Exploring Substance Use Disorder Treatment in Rural Communities: Access, Utilization, and Perceived Barriers

Substance misuse and substance use disorders (SUDs) remain pressing concerns in rural communities across the United States. In 2023, more than half of rural residents aged 12 and older reported alcohol use in the past year, while over one-fifth reported using other illicit drugs. The prevalence of SUD as defined by DSM-5 in rural areas was 15.6%, slightly less than urban regions, but both populations misuse substances at similar rates. However, rural Americans confront added challenges such as elevated opioid prescription rates, lower income and education levels, and reduced likelihood of having health insurance, which can worsen the impact of substance use. Notably, drug overdose deaths are rising faster in rural areas than in urban areas.

One significant issue is the underutilization of SUD treatment. Only about 6% of rural residents reported receiving treatment in the past year, approximately half the rate for urban areas. Various obstacles hinder rural treatment access, including limited facility availability, higher thresholds for seeking care, and prevalent beliefs about treatment ineffectiveness. These practical and perceptual barriers contribute to the complexity of rural-urban differences in behavioral health treatment and highlight the importance of adopting a social-ecological approach to address these disparities.

Previous research has explored various aspects of rural SUD, including treatment duration, perceived needs, prevalence, and opioid-specific strategies. These studies, however, were often restricted by dated data or limited geographical scope. Since then, developments such as expanded telehealth options, evolving Medicaid policies, and intensified efforts in the opioid crisis have reshaped the treatment landscape, underscoring the need for up-to-date, nationally representative research.

The federal government has initiated policies to expand rural SUD treatment, such as the 2017 SUPPORT Act and increased telehealth access during COVID-19. At both federal and state levels, efforts continue to prioritize evidence-based care, reduce overdose deaths, and address persistent rural health challenges. For policymakers, understanding key social-ecological factors such as the perceived need for treatment, beliefs about its effectiveness, insurance status, and co-occurring mental health issues is critical to closing the rural treatment gap. This project aims to provide actionable insights into rural-urban differences in SUD care and perceived barriers, equipping stakeholders with knowledge to inform policies, target funding, and design tailored interventions. These findings will support more effective, sustainable solutions to improve behavioral health for rural Americans and foster progress toward HRSA's rural treatment goals.