Dirt roads. Tractors. Crops. Cattle. Methamphetamine. While something in that list may seem out of place, research by the National Institute on Drug Abuse (NIDA) suggests that drug abuse, addiction, and other related consequences are serious and growing problems in rural areas.

In its NIH Health Disparities Strategic Plan for Fiscal 2009-2013, NIDA said, “While we are actively working to expand our knowledge base on drug abuse and addiction in these communities, providing drug abuse prevention, treatment, and services and conducting drug abuse research in rural areas are difficult due to issues such as confidentiality, access to services, logistical difficulties, and a limited cadre of researchers and health care providers in rural areas.”

As part of that effort, NIDA funded a recent study at the University of Arkansas for Medical Sciences in which 710 rural users of cocaine and methamphetamine were interviewed at baseline and every six months for 36 months to determine their degree of use of substance abuse and mental health services during a three-year period. Participants were recruited using respondent-driven sampling, a variant of snowball sampling, in which study staff members recruited individuals through a variety of community activities who then spread word of the study. The counties were classified as rural according to the federal Office of Management and Budget definition of a nonmetropolitan county. A total of 519 participants (73 percent) completed all of the interviews. Results were published in the october Psychiatric Services.

Most of the participants who completed all seven interviews received no substance abuse or mental health services while they participated in the study. Of those who did receive services, more received mental health services than substance abuse services, and only a few who received mental health services later transitioned into substance abuse services.

The study did not examine reasons for the lack of use of services, but lead author Geoffrey Curran, Ph.D., a medical sociologist and an associate professor of psychiatry in the College of Medicine at the University of Arkansas for Medical Sciences, told Psychiatric News that “many barriers exist to seeking professional help in rural communities; the major ones are transportation, travel distance, time investment, and cost.”

Perhaps the most interesting finding of the study was that many subjects stopped their substance abuse without treatment over the study period. At baseline, 83 percent of the participants met DSM-IV criteria for a drug use disorder and 57 percent met criteria for an alcohol use disorder, but by 36 months, the rates had dropped to 30 percent and 26 percent, respectively.

“We know that many people reduce or stop their substance use without professional help; many observational studies show declines in substance use over time among those who do not seek formal treatment,” said Curran. “Two possible explanations are that these studies might be enrolling people at a ‘high point’ in their ‘use career,’ and over time their use diminishes (perhaps to reappear later). And the studies themselves might function as an intervention, even though no treatment is offered. It’s possible that answering these questions every six months for two to three years prompted change.”

Curran and colleagues described the future of their research: “These analyses did not tell us which participants were more likely to receive mental health [services] compared with substance abuse services, and analysis of this issue is ongoing… . Overall, we know much more about use of substance abuse services by substance users than we know about their use of mental health services, and future work is needed to better understand the extent of help seeking for mental health services in this frequently comorbid population.”

An abstract of “Trajectories in Use of Substance Abuse and Mental Health Services Among Stimulant Users in Rural Areas” is posted at <http://ps.psychiatryonline.org/article.aspx?articleid=178326>.