Challenges in Rurally Based Alcohol and Drug Abuse Treatment Services

This paper describes alcohol and chemical dependency treatment needs in a sparsely populated area largely consisting of casino employees and their families. The area also contains many retirees who come because of the climate and the casino environment. In addition, the area attracts water sports enthusiasts and campers because the Colorado River separates Bullhead City, Arizona; Needles, California; and Laughlin, Nevada. As a result of these factors, the community population triples on weekends from October to May. Vacationers from all over the l,limited States, mostly retirees, bring recreational vehicles and relocate here for the winter months.

When these people need treatment for alcohol and chemical dependency, support groups and professionals from their home communities must be contacted for refretrialserrals. For this reason, a directory of substance abuse resources in rural areas is needed.

When I first relocated to this area, there were few professionals in our field, and most of the population had to go 100 miles to I.as Vegas for inpatient or outpatient treatment. Therefore, a treatment center was started to provide treatment modalities needed in this environment. This area is growing quickly and, as casinos open (there are now 10 casinos, and they are rapidly expanding), new employees relocate from larger cities where all treatment components are usually available.

Step 1: Determining Need

Because of the rapid population growth, I persuaded the firm in Riverside, California, in which I was serving as Treatment Program Director to allow me to return here (it is my home community) to conduct a community needs assessment. I did the assessment by contacting casino management, community resources, and insurance companies. Because of the assessment's initial results, the Bullhead Community Hospital committed to providing some office and treatment space.

After 6 months of taking phone calls and making assessments, I determined that an intensive outpatient substance abuse program was needed. The program required patients to attend Monday through Friday for 3 hours a day for 4 weeks. Any patients needing inpatient detox or rehabilitation had to be referred to Las Vegas, although many patients were detoxed by our program's Medical Director on an outpatient basis.

Step 2: Expanding Services

After 1 successful year, I found that many people needed inpatient detox services. Therefore, I developed policies and procedures for starting a six-bed detox unit in our small community hospital. The unit was licensed by the State on January 3, 1993.

Because of the community's needs, I will focus next on developing policies and procedures for licensing an inpatient rehabilitation program. My experience with such programs has shown that it is better to go "one step at a time" and to make each modality successful before considering opening another. Marketing the program and contracting with insurance companies is done by me.

Of course, the program will rarely be able to refer patients for mental health issues because of the limited number of mental health professionals in a small community like this one. Being the only structured program in the Tri-State area, we provide services for Needles, California; Laughlin, Nevada; and Bullhead and Kingman, Arizona. Many of our referrals come from Employer Assistant Professionals, health management companies, and the small community hospitals in these cities.

The substance-abuse population here is different from that of other small communities, since the explosive growth has brought a new population that work in casino environrnents. Of those in this group who use drugs, most have a drug of choice. The most predominant drugs here are speed, marijuana, and alcohol.

The casino environment, in which alcohol and gambling are readily available 24 hours a day, affects families. A large percentage of both husbands and wives work in casinos (often on different shifts); therefore, the children of this population suffer the most ill effects.

In 1992, we had our first Christmas party for patients who have graduated from the program and have remained clean and sober. While some graduates could not attend because of work schedules and some attendees were family members rather than graduates, we had 70 positive RSVPs to this event. This attendance speaks for the program's success.

Principles of Successful Treatment

However, this program does not conclusively answer many of the deeper problems that cause substance abuse. Possibly 80 percent of those who live here came from other areas. Many of them leave their hometowns to get away from the drug environment. They do not realize that they choose the environment; the environment does not choose them. Everyone grows up with different values and personality traits; in recovery, these must change. For each substance-abusing person, we need to find the cause(s) of their abuse. For a large percentage of our patients, it began with physical, sexual, or verbal abuse by relatives or friends, which of course profoundly affects their self-esteem and ability to trust. They turn to alcohol and drugs to make them feel better and to mask their feelings, because they do not know how to properly deal with their feelings.

In cutting through the patient's denial of the addiction, the counselor has to deal with the denial of the cause. Many patients need to spend a lot of time with the counselor to create enough trust to be honest about their feelings—one of the most important phases of recovery.

Successful treatment programs are founded upon a variety of concepts. In my 17 years of experience, the most important factor has been to hire employees who are knowledgeable, compassionate, and understanding of the patient's problems, but are also assertive enough to tell them what they need to hear to help them and their families through recovery. It is also important to create a treatment program that focuses on the population's needs and to be willing to change the program's components as the needs change.

Several measures are needed to reduce substance abuse. Education on substance abuse is required in schools so that abuse can be prevented or terminated early on. Individuals and employers need to be educated to identify problems that can lead to signs of substance abuse. Insurance policies or any future national health plan should provide chemical dependency coverage. State-funded programs need to provide continuing education on new techniques for professionals in this and other small communities to attract professionals to these areas.

Alcohol and drug abuse in this area has increased, not decreased. Street or prescription drugs can easily be purchased. The flow of drugs into this country must be stopped and requires more attention from the Government. If drugs become scarce, prices will increase, and they will become unaffordable for most people. Such a situation would remove many adolescents from the drug scene.

Are these the only solutions? No, but there are no perfect solutions. This paper is written on the basis of my experience in this area;the opinions expressed are based on the needs of people here.

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