Experiences of Recovery from Alcohol and Substance Use Disorders and Access to Recovery-Oriented Systems of Care in Rural and Small-Town Minnesota

Abstract

Methods: In-depth, semi-structured interviews were conducted with 34 long-time (average 30-year) residents of the region. 56% were in recovery from AUD/SUD, 15% were treatment providers, 29% were both. We explored their perspectives of, and experiences with, small-town and rural ROSC. Data: The data were comprised of 34 hour-long, audio-recorded interviews which were transcribed verbatim and coded using thematic analysis, a qualitative data analytic technique. Participants were 56% female, 51 (SD=15) years of age with 14 (SD=3) years of education. 88% were white. Roughly one third were never married (35%), married (27%), and divorced (29%). Length of abstinence for those in recovery ranged from 11 days to 36 years. Providers had 17 (SD=11) years practice experience. Results: Participants described a range of challenges to recovery in rural communities: long distances to travel; scant 12-step meetings; lack of gender, ethnic, and age diversity in recovery communities; difficulty avoiding friends who still drink/use drugs; and social stigma derived from normative small-town gossip. Participants also described strategies for success. They accessed ROSCs such as 12-step meetings, recovery community organizations, recovery churches, and Celebrate Recovery. They carpooled with others to attend recovery-oriented celebrations, joined recovery social groups such as motorcycle clubs, and traveled to distant towns to support fledgling meetings. Some small towns served as “recovery hubs” featuring numerous 12-step meetings, established treatment centers, and sober living homes, while other communities offered less. A local recovery community organization provided recovery celebration events and telephone outreach, which were seen as valuable and sustaining. A number of local churches established “recovery ministries” with special programming and outreach to individuals in recovery, which were also deemed valuable. Surprisingly, online recovery communities were not accessed to fill the gap in service. Conclusions: Features of small-town and rural-community life such as population dispersion, ethnic and age homogeneity, and limited recreational options presented obstacles to recovery, but individuals readily employed strategies to access what is available locally and at a distance, and worked to expand and diversify ROSC in the region.