Foreword

The Center for Substance Abuse Treatment (CSAT) and the National Rural Institute on Alcohol and Drug Abuse (NRIADA) are pleased to jointly sponsor this publication, which is a compilation of papers submitted to the 1994 Award for Excellence contest. The Award for Excellence called for papers addressing the special challenges of providing quality treatment services to substance abusers in rural and frontier areas.

Papers were particularly solicited in the following areas:

• Experiences, ideas, practical measures, and recommended actions for implementing health care reform initiatives in rural areas (such as regional cross-State provider arrangements)

• Innovative strategies, policies, and programs for improving the delivery of substance abuse, health, and public health services in rural and frontier areas

• Proposals for political and economic solutions that would expand the development of services in rural/frontier areas

• Strategies for building rural coalitions and networks

• Approaches for special issues related to substance abuse, such as rural crime, gangs, and violence, including family violence

• Research studies and needs assessment data showing the prevalence of AOD abuse problems in rural and/or frontier settings, as well as their effects on rural crime, family life, and social, cultural, and economic conditions

• Cost-benefit analyses showing the impact at the Federal and State levels from resolving substance abuse and public health needs of rural and frontier communities

The papers presented here are a remarkable portrait not only of the daunting AOD problems that face rural and frontier America but, more importantly, of the viable approaches to those problems that are being created in rural and frontier areas.

The top three winners of this contest illustrate three successful approaches to helping substance abusers in rural and frontier areas deal with their problems. Riedel, Hebert, and Byrd describe an innovative program in their paper, "Inhalant Abuse: Confronting the Growing Challenge." Our Home, Inc., in Huron, South Dakota, has unlocked the doors of treatment to rural, inhalant-abusing youths—mostly American Indian youths—who did not before have access to treatment. This comprehensive residential treatment program provides a length of stay between 90 and 120 days. The treatment gives these young inhalant abusers, who are an average of 13 years old, the opportunity to detoxify, reduce impairment in neurocognitive functions, improve academic performance, and stabilize emotionally and behaviorally.

Tanya Tatum describes two substance abuse programs designed to address the needs of Appalachian women in Ohio. "Rural Women's Recovery Program and Women's

Outreach . . . Serving Rural Appalachian Women and Families in Ohio" is designed to take advantage of the strengths of these women, as well as their wealth of culture and spirit of perseverance. Appalachian women have specific cultural barriers, which include "a mistrust of outsiders, fear of the 'system,' the conscious exclusion of specific groups in a bureaucracy, a tradition of self-sufficiency and taking care of one's own, and geographic and social isolation." Tatum's group found that the key to delivering effective programs was to gain acceptance from the community and client population. They built on the personal and collective strengths of individuals and of the communities to be served.

A successful rural coalition in Northwest New Mexico is the subject of a paper by Raymond Daw and Herb Mosher. "The Bridges of McKinley County" describes a county that had the highest composite rate of alcohol-related problems of all counties in the United States from 1975 to 1985. The rural coalition that Daw and Mosher describe initiated The March of Hope, a journey made by a group of citizens who walked 200 miles in 10 days from Gallup to the State Legislature in Santa Fe. This rural coalition has been the catalyst to a regional response that has closed drive-up liquor windows, built a detoxification and assessment center, reformed State driving-while-intoxicated laws, and offered new prevention and treatment services.

Successful strategies and insights into the AOD problems facing rural and frontier Americans are mirrored in the other papers submitted to the Award for Excellence. These papers illustrate the difference that can be made for people suffering from alcohol and other drug problems in rural and frontier America.

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