing surveys to study alcohol use among Arab Americans through an acculturation lens. Overall it was reported that on a national level, 50.8% of English speaking Arab Americans reported lifetime alcohol use compared to the White majority group whose lifetime alcohol consumption was 87%. The rate of alcohol abuse among Arab Americans was 3.8%, while 7.9% of the majority group reported alcohol abuse. However, on a state based level, English speaking Arab Americans had a similar rate of binge drinking as the White majority group, at approximately 17%. Authors identified the lack of databases present to estimate alcohol use among Arab Americans, which limits an accurate understanding of prevalence rates. Based on the data they analyzed, alcohol consumption is consistent with an acculturation model.
Much of the literature provides readers with evidence to show the strong association between acculturation and substance use. This supports the need to develop culturally competent treatment services to ethnic minorities experiencing substance use concerns.
Culture specific treatment services
Data from future research or from the studies retrieved in this review can inform the development of treatment programs and outreach efforts to provide a more appropriate provision of care for Muslim groups in North America and abroad.
After a comprehensive review of the literature it is clear that research has recently begun to accumulate that examines substance use among Muslim in the US Among the six studies found in this review, Muslim college students received the most attention, with researchers examining risk and protective factors of alcohol use patterns and discouraged and prohibitive Islamic behaviors, such as substance use, gambling and pre-marital sexual intercourse [4-6]. Acculturation received the attention of two studies, which investigated the correlation between acculturation and substance use and the second one examining alcohol use patterns among US Arabs while being examined through the use of an acculturation lens [18,24]. In the final section of this paper the review yielded one study that focused on comparing substance use treatment admissions among various ethnicities and agencies in the US that provide non-English speaking accommodations for their clientele.
There was a strong indication among the studies found in where writers [4-6,18,28] discussed the need to improve research methods. Furthermore, three out of the five studies found collected data that was either from only one clinic  one university  and from one state that had a high density of Muslim Arab Americans [5,18,26] which would limit the generalizability of the findings. This limited generalizability is especially true for the three college student studies from the US because they are conducted by the same research group who may have used the same data set as well.
Data from these five studies was collected from individuals who followed through with accessing treatment, which excludes individuals that do not disclose substance use concerns due to the stigma. Another major limitation is the lack of data on female Muslim clients quite possibly because there is a stronger stigma associated with substance use among Arab-American women when compared to their male counterparts .
Several researchers have commented that study methods could be improved by including the measurement of variables such as religion, ethnicity, culture, societal norms and influences [28,29]. Among the five studies that were reviewed, no qualitative studies were found. One of the major strengths of qualitative methods is the knowledge it provides through the dynamics of social process  and its distinct ability to answer how and why questions . While qualitative studies lack generalizability, they are tempered by the emergence of comparable findings within diverse samples and settings . It will also be challenging to collect face to face interview data due to the stigma associated with substance use among individuals that identify with a prohibitive religion/culture.
Research on substance use among US Muslims has likely been conducted because of the rapidly growing population and evidence showing a significant concern regarding substance use consumption. Services tailoring to this group’s treatment need will have to seriously consider allocating some funding toward culturally specific services as well as culturally competent training for staff. But this will not be easy when considering the diversity of cultures that exist among this population.
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Citation: Doukas N, Ahmed S (2016) Substance use among Muslims Residing in the United States: a Literature Review. J Alcohol Drug Depend Subst Abus 2: 006.
Copyright: © 2016 Sarah Ahmed, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.