Community place attachment as a significant correlate of motivation to change substance use behavior among adults who inject drugs in rural U.S

Front Public Health. 2026 Mar 25;14:1746203. doi: 10.3389/fpubh.2026.1746203. eCollection 2026.

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 (β = 0.155, p = 0.009).

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.

PMID:41960400 | PMC:PMC13057335 | DOI:10.3389/fpubh.2026.1746203