Introduction
The persistent problem of addiction, together with the nature of co-occurring disorders, poses a significant danger to individuals’ lives, especially those living in rural areas. This research proposal addresses the critical void in addiction treatment, providing a comprehensive view of multiple issues that arise from co-occurring disorders among people living in rural communities. The urgency of addressing this problem is impossible to overestimate, as it influences the health and life quality of residents in rural areas. This research addresses the current inadequacies in addiction care and explores feasible solutions to improve mental health services for small towns. This research argues that the exploration and correction of the issues present in addiction treatment is necessary for delivering practical support to people fighting co-existing disorders in rural areas. The issues arising from the existing gaps in care require thorough analysis and systematic interventions to improve the quality of life for people suffering from various disorders in rural areas.
Problem Statement
The intersection of addiction and co-occurring disorders in rural settings presents a formidable challenge to people seeking sufficient care and support. The poor availability of specialized treatment centres, lack of mental health resources, and social stereotypes make the situation complicated for this fragile group. The failure to provide personalized interventions creates a perpetual cycle of relapse into or exacerbation of co-occurring disorders that results in further overstressing both individuals and the societies in which they live.
Research Question
This research aims to conduct a comprehensive review and formulate effective strategies for addressing the emerging problems in addiction care that have been prevalent in individuals with co-occurring disorders, especially in rural areas. The study attempts to explore the complex issues faced by the target population through an analysis of the identification of these gaps. The overarching question guiding this research is: What particular actions and treatments can be put in place to enable efficient identification and tackling of the existing gaps in addiction care that would create a better environment for mental wellness among people with co-morbidity disorders living in rural areas?
Literature Review
The current literature shows the complex nature of challenges that are linked to people living in rural settings and suffering from opioid use disorder (OUD) as well as co-occurring mental health disorders. Snell-Rood et al. highlight the challenges and opportunities of integrated care delivery in rural contexts. Rural primary healthcare professionals face challenges providing adequate mental health services due to staff shortages and limited telehealth access (Snell-Rood et al., 2021). The fragmentation of the care system stifles better care, thus limiting referrals to county mental healthcare systems and private providers. The research highlights the lack of integration in the care system reflected in limited training on integrated care and mental health inpatient assessments, which further aggravates patients with co-occurring disorders and causes high levels of stress among providers.
More contemporary studies provide some insights into the urban-rural differences in Alcohol, Drug Use and Mental Health (ADM) conditions, particularly in South Dakota, which is a rural state (Davis et al., 2016). Although the rates of ADM conditions may not vary considerably, this study indicates significant limitations in access to care for rural and reservation areas. This gap in care access between urban and rural areas points to the mismatch of clinical screening with awareness of needed care, thus highlighting the need for educational campaigns and efforts to improve accessibility in the countryside.
Pullen and Oser probe the perceptions of alcohol and drug abuse counsellors working in rural and urban settings, outlining challenges that influence treatment results. Rural communities present unique challenges that significantly impact treatment efficacy, as lack of access to specialized services challenges progress (Pullen & Oser, 2014). This study fits into broader conversations on tailoring substance abuse treatment to local realities, suggesting that particular challenges should be acknowledged and considered in the countryside and cities.
McGovern et al. emphasize the timely requirement for data on co-occurring disorders in addiction treatment centres, recognizing the new direction of treatment and the need to have informed service systems. The study describes mood disorders, anxiety disorders, post-traumatic stress disorder, severe mental illnesses, antisocial personality disorder and borderline personality syndrome to be typical among patients seeking addiction treatment (McGovern et al., 2006). The study recommends the need for a comprehensive understanding of the complex interdependence between substance abuse disorders and co-occurring mental health problems, as well as challenges associated with service delivery, such as the shortage of psychiatric specialists and required resources.
In synthesizing these studies, a refined research question emerges: What are the systemic barriers and workforce challenges that contribute further to the gap in addiction care widening issues for individuals with co-occurring disorders from rural areas? This revised question encompasses the significant findings from the literature regarding personnel shortages, access limitations, and mixed patterns of treatment systems in rural areas. This investigation’s goal is to examine these systemic issues in order to understand the challenges and inform evidence-based interventions to improve addiction care for individuals with co-occurring disorders living in rural areas.
Methodological Approach
The research in this study utilizes a qualitative research method based on the hub-and-spoke model that was adopted by the state of California. The in-depth interviews with 26 healthcare workers and 16 system-level stakeholders will yield helpful information on the challenges faced by people with co-occurring disorders in rural California. A qualitative investigation was undertaken to collect the varying experiences of healthcare providers, providing a solid basis for understanding the gaps in addiction care.
Moreover, a cross-sectional survey will be carried out in South Dakota over the year, and quantitative methods will be used to collect 7675 surveys from certain places. This quantitative methodology-based approach will provide an opportunity for the analysis and comparison of participatory demographics, providing statistical data regarding diverse situations of addiction as well as co-occurring disorders in different settings. Employing qualitative and quantitative approaches helps provide a thorough understanding of the complex issues within addiction treatment in remote areas.
Accordingly, this research proposal serves as a starting point for the in-depth study of the issue of the addiction care gap and its consequences for people suffering from co-occurring disorders in rural areas. Using a mixed-method approach, the study aims to present a comprehensive picture of this vulnerable group’s challenges and provide helpful information to design appropriate interventions and policy initiatives.
References
Davis, M. M., Spurlock, M., Dulacki, K., Meath, T., Li, H. (Grace), McCarty, D., Warne, D., Wright, B., & McConnell, K. J. (2016). Disparities in Alcohol, Drug Use, and Mental Health Condition Prevalence and Access to Care in Rural, Isolated, and Reservation Areas: Findings From the South Dakota Health Survey. Journal of Rural Health, 32(3), 287–302. https://doi.org/10.1111/jrh.12157
McGovern, M. P., Xie, H., Segal, S. R., Siembab, L., & Drake, R. E. (2006). Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers. Journal of Substance Abuse Treatment, 31(3), 267–275. https://doi.org/10.1016/j.jsat.2006.05.003
Pullen, E., & Oser, C. (2014). Barriers to substance abuse treatment in rural and urban communities: counsellor perspectives. Substance use & misuse, 49(7), 891-901. https://doi.org/10.3109/10826084.2014.891615.
Snell-Rood, C., Pollini, R. A., & Willging, C. (2021). Barriers to integrated medication-assisted treatment for rural patients with co-occurring disorders: The gap in managing addiction. Psychiatric Services, 72(8), 935–942. https://doi.org/10.1176/appi.ps.202000312
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