Identifying and Addressing Barriers to Effective Substance Misuse Treatment in Rural Settings

Those seeking treatment for opioid or substance use disorder (OUD/SUD) often face obstacles, which may be exacerbated in rural areas. Barriers to treatment, such as access, stigma, and policies that no longer reflect the current needs of clients seeking treatment for OUD/SUD, are well-documented. However, barriers once engaged in treatment that impact persistence are relatively unstudied. This study sought to understand the barriers related to effective treatment provision with clients in OUD/SUD treatment, particularly those in rural settings. This exploratory qualitative study consisted of two focus groups with 18 graduate social work and counseling psychology students completing a two-semester practicum at OUD/SUD treatment facilities. The student practitioners were trained in screening, intervention, and treatment services for SUD in rural and underserved locations. Participants reflected on the barriers for clients who sought OUD/SUD treatment and the subsequent impact on treatment efficacy. Three themes emerged, including Substance Use Treatment and Criminalization Policies, Rurality, and COVID-Related Adjustments. Mitigating barriers to OUD/SUD treatment, particularly in rural communities, is important to effectively address treatment needs. Understanding the ongoing support needed for clients to address barriers once engaged in treatment is critical to treatment persistence. Recognizing and addressing the identified barriers, particularly those with macro or community-level impacts, supports the client's harm reduction, treatment, and recovery needs to better position clients for successful outcomes. Public Health Significance Statement Identifying and addressing barriers to persistence in OUD/SUD treatment is of critical importance, particularly in rural communities where treatment resources may be limited, yet mortality rates rival those of urban communities. Recognizing and mitigating the identified barriers, particularly those with macro- or community-level impacts, reflects the harm reduction, treatment, and recovery emphasis of public health modeling.