Drug Treatment Centers Located in Neighborhoods More Dangerous than Where Most Patients Reside, and May Reduce Chances of Recovery

NEW YORK CITY, April 7 ??? While it???s no secret that drug and alcohol treatment facilities tend to be located in disadvantaged neighborhoods, a new study shows that struggling patients using these facilities are being exposed to environments that could increase their risk of relapse, according to a new study in the Journal of Urban Health: Bulletin of The New York Academy of Medicine.

Researchers from UCLA and Charles R. Drew University carried out the first-ever quantitative assessment of ???neighborhood character??? at all 494 residential and outpatient treatment centers in Los Angeles County that received public funds during 2000. The study analyzed records on 22,707 patients, as well as Census data. Higher levels of violence, drug activity, and economic disadvantage were found in the zip codes where treatment centers are located, compared to the rest of the county. More surprisingly, the study found higher levels of these unfavorable conditions in zip codes where treatment centers are located, than in those where clients live.

Approximately 20 percent of clients in the city of Los Angeles attend treatment in zip codes that are more economically disadvantaged than where they live, the study found, and between nine and 18 percent of clients countywide receive treatment in areas where violence and drug activity is substantially more prevalent than in their home zip codes.

???These kinds of neighborhood conditions are likely to interfere with recovery from addiction by increasing stress and environmental triggers for using drugs and alcohol,??? said lead author Jerry O. Jacobson, Ph.D., Coordinator of the Strategic Information Unit of the U.S. Centers for Disease Control and Prevention???s Global AIDS Program in Central America and Panama. At the time of the study, Jacobson was a Postdoctoral Fellow with the UCLA Integrated Substance Abuse Programs.

Patients in Los Angeles who must travel into dangerous and drug-filled communities to reach an outpatient treatment center, and inpatients who live these conditions on a daily basis, are systematically less likely to complete treatment, according to preliminary evidence in another of Jacobson???s studies, not yet published. Previous statistical studies have shown strong associations between neighborhood conditions and drug use, even after accounting for differences between individuals, he said.

???Where to place drug and alcohol treatment centers has always been a contentious issue marked by not-in-my-backyard concerns and political resistance from wealthier communities,??? Jacobson said. ???Current locations tend to depend more on the path of least resistance. At least in the scientific literature, virtually no attention has been paid to the appropriateness of neighborhood conditions and their effect on treatment outcomes, although treatment providers and others are certainly aware of the issue.???

Jacobson said that previous studies on the location of drug treatment facilities have focused almost exclusively on geographic proximity to clients. ???Neighborhood conditions should also enter into the facility location decision,??? he said.

The research also calls into question the commonly held notion that clients at public treatment centers hail exclusively from the poorest neighborhoods with the most drug activity, Jacobson said. He found that clients at public treatment centers actually hail from a many different types of neighborhoods.

The Journal of Urban Health is a bimonthly publication of the Academy and is edited by David Vlahov, PhD, Director of the Academy Center for Urban Epidemiologic Studies. The New York Academy of Medicine, the country???s premier urban health policy and intervention center, focuses on enhancing the health of people living in cities through research, education, advocacy, and prevention. Visit us online at www.nyam.org. ###

Posted on April 7, 2006

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