Addressing Substance Use Disorders in Rural Communities

August 2020

Authors: Camille C. Cioffi, University of Oregon, &
Sara Anderson

Rural communities encounter a number of obstacles providing medical and behavioral health support to their residents. Providing access to prevention and treatment for substance use disorders is no exception to this rule, and is often more challenging due to stigma; overall lack of access to healthcare; lack of physicians that are certified to provide medication assisted treatment options; and lack of transportation. Potential solutions to address these challenges are discussed below.

Telehealth and Mobile-Based Interventions

  • Telehealth and mobile interventions can include opportunities to interface with physicians and behavioral health specialists.

  • Physicians can interface with patients to renew access to medication assisted treatment (MAT). This may be the only way people living in rural communities can receive MAT since there are fewer prescribers in rural communities.

  • Behavioral health specialists can also interface using telehealth interventions to provide individual therapy and parenting training. For example, the Family Check-Up, an evidence-based parenting intervention is being used in rural Oregon for parents with substance use disorders.

Peer Providers[1]

Peer providers can be leveraged in rural communities to provide low cost peer-to-peer support for people with substance use disorders. Additionally, these types of support roles provide people in long-term recovery with employment opportunities.

  • Other names: Peer recovery/support specialist, recovery coach, community health workers

  • Peer providers provide billable recovery support. They typically have lived experience as a person in recovery and provide linkages to treatment for people with substance use disorders. To reduce barriers to peer providers, such as access and cost, it is important to ensure that peers are able to be the first point of entry in behavioral health settings. For example, eliminating the need for a therapist to refer an individual to a peer provider.

 

Prescriber training[2]

Prescribers should be trained on the benefits and risks of prescribing opioids, including strategies to prevent misuse, while maintaining legitimate and appropriate access to opioids for their patients. Additionally, prescribers have the responsibility to educate their patients on the overdose potential of prescription drugs and the importance of safeguarding prescriptions including safe keeping of medication and access to local medication disposal.

Prevention[3]

Prevention of substance use disorders in rural communities should focus on reducing the intergenerational transmission of substance use. Prevention programs should be a collaboration between parents, schools, physicians, and public health departments, among others. The following strategies can prevent substance use disorders:

  • Family Intervention

    • Interventions that reduce substance use and improve parenting skills among parents with substance use disorders may reduce the intergenerational transmission of substance use. Behavioral treatment that allows mothers and fathers to bring their children to treatment and provides parenting support has been shown to decrease the likelihood of relapse and reduce child welfare burden.

  • School-Based Prevention Programs
    • School-based programs that provide parent education on prescription drug safety and opportunities to take back prescription medications can prevent child misuse of prescription medication. Additionally, universal interventions that provide both teacher-to-student and school-to-parent education result in a lower likelihood of substance use disorder among children and adolescents.

  • School-Based Health
    • School-based health centers (SBHCs) are a key mechanism to provide preventative and ongoing care especially to youth who may lack access, such as those in rural areas. SBHCs also can use a telehealth model to provide behavioral or specialist services when youth are in need.

Transportation[4]

Transportation can block access to needed treatment for rural residents. Treatment infrastructure could be expanded to provide transportation services, or collective transportation services among a variety of social service agencies, to improve access.

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  1. Peer Providers. Peer Providers / SAMHSA-HRSA. https://www.integration.samhsa.gov/workforce/team-members/peer-providers. Accessed February 21, 2020.

  2. Preventing Prescription Drug Misuse: Selected Strategies and Associated Risk Factors. Prevention Solutions@EDC. https://preventionsolutions.edc.org/sites/default/files/attachments/Preventing-Prescription-Drug-Misuse-Selected-Strategies-and-Associated-Risk-Factors_0.pdf Accessed February 21, 2020.

  3. Rural Prevention and Treatment of Substance Use Disorder Toolkit. Rural Prevention and Treatment of Substance Use Disorder Toolkit. https://www.ruralhealthinfo.org/toolkits/substance-abuse. Accessed February 21, 2020.

  4. Marsh, J., D'Aunno, T., & Smith, B. (2000). Increasing access and providing social services to improve drug abuse treatment for women with children. Addiction, 95(8), 1237–1247. https://doi.org/10.1046/j.1360‐0443.2000.958123710.x

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