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Rural Health Information Hub
Rural Health Information Hub

Factors that Contribute to Substance Use Disorders in Rural Communities

Historically, U.S. drug policy focused on enforcement, leading to high incarceration rates for drug offenses. In recent years, federal policy has begun to emphasize prevention and treatment, recognizing the biological, psychological, and social factors underlying substance use disorders (SUDs). For example, the U.S. Department of Health and Human Services' Overdose Prevention Strategy promotes the full continuum of SUD care, including prevention, treatment, and recovery, and suggests shifting from criminalizing substance misuse to addressing it as a public health issue. A health-focused approach acknowledges the individual, social, and structural factors that contribute to preventing and treating SUDs in rural communities.

Individual Factors

These factors focus on personal challenges and characteristics that may influence an individual's ability to engage with and benefit from SUD treatment and recovery:

  • Motivation for change. An individual's motivation for change can significantly impact their willingness to engage and succeed in SUD treatment. Some individuals may struggle with readiness for behavior change or motivation to begin SUD treatment, even when referred by a healthcare provider.
  • Financial constraints. Individuals with SUD may be uninsured, underinsured, or face high out-of-pocket costs for treatment, which may lead to financial strain or interruptions in treatment.
  • Biological predisposition. Genetic and neurological factors can affect an individual's risk of developing SUD.
  • Health-related issues. Co-occurring physical and mental health conditions can pose additional barriers to receiving and adhering to treatment.

Social Factors

These factors address interpersonal, societal, and community influences that shape access to resources and support for SUD treatment in rural areas:

  • Stigma and confidentiality concerns. The historical classification of substance use as a crime contributes to stigma surrounding SUDs, which may deter individuals from seeking treatment and social support services. Social stigma and lack of anonymity in small communities exacerbate these challenges.
  • Support networks. Receiving support from friends, family, and peers can be critical to effective treatment and recovery from SUDs.

Structural Factors

These factors highlight the institutional barriers that impact the availability and accessibility of SUD prevention, treatment, and recovery services in rural communities:

  • Complicated systems of care. Fragmented and complex systems for SUD treatment, ranging from counseling to medication and case management, can overwhelm both providers and patients in rural areas with limited support.
  • Lack of interagency coordination and communication. Effective SUD treatment often requires multiple services and coordination between agencies, which can be challenging in rural areas where facilities and providers are limited and often located far apart.
  • Limited resources and personnel. Rural areas frequently have limited resources for SUD prevention and treatment programs. This includes fewer providers overall, limited educational materials, and fewer opportunities for continuing training. Law enforcement personnel and prevention programs may also be spread over large geographic areas.
  • Availability of mental health services. Rural counties often have fewer mental health providers and treatment facilities as well as limited case management services. This shortage can lead to longer wait times for those seeking SUD treatment and recovery support services.
  • Insufficient hospital capacity. Rural hospitals not adjacent to urban areas typically have fewer inpatient and residential beds, making it difficult to serve the large geographic areas they cover.
  • Transportation access. Inadequate or nonexistent rural public transportation systems make it difficult for rural residents to access treatment facilities. Rural residents may also need to travel long distances to access care.
  • Homelessness and substandard housing. Those struggling to meet basic needs, such as secure housing, may find it hard to prioritize SUD treatment.
  • Poverty and unemployment. Due to high rates of poverty and unemployment in rural areas, limited financial resources and economic instability can hinder SUD treatment.
  • Fear of legal repercussions. Individuals may fear legal consequences if their substance use is discovered, which can deter them from seeking treatment. This concern is pronounced in areas where substance use is heavily criminalized, and individuals may worry about potential arrest or involvement in the criminal justice system.

Opportunities for Progress

Rural communities also have opportunities to improve access to prevention, treatment, and recovery for SUDs. New models, such as mobile clinics and telehealth, are expanding access to mental health and SUD services in remote areas. Co-locating behavioral health and primary care services has also shown promise, providing more integrated care. Additionally, strong community engagement and social support networks often present in rural areas can serve as powerful facilitators for recovery and prevention efforts.

Resources to Learn More

Comprehensive Case Management for Substance Use Disorder Treatment
Document
Provides an overview and guidance on case management and care coordination for SUD treatment.
Organization(s): Substance Abuse and Mental Health Services Administration
Date: 2021

Rural Community Action Guide
Document
Reports on the challenges faced by rural communities addressing opioid misuse and illicit drug use, and offers strategies for mitigating the impact of SUDs in rural communities.
Organization(s): U.S. Department of Agriculture
Date: 1/2020