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Overcoming Psychological Barriers
Just as important as the physical barriers that keep rural residents from treatment are
the psychological barriers, said author Trudee Ettlinger, Ph.D., A.P.R.N., L.A.D.C., C.C.H.P., an associate professor of nursing at Norwich University in Northfield, VT.
“Physical barriers can always be overcome, but there’s something else that
happens in rural areas, especially around disadvantaged women of child-bearing age,” said Dr. Ettlinger. “There’s an enormous amount of stigma.”
Dr. Ettlinger’s contribution, “Delivering a Maternal Substance Abuse Intervention Program Along the Rural Route,” provides a model for overcoming that stigma. The
paper describes the Rocking Horse program, a substance abuse prevention program for lower-income mothers in rural Vermont.
The program is supported in part by the state’s Substance Abuse Prevention and Treatment block grant from SAMHSA.
Designed to get women into treatment before they’re in crisis, the Rocking Horse
program teaches at-risk women about the dangers of alcohol and illegal drug use.
The program consists of 10 weekly get-togethers. In a warm and caring environment, the
participants learn about the impact of substance abuse on their health, relationships,
young children, and life troubles. A substance abuse treatment professional and a specialist in child and maternal health lead the discussions. Because they live in the same communities as the participants, the leaders serve as both mentors and role models. The program provides transportation, onsite childcare, and healthy snacks.
To combat stigma, the discussions take place in church basements rather than at an agency. “It doesn’t arise out of welfare; it doesn’t arise out of child protection; and it doesn’t arise out of a treatment center,” said Dr. Ettlinger. “It belongs to the community.” Even the name helps battle stigma, she added. “Rocking Horse is a non-value-laden name,” she said. “And no one knows what it is.”
Over the program’s 5 years of existence, informal evaluations have suggested that
the approach works. Using pre- and post-tests, Dr. Ettlinger and her colleagues have found that participants seem to handle stress better, parent more effectively, and increase their
understanding of the risks of alcohol and drug use. There even appear to be dramatic reductions in their binge drinking.
Although more formal evaluation is needed, said Dr. Ettlinger, the women themselves clearly believe the program has something to offer.
The program has proven so popular that there are now reunion groups for women who have
finished the 10-week program but want more. The monthly sessions help the women stay connected, Dr. Ettlinger added.
To request a free print copy of TAP 28, contact SAMHSA’s Health Information Network
at 1-877-SAMHSA-7 (1-877-726-4727) or 1-800-487-4889 (TDD). Request inventory number SMA06-4183.
Online, the full text of TAP
28 is available in PDF format at www.kap.samhsa.gov/products/manuals/pdfs/TAP28.pdf. 
« See Part 1: Overcoming Barriers to Prevention, Treatment
See Also—Rural Substance Abuse: Overcoming Barriers to Prevention and Treatment
Rural Resources »
2008 Conference, Web Casts »
From the Administrator:
Putting Rural Substance Abuse “On the Map” »
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