Addiction in Rural Central Appalachia: Utilizing Local Values to Consider Effective Treatment Avenues

Nationally, rural regions are burdened with high rates of drug abuse. Rates in rural Central Appalachia exceed national averages, especially in the abuse of nonmedical prescription drugs and heroin. Contributing factors to rates of substance use in this region could be related to the patterns of drug use, pharmaceutical companies targeting the population, and inadequate training for mental health professionals. Here, we review the challenges to and opportunities for treatment of substance use disorders in rural Central Appalachia. According to studies that will be reviewed, challenges involve limited availability of evidence-based, effective treatments for addiction in these communities that lack access to health care and trained professionals. A lack of trust in mental health professionals and deficient public health education contribute to lower rates of treatment seeking. By examining the literature on the culture, customs, values, identities and income inequality of the region, the authors consider strategies to reduce substance use and improve treatments. Treatment opportunities include those that incorporate family into the recovery process, including the Community Reinforcement Approach, and treatments that reduce burden of travel, including telehealth approaches and remote contingency management. Other treatments include medication-assisted therapies, which provide pharmacological relief for substance users, and public health initiatives such as participatory development and lay health advisers, which help educate and integrate communities. Finally, harm reduction strategies such as syringe exchange programs provide opportunities to reduce spread of disease and improve health in rural Central Appalachia. Both strengths and weaknesses of these interventions and policies will be discussed