Why Does the Abuse Settle In Appalachia?

Appalachia suffers from disproportionately high rates of substance abuse and mental health disorders, including the alarmingly increasing abuse of prescription painkillers. Why Appalachia? The question is asked repeatedly by those who long for an end to the epidemic of prescription drug addiction. A research study by the National Opinion Research Center at the University of Chicago provides some interesting findings concerning the question.  (Zhiwei Zhang, Ph.D., Alycia Infante, M.P.A. , Michael Meit, M.A., M.P.H., and Ned English, M.S.,"An Analysis of Disparities in Mental Health Status and Substance Abuse Prevalence, and Access to Treatment Services in the Appalachian Region," National Opinion Research Center, 2009)

The Appalachian Regional Commission ordered the study after years of stories detailing increased prescription drug abuse problems in the region.

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. Appalachia has a poverty rate three times that of the national rate, a high cancer rate and a high rate of toothlessness. Many suggest the use of drugs and alcohol help numb the pain of the residents' reality. Robbery, theft and other types of personal crimes continue to soar as addicts seek money to buy Lortab, Xanax, and OxyContin.

The availability of prescription drugs and the lure for making a quick dollar add to the high distribution rate of Rx drugs in Appalachia. In the area, public disregard for the dangers associated with drug abuse runs very high.

"People's lives have been devastated," said Michelle Klassen, author of the research project titled "Hillbilly Heroin: OxyContin in Appalachia." Klassen continued, "It's a tricky one (problem) because it's not something the government can just go in and fix. It's a deeply embedded cultural issue." (Jennifer Choi, "Teen Presents On OxyContin Abuse In Appalachia Region," www.explorehoward.com, April 17 2009)

Anne Pope, federal co-chair of the ARC, released the National Opinion Research Center report at a news conference 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.

Kentucky Governor Steve Beshear added, "When people don't have good jobs to support familiies, I think that leads to depression and anxiety, which in turn leads to substance abuse." (Bill Bishop, "As Poverty Worsens In Appalachia, So Do Drug Abuse and Depression," www.dailyyonder.com, August 14 2008)

Here are some highlights of the study:

1. 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.

2. 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.


3. 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. 

4. Marijuana use rates are also lower in Appalachia than in the nation. 

5. However, cigarette use is higher in Appalachia among both adults and teens than in the nation.


6. Proportionately more Appalachian adults abuse prescription drugs than in the nation.  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."

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


   A. 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. 

   B. 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. 

   C. 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.

Residents in these regions work hard for a living—maybe involving coal mining, logging, or farming. These are all occupations prone to injury and pain, likely to be relieved by prescription drugs. The more prescriptions written increase the potential for availability to those who would abuse or sell these drugs.

Diane Sawyer explored the problems in Appalachia in her documentary "A Hidden America: Children of the Mountains."

Sawyer thinks the children in Appalachia face a very tough future. "I think you can argue that the history of the hills and the isolation of the hills is an added mountain to climb," she said. "As they say, to go to Cincinnati, it's like going to Istanbul. I think the feeling that they are not respected or valued. You can introduce them in sitcoms, you can introduce them as jokes. This is also a psychological weight that a lot of people carry." (David Bauder, "Diane Sawyer Reports On Appalachian Poverty," The Huffington Post, February 11 2009)

 Want negativity? Check out Bill O'Reilly's take on Kentuckian Diane Sawyer's research on Appalachia. Please notice at the end of the interview, O'Reilly says to Sawyer, "I'm with you." What a joke, O'Reilly.