Foreword

The 1996 Award for Excellence papers are a culmination of the third Call for Papers from the Center for Substance Abuse Treatment (CSAT) and the National Rural Institute on Alcohol and Drug Abuse (NRIADA). The Call for Papers recognizes that States and counties in rural and frontier areas face special challenges in providing their citizens with adequate services and skilled treatment providers. These challenges call for innovative, unusual strategies and approaches and, in this current period of State health care reform, for solutions designed to work in rural areas (with 50 or fewer people per square mile) and frontier counties (with 6 or fewer people per square mile). In addition to describing the initiative, strategy, or program in depth, authors responding to the Call for Papers were asked to discuss problems and barriers that were encountered.

The papers that are published here offer a compelling look at a number of ways in which rural and frontier America is addressing alcohol and other drug abuse and the problems that accompany the abuse. Recognizing the efforts of AOD experts, caregivers, and communities in rural and frontier areas is one important goal of the Award for Excellence. Representatives of CSAT and NRIADA presented awards to the authors of the first, second, and third place papers at the National Rural Institute on Alcohol and Drug Abuse held in Eau Claire, Wisconsin in June 1996. David M. Paschane accepted the first place award for "Drug Use, Sexually Transmitted Diseases, and SexRelated Risk Behaviors in Alaska," which he wrote with Henry H. Cagle, Andrea M. Fenaughty, and Dennis G. Fisher. The second place award was presented to Boyd D. Sharp, Rodney (Roadrunner) Clarke, and Richard Pohl for their paper, "In Rural and Frontier America, It Takes a Whole Community to Rehabilitate a Substance Abusing Criminal." The third place award was accepted by Wayne Dougherty on behalf of Catherine E. Bartels, author of "Continuum of Services for Offenders in South Dakota." The awardees discussed their programs in workshops held at the Institute.

The Award for Excellence also brings recognition to other programs. The Ten Sleep, Wyoming community/school program, described in this volume, received an outstanding program award from NRIADA. Steve Sohm, who wrote "Prevention and Intervention Substance Abuse Programs in the Ten Sleep, Wyoming, School" accepted the award for Ten Sleep. Jim Armstrong of Bullhead City, who wrote about that community's strategies for building rural coalitions and networks in the 1994 Award for Excellence publication, received a community award at the Institute. Recognition of the accomplishments of the programs and strategies described in the Award for Excellence papers continues with the publication of these papers.

Communicating the ideas behind successful frontier and rural initiatives is the major focus of the Award for Excellence. Communication and access to treatment have traditionally been problematic in areas where populations are widely dispersed and hard to reach. Some of the Award for Excellence papers are beginning to reflect what may be a partial answer to these problems.

Some experts in rural areas believe that telecommunications technologies are key to resolving problems of access and fostering development in rural areas. According to a recent General Accounting Office report (Rural Development: Steps Towards Realizing the Potential of Telecommunications Technologies, GAO/RCED96155, June 1996), advanced telecommunications technologies—the Internet, videoconferencing, and highspeed data transmission—offer rural areas the opportunity to overcome their geographic isolation, take advantage of expertise in other communities, improve medical services, create new jobs, and improve access to education. The opportunities provided by these new technologies are also beginning to have an impact on the delivery of substance abuse services, as is reflected in some of the papers offered here.

For instance, Angeline Bushy notes the availability of peer support, consultation services, and educational courses via electronic media to rural service providers. She cites collaborative efforts between educational institutions and health care agencies made possible by the new technology. As described by Paul Higbee and Ernest Bantam, the Black Hills Careers Academy in South Dakota, a school for rural youth whose lives have been disrupted by substance abuse, encourages students to use the Internet to broaden their view of who they are and to explore potential careers. Kathryn Puskar and her colleagues describe a system in which rural school personnel could transmit data to a university computer for analysis.

In these rapidly changing times of health care reform, and the adjustments that Federal, State, county, and local jurisdictions are making in their delivery of substance abuse services, exploring new ways of communicating about and delivering AOD care makes a great deal of sense. Telecommunications technologies are one avenue for exploration. The papers presented here offer other avenues for thoughtful exploration of techniques that may be useful to communities searching for approaches to the problems associated with AOD use. Working in partnership together, we believe that we will successfully address the complex problems that we face.

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