Kentucky substance abuse man stares at the ground

Substance Abuse Counselors Identify Barriers to Treatment

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Research Summary


Kentucky substance abuse counselors identified lack of funding, transportation, bureaucracy, and lack of interagency cooperation as the four key barriers to successful client outcomes in rural and urban communities.

Key Findings

Substance abuse counselors shared their perceptions that:

  • Service provision is limited by a lack of resources and funding for services in both rural and urban communities.
  • Lack of transportation is a greater challenge in rural areas.
  • Treatment in rural areas must recognize client-level barriers to be effective. Barriers include transportation, disadvantaged socioeconomic status, and the impact of family legacies of abuse.
  • Bureaucratic challenges such as heavy caseloads, lack of case management, excessive paperwork, and delays getting clients into treatment may prevent service provision in both rural and urban communities.
  • Increased interagency cooperation is needed to provide additional required services, such as supervised detoxification and mental health services in both urban and rural communities.
  • Meeting clients’ basic needs, such as housing and access to basic dental and medical care, is particularly challenging in rural communities.

Counselor-Identified Barriers to Effective Substance Abuse Treatment, Major Themes and Subthemes

  • = Urban Challenges
  • = Rural Challenges
  • = Urban & Rural Challenges

Lack of Funding

Difficulty meeting needs of non-English speaking clients

Lack of technological resources - i.e., computers

Heavy caseloads and understaffing

Fewer treatment options for rural clients

Lack of educational resources for clients

Limited continuing education opportunities for counselors

Lack of good facilities (e.g., building resources)

Transportation and Accessibility

Challenges getting to treatment facilities, especially in rural areas

Client distance from treatment centers

Reliance on friends/family for transportation

Bureaucratic Challenges

Lack of case management

Excessive paperwork

Delays getting clients into treatment in rural areas

Lack of Interagency Cooperation

No continuum of care

Lack of detoxification facilities

Lack of mental health services

Clients must improvise to access treatment services ^

Challenges meeting housing needs of clients

Need for dental and medical services

^ Both rural and urban counselors recognize that there are fewer treatment options, as well as challenges and delays getting clients into treatment in rural communities

Put It Into Practice


Tips and tools to help you apply best practices at work.

This research suggests that substance abuse treatment programs work best when they’re tailored to unique community needs. Especially among rural clients, unique cultural characteristics must be addressed, such as family histories of abuse and community encouragement of substance use.

The ability of substance abuse counselors to provide more diverse services, along with increased interagency collaboration, could improve client outcomes in Kentucky.

Tools to Get Started

More About the Research

Substance abuse is a major public health concern in rural and urban communities. Lack of funding, concentrated poverty, and the increased availability and use of drugs, formerly challenges faced primarily by urban communities, now exist in rural communities as well.

This study builds upon extensive research into the barriers to substance abuse treatment in both rural and urban communities. It compares rural and urban substance abuse counselors’ perceptions of barriers to providing effective substance abuse treatment services.

The study examines this complex issue from the unique perspective of counselors who are both aware of the organizational challenges of delivering services and intimately connected with clients. It simultaneously compares perspectives of rural and urban counselors who work within a single state at state-funded treatment sites. This research provides a more direct comparison between the challenges of providing substance abuse treatment in rural and urban communities than previous research.

Findings from this study could inform targeted efforts to improve the accessibility and effectiveness of substance abuse treatment in both rural and urban communities.

Learn More

Pullen, A., & Oser, C. (2014). Barriers to Substance Abuse Treatment in Rural and Urban Communities: A Counselor Perspective. Subst Use Misuse, 49 (7), 891-901.