Last week Carlos Herndon shared the problem that rural areas face especially when it comes to finding treatment for substance abuse. In that post, he addressed the challenge that the significant distances in rural areas plays in finding treatment options. This week he takes a look at the culture that exists in rural areas and how this presents two additional challenges: age and independence.
Age
Within Montana the average age of first drug or alcohol use is 13. Three challenges arose from this young age. First materials for prevention or treatment were tailored for high school students with only limited application for middle school or younger children. Second in the case of alcohol abuse it showed how ingrained into the families and culture alcohol use had become. Third the rapid rise of prescription drug abuse made drugs accessible to younger children not previously able to access illegal drugs. The factors that caused them to begin use of drugs/alcohol by age 13 began when they were much younger. Programs begin to focus prevention efforts at pre-teen children to educate the children and their families about the risks. They began devoting resources to work with elementary schools, boys and girls clubs, and after school programs to assist in getting their prevention message out to a younger audience. They identified groups that were successful at working with teens and worked with them on how to retool their material to be more effective with younger children. Finally they worked with community groups and leaders to promote the message that alcohol does not have to be an integral part of every event.
This was done through distribution of materials and ad campaigns and by helping city leaders and community groups to look at different options when holding events to lessen the serving of alcohol. Alcohol use was so universal at events both private and public that it was viewed by children as normal and necessary for good times. Prevention methods focus on changing behavior through changing the culture that encourages that behavior.
Lastly they raised awareness about the rise of prescription drug abuse among school age populations. It has surpassed meth use among the population and is second only to marijuana in some areas and the number 1 drug of choice in other areas. 23% of high school students reported using or distributing prescription drugs illegally on more than 3 occasions within the past twelve months in my service area. Prescription drugs are very attractive to middle and high school students since they are easily obtainable within the homes of relatives at no cost, have a high resell value, are harder to spot than illegal drugs, not viewed as dangerous as illegal drugs, and negated having to deal with drug dealers. Treatment programs hold community based education sessions and within schools they are educating students that prescription drugs are often as dangerous when used improperly as illegal drugs and can be more addictive. The community education has focused on educating parents and grandparents on the rising problem and giving them practical advice on how to secure the legally prescribed narcotics within their home.
Independence
In any area rural or urban admitting that you have a problem and need help are hard things for people to admit. This is increased in rural areas where self-sufficiency and rugged individuality are admired traits. Asking for help is often viewed as a weakness or moral failure. Getting people to admit that there is a problem and undergoing treatment in communities where everyone knows everyone is much harder as the chances are high if you go to treatment your neighbors will know it. Fear of being “found out” prevents many people who know they need treatment from seeking it. To combat these issues treatment programs have adopted 2 strategies. First is to have outreach campaigns utilizing print, commercial, and social media that utilize people from occupations that are generally viewed as “tough” such as law enforcement, ranching, rodeo, or mining. These send a powerful message that admitting to seeking treatment is a sign of strength not weakness. The second strategy is to provide treatment at neutral locations such as schools or faith based institutions so that a person needing treatment doesn’t have to risk being seen at a treatment facility. Programs located off site have a higher rate of initial participation and a higher rate of completion then those located in traditional clinic setting.
To summarize the path to success lies in knowing the people and culture you are working in. This requires close collaboration with other community groups to develop a targeted strategy. Efforts should focus on identifying the unique challenges and attitudes present in each community and tailoring your message and to address their needs.