Exploring Socio-Ecological and Structural Factors Among Black Men in Rural South Carolina to Inform Substance Use Disorder Interventions: A Qualitative Study.

Objective: This formative study aimed to explore socio-ecological and structural determinants that influence substance use disorders (SUD) among Black men in rural areas of South Carolina (USA) and inform the design of culturally relevant community-based interventions.

Methods: Black adult men (N = 15; ages 33-66 years) with known SUD were recruited from outpatient treatment centers, homeless shelters, and via community outreach initiatives within rural areas of South Carolina. Written informed consent was obtained, and interviews were conducted using a structured interview guide. Interview data was audio-recorded, coded and analyzed until consensus was reached on emergent themes. Data were collected between June 2023 and May 2024.

Results: Five primary themes emerged: perceptions and experiences with substance use, contributing factors to substance use, determinants of treatment acceptance, and relapse triggers. Findings from this work highlight barriers such as financial constraints, peer influence, social dynamics, and systemic inequalities that hinder SUD treatment engagement for Black men in the rural South. Facilitators such as community and familial support, cultural considerations, and self-awareness were identified as critically important for encouraging treatment acceptance.

Conclusion: This exploratory study provides insight into the socio-cultural and structural complexities faced by Black men in rural South Carolina (USA) regarding SUD treatment and relapse prevention. Our findings support the call for culturally sensitive, community-driven research and interventions that address both personal and systemic challenges. Larger and interdisciplinary studies are needed to address urgent prevention and treatment gaps, and pervasive disparities in SUD treatment outcomes for Black men in medically underserved rural communities.