The lighter colored counties in this map in Central Appalachia showed higher levels of mental health problems and drug abuse.

A greater proportion of people in Appalachia abuse prescription drugs and report mental health problems than in the nation as a whole, according to a report released this week by the federal Appalachian Regional Commission

The incidence of drug addiction and mental troubles is not uniform in the region, and this is the most interesting part of the report. In the poorer counties in the region, reports of drug abuse and general mental health problems are significantly higher than in the rest of Appalachia.

(Large .pdf file of report is here .)

Appalachia here is defined by the boundaries of the Appalachian Regional Commission, which includes 410 counties in 13 states. Parts of Mississippi are considered Appalachia, as are counties in New York. The ARC boundaries were originally set in 1965 to include a large number of Representatives and Senators. Parts of Kentucky's Bluegrass region became Appalachia. So did relatively flat counties in Alabama.

The central portion of Appalachia contains the coal counties of West Virginia, Kentucky, Tennessee and Virginia. (See map.) These are the economically depressed counties the Kennedys and Lyndon Johnson visited in the '60s and the territory most people imagine when they hear stories of Appalachia. Counties in central Appalachia are poorer. Their economies are centered largely on coal mining. And the researchers found that the people who live there have greater drug abuse and mental health problems than Appalachians who live in regions that aren't dominated by a coal economy.

The report, compiled by the National Opinion Research Center at the University of Chicago, doesn't explore these differences. But the report shows that poverty, depression, mental illness and drug and alcohol abuse reinforce each other, especially in these coal mining regions of central Appalachia.

Anne Pope, federal co-chair of the ARC, released the report at a news conference this week in London, Kentucky. She said the higher incidence of prescription drug abuse directly affected the region's ability to improve its economy. “Communities cannot grow if there is a major substance-abuse problem,” Pope said.

The Appalachian Regional Commission ordered the study after years of stories detailing increased prescription drug abuse problems in the region. The study also sought to determine if the region lacked treatment facilities.

Here are the major findings contained in the more than 200-page study:

Counties in red are economically distressed, according to the Appalachian Regional Commission.

“¢ A higher proportion of Appalachian adults than in the nation as a whole report serious psychological distress and major depressive disorders. These problems are independent of drug abuse. In Appalachia, 13.5% of adults have encountered a problem with serious psychological distress compared to 11.6% nationally.

“¢ Appalachians are less likely to use methamphetamines than the national average. Meth abuse rates are rising in Appalachia, but no faster than in the rest of the nation.

“¢ Proportionately fewer Appalachian adults used alcohol in the last year compared to adults in the rest of the country. And while 20.6% of Appalachian adults were binge alcohol users in the last year, outside the region 24.5% of adults were binge drinkers. Marijuana use rates are also lower in Appalachia than in the nation. However, cigarette use is higher in Appalachia among both adults and teens than in the nation.

“¢ Proportionately more Appalachian adults abuse prescription drugs than in the nation. An increasing number of Americans across the nation are abusing prescription drugs. That trend is increasing faster in Appalachia than in the rest of the nation, however. “Admission rates for the primary abuse of other opiates and synthetics are higher in Appalachia than in the rest of the nation,” according to the report. “Further, while rates are rising both across the nation and in Appalachia, the rate of increase in Appalachia is greater.”

“¢ There were greater incidences of addiction and abuse among Appalachian adolescents than among Appalachian adults.

“¢ Access to substance abuse and mental health treatment in Appalachia “compares favorably to the United States as a whole.” In fact, proportionately more adults in the region received outpatient assistance than in the nation in the latest year studied.

When the NORC researchers came to central Appalachia (essentially Eastern Kentucky and contiguous portions of Virginia, West Virginia and Tennessee), things changed, dramatically. In these coal counties, use of heroin and other opiates was “significantly higher” than in the rest of the region. The use of these drugs was increasing faster in these counties than in the rest of the nation. Females and those under 24 years of age were more likely to be admitted to treatment than in the rest of Appalachia. The report also found that the “central Appalachian sub-region is
found to have the highest prevalence rates of both serious psychological distress and major depressive episode.”

Drug abuse and mental illness among teenagers rose as the economy declined. The report found:

The picture of substance use and mental health concerns among Appalachian adolescents becomes even clearer when analyses are conducted by county economic status level, suggesting that economic status plays a key role in mental health and substance abuse issues. Findings demonstrate that adolescents in distressed and at-risk Appalachian counties ““ compared to adolescents in other Appalachian counties ““ have the highest rate of non-medical use of psychotherapeutics. Cigarette and alcohol use are also key concerns for adolescents in Appalachia. Proportionately more adolescents reported heavy alcohol use inside Appalachia than outside of Appalachia. Similarly, proportionately more adolescents used cigarettes in Appalachia than outside of Appalachia; usage was higher for lifetime use, past year use, and past-month use.

See also this good story by Bill Estep of the Lexington (KY) Herald-Leader on this report and reaction in Kentucky.

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