Utilization of outpatient medical care and substance use among rural stimulant users: Do the number of visits matter?

Rural substance users are less likely than their urban peers to use formal substance use treatment. It is therefore important to understand how the utilization of potentially more appealing care options, such as outpatient medical care (OMC), may affect substance use over time. This study sought to examine whether the number of OMC visits, after controlling for important covariates, was associated with days of alcohol, crack and powder cocaine, and methamphetamine use among a sample of rural stimulant users over a three year period. Data were collected from a natural history study of 710 stimulant users living in rural communities in Arkansas, Kentucky, and Ohio. Participants were adults, not in drug treatment, and reporting stimulant use in the last 30 days. In terms of alcohol use, for participants with higher employment-related problems, having 3 or more OMC visits (relative to none) was associated with fewer days of alcohol use. The results for days of cocaine and methamphetamine use were mixed. However, we did find that for participants reporting at least one substance use treatment or mutual help care visit in the past 6-months, having 1-2 OMC visits (compared to none) was associated with fewer days of crack cocaine use. Regarding methamphetamine use, results showed that for participants without medical insurance, having 3 or more OMC visits (compared to none) was associated with significantly fewer days of methamphetamine use if they also reported greater than or equal to a high school education. The findings from this study may help us begin to understand some of the characteristics of rural drug users, who utilize OMCs, associated with reductions in substance use. These findings may help health care administrators better plan, coordinate, and allocate resources to rural OMCs to more effectively address substance use in this population.