Substance use disorders (SUDs) continue to impose profound health, social, and economic burdens across the United States, with persistent disparities in access to prevention, treatment, and long-term recovery support. In many communities, particularly rural and underserved areas, religious congregations remain trusted institutions that provide social capital, moral guidance, and informal care networks. Yet their role within the broader addiction response infrastructure remains unevenly conceptualized and insufficiently integrated into public health strategy. This narrative review examines how religious congregations and faith-based organizations engage substance use prevention, treatment, recovery support, and policy collaboration in the U.S. context. The literature reveals that congregations frequently function as informal safety-net providers, offering youth prevention initiatives, pastoral counseling, recovery ministries, referral pathways, and reintegration support. Theological interpretations of addiction, ranging from sin-based to medicalized and trauma-informed frameworks, substantially shape institutional responses and openness to harm reduction and medication-assisted treatment. While many congregations demonstrate willingness to collaborate with healthcare systems, structural limitations, training gaps, and ethical concerns regarding inclusivity and religious coercion persist. Evidence remains largely qualitative and descriptive, with limited rigorous outcome evaluation. Religious institutions represent a significant yet underutilized component of the U.S. addiction response ecosystem, requiring stronger cross-sector integration and expanded empirical assessment to maximize public health impact.