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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 (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 providers.
  • 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 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 SUDs who are seeking treatment and recovery support services.
  • Insufficient 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
Document
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
Date: 1/2012

Barriers to Substance Abuse Treatment in Rural and Urban Communities: A Counselor Perspective
Document
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
Date: 6/2014

Distribution of Substance Abuse Treatment Facilities Across the Rural-Urban Continuum
Document
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
Date: 10/2007

The Role of Rural Hospitals in Addressing Substance Use Problems
Video/Multimedia
Discusses the driving factors for substance use and misuse in rural areas and 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

Preventing Substance Misuse in Rural Settings
Document
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