Substance Use and Abuse in Rural America

Mhs, Jennifer D. Lenardson; Hartley, Mha; Gale, John; Mlis, Pearson

doi:10.1891/9780826108951.0008

Cited by 24 publications

(37 citation statements)

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“…Despite these challenges, examining geographic context is critical as research has shown rural and urban differences in drugs of choice, drug availability, cultural influences, treatment availability, treatment utilization, the provision of services within treatment centers, and treatment retention (Keyes et al, 2014; Knudsen, Johnson, Roman, & Oser, 2003; Lenardson & Gale, 2007; Metsch & McCoy, 1999; Oser et al, 2012; SAMSHA, 2011, 2012, 2013a; Schoeneberger et al, 2006; Shannon, Perkins, & Neal, 2014; Warner & Leukefeld, 2001). Similar to research noted above, this study found that geographical discordance varied significantly by geographic region, with 24% of rural clients being categorized as discordant, compared to 8% and 1% of suburban and urban clients, respectively.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes for prescription drug misusers: the negative effect of geographic discordance

Oser

Harp

2015

Journal of Substance Abuse Treatment

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This is the first known study to examine geographic discordance (traveling from one's home residence to a county with a different socio-cultural context to receive substance abuse treatment) as a predictor of clinical and social functioning treatment outcomes (i.e., relapse, self-help attendance, anxiety, and incarceration) among a sample of prescription drug misusers. Treatment entry and 12-month follow-up client-level survey data was collected from 187 clients who misused prescription drugs, and center-level survey data was collected from the supervisors at treatment centers attended by the clients. Multivariate models reveal that geographic discordance significantly increased the odds that prescription drug misusers would report relapse to prescription opioid misuse, anxiety, and any incarceration at follow-up. Moreover, geographically discordant clients were significantly less likely to have attended a self-help group, net of the effect of other individual- and center-level factors. Implications for clinical practice and substance abuse treatment policy are provided.

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Section: Discussionmentioning

confidence: 99%

Treatment outcomes for prescription drug misusers: the negative effect of geographic discordance

Oser

Harp

2015

Journal of Substance Abuse Treatment

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“…40 However, research suggests that rural treatment centers are more likely to offer outpatient care 11 and less likely to offer more extensive care like intensive outpatient care. 7 This too may be due to restricted staffing and funding resources.…”

Section: Introductionmentioning

confidence: 99%

“…Few studies have examined how rural and urban SUD treatment centers differ in treatment provision 6,7 . Those that have examined treatment quality utilize limited measures of quality and/or use bivariate comparisons that do not adequately control for relevant center characteristics and other quality indicators.…”

Section: Introductionmentioning

confidence: 99%

Rural substance use treatment centers in the United States: an assessment of treatment quality by location

Edmond

Aletraris

Roman

2015

The American Journal of Drug and Alcohol Abuse

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Background While previous research has added to the understanding of rural residents’ unique health challenges, much remains to be learned about the provision of substance use disorder (SUD) treatment in rural areas. A key question is difference in structural resources and quality of care between rural and urban treatment centers. Objective To examine differences in treatment quality in rural and urban centers and to determine if differences in treatment quality are contextualized by centers’ structural resources. Methods Utilizing combined data from two representative samples of SUD treatment centers (N=591), we used a series of multivariate regressions to analyze the association between center rurality and various indicators of structural characteristics and treatment quality. Interaction effects were further examined between structural characteristics and treatment quality indicators. Results We found that structural and quality differences between rural and urban treatment centers were present. Rural centers had reduced access to highly educated counselors, were more likely to be nonprofit, dependent on public funding, offered fewer wraparound services, and had less diverse specialized treatment options. Our results also indicated that rural centers were less likely to prescribe buprenorphine as part of their treatment but were more likely to employ nursing staff and offer specialized treatment for adolescents. Rural center access to a physician contextualized the association between center rurality and the more limited provision of wraparound services. Conclusion Our findings suggest that treatment quality differs between urban and rural centers in complex ways that are subject to resource availability.

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“…A national survey of rural “detoxification” services revealed that only 18% of rural residents live in a town with these services [32]. Rural facilities that provide these services rarely: (1) offer the range of treatments endorsed by national medical societies such as the American Society of Addiction Medicine, (2) have services tailored for populations such as adolescents, elderly, or women, (3) accept public insurance or use sliding fee scales, (4) provide prompt admission, or (5) link patients to robust addiction treatment services on discharge [32].…”

Section: Treatment Availability In Rural Areasmentioning

confidence: 99%

“…Rural facilities that provide these services rarely: (1) offer the range of treatments endorsed by national medical societies such as the American Society of Addiction Medicine, (2) have services tailored for populations such as adolescents, elderly, or women, (3) accept public insurance or use sliding fee scales, (4) provide prompt admission, or (5) link patients to robust addiction treatment services on discharge [32]. Thus, given limited efficacy, availability and services, rural inpatient treatment of OUD is unlikely to have a substantial impact for the vast majority of individuals with OUD; however, expansion may be critical to address the needs of individuals who do not derive benefit from outpatient treatment or to help with the initiation of naltrexone (see below).…”

Section: Treatment Availability In Rural Areasmentioning

confidence: 99%

Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment

et al. 2018

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Purpose of review: To describe the epidemiology opioid use disorder in the rural United States as it pertains to HIV and hepatitis C transmission and treatment resources. Recent findings: Heroin and fentanyl analouges have surpassed prescription opioids in their availability in rural opioid markets adding to HIV and hepatitis C (HCV) and overdose risks. Only 18% of rural individuals live in towns with inpatient services which are of limited quality and utiity. Opioid treatment programs that provide methadone are not located in rural areas and only 3% of the primary care providers have the ability to prescribe buprenorphine. National models and resources have been established but lack implementation in rural areas leading to ongoing HIV and HCV transmission and overdose. Summary: Addressing the adverse impact of opioids in the rural U.S. will require a concerted effort to implement effective treatments according to national standards.

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Substance Use and Abuse in Rural America

Cited by 24 publications

References 0 publications

Treatment outcomes for prescription drug misusers: the negative effect of geographic discordance

Treatment outcomes for prescription drug misusers: the negative effect of geographic discordance

Rural substance use treatment centers in the United States: an assessment of treatment quality by location

Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment

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