The forgotten fifth: rural youth and substance abuse.

• Author: Pruitt, Lisa R.
• Position: Symposium: Drug Laws: Policy and Reform

This Article seeks to raise the visibility of the roughly twenty percent of the U.S. population who live in rural places--an often forgotten fifth--in relation to the particular challenges presented by adolescent substance abuse. Despite popular notions that substance abuse is essentially an urban phenomenon, recent data demonstrate that it is also a significant problem in rural America. Rural youth now abuse most substances, including alcohol and tobacco, at higher rates and at younger ages than their urban peers.

The Article assesses the social, economic and spatial milieu in which rural adolescent substance abuse has burgeoned. Features of some rural communities, such as a tolerance for youth and lenient and informal law enforcement responses, appear to benefit youth. Indeed, these are consistent with juvenile justice trends, such as diversion programs. Yet other characteristics of rural communities, such as limited social service and healthcare infrastructures, undermine the efficacy of such programs.

Arguing that national drug policies often reflect urban agendas and leave rural communities disserved, this Article calls for policies that are more sensitive to rural contexts. It advocates nuanced empirical research that will provide a more comprehensive understanding of rural risk factors and, in turn, inform rural prevention, treatment, and diversion programs. Finally, it argues that federal, state, and local responses to adolescent substance abuse must tackle deficiencies in rural infrastructure, while keeping in mind factors that differentiate rural places from what has become the implicit urban norm in law- and policy making.

1. THE RURAL SOCIOECONOMIC AND CULTURAL MILIEU II. SUBSTANCE ABUSE BY RURAL YOUTH A. THE PHENOMENON B. ACCESS AND AVAILABILITY III. RESPONDING TO THE PROBLEM: RURAL CHALLENGES A. EDUCATION AND PREVENTION 1. Schools 2. D.A.R.E 3. After-school programs 4. Media B. TREATMENT 1. Transportation 2. Cost C. CRIME, POLICING, AND SENTENCING D. DIVERSION PROGRAMS E. FUNDING IV. CONCLUSION Let me bring to mind two popular and apparently unrelated American images. First, our drug problem is an urban one, manifest in cities, where men of color traffic in cocaine, crack, and other hard drugs. (1) Second, rural communities and small towns are particularly safe places to raise children. (2) In fact, both images are at least part myth--one urban legend, the other rural legend.

   Substance abuse is now a greater problem among rural youth than among their urban counterparts. Rural youth not only abuse tobacco and alcohol at higher rates than urban youth, (3) they also use hard drugs such as cocaine and methamphetamine at higher rates. (4) Further, rural adolescents tend to begin using drugs at a significantly earlier age, (5) and they are more likely than their urban counterparts to sell drugs. (6)

   About one-fifth of our nation's populace lives in rural (7) areas, (8) which makes rural residents a sizeable minority group. Yet, over the course of the twentieth century, as our nation evolved from a rural one into one that is dominated by cities, (9) we have become urban focused. (10) That orientation has rendered largely invisible to law- and policy-makers the rural manifestations of social problems such as illicit drug use. (11)

   In fact, substance abuse has long been a problem in rural America, albeit a little known one. (12) The situation has worsened in the past few decades as rural places have increasingly become sites of drug production and shipment. This trend, along with technological advancements such as the Internet, has enhanced the rural availability of methamphetamine, cocaine, and prescription drugs. Rural communities have struggled to adjust to this evolving challenge, but they often lack the resources to provide prevention and treatment programs, and cultural differences may render national programs ineffective in rural contexts. Meanwhile, rural law enforcement agencies are perennially underfunded and are less likely than their urban counterparts to have the personnel or expertise to deal with the challenges presented by drug trafficking.

   This Article seeks to raise the visibility of the forgotten rural fifth of our population in relation to the particular challenges presented by adolescent substance abuse. An effective response to teen drug use in rural America requires an understanding of how rural places differ--socially, culturally, and economically--from the presumptive urban norm in law- and policy-making. To that end, Part I provides a brief overview of the rural milieu, to the extent that it can be generalized across regions. Part II provides a detailed account of youth drug use in rural areas. Part III describes the rural-specific challenges to addressing this social problem. The conclusion offers suggestions for place-specific and rural-sensitive policies that will respond more effectively to the drug scourge that is further darkening the bleak horizon facing many rural youth in America.

1. THE RURAL SOCIOECONOMIC AND CULTURAL MILIEU

   Rural myths abound. "The country life" is commonly associated with pleasing simplicity and pastoral landscapes. (13) Rural youth, the myths suggest, have distinctly pleasant childhoods where they play safely in wide open spaces, insulated from urban concerns. (14) They are healthy, sheltered, and invulnerable--so the story goes.

   Like other aspects of the rural idyll, this portrayal is far from complete. (15) Poverty rates have long been higher in rural places than in urban ones, (16) and children and youth are a particularly vulnerable rural population. (17) Educational attainment is lower in rural places where there are fewer educational opportunities, fewer incentives for educational advancement, and a lesser ability to afford tertiary education. (18) These factors, in combination with a dearth of high-skill jobs and the low cultural value placed in formal education, (19) contribute to a significant educational gap between urban and rural residents. (20) Along with the lack of economic opportunity, declining populations contribute to a decreased tax base and an eroding infrastructure. (21)

   Other challenges associated with rural spatiality limit and shape day to day choices. Greater distances separate rural residents from jobs, services, and each other, yet public transportation is rare and inefficient. (22) Less than 10% of federal public transportation funds go to rural areas, (23) and only 60% of rural counties offer public transportation. (24) High travel costs diminish use of services when they are located in the county seat or in another distant regional center. (25)

   These structural challenges have been aggravated in recent years by some of the consequences of globalization. Economic restructuring in many rural areas has resulted in a dramatic loss of well-paying, blue-collar jobs with benefits. (26) At the same time, the number of female-headed families has increased dramatically, and they are now almost as prevalent in rural as in urban places. (27) These trends have sent many rural women into the job market. (28) Indeed, for the past quarter century, rural mothers of young children have consistently been employed at higher rates than their urban counterparts. (29) This, coupled with the dearth of child care options in most rural places, (30) has led to a rise in the number of rural latchkey kids. (31)

   Rural spatiality also has social consequences. Sparseness of population tends to produce "high density of acquaintanceship" (32)--and predominance of personal, face to face social relationships among similar people." (33) Lack of anonymity and concerns about confidentiality are thus characteristic of rural places, where residents usually know their neighbors, resulting in an informal social control that may penalize those who don't conform to community expectations. (34)

   Such community expectations typically reflect traditional beliefs (35) and conservative values, including self-reliance. (36) Like lack of anonymity, these characteristics have been linked to rural residents' interpersonal familiarity with one another. (37) Tradition and conservatism have also been associated with the homogeneity and lack of mobility (38) that typically mark rural populations, features which have left rural residents less likely to challenge existing beliefs or embrace change.

   Even as rural areas have wrestled with the enduring demons of poverty, human capital deficits, limited economic diversity, and population loss, they have faced new challenges in recent decades. The gap between rural and urban crime rates has narrowed in recent years. (39) Compared to metro places, small towns and rural areas have especially high rates of fraud, driving under the influence (DUI), and family violence. (40) Alcohol and drugs have come to play a significantly greater role in rural crime. (41)

   All these characteristics of rural places have profound impacts on rural youth. Not least is a socioeconomic landscape that limits their educational and employment prospects. (42) One recent study of rural youth found them "at greater risk for both depression and diminished educational aspirations." (43) It also found that they "suffer greater loneliness and may be less likely to obtain the social support needed to mediate the impact of stressor events." (44) Studies of young adults aged eighteen to twenty-four indicate that they are more likely to be idle--that is, unemployed and not enrolled in postsecondary education or the armed forces--than their urban counterparts. (45)

   Like their urban counterparts, rural teens are influenced by peers, sometimes for the worse. Studies of peer influence on rural youth are limited and inconclusive, but a 2006 article suggests that rural teens follow their marijuana-using peers into both drug and alcohol use. (46) Parental circumstances, such as low income, also predict youth drug use. (47)

   On a more positive note, several studies...