• Posted May 10, 2024

Getting Help for Alcohol, Drug Abuse Tougher for Rural Americans

When folks in rural America need treatment for a substance use disorder, significant obstacles stand in their way, researchers say.

They are more likely to have to look outside their insurance network for care, resulting in higher out-of-pocket costs, according to a recent study published in the journal Health Services Review. Limited resources are a big reason rural Americans are less likely than their urban counterparts to seek care for substance abuse issues or to receive ongoing help.  

"Rural areas are continuously plagued with a shortage of behavioral health providers and more limited health resources overall," senior author Wendy Xu, an associate professor of health services management and policy at Ohio State University, said in a news release. "These challenges are compounded by the fact that most insurance plans use managed care arrangements, some of which use highly limited provider networks."

For the new study, her team looked at a nationwide database of commercial insurance claims filed between 2016 and 2018. It included about 40 million adult patients a year. 

Overall, fewer than half of people received treatment for substance use. 

The data highlighted several geographic disparities: 

• Compared to those in urban areas, rural patients were less likely to initiate treatment for disorders involving alcohol (37% versus 38%), opioids (41% versus 44%) or other drugs (38% versus 40%).

• Rural patients were less likely than city-dwellers to be in ongoing treatment for alcohol (15% versus 17%), opioids (21% versus 23%) and other drugs (16% versus 18%).

• When they did receive care, rural patients were more likely to get it out-of-network, resulting in higher costs. 

Xu said the findings add important understanding to the barriers people face in getting and completing treatment for substance use disorders.

Researchers said one way to address these problems might be what is known as the Collaborative Care Model, which has gained popularity in recent years.

"This model allows primary care clinicians working with a behavioral health care manager, who often is not an advanced clinician, to treat substance use disorders in collaboration with a psychiatric consultant who doesn't have to live and work in the area," Xu said.

In that model, prescribing and ongoing care are usually delivered virtually and billed through the patient's primary care provider. 

Lead author Eli Raver, a doctoral student in public health at Ohio State, said the disparities found in this study exist across the spectrum of substance use disorders.

"A lot of policy focus has been on the opioid crisis, as it should be," he said in a news release, "But I think it's interesting and troubling to see that, regardless of which substance we're talking about, there is high out-of-network usage and low overall participation in care."

More information

The National Institute on Alcohol Abuse and Alcoholism has more about alcohol and your health.

SOURCE: Ohio State University, news release, May 7, 2024