ERIC ED389507: Rural Issues in Alcohol and Other Drug Abuse Treatment: Award for Excellence Papers. Technical Assistance Publication Series No. 10.

71 Pages·1994·1.6 MB·English

by  ERIC

DOCUMENT RESUME
RC 020 374
ED 389 507
Rural Issues in Alcohol and Other Drug Abuse
TITLE
Treatment: Award for Excellence Papers. Technical
Assistance Publication Series No. 10.
Substance Abuse and Mental Health Services
INSTITUTION
Administration (DHHS/PHS), Rockville, MD. Center for
Substance Abuse Prevention.
DHHS-(SMA)-94-2063
REPORT NO
94
PUB DATE
71p.; Publication also sponsored by the National
NOTE
Rural Institute on Alcohol and Drug Abuse.
Reports
General (020)
Collected Works
PUB TYPE
Descriptive (141)
MF01/PC03 Plus Postage.
EDRS PRICE
*Alcohol Education; Community Services; Correctional
DESCRIPTORS
Education; *Delivery Systems; *Drug Education;
Elementary Secondary Education; *Intervention;
Outreach Programs; Policy Formation; *Prevention;
Program Descriptions; *Rural Areas; Rural Education;
School Community Programs; Substance Abuse; Youth
Programs
ABSTRACT
This document consists of papers that received
recognition in a competition sponsored by the Center for Substance
Abuse Treatment and the National Rural Institute on Alcohol and Drug
Abuse. The competition sought to focus attention on problems in
providing treatment and prevention services for drug and alcohol
problems in rural areas. The papers address a wide array of issues
and populations, from schoolchildren to alcohol-dependent adults to
criminal offenders. The introductory paper entitled, "Bringing
Excellence to Rural and Frontier America: Advocacy for Substance
Abuse Services in the 1990s" (Susan L. Becker) suggests what local
and state programs can do to help overcome the barriers that
interfere with gaining support from policymakers. The first- and
secord-place award papers are respectively entitled "Adult and
Adolescent Community Correctional Services Program" (William S.
Tanner) and "The Upper Peninsula Teen Leadership Program:
Marquette-Alger Intermediate School District" (Dee Lindenberger).
(1) "You Can't Get There from Here:
Third-place award papers include:
The Choice/Skyward Experience" (Rachel Cyr Henderson, Susan F. Long);
(2) "School Teacher's Role in a School-Community Alcohol Intervention
"Challenges in Rurally Based
Program" (Ian M. Newman and others);
(3)
Alcohol and Drug Abuse Treatment Services" (James A. Armstrong) ;
(4)
"Issues in Providing Alcohol and Drug Abuse Services in
Rural/Frontier Counties of California" (Kenneth R. Fleming);
(5)
"Building Community-Based Abuse Prevention Coalitienc" (Jim Meek);
(6) "Cultural Diversity As a Positive Force in the Treatment of
Native American Alcohol and Other Drug Abuse" (Anne Muldoon); (7)
"Transitional Recovery" (Larry R. Seybold); and (8) "Project TEA:
Iowa State Penitentiary Substance Abuse Program" (Robert E. Schneider
and others) .
(LP)
Center for Substance Abuse Treatment
S DEPARTMENT
OF III:AI:HI AND
I IIJMAN SERVK:ES
Public I tealth Servne
Rural Issues in
Substance Abuw ,md
Mental Health Services
Adnuntstrat Ion
Alcohol and Other
Drug Abuse
Treatment
Technical Assistance Publication Series
10
U.S. DEPARTMENT OF EDUCATION
Clercs of EducahoneI Research and Improvement
ED
TIONAL RESOURCES INFORMATION
CENTER (ERIC)
Thus document has been reprosuced as
recenred from the person or organozatton
corgrnahng d
o MOO, changes have been made to rrnprove
hIP(Oductron oulIrty
Pornts of vw, or oprmOns stated rn Ines docu
mint do not nocessardy represent offic.si
OERI posdan or pohcy
,
I PO
7,71:4
C..47
Cs1
BESTtC4PYIPA.ABLEi
Rural Issues in
Alcohol and Other
Drug Abuse
Treatment
Award for Excellence Papers
Technical Assistance Publication Series
10
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental I lealth Services Administration
Center for Substance Abuse Treatment
Rockwall 11, 5600 Fishers Lane
Rockville, MD 20857
3
This publication is part of the
Health
Services
and
Mental
Substance Abuse Prevention and
Administration. Richard Bast served as
Treatment Block Grant technical
the Government project officer.
All material
assistance program.
The opinions expressed herein are the
appearing in this volume except quoted
views of the authors and do not
passages from copyrighted sources is in
the public domain and may be repro-
necessarily reflect the official position of
CSAT or any other part of the U.S.
duced or copied without permission
Department of Health and Human
from the Center for Substance Abuse
Treatment (CSAT) or the authors.
Services (DHHS).
Citation of the source is appreciated.
This publication was prepared for
DHHS Publication No.
publication under contract number
(SMA) 94-2063
Printed 1994
270-90-0001 from the Substance Abuse
Contents
Foreword
Susan L. Becker, Center for Substance Abuse Treatment
Bringing Excellence to Rural and Frontier America:
Advocacy for Substance Abuse Services in the 1990s
1
AWARD FOR EXCELLENCE PAPERS
First Place Award
William S. Tanner, Maine
Adult and Adolescent Community
Correctional Services Program
7
Second Place Award
Dee Lindenberger, Michigan
The Upper Peninsula Teen Leadership Program:
Marquette-Alger Intermediate School District
11
Third Place Award
Rachel Cyr Henderson and Susan F. Long, Maine
You Can't Get There From Here:
The Choice/Skyward Experience
25
Third Place Award
Ian M. Newman, Mary Lee Fitzsimmons, Kim M. Maschmann, and
1.W. Upright, Nebraska
School Teacher's Role in a School-Community
Alcohol Intervention Program
29
James A. Armstrong, Arizona
Challenges in Rurally Based Alcohol and
Drug Abuse Treatment Services
35
Kenneth R. Fleming, California
Issues in Providing Alcohol and Drug Abuse
Services in Rural/Frontier Counties of California
37
Jim Meek, Iowa
Building Community-Based Abuse Prevention Coalitions
45
Anne Muldoon, Wisconsin
Cultural Diversity as a I'ositive Force in the Treatment of
Native American Alcohol and Other Drug Abuse
49
Larry R. Seybold, Wisconsin
Transitional Recovery
97
Robert E. Schneider, J. Scott Stevens, and Rob F. Riley Ill, Iowa
Project TEA: Iowa State Penitentiary
Substance Abuse Program
63
5
Foreword
But those developing programs
alcohol and other drug problems.
The Center for Substance
The goal of the competition was to
must also be prepared to act as
Abuse Treatment
elicitand then publicizethe
advocates with local and State
(CSAT) and the National
innovative and unusual strategies,
policymakers, who can help
Rural Institute on
provide the understanding,
approaches, and research findings
Alcohol and Drug
from rural programs.
funding, and other resources to
Abuse (NRIADA) are pleased to
make new initiatives possible. The
sponsor this publication jointly. For
In response to this challenge,
first paper in this collection,
too long, the problems of alcohol
CSAT and NRIADA received an
originally presented at the
and drug abuse in rural areas have
excellent collection of papers
NRIADA's annual conference,
received short shrift in the national addressing a wide array of issues
suggests what local and State
and populations, from school-
consciousness. As national studies
programs can do to help overcome
children to alcohol-dependent
show, those who live in rural areas
the barriers that interfere with
adults to criminal offenders. The
are just as likely to have alcohol
gaining support from
submitted papers are printed here:
and other drug problems as those
policymakers. Working
some describe local programs,
who live in large and small cities.
togetherwith collaboration
while other programs affect entire
The choice of addictive substances
between the public and private
regions. Readers will find many
may differ, but the prevalence of
sectorswe can make a real and
unusual and innovative strategies.
abuse is virtually the same for
meaningful difference for rural
To name just one examplean
country and city dweller alike. Yet
people suffering from alcohol and
isolated treatment agency on the
rural areas face special difficulties
other drug problems, and bring
coast of Maine solved their
in providing high-quality
excellence to rural America.
patients' transportation problem by
treatment and prevention services
offering space for a "club" to the
to their widely dispersed
Susan L. Becker
populations often without the
local recovering community; the
Associate Director for State
flourishing club now provides a
help of public transportation.
Programs
safe gathering place, recreational
To help focus attention on the
Center for Substance Abuse
events and holiday meals, and a
special service delivery problems
Treatment
place of comradeship and support
of rural areas, CSAT and NRIADA
to patients.
sponsored an "Award for
Larry Monson
Excellence" competition in the Fall
We are pleased to offer the field
Coordinator
this fine group of papers, with their
of 1992. Individuals and agencies
National Rural Institute on
from rural areas across the country
many ideas for meeting the
Alcohol and Drug Abuse
were invited to submit papers
challenge of providing high-quality
services to rural areas. Knowing
describing their efforts in
what to do is the critical first step.
providing services to those with
V
Bringing Excellence to Rural and
Frontier America: Advocacy for
Substance Abuse Services in the 1990s
Susan L. Becker*
with a dilemma. When a problem
evidence that the problern exists.
Since President Nixon
and its constituency are invisible to
declared the first modem
In 1990, a report on rural drug
the majority of the public, how can
war on drug abuse in
abuse by the General Accounting
a rural State develop the necessary
1974, America has been
Office stated that total substance
support not only to acknowledge
concerned with substance
abuse rates are about as high in
the problem and the need, but also
abuse. While there is acknow-
rural and frontier States as in
to develop excellence in the State's
ledgement that alcohol and other
nonrural States. What differentiates
prevention and treatment services?
drug use are problems for all of
between rural and nonrural areas is
society, media and political
Louis Swanson, in assessing
that the prevalence rates for
rural development problems,
attention seem locked on scenarios
particular drugs may vary. For
identified six current barriers to
suggesting that substance abuse is
example, the rate of cocaine use
action. I believe these barriers
predominantly, if not uniquely, a
appears to be lower in rural areas
apply to the problem of how we
problem of the inner cities.
than in cities, whereas prevalence
can achieve excellence in the
Participants in this eighth annual
rates for other drugs, such as
delivery of substance abuse
conference of the National Rural
inhalants, may be higher.
services in rural and frontier
Institute on Alcohol and Drug
Alcohol is the most widely
America. These barriers include:
Abuse are acutely aware that this is
abused substance in rural areas.
not so. For too long, the national
However, more than 4 of every 10
1. Flawed views of rural America
consciousness and the national
rural high school seniors have tried
2. Serious limitations to the social
agenda of the "War on Drugs"
marijuana; 1 in 11 rural high school
and health data on rural areas
have been oblivious to th:- alcohol
seniors reports having tried
and drug problems of rural and
3. Failure to see rural areas as
cocaine. Among students in rural
frontier Amz-ica.
connected to the larger U.S.
areas, the lifetime, annual, and
society
30-day prevalence rates for
stimulants, inhalants, sedatives,
Prevalence of
4. A perception that many rural
and tranquilizers are comparable to
problems do not have a viable
Substance Abuse
those of seniors in nonrural areas
political solution
(Johnston et al. 1989, pp. 42-46).
Problems in Rural
5. Absence of a unified rural
Most prison inmates in rural States
constituency, combined with the
America
have abused alcohol, other drugs,
presence of formidable
or both (U.S. General Accounting
opposition to rural programs
Office 1990).
The question is not whether alcohol
other than farm price supports
Clearly, the problem exists and
and other drug use is a problem in
6. State and Federal fiscal crises
has been documented. This
rural and frontier areas.
presents rural and frontier States
(Swanson 1990, pp. 21-29).
Prevalence data provide ample
'This paper is adapted from a speech presented by Susan L. Becker, Associate Director for State Programs, Center for Substance Abuse Treatment, at
the eighth annual conference of the National Rural Institute on Alcohol and Drug Abuse. The speech was the keynote address for the I laroki
Hughes Awards Luncheon on June 10, 1992.
1
P-1
Bringing Excellence to Rural and Frontier America: Advocacy for Substance Abuse Services in the 1990s
comparable rates of drug use-15
substance abuse services to the
Barrier #1: Flawed
population in need.
percent and 13 percent
Views of Rural
respectively. The rates of drug use
among this age group are
America
Barrier #2:
significant, since they imply that
Serious
these young adults have a
I believe the most formidable
substantial level of chronic drug
Limitations to
barrier to excellence lies in the
use and a need for appropriate
flawed views of rural America that
Social and Health
treatment resources. These findings
are commonly held. This barrier
have significant iinplications
Data
concerns the economics of health
concerning the type of substance
care delivery in rural and frontier
abuse services that are needed in
The second barrierthe limits
areas. It is commonly believed that
rural areas. More importantly,
imposed by the scarce social and
wages, labor costs, and building
they demonstrate the extent to
health data concerning rural and
space are less costly in rural areas
which drug use in rural areas is
frontier areasexacerbates the first
and that, as a result, rural health
similar to use in both large and
barrier of flawed views. This
care services are less expensive to
small metropolitan areas.
information gap could be remedied
deliver compared to their costs in
through utilization of existing
urban areas (Public Law 102-321,
Local Data Sources
indicator data or through the
Section 1933 and Section 707).
planning and health resources of
At a time when State and Federal
This view is flawed, however, in
the States and State universities.
resources are limited, individuals
that it fails to consider the
Unfortunately, most rural and
"diseconomies of scale" and the
as well as service providers need to
frontier jurisdictions and providers
available infrastructure that
gain maximum benefit from all
have been slow to utilize these
differentiate urban and rural
existing sources of data. While the
available resources.
settings (U.S. General Accounting
most ideal data would be a
Office 1990). Thus, while building
quantified needs assessment for the
Available National Data
costs may be lower in rural
population served, familiarity with
settings, rural and frontier areas
The National Household Survey is
existing local agency statistics can
face a unique challengethat of
one example of data available for
generate a great deal of supporting
providing physical access to
rural and frontier States to use in
and helpful information. Local
services for clients who may live
documenting their need for
health departments can provide
significant distances from the
services. The 1988 survey,
data about the rates of infectious
treatment or prevention site. Rural
conducted by the National Institute
diseases associated with alcohol
States also face the challenge of
on Drug Abuse, compared the
and other drugs of abuse in their
recruiting and retaining qualified
relationship of drug use to
particular areas, as well as data
professional staff who live in
demography by analyzing
concerning local teenage
proximity to the site, but who must
age-controlled data for large
pregnancy rates. Local justice
be willing to travel almost metropolitan areas, small
agencies can provide data
continuously. metropolitan areas, and
concerning the rates of crime and
nonmetropolitan areas (National
Similarly, the coordination of
of accidents associated with alcohol
Institute on Drug Abuse 1989).
services may prove more costly
and other drug use.
Significantly, the Household
and more labor intensive within
Learning to use and regularly
Survey showed that large
the rural delivery system because
review such data would not only
metropolitan areas and rural areas
of the difficulties posed by
go a long way toward overcoming
had similar rates for drug use
distance, service availability, and
the flawed views of others, it
among youth aged 12 to 17
accessibility. When calculating per
would also convert some flawed
yearsapproximately 9 percent.
client expenditures, it is imperative
self-views of rural America. Those
Such figures suggest that youth in
to include such critical expense
who live in rural and frontier States
this age group have a comparable
items as travel, availability of
are no longer secure from the
need for prevention and education
specialized personnel, accessibility
threat of HIV, tuberculosis, or
efforts, whether they live in rural
of other needed health and mental
drug-related crime. Further, the
or in large metropolitan areas.
health services, and infrastructure
needs of rural people who are
Young adults aged 26 through 34
costs. Inclusion of these expenses
being served may be changing.
in both large metropolitan and
can drastically affect the accuracy
The service system must be
of cost projections on providing
n, +nmet ropolitan areas also had
Bringing Excellence to Rural and Frontier America: Advocacy for Substance Abuse Services in the 1990s
Consider the following estimates
alcohol and other drug abuse as
sensitive, flexible, and adaptive to
for the cost of health and remedial
connected to the larger U.S. society.
meet these evolving needs.
The day for insularity has passed.
care for health problems related to
While it may once have been true
drug and alcohol
We cannot afford to see substance
that rural and frontier areas had a
abuse problems as a separate and
A cost of $785 is estimated for a
problem only with alcohol, this is
distinct issue.
certainly not true today. As stated
single case of hepatitis B (CDC
The abuse of alcohol and other
earlier, existing studies
1990; CDC 1992a; Alter et al.
drugs must be seen as a public
demonstrate that alcohol is the
1990)
health problem and addressed
most widely and commonly used
A cost of $50,125 is projected for
accordingly. When we view the
substance, but that rates of drug
the treatment of one person with
abuse of alcohol and other drugs in
use for rural youth and young
the human immunodeficiency
a public health context, we can
adults are comparable to
virus (HIV) (CDC 1991a; CDC
speak forcefully about the
prevalence rates in large and small
1992b; Kahn 1992)
consequences of the use and abuse
metropolitan areas.
An expenditure of
of these agents in a manner that
The availability of heroin is
approximately $102,125 is
connects the consequences to the
limited in rural areas; however, this
estimated for each case of
local community and to the State at
does not negate the possibility that
acquired immunodeficiency
large. When the connection
rural people can be addicted to
syndrome (AIDS) (CDC 1991b;
between rural substance abuse
narcotics acquired through illicit
Kahn 1992)
problems and the larger
trade in prescription drugs.
Current estimates approach
community is successfully made, it
In'cravenous drug use is most
$1,400,000 to cover lifetime
will create new stakeholders
commonly associated with heroin
medical and institutional care for
invested in the successful
and narcotics, but abusers of
one child with the fetal alcohol
resolution of rural problems.
methamphetamine also commonly
syndrome (FAS) (Weeks 1990)
While some control may be lost,
administer their drugs
Each of these and many more
the benefit will be a more effective
intravenously. The prevalence of
health problems are significantly
network of problem solving that
intravenous drug use, regardless of
associated with the misuse of
will develop through increased
the agent used, has significant
alcohol and other drugs. The
resources and the investment of
implications. For instance, analysis
indirect and direct costs of alcohol
more people in a positive outcome.
of Arkansas prison data revealed
and other drug use should be
that, in the State's four rural
presented as justification for both
Direct and Indirect Costs
counties with a high rate of
prevention and treatment services.
intravenous methamphetamine
of Alcohol and Drug
The most significant point about
use, the rate of HIV infection was
Abuse
these costs to society is that,
also elevated.
through prevention and early
How do alcohol and other drug use
More accurate and specific data
intervention services, these costs
relate to public health services and
is needed before it will be possible
may be significantly reduced.
expenditures by society at large?
to understand fully the extent of
Every case of alcohol and drug
Drug and alcohol use directly affect
substance abuse problems in rural
abuse that effective outreach,
the extent of expenditures needed
areas. Nevertheless, there is ample
prevention, and treatment can
to provide services and also affect
evidence to suggest that the
identify early or prevent entirely
the type and extent of health care
problem is extensive and that
will produce cost savings for State
and support services needed by a
aggressive intervention is needed.
and Federal Medicaid expenditures
community. The process of
and for society as a whole.
educating policymakers must
Barrier #3:
Those of us in the substance
emphasize that the direct and
abuse field must learn to
indirect costs of alcohol and drug
View of Rural
demonstrate not only that
abuse are shared by all of society.
Problems as
treatment works, but also that it is
Beyond the costs of treatment
a wise investment in today's
and prevention services, there are a
Disconnected
economy. Without intervention,
wide range of health problems
From U.S. Society
our communities will endure the
associated with drug and alcohol
continued costs associated with
use; these associated health
drugs and alcoholcosts of
problems are significant factors in
The third barrier to excellence is
accidents and injuries as well as
calculating the overall cost of
the failure to view rural and
additional 6xpenditures for
substance abuse to society.
frontier areas and their problems of
9
Bringing Excellence to Rural and Frontier America: Advocacy for Substance Abuse Services in the 1990s
disability, lost productivity, and
increase the community's economic
Local and county governments
costs secondary to criminal activity.
opportunities, because potential
State agencies
employers want safe, healthy, and
State legislative committees
Impact of Rural Supply,
reliable work forces and
Coalitions with other community
Production, and
communities. Every program
groups
needs to participate in some formal
Distribution of Drugs
It is important to hold meetings
quantitative evaluation studies.
with State governors, to inform
In addition to the health care and
Innovative programs should be
Federal legislators of needs and
crime costs generated by rural drug
fully documented as effective
concerns, and to present the
abuse, policymakers must be made
treatment modalities and as
group's agenda to relevant Federal
to consider the crucial role that
cost-effective intervention models.
agencies. The National Rural
rural and frontier areas play in the
Overcoming each of these
Institute on Alcohol and Drug
overall supply, production, and
barriers requires that rural and
Abuse itself can serve as a
distribution of drugs. Drug
frontier communities be clear in
powerful vehicle for organizing
cultivation and drug laboratories
their goals. They need to be
and directing the interests of rural
are certainly more likely to be
effs,ctively organized and to be
and frontier communities. With all
found in less populated rural and
active in directing all available
of the competing interests for
frontier areas.
resources toward their
funding and special consideration,
Drug smugglingwhether
achievement.
those with an organized and active
overland or by air in light
constituency are most likely to
aircraftis a phenomenon of
receive attention and action.
Barrier #5:
extremely rural and frontier areas;
this smuggling is supported by our
Absence of a
extensive interstate transportation
Barrier #6: State
Unified Rural*
networks. As a result of both
And Federal Fiscal
availability and organized and
Constituency
active distributors, the drug use
Crises
problem at production/
Unfortunately, a fifth barrier has
importation points in rural and
been the absence of a unified rural
Finally, consideration must be
frontier areas may be worse than in
given to the sixth barriercurrent
constituency able to advance
most large metropolitan areas.
concerns and needs and to propose
State and Federal fiscal crises.
solutions. Each rural and frontier
Advocates for rural program
State would benefit from having an
excellence need to be aware of and
Barrier #4:
active and organized group of
to understand the elements of a
Perceived Lack of
substance abuse provEers, a
particular State budget crisis. It is
government-sponsored advisory
critical for advocates to educate
A Viable Political
council, and a rural caucus. When
themselves about how substance
Solution
political leaders and funding
abuse problems relate to budgetary
problems. Ask yourself these
agencies are making decisions, they
There is a perception that many
look to organized groups who can
questions. How much do you
rural problems do not have a viable
know about your State budget
speak with a unified voice for a
political solution. This flawed
given population; they look for
crisis? Does your State have a
view acts as a barrier to effective
data that can provide valid and
problem of income, a problem of
program development and
reliable proof of a position. This outlay, or a combination of the
therefore must be challenged
two? Which outlays pose the
requires local and State
head-on with quantitative data
greatest strain on the budget?
organizational efforts, as well as
trom national and local studies.
efforts among those across State
The substantial outlays for
lines who have similar interests
Every rural and frontier
prison costs, Medicare, and
advocate needs to educate
and causes to advance.
Medicaid can all be related to the
community decisionmakers in local
Once organized, efforts must be
costs associated with chronic
businesses and local government
made at all levels of
alcohol and other drug abuse. In
on scientific findings,
decisionmaking through active
this circumstance, modest
demonstrating that rehabilitation,
communication and involvement
investments in substance abuse
education, and prevention efforts
with many individuals and groups.
treatment and prevention can
in substance abuse are effective
Those who should be approached,
produce large cost offsets and can
and work. Such efforts can
involved, and worked with include:
contribute significantly to the
4
0