Nearly 18% of adults in the U.S. struggle with substance use disorder (SUD). While access to SUD treatment and support is a problem nationwide, it is particularly pronounced in rural communities. Limited options for care, support resources, and healthcare staff, plus transportation barriers, the burden of stigma, and confidentiality concerns make it complicated for individuals to receive treatment.
Unfortunately, the SUD crisis has hit hard in rural communities. These areas, where about 20% of Americans live, are experiencing a frightening increase in the misuse of prescription painkillers, alcohol, methamphetamines, and opioids, stressing healthcare resources that are already scarce. As a result, many people with SUD in rural communities do not receive adequate treatment or any treatment at all.
To address this crisis, some rural areas are turning to innovative solutions, such as evidence-based digital tools, to bridge gaps, deliver needed options, heal their struggling communities, and provide hope for a better future.
The Unique Challenges of SUD in Rural Communities
Although SUD takes a toll on all communities, the issues are magnified in rural areas for various reasons.
- Limited resources for treatment, prevention, and recovery: Many rural communities lack established treatment facilities or a support network for individuals seeking SUD care. Even if they have the facilities, they don’t have the staff or resources to meet demand. Communities across the U.S. are experiencing a critical shortage of behavioral health workers, a problem exacerbated in rural communities due to the smaller workforce. As a result, rural residents are 4.5 times more likely to receive inpatient treatment due to a court order by law enforcement and 9 times less likely to have access to medication-assisted treatment (MAT) options to relieve withdrawal symptoms than their urban counterparts.
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- Difficulty assessing a community’s overall health: Screening for SUD in rural areas can be complicated by limited healthcare resources, high patient volumes, and multiple demands on already overworked providers. In addition, individuals in smaller communities may be less likely to honestly report substance use for fear of legal or social repercussions, making it difficult for public health officials to understand the scope of use fully.
- High rates of poverty: Unemployment and poverty are associated with drug use, according to the USDA Economic Research Service, and the overall rate of poverty in rural areas is significantly higher than it is in urban or suburban areas. Individuals in rural communities are more likely to be unemployed and have lower educational attainment rates than other areas. In addition, people who are unemployed often do not have health insurance coverage, so SUD treatment may not be affordable. In fact, Medicare and Medicaid are the primary payers for 68% of SUD inpatient hospital stays in rural areas compared to 60% in urban areas.
- Transportation barriers: People seeking SUD interventions, treatment, or recovery services often travel longer distances to receive care, which can challenge employment and family life. Rural areas’ lack of public transportation makes access to care more difficult.
- Physical distance between care facilities and organizations: As people seek and enter treatment, their care may require coordination between primary care providers, specialists, treatment facilities, criminal justice agencies, and others. Facilitating linkages to care can be challenging with various agencies and tracking systems.
- Lack of anonymity when seeking help: Fewer facilities and options for individuals with SUD reduce the opportunity for anonymity and privacy. In addition, individuals seeking help for SUD may find it challenging to avoid friends and family members who share their addiction but are not striving for recovery.
- The burden of stigma: Individuals in rural areas may be unwilling to seek treatment because of the stigma surrounding asking for help and receiving services. As substance use is considered a crime, individuals may fear legal penalties if they open up about their use.
- Treatment and recovery services are one-size-fits-all: In more densely populated areas, people can find treatment and support options specifically tailored to them—groups for women or ethnic groups, for example. This is not the case in rural areas, which could discourage some individuals from seeking help.
Exploring Solutions: How Digital Tools Can Help
Digital tools are software programs that use evidence-based interventions to aid in preventing, treating, or managing health conditions. They can be used as standalone products or in combination with other treatments. Digital delivery provides many benefits that can help solve some of the most pressing problems in rural communities.
- Improve healthcare equity: Unlike in-person treatments and therapies, digital tools, often delivered online or via a smartphone app, are available anywhere, anytime. The 24/7 nature of digital solutions helps to fill the gaps between treatments and meetings and removes the need for individuals to travel or lose their anonymity to receive recovery support, providing an equal opportunity to SUD resources.
- Increase understanding of the SUD crisis in a specific region: Digitally delivered screenings allow individuals to take self-assessments and receive results privately through a smartphone app or during an appointment with a healthcare provider. Using a digital tool gives public health officials better insight and data about local substance use and its reach in the community. Officials can easily collect and access data for better reporting by managing screening tools through a digital central hub. Promoting digital screening tools in an area is easily accomplished through widespread sharing of the online tool through a URL and QR codes.
- Expand the reach of providers without adding extra costs or staff: Digital tools amplify the work of providers by automating tasks such as screenings for at-risk individuals, referrals to care, skill-building modules that incorporate digital cognitive behavioral therapy (CBT) techniques, care coordination, and delivery of digital contingency management (rewards). In addition, digital tools help individuals in recovery from SUD confidentially access educational resources, inspiration, virtual support groups, crisis interventions, and peer support.
- Facilitate communication and collaboration between care providers, communities, and organizations: Digital tools create a virtual paper trail that facilitates a connected healthcare ecosystem, aiding communities in understanding the scope of SUD in their areas to help them better address critical needs. Stronger coordination and collaboration between healthcare providers, public health officials, criminal justice departments, treatment facilities, and other organizations supporting mental and behavioral health will allow all partners to be more effective in addressing an area’s social determinants of health.
- Offer more options for customized support: Virtual meetings, digital support groups, and forums provide opportunities for individuals to find others like themselves as they embark on their recovery journeys. Connecting with others who can directly relate to your situation is powerful. The availability of groups specifically for women, Spanish speakers, or people of color removes a potential barrier that may prevent some people from seeking treatment.
- Reduce stigma: Using digital tools allows individuals to learn more about their own relationship with substance use and that of others in their community. Better education can bring about a greater understanding of SUD, lessening the impact of stigma.
Funding Sources for Digital Behavioral Health Tools in Rural Communities.
Various organizations offer funding programs specifically aimed at supporting rural community initiatives that address the crisis of substance use disorder (SUD). These programs often require that digital solutions effectively meet certain criteria. Here are some funding opportunities that rural organizations and agencies can consider to implement digital tools for combating SUD.
Enhancing SUD Care in Rural Communities
The SUD crisis presents multiple challenges in rural America, from a lack of care options to workforce shortages to the difficulty in maintaining client privacy. However, digital tools can offer a path forward, bridging the gaps in treatment, extending the reach of healthcare providers, public health officials, and health plans, and delivering necessary interventions and support to those who need it, no matter where they live.
By embracing evidence-based digital solutions, providers, public health officials, and health plans can begin to ease the impact of SUD for individuals and families living in rural communities.
