Research Alert: September 4, 2026

Non-Metropolitan vs. Metropolitan Variations in Alcohol, Illicit Drug, and Prescription Therapeutic Drug Misuse

This report uses 2023 and 2024 National Survey on Drug Use and Health data to provide contemporary prevalence rates for alcohol use, illicit drug use, and prescription psychotherapeutic drug misuse among metropolitan (metro) and non-metropolitan (non-metro) residents nationally.

Key Findings:

• Alcohol Use. The prevalence of past year and past 30-day drinking was lower among non-metro than metro residents. However, non-metro drinkers engaged in more frequent binge drinking than metro drinkers. Drinking 3-5, 6-19, and 20-30 days over the past 30 days were higher among non-metro than metro residents.
• Illicit Drug Use. Hallucinogens were the mostly commonly used illicit drugs among non-metro as well as metro residents. Methamphetamine use was significantly higher among non-metro than metro residents.
• Prescription Pain Reliever Use. The misuse of prescription pain killers, primarily prescription opioids, was higher among non-metro than metro residents.

Additional Resources of Interest:

• More FORHP-funded research on Mental and behavioral health, Substance use and treatment
• More information about the Rural and Underserved Health Research Center
• More information from the Rural Health Information Hub's topic guide: Substance Use and Misuse