Addiction in Urban vs. Rural Areas

02/13/20: Addiction
Whether you’re in the big city or the rural countryside, no one is safe from addiction. Anyone, no matter where they live, can come face to face with a substance abuse issue. However, where a person lives can most definitely affect their ability to find resources and programs to treat the addiction. Many people have the misconception that urban areas are hubs for drug use and crime, while rural areas are generally not, but that is not necessarily the case. Urban areas are better connected and people living in cities not only have access to more resources, but taking advantage of them is much easier and more convenient. Unfortunately, rural populations don’t have this luxury, which can make it more difficult for addicts in rural areas to get help. There are many layers to this, and we will discuss that in detail in this article. The more we understand the differences between urban and rural drug use, the better we will be able to build and properly direct resources.

What do the numbers say?

DEMOGRAPHICS

  • It was found that cocaine and heroin are more prevalent among urban drug users, while alcohol, opiate pain reliever, and stimulants are common with rural drug users.
  • In 2009, of all treatment admissions in the United States, 31.4 percent were located in urban areas, and 7.2 percent were located in rural areas.
  • Rural admissions were less racially and ethnically diverse and were younger.
  • Males represented more than two-thirds of both urban and rural admissions.
  • Non-Hispanic whites made up 77.1 percent of rural admissions and 38.1 percent of urban admissions.
  • 34.2 percent of rural admissions were under the age of 26, compared to 23.5 percent of urban admissions.
  • Over 60 percent of urban and rural admissions reported having no health insurance.

SUBSTANCES

  • Alcohol abuse was more common in rural areas than urban (49.5 percent vs 36.1 percent).
  • Urban patients were more likely than rural patients to report primary use of heroin (21.8 vs. 3.1 percent) or cocaine (11.9 vs. 5.6 percent).
  • Urban patients were nearly twice as likely (43.1 percent) as rural patients (23.5 percent) to report using their primary substance of abuse on a daily basis.
Statistics courtesy of SAMHSA’s ‘A Comparison of Rural and Urban Substance Abuse Treatment Admissions

Barriers to Treatment

Both urban and rural areas have struggles regarding adequate resources. In urban areas, even though there are more rehabilitation centers, the needs for treatment often outweigh the availability of services. This is made more complicated by a lack of funding and the challenges of working with such a large and very diverse group of clients. Despite this, urban treatment centers have an advantage over rural ones because there are more resources available to patients and specialized programs for minorities and special groups. The technology and methods used may also be more up-to-date and advanced than those in rural areas. Substance abuse in rural areas has been a growing issue, and these areas are struggling to keep up with the increasing demand for services. Rural areas are disproportionately disadvantaged with a lack of basic services and underutilization of the services that are available. In addition, the population in rural areas tend to be more spread out over a larger area, making access to treatment centers that much more difficult. Not to mention, there are much fewer transportation options than in urban areas, and the distance to travel is likely to be much greater. And since research indicates that shorter travel distances are associated with longer stays and greater success rates for substance abuse, this means that rural patients are at a greater risk for dropping out of treatment before completion. As mentioned in the first paragraph, rural areas also lack specialty substance abuse treatment options, such as those tailored to the LGBTQ+ community, women, racial minorities, etc. Since there is no one-size-fits-all treatment method for addiction, even if these groups of people were to enroll in a treatment program, the program may not be able to supply what they truly need.

What are the implications?

One of the biggest issues we see with drug use in rural areas is that drug users tend to start abusing substances earlier in life than those in urban areas. This might be due to the lower quality of early education, and not as streamlined access to higher education. This, combined with an increasing number of absentee parents can explain the high number of teenage alcohol abuse in rural areas. While prescription opioid misuse is increasingly prevalent in both urban and rural areas, there are significantly higher numbers of heroin users in urban areas. Heroin is highly addictive, and easy (and cheap) to obtain. Many people who started out abusing prescription drugs, given to them by their doctor, ultimately turn to heroin because of how much easier it is to get your hands on. Interestingly enough, prescription medication is much easier to obtain in rural areas and thus is more commonly abused than heroin. This is likely because of the tight-knit nature of the communities in these areas, where having close, personal relationships with your doctor or friends/family members with prescriptions can make it much easier to obtain these pills.

What can be done?

Policymakers should always be striving to increase funding and access to resources for substance abuse treatment. However, now is an even more crucial time to act because of the drug epidemics sweeping all areas of the country. Further research is essential for understanding organizational and community barriers to treatment. Prevention programs in rural areas can help to reduce the overall need for addiction treatment resources. It needs to be a whole-community effort to develop these prevention strategies. Here are some examples of actions that urban and rural communities can take to prevent the rise of addiction:
  • Welcoming speakers to engage with children and teens in schools to help them understand the consequences of substance abuse.
  • Encouraging churches and service clubs to provide more opportunities for building support systems, especially for individuals in recovery.
  • Holding community meetings to raise awareness of addiction issues.
  • More in-depth, routine health screenings for children and adults to identify risk factors.
  • Training law enforcement regarding liquor license compliance, underage drinking, and intervening with impaired drivers.
  • Training volunteers to identify and refer at-risk individuals.
  • Developing a substance abuse prevention and/or treatment program specially for the community.
  • Increasing the number of specialized treatment programs and opportunities.
  • Offering care coordination and system navigation services.
  • Collaborating with human services providers and organizations to ensure that families affected by substance abuse have adequate access to food, housing, mental health services, etc.
  • Providing overdose prevention training to emergency services, first responders, and the community

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