Rural women's first-person perspectives on the role of mental health in substance use

Introduction: Some evidence suggests that co-occurring conditions may be more prevalent among rural populations. Rural women face limited behavioral health care, social barriers, and structural vulnerability that heighten their risk for co-occurring conditions. This qualitative study examines the first-person narratives of rural women to identify their perspectives on the cooccurrence of substance use and mental health symptoms. Methods: Investigators performed secondary analysis of transcripts from intervention sessions (n=87) from incarcerated, rural women who were using drugs (n=24) who took part in an intervention based on motivational interviewing using a thematic analysis approach. Results: In this sample of low-income Appalachian women in the rural USA, many described their substance use as emerging from a desire to escape mental health symptoms emerging from life stress and trauma. Although many remarked on their desire to 'deal with' the issues at the root of their mental health symptoms, they possessed limited options for formal treatment, let alone resources for coping. Instead, they encountered stigmatizing discourses about addiction that inadvertently reinforced their poor self-worth, only furthering substance use and confusing their sense of themselves. Conclusion: These findings demonstrate the importance of creating pragmatic strategies to make behavioral health treatment available to rural women, in combination with larger programs that address the social conditions putting women at risk for poor mental health and substance use.