ArticleFrontiers in public health2026
Community place attachment as a significant correlate of motivation to change substance use behavior among adults who inject drugs in rural U.S.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: While motivation is critical for substance use disorder (SUD) recovery, many individuals fail to engage in treatment. The need to belong is a fundamental human motivation, yet the role of community place attachment (CPA) as a social asset in fostering motivation to change substance use behaviors (MCSUB) among people who inject drugs (PWID) is understudied. This paper examines the effect of CPA on PWIDs' MCSUB. Methodology: Cross-sectional data were collected from 350 PWID recruited from syringe service programs in rural Appalachian Kentucky (2018-2021). We used hierarchical multivariable linear regression to assess the association between CPA and MCSUB, controlling for socio-ecologic covariates including socio-demographics, mental health disorders (MHD), substance use stigma (SUS), violence experiences (VE), and substance use treatment utilization (SUTU). Key findings: A majority of participants (68.0%) reported high MCSUB, yet only 34.4% reported past-year SUTU, revealing a significant "motivation-treatment gap." In the final model, stronger CPA was significantly associated with higher MCSUB ( Conclusion: Fulfilling the need to belong through community place attachment may be a key social asset that enhances internal motivation for recovery among PWID. However, this motivation is often insufficient to overcome barriers presented by co-occurring MHD and trauma. Findings underscore the importance of asset-based approaches that strengthen community place attachment/ identity or belongingness. Integrating care for substance use disorders, mental health disorders, and trauma-informed care in tailored interventions and policies for PWID may further enhance motivation to change substance use behavior and support translation of motivation into action.
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