REGION'S DRUG ABUSE CALLED UNIQUE

Meeting Addresses Culture, History

KINGSPORT, Tenn. - Treatment professionals who try to help Appalachian
people conquer substance-abuse problems need to beware that they might face
special conditions stemming from the region's culture and history.

That was one message yesterday as treatment providers gathered to discuss
concerns about prescription drug abuse in Appalachian regions of Kentucky,
Virginia, West Virginia, Tennessee and North Carolina.

The Appalachian region is home to some of the nation's worst
prescription-drug abuse. The Herald-Leader reported last January that in
parts of six counties in Eastern Kentucky, drugstores, hospitals and other
dispensaries received more narcotics per person than anywhere else in the
nation over the past four years.

And while treatment centers have lengthy waiting lists of clients, they
face deeper challenges than the number of available beds, providers say.

Al Greene, professor emeritus at Appalachian State University in Boone,
N.C., told more than 120 people gathered for the conference that
Appalachian history and development created cultural factors that influence
substance abuse.

For instance, the historic isolation of the region led to a strong strain
of reliance on self and family. That can mean that when people abuse
alcohol or drugs, they wait longer to seek help and exhaust family
resources first, so they are sicker when they finally seek professional
help, Greene said.

It also means treatment must be oriented toward a patient's family, Greene
said.

Greene mentioned a number of other factors that play a role in the drug
abuse in the region, including economic problems and a pattern of outside
exploitation, contributing to a fatalistic view of the world and a feeling
of powerlessness. And a history of prescription drug use -- tied in part to
physically punishing industries such as logging and mining -- created an
acceptance of pills that colors how some people regard abuse.

"You're not a dope fiend. You're taking medicine," Greene said.

Conference organizer Mac Bell, an official with the Kentucky Division of
Substance Abuse, said the event grew out of discussions about common
problems with prescription-drug abuse in Central Appalachia.

Treatment literature doesn't address the role of culture in drug abuse and
treatment, Bell said, so one goal of the conference was to get a better
understanding of how to reach Appalachian patients and try to meet their needs.

"This is a different kind of drug culture," Bell said.

For instance, many people who sell drugs in the region are doing it to feed
their families, not out of greed, he said.

Mike Townsend, director of the Kentucky Division of Substance Abuse, said
Appalachian states want the federal government to recognize the region as a
unique cultural area deserving of more federal money for drug treatment.