Sociodemographic Differences in Substance Abuse Treatment and Peer Recovery Support Service Accessibility

Introduction/Background

The ability to access treatment for substance use disorders (SUD) remains a pressing concern in the United States. For years, there has existed a treatment gap between those that experience a SUD and those that receive treatment. This treatment gap has an impact at the individual level where

Barriers to treatment are conceptualized as being either individually or structurally based. Individual barriers include not being ready or motivated for treatment and lack of fit with the clinical setting. Structural barriers include longer distances to treatment facilities and a dearth of affordable treatment options. These structural barriers are particularly salient in rural areas where low population density and less developed infrastructure combine to limit access to treatment facilities.

Methods

This study focuses on New Hampshire (NH) which had the second highest rate of both drug-induced deaths in 2015 and substance use disorders in 2014 in the United States. Data were combined from several sources to investigate access to substance abuse treatment services at a neighborhood level. The NH Bureau of Drug and Alcohol Services’ (BDAS) Treatment Resource Guide was combined with a listing of all NH licensed alcohol and drug counselors to develop a listing of formal substance use disorder treatment services. Secondly, the NH BDAS Recovery Resource Guide was combined with the locational information for Alcoholics Anonymous (AA), Heroin Anonymous (HA), and Narcotics Anonymous (NA) to create a listing of peer and informal substance use disorder support services. Addresses for these facilities were geocoded (>97% match rate for both service types) and density measures (facilities per 1,000 residents) calculated at the census tract level. The density measures were compared to sociodemographic variables from the US Census: racial diversity, poverty, residential instability, and educational attainment.

Results

Density rates for formal substance abuse treatment services was .21 per 1,000 residents and .35 per 1,000 residents for peer support and informal recovery support services. These service types tended to cluster together and there was a moderate (r=.53, p<.05) correlation between the service types.

Findings indicate that as racial diversity increases the availability of formal substance abuse treatment decreases. Access to peer support and informal recovery support services was higher in more impoverished areas.

Conclusion/Implications

The high substance use disorder rates in NH call for efficient delivery of substance abuse treatment. Findings from this study indicate services are less available in areas of the state that are racially diverse. These areas of the state also tend to be more densely populated, so additional capacity would have the potential for reaching a large number of residents. For peer support and informal recovery services, poverty was associated with a greater density. This addresses a service barrier in terms of financial costs as both peer recovery support and AA, HA, and NA are free services to residents. These findings support the need to be mindful of place when developing substance use disorder services.