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Rural Health Information Hub

Factors that Contribute to Substance Use Disorder in Rural Communities

Multiple factors contribute to the high burden of substance misuse and substance use disorder (SUD) in rural communities, including:

  • High rates of poverty and unemployment – According to the USDA Economic Research Service, the overall rate of poverty is significantly higher in rural areas compared to urban areas, and employment and educational attainment rates are lower than in urban areas. Poverty and unemployment have shown to be associated with drug use. Research by the University of New Hampshire documented that people are selling illegal substances to pay bills and other expenses.
  • Increased availability of prescription opioids – Research indicates that states with large rural populations also have some of the highest rates of opioid prescription. Prescription opioids have historically been prescribed to maintain productivity in heavy labor industries like mining.
  • Barriers to treatment – Rural communities have fewer treatment facilities, mental health providers, and detoxification services. People who live in rural communities may experience longer travel distances to available facilities. These barriers prevent individuals from accessing treatment for SUDs. In addition, negative attitudes about SUDs, including the belief that SUDs are a moral failing, may prevent individuals from seeking needed treatment, even when it is available. This is particularly a problem in small rural communities with few mental health and/or healthcare providers where there is less privacy for those seeking treatment for SUDs.

Resources to Learn More

An Analysis of Mental Health and Substance Use Disparities and Access to Treatment Services in the Appalachian Region
Analyzes disparities in mental health status, the prevalence of substance use disorders (SUDs), and accessibility of treatment services in the Appalachian region. Includes quantitative data and case studies in the analysis.
Author(s): Zhang, Z., Infante, A., Meit, M., et al.
Organization(s): NORC at the University of Chicago, East Tennessee State University, Appalachian Regional Commission
Date: 8/2008

Opioid Use Disorder: Challenges and Opportunities in Rural Communities
Describes the disproportionate impact of the opioid crisis on rural areas. Discusses issues related to rural treatment capacity and offers potential solutions to address the rural treatment gap.
Organization(s): Pew Charitable Trusts
Date: 2/2019

Rural Communities in Crisis: Strategies to Address the Opioid Crisis
Discusses factors contributing to the opioid epidemic in rural areas and suggests policy strategies to help rural communities address the opioid crisis.
Organization(s): National Rural Health Association
Date: 4/2016