FAITH-BASED SUCCESSES

In the second week of his administration, President Bush plans to make a
pitch for one of the centerpieces of his campaign: "faith-based" programs
as a means of dealing with many of the country's social problems.

The idea of the federal government providing money for programs sponsored
by religious institutions is, of course, highly controversial, especially
among those of us who revere the separation of church and state. But there
is evidence that faith-based programs have genuine, scientific value in
dealing with alcohol and, by extension, drug problems. We do not have to
take it as a matter of faith that some of these programs save lives.

In 1982 George Vaillant studied the natural history of drinking problems.
Most studies are retrospective, looking at clinic populations that
invariably have a sizable number of dropouts. Vaillant reexamined a group
of 420 men originally studied in 1952. He determined that in the succeeding
30 years, 105 of the men developed major drinking problems. Most important,
nearly half of these 105 eventually achieved a stable sobriety by
establishing at least three elements in their lives: (1) a substitute
gratification or dependency, (2) a powerful negative reinforcement against
drinking and (3) a "magical" instilling of hope and self-esteem.

The threat of arrest may indeed be the most powerful man-made reinforcement
against alcohol and drug abuse. But Vaillant's study shows that when the
fear of arrest is not combined with the other elements, it is not
particularly effective in curbing substance abuse.

By far the least advisable method is a substitute drug, although as a
psychiatrist I would have no trouble urging a 70-year-old alcoholic with
cirrhosis of the liver to turn to marijuana -- to rot out his lungs for a
while and give his liver a rest.

But what truly works, as shown in Vaillant's study, is religious
involvement, participation in quasi-religious groups such as Alcoholics
Anonymous and other 12-step programs, or workaholism. For the latter to be
effective, the work needs to be gratifying and substance abusers must be in
work situations in which they do not want to disappoint employees,
colleagues or boss -- hence the negative reinforcement against alcohol and
drugs.

Religion works remarkably well for many: It provides a substitute
dependency, a powerful negative reinforcement -- who wants to let down God
when one is in the "foxhole" of a drinking problem? -- and a means of
instilling hope and self-esteem.

Simply having a supportive family is not enough. Laura Bush could have
pleaded and prodded all she wanted, but it took George W. Bush's turn to
religion to allow him to become sober.

Why should government programs try to reinvent the wheel? Government
programs are not at all adept in coming up with substitute gratifications
that can mimic the pleasures of alcohol or drugs. And I defy anyone to
produce a government program that has a touch of magic in its ability to
instill hope and self-esteem.

In fact, a case can be made that government programs, by the very fact of
their creating a dependency on a large, impersonal system, help deflate
self-esteem.

Politicians and even parents run a risk when they try to stuff religion
down people's throats. We can only hope, however, that some of the natural
- -- and even supernatural -- forces that George Vaillant described and that
George W. Bush discovered for himself can get a fair and nuanced hearing
before the American people.

The writer is associate director of psychiatric services for students at
Georgetown University.