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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. These barriers may include:

  • Complicated system of care to treat substance use disorders: Providers and patients alike may find it difficult to navigate the complex treatment system for substance use disorders, 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 use disorders 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 use disorders 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 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 use disorders who are seeking treatment and recovery support services.
  • Insufficient capacity in hospitals to treat substance use disorders: 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 substance use disorders 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 use disorder.
  • Patient refusal of treatment: Individuals may refuse to engage in treatment for a substance use disorder 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: Rural residents seeking treatment for substance use disorders 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 disorder as a criminal behavior: Historically, substance misuse 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 use disorder and seek treatment.

Resources to Learn More

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

Barriers to Substance Abuse Treatment in Rural and Urban Communities: A Counselor Perspective
This study documents some of the barriers to accessing treatment for substance abuse in both 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
Date: 6/2014

Distribution of Substance Abuse Treatment Facilities Across the Rural-Urban Continuum
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

The Role of Rural Hospitals in Addressing Substance Use Problems
This webinar, featuring speaker John Gale, MS, from the University of Southern Maine’s Rural Health Research Center, discusses drivers for substance use and misuse in rural areas. It also outlines how rural hospitals can implement community-level solutions to address substance use prevention and treatment as part of their community benefit portfolio.
Organization(s): National Rural Health Resource Center
Date: 1/2018