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Rural issues General comments Unfortunately, there is a lack of relevant UK research for this question. Investigations of these communities have tended to be incorporated into larger socio-economic reports and substance misuse, although perceived as a large problem in some areas, has not generally received specific attention. The HDA published the following recommendations for an appropriate framework for young people (Coomber et al., 2005; An interim review of the `grey’ literature regarding drug prevention in young people aged 11-18 with a special emphasis on vulnerable groups. London, HDA):
Evidence suggests that there is little difference in drug use among young people between rural and urban areas (Forsyth and Barnard, 1999; Henderson, 1998). However, there are a number of drug-related issues, which are quite specific to rural areas . These issues can play a significant role in a success or failure of a drug prevention project and can be summarised under three headings; geographical separation, community or non-individual level factors, and individual-level factors. 1. Geographical separation (Mentor UK 2004; Cragg Ross Dawson 2003; Henderson 1998)
2. Community or non-individual level factors (Henderson 1998) Community or non-individual level factors can act as barriers to obtain support and acceptance for a drug prevention programme, both of which have a huge effect on successful implementation and maintenance of the project. It was explained that because of a relative lack of anonymity in rural areas, young people are highly visible and their public behaviour attract unnecessary focus from adults. Particularly, drugs or crime-related incidents in community could lead to a ‘panic’ or over-reaction in the community. These can adversely affect relationships between young people and adults. Similarly, people who are not from the community can be highly visible and project workers coming from outside of the area are not an exception. They tend to be seen as ‘outsiders’ by community residents and achieving an ‘insider’ status may require some time and effort. Likewise, drug prevention projects brought into community by ‘outsider’ workers can be seen as ‘one-off’ and/or ‘imported’ initiatives and the community may be reluctant to support such initiatives. Moreover, there is a reluctance to recognise drug problems in the community and a tendency to attribute social problems to ‘outsiders’, which include drug using individuals. Furthermore, existing community groups are likely to be ‘traditional’ in a sense that they are not keen at acting on social issues. 3. Individual-level factors Individual-level factors tend to result from negative attitudes towards drug users and their families. Being stigmatised or labelled as a ‘drug user’ in a small-knit community probably has a significant adverse impact on every day life of the users and families. As a consequence, drug using individuals or family of drug users may not want to seek help or attend drug/alcohol prevention services due to a fear of being labelled or stigmatised (Henderson 1998). Similarly, the stigma attached to drug use may prevent those young people to go to see their family doctors, reducing help/support seeking behaviour. Some rural GPs also tend to lack knowledge of drugs/alcohol services and/or treatment (e.g. methadone prescription) (Cragg Ross Dawson 2003). Furthermore, some doctors do not want to have drug using individuals in their surgery. Likewise, some pharmacists may not want to dispense methadone. A consequence of these is that young people with alcohol/drug problems may not receive referral to appropriate services. Substance use training for health professionals is also important to increase knowledge on drug treatment and services and foster positive attitudes towards those who use drugs. On the other hand, there are low expectancies and awareness of services among people in rural areas due to the absence of local services, a lack of continued attention to rural areas by national policy, and under-developed service structure (Cragg Ross Dawson 2003; Henderson 1998). B. Case studies and project methods (Henderson 1998) Henderson (1998) described four rural drug prevention initiatives in her report and these case studies illustrated that a variety of project methods have been used for community-based initiatives. The Somerset Parents’ and Rural Communities (SPARK) project in West Somerset was a National Drug Agency project with the aims of developing community drugs awareness, parent focused education, and parent support and counselling services. It provided parents with a range of services including advice and information sessions for parents’ groups, helplines, and family casework. Substance Misuse Prevention Development in Essex was a district council project, aimed at creating new and specific drugs prevention community initiatives. Its activities included production of guide for Parish and District Councils, parent support groups, drug awareness sessions for parents, peer education projects, and an information and advice bus. The Windmill Centre Drugs Education Project in Castle Donnington was a youth service project, developed in response to an increase in a local concern about drug use among young people in the area. It was a centre-based project and a number of activities were taken place, which included peer education groups/projects, art-based projects, development of a youth counselling service, and establishment of youth council. The Young People’s Mobile Advice and Information Programme was a youth work based mobile service in Sussex. There were five projects derived from this programme, which varied in the aims, formats, approaches, settings and durations. The ReachOut bus was one of the projects. It provided visitors with drugs and general information leaflets, posters and games, computers, and careers’ advice resources. It was equipped with a small kitchen facility and seating area and sold drinks and snacks. Also, drugs and sexual health sessions and peer education projects were held on the bus. C. Impact of the projects The above-mentioned projects were not evaluated for drug use outcomes. However, a qualitative evaluation of these projects indicated that the communities and participants received a number of positive impacts from these initiatives (see Henderson 1998). Firstly, it was described that these projects were able to establish a broadly positive profile and be integrated into community structures. For example, ReachOut was reported to be successful at developing more favourable attitudes towards young people among locals, achieving local acceptance, and providing young people with diversionary activities. SPARK was reported to have helped reduce a ‘blind panic’ and fear in the community about drug use among young people. Secondly, it was explained that some projects were able to increase young people’s community involvement. For example, the youth projects provided young people with opportunities to be actively involved in their communities. Thirdly, changes in local structures and working traditions of local agencies and organisations were reported to be achieved. For example, it was explained that ReachOut model of working has significantly changed and extended local multi-agency working. Finally, positive changes in attitudes to and knowledge of drugs and drug issues among participants were reported, which could be attributed to the project effects. In addition, the Sussex mobile service was monitored for the number of contacts/repeat contacts, the gender and age profile, and the number and type of drugs mentioned in discussions. These data show that ReachOut attracted 2,599 visits. The majority of visitors were young (on average, 91% were 14 – 17 year olds) and their drug-related concerns were mostly related to alcohol, cigarettes, and cannabis. D. Key factors for good practice Multi-agency work The above case studies highlighted that multi-agency working plays an important role in development and maintenance of a drug prevention project in rural areas. Consultations with community and community leaders appear to be essential, in order to access vital local expertise and information for designing a meaningful programme for young people in the area. Personal contact including attendance at meetings and distribution of drugs information can provide opportunities for positive contact with the community. A problem with multi-agency work is that it can be expensive in terms of cost (e.g. travelling, administration) and time (building up trusting relationships with the community may take some time). In addition, there may be organisational restrictions that prevent collaborative working. However, building up good working relationships with community can help overcome a barrier of being ‘outsider’ and raise a profile of the programme. So, it accrues benefits over time, as implementation of the programme should then be more favourably accepted by the community. In addition, working with local media could increase a chance of successful implementation of a programme. The Windmill Project worked actively with local media, in order to raise an awareness of the project profile. Project workers A project team needs to have project workers with a wide range of skills. The four case studies illustrated that a successful project requires good networking, social, drug prevention related and evaluation/research/survey skills in project workers. Continuous support for project workers is important, particularly if their managers or colleagues are physically distant, they can experience psychological isolation and a lack of supervision. Long-term programmes Hawkins et al. (2004) noted that there has been a long history of ‘parachute’ academics who ‘drop in’ to communities to provide prevention programming, leaving as soon as data are collected. They emphasised an importance of building up a collaborative relationship with community and of providing long-term initiatives. Likewise, new initiatives in rural communities in the UK are also often seen as ‘imported’ (Henderson 1998). Drug prevention should have long-term perspectives, in order for it to be effectively implemented and integrated in the community and its enduring outcomes assessed. E. Other projects/studies Some rural areas have transient and/or seasonal populations (e.g. tourists, dance or music festival attendees and travellers), which can affect local drug availability and/or drug use behaviour. Dance festivals can possess drug-related risks among attendees, especially if drug availability, accessibility, and positive attitudes towards drug use were high. Answered by Dr Harry Sumnall 13/1/06 References Asthana S, Halliday J, Bringham P, Gibson A (2002) Rural deprivation and service need: A review of the literature and an assessment of indicators for rural service planning. Bristol, South West Public Health Observatory
96721 Dean A. From: Substance Use & Misuse: 37 (5-7), 2002, p.749-765. This paper provides a detailed discussion of substance use and misuse in a rural community in the Western Highlands of Scotland, United Kingdom. Attention is focused on the way in which patterns of substance use arise from a complex interplay of historical, cultural, social, and personal events. The discussion illustrates how large changes in patterns of intoxication in rural communities can be rendered intelligible through an understanding of the impact of economic, religious, and social changes. The analysis is based on an historical and ethnographic account, carried out between 1987 and 1990 with adolescents, of patterns of use which range from pagan ceremonies in the 16th century to contemporary ''soft drug'' use.
UK. Hansard. Written Answers. From: Hansard: 30 Nov., 2000, col.545-546. Questions regarding what action on drug misuse awareness in rural communities is being taken; comments on an drugs education project in schools in the Highlands; the use of drug courts in Scotland.
UK. Hansard. Written Answers. From: Hansard: 15 Nov, 2000 Young People in rural communities deserve social justice as well. Comments regarding the fact that it is impossible to get access to decent youth facilities. Social services are being lost in rural communities.
Forsyth A.J.M., Barnard M. From: Addiction: 94(11), 1999, p.1707-1718. Aims: To compare life-time prevalence of illicit drug use between adolescents resident in adjacent urban and rural localities. Design: Samples of schoolchildren attending urban and rural comprehensive schools (n = 2558) were obtained using an identical questionnaire survey method. Setting: Respondents were recruited from 10 schools in two contrasting adjacent local authorities. Five representative schools in each locality were chosen. Participants: All children present in each school, in the two final compulsory school years, were eligible for this study. Measurements: Respondents were asked to provide detailed information about their place of residence and use illegal drugs. The data obtained in schools were compared with local geographical statistics, such as levels of deprivation. Findings: As expected from the demographics of their respective localities, the urban schools displayed higher levels of deprived children and lower levels of school achievement. These socio-economic differences were not reflected in reported levels of life-time drug use. This was true both between and within the urban and rural samples. Conclusion: These findings suggest that adolescent drug use in Scotland is not particularly concentrated in areas of urban deprivation.
MAJID A., Holmes R., Dresselberger U., Simmonds P., Mckee T.A. From: Journal of Medical Virology: 46(1), 1995, p.48-51. The prevalence of hepatitis C virus (HCV) infection amongst a group of intravenous drug users (IVDUs) resident in West Suffolk (East Anglia, England) was investigated and compared with the prevalence of infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV). In addition, both the level of HCV persistence, as defined by detection of viral RNA, and the HCV genotypes present in this population were determined. It was found that HCV antibodies were present in 59% of those tested; by comparison 22% had antibodies to HBV and 1% antibodies to HIV. HCV RNA was found in 44% of those with HCV antibody. HCV genotype 1 was the most prevalent within this population although both genotypes 2 and 3 were also represented. (C) 1995 Wiley-Liss, Inc.
Scottish Drugs Forum. Glasgow: SDF, 1997. 8p. Policy statement covering the issues and concerns relevant to rural communities, including problems in identifying the extent and nature of drug use, the needs of drug users and their families, and services which would respond to these needs.
RICKFORD F. From: Community Care: 2-8 Nov, 1995. The impact of drugs on rural communities has been heavily underestimated. The author assesses the growing crisis and asks how it can be prevented.
UK. Home Office. Drugs Prevention Initiative. London: Home Office, 1995. 33p. This report is about the work of the Drug Prevention Intiative (DPI) April 1995, to March 1996 a year when Phase II got into action, details of the programme of work for the next four years are given, based on scores of projects which are being prepared or are now underway. This report explains the planning and preparation procedures, key achievments made. The programme of work outlines each major theme and gives examples of individual projects. Themes include community involvement, work with parents, young people outside school, support for drugs education in schools, peer approaches, rural communities, criminal justice, training, local information and communications campaigns, involving racially and culturally diverse groups.
DEAN A. From: Int J Sociol Soc Policy: 15(1 2 3), 1995, p.134-155. SCOTLAND ALCOHOL ARTIFICIAL GROUPS CANNABIS CASE REPORTS DISTRIBUTION FIRST-HAND ACCOUNTS GEOGRAPHY HALLUCINOGENIC PLANTS AND PREPARATIONS ILLICIT INTERPERSONAL LEVEL INTERVIEWING POLYDRUG USE REFERENCE GROUPS REGIONAL RURAL SETTING UK VOLATILE SUBSTANCES 70715 BRITISH ASSOCIATION OF SOCIAL WORKERS. Birmingham: British Association of Social Workers, n.d. v, 128p. This publication is intended as a guide for all social work practitioners working in the drugs field. It aims to clarify the many reasons why statutory social workers should become involved with drug users, and gives information designed to provide an adequate understanding of the issues surrounding drug use. Among the issues addressed are assessment, harm reduction, prescribing policies, women's issues, services for minority groups, young people and services, older people and services, drugs in rural communities and homelessness and drug use. The appendices include a summary of drugs legislation, a drug slang directory and guidelines for good practice and policy when working with drug using parents.
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