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ARC Study: Disproportionately High Rates of Substance Abuse in Appalachia

August 2008


London, Kentucky, August 12, 2008—According to an ARC-commissioned study announced today by Kentucky Governor Steven L. Beshear and ARC Federal Co-Chair Anne B. Pope, Appalachia suffers from disproportionately high rates of substance abuse and mental health disorders, including the alarmingly increasing abuse of prescription painkillers. Conducted for ARC by the National Opinion Research Center (NORC) at the University of Chicago, the study also reveals that Appalachia is doing better than the rest of the nation in terms of access to treatment for substance abuse and mental health problems.

The study analyzed disparities in mental health status and substance abuse prevalence, as well as access to treatment services, across the 410 counties and 13 states of Appalachia by using community hospital discharge data, national household survey data, and treatment episode data. To supplement quantitative data sources, case studies were conducted in partnership with East Tennessee State University.

The study found particular disparities associated with Appalachian sub-regions, county economic distress level, and coal-mining areas, confirming the presence of a place-based disparity in the Appalachian Region.

Beshear stated that the study "clearly illuminates a major problem we are facing all across Appalachia, and particularly in our state's 51 ARC counties. This is why it is imperative that we do not lose productive members of our workforce, or particularly our kids, the future of our towns, to drug addiction."

Noting that substance abuse had become a "major impediment to economic growth in the Appalachian Region," Pope said the report was a great help to "scientifically understand the scope of the problem." But, Pope noted, it was then essential "to doing something about it."

To that end, Pope and Beshear announced a $250,000 ARC grants competition to help communities improve their intervention and service programs dealing with the issues of illegal drugs and prescription drug abuse. The grants will range from $40,000 for individual communities to as much as $75,000 for multi-state programs. More information about the grants competition is available at

Key findings from the study include the following:

Substance Abuse

  • Prescription Painkillers: Admission rates for primary abuse of prescriptions painkillers (opiates and synthetics) are higher in Appalachia than in the rest of the nation. This is especially true in coal-mining areas. Admission rates are rising across the nation, but are rising at a faster pace in Appalachia. Appalachia's rate, which doubled from 2000 to 2004, is more than twice the nation's.
  • Methamphetamine: Usage and admission rates for methamphetamine are lower across Appalachia than in the rest of the nation, although the Region's rates are rising faster than the nation's.
  • Alcohol: Alcohol is still the predominant substance of abuse nationally and in Appalachia.

Mental Health

  • Mental health diagnoses for serious problems independent from substance abuse are proportionately higher in Appalachia than in the rest of the nation.
  • Mental health problems are not equally distributed across the Region: the study found higher rates of serious psychological stress and major depressive episodes in central Appalachia than in northern and southern Appalachia.

Treatment of Substance Abuse and Mental Health Disorders

  • Adults in the Appalachian Region with mental health problems reported a somewhat greater likelihood of having received outpatient mental health treatment or counseling in the past year, compared with adults outside the Appalachian Region, according to the national household survey.
  • The vast majority of Appalachian treatment facilities offer some substance abuse treatment.
  • While access to substance abuse and mental health treatment is a problem across the nation, in some respects treatment availability is better in Appalachia than in the rest of the nation.