Murphy and colleagues analysed data collected about a cohort of young people aged under 21 who presented for treatment for substance use to the Matt Talbot treatment service between 2001 and 2011.¹ The aim of the study was to investigate the differences in substance use between young people residing in urban and rural areas. The cohort consisted of 436 young people; just over half (51.3%) were rural attendees – 223 from Cork County and one from Kerry (rural attendees) and 212 from Cork City (urban attendees). Young males accounted for over 95% of both urban and rural attendees; overall, both groups had a similar mean age, urban attendees with a mean age of 16.7 years and rural attendees 16.8 years. Over 90% of both groups resided with their parents.  

Employment and education status

The groups differed markedly in terms of current employment and education status. A third (33.3%) of urban attendees reported being unemployed compared to 22.2% of the rural group; 10.3% of rural attendees were in paid employment compared to 4% of urban attendees. A higher percentage of rural attendees (47.4%) reported to be a student compared to 37.4% of urban attendees; however, urban attendees made up a higher percentage of those attending an adult training course (22.2%) compared to 17% of rural attendees.

Problem substance use

Over half of both groups (59.6% rural attendees and 54% urban attendees) presented for treatment for cannabis use as their main problem substance. Marked differences were observed between both groups for problems with alcohol use and benzodiazepine use. A higher percentage of rural attendees (32.3%) presented for treatment for problem alcohol use, in contrast to 22.5% of urban attendees; conversely, 16% of urban attendees compared to 4% of rural attendees reported presenting for treatment for problem benzodiazepine use. With regard to ‘head shop’ drugs, 4.2% of urban attendees presented for treatment for problem use of these substances, compared to 0.9% of rural attendees. Surprising about this finding is the relatively low overall percentage of the cohort presenting with problem ‘head shop’ drug use: given the ‘moral panic’ that arose concerning the availability and potential risks of ‘head shop’ drugs during the period of data collection, which culminated in legislation to close ‘head shops’ in 2010, it would appear that very few of this cohort were immediately affected by the types of substance available in ‘head shops’. Less than 2% of the overall cohort reported opioids as their main problem substance, while a slightly higher percentage of rural attendees (2.2%) reported problems with cocaine compared to 1.9% of urban attendees.

Poly-substance use

A higher percentage of urban attendees reported poly-substance use: 73.7% reported using at least three different substances during their lifetime compared to 52.2% of rural attendees; 49.3% of the urban group reported using three different substances in the last month compared to 31.3% of rural attendees; and daily use of at least two different substances was reported by 11.3% of urban attendees compared to 4.9% of rural attendees.

Initial use of substances

There were no marked differences in age of first use of any substance, with the mean age for urban attendees being 12.4 years and rural attendees 12.7 years. The vast majority of both urban (81.7%) and rural (80.9%) attendees reported cannabis as the first substance used. A higher percentage of urban attendees (4.1%) reported benzodiazepines as first substance used compared to 1.5% of rural attendees, and 6.1% of urban attendees reported inhalants as first substance used compared to 0.5% of rural attendees. On the other hand, 16% of rural attendees reported alcohol as first substance used compared to 7.6% of urban attendees.

Referral to treatment

A higher percentage of rural attendees (44.3%) compared to urban attendees (37%) were referred for treatment by the Irish legal system; this finding suggests these attendees were likely to have experienced problems with crime and/or social misbehaviour.

Concluding remarks

The authors point out that this is the first Irish study comparing service users from urban and rural settings; on this basis alone the study is welcome as it contributes to a gap in the literature. The main aim of the study was to investigate differences in substance use between young people residing in urban and rural areas. The main differences found were:

1. almost a third of the rural group presented for treatment for alcohol use as their problem drug, in contrast to 22.5% of the urban group,
2. 16% of the urban group presented with benzodiazepine as their main problem drug, in contrast to 4% of the rural group, and
3. a higher proportion of the urban group reported using a variety of substances during their lifetime, during the past month and during the past week.  

1. Murphy KD, Byrne S, Sahm LJ, Lambert S and McCarthy S (2014) Use of addiction treatment services by Irish youth: does place of residence matter? Rural and Remote Health, (14): 2735