African American cocaine users' preferred treatment site: variations by rural/urban residence, stigma, and treatment effectiveness

• Fifty-eight percent of rural cocaine users preferred distantly located treatment.
• Fifty-seven percent of urban cocaine users preferred local treatment.
• Rejection/Discrimination was related to a preference for distant treatment.
• Local treatment effectiveness was related to a preference for local treatment.
• Regionalization of drug abuse treatment may better satisfy rural cocaine users.

To encourage access, policy makers and providers need information about variations in drug users' treatment preferences. This study examined how rural/urban residence, stigma surrounding drug use, and perceived treatment availability and effectiveness are associated with African American cocaine users' preferences for the site of treatment (local, or in one's home town; nearby, or in a town nearby; and distant, or in a town farther away). Two hundred rural and 200 urban cocaine users were recruited using respondent-driven sampling and completed in-person interviews. Multinomial logit regression analyses were conducted to estimate the relative odds of preferring local vs. nearby and local vs. distant treatment. Rural cocaine users preferred distant (58%), and urban users preferred local (57%) treatment. Rural residence and a lifetime history of treatment were associated with higher odds of preferring nearby vs. local treatment; older age and greater perceived local treatment effectiveness were associated with lower odds of preferring nearby vs. local treatment. Rural residence, access to an automobile, higher rejection/discrimination stigma scores, and higher Brief Symptom Inventory-Global Severity Index scores were associated with higher odds of preferring distant vs. local treatment; older age, lower educational attainment, and greater perceived discrimination after treatment were associated with lower odds of preferring distant vs. local treatment. The findings from this study suggest that a regional approach to organizing drug use treatment services could better satisfy the preferences of rural African American cocaine users, whereas local treatment services should be expanded to meet the needs of urban cocaine users.