Need for Substance Use Disorder Prevention, Treatment, and Recovery Programs in Rural Communities

Research indicates that fatal drug overdose rates have been rising across the U.S. Rural areas have lower access to treatment for substance use disorders (SUDs) despite high need. Additionally, the COVID-19 pandemic exacerbated drug use and overdose risks in rural communities, with substances like fentanyl playing a significant role.

This section provides an overview of key considerations related to the need for SUD programs in rural areas. For additional information, see the Substance Use and Misuse in Rural Areas topic guide.

Alcohol, Methamphetamine, and Opioid Use Disorders in Rural Communities

Rural communities experience disproportionately high rates of heavy alcohol use among youth and adults, with alcohol-induced deaths rising at a faster pace compared to urban areas. Alcohol is frequently used in combination with other substances which increases the risk of overdose and other life-threatening outcomes. Additionally, alcohol use disorder often co-occurs with other mental health conditions such as depression, anxiety, trauma, and stress-related disorders, making treatment and recovery efforts increasingly complex.

Methamphetamine use is higher among adults in rural areas than in urban regions, with individuals in nonmetropolitan areas facing unique risks. While domestic methamphetamine production has significantly declined since its peak in the early 2000s, cheaper and more potent sources from outside of the U.S. are contributing to a resurgence of use in rural areas. Overdose risks are especially high among individuals who use both methamphetamine and opioids, highlighting the complex and interconnected nature of SUDs.

The opioid epidemic has had a profound impact across the U.S., with rural areas experiencing unique challenges. Rural communities have seen significant increases in opioid-related hospitalizations and emergency department visits over time, though there have been some improvements in recent years. Overdose rates involving natural and semisynthetic opioids remain high in rural regions, exceeding those in urban areas. The prevalence of illicit synthetic opioids, such as fentanyl, has further exacerbated the crisis, contributing to elevated overdose rates instates with large rural populations, such as West Virginia and Maine.

Intersection between Mental Health, Suicide Risk, and Substance Use in Rural Communities

Mental health challenges, such as depression, anxiety, and trauma, are linked to SUDs. Outcomes from these co-occurring disorders disproportionately impact rural areas. Other environmental factors, such as lack of housing or employment, can further exacerbate co-occurring disorders. These unaddressed challenges can increase the risk of suicide in rural communities.

Meeting the needs of rural residents with these interconnected conditions requires an integrated approach to mental health services, suicide prevention, and substance use treatment. For more information about mental health and suicide in rural communities, see the Mental Health in Rural Communities Toolkit and the Rural Suicide Prevention Toolkit.

Economic Impacts of Substance Use Disorders in Rural Communities

SUDs place economic pressure on rural communities, driving up healthcare costs and disrupting local economies. Frequent emergency care visits, hospitalizations, and reduced workforce participation strain rural systems already susceptible to economic challenges. Economic impact can be seen through the loss of workforce participation, as many individuals affected by SUDs are of working age. This can lead to challenges like absenteeism, reduced productivity, and recruitment difficulties for local businesses. For rural regions, where economic resources may already be stretched thin, these impacts can create additional barriers to growth and recovery.

Resources to Learn More

Appalachian Overdose Mapping Tool
Map/Mapping system
Combines social, demographic, and economic data with county drug overdose death rates in a data visualization tool for rural Appalachia. Provides communities with information to identify key areas for discussion, prevention, and intervention.
Organization(s): NORC at the University of Chicago, Appalachian Regional Commission

Drug Overdose Deaths in the United States
Map/Mapping System
Helps leaders, researchers, and policymakers assess effective actions for addressing the opioid crisis at the local level. Overlays substance misuse data against socioeconomic, census, and other public information.
Organization(s): NORC at the University of Chicago

Trends in the Rate of Opioid-Related Hospitalizations
Document
Offers national demographic trends, including breakdowns by sex, income, patient location, and age.
Organization(s): Agency for Healthcare Research and Quality
Date: 5/2019