Christian Congregations as Sites of Response to Community Substance Use Issues: An Exploratory Needs Assessment Survey of Clergy in North Carolina, USA.

Opioid overdose deaths have devastated communities across the USA for over two decades. This study explores how Christian clergy in North Carolina perceive and respond to substance use issues, including opioid misuse. An anonymous online survey of clergy in 24 North Carolina counties was conducted from December 2020 to February 2021 (n = 105, response rate 7.6%). Nearly all respondents (98%) reported that their congregations offered at least one form of support for those affected by substance use issues. Over half (58%) reported someone seeking help for substance use in the past year, and clergy noted significant family impacts such as financial hardship, job loss, and overdose. Relative to evangelical Protestant congregations, mainline Protestant congregations were reported as more likely to view addiction as disease rather than sin and to support medication-assisted treatment and syringe exchange. Clergy expressed strong interest in practical resources that are more relational than educational. Limitations include a low response rate, a predominantly white, Christian sample, and pandemic-era timing. Findings highlight opportunities for trust-based partnerships between public health and faith communities that respect theological commitments while building on congregations' existing strengths and practices.