Rural Substance Use Disorder Treatment Barriers and Facilitators in the Southeastern United States

BACKGROUND AND PURPOSE: Substance use is a behavioral health crisis in the rural United States and has been identified as one of the top ten priorities in Rural Healthy People 2020. This is a particularly significant concern in the rural Southern United States that has the greatest substance use services disparity in the country. Individuals in rural communities have unique barriers to recovery from substance use disorders. Implementing evidence-based social work interventions in these underserved communities to address the needs of this population is associated with a unique set of challenges. To improve policy, social work practice and research in this area, this study explored client and agency stakeholder-perceived barriers and facilitators to substance use treatment delivery in rural communities.

METHODS: Group and individual interviews were conducted with 40 key stakeholders and 40 clients at 9 substance abuse agencies serving rural communities in a southeastern state. Stakeholders include 5 board members, 10 agency staff, and 35 professionals from partner agencies. Qualitative thematic analysis was used to identify perceived barriers and facilitators to client-centered substance abuse services in rural communities. Twenty-four qualitative interview transcripts, 6 sets of cross-site process notes, and 8 sets of program-specific researcher field notes were analyzed using MaxQDA software. First-cycle coding was performed using provisional codes derived from interview prompts, with additional open coding to further break down the data and provide analytic leads for exploration. After discussion and consensus about the findings as related to facilitators and barriers to care, second-cycle axial coding was then performed to differentiate and organize codes used to identify the most salient themes related to facilitators and barriers to care.

RESULTS: Forty clients of substance abuse treatment agencies participated in 8 focus groups. Eighty percent of the sample was female. In terms of race/ethnicity, 67.5% reported as White, 30% reported as Black/African American, and 2.5% reported as Latina/o or Hispanic. The mean age of respondents was 34 years old. Forty stakeholders participated in 24 interviews (15 individual interviews and 9 group interviews). In terms of professional role, 7 were board members, 24 were staff, and 9 were directors/administrators. Of those who were interviewed, 45% were female. In terms of race/ethnicity, 75% reported as White, 22.5% reported as Black/African American and 2.5% reported as “Other.” The qualitative data analysis resulted in the identification of 2 themes reflecting both barriers and facilitators of substance use services in these rural Southeastern communities: service availability, technology and 2 themes reflecting barriers of such services: cost and stigma.

CONCLUSIONS AND IMPLICATIONS: This study identifies novel barriers and facilitators to substance use care related to policy, social work practice and research and highlights essential areas for consideration when developing and implementing integrated care programs in these underserved geographic regions. These findings can be used to inform client-centered social work care to individuals with substance use disorders living in rural communities.