Coalition on Appalachian Substance Abuse Policy


	Overview and History *Substance Abuse in Appalachia* The Coalition on Appalachian Substance Abuse Policy (CASAP) focuses on a problem affecting the narrow corridor of America known as Appalachia. This largely mountainous region is mostly rural, with depleted natural resources and few centers of industrial development. Many counties are profoundly distressed economically, distressed in an ability to determine a healthy future for their residents. CASAP is concerned about one of the contributors to this distress – the problem of substance abuse. *How is Appalachia Different?* Substance abuse professionals, mental health, health care, and law enforcement specialists have met over the past 6 years to define the extent of the problem in Central Appalachia. They agree on the need to reclaim Appalachia and to restore hope for an area marked by a human watershed of despair manifested in the near epidemic of substance abuse. The physical landscape of Appalachia is distinguished by mountains that have been gouged away. Likewise, the psychological landscape of Appalachia bears witness to the gouging of higher community goals and expectations for a better future. The psychological tailings, the defeat of community aspirations, are evident in every school, every business, in hospital emergency rooms, mental health centers, and on the roads. Overdose deaths affect almost every town. Much attention has been paid to overdose deaths from prescription painkillers like oxycodone and methadone as well as other opiates (Herald-Leader, 2003 and Roanoke Times, 2007). Alcohol, marijuana, prescription tranquilizers, methamphetamine and other mind-altering drugs also damage Appalachian lives and destroy hope. They medicate despair. Social status and economic conditions of Central Appalachia define poor health, disparities in health care, and a lack of federal and state governmental policy directed at the substance abuse problems in Appalachia. One of the sources of the current drug abuse crisis is the depressed economy, the poverty and the lack of development, jobs and futures in Central Appalachia. Poverty was defined as “capability deprivation” by Nobel Prize laureate, Amartya Sen. Income alone does not determine poverty, but it is the degree to which people experience the ability to participate equally in society and to benefit from fundamental social equities. Looking closely at the fabric of Appalachian society, we see many examples of capability in a state of deprivation. The freedom to have safe and healthy landscapes, schools and jobs has been lost. In the wake of hopelessness, mind-altering drugs become a substitute, a last refuge for those who see little chance of satisfaction or happiness in reality. *We Believe in a Different Future* The Coalition on Appalachian Substance Abuse Policy believes that changes in policies at federal, state and local government levels can help stem the growing incapacitation of our communities. We believe that addressing health care disparities with greater economic self-sufficiency at individual and community levels can make a difference in the quality of life in Appalachia. We also believe that a failure to address these policy needs will spell a continuing decline in the health and well-being of citizens throughout the region. The Coalition on Appalachian Substance Abuse Policy presents a call to examine substance use in Appalachia as a serious social, economic, health, and personal problem with far-reaching implications for the future. CASAP relates to federal, state and local governments and to community citizens as well as substance use and health provider systems. To join CASAP in advocating for policy change, complete the membership form and mail with your registration fee. CASAP History University leaders, local, state and federal planners/administrators, regional and local service providers, along with treatment professionals from Kentucky, Ohio, Tennessee, Virginia, and West Virginia, organized the first Appalachian Regional Substance Abuse Summit Conference in March of 2002. The conference identified five major substance abuse policy issues facing Appalachians. These include: Confusing or absent health and economic policy related to Appalachian substance abuse. Decision-makers lacking knowledge about substance abuse patterns unique to Appalachia. Significant health disparities compared to the rest of the nation. Extensive economic damage directly linked to substance abuse. Overextended mental health and substance abuse resources. Background During the fall of 2001, a small group of individuals with much experience in substance abuse policy and treatment responded to that urgency by forming the four-state coalition now known as the Coalition on Appalachian Substance Abuse Policy (CASAP). Seed money from the Appalachian Regional Commission supported the Summit meeting at which CASAP was officially launched. The purpose of the Coalition is to support the work of the states of Kentucky, Tennessee, Virginia, and West Virginia as they address the patterns, causes, and consequences of substance abuse problems in their Appalachian counties. Members of the Coalition share the following beliefs: Substance abuse in Central Appalachia has characteristics and commonalities that not only justify but also demand solutions that transcend state boundaries. Only a concerted, focused, substantial effort will be sufficient to address the threat that substance abuse represents to the economic well-being and the physical, emotional, and social health of the region. Summit participants identified huge gaps in the information needed to address patterns of substance abuse in Central Appalachia. They further noted that there is insufficient scientific information about the specific harmful effects of the substance abuse patterns observed in Appalachia and about the most effective ways to design treatment in an Appalachian context, a lack of information that is costly. They concluded that, with improved information, resources devoted to prevention and treatment could be used to design highly effective substance abuse programs specifically for Appalachia. Unique Characteristics Affecting Substance Abuse In Appalachia Substance abuse is a drain on economic life in Appalachian communities: money spent on drugs leaves the region, the workforce is weakened by substance abuse, treatment is costly, community trust is eroded and family stability is compromised. Medical Providers with limited substance abuse training are often ill equipped to address problems of addiction and drug abuse. Comparatively low education levels, high rates of unemployment, and job related injuries, are closely linked to abuse of alcohol, illicit drugs, and prescription medications. A long history of anti-regulatory beliefs influence official and unofficial protection of substance sales and abuse.