Skip to main content Accessibility help
×
Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-19T12:28:32.306Z Has data issue: false hasContentIssue false

17 - Disparities in Alcohol Treatment Access in Rural Areas

Opportunities for Change

from Part III - Macro Level

Published online by Cambridge University Press:  23 December 2021

Jalie A. Tucker
Affiliation:
University of Florida
Katie Witkiewitz
Affiliation:
University of New Mexico
Get access

Summary

Persons living in urban and rural areas have similar rates of alcohol use, yet the latter possess far fewer options for treatment of alcohol and other substance use disorders. There is underappreciated diversity across rural communities that compels an understanding of the broad social and economic determinants of their alcohol and other drug use and engagement with treatment. This chapter examines the delivery of treatment for alcohol use disorder in rural healthcare systems with special attention to the primary care setting, the venue most accessible to rural residents. Novel approaches for rural treatment of substance use disorders are identified that match social and cultural trends of substance use while leveraging the limited resources of the rural behavioral healthcare landscape.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ali, M. M., Nye, E., & West, K. (2020). Substance use disorder treatment, perceived seed for treatment, and barriers to treatment among parenting women with substance use disorder in US rural counties. The Journal of Rural Health. https://doi.org/10.1111/jrh.12488Google Scholar
Babor, T. F. (2018). Effective policy measures to reduce alcohol-related harm: An update of the book, “Alcohol: No ordinary commodity.Alcoholism: Clinical and Experimental Research, 42 ,85A. https://doi.org/10.1111/j.1360-0443.2010.02945.xGoogle Scholar
Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007). Screening, brief intervention, and referral to treatment (SBIRT): Toward a public health approach to the management of substance abuse. Substance Abuse, 28(3), 730. https://doi.org/10.1300/J465v28n03_03Google Scholar
Barry, C. L. & Huskamp, H. A. (2011). Moving beyond parity—mental health and addiction care under the ACA. The New England Journal of Medicine, 365(11), 973. https://doi.org/10.1056/NEJMp1108649CrossRefGoogle ScholarPubMed
Beals, J., Belcourt-Dittloff, A., Freedenthal, S., Kaufman, C., Mitchell, C., Whitesell, N., Albright, K., Beauvais, F., Belcourt, G., Duran, B., Fleming, C., Floersch, N., Foley, K., Jervis, L., Kipp, B. J., Mail, P., Manson, S., May, P., Mohatt, G., & Walters, K. (2009). Reflections on a proposed theory of reservation-dwelling American Indian alcohol use: Comment on Spillane and Smith (2007). Psychological Bulletin, 135(2), 339343. https://doi.org/10.1037/a0014819Google Scholar
Bensley, K. M., Fortney, J., Chan, G., Dombrowski, J. C., Ornelas, I., Rubinsky, A. D., Lapham, G. T., Glass, J. E., & Williams, E. C. (2019). Differences in receipt of alcohol-related care across rurality among VA patients living with HIV with unhealthy alcohol use. Journal of Rural Health, 35(3), 341353. https://doi.org/10.1111/jrh.12345CrossRefGoogle ScholarPubMed
Booth, B. M., Kirchner, J., Fortney, J., Ross, R., & Rost, K. (2000). Rural at-risk drinkers: Correlates and one-year use of alcoholism treatment services. Journal of Studies on Alcohol, 61(2), 267277. https://doi.org/10.15288/jsa.2000.61.267Google Scholar
Borders, T. F., & Booth, B. M. (2007). Rural, suburban, and urban variations in alcohol consumption in the United States: Findings from the national epidemiologic survey on alcohol and related conditions. Journal of Rural Health, 23(4), 314321. https://doi.org/10.1111/j.1748-0361.2007.00109.xCrossRefGoogle Scholar
Boyd, M. R., Berger, K. C., Baliko, B., & Tavakoli, A. (2009). Predictors of alcohol and drug problems in rural African American women. Issues in Mental Health Nursing, 30(6), 383391. https://doi.org/10.1080/01612840802509478Google Scholar
Boyd, M. R., & Mackey, M. C. (2000). Alienation from self and others: The psychosocial problem of rural alcoholic women. Archives of Psychiatric Nursing, 14(3), 134141. https://doi.org/10.1053/py.2000.6383CrossRefGoogle ScholarPubMed
Boyd, M. R., Moneyham, L., Murdaugh, C., Phillips, K. D., Tavakoli, A., Jackwon, K., Jackson, N., & Vyavaharkar, M. (2005). A peer-based substance abuse intervention for HIV+ rural women: A pilot study. Archives of Psychiatric Nursing, 19(1), 1017. https://doi.org/10.1016/j.apnu.2004.11.002Google Scholar
Brave Heart, M. Y. H., Chase, J., Elkins, J., & Altschul, D. B. (2011). Historical trauma among indigenous peoples of the Americas: Concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43(4), 282290. https://doi.org/10.1080/02791072.2011.628913Google Scholar
Broffman, L., Spurlock, M., Dulacki, K., Campbell, A., Rodriguez, F., Wright, B., McConnell, K. J., Warne, D., & Davis, M. M. (2017). Understanding treatment gaps for mental health, alcohol, and drug use in South Dakota: A qualitative study of rural perspectives. Journal of Rural Health, 33(1), 7181. https://doi.org/10.1111/jrh.12167CrossRefGoogle ScholarPubMed
Browne, T., Priester, M. A., Clone, S., Iachini, A., DeHart, D., & Hock, R. (2016). Barriers and facilitators to substance use treatment in the rural south: A qualitative study. The Journal of Rural Health, 32(1), 92101. https://doi.org/10.1111/jrh.12129Google Scholar
Buer, L. (2020). RX Appalachia: Stories of treatment and survival in rural Kentucky. Haymarket Books.Google Scholar
Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences of the United States of America, 112(49), 1507815083. https://doi.org/10.1073/pnas.1518393112Google Scholar
Chan, Y. F., Lu, S. E., Howe, B., Tieben, H., Hoeft, T., & Unützer, J. (2016). Screening and follow-up monitoring for substance use in primary care: An exploration of rural–urban variations. Journal of General Internal Medicine, 31(2), 215222. https://doi.org/10.1007/s11606–015-3488-yCrossRefGoogle ScholarPubMed
Davis, M. M., Spurlock, M., Dulacki, K., Meath, T., Li, H. F. G., McCarty, D., Warne, D., Wright, B., & McConnell, K. J. (2016). Disparities in alcohol, drug use, and mental health condition prevalence and access to care in rural, isolated, and reservation areas: Findings from the South Dakota health survey. Journal of Rural Health, 32(3). https://doi.org/10.1111/jrh.12157Google Scholar
Department of Health and Human Services, Health Resources, and Services Administration (2018). HRSA’s home visiting program: Supporting families impacted by opioid use and neonatal abstinence syndrome. US Department of Health and Human Services. https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/MIECHV-Opioid-NAS-Resource.pdfGoogle Scholar
Dixon, M. A., & Chartier, K. G. (2016). Alcohol use patterns among urban and rural residents: Demographic and social influences. Alcohol Research: Current Reviews, 38(1), 6977. www.ncbi.nlm.nih.gov/pmc/articles/PMC4872615/Google Scholar
Edmond, M. B., Aletraris, L., & Roman, P. M. (2015). Rural substance use treatment centers in the United States: An assessment of treatment quality by location. American Journal of Drug and Alcohol Abuse, 41(5), 449457. https://doi.org/10.3109/00952990.2015.1059842Google Scholar
Edmonds, A. T., Bensley, K. M., Hawkins, E. J., & Williams, E. C. (2020). Geographic differences in receipt of addictions treatment in a national sample of patients with alcohol use disorders from the US Veterans Health Administration. Substance Abuse. https://doi.org/10.1080/08897077.2020.1803176Google Scholar
Feldstein, S. W., Venner, K. L., & May, P. A. (2006). American Indian/Alaska Native alcohol-related incarceration and treatment. American Indian and Alaska Native Mental Health Research (Online), 13(3), 122. https://doi.org/10.5820/aian.1303.2006.1Google Scholar
Friedmann, P. D., Andrews, C. M., & Humphreys, K. (2017). How ACA repeal would worsen the opioid epidemic. New England Journal of Medicine, 376(10), e16. https://doi.org/10.1056/NEJMp1700834CrossRefGoogle ScholarPubMed
Garcia, A. (2010). The pastoral clinic: Addiction and dispossession along the Rio Grande. University of California Press.Google Scholar
Goldman, L., Lim, M. P., Chen, Q., Jin, P., Muennig, P., & Vagelos, A. (2019). Independent relationship of changes in death rates with changes in US presidential voting. Journal of General Internal Medicine, 34(3), 363371. https://doi.org/10.1007/s11606–018-4568-6Google Scholar
Gordon, A. J., Ettaro, L., Rodriguez, K. L., Mocik, J., & Clark, D. B. (2011). Provider, patient, and family perspectives of adolescent alcohol use and treatment in rural settings. Journal of Rural Health, 27(1), 8190. https://doi.org/10.1111/j.1748-0361.2010.00321.xGoogle Scholar
Gryczynski, J., Mitchell, S. G., Peterson, T. R., Gonzales, A., Moseley, A., & Schwartz, R. P. (2011). The relationship between services delivered and substance use outcomes in New Mexico’s screening, brief intervention, referral and treatment (SBIRT) initiative. Drug and Alcohol Dependence, 118(2–3), 152157. https://doi.org/10.1016/j.drugalcdep.2011.03.012Google Scholar
Harris, J. K., Beatty, K., Leider, J.P., Knudson, A., Anderson, B. L., & Meit, M. (2016). The double disparity facing rural local health departments. Annual Review of Public Health, 37(1), 167–84. https://doi.org/10.1146/annurev-publhealth-031914-122755Google Scholar
Hunt, G., & Barker, J. C. (2001). Socio-cultural anthropology and alcohol and drug research: Towards a unified theory. Social Science and Medicine, 53(2), 165188. https://doi.org/10.1016/S0277–9536(00)00329-4Google Scholar
Huskamp, H. A., Busch, A. B., Souza, J., Uscher-Pines, L., Rose, S., Wilcock, A., Landon, B. E., & Mehrotra, A. (2018). How is telemedicine being used in opioid and other substance use disorder treatment? Health Affairs, 37(12), 19401947. https://doi.org/10.1377/hlthaff.2018.05134Google Scholar
Kang-Brown, J., & Subramanian, R. (2017). Out of sight: The growth of jails in rural America. Vera Institute on Justice.Google Scholar
Kelley, A., Fatupaito, B., & Witzel, M. (2018). Is culturally based prevention effective? Results from a 3-year tribal substance use prevention program. Evaluation and Program Planning, 71, 2835. https://doi.org/10.1016/j.evalprogplan.2018.07.001Google Scholar
Keyes, S. (2017). Alcohol prohibition in America is not over yet. Pacific Standard. https://psmag.com/news/gin-and-tonic-hold-the-ginGoogle Scholar
Komaromy, M., Duhigg, D., Metcalf, A., Carlson, C., Kalishman, S., Hayes, L., Burke, T., Thornton, K., & Arora, S. (2016). Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders. Substance Abuse, 37(1), 2024. https://doi.org/10.1080/08897077.2015.1129388Google Scholar
Lambert, D., Agger, M., & Hartley, D. (1999). Service use of rural and urban Medicaid beneficiaries suffering from depression: The role of supply. Journal of Rural Health, 15(3), 344355. https://doi.org/10.1111/j.1748-0361.1999.tb00756.xGoogle Scholar
Lee, B. A., & Sharp, G. (2017). Ethnoracial diversity across the rural-urban continuum. Annals of the American Academy of Political and Social Science, 672(1), 2645. https://doi.org/10.1177%2F0002716217708560Google Scholar
Lee, J. P., Pagano, A., Moore, R. S., Tilsen, N., Henderson, J. A., Shell, A. I., Davids, S., LeBeaux, L., & Gruenewald, P. (2018). Impacts of alcohol availability on tribal lands where alcohol is prohibited: A community-partnered qualitative investigation. International Journal of Drug Policy, 54, 7786. https://doi.org/10.1016/j.drugpo.2018.01.010CrossRefGoogle ScholarPubMed
Marsch, L. A., & Dallery, J. (2012). Advances in the psychosocial treatment of addiction: The role of technology in the delivery of evidence-based psychosocial treatment. Psychiatric Clinics of North America. https://doi.org/10.1016/j.psc.2012.03.009Google Scholar
McCarty, D. (2019). A changing landscape for treatment of alcohol and drug use disorders. American Journal of Public Health, 35(2), 481493. https://doi.org/10.2105/AJPH.2019.305080Google Scholar
Mulia, N., Lui, C. K., Ye, Y., Subbaraman, M. S., Kerr, W. C. & Greenfield, T. K. (2019). US alcohol treatment admissions after the Mental Health Parity and Addiction Equity Act: Do state parity laws and race/ethnicity make a difference? Journal of Substance Abuse Treatment, 106, 113121. https://doi.org/10.1016/j.jsat.2019.08.008Google Scholar
Mulia, N., Ye, Y., Greenfield, T. K. & Zemore, S. E. (2009). Disparities in alcohol‐related problems among White, Black, and Hispanic Americans. Alcoholism: Clinical and Experimental Research, 33(4), 654662. https://doi.org/10.1111/j.1530-0277.2008.00880.xCrossRefGoogle ScholarPubMed
Mulligan, J. M., & Castañeda, H. eds. (2017). Unequal coverage: The experience of health care reform in the United States. New York University Press. www.jstor.org/stable/j.ctt1pwtbzpGoogle Scholar
Novins, D. K., Spicer, P., Fickenscher, A., & Pescosolido, B. (2012). Pathways to care: Narratives of American Indian adolescents entering substance abuse treatment. Social Science and Medicine, 74(12), 20372045. https://doi.org/10.1016/j.socscimed.2012.02.004Google Scholar
Palombi, L., Hawthorne, A. N., Irish, A., Becher, E., & Bowen, E. (2019). “One out of ten ain’t going to make it”: An analysis of recovery capital in the rural upper midwest. Journal of Drug Issues, 49(4), 680702. https://doi.org/10.1177/0022042619859309Google Scholar
Ponicki, W. R., Henderson, J. A., Gaidus, A., Gruenewald, P. J., Lee, J. P., Moore, R. S., Davids, S., & Tilsen, N. (2018). Spatial epidemiology of alcohol- and drug-related health problems among Northern Plains American Indians: Nebraska and South Dakota, 2007 to 2012. Alcoholism: Clinical and Experimental Research, 42(3), 578588. https://doi.org/10.1111/acer.13580CrossRefGoogle ScholarPubMed
Pullen, E., & Oser, C. (2014). Barriers to substance abuse treatment in rural and urban communities: Counselor perspectives. Substance Use & Misuse, 49(7), 891901. https://doi.org/10.3109/10826084.2014.891615CrossRefGoogle Scholar
Quintero, G. A., Lilliott, E., & Willging, C. (2007). Substance abuse treatment provider views of “culture”: Implications for behavioral health care in rural settings. Qualitative Health Research, 17(9), 12561267. https://doi.org/10.1177/1049732307307757Google Scholar
Radin, S. M., Kutz, S. H., Marr, J. L., Vendiola, D., Vendiola, M., Wilbur, B., Thomas, L. R., & Donovan, D. M. (2015). Community perspectives on drug/alcohol use, concerns, needs, and resources in four Washington state tribal communities. Journal of Ethnicity in Substance Abuse, 14(1), 2958. https://doi.org/10.1080/15332640.2014.947459Google Scholar
Saunders, E. C., Moore, S. K., Gardner, T., Farkas, S., Marsch, L. A., McLeman, B., Meier, A., Nesin, N., Rotrosen, J., Walsh, O., & McNeely, J. (2019). Screening for substance use in rural primary care: A qualitative study of providers and patients. Journal of General Internal Medicine, 34(12), 28242832. https://doi.org/10.1007/s11606–019-05232-yGoogle Scholar
Schmidt, L. A., Makelia, P., Rehm, J., & Room, R. (2010). Alcohol: Equity and social determinants. In Blas, E. & Kurup, A. S. (Eds.), Equity, social determinants, and public health programs (pp. 1130). World Health Organization.Google Scholar
Shore, J. H., Yellowlees, P., Caudill, R., Johnston, B., Turvey, C., Mishkind, M., Krupinski, E., Myers, K., Shore, P., Kaftarian, E., & Hilty, D. (2018). Best practices in videoconferencing-based tele mental health April 2018. Telemedicine and E-Health, 24(11), 827832. https://doi.org/10.1089/tmj.2018.0237Google Scholar
Showalter, D. (2020). Steps toward a theory of place effects on drug use: Risk, marginality, and opportunity in small and remote California towns. International Journal of Drug Policy, 85.https://doi.org/10.1016/j.drugpo.2019.102629Google Scholar
Spence, R. T., & Wallisch, L. S. (2007). Alcohol and drug use in rural colonias and adjacent urban areas of the Texas border. Journal of Rural Health, 23(Suppl.), 5560. https://doi.org/10.1111/j.1748-0361.2007.00124.xGoogle Scholar
Spencer, M. R., Curtin, S. C., & Hedegaard, H. (2020). Rates of alcohol-induced deaths among adults aged 25 and over in urban and rural areas: United States, 2000–2018. (NCHS Data Brief, No 383). US Department of Health and Human Services. www.cdc.gov/nchs/products/databriefs/db383.htmGoogle Scholar
Substance Abuse and Mental Health Services Administration & Office of the Surgeon General (2016). Facing addiction in America: The surgeon general’s report on alcohol, drugs, and health. US Department of Health and Human Services.www.ncbi.nlm.nih.gov/books/NBK424848/Google Scholar
Torres Stone, R. A., Whitbeck, L. B., Chen, X., Johnson, K., & Olson, D. M. (2006). Traditional practices, traditional spirituality, and alcohol cessation among American Indians. Journal of Studies on Alcohol, 67(2), 236244. https://doi.org/10.15288/jsa.2006.67.236Google Scholar
Travis, T. (2019). Toward a feminist history of the drug-using woman—and her recovery. Feminist Studies, 45(1), 209233. https://doi.org/10.15767/feministstudies.45.1.0209Google Scholar
Weisner, C., & Schmidt, L. A. (2001). Rethinking access to alcohol treatment. In Galanter, M. (ed.), Recent developments in alcoholism — services research in the era of managed care, 15, 107136. New York: Kluwer Academic Publishers.Google Scholar
Willging, C. E., Harkness, A., Israel, T., Ley, D., Hokanson, P. S., DeMaria, C., Joplin, A., & Smiley, V. (2018). A mixed-method assessment of a pilot peer advocate intervention for rural gender and sexual minorities. Community Mental Health Journal, 54(4), 395409. https://doi.org/10.1007/s10597–017-0168-xGoogle Scholar
Willging, C. E., Quintero, G. A., & Lilliott, E. A. (2014). Hitting the wall: Youth perspectives on boredom, trouble, and drug use dynamics in rural New Mexico. Youth and Society, 46(1), 329. https://doi.org/10.1177/0044118X11423231Google Scholar
Williams, E. C., Matson, T. E., & Harris, A. H. S. (2019). Strategies to increase implementation of pharmacotherapy for alcohol use disorders: A structured review of care delivery and implementation interventions. Addiction Science & Clinical Practice, 14(6). https://doi.org/10.1186/s13722–019-0134-8Google Scholar
Woodruff, K., & Roberts, S. C. M. (2019). “Alcohol during pregnancy? Nobody does that anymore”: State legislators’ use of evidence in making policy on alcohol use in pregnancy. Journal of Studies on Alcohol and Drugs, 80(3), 380388. https://doi.org/10.15288/jsad.2019.80.380Google Scholar
Young, J. P., Achtmeyer, C. E., Bensley, K. M., Hawkins, E. J., & Williams, E. C. (2018). Differences in perceptions of and practices regarding treatment of alcohol use disorders among VA primary care providers in urban and rural clinics. The Journal of Rural Health, 34(4), 359–68. https://doi.org/10.1111/jrh.12293CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×