Bill Knight column for Mon., Tues. or Wed., Nov. 26, 27 or 28
Substance abusers treated in rural areas are more likely than substance abusers in urban treatment centers to be non-Hispanic Whites 18 to 25 years old, report primarily alcohol abuse or abuse of non-heroin opiates such as Oxycontin or Vicodin, and admit starting their abuse in their pre-teens.
That’s according to a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) comparing patients admitted to rural facilities to patients admitted to urban facilities.
Rural substance abuse treatment admissions were more likely than urban admissions to be referrals from the criminal justice system (51.6 vs. 28.4 percent) and less likely to be self-referrals or referrals from family members or friends (22.8 vs. 38.7 percent).
Rural admissions were significantly less likely than urban admissions to report daily use of their primary substance (23.5 vs. 43.1 percent), and more likely to have first used that substance prior to turning 18 (32.1 vs. 26.7 percent).
Admissions receiving treatment at facilities located in rural areas (nonmetropolitan areas without a city) were compared with admissions receiving treatment at facilities located in cities (central metro areas) for the study, “A Comparison of Rural and Urban Substance Abuse Treatment Admissions” in a Treatment Episode Data Set (TEDS) Report released this summer.
“There is a real need in this country for substance abuse prevention and treatment in both rural and urban areas. This report underscores that need,” said SAMHSA Administrator Pamela S. Hyde. “It’s a tool that policymakers and treatment providers can use to more effectively meet the substance abuse prevention and treatment needs of the communities they serve.”
Rural and urban substance abusers both showed a similar lack of health insurance (probably tied to income levels) and gender distribution, but different ethnic, racial and age make-ups.
“Over one third of rural admissions (34.2 percent) were under the age of 26 compared to less than a quarter of urban admissions (23.5 percent),” the report found. “More than 6 in 10 urban and rural admissions reported having no health insurance (61.9 and 65.9 percent, respectively).”
Statistics for the study were from 2009, the most recent data available.
The information was reported by state-licensed substance abuse treatment facilities (mainly those that received public funding) from throughout the country.
There were other stark differences.
The types of substances abused were strikingly different:
* alcohol was abused by 49.5 percent for rural patients, and 36.1 percent for urban patients;
* heroin was abused by 3.1 percent of rural patients but 21.8 percent of urban patients; and
* other opiates, such as prescription drugs, were abused by 10.6 percent of rural patients and 4 percent of urban patients.
* methamphetamine abuse was comparable – by 6.3 percent of rural patients and 6.1 percent of urban patients.
The frequency of abuse was much different, too, with 23.5 percent of rural patients abusing daily compared to 43.1 percent of urban patients abusing daily, and those abstaining for a month varying from 40.6 percent of rural patients to 24.3 percent of urban patients.
There were differences in employment status as well. There were more jobless patients in rural areas (42.6 percent) than urban (37 percent), and part-time workers accounted for 10 percent of rural patients but only 5.5 percent of urban patients.
About one-third (34.2 percent) of rural patients were younger than 26; urban patients that young were just 23.5 percent of their total.
Maybe the most surprising statistic was that number on how much earlier rural abusers started abusing – 32.1 percent of rural abusers started between 15 and 17 years old, but 26.7 percent of urban abusers started that young. Of rural patients, 32.7 percent started abusing at 18 or older while 45.6 percent of urban abusers started then. Most shocking, perhaps, 10.2 percent of rural abusers started at age 11 or younger, but just 6.6 percent of urban abusers started that early.
“Rural communities may consider focusing scarce public health resources on alcohol, marijuana, and prescription drugs to best address the needs of their populations,” the report recommends. “Early prevention and intervention efforts in rural areas may help to mitigate future substance dependence and abuse in light of the high rate of adolescent initiation among rural admissions. This may, in turn, alleviate the strain substance abuse and its associated problems (e.g., negative health outcomes, crime) levy on rural substance abuse treatment, health care, and law enforcement systems.”
[Pictured: Report cover from Substance Abuse and Mental Health Services Administration (SAMHSA)]