Detox is an important modality in the treatment of substance-abuse as it serves as the gateway to longer term treatment. Detox involves alleviating short-term symptoms of withdrawal (e.g., extreme discomfort and medical instability) from alcohol or drug (AOD) dependence. Successful detox requires both medical management of a client's withdrawal process and therapeutic intervention to prepare the client to engage in active treatment of his/her AOD dependence. A review of the literature revealed little national-level data on the availability and delivery of rural detox services. Anecdotal evidence from past work suggests that rural detox services, particularly for drugs such as opiates and meth, are typically unavailable to patients in rural areas. Using the Inventory of Substance Abuse Treatment Services (I-SATS), a comprehensive listing of substance abuse treatment facilities in the US, we identified 2,203 facilities providing detox services of which 76% are located in urban areas, 13% in nonmetro micropolitan/large town areas (e.g. areas with an urban cluster of 10,000-49.999 persons), 8% in nonmetro small towns (e.g., areas with an urban cluster of 2,500-9,999), and 4% in nonmetro isolated areas. This project will involve a telephone survey of a random sample of rural detox services stratified by type of rural area.

Using secondary data from the I-SATS and the primary data from our survey, this project will address the following questions:

• What are the organizational, practice, staffing, financial, and clinical characteristics of rural detox providers?
• What are the access issues related to detox services in rural communities?
• What are the issues related to the referral of patients once their course of detox care is complete?
• How do rural detox services fit within the greater health care delivery system at the local level and within the SA treatment system?
• What are the major challenges facing rural detox providers? What policy incentives and support might help to overcome these challenges?

The products for this project include a working paper and related journal articles describing the distribution and characteristics of rural detox providers, access issues, the role of detox services within local rural delivery systems, barriers to the delivery of detox services by rural providers, and policy and regulatory incentives needed to encourage the development of rural detox services.

Publications

• Availability, Characteristics, and Role of Detoxification Services in Rural Areas
  Maine Rural Health Research Center
  Date: 12/2009
  Few detox providers (n=235) serve rural America; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve patients across a 100-mile radius, making travel distances a barrier to outpatient care. Referral options to substance abuse treatment are limited, especially in isolated rural areas.
• Few and Far Away: Detoxification Services in Rural Areas (Research & Policy Brief)
  Maine Rural Health Research Center
  Date: 12/2009
  This policy brief finds that few rural detox providers exist; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve a 100-mile radius. Travel distances are a barrier to outpatient detox models. Referral options to substance abuse treatment are limited, especially in isolated rural areas.