Barriers to Preventing and Treating Substance Use Disorders in Rural Communities
Rural communities face barriers to developing programs that prevent and treat substance use disorders
(SUDs). These barriers may include:
A complicated system of care to treat SUDs. Providers and patients alike may find it
difficult to navigate the complex treatment system for SUDs,
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
Lack of interagency coordination and communication. While effective treatment
for SUDs 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 SUD prevention and
treatment programs means there are fewer providers overall, and for existing providers, there is a
lack of resources, educational materials, and continuing training. Further, law enforcement
personnel and prevention programs are distributed over wide
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 SUDs who are seeking treatment and
recovery support services.
capacity in hospitals to treat SUDs. Rural hospitals not adjacent
to urban areas typically have fewer inpatient and residential beds compared to urban areas and
areas adjacent to cities. Rural facilities serve larger areas, and these facilities have fewer
treatment services for SUDs 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. Individuals who cannot meet basic needs such as housing may face difficulties
with focus on treatment for an SUD.
Motivation for change. Many individuals face difficulties with initiating and maintaining
behavior change. Individuals may not have the motivation
to begin SUD treatment, 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. Treatment programs may need to
address an individual's readiness
to change their behavior.
Stigma and confidentiality concerns. The historical classification of substance
use as a crime has led to stigma surrounding substance misuse. Stigma is a barrier to recovery
and affects whether individuals with SUD seek treatment and social support services. Fear of
legal penalties for drug use may impact whether individuals are willing to openly discuss their
SUD and seek treatment. Stigma surrounding SUD may be exacerbated for rural residents seeking
treatment for SUD because of a lack of
anonymity in small communities where there are few mental health providers.
Resources to Learn More
"If Only Someone Had Told Me...":
Lessons from Rural Providers
Presents the findings from a qualitative study of rural healthcare providers discussing challenges
and lessons learned related to practicing in rural communities. Discusses concerns relevant to
treating substance use disorders.
Author(s): Chipp, C., Dewane, S., Brems, C., et al.
Citation: Journal of Rural Health, 27(1), 122-130
Barriers to Substance Abuse Treatment
in Rural and Urban Communities: A Counselor Perspective
Examines the barriers to accessing treatment for substance abuse in rural and urban areas from the
perspective of substance abuse treatment counselors.
Author(s): Pullen, E. & Oser, C.
Citation: Substance Use and Misuse, 49(7), 891-901
Distribution of Substance Abuse
Treatment Facilities Across the Rural-Urban Continuum
Examines how substance abuse treatment services may vary between rural and urban areas by analyzing
data from the National Survey of Substance Abuse Treatment Services. Discusses how rural areas often
have fewer facilities, services, and inpatient/residential beds for substance abuse treatment.
Organization(s): Maine Rural Health Research Center
Substance Misuse in Rural Settings
Outlines rural-specific challenges to addressing substance use and includes information about how to
leverage rural assets to help prevent substance use.
Organization(s): Education Development Center