Community-Level Barriers to Recovery for Substance-Dependent Rural Residents

Young, Lance Brendan; Grant, Kathleen M.; Tyler, Kimberly A.

doi:10.1080/1533256x.2015.1056058

Cited by 53 publications

(30 citation statements)

References 66 publications

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“…The present study extends our knowledge about access barriers and support needs of PWLE, and lls an important gap in current research by providing PWLE perspectives on substance use treatment and service issues. Speci cally, our results con rm particular barriers to accessing treatment among PWLE, such as lack of information about available services, lack of motivation to seek support, discrimination and stigmatization, accessibility issues (including geographic and transportation), cost of treatment, service capacity and wait lists, among other structural barriers [48][49][50][51][52][53][54][55].…”

Section: Discussionmentioning

confidence: 55%

WITHDRAWN: Examining Substance Use Services and Treatment Barriers and Needs among People with Lived Experience (PWLE) in Ontario, Canada.

Russell

Ali

Nafeh

et al. 2020

Preprint

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Introduction: Substance use is a complex issue, with rates of illicit and licit substances varying across Canada, and in Ontario, specifically. Services and treatment options for problematic substance use remain vital. Recent initiatives to increase the effectiveness of services have been implemented, however, a disconnect remains between the availability and accessibility of these programs and the real-world experiences and needs of people with lived experience (PWLE). There is a lack of knowledge regarding barriers to accessing services and service needs, yet PWLE are best suited to identify these factors. As such, this study critically examined these issues among a cohort of PWLE in Ontario, Canada. Methods: Semi-structured, one-on-one interviews with n=50 adult PWLE participants were conducted. Participants were recruited from substance use services across Ontario, based on ConnexOntario’s directory of all provincial addiction services, as well as by word-of-mouth. Questions focused on participants’ experiences and perspectives on substance use services. All data were transcribed and underwent an inductive thematic analysis based on key themes that emerged. Results: Beneficial services identified varied based on participant experiences and needs. A variety of barriers to service access were acknowledged, primarily related to system-level issues such as an overall lack of services, a lack of service capacity, and a severe lack of service coordination and gaps in service delivery. Recommendations revolved around the need for low-barrier, affordable, seamless services run by non-judgemental staff, including fellow PWLE. Conclusions: This study identified needs and barriers to substance use care among PWLE in Ontario, and highlighted important areas for policy change and program planning and implementation. Concrete recommendations include the development of a government-funded, low-barrier, comprehensive and integrated model of substance use services that includes PWLE as collaborators and program facilitators to ensure that services are as successful and meaningful as possible. Results from this study will work towards the improvement of substance use treatment and service provision across the province.

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Section: Discussionmentioning

confidence: 55%

WITHDRAWN: Examining Substance Use Services and Treatment Barriers and Needs among People with Lived Experience (PWLE) in Ontario, Canada.

Russell

Ali

Nafeh

et al. 2020

Preprint

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“…Calculating performance using these measures with a focus on rural clients is only a first step in investigating the root causes of clients not continuing treatment. Other considerations include the broader range of barriers to continuing treatment: patient factors (eg, lack of motivation to enter treatment, competing responsibilities, and stigma), program issues (eg, wait time for appointments), and system barriers (eg, cost of services and limited system capacity) …”

Section: Discussionmentioning

confidence: 99%

“…Other considerations include the broader range of barriers to continuing treatment: patient factors (eg, lack of motivation to enter treatment, competing responsibilities, and stigma), program issues (eg, wait time for appointments), and system barriers (eg, cost of services and limited system capacity). 10,51 While the potential mitigating effect of an intervention aimed at improving continuity was mixed, focusing on travel time still has potential to be used to assess quality improvement efforts. As policy makers focus on performance, it is critical to include travel time when evaluating potential approaches to the complex issue of access to continuing treatment for rural clients with substance use disorders.…”

Section: Discussionmentioning

confidence: 99%

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

Garnick

Horgan

Acevedo

et al. 2019

The Journal of Rural Health

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Purpose Treatment after discharge from detoxification or residential treatment is associated with improved outcomes. We examined the influence of travel time on continuity into follow‐up treatment and whether financial incentives and weekly alerts have a modifying effect. Methods For a research intervention during October 2013 to December 2015, detoxification and residential substance use disorder treatment programs in Washington State were randomized into 4 groups: potential financial incentives for meeting performance goals, weekly alerts to providers, both interventions, and control. Travel time was used as both a main effect and interacted with other variables to explore its modifying impact on continuity of care in conjunction with incentives or alerts. Continuity was defined as follow‐up care occurring within 14 days of discharge from detoxification or residential treatment programs. Travel time was estimated as driving time from clients’ home ZIP Code to treatment agency ZIP Code. Findings Travel times to the original treatment agency were in some cases significant with longer travel times predicting lower likelihood of continuity. For detoxification clients, those with longer travel times (over 91 minutes from their residence) are more likely to have timely continuity. Conversely, residential clients with travel times of more than 1 hour are less likely to have timely continuity. Interventions such as alerts or incentives for performance had some mitigating effects on these results. Travel times to the closest agency for potential further treatment were not significant. Conclusions Among rural clients discharged from detoxification and residential treatment, travel time can be an important factor in predicting timely continuity.

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“…For example, 44% of pre-trial programs for adults established between 2000 and 2009 were in rural areas whereas only 13% were urban, suggesting that rural probation departments utilize pre-trial CS more (Pretrial Justice Institute, 2009). Rural CS agencies face unique barriers to service delivery such as having fewer substance use and mental health providers and further distances to service locations (Dew, Elifson, & Dozier, 2007;Young, Grant, & Tyler, 2015). In addition, social and cultural factors in rural areas can influence perceptions of substance use and treatment acceptance (Dew et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Geographic differences in substance use screening for justice-involved youth

Marks

Leukefeld

Dennis

et al. 2019

Journal of Substance Abuse Treatment

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Justice-involved youth report high rates of substance use. Community Supervision (CS) agencies are uniquely positioned to impact public health through substance use identification and early intervention. Geographic location (i.e., living in an urban versus rural area) is an understudied factor that can be associated with differences in service and resource availability. A secondary analysis of a nationally representative sample of CS agencies assessed agency and youth characteristics, as well as substance use screening in urban and rural CS agencies. Respondents representing rural agencies reported higher rates of substance use, yet were less likely to report using screeners focused on substance use. Respondents representing urban CS agencies reported a wider variety of screening instruments and were more likely to test for drug use during screening. Differences in the screening process can reflect adaptive and culturally responsive approaches to addressing substance use as well as unique barriers to service provision. System-wide improvement is contingent upon implementation strategies that identify and acknowledge geographic differences to more adequately address the common and unique needs of the justiceinvolved youth they serve.

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Community-Level Barriers to Recovery for Substance-Dependent Rural Residents

Cited by 53 publications

References 66 publications

WITHDRAWN: Examining Substance Use Services and Treatment Barriers and Needs among People with Lived Experience (PWLE) in Ontario, Canada.

WITHDRAWN: Examining Substance Use Services and Treatment Barriers and Needs among People with Lived Experience (PWLE) in Ontario, Canada.

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

Geographic differences in substance use screening for justice-involved youth

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