New Center Seeks Answers on Trajectory of Rural Drug Addiction

Leaders of a newly established research center on drug addiction in rural areas are recruiting participants who they hope will teach them as much about the phenomenon of rural drug use as longitudinal cohorts taught researchers about the progression of HIV in the early years of that crisis.

The recruiting task is by no means simple, with the Rural Drug Addiction Research Center reaching out to community organizations, detox centers, police departments and others to help identify active drug users who might want to participate. “The level of stigma in rural areas is high,” center director Kirk Dombrowski, PhD, tells Addiction Professional.

Funded with a five-year grant from the National Institutes of Health (NIH), the center will focus on regions of Nebraska, Kansas, Iowa and Missouri that are proximate to the Lincoln campus of the University of Nebraska. Dombrowski, a professor of sociology whose interest in rural addiction issues dates to his graduate work in the 1990s, says drug use trends in the Midwest tend to receive comparatively little attention.

“There is a lot of attention lately to overdose,” he says, which is an issue generally more prominent in parts of the country where opioids dominate the landscape (although fentanyl's emergence in the stimulant supply has begun to change that to some degree).

“People don't recognize, for instance, that Iowa has the nation's biggest problem of hospitalization for meth overdose,” Dombrowski says. “It doesn't get the same resonance.”

Building on past research

Research projects conducted at the University of Nebraska in recent years, including studies of alcohol use and suicide in Alaska Natives and of injection drug use and HIV in Puerto Rico, helped establish a vision to take on greater aims in addiction research at the university. The new center has taken on the slogan “from synapse to society” in describing its focus. There will be an emphasis on public health issues tied to addiction.

Dombrowski says there are numerous misconceptions about the dynamics of substance use in rural areas. For example, the significant presence of polysubstance use in rural populations often is attributed to irregularities in the drug supply, but Dombrowski says research has shown that the issue actually reflects the tendency for users to take on the habits of people from whom they learned. That concept is known as “homophily” in sociology. It is analogous to why new smokers tend to use the same brand as those who first introduced them to cigarettes, Dombrowski says.

Another goal of the center will involve growing the research community by giving early-career faculty the tools to excel in this area of study. Once these individuals are able to secure research support on their own, they will move out of center support and other new researchers can be brought in, Dombrowski says.

Tracking participants

Dombrowski says it has been difficult historically to sustain research cohorts in rural communities, but adds that injection drug users in the Puerto Rico study participated for five years.

Leaders of the new center hope to interview participants in the new cohort twice a year for the next four years, once the entire cohort has come on board.