Rural at-risk drinkers: Correlates and one-year use of alcoholism treatment services

Objective: The purpose of this study was to identify a community sample of rural and urban at-risk drinkers, to compare them in terms of sociodemograp hics, access measures and severity of illness, and to study them prospectiv ely to identify rural/urban differences in use of 12-month alcoholism treat ment services. Method: A brief telephone screening interview of over 12,000 respondents in six southern states identified a sample of at-risk drinkers . A baseline interview was administered to 733 individuals (67% men, 50% ru ral residents) that obtained information on substance use and psychiatric d isorders, psychosocial factors, social support, four dimensions of access t o alcoholism treatment services and prior alcoholism service use. Interview s at 6 and 12 months obtained self-reports of subsequent receipt of alcohol ism treatment services. Results: We identified modest differences between r ural and urban at-risk drinkers. The rural sample was significantly less we ll-educated and reported significantly less affordability, accessibility an d acceptability of some treatment services (p < .05). Rural at-risk drinker s also appeared to possess significantly greater illness characteristics, i ncluding more lifetime DSM-IV criteria for alcohol use disorders, more freq uent recent alcohol disorders and more chronic medical problems (p < .05). The longitudinal sample comprised 579 participants, of whom 7% reported rec eiving some form of alcoholism treatment services in the year after the ini tial interview. In bivariate analysis, rural drinkers in the sample reporte d greater use of help for their drinking, more use of psychiatrists and mor e use of inpatient, outpatient and ER treatment settings than did their urb an counterparts. However, significant independent predictors of 12-month al coholism treatment use in multiple logistic regression were female gender ( OR = 0.3), greater social support (OR = 2.2) and illness or severity charac teristics including recent diagnosis of alcohol dependence (OR = 3.3), soci al consequences of drinking (OR = 1.7), concurrent medical problems (OR = 2 .1) and prior treatment experience (OR = 4.4). Conclusions: We found modest differences among rural and urban at-risk drinkers and some evidence of gr eater barriers to treatment and greater illness severity among rural inhabi tants. Further research is needed to know whether community interventions w ith social networks and other interventions to improve social support may h elp bring at-risk drinkers into treatment in both urban and rural settings as well as provide other support for sobriety.