Community Structure and Substance Abuse Treatment Access

Gretchen H. Thompson Karl A. Jicha R.V. Rikard Robert L. Moxley North Carolina State University

Research presentation at the 2012 Rural Sociological Society meetings.

Research funded in part by USDA-CES grant, through the department of Sociology and Anthropology at North Carolina State University.

Forthcoming book chapter in Against Urbanormativity:

Perspectives on Rural Theory, Thomas and Fulkerson, Lexington Books.

For more information contact Gretchen Thompson at ghthomps2@gmail.com.

Substance abuse research indicates that many rural communities have reached urban proportions in alcohol and drug abuse levels (Donnermeyer 1992; Moxley 1992; Wright and Sathe 2005).

Rural youth have higher rates of alcohol and

methamphetamine use than their urban counterparts (Lambert et al., 2008).

In North Carolina the leading causes for incarceration continue to be drug-related crimes (Governor’s Crime Commission 2011).

Rates of substance abuse are expected to

worsen across the state given the current economic downturn (Governor’s Crime Commission 2011).

Rural communities often lack resources to address substance abuse problems due to structural, political, economic, and cultural barriers.

These include: the lack of access to substance

abuse treatment, perceived social stigma in rural areas, geographical isolation, and the financial burden associated with treatment (Wright and Sathe 2005).

Structural dimensions of communities constitute a community’s capacity to problem solve (Merschrod 2008; Moxley and Proctor 1995; Young 1999, 2007). Political competitiveness—degree of competitive

exchange among interest groups in a community, similar to bridging social capital (Flora and Flora 2007).

Solidarity—degree to which communities demonstrate a cohesive vision, similar to bonding social capital (Flora and Flora 2007).

Centrality—degree to which a community is linked to surrounding communities and political institutions and resources, similar to linking social capital (Woolcock 2002) and political capital (Flora and Flora 2007).

Rural as an additional dimension of inequality, urbanormative ideologies dominate the community development lexicon (Thompson, Lowe, Fulkerson, and Smith 2011).

Intersectionality of rural with commonly

examined axes of inequality: race and gender (Hill Collins 2000).

Inequality—rural/race/gender—as a community

structural variable (Eberts 2012) that reproduces public health disparities.

Sample: 100 County Seats Response Rate 84% Communities Surveyed

Dillman (2010) Survey Method

NC Community Key Informant Survey Town Clerks

Community Structural Dimensions Indicators

U.S. Census Data Community Demographic Indicators

Variable Full Model *Statistically significant < .05 Standardized betas italicized

Population 2000 (ln)

.320* (4.140)

Median Household Income 2000 (ln)

.002085* (2.225)

Percent African American 2000 (ln)

-.048 (-.952)

Solidarity (Community Monument, Plaque, or Memorial)

.451* (2.725)

Rigidity (Residential Segregation)

-.238 (-1.447)

Political Competitiveness (One party Dominates Elections)

.348* (-2.419)

Centrality (Number of State and Federal Agencies)

.019* (2.318)

Female Headed Households to Rural Population (Ratio)

.034* (2.527)

Female Headed Households*African American Population to Rural Population (Ratio)

-.00729* (-3.595)

(Constant)

-2.791*

Race, gender, and rurality coalesce in a matrix of structural inequalities that worsens conditions for African Americans and women in previously unstudied ways.

Present study demonstrates that rural

communities face additional challenges in regards to public health and minority populations.

Community structural dimensions underpin problem solving capacity in the form of substance abuse.

These dimensions are local level mechanisms

that may be engaged to enhance public health, particularly given neoliberal economic policies and devolution of state institutions.

THANK YOU!