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Alcoholism & Addiction

Substance Abuse Treatment Compared in Rural and Urban Settings

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides regular reports about the trends across the United States related to substance use and treatment. The information the administration provides aids policymakers in determining where to strategically locate substance abuse treatment centers and in the development of education and intervention materials.

A recent report issued by SAMHSA focused on examining the differences in substance abuse when comparing urban and rural populations seeking treatment. The report is intended to help in reducing the disparities in the treatment available for substance abuse by providing information about various aspects of urban and rural substance abuse.

Using the Treatment Episode Data Set (TEDS), the report includes information about treatment admissions in the extremes of rural and urban environments during the year 2009.

The demographic characteristics examined between rural and urban treatment centers showed that there were similar gender distributions, but in rural areas the population treated was less diverse both racially and ethnically and were generally younger than those treated at an urban center. Males made up more than two-thirds of the admissions in both rural and urban settings.

Rural admissions were more apt to hold a high school diploma or GED, and urban admissions were more likely to have less than a high school education. Rural admissions were also more likely to be employed.

There were differences noted in the primary substance of abuse, with rural admissions more apt to use alcohol or non-heroin opiates as their number one substance of abuse. Urban admissions were more likely to report cocaine or heroin as their primary substance of abuse. Those admitted to an urban treatment center were nearly twice as apt to report daily use of their primary substance of abuse.

The age of first use was younger among rural admissions, with an age of initiation between 15 and 17 for 32.1 percent of admissions, versus 26.7 of the urban admissions.

The urban and rural admissions also differed in the source of the referral for treatment. Rural admissions were more likely than urban admissions to be through the criminal justice system, at a rate of 51.6 percent versus 28.4 percent.

Rural admissions received regular outpatient care at an increased rate when compared with urban admissions (63.2 percent verus 43.8 percent) and were less likely to be treated with detoxification. Urban admissions were also more apt to report a more extensive treatment history when compared with those admitted at a rural treatmen center.

In urban areas, 14.5 percent of admissions reported that there were five or more prior treatment episodes compared with 8.1 percent in rural admissions. These differences may be a result of an increased use of heroin in rural areas when compared with urban areas. Cases involving heroin are more likely to involve detoxification.

Urban admissions were about five times as likely to be homeless when compared with rural admissions.

The findings of the report highlight the ongoing need to compare and adjust the services available to urban and rural populations for substance abuse treatment.

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