It’s easy to think that urban adolescents have the highest risk for dangerous behaviors.

But when it comes to alcohol abuse, rural teens rise to the top.

Four percent of rural teens ages 12 and 13 are regular drinkers, compared with 1.5 percent of their urban counterparts.

“For the 14- to 15-year olds, it goes up to 12 percent,” says Duke psychiatrist Ashwin Patkar, MD, who, along with principal investigator Robert Hubbard, PhD, is leading a new effort to address underage drinking in these communities.

Duke is one of four sites in the country to receive a PARTNER (Prevention Approaches to Underage Alcohol Use) grant from the National Institute on Alcohol Abuse and Alcoholism.

The three-year, $1.6-million grant will fund Duke to work with communities in Durham, Franklin, Granville, Halifax, Person, Vance, and Warren counties to create prevention and treatment interventions for underage drinking designed specifically for these underserved areas, which are home to about 45,000 teens.

Patkar explains that the barriers to prevention and care in rural communities can be profound.

Widespread poverty means that many are uninsured, and many others have inadequate insurance for alcohol abuse treatment. Even for those who can afford it, the treatment services available are much more limited (and access is more difficult) than in urban areas.

Also, he notes, drinking is a part of the cultural fabric of many rural areas, and stigma in these tight-knit communities precludes the privacy and anonymity that some families need to feel comfortable seeking help for substance abuse.
Duke’s PARTNER program will begin by building upon relationships with Duke-affiliated primary-care clinics in these counties to find the best ways to screen for alcohol use as part of standard clinical care.

PARTNER will also establish a referral system with churches, schools, police, and the social services system, so that adolescents who are identified in incidents involving alcohol can be recommended for treatment.

“It’s really an exciting opportunity to build a stronger relationship between Duke and these communities,” says Patkar. “We want to get these kids the help they need now, and find out what will help them best, instead of trying to address even worse problems 20 years down the road.”