Substance Use in Rural Communities and Small Towns

No matter where you live, you should know that help is available. With the proper treatment, you can overcome addiction and regain control of your life.

Risk Factors & Causes of Substance Use in Rural Communities

Risk factors and possible causes of substance use in rural communities include issues that can affect people who live anywhere, such as:²

• A lack of parental supervision.
• Initiating substance use at an early age.
• Easy access to drugs or alcohol.
• Poverty.

In addition, people who live in rural communities may face other risk factors, including:^1,3

• Low levels of education.
• Unemployment.
• Lack of access to mental health services.
• Social isolation.
• Increased likelihood of high-risk behaviors.

Statistics & Facts on Substance Use in Rural Communities

• Overdose rates in rural counties increased from 4.0 to 19.6 per 100,000 people between 1999 and 2019.⁴
• Per capita, the opioid overdose rate in rural communities is 45% higher than in cities.⁵
• Around 9.2% of people aged 12-20 living in rural areas binge-drink alcohol (5 or more drinks for males or 4 or more for females) in the past moth, compared to 8% of those living in big cities.¹
• 3.5% of people aged 12 and older in rural areas misuse opioids, compared to 3.1% in big cities.¹
• Young adults aged 18-25 who live in remote rural areas misuse methamphetamine at almost twice the rate as those who live in urban areas.⁶
• 9% of young adults living in rural communities misused prescription pain relievers in the past year, compared to 8% of those living in urban areas.⁶
• Around 14% of behavioral health treatment facilities in the U.S. are in rural communities, and less than half of these specialize in addiction treatment.⁵

Treatment Options & Rehab

Just because you suffer from addiction and live in a small rural community does not mean that you won’t have access to reputable rehabilitation services. Sometimes it is helpful for people who struggle with addiction in their small, rural communities to travel to a larger metropolitan area to receive help for their substance use disorder and other co-occurring mental health conditions. Rehab can help you stop the cycle of substance use and start the path to recovery. Your treatment options for substance use disorder (SUD) may include:⁷

• Detox. This type of treatment can help you safely and comfortably undergo withdrawal from your drug of choice and help you become medically stable and abstinent.
• Inpatient rehab. In inpatient treatment, you live at a treatment facility (such as a hospital or freestanding inpatient rehab) for the duration of your treatment at this level of care. Inpatient can be beneficial for some people, such as those with severe addictions or co-occurring mental health disorders, like depression.
• Outpatient treatment. You live at home but travel to a treatment facility. Treatment can occur on a variety of intensity levels depending on the program and your needs.

Treatment can look somewhat different depending on the substance you use. You may receive different behavioral therapies, such as cognitive-behavioral therapy or contingency management, to promote changes to thoughts and behaviors that contribute to substance use.⁸ You may also receive medication-assisted treatment (MAT), which means medication in combination with behavioral therapies.⁹

Barriers to Finding Treatment in Rural Communities

Certain barriers may hinder or prevent people in rural communities from seeking or receiving treatment, but many of these can be overcome. Barriers may include: ^5,11

• Fewer treatment facilities. Research shows that rural communities have fewer treatment facilities; if they are available, people may end up on waiting lists at those facilities, which may discourage them from entering treatment.
• Transportation difficulties. Rural communities generally have fewer public transportation options, and treatment centers can be miles away or in other counties. The rising cost of fuel and unreliable automobiles can further compound the problem. Despite these challenges, traveling to a rehab center or going out of state shouldn’t prevent you from seeking help when your health and wellbeing are at stake.
• The cost of treatment. Many rural communities face poverty, and it can be difficult to pay for treatment out-of-pocket if you don’t have insurance or stable employment, although options do exist that can help you meet the cost of treatment.