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Treating Alcohol and Other Drug Abusers in Rural and Frontier Areas Technical Assistance Publication (TAP) Series 17

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Treating Alcohol and Other Drug Abusers in Rural and Frontier Areas Technical Assistance Publication (TAP) Series 17 Treating Alcohol and Other Drug Abusers in Rural and Frontier Areas Technical Assistance Publication (TAP) Series 17 DHHS Publication No. (SMA) 95-3054 Printed 1995 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Rockwall II, 5600 Fishers Lane Rockville, MD 20857 Foreword The Center for Substance Abuse Treatment (CSAT) and the National Rural Institute on Alcohol and Drug Abuse (NRIADA) are pleased to jointly sponsor this publication, which is a compilation of papers submitted to the 1994 Award for Excellence contest. The Award for Excellence called for papers addressing the special challenges of providing quality treatment services to substance abusers in rural and frontier areas. Papers were particularly solicited in the following areas: Experiences, ideas, practical measures, and recommended actions for implementing health care reform initiatives in rural areas (such as regional cross-State provider arrangements) Innovative strategies, policies, and programs for improving the delivery of substance abuse, health, and public health services in rural and frontier areas Proposals for political and economic solutions that would expand the development of services in rural/frontier areas Strategies for building rural coalitions and networks Approaches for special issues related to substance abuse, such as rural crime, gangs, and violence, including family violence Research studies and needs assessment data showing the prevalence of AOD abuse problems in rural and/or frontier settings, as well as their effects on rural crime, family life, and social, cultural, and economic conditions Cost-benefit analyses showing the impact at the Federal and State levels from resolving substance abuse and public health needs of rural and frontier communities The papers presented here are a remarkable portrait not only of the daunting AOD problems that face rural and frontier America but, more importantly, of the viable approaches to those problems that are being created in rural and frontier areas. The top three winners of this contest illustrate three successful approaches to helping substance abusers in rural and frontier areas deal with their problems. Riedel, Hebert, and Byrd describe an innovative program in their paper, "Inhalant Abuse: Confronting the Growing Challenge." Our Home, Inc., in Huron, South Dakota, has unlocked the doors of treatment to rural, inhalant- abusing youths—mostly American Indian youths—who did not before have access to treatment. This comprehensive residential treatment program provides a length of stay between 90 and 120 days. The treatment gives these young inhalant abusers, who are an average of 13 years old, the opportunity to detoxify, reduce impairment in neurocognitive functions, improve academic performance, and stabilize emotionally and behaviorally. Tanya Tatum describes two substance abuse programs designed to address the needs of Appalachian women in Ohio. "Rural Women's Recovery Program and Women's Outreach . Serving Rural Appalachian Women and Families in Ohio" is designed to take advantage of the strengths of these women, as well as their wealth of culture and spirit of perseverance. Appalachian women have specific cultural barriers, which include "a mistrust of outsiders, fear of the 'system,' the conscious exclusion of specific groups in a bureaucracy, a tradition of self-sufficiency and taking care of one's own, and geographic and social isolation." Tatum's group found that the key to delivering effective programs was to gain acceptance from the community and client population. They built on the personal and collective strengths of individuals and of the communities to be served. A successful rural coalition in Northwest New Mexico is the subject of a paper by Raymond Daw and Herb Mosher. "The Bridges of McKinley County" describes a county that had the highest composite rate of alcohol-related problems of all counties in the United States from 1975 to 1985. The rural coalition that Daw and Mosher describe initiated The March of Hope, a journey made by a group of citizens who walked 200 miles in 10 days from Gallup to the State Legislature in Santa Fe. This rural coalition has been the catalyst to a regional response that has closed drive-up liquor windows, built a detoxification and assessment center, reformed State driving-while-intoxicated laws, and offered new prevention and treatment services. Successful strategies and insights into the AOD problems facing rural and frontier Americans are mirrored in the other papers submitted to the Award for Excellence. These papers illustrate the difference that can be made for people suffering from alcohol and other drug problems in rural and frontier America. Award for Excellence Review Panel Barbara Groves, M.M. Regional Coordinator Oregon Office of Alcohol and Drug Abuse Programs Salem, Oregon Vicki L. Lentz Green County Mental Health Services, Inc. Muskogee, Oklahoma Larry W. Monson, ACSW Coordinator National Rural Institute on Alcohol and Drug Abuse Tony, Wisconsin Leon PoVey Director Utah Division of Substance Abuse Salt Lake City, Utah Peggi White, R.N., C.S. Family Nurse Practitioner New Choice Drug and Alcohol Recovery Champaign, Illinois Inhalant Abuse: Confronting the Growing Challenge Steve Riedel, M.S. Ed. Associate Director Our Home, Inc. Tim Hebert, M.S. Paul B. Byrd, Ph.D. Our Home, Inc. Huron, South Dakota Abstract The purpose of this paper is to describe the innovative programming of the Our Home, Inc. Inhalant Abuse Treatment Program and to review its outcomes. This project has implemented a comprehensive treatment program for rural, inhalant abusing youth. Prior to this effort, affected youths did not have access to treatment services. Thus, the overall project significance rests in the accomplishment of unlocking the doors of treatment for this special population. This paper does the following: Summarizes the program's distinctive treatment procedures Defines the objective methods used to assess outcomes Highlights the test and retest procedures used to obtain neurocognitive and academic achievement outcome measures Reviews patient utilization and retention data Related literature indicates that inhalant abuse is an increasing concern in the United States. The literature also indicates that it is a severe form of substance abuse. Historically, nonintervention has been applied to this problem, and wide gaps have been evident in the treatment system. Finally, the literature suggests that biopsychosocial factors hold implications for treatment. Neurocognitive impairment of users is a particular concern. Findings indicate that a significant population of youth with inhalant abuse problems does exist in this rural catchment area in South Dakota. The project activities have led to enhanced patient identification, treatment access, and treatment retention. We have found supporting evidence of problem severity. Neurocognitive deficit scores among the collective patient population have been reduced by as much as 28 percent during treatment. Composite academic achievement gains range from 1.01 to 1.06 years. Posttreatment findings suggest that at least 34 percent of the patients report no inhalant abuse at the 6-month point after discharge. Inhalant abuse has been an overlooked and severe form of substance abuse in rural catchment areas. Youths with inhalant abuse problems can be identified, referred to, and retained in treatment. Treatment participation results in positive and objective outcomes. It is recommended that the current policy of nonintervention should not continue. This growing inhalant abuse problem must be challenged. The problem should be given the consideration of governmental, planning, and service providing entities, so that comprehensive approaches responsive to inhalant abuse can be implemented. Finally, the programs implemented should be objectively evaluated, so that comparisons among approaches can be made. Purpose of the Project The purpose of the Our Home, Inc. Inhalant Abuse Treatment Program is to challenge the problem of inhalant abuse by making a comprehensive treatment program available to affected youth. In 1987, H.G. Morton wrote that "solvent abuse appears to be an embarrassment to children's services; rather than accepting the challenge of inhalant abuse, a policy of nonintervention exists and this policy is unacceptable." Dyer (1991) noted that "treatment facilities set up for inhalant abusers are nonexistent." Jumper-Thurman and Beauvais (1992) noted the "lack of even a rudimentary treatment model." Despite such commentaries in the literature, adolescent inhalant abuse has by and large been underacknowledged by the prevention and treatment delivery systems. A specific void has been particularly evident in comprehensive inhalant abuse treatment services. In an attempt to fill this service void, Our Home, Inc. successfully sought an Office for Treatment Improvement (now the Center for Substance Abuse Treatment [CSAT]) grant. The project sought to "unlock the treatment doors to a population of moderate and severe drug users (inhalant abusers) whose treatment needs have been ignored at national and local levels." This mission continues to be the project's primary purpose. A critical but coexisting purpose also existed. This second purpose was to develop an inhalant abuse treatment model that would address the wide range of social, psychological, academic, and neuropsychological deficits associated with inhalant abuse. Developing a
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