National Study of Substance Abuse Prevalence and Treatment Services in Rural Areas

Research center:
Lead researcher:
Project funded:
September 2004
Project completed:
January 2008
Health disparities, Health services, Rural statistics and demographics, Substance abuse
Substance abuse is a major and growing threat to the health and well-being of rural individuals, their families, and their communities. It frequently co-occurs with mental and/or physical health problems and is detrimental to effective school, job, and parenting performance and highly correlated with anti-social and criminal behavior. These problems may be more pervasive in rural areas given that higher rates of substance abuse are associated with higher levels of poverty and unemployment and lower levels of income. Substance abuse strains rural service systems which are often overextended and under-resourced relative to urban systems. The ability to organize effective substance abuse delivery systems in rural communities is hampered by limited supplies of specialized providers and services, low population densities, and long travel distances for rural persons to obtain care.

Given the apparent disparity between need and the availability of services in rural areas, this project is exploring these issues through the use of two national surveys sponsored by the Substance Abuse and Mental Health Services Administration. The National Survey on Drug Use and Health was used to examine the prevalence of the use of different substances across rural areas, demographic groups, and regions of the country. The National Survey of Substance Abuse Treatments Services was used to document the distribution of substance abuse treatment services across rural areas and geographic regions and to describe the extent to which rural substance abuse treatment providers are offering a comprehensive array of services as well as services targeted to the needs of special populations.

Presentations to regional and national audiences on this topic as well as a rural substance abuse briefing paper will be prepared identifying national and regional issues for future rural substance abuse research and policy. A journal article will also be submitted to a peer-reviewed publication.


  • Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum
    Date: 10/2007
    Considering recent growth in substance abuse among rural populations and the documented scarcity of rural health resources, this study examines the distribution of substance abuse treatment services across the continuum of rural and urban counties, identifying the type and intensity of services provided. Using the 2004 National Survey of Substance Abuse Treatment Services linked to the 2003 Rural-Urban Continuum Codes, we found few substance abuse treatment facilities operating outside of urban and rural adjacent areas and limited availability of intensive services across rural areas. This situation is particularly striking for opioid treatment programs, which are nearly absent in rural areas. The narrow range of services available in rural areas may preclude an individualized treatment approach and long-term follow-up recommended by professional organizations and other experts. The greater proportion of rural-based facilities accepting public payers and providing discounted care may reflect higher rates of uninsurance and underinsurance.
  • Distribution of Substance Abuse Treatment Facilities Across the Rural - Urban Continuum (Research & Policy Brief No. 35B)
    Date: 02/2008
    This Research & Policy Brief highlights findings from a recent study examining the distribution of substance abuse treatment facilities in rural and urban counties and identifying the type and intensity of services provided. Key findings include:
    • Access to substance abuse treatment is limited in rural areas by fewer treatment beds.
    • Less populated rural areas contain a small proportion of facilities offering a range of core services and varying levels of outpatient and intensive services.
    • Opioid treatment programs are nearly absent in rural areas.
  • Substance Abuse Among Rural Youth: A Little Meth and a Lot of Booze
    Date: 06/2007
    Research and policy brief examining substance abuse among rural youth, with rural-urban comparisons methamphetamine, oxycontin, and alcohol abuse.