Rural substance use treatment centers in the United States: an assessment of treatment quality by location

Abstract

Background: While previous research has added to the understanding of rural residents’ unique health challenges, much remains to be learned about the provision of substance use disorder (SUD) treatment in rural areas. A key question is difference in structural resources and quality of care between rural and urban treatment centers. Objective: To examine differences in treatment quality in rural and urban centers and to determine if differences in treatment quality are contextualized by centers’ structural resources. Methods: Utilizing combined data from two representative samples of SUD treatment centers (n = 591), we used a series of multivariate regressions to analyze the association between center rurality and various indicators of structural characteristics and treatment quality. Interaction effects were further examined between structural characteristics and treatment quality indicators. Results: We found that structural and quality differences between rural and urban treatment centers were present. Rural centers had reduced access to highly educated counselors, were more likely to be non-profit and dependent on public funding, offered fewer wraparound services, and had less diverse specialized treatment options. Our results also indicated that rural centers were less likely to prescribe buprenorphine as part of their treatment but were more likely to employ nursing staff and offer specialized treatment for adolescents. Rural center access to a physician contextualized the association between center rurality and the more limited provision of wraparound services. Conclusion: Our findings suggest that treatment quality differs between urban and rural centers in complex ways that are subject to resource availability.

• Addiction
• rural
• substance use disorder
• treatment quality
• urban

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.