Drug and alcohol use in adolescence is often a popular topic in media stories and pop culture but, due to the stigma associated with substance use amongst Muslims, does not get the same attention in the Muslim community. Furthermore, this topic remains understudied due to under-reporting, as well as a perceived immunity from this issue due to the Islamic prohibition of alcohol and drug use, but can be a source of religious doubts, especially in youth. This paper hopes to outline the importance of this topic in terms of the impacts of such use, provide a primer to parents (and others) on using a gradual approach when discussing this topic with teens, and equipping teens with the ability to make the correct decisions.
Adolescence is a critical developmental stage during which the body undergoes various physiological and behavioral changes. The brain is especially going through a period of remodeling, which contributes to some of the behavioral changes observed in teens such as increased impulsivity, risk-taking, as well as greater affiliation with peers, which is further accentuated by the societal norms associated with adolescence around independence from parents and identity development. All these factors combine to make substance use common in this population: adolescents are more likely to experiment with, and are especially vulnerable to, the effects of these drugs. In addition, adolescents are also known to use substances in order to cope with stress and bullying. The prevalence of alcohol and drug use among adolescents remains problematically high worldwide. Furthermore, there have been recent increases in certain patterns of substance use such as vaping (use of hand-held e-cigarette devices) of nicotine and cannabis, as well as an opioid epidemic. This has also come in conjunction with changing landscapes around the legal status of drugs such as cannabis, with multiple western countries legalizing cannabis either for medicinal or recreational purposes.
According to the latest “Monitoring the Future” survey, substance use in the American population remains high, with more than 20% of grade 12 students reporting past 30-day use of alcohol, cannabis, nicotine vaping, and/or illicit drug use. Similar trends are also observed in Europe, with nearly 80% reporting having used alcohol in their lifetime; while there have been year-to-year reductions in overall use, worrisome trends related to risky cannabis use and vaping present concern as well. While the prevalence of substance use in Muslim youth in North America has not been studied extensively, we have some studies that provide us an indication of these rates being similar to the national average. For example, 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. Others have reported an increase in normalization of cannabis use amongst Pakistani and Bangladeshi youth in the UK. Lastly, even though the data is scarce for substance use rates in the Arab world, The Arab Youth Survey recently reported that 57% of the youth surveyed thought that substance use amongst young Arabs was on the rise. These changing attitudes, combined with the recent trends in substance use and legalization make this an important topic warranting further discussion and concern for our community.
Benefits of prevention
There is immense wisdom in everything that Allah commands, as the shariah seeks to maximize benefit to humanity and minimize potential harm. Fitting with this theme, the prevention of substance use during adolescence is beneficial in many ways. Firstly, 90% of addictions to substances result from drug use before the age of 21, with earlier age of initiation being associated with a greater likelihood of developing a substance use disorder later in life. We should also remember that prevention could also mitigate some of the other more immediate risks associated with adolescent substance use: violence, risky driving (including speeding and driving under the influence), risky sexual behaviors, unintended pregnancies, infections, and mental health risks such as substance-induced psychosis. Importantly, the Islamic legal maxim of “No Harm Shall Be Inflicted nor Reciprocated” promotes the prevention of harm in all its forms, including the short-and long-term harms of substance use during adolescence. Lastly, empirical research on the topic has suggested that adolescence is an opportune time for prevention-based interventions, and multiple avenues have been found to be efficacious in this regard.
Role of parents
Parents have an immense responsibility in Islam to nurture their children physically and emotionally, and to teach them to distinguish right from wrong. Allah commands us to play a protective role for our children:
O you who believe, protect yourselves and your families from a Fire whose fuel is people and stones, overseen by formidable and severe angels, who never disobey whatever Allah orders—always doing as commanded.
This is further emphasized by the saying of the Messenger of Allah ﷺ saying:
Each of you is a shepherd and each of you is responsible for his flock. The amīr (ruler) who is over the people is a shepherd and is responsible for his flock; a man is a shepherd in charge of the inhabitants of his household and he is responsible for his flock; a woman is a shepherdess in charge of her husband’s house and children and she is responsible for them; and a man’s slave is a shepherd in charge of his master’s property and he is responsible for it. So each of you is a shepherd and each of you is responsible for his flock.
Building upon this guidance from the Qur’an and Sunnah, parents are an essential cornerstone of the Muslim community that ensure the transmission of Islamic values, while caring for and fostering faith in subsequent generations. Especially when it comes to substance use in adolescence, parents can play an important role in either permitting or preventing substance use. Parental permissiveness toward drug use was associated with young people being more likely to use alcohol, tobacco, and cannabis, whereas parental monitoring had the opposite (preventative) effect. Secondly, in a systematic review of longitudinal studies, delayed alcohol initiation could be predicted by parental modeling, involvement, and the quality of the parent-child relationship. Relatedly, since parents are an important source of socialization for children (i.e., children learn to communicate as well as behave from their interactions with their parents), communication between the parents and adolescents about substance use in the media as well as anti-substance use messaging were related to adolescents espousing anti-drug use views as well as reduced recent drug and alcohol use. Lastly, a negative parent-child relationship is also associated with a greater risk for adolescent alcohol use.
Modern social science also places considerable emphasis on parenting styles and the role they play in the development of adolescent behavior as well as the parent-adolescent relationship. The seminal typological division of parenting styles divides them into four types (outlined in Table 1 below) based on responsiveness and demandingness: Authoritative parenting is high in responsiveness and demandingness, providing warmth, support, and clearly defined rules and discipline; authoritarian parenting is low-responsiveness but high-demandingness with arbitrary harsh punishments to gain compliance with no give-and-take or explanation; indulgent parenting is low-demandingness but high-responsiveness, with high satisfaction of children’s needs, but no or minimal discipline; neglectful parenting is low in both responsiveness and demandingness, not providing warmth, nor setting rules for their children. As an example, an authoritative parent may ask for an explanation from a teen who wants to stay out late, and discuss how to be responsible, whereas an authoritarian parent may set rules without space for discussion or consideration for the teen’s need for agency; on the other side of the spectrum, an indulgent parent may not have any rules related to staying out late, and might choose to remind the teen to have fun instead, while a negligent parent may not be aware or concerned about their teen’s whereabouts at all. Highest levels of parent-adolescent cohesion are associated with authoritative parenting, whereas youth-parent conflict is highest with authoritarian and neglectful parents. Authoritative parenting was also the only style that was associated with reduced alcohol drinking after adjusting for proximal risk factors; moreover, authoritative parenting was associated with the least risk for substance use.
Table 1: Parenting styles (as a function of responsiveness and demandingness).
The other reason parents are important in our modern Muslim context is due to the impacts of discrimination and Islamophobia, both of which are risk factors for the development of substance use. A recent study of Arab Muslim students from Israel showed that greater exposure to community violence victimization was related to an increase in the use of alcohol, consistent with a wealth of studies of other youth who face discrimination. However, one of the most important protective factors in the impact of Islamophobia and discrimination on substance use was positive parent-child communication, further emphasizing the importance of parental discussion of these topics with their adolescent children. Lastly, beyond the evidence outlined here, Islam’s emphasis on respect and obedience for parents such as the advice by Luqmān (And we have enjoined on man to be dutiful and good to his parents [Qur’an 31:14]) make the parents an appropriate vehicle for transmitting this message, as it might be more likely to be met with compliance compared to receiving this messaging from others.
The Qur’an presents a model of a healthy parent-child relationship in outlining the advice of Luqmān (AS) to his son. Luqman was comprehensive in his advice, and focused on teaching his son who Allah was before telling him what Allah commanded. He understood that the best way to get his son to adhere to Allah’s commands was instilling the love and awe of Allah in his heart. The key lesson is that Luqman openly communicated with his son, which sets a Qur’anic example for parents to be willing to engage in difficult conversations about problematic beliefs and behaviors. This approach is central to the theme of this article: establishing a healthy parent-child relationship and fostering a healthy child-Allah relationship prior to encouraging them to follow the commandments of Allah, will help children abstain from transgressions against Allah’s commands.
“Just Say No” is just not enough
There have been a variety of approaches and messaging around substance use in adolescence that have been used to promote prevention. “Just say no,” which was a slogan promoted by Nancy Reagan in the 1980s as a part of a zero-tolerance drug education campaign revolving around saying no when offered drugs, has not necessarily worked well. D.A.R.E (Drug Abuse Resistance Education; another zero-tolerance drug education program from the “war on drugs” era) is another example of this type of messaging not having much efficacy, where youth in the program did not differ from their peers who were not a part of the program in their substance use rates. Contrary to these “Just Say No” approaches, the sīrah of the Prophet Muhammad ﷺ provided an alternative gradual and context-dependent model for dealing with drugs, alcohol, and other vices. ʿĀʾishah (RA) mentioned that if a zero-tolerance order to abstain from alcohol was the first to be revealed, then people would not have followed the order, emphasizing the need for connection-building when discussing this topic and extolling the benefits of the Qur’an’s gradual approach to prohibition:
Yūsuf ibn Māhak reported: ʿĀʾishah, may Allah be pleased with her, said, “Verily, the first verses to be revealed were from the shorter chapters at the end of the Qur’an. In them is mentioned Paradise and Hellfire, until people were firmly established upon Islam and verses of lawful and unlawful were revealed. If the first verse to be revealed was ‘do not drink wine,’ they would have said, ‘we will never stop drinking wine.’ And if the first verse to be revealed was ‘do not commit adultery,’ they would have said, ‘we will never stop committing adultery.’”
There are two very important lessons that we can derive from this hadith as it relates to the topic of discussing substance use: ʿĀʾishah mentions that what preceded the prohibition were numerous short surahs from the end of the Qur’an, whose subject matter revolved around the foundational aspects of imān. These foundations included understanding who Allah is and the reality of accountability in the hereafter. This was intended to motivate people to seek His pleasure and the reward of paradise, and to be fearful of His punishment. Thus, the major takeaway is the need to first inculcate a healthy relationship with Allah (as well as a healthy relationship between the advisor and advisee) prior to simply prohibiting people from their alcohol drinking in a manner similar to the “just say no” campaign. Unfortunately, for most parents, the “talk” related to the two important topics mentioned in this hadith (i.e., alcohol and sexual intercourse) usually happens on the drive to a university campus, and can basically be summed up as “Don’t drink alcohol and don’t have sex!” The resultant adherence to this messaging is probably as effective as the scenario described by our mother, ʿĀʾishah (RA). Importantly, research on parenting styles suggests that authoritarian (high demandingness without responsiveness) styles of parenting contribute to the risk for substance use in adolescence.
This hadith also alludes to the gradual nature of the prohibition in the Qur’an, which forms the basis of this article and the need for the messages to be developmentally appropriate. Similar approaches employing gradualism in the form of a spiritually adapted psycho-education program were effective in improving knowledge related to substance use, and increased willingness to seek medical help in a recent study in Muslim adults, suggesting that this approach may also prove beneficial in adolescents.
Stage 1: Permissible blessings of Allah
Part of forming a relationship with Allah is recognizing the vast blessings He has bestowed upon us. The first step as it relates to drinks derived from fruits in the Qur’an is the initial permissibility of these drinks and their nutritional benefits:
And from the fruits of palm trees and grapevines you derive intoxicants as well as wholesome provision. Surely in this is a sign for those who understand.
In fostering our children’s relationship with Allah and the shariah, an abundance mindset is useful so they can begin to appreciate the freedom and ease in Allah’s religion. This is where the Islamic maxim of “al-aṣl fī al-ashyāʾ al-ibāḥah (The default ruling of anything is permissibility)” is important and follows the first step of revelation as it pertains to intoxicant use. Oftentimes, our communication with our children focuses on what is impermissible in Islam, with doubts often arising related to the supposedly restrictive teachings of Islam. An important consideration here is that Allah (SWT) has made the vast majority of things permissible, and these should be recounted with children from an early age, so they develop a relationship with Allah based on His mercy and acknowledgement of the blessings bestowed upon us as believers, starting with the blessing of faith. This by no means suggests that our messaging should center on permissibility of drugs and alcohol, which is no longer the case, but instead to focus on the numerous permissible blessings from Allah.
Stage 2: Pros and cons
Another important Islamic maxim is that “harm must be eliminated.” Building on the message of the abundance of permissible blessings, it is also important to convey to children that Allah (SWT) has only made harmful things prohibited and allowed everything else. Accordingly, the second step is to present the harms and benefits associated with alcohol and substance use. As Allah (SWT) states in the Qur’an:
They ask you [O Prophet] about intoxicants and gambling. Say, “There is great evil in both, as well as some benefit for people—but the evil outweighs the benefit.” They [also] ask you [O Prophet] what they should donate. Say, “Whatever you can spare.” This is how Allah makes His revelations clear to you [believers˺], so perhaps you may reflect.
This is where we can lean on resources created by the National Institute on Drug Abuse as well as other organizations that have done a good job of laying out the pros and cons of alcohol and drug use. These resources include developmentally appropriate lesson plans and talk tool kits, and can be used by parents as background preparation for these important conversations. In accordance with the approach in the ayah above, these resources mention that although there might be some positive effects of alcohol or drug use, the risks and harms outweigh any minor benefits (albeit most of these resources focus on the issue from a purely public health perspective). For example, one of the positive effects related to drugs and alcohol may be increased sociability. However, the harms from this use during adolescence can be many, including short-term risks like impaired driving or blacking out. Moreover, some of the research from my own research group has found that adolescent substance use is associated with long-term deficits, which can be summarized as fitting into increased risk of dysfunction in three major domains: cognitive deficits, future substance use, and psychopathology; importantly all these dysfunctions contravene one of the purposes of the shariah: the preservation of intellect. Depending on the drug, the cognitive deficits can range from impairments in attention and inhibitory control (cannabis) to increased impulsivity (alcohol). Most substances used during adolescence increased the risk of developing a use disorder (of that substance or others). Importantly, even those who reported using substances only for “self-medication” (the use of alcohol or drugs as a method of coping with a mental illness) were at heightened risk for developing new-onset drug dependence, and was associated with persistence of the mental illness. The risk of psychopathology varies with drugs, ranging from increased risk for psychosis with cannabis to depression and anxiety in the case of alcohol and tobacco. Even more importantly, a recent study showed that low levels of alcohol drinking (even as little as a sip) in children is associated with a two-fold increase in their odds of life-time suicidality compared to those with no alcohol drinking. Discussing these risks (especially the long-term effects) and benefits associated with substance use with teens helps them feel empowered in their ability to make decisions and promotes rational decision-making skills, which will benefit them beyond this discussion as well.
Stage 3: Drug use and religion
The next step in the prohibition of alcohol was related to prayer and involved a command to abstain from prayer while intoxicated:
O believers! Do not approach prayer while intoxicated until you are aware of what you say, nor in a state of “full” impurity—unless you merely pass through “the mosque”—until you have bathed. But if you are ill, on a journey, or have relieved yourselves, or been intimate with your wives and cannot find water, then purify yourselves with clean earth, wiping your faces and hands. And Allah is Ever-Pardoning, All-Forgiving.
The third step in discussing this topic with teens revolves around the spiritual impacts of substance use as well as the role of spirituality as a protective factor against substance use. Islam places a lot of emphasis on cognitive presence in acts of worship and in life (as indicated above with the preservation of intellect), and no act requires this more than the daily prayers. Moreover, the importance of mindfulness in prayer relates back to it achieving its purpose of connecting with Allah. Due to the intoxicating effects of drugs and other psychoactive substances the ability to build and foster a spiritual connection with Allah (SWT) is hindered, especially in the formative years of adolescence when individuals are recognizing the sweetness of prayer, and making it a part of their daily routines. Moreover, as described above, the impact of substance use during adolescence can go beyond just the acute intoxication phases. Changes in cognitive capacity or increased psychopathology risk (e.g., anxiety or psychosis) could also impact the spiritual identity and practice of a person, and thereby result in long-term spiritual consequences (i.e., through reducing capacity for connecting with Allah), thereby depriving a person of spiritual fulfillment long after the use of the drugs or alcohol.
Lastly, the relationship between substance use is also known to be bi-directional in that spirituality can serve as a protective factor against substance use. As an example, past year alcohol use was found to be lower among students with higher religiosity. Furthermore, living in a community with more Muslims, and having few people drinking in their social network were additional protective factors. Conversely, Muslim immigrants in Germany who scored high for problem drinking were most likely to report not being religious. Even in the broader population, religiosity has been shown to be a protective factor against alcohol and drug use. Some of the most popular recovery programs (e.g., Alcoholics Anonymous) also attempt to leverage this relationship to foster successful abstinence. Considering the impact of peers on substance use in adolescence, combined with the protective effects of religiosity, this statement of the Prophet ﷺ becomes an important reminder in this context and a necessary part of these conversations:
The Prophet ﷺ said: A man follows the religion of his close friend; so each one should consider whom he makes his close friend.
Relatedly, adolescents’ religious beliefs and behavior are significantly influenced by those of their friends: youth with religious friends are more likely to be religious (i.e., attend services, rate the importance of religion higher) than youth with non-religious friends. Conversely, lower peer religiosity increases likelihood of substance use amongst adolescents. While it might be difficult to disentangle the causal factors in the relationship between religiosity and substance use, the bidirectional relationship as well as strength of these associations make this an important point of discussion in the context of substance use and adolescents.
Stage 4: Prohibition and contextualization
The fourth step is the prohibition of alcohol (and intoxicating drug) use, and also the contextualization of the substance use.
O believers! Intoxicants, gambling, idols, and drawing lots for decisions are all evil of Satan’s handiwork. So shun them so you may be successful. Satan’s plan is to stir up hostility and hatred between you with intoxicants and gambling and to prevent you from remembering Allah and praying. Will you not then abstain?
This is the most important step of these conversations when discussing drug and alcohol use in adolescence. Just as the earlier steps built up to this prohibition in the Qur’an, the discussion of prohibition requires preparation for it to have maximal uptake. If the youth understand the physical and spiritual consequences of substance use, as well as the abundance of blessings of Allah upon them, they will be more receptive to the prohibition. Just as important as the prohibition is the fact that Allah (SWT) places it in the context of other common practices of the time such as gambling and drawing lots for decisions, as well as describing the harm associated with them.
This point is especially important in the context of legalization or decriminalization of substance use. Even though all the practices mentioned in the āyah were societally accepted at the time of revelation, Allah (SWT) still points to the harms associated with these practices, and commands abstinence. This is important to communicate to kids that even though a drug may have been legalized in our society, its legal status in the eyes of Allah (SWT) does not change. This question often arises in relation to cannabis legalization, but cannabis does not differ in that regard from other societally legal substances like alcohol and tobacco, that are still impermissible Islamically. Furthermore, this verse also brings up the impacts on society associated with these impermissible actions. This becomes abundantly clear when we view the costs of substance use in society estimated at being almost 750 billion US dollars per year when considering lost productivity and health care costs. Beyond the economic costs, it is estimated that substance use beyond age 15 costs men approximately 1.4 years and women 0.7 years when it comes to life expectancy. Specifically, 45 percent of all traffic fatalities are alcohol-related, and estimates suggest that 18 percent of 16-20 year old drivers drive under the influence of alcohol.
It is also important for us to establish broader definitions of what falls under the “khamr” (intoxicant) category for Muslims at large. Interestingly, when looking at trends of substance use in immigrant populations in Europe, while Muslim immigrants usually show lower prevalence of alcohol drinking, this was not the case for tobacco and illicit drug use, further signifying that singling out alcohol in our talks with youth may be inadvertently contributing to the use of other substances. Moreover, focusing on the importance of minimizing the harms associated with drug and alcohol use would also impact drug use habits that are more common in the Muslim world compared to the rest of the global population such as cigarette smoking. Especially with cigarette smoking, it is important to ensure early prevention as it remains the single largest preventable cause of death worldwide: the Islamic maxim “harm must be eliminated” supports this preventative approach and warrants community-wide discussions related to the high prevalence of this behavior in our community.
The second āyah above (i.e., Satan’s plan is to stir up hostility and hatred between you with intoxicants) emphasizes the importance of social connectivity and prevention of hostility between Muslims. Importantly, the most effective programs in preventing adolescent substance use based on existing evidence are those that promote life skills training and build social resistance skills in adolescents; these skills are important in the context of peer influence being a major motivator behind initiation of substance use by adolescents. Related to the earlier point around the protective effects of religiosity, here the emphasis on community building in the ayah further reinforces the importance of building stronger communities and equipping our youth with important social skills and agency as members of the community. Workshops and psycho-educational programming like the one organized and designed by Dr. Ahmed Hassan combined with community building exercises would be beneficial to be adapted for use with adolescent populations.
Dealing with alcohol and drug use
It might not always be possible to prevent the initiation of drug or alcohol use, especially in situations where this topic was never discussed, and the parents come to learn of it abruptly. It is likely that the reaction of the parents might be one of anger and severe disappointment, which might create further divisions in the relationship. This is especially important in light of the protective effects of a strong parent-child relationship emphasized above; the presence of warmth differentiates authoritative parenting from authoritarian parenting, even when both involve disciplining the child, but produce diametrically different substance use-related outcomes. Even after the final stage of the prohibition of alcohol, and the institution of punishment, we have multiple examples of the Prophet (SAW) dealing with compassion and mercy with companions who had struggled with drinking alcohol:
During the lifetime of the Prophet ﷺ there was a man called ʿAbd Allāh whose nickname was Donkey, and he used to make Allah’s Messenger ﷺ laugh. The Prophet ﷺ lashed him because of drinking [alcohol]. And one day he was brought to the Prophet ﷺ on the same charge and was lashed [again]. On that, a man among the people said, “O Allah, curse him! How frequently he has been brought [to the Prophet ﷺ on this charge]!” The Prophet ﷺ said, “Do not curse him, for by Allah, I know he loves Allah and His Apostle.”
Abū Hurayrah said, “A man who drank wine was brought to the Prophet. The Prophet ﷺ said, ‘Beat him!’ Abū Hurayrah added, “So some of us beat him with our hands, and some with their shoes, and some with their garments [by twisting it] like a lash, and then when we finished, someone said to him, ‘May Allah disgrace you!’ On that the Prophet ﷺ said, ‘Do not say so, for you are helping Satan to overpower him.’”
The first hadith is important in that it considers the chronic relapsing nature of alcohol and substance use disorders, while emphasizing the importance of religious connection and love for Allah and the Prophet ﷺ. Importantly, it also shows that the Prophet ﷺ had a meaningful relationship with this companion, and did not shun him. As a community, we can be meaningful partners in recovery, instead of contributing to additional risk by depriving those struggling with substance use of the protective benefits of community involvement and acculturation.
Both aḥādīth emphasize the importance of not cursing these individuals, which further highlights the importance of remembering that even with these actions, these individuals are not deprived of the mercy of Allah (SWT). This is consistent with the Qur’anic message of mercy:
Say, [O Prophet, that Allah says], “O My servants who have exceeded the limits against their souls! Do not lose hope in Allah’s mercy, for Allah certainly forgives all sins. He is indeed the All-Forgiving, Most Merciful.” 
Especially in adolescence, the message of mercy and hope is beneficial when considering spiritual benefits as well as the physical, personal and economic impacts of achieving abstinence, as it relates to factors that are important to adolescents. In at-risk youth, abstinence for 12 months from all substance use was associated with positive long-term educational and economic outcomes compared to those that used any drugs during this time, suggesting that abstinence even after initiating use is sufficient in improving outcomes and reducing harm. Therefore, all attempts should be made to present a message of hope and trust in the mercy of Allah, instead of disparaging comments that might drive one further away from reconnecting with Allah.
This primer first highlights the importance of the problem of drug and alcohol use during adolescence, and then presents potential evidence-based solutions that are based on the gradual prohibition of alcohol in Islam. The importance of leaning on scriptural guidance combined with the scientific research currently available related to the effects of substance use during adolescence will help empower youth to make decisions related to their use of substances, and hopefully reduce the harm associated with this use.
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