The Words We Use: Enhancing Access to Services for Rural Substance-Using Populations

Overview: This workshop promotes culturally competent service delivery through examination of the social context, the existence and origins of stigma and stereotypes, and the influence of institutional barriers on access to and delivery of substance use treatment services, particularly in rural areas.Proposal text: If the agencies and systems social work intervenes with may perpetuate marginalization, then social work must examine its role in order to achieve social justice (CSWE,2021). Expanding upon this proposition, and aligned with CSWE’s call for access to health care as a basic human right, social work must address the ways in which personal and institutional systems may further marginalize substance using populations of all identities (Martinez et al.,2018). Rural opioid-using individuals in particular face multiple layers of marginalization and vulnerability that can affect treatment access and outcomes (Mitchell,2019; Mitchell & Rodis,2020).

Much is known about how best to treat opioid use disorder. The combination of opioid replacement treatment (ORT) plus any form of psychotherapy is the most effective means of addressing the physical and psychological impacts of opioid use (Amato et al.,2011; Dugosh et al.,2016). Yet, even before the onset of Covid-19, opioid use disorder remained an intractable problem, particularly in rural areas (Cromartie,2017; Noonan,2017). Covid-19 has only exacerbated the issues, with devastating impact as seen in the skyrocketing rates of overdose deaths in 2020 (NIDA, 2022). Overdose deaths involving any opioid jumped nearly 50% between 2018 and 2020 (NIDA, 2022).

How can social work contribute to addressing the issues?

As social work educators, we promote culturally competent service delivery through examination of the context (social determinants of health), the existence and origins of stigma and stereotypes, and the influence of institutional barriers (Martinez et al., 2018) on access to and delivery of substance use treatment services, particularly in rural areas. Stigma, defined as negative judgment enacted through power (Hatzenbuehler et al.,2013), can be a barrier to receiving substance abuse treatment (Stringer & Baker,2018) and may be at the root of broader population-based health inequalities (Hatzenbuehler et al.,2013). Socially determined aspects of health can impede or promote access to treatment (Mitchell,2020), thus leaving already marginalized populations more vulnerable.

Addressing these issues begins in the classroom. To be human is to have opinions, biases, ideas; we are not neutral beings (McWilliams,2003; Sue,2001) and social workers are not exempt. Yet to meet our ethical obligation to provide culturally competent services to our clientele (NASW,2021), we must continually examine and self-examine to identify our areas of non-neutrality, both in practice and in our classrooms (Sue et al.,2009; Tumala-Narra,2014).

To that end, drawing on results of a recent study examining factors influencing substance use treatment outcomes in a rural population (Mitchell,2020), presenters will identify social determinants of health that might impede or facilitate SUD treatment for rurally located populations. The conference workshop will become a living learning laboratory, with participants invited to consider the words we use and the agency structures within which we operate as contributing to treatment outcomes in the context of the biopsychosocial factors previously identified. Participants will leave the workshop with an enhanced sense of individual skills or practices to employ in classrooms and/or incorporate into service provision, promoting social justice through treatment access for rurally located individuals and families affected by substance use, particularly opioid abuse.