to an urban county.^237 In 2010, 8.9 million rural
residents had no access to inter-city public
transportation,^238 posing a significant barrier to
treatment access.^
Rural residents tend to have lower incomes and
are less likely than non-rural residents to have
health insurance, which limits their ability to
afford and pay for treatment.^239 And since rural
residents are more likely than urban residents to
be self-employed, they have fewer encounters
with employee assistance programs.^240 For these
reasons, rural residents who engage in risky
substance use or have other health problems tend
to delay seeking preventive care, resulting in the
need for more costly care in the future.^241
Native Americans.......................................................................................................
National data on racial/ethnic differences in the
addiction treatment gap are limited with regard
to Native Americans due to small sample sizes
for this population.^242 However, existing data
suggest that Native Americans are the likeliest
of all racial/ethnic groups to smoke and to meet
clinical criteria for addiction involving alcohol
and other drugs.^243 National data also suggest
that the group with the largest treatment gap is
Native Americans.^244 One estimate indicates
that less than one-fifth of addiction treatment
programs nationally offer specialty services for
Native Americans.^245