ARC | Substance Abuse in Ap... - HPMkentucky

ARC | Substance Abuse in Appalachia

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HEALTH

The Problem: Rising Substance Abuse Rates and Lack of Treatment Options

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There is a growing concern that substance abuse is eroding the economic and social fabric of the Appalachian Region. Recent articles about the abuse of OxyContin in Central Appalachia, the increased use of alcohol and other drugs among youth in rural areas, and the limited availability of substance abuse treatment services in the Region give credence to this belief. Not only is substance abuse a public health problem, studies show it impacts education, economic development, and family life. During the past year local, regional, and national media have focused on the increased abuse of prescription drugs in Appalachia—particularly OxyContin (OC), a long-acting narcotic used for pain management. A January 2003 article in the Lexington Herald-Leader noted "in an analysis of federal data, on a per capita basis, Eastern Kentucky drugstores, hospitals and other legal outlets received more prescription painkillers than anywhere else in the nation."1 These drugs are being averted and abused, and OC is now considered the "street drug of choice" in many areas of Appalachia. At a summit on drug abuse in June 2002 in Lexington, Kentucky, Mike Townsend, director of the Kentucky Division of Substance Abuse, reported 2,600 drug related deaths in Kentucky during the past two years; 1,300 of these deaths occurred in the mountains of eastern Kentucky, which has only 20 percent of the state's population. In other words, Appalachian Kentucky is experiencing drug related deaths at about four times the rate of the rest of the state.2 Eastern Kentucky isn't the only area that suffers. Substance abuse does not respect state borders-users, sellers, and distribution networks cross state lines. Only by using a multi-state or regional response can the problem be adequately addressed.

The Response: Creation of the Coalition on Appalachian Substance Abuse Policy In 2001 a group of dedicated mental health and substance abuse professionals in Central Appalachia established the Coalition on Appalachian Substance Abuse Policy (Coalition ASAP)- the first

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line of defense in their war on drugs. ARC funding-through a $10,000 Kentucky Flex-E-Grant-helped create the coalition. And a $5,000 ARC Co-Chair grant supported their first regional conference in March 2002, which was attended by 50 substance abuse professionals from Central Appalachia. Louise Howell, Ph.D., executive director of Kentucky River Community Care, a mental health and substance abuse program in eastern Kentucky, chairs the Coalition; representatives from Kentucky, Tennessee, Virginia, and West Virginia serve on the executive committee. A Regional Approach to Substance Abuse Through Coalition ASAP Coalition ASAP is a multi-state initiative involving public officials, local communities, and treatment professionals seeking to:3 Identify the scope and characteristics of substance abuse problems and substance abuse treatment in Appalachia. Increase communication among Appalachian communities that are addressing substance abuse and health problems to identify common interests and concerns. Develop more information about and a better understanding of the effects of substance abuse on economic development and overall well being. Develop and use data-collection strategies that are appropriate to Appalachia. Explore national and statewide policies that can contribute to better identification of Appalachian-specific substance abuse problems. Identify resources for addressing substance abuse problems. Propose policies that create ways of solving these problems. The Coalition will address questions such as: Is there something about drug use in Appalachia that makes it different? Are the risk factors different? Are the substances abused different? Is the degree of urgency or crisis different? Are current federal and state policies adequate to deal with the problem? Are the problems within Appalachia due to poverty, lack of jobs, and/or culture? At the March 2002 Summit Conference (funded by ARC) the Coalition identified a number of unique characteristics affecting substance abuse in Appalachia, including: Substance abuse is a drain on economic life in Appalachian communities: money spent on drugs leaves the Region; the workforce is weakened by substance abuse; treatment is costly; community trust is eroded; and family stability is compromised. Medical providers with limited substance abuse training are often ill equipped to address problems of addiction and drug abuse.

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Comparatively low education levels, high rates of unemployment, and job related injuries are closely linked to abuse of alcohol, illicit drugs, and prescription medications. A long history of anti-regulatory beliefs influences official and unofficial protection of substance sales and abuse.

Appalachia Needs More Options for Substance Abuse Treatment A recent study conducted for the Commission by Project HOPE's Center for Health Affairs documented that the Region has few options when it comes to treatment for substance abuseparticularly true in our distressed counties. The study found that only 8 percent of distressed Appalachian counties had a provider of hospital-affiliated substance abuse outpatient services, and only 20 percent of distressed counties had hospital-affiliated mental health services.4 Nationwide outpatient drug and/or alcohol treatment options have been decreasing in recent years, so it is not surprising that substance abuse is particularly acute in Appalachia. Across the nation "the percentage of counties with hospital-affiliated outpatient drug and/or alcohol treatment fell from 29 percent in 1994 to 25 percent in 2000," according to the Project HOPE study. Three factors that may contribute to the limited number of treatment alternatives available: 1. There is often a stigma attached to seeking help with mental health or substance abuse problems. 2. There is a chronic shortage of mental health professionals. 3. There is often lack of local support for setting up regional treatment centers that will treat substance abuse patients. Lack of local support can be related to the fact that treatment centers often serve patients from outside the local community. As Project HOPE points out, this "suggests that there may be a need for regional planning and regional funding of mental health services."

Gilbert, West Virginia, Creates the STOP Program: a Proactive, Community-based Approach Gilbert, a small town of 425 in the coalfields of Mingo County, West Virginia, learned it had an OxyContin problem after a rash of break-ins, suicides, and car crashes. So in October 2000, about twenty concerned residents attended the first official meeting of STOP—Strong Through Our Plan. The residents immediately decided that weekly meetings—not monthly as initially expected-were needed to develop a mission statement, establish work teams, and get a handle on the problem. The STOP members addressed the drug problem in their

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community openly—they refused to shy away from publicity, even though it was often negative (the town was referred to as "Pillbert"), and they refused to remain a community in denial. One of the first things they did was to involve churches, often a strong force in Appalachian communities. In addition, the town's physician assistant copied pictures of OxyContin pills and distributed them throughout the community. As expected, most adults had no idea what they were looking at. However, the town's adolescents not only knew what the pills looked like, but where to obtain them and how to use them. STOP's Intervention Efforts STOP organized six areas for intervention— 1. Education 2. Supply/demand 3. Youth alternative activities 4. Rehabilitation 5. Public relations 6. Political action The Education Team, for example, sponsored workshops for parents and teens; worked with local schools; sent home pictures of OxyContin with report cards to all parents; and invited speakers to cover different aspects of substance abuse and addiction. The Supply/Demand Team invited a representative of Purdue Pharma (the manufacturer of OxyContin) to address STOP members, as well as attorneys and local police. STOP plans to focus on public relations, political action, and alternative activities for youth. Although rehabilitation was one of the six areas initially identified for action, STOP members will focus less on this area, having learned how difficult it is to get someone into a treatment program, given the lack of such programs in the Region. STOP Activities Expand to Other Communities STOP activities have spread from Gilbert to at least three other counties in West Virginia—Logan, Wyoming, and Nicholas. The design changes to fit the unique requirements of each community and its substance abuse problem. In Gilbert, for example, mostly parents and peers expressed initial concern about the drug problem; in Wyoming County, many of the grandparents of drug abusers took a leading role.

A Committed Community Is Key: "If It's to Be, It's Up to Me" Regardless of how the program is structured, who gets involved, or what aspect of the substance abuse problem is addressed first, a committed community is frequently the best—sometimes the only—remedy to a serious, life threatening drug problem in Appalachia. Perhaps the STOP Program's motto in Gilbert best expresses this approach: "If it's to be, it's up to me."

The Challenges Ahead

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Substance abuse in Appalachia will not be overcome without federal, state, and local partners working collaboratively to address this multi-faceted problem.

Attract Federal Government Attention Coalition ASAP is in discussions with the Center for Substance Abuse Treatment (the federal agency whose mission is to improve the lives of individuals and families affected by alcohol and drug abuse by ensuring access to treatment) to focus the federal government's attention on the devastating effects of substance abuse in Central Appalachia.

Communities Must Continue to Help Themselves Gilbert, and hundreds of other communities like it throughout the Region, will continue to respond to their drug problem because they know they must. And although these communities welcome help from others, they know they can no longer sit and wait for help as substance abuse ravishes their communities. For more information on substance abuse and other healthrelated issues, see ARC's section on Health Care Information, Initiatives, Research, and Policy Resources. Footnotes 1

L. Johnson, "Eastern Kentucky, Painkiller Capital," Lexington Herald-Leader, 19 January 2003. 2 D. Matthews, "Appalachian Substance Abuse Strategic Initiative" Final Report, 10 December 2002. 3 C. Cole, "Coalition on Substance Abuse Policy," Conference Proceedings, 7 March 2002. 4 J. Stensland et al,. Project HOPE Center for Health Affairs, "An Analysis of the Financial Conditions of Health Care Institutions in the Appalachian Region and Their Economic Impacts," December 2002. Health Sources of Funding Best Practices Examples of ARC Health Care Projects Data and Research Reports News and Events Spotlight on Health Care Issues Directory of Health Care Resources

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