More drug use, less treatment in E. Ky.

A higher proportion of people in Appalachia abuse prescription painkillers than in the rest of the nation, and the problem is even greater in coal-mining areas such as Eastern Kentucky, according to a federal study.

Compounding the problem, relatively few facilities in Appalachia offer short and long-term residential treatment — the kind of service needed by many people addicted to OxyContin and other painkillers.

“There's truly an access-to-health-care disparity for these coal-producing counties that we need to address,” said David Mathews, director of adult services with Kentucky River Community Care, which provides services including substance-abuse and mental-health treatment in eight Eastern Kentucky counties.

The findings are included in a new study of access to substance-abuse and mental-health treatment in Appalachia that was underwritten by the Appalachian Regional Commission— a federal-state partnership that works to create opportunities for self-sustaining economic development and a better life for Appalachian residents.

The study underlines the cyclical relationships between poverty, depression and drug abuse in parts of Appalachia, and the resulting need for more treatment facilities.

Anne Pope, federal co-chair of the agency, and Gov. Steve Beshear announced the results at a news conference Tuesday in London.

Pope said Beshear had pushed ARC to tackle the issue of substance abuse, and also cited the efforts of Louise Howell, executive director of Kentucky River Community Care.

Pope said trying to reduce substance abuse fits with ARC's mission to boost economic development because substance abuse is a barrier to improving the economy.

“Communities cannot grow if there is a major substance-abuse problem,” Pope said.

Distress, depression

Researchers found that, generally, access to substance-abuse and mental health care in Appalachia compared favorably with access in the rest of the country.

However, there were differences within the sprawling region — which includes all of West Virginia and parts of 12 other states from New York to Mississippi.

The central part of the region, including Eastern Kentucky, faces some significant challenges, the study found.

For instance, more residents of Appalachia reported problems with serious psychological distress and major depression, and the rate of such problems was higher in Central Appalachia. The study was based on analysis of information from surveys, hospitals and treatment facilities.

There is a link between the economy and mental-health problems such as depression, treatment providers said. Most of the counties considered economically distressed by the ARC are in Eastern Kentucky.

“When they're not able to provide for their families, the stress and depression are going to increase,” Kathy Tremaine, director of Cumberland River Comprehensive Care, said of people having financial problems.

The study found that, as the main reason for being admitted to treatment, abuse of drugs such as prescription painkillers was higher in Appalachia — especially in coal-mining areas — than elsewhere.

Such abuse is rising across the country, but it's going up faster in Appalachia, particularly in those mining areas, researchers found.

And despite concerns about prescription drug abuse, alcohol was the main reason for people being admitted to treatment in Appalachia, as in the nation. The study found a much higher percentage of people in Appalachia being admitted primarily for alcohol abuse – 45 percent in 2004, compared with 22 percent in the nation.

Less cocaine, meth

There was good news in the study. Among other things, it found relatively lower marijuana and cocaine use in Appalachia and lower treatment admission rates for heroin. It also found that, although there might be “hot spots” of methamphetamine abuse, use of the drug was lower overall in Appalachia than in the United States.

People in the region have recognized the problems and responded with a variety of programs such as school-based prevention activities to try to prevent drug abuse, though there is a need for more.

Researchers also found that proportionately more facilities in Appalachia offered intensive outpatient care, mental-health assessment and substance-abuse family counseling; that nearly all facilities offered some form of substance-abuse treatment; and facilities offered more free and reduced-cost treatment and accepted more forms of payment.

However, fewer facilities there offered outpatient detoxification, and there were fewer places where people could stay for short- or long-term substance-abuse treatment.

Mathews, with Kentucky River Community Care, said that it's clear there is a need for more treatment for substance-abuse and mental-health problems.

Surveys found that in the same Eastern Kentucky counties where people reported relatively high rates of painkiller abuse and drug dependence, a higher percentage of people said they had needed drug treatment in the last year but had not gotten it.

People told researchers about a variety of barriers to substance-abuse and mental-health treatment, including lack of transportation, lack of money and fear of being stigmatized.

Money is a key issue for treatment providers as well.

The state cut funding for community mental-health centers 3 percent in the current budget, and funding hadn't gone up to match costs even before, Tremaine said.

“We've gone underfunded for the last 10 years,” she said.

Tremaine said that means the centers provide services without getting reimbursed. Cumberland River doesn't turn away people needing treatment, but the question is how long that can continue, she said.

Waiting for treatment

A shortage of money for residential substance-abuse treatment services — especially to hire trained people to provide treatment — means there is a waiting list to get into such facilities in Eastern Kentucky.

The danger is that people might not come back when a spot finally opens up.

“If we don't get people in when they're motivated, we've lost them,” Mathews said.

Beshear said a state initiative to build 10 substance-abuse treatment centers in Kentucky, called Recovery Kentucky, will help address the shortage of residential care in the state. Five are already open.
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source: Lexington Herald Leader, http://www.kentucky.com