While both urban and rural communities face a growing challenge, rural communities face greater challenges in dealing with the opioid crisis. These challenges have not only contributed to the rapid rise of opioid misuse and deaths in rural communities, which has seen as increase at a rate of over three times that of metropolitan counties, but they have also hindered individuals from obtaining necessary assistance and treatment for substance use disorders. If the church is going to help to address the crisis, then it needs to understand the challenges confronting rural communities.
The Crisis is Multifaceted and Requires a Multifaceted Approach.
Too often, when we assess the causes and struggles to overcome addiction, we attribute the problem solely to the failure of the individual to make the right choices. However, this fails to understand the complexity of reasons why individuals become ensnared in addiction. While it is true that ultimately the solution is found in the redemptive work of Christ, we must also understand that the reasons a person becomes addicted is complex and stems from a number of different causes. These factors include the struggle to deal with pain management, economic struggles, and family history, to name a few. Consequently, helping people requires a multidimensional approach that is grounded in spiritual transformation but recognizes that other resources and assistance are needed as well. For the pastor to help individuals with drug addiction, the pastor needs to not just address the spiritual aspect of addition, but also work with other agencies to deal with the physical and emotional problems contributing to addiction and are an outgrowth of addiction. This begins by recognizing and addressing the barriers and challenges that exist in rural communities to provide adequate help for people.
Rural Communities face Cultural Barriers:
While rural people face many of the same barriers dealing with recovery which exist in urban communities, there are challenges unique to or more acute in rural areas. This begins with the attitude people have in rural communities regarding addiction. In rural communities, there is often a stigma attached to the problem of addiction. Rural people value a sense of independence and self-sufficiency. Drug addiction then is seen as a sign of weakness and moral failure; therefore, people are reluctant to acknowledge the problem even when they are struggling with it. This is further compounded because rural people are expected to perform their manual work regardless of injuries. They are encouraged to “work through the pain” for the tasks need to be done regardless of any injury a person might have. This not only contributes to the abuse of opioids but also leads to further reluctance for seeking help.[i] This is further compounded by the difficulty in maintaining anonymity in communities where everyone knows one another. Consequently, rural people can be hesitant to obtain help to deal with their struggle, even from their pastor, for fear that others may find out.[ii] Because of this stigma, rural individuals are less likely to seek help themselves than urban individuals (22.8 vs 38.7 percent) and are more likely to be referred by the criminal justice system than urban individuals 51.6 vs 28.4 percent).[iii] Because they are channeled through the legal system rather than mental health, they are 50% more likely to face incarceration.[iv] To help individuals in rural communities it is important for the pastor to develop trust and confidentiality with individuals so they will be open to acknowledge their problems.
Rural communities face structural barriers.
Even more acute than the cultural barriers are the structural barriers existing in rural communities, making it more difficult to obtain treatment for addictions. Even when people want help, they often find help unavailable. Rural communities often lack the infrastructure to deal with drug addiction. There are five issues in particular that hinder people from getting the necessary assistance.
First, rural communities lack treatment facilities. What distinguishes rural from urban communities regarding the opioid crisis is not so much the abuse of opioids or the mortality rate, but the disproportionately fewer clinics, hospitals, and treatment centers available for people to access.[v] Even when they are able to get help, the counselors and agencies are not equipped to deal with the rural-specific issues underlying the problem.
Even when treatment centers are available there is often inadequate funding necessary to provide the training and necessary facilities to effectively help. The result is that those who work in rural treatment centers are less equipped to provide a diverse array of options for substance abuse and are less equipped to provide specific resources and help that is tailored to the individual needs, especially women and racial minorities. This further hinders people from seeking treatment.[vi]
Second rural communities lack access to mental health treatment and family counseling. Substance abuse has long been connected to mental health problems. Treating drug abuse often requires the treatment of mental health disorders as well. This is especially true among adolescents, where 43% of those who are addicted to drugs also have mental health problems. But because of the lack of services, they are often only treated for one of the issues but not both, resulting in more frequent relapses.[vii] More than 60% of rural Americans do not have access to mental health care and so the majority (65%) of rural Americans turn to the primary care provider for assistance. However, they are often adequately trained to deal with mental health issues.[viii] Not only is there a lack of mental health services, but there is also a lack of family counseling resources as well. Research has shown that especially among adolescents, family dynamics play an important role in both the prevention and treatment of drug addiction. Furthermore, addiction has a significant impact on the family. Yet the family often does not have access to help in dealing with the fallout of addiction. This places rural individuals at a disadvantage.
Third, rural communities lack transportation for people to have access to distant assistance. Because of the lack of public transportation, they are more reliant upon family and friends to help. However, they may be reluctant to do so because they have either been enabling or using with them or they are reluctant to get involved because of past history with the individual. This problem is compounded by the fact that resources are often a significant distance away. As a result, rural individuals especially find it difficult to attend outpatient treatment.[ix]
Fourth, many in rural communities lack medical insurance. Twenty-three percent of rural residents lack medical insurance with high rates in the south and west.[x] This, coupled with the economic struggles people face in rural communities often make treatment and counseling prohibitive. You cannot get help when you cannot afford help.
Fifth, rural communities lack adequate prevention programs. It is not enough merely to provide help for those trapped in addiction, to address the crisis prevention and education programs need to be in place. However, tragically these programs are often lacking. To further add to the challenge there is often a failure for different agencies to work together to address the problem in the community.[xi] This not only includes the cooperation of counselors, detoxification centers, and mental health services, but also between the church, school, and law enforcement agencies to deal with the problem.
But this then brings us to the church and the role the church in rural communities. The church has an important role to play in assisting rural communities to address the opioid crisis in general. The church can have a critical role in both the treatment and prevention of addiction.
Part 4: The Role of the Church in Addressing the Opioid Crisis in Rural Communities.
[i] Gilbert A. Quintero, Elizabet Lilliott, and Cathleen Willging, Subsance Abuse Treatment Provider Views of “Culture”: Implications for Behavioral Health Care in Rural Setting” Qualitative Health Research, Vol 117, Number 9, November 2007, 12-56-1267.
[ii] Shannon M. Monnat and Khary K. Rigg, The Opioid Crisis in Rural and Small Town America. Carsey Research, National Issue Brief #135, Summer 2018. https://lernercenter.syr.edu/wp-content/uploads/2018/06/The-Opioid-Crisis-in-Rural-and-Small-Town-America_18-1.pdf. Accessed August 27, 2020.
[iii] A Comparison of Rural and Urban Substance Abuse Treatment Admissions, The TEDS Report, July 31, 2012, https://www.samhsa.gov/sites/default/files/teds-short-report043-urban-rural-admissions-2012.pdf, Accessed August 27, 2020.
[iv] Josh Keller and Adam Pearce, A Small Indiana County Sends More People to Prison than San Francisco and Durham, N.C., Combined. Why? The New York Times, Sept. 2, 2016, https://www.nytimes.com/2016/09/02/upshot/new-geography-of-prisons.html?_r=0, Accessed August 27,2020.
[v] Shannon M. Monnat and Khary K. Rigg, The Opioid Crisis in Rural and Small Town America.
[vi] Erin Pullen, and Carrie Oser, Barriers to Substance Abuse Treatment in Rural and Urban Communities: A Counselor Perspective. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995852/. Accessed August 27, 2020.
[vii] Rachel L. Anderson and Josephine Gittler, Child and Adolescent Mental Health: Unmet Need for Community-Based Mental Health and Substance Use Treatment Among Rural Adolescents, Community Mental Health Journal, Vol. 41, no 1, Februrary, 2005.
[viii] Dennis Hohatt, Rural Mental Health: Challenges and Opportunities Caring for the Country. https://www.ruralhealthinfo.org/topics/mental-health. Accessed August 27,2020.
[ix] Erin Pullen, and Carrie Oser, Barriers to Substance Abuse Treatment in Rural and Urban Communities: A Counselor Perspective.
[x] Michael Meit, et al, Rural Health Reform Policy Research Center: The 2014 Update of the Rural-Urban Chartbook, October 2014, https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf. Accessed August 27,2020
[xi] Erin Pullen, and Carrie Oser, Barriers to Substance Abuse Treatment in Rural and Urban Communities: A Counselor Perspective.
