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. 2017 Apr;41(2):123-135.
doi: 10.1037/rmh0000064.

Substance Use in Rural Central Appalachia: Current Status and Treatment Considerations

Lara Moody  1   2 , Emily Satterwhite  3 , Warren K Bickel  1
Affiliations

Substance Use in Rural Central Appalachia: Current Status and Treatment Considerations

Lara Moody et al. Rural Ment Health. 2017 Apr.

Abstract

The burden of substance use and especially the unmatched rates of overdoses in rural Central Appalachia highlight the need for innovative approaches to curb the initiation to drug misuse and to address current substance use disorders. Effective substance use interventions involve a thorough understanding of the region. In Central Appalachia, many of the barriers to treatment are shared with other rural and impoverished areas, including a lack of access to health care and lack of health care providers with specialized training. Parts of Appalachia also present their own considerations, including the challenges of fostering trust and encouraging treatment-seeking in communities with dense, long-term, place-based social and family networks. Current policies and interventions for substance use have been largely inadequate in the region, as evidenced by continued increases in substance use and substance-related deaths, especially related to nonmedical prescription drug use and increasing heroin use. The authors discuss ways in which rural life, poverty, identity, and values in Appalachia have influenced substance use and treatment and propose strategies and interventions to improve outcomes.

Keywords: Addiction; Appalachia; injection drug use; opioid use; rural; treatment.

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Figures

Figure 1
Figure 1
The outlined regions depicts counties in Central Appalachia.
Figure 2
Figure 2
County healthcare cost, coverage, and access index scores across Appalachia (from Lane et al., 2012, Health Care Costs and Access Disparities in Apppalachia, Appalachian Regional Commission). Blue represents good access, coverage, and payment compared to the national average. White indicates the County’s index score is close to the national average. Red indicates the index score is well below the national average. Panel a shows the combined index scores for cost, coverage, and access. Panel b shows the percentiles for healthcare insurance coverage only.
Figure 3
Figure 3
Appalachian Regional Commission county-by-county map of economic disparity.
See this image and copyright information in PMC

References

    1. Abbott PJ. A review of the community reinforcement approach in the treatment of opioid dependence. Journal of Psychoactive Drugs. 2009;41(4):379–385. - PubMed
    1. Abbott PJ, Moore BA, Weller SB, Delaney HD. AIDS risk behavior in opioid dependent patients treated with community reinforcement approach and relationships with psychiatric disorders. Journal of Addictive Diseases. 1998;17(4):33–48. - PubMed
    1. Algeo K. Locals on local color: Imagining identity in Appalachia. Southern Cultures. 2003;4(4):27–54.
    1. Allen ST, Ruiz MS, O’Rourke A. The evidence does not speak for itself: The role of research evidence in shaping policy change for the implementation of publicly funded syringe exchange programs in three US cities. International Journal of Drug Policy. 2015;26(7):688–695. - PMC - PubMed
    1. Appalachian Regional Commission. Graph illustration of the Appalachian region. 2013 Retrieved August 8, 2016, from https://www.arc.gov/appalachian_region/TheAppalachianRegion.asp.

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