Predictors of mental health and substance use disorder treatment use over 3 years among rural adults using stimulants

Abstract

Background: Persons using substances, living in rural communities, tend to underutilize mental health (MH) and substance use disorder (SUD) treatment compared with their urban peers. However, no studies have examined longitudinal predictors of MH and SUD treatment use among rural persons using stimulants. Methods: Data were collected through interviews conducted between 2002 and 2008 from a natural history study of 710 adults using stimulants and living in rural counties of Arkansas, Kentucky, and Ohio. Each study site recruited participants using respondent-driven sampling (RDS). Participants were adults, not in drug treatment, and reporting past-30-day use of methamphetamine, crack cocaine, or powder cocaine. Study participants completed face-to-face baseline assessments and follow-up interviews using computer-assisted personal interviews. Follow-up interviews were conducted at 6-month intervals for 3 years. Results: Our results show that being male, nonwhite, and having a prior lifetime history of MH or SUD treatment use were associated with lower odds of using MH and SUD treatment over time; having medical insurance and living in a state with potentially greater availability of MH and SUD treatment were associated with higher odds of using MH and SUD treatment over the 3-year period. Further, reporting greater legal problems and alcohol severity were associated with greater odds of using MH and SUD care, whereas greater employment problems was associated with higher odds of SUD but not MH treatment use. Conclusions: Findings from this study could be used to inform clinical and public health strategies for improving linkage to MH and SUD care in this population. Our findings also highlight the importance of having medical insurance as a potential facilitator to utilizing SUD care in this population and support the need for health care policies that increase the ability of rural adults who use stimulants to pay for such services.

Keywords:

• Predictors of mental health care
• predictors of substance abuse care
• rural adults using stimulants

Acknowledgments

The authors acknowledge Kristina Kennedy for her helpful comments and suggestions.

Additional information

Funding

This research was supported by National Institute on Drug Abuse grant R01 DA15363 to Brenda M. Booth and grant R01 DA14340 to Harvey A. Siegel, who died on December 22, 2004. As a result, Robert Carlson assumed the role of Principal Investigator of grant R01 DA14340. There are no conflicts of interest to report. The views expressed are the authors’ and do not necessarily reflect those of the VA. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Notes on contributors

Michael A. Cucciare

Michael Cucciare, Brenda Booth, and Geoffrey Curran participated in the research conception and design, data collection, and interpretation of results. Songthip Ounpraseuth conducted the data analysis and helped with the interpretation of results.

Songthip T. Ounpraseuth

Michael Cucciare, Brenda Booth, and Geoffrey Curran participated in the research conception and design, data collection, and interpretation of results. Songthip Ounpraseuth conducted the data analysis and helped with the interpretation of results.

Geoffrey M. Curran

Michael Cucciare, Brenda Booth, and Geoffrey Curran participated in the research conception and design, data collection, and interpretation of results. Songthip Ounpraseuth conducted the data analysis and helped with the interpretation of results.

Brenda M. Booth

Michael Cucciare, Brenda Booth, and Geoffrey Curran participated in the research conception and design, data collection, and interpretation of results. Songthip Ounpraseuth conducted the data analysis and helped with the interpretation of results.