The dangers of illegal drugs and the abuse of legal drugs are ever-changing, making it essential for law enforcement and the public to stay vigilant in the fight against these substances. The combination of poverty, occupational difficulties, lack of health care coverage, and a shortage of qualified substance abuse treatment providers in Middle Tennessee has created a need for multifaceted policy interventions. A lack of public health information on the risks and liability for abuse related to prescription painkillers has meant that people are unaware of the consequences of starting their use (Zhang et al.). Implementing psychological treatments is often expensive, even if health care coverage is expanded, and may require substantial initial investment by government agencies, for example, through outreach and implementation initiatives through the National Institutes of Health, grant funding mechanisms through the Mental Health and Substance Abuse Services Administration (SAMHSA), as well as other grant funding mechanisms. Counties in Central Appalachia have occupational difficulties and are largely clustered around coal mining areas that are already at greater risk of prescription drug abuse.
Appalachians are consistent with standard middle class Americans in terms of race, religion, descent, and language. Culturally appropriate public health strategies that promote trust and community participation can lower the threshold for seeking treatment and reduce the public health burden for those who are not yet prepared to stop substance use. Tennessee reports that 80% of crimes in the state have a drug-related link, making it essential to combat the use and abuse of illegal drugs. Rural health care providers across the country, including those who treat substance abuse disorders, may not receive sufficient training in evidence-based treatments.
In addition to public health initiatives in rural areas of Central Appalachia, training and adoption of evidence-based treatments can provide the tools needed to successfully treat people with substance use disorders. Teresa Waters, professor of preventive medicine at the University of Tennessee Health Science Center, researched the costs associated with substance abuse. Prescription drug abuse has had disastrous consequences in the state, including overdose deaths, rising hospital costs and emergency room visits, the detention of children in state custody, and incarceration for drug-related crimes. Current policies and interventions for substance use have been largely inadequate in the region.
The authors discuss how rural life, poverty, identity and values in Appalachia have influenced substance use and treatment and propose strategies and interventions to improve outcomes. Taken together, treatment initiatives with the support of funding initiatives in Central Appalachia can pave the way for similar models in other rural areas struggling with comparable mental health and substance abuse issues.