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Barriers to Preventing and Treating Substance Abuse in Rural Communities

Rural communities face barriers to developing programs that prevent and treat substance abuse. These barriers may include:

  • Complicated system of care to treat substance abuse: Providers and patients alike may find it difficult to navigate the complex substance abuse treatment system, which consists of individual and group counseling, inpatient and outpatient treatment, case management, and medication as well as additional services and programs. Difficulty navigating this complex system can lead to delays in treatment, especially in rural areas where there is a shortage of providers.
  • Lack of interagency coordination and communication: While effective treatment for substance abuse requires multiple treatment services, linkage to these services and coordination between agencies can be difficult in rural areas where there is a shortage of facilities and providers who serve large geographic areas and are located far away from one another.
  • Limited resources and personnel: Limited resources for substance abuse prevention and treatment programs means there are fewer providers and a lack of resources, educational materials, and continuing training on substance abuse for providers. Furthermore, law enforcement personnel and prevention programs are distributed over wide geographic areas.
  • Lack of mental health services: States with large rural populations have fewer mental health providers and treatment facilities and a lack of case management services. Fewer providers may mean longer wait times for people with substance abuse issues who are seeking treatment and recovery support services.
  • Insufficient capacity in hospitals to treat substance abuse: Rural hospitals not adjacent to urban areas typically have fewer inpatient and residential beds compared to urban areas and areas adjacent to cities. Facilities serve larger areas, and these facilities have fewer substance abuse treatment services compared to urban areas.
  • Transportation barriers: Inadequate or nonexistent rural public transportation systems exacerbate the issue of insufficient treatment facilities by making it difficult for rural residents to reach them.
  • Homelessness and substandard housing: When individuals cannot meet basic needs such as housing, it is difficult for them to focus on treatment for a substance abuse.
  • Patient refusal of treatment: Individuals may refuse to engage in treatment for substance abuse even when they are referred by a primary care or other healthcare provider. Individuals may feel they are unready or refuse to engage in treatment for substance abuse.
  • Stigma and confidentiality concerns: Rural residents seeking treatment for substance abuse face stigma exacerbated by a lack of privacy in small communities where there are few mental health providers and a lack of anonymity.
  • Substance use as a criminal behavior: Historically, substance abuse has been viewed as a criminal behavior instead of a chronic disease. Fear of legal penalties for drug use may impact whether individuals are willing to openly discuss their substance abuse and seek treatment.

Resources to Learn More

“If Only Someone Had Told Me…”: Lessons from Rural Providers
Document
In this study, rural healthcare providers discuss challenges and lessons learned relating to practicing in rural communities, including confidentiality concerns relevant to treating substance abuse.
Author(s): Chipp, C., Dewane, S., Brems, C., Johnson, M., Warner, T., and Roberts, L.
Location: Journal of Rural Health, 27(1), 122-130.
Date: 1/2012

Barriers to Substance Abuse Treatment in Rural and Urban Communities: A Counselor Perspective
Document
This study documents some of the barriers discussed above to accessing treatment for substance abuse in both rural and urban areas, from the perspective of substance abuse treatment counselors.
Author(s): Pullen, E. and Oser, C.
Location: Substance Use and Misuse, 49(7), 891-901.
Date: 6/2014

Distribution of Substance Abuse Treatment Facilities Across the Rural-Urban Continuum
Document
An analysis of data from the National Survey of Substance Abuse Treatment Services to examine how substance abuse treatment services may vary between rural and urban areas. It found that rural areas largely had fewer facilities, services and inpatient/residential beds for substance abuse treatment.
Organization(s): Maine Rural Health Research Center
Date: 10/2007