The opioid epidemic has affected nearly all Americans in some way, but Black and Latino communities have been disproportionately impacted, due to disparities in access to services and treatment. While medication-assisted treatment (MAT) is considered the gold standard for reducing mortality and advancing recovery from opioid use disorder (OUD), research finds that Black and Latino individuals have reduced access to MAT and its positive outcomes. Additionally, there is evidence that a lack of culturally informed behavioral health treatments negatively impacts Black communities, Indigenous communities, and communities of color. Criminal justice involvement due to drug-related offenses further compounds these challenges.
The Imani Breakthrough Project, based in the Yale Program for Recovery and Community Health (PRCH), targets these issues directly. Imani is a culturally responsive and community-driven substance use recovery program operated in local churches throughout Connecticut. Using trained facilitators and mentors with lived experience, participants, including those with justice involvement, are supported through a recovery process grounded in wellness and community.
Merging Faith and Recovery
Imani focuses on meeting the people it serves where they often feel most comfortable and safe: at church. Black and Latino individuals are more likely to seek substance use disorder help in a religious setting or with clergy and other faith leaders. A higher proportion of Black and Latino people attend church weekly and profess an absolute belief in God as compared to white people.
According to Imani’s Principal Investigator and Curriculum Developer Chyrell Bellamy, PhD, MSW, churches can be a safe and inviting setting for holistic healing. Given the prominence of religion and faith-based leaders in Black and Latino cultures, she notes addiction and mental illness are often seen as a spiritual problem with a spiritual solution.
“Few Black and Latino people stick with traditional substance use disorder treatment or find it helpful,” says Dr. Bellamy. “Some say treatment has not been culturally responsive; and for some, it has felt coercive. With Imani, having the opportunity to learn about treatment while also focusing on their lives in the community and their wellness has been helpful.”
Not only is the physical space welcoming and familiar, but the church community itself plays an important role in programming. In many of the churches, the congregation learns about the program at the Sunday service, where participants are invited to tell their stories. “In this process, stigma related to substance use is mitigated,” notes Dr. Bellamy. The church community can also be a referral source for many people who need treatment and spiritual and other social supports.
The majority (68 percent) of Imani participants have a history of incarceration, with 19 percent currently on probation or parole. “People of color returning home after incarceration are less likely to start treatment and less likely to finish treatment,” says Dr. Bellamy. “And a lot of that has to do with the total lack of cultural competency in treatment modalities.” Imani addresses this challenge through a culturally responsive and trauma-informed approach to their services, designed specifically for the life experiences and perspectives of people of color in their communities.
The Citizenship and Wellness Framework
The Imani Breakthrough Project has 2 components: 12 weeks of classes and activities centered on recovery education and mutual support, followed by 14 weeks of individual wraparound coaching. The first 12 weeks include an introduction to MAT, harm reduction, self-advocacy, and social and emotional wellness. During this time, participants are assigned a coach who provides one-on-one support.
Two principles ground Imani and its curriculum: wellness and citizenship. Classes and discussions are framed around SAMHSA’s Eight Dimensions of Wellness (adapted from Dr. Margaret Swarbrick’s wellness approach): social, environmental, physical, emotional, spiritual, occupational, intellectual, and financial. The facilitators are trained in Intentional Peer Support (IPS) (developed by Shery Mead), a way of transforming relationships through inspired partnership rather than “helping” someone with a problem. IPS promotes a trauma-informed relationship that sees people’s lives in the context of mutually accountable communities and encourages movement forward rather than demanding or mandating abstinence. The program’s key components are cultural responsiveness, harm reduction, and spreading knowledge about MAT.
Since strong connection and a sense of belonging are key to recovery and reintegration into the community, Imani incorporates classes on the Five R’s of Citizenship: rights, roles, resources, responsibilities, and relationships. The Five R’s come from the Citizens Project, a recovery curriculum (developed by Drs. Michael Rowe and Madelon Baranoski) for individuals who have experienced incarceration.
Producing Meaningful Change
In a recent study of Imani Breakthrough Project outcomes, Dr. Bellamy and her colleagues found that 42 percent of participants completed the full 12 weeks. They also noted a “significant increase in both citizenship scores and dimensions of wellness from baseline to week 12, with the greatest improvements in the occupational, intellectual, financial, and personal responsibility dimensions.”
Data from participatory conversations with participants and facilitators showed many aspects of how the program helped participants improve their lives through building goals, being recognized as productive and valued members of society, connecting with others, and having positive relationships with their loved ones and their community.
“Spirituality is a motivator,” says an Imani participant. “Sometimes, it is the only thing that you have.”
For more information, contact Imani Project Directors Dr. Chyrell Bellamy at Chyrell.firstname.lastname@example.org and Dr. Ayana Jordan at email@example.com.
 Substance Abuse and Mental Health Services Administration, The Opioid Crisis and the Black/African American Population: An Urgent Issue, Publication No. PEP20-05-02-001 (Office of Behavioral Health Equity. Substance Abuse and Mental Health Services Administration, 2020), https://store.samhsa.gov/product/The-Opioid-Crisis-and-the-Black-African-American-Population-An-Urgent-Issue/PEP20-05-02-001.
 See for example Mara A.G. Hollander, Chung-Chou H. Chang, Antoine B. Douaihy, Eric Hulsey, and Julie M. Donohue, “Racial Inequity in Medication Treatment for Opioid Use Disorder: Exploring Potential Facilitators and Barriers to Use.” Drug and Alcohol Dependence 227 (October 2021), https://doi.org/10.1016/j.drugalcdep.2021.108927.
 Substance Abuse and Mental Health Services Administration, NNEDLearn Implementation Analysis: Evidence-Based and Culturally Relevant Behavioral Health Interventions in Practice: Strategies and Lessons Learned from NNEDLearn, Publication No. PEP21-05-02-001MD (Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration, 2021), https://store.samhsa.gov/product/evidence-based-culturally-relevant-behavioral-health-interventions-practice-strategies/PEP21-05-02-001.
 Keturah James and Ayana Jordan, “The Opioid Crisis in Black Communities,” Journal of Law, Medicine & Ethics 46, no. 2 (2018): 404–21, https://doi.org/10.1177/1073110518782949.
 Chyrell D. Bellamy, Mark Costa, Janan Wyatt, Myra Mathis, Ariel Sloan, Mariana Budge, Kimberly Blackman, Luz Ocasio, Graziela Reis, Kimberly Guy, Reverend Robyn Anderson, Michelle Stewart Copes, and Ayana Jordan. “A Collaborative Culturally-Centered and Community-Driven Faith-Based Opioid Recovery Initiative: The Imani Breakthrough Project,” Social Work in Mental Health 19, no. 6 (November 2, 2021): 558–67, https://doi.org/10.1080/15332985.2021.1930329.
 Pew Research Center, “Religious Landscape Study. Racial and Ethnic Composition,” Accessed April 4, 2023, https://www.pewresearch.org/religion/religious-landscape-study/racial-and-ethnic-composition/.