Introduction
Drug abuse and mental health issues are two epidemics that go hand-in-hand. Particularly in rural, isolated areas, these issues are often exacerbated by external factors, such as a lack of resources for both mental health treatment and drug rehabilitation. Compared to more urban and accessible places, rural healthcare is at a disadvantage in all fields because of its subpar quality. Especially for issues as taboo as mental health and addiction, the lack of accessible and quality mental health and rehabilitation resources in rural communities as well as the stigma surrounding these issues fuels them, leading to the question of how to curb the prominent difficulties of mental health and addiction in rural environments.
Opioid, Alcohol, and Other Drug Abuse in Rural Areas
Opioids, a prescription painkiller, are among the most abused drugs in rural America due to their addictive properties. Dr. Richard Jenkins, a Health Scientist Administrator with the National Institute on Drug Abuse, explains the opioid epidemic by splitting it up into four phases. These phases begin with prescription opioid use that leads to increased heroin use once people lose access to their prescriptions before the introduction of synthetic opioids, such as fentanyl. Jenkins describes the last phase as the “twin epidemics” of opioids and psychomotor stimulant usage, or cocaine and methamphetamine (Higgins). The dual use of opioid and psychomotor stimulants is harder to treat, leading to more fatal drug overdoses. One study that aimed to understand the divide between rural and urban opioid usage suggests that opioid misuse is concentrated in places in the United States with large rural populations, such as Kentucky, West Virginia, Oklahoma, and Alaska. This is due to factors such as higher rates of drug prescription in rural versus urban areas, stress due to poverty and unemployment, and increased “social and kinship networks” that fuel an ability to obtain opioids through close friends or family (Keyes). These reasons convey how both the system of healthcare and the culture of living rurally can contribute to opioid addictions.
While the issue of opioid misuse is widespread across all regions, the “overarching obstacle” of rural healthcare pertaining to the opioid epidemic is inadequate treatment access (Higgins). One study, focused in South Dakota, suggests that the prevalence rates for alcohol, drug use, and mental health (ADM) conditions are similar across rural and urban South Dakota and that the difference lies in the access to care. The findings of this study “emphasize the barriers that rural populations face in obtaining ADM treatment due to challenges with availability, accessibility, affordability, and acceptability of care” (Davis). According to the South Dakota Health Survey, 98.1% of respondents who screened positive for substance use and 63.8% of respondents who screened positive for a mental health condition did not believe that they needed treatment. People in isolated areas also had limited knowledge of ADM treatment choices and were also less likely to have a primary care provider. The lack of knowledge and accessibility in relation to ADM issues in isolated regions displays that while the rates of addiction may not be significantly more prominent in rural areas, the main issue lies in the lack of accessibility and education relating to substance abuse and mental health.
The Relationship Between Mental Health and Addiction
For many in rural areas where treatment or medication is not as easily accessible, mental health issues often fuel or spark addiction due to a desire to feel better mentally and a lack of resources that have the ability to provide adequate and prescribed help. In the Southern Oral History Program, Chasity Hargrove from Dunn, NC, details her experiences with a mentally ill mother. Hargrove discusses how her mother always had mental issues, and that instead of prescription medication, she “got ahold of something” and that “whatever she did was laced” (Hargrove, 6). These laced drugs caused a series of health issues over the years, leading to her placement in a nursing home before she died. Furthermore, her father worked as a drug dealer and struggled with substance abuse as well, causing Chasity to be raised by her grandparents for the majority of her life. Chasity’s experience with family members who have drug and mental health issues showcases how common addiction and mental illness are in rural areas as well as how they fuel one another.
Arch Woodard, a primary care physician, also discusses mental health and addiction in the Southern Oral History Program. Woodard’s interview talks about drug abuse and mental health from the point of view of the healthcare provider, offering a different perspective. He states that the mental health services where he is located in Burnsville, NC, are “pretty sparse,” and that there’s no psychiatrist in the area (Woodard, 37). He goes on to explain that family practice doctors and internists often provide mental health help because that’s all that’s available. Woodard also says that there are many people in the area with depression and that much of the medicine previously used to treat it was ineffective or abused heavily. The lack of resources for those with mental health struggles in areas such as Burnsville emphasize the need for facilities and professionals in rural areas to prevent the positive feedback loop of mental health disorders and addiction.
Potential Solutions for the Future of Rural Healthcare
Fixing the drug abuse issue in rural regions can look several different ways. Some solutions, according to Higgins, are as simple as connecting directly with local communities and clinicians who are actively treating those with substance abuse issues to “overcome barriers” and “craft local solutions” (Higgins). Solving or remediating unique, location-specific problems calls for solutions that adjust to the community’s needs. Because the intertwined issues of mental health and addiction appear differently across geographical regions, rural areas often need more care and attention to amend rural healthcare injustices and inequalities in comparison to urban healthcare in less isolated locations.
Davis’s study rooted in South Dakota offers similar courses of action for solving drug and mental health issues, such as addressing barriers with cost of care, perhaps through Medicaid expansion. Although many models of rural healthcare improvement are limited due to the lack of specialists in these areas, this article also suggests that community-level education is important as well. Educating the population about conditions and opportunities for recovery and decreasing the stigma around finding help and care can contribute to better healthcare in rural areas (Davis). Simply educating those in need on what the next steps should be for someone suffering from an addiction or mental health crisis can make a difference in rural environments and reduce the stigma that surrounds these issues that ultimately prevent people from asking for help.
Conclusion
The complexity of the combined issues of mental health conditions and addiction overall exhibit that this problem requires a holistic, interdisciplinary approach to effectively solve the obstacles involved with rural healthcare. Education based in the community and its needs as well as increased attention to improving rural healthcare are the correct steps that need to be taken to prioritize a frequently overlooked issue. Though location is just one factor, it’s prominent enough to need a different and careful approach to healthcare based on the area, especially in stigmatized topics such as mental health disorders and addiction.
References
Davis, Melinda M., et al. “Disparities in Alcohol, Drug Use, and Mental Health ConditionPrevalence and Access to Care in Rural, Isolated, andReservation Areas: Findings From the South Dakota HealthSurvey.” The Journal of Rural Health, vol. 32, no. 3, 2016, pp. 229-339. Wiley Online Library, https://onlinelibrary.wiley.com/doi/full/10.1111/jrh.12157.
Hargrove, Chasity. Interview with Shelby Smith. 15 July 2019 (Y-0101). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Higgins, Stephen T. “Behavior change, health, and health disparities 2021: Rural addiction and health.” Preventive Medicine, vol. 152, no. 8, 2021, pp. 0-5. ScienceDirect, https://www.sciencedirect.com/science/article/pii/S0091743521004035.
Keyes, Katherine M., et al. “Understanding the Rural–Urban Differences in Nonmedical Prescription Opioid Use and Abuse in the United States”, American Journal of Public Health 104, no. 2 (February 1, 2014): pp. e52-e59. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2013.301709
Woodard, Arch. Interview with Emma Miller. 23 July 2019 (Y-0079). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.