Alcohol Use Disorders Risk and the Role of Contextual Religiosity

Mature African American man praying and reading the Bible.
Lower risk for alcohol use disorders and suicide was associated with Historically Black Protestant membership rates.

Alcohol use disorders (AUD) risk for individuals varies based on the religious membership rates among Protestant groups within their geographic state of residence, according to research published in the Journal of Affective Disorder.

Researchers collected data from wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions, which included 34,326 participants. They then assessed whether contextual religiosity, like geographic state, and membership rates of Catholics and 3 major Protestant traditions (Evangelical, Mainline, and Historically Black) are associated with AUD risk and suicidal thoughts among individuals in the past year using regression analysis. Secondary analysis tested for interactions between individual race/ethnicity and contextual religiosity found in the regression analysis.

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While some contextual religious variables were strongly associated with risk for AUD, suicidal thoughts were not. Individuals living in a state with higher membership rates of Evangelical Protestants had an overall higher AUD risk (adjusted relative risk, 1.27; 95% CI, 1.08-1.49), while individuals living in states with higher membership rates of Historically Black Protestants had a lower AUD risk (adjusted relative risk, 0.83, 95% CI, 0.72-0.96). Catholic or Mainline Protestant adherence rates were not significantly associated with individuals’ risk for AUD in the past 12 months. High contextual religiosity was not associated with AUD risk or with suicide risk. The relationship between individual race and contextual-level religious variables was not significant.

The study was limited by an inability to establish causality between religiosity and AUD outcomes because of the National Epidemiological Survey on Alcohol and Related Conditions’ observational, cross-sectional nature.

Overall, researchers found that contextual religiosity could have an impact on AUD risk beyond one’s individual religiosity and they recommend that future studies conduct race-specific analyses and examine contextual religiosity effects in smaller, more homogenous areas.

“If our results are replicated, research could then explore the extent to which information on contextual religiosity could be incorporated into treatment or prevention efforts for AUD,” concluded researchers.


Ransome Y, Perez A, Strayhorn S, Gilman SE, Williams DR, Krause N. Contextual religiosity and the risk of alcohol use disorders and suicidal thoughts among adults in the United States. J Affect Disord. 2019;250:439-446.