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SAMHSA News - July/August 2007, Volume 15, Number 4

Rural Substance Abuse: Overcoming Barriers to Prevention and Treatment (Part 2)

Overcoming Psychological Barriers

Just as important as the physical barriers that keep rural residents from treatment are the psychological barriers, said author Trudee Ettlinger, Ph.D., A.P.R.N., L.A.D.C., C.C.H.P., an associate professor of nursing at Norwich University in Northfield, VT.

“Physical barriers can always be overcome, but there’s something else that happens in rural areas, especially around disadvantaged women of child-bearing age,” said Dr. Ettlinger. “There’s an enormous amount of stigma.”

Dr. Ettlinger’s contribution, “Delivering a Maternal Substance Abuse Intervention Program Along the Rural Route,” provides a model for overcoming that stigma. The paper describes the Rocking Horse program, a substance abuse prevention program for lower-income mothers in rural Vermont.

The program is supported in part by the state’s Substance Abuse Prevention and Treatment block grant from SAMHSA.

Designed to get women into treatment before they’re in crisis, the Rocking Horse program teaches at-risk women about the dangers of alcohol and illegal drug use.

The program consists of 10 weekly get-togethers. In a warm and caring environment, the participants learn about the impact of substance abuse on their health, relationships, young children, and life troubles. A substance abuse treatment professional and a specialist in child and maternal health lead the discussions. Because they live in the same communities as the participants, the leaders serve as both mentors and role models. The program provides transportation, onsite childcare, and healthy snacks.

To combat stigma, the discussions take place in church basements rather than at an agency. “It doesn’t arise out of welfare; it doesn’t arise out of child protection; and it doesn’t arise out of a treatment center,” said Dr. Ettlinger. “It belongs to the community.” Even the name helps battle stigma, she added. “Rocking Horse is a non-value-laden name,” she said. “And no one knows what it is.”

Over the program’s 5 years of existence, informal evaluations have suggested that the approach works. Using pre- and post-tests, Dr. Ettlinger and her colleagues have found that participants seem to handle stress better, parent more effectively, and increase their understanding of the risks of alcohol and drug use. There even appear to be dramatic reductions in their binge drinking.

Although more formal evaluation is needed, said Dr. Ettlinger, the women themselves clearly believe the program has something to offer.

The program has proven so popular that there are now reunion groups for women who have finished the 10-week program but want more. The monthly sessions help the women stay connected, Dr. Ettlinger added.

To request a free print copy of TAP 28, contact SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) or 1-800-487-4889 (TDD). Request inventory number SMA06-4183. Online, the full text of TAP 28 is available in PDF format at of Article

See Part 1: Overcoming Barriers to Prevention, Treatment

Rural Resources »

2008 Conference, Web Casts »

From the Administrator: Putting Rural Substance Abuse “On the Map” »

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Inside This Issue
Rural Substance Abuse:
Overcoming Barriers to Prevention, Treatment
 Part 1
 Part 2
 Rural Resources
 2008 Conference, Web Casts
From the Administrator:
Putting Rural Substance Abuse “On the Map”

Sign Up for SAMHSA's eNetwork!

Grants: Looking Ahead to 2008

Suicide Prevention &

Anti-Stigma Campaign: Friends Make a Difference

Preventing FASD in Native Communities

Underage Drinking
Radio PSAs Help Parents “Start Talking”

Action Guides for Families, Educators

Ready for Recovery Month?

Mental Health Workgroup Meets with Afghanistan Ambassador

Keeping Children Safe, Helping Families Recover

Co-Occurring Disorders: Two New Papers

Drug Tests or Self Reports: Which Works Best?

Treatment Directory Updated

New Navajo & Russian Publications

Problem Gambling: Beating the Odds

Behavioral Health: CA’s Asian Pacific Family Center

Mental Health on Campus: R.I.S.E. Helps Students


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SAMHSA News - July/August 2007, Volume 15, Number 4