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Substance Abuse in Rural Areas Models and Innovations

These stories feature model programs and successful rural projects that can serve as a source of ideas and provide lessons others have learned. Some of the projects or programs may no longer be active. Read about the criteria and evidence-base for programs included.

Evidence-Based Examples

Helping Kids PROSPER
Updated/reviewed January 2017
  • Need: An approach to support sustained, quality delivery of evidence-based programs for youth and families in rural communities.
  • Intervention: PROSPER, a program delivery system, guides communities in implementing evidence-based programs that build youth competencies, improve family functioning, and prevent risky behaviors, particularly substance use.
  • Results: Youth in PROSPER communities reported delayed initiation of a variety of substances, lower levels of other behavioral problems, and improvements in family functioning and other life skills.

Effective Examples

funded by the Federal Office of Rural Health Policy Madison Outreach and Services through Telehealth (MOST) Network
Updated/reviewed November 2017
  • Need: More mental health and substance abuse prevention and treatment services in rural Texas.
  • Intervention: A network was formed to bring counseling services through telehealth systems and community health workers to Brazos Valley, Texas.
  • Results: The program improved health outcomes, increased general knowledge of the impact of substance abuse, and raised awareness of services among Hispanic residents.
Strong African American Families-Teen (SAAF-T)
Updated/reviewed April 2017
  • Need: There is a lack of interventions that addresses teenager behavioral problems, particularly for rural African American adolescents.
  • Intervention: Rural, locally trained leaders administered five 2-hour meetings for teenagers and their primary caregivers. Trainings focused on reducing risks that prevent positive development, specifically sexual risk-taking that can lead to HIV and other STIs.
  • Results: Teens reported reduced conduct problems, depressive symptoms, and substance abuse. Families were strengthened, and SAAF-T reduced unprotected intercourse and increased condom efficacy.
keepin’ it REAL Rural
Updated/reviewed March 2017
  • Need: A drug and alcohol prevention program for middle school kids that is specific to rural culture in Pennsylvania and Ohio.
  • Intervention: An adaptation of the evidence-based keepin' it REAL curriculum was customized for rural middle school students.
  • Results: Students showed a reduction in all substance use and less personal acceptability of substance use.
Midcoast Maine Prescription Opioid Reduction Program
Updated/reviewed March 2017
  • Need: Reduction in the number of emergency department dental patients abusing opioid prescriptions in rural southeastern Maine.
  • Intervention: Using a one-page opioid prescription guideline, opioid prescribing and emergency room visits for dental pain decreased.
  • Results: The rate of opioid prescription dropped nearly 20% after implementation, and in comparing the 12-month period before and after implementation, dental pain emergency department visits decreased from 26 to 21 per 1,000.
Project Lazarus
Added December 2015
  • Need: To reduce overdose-related deaths among prescription opioid users in rural Wilkes County, North Carolina
  • Intervention: Education and tools are provided for prescribers, patients and community members to lessen drug supply and demand, and to reduce harm in prescription opioid use
  • Results: Opioid overdose death rates have decreased in Wilkes County

Promising Examples

funded by the Federal Office of Rural Health Policy Northern Dental Access Center Patient Support and Outreach Program
Updated/reviewed October 2017
  • Need: To connect low-income people in rural northwest Minnesota to dental care and support services in order to address barriers to care.
  • Intervention: Partners work together to provide patient transportation, care coordination, and insurance navigation and enrollment.
  • Results: Patients accessing support services are more likely to complete dental treatment. Over 1,000 people a year have been assisted with Medicaid enrollment, and reported use of the emergency department for dental pain has been reduced.
funded by the Federal Office of Rural Health Policy Nurse Navigator and Recovery Specialist Outreach Program
Updated/reviewed October 2017
  • Need: To properly address and treat patients who have concurrent substance abuse and chronic healthcare issues.
  • Intervention: A referral system was created that utilizes Community Health Workers (CHWs) in a drug and alcohol treatment setting.
  • Results: This program has reduced hospital emergency visits and hospital readmissions for patients since its inception.
Integrated Chronic Pain Treatment and Training Project
Added August 2017
  • Need: To reduce prescription opioid misuse and overdoses in North Carolina.
  • Intervention: The ICPTTP standardizes and streamlines chronic pain management in primary care clinics.
  • Results: The ICPTTP has reduced patients' average daily morphine equivalent dose, and 25% of program participants have stopped taking opioids altogether.
Communities that Care (CTC) Coalition
Updated/reviewed May 2017
  • Need: A way to address substance abuse among teenagers in Massachusetts's predominately rural areas of Franklin County and the North Quabbin Region.
  • Intervention: A community-based prevention initiative was formed to reduce youth violence, delinquency, and alcohol and tobacco use.
  • Results: CTC has seen significant reductions in substance abuse among local youth in the 30 rural towns they serve.
funded by the Federal Office of Rural Health Policy Healthy Outcomes Integration Team
Updated/reviewed November 2016
  • Need: To provide integrated treatment planning and coordinated healthcare services to rural residents.
  • Intervention: This program was designed to treat adults who have a serious mental health condition and those who have, or are at risk of developing, chronic health conditions.
  • Results: Thus far, 84 clients have received integrated health and mental health services.
funded by the Federal Office of Rural Health Policy Cross-Walk: Integrating Behavioral Health and Primary Care
Updated/reviewed October 2016
  • Need: To address and treat substance abuse and depression in the Upper Great Lakes region.
  • Intervention: Cross-Walk, a program that integrates behavioral healthcare into primary care services, was developed in Michigan's Marquette County.
  • Results: The collaborative efforts strengthened care management services in local healthcare facilities as 344 patients were referred to a behavioral health specialist.
funded by the Federal Office of Rural Health Policy 4P's Plus Pregnancy Support Project
Added September 2015
  • Need: To provide pregnancy support services to Native American women who struggle with substance use.
  • Intervention: An integrated behavioral health network was implemented in Lake County, California.
  • Results: As a result of this project, fewer Native American babies were exposed to alcohol, tobacco, and other drugs.

Other Project Examples

Gloucester ANGEL Program
Updated/reviewed August 2017
  • Need: To address opioid addiction as a disease rather than a crime in rural Massachusetts.
  • Intervention: The Gloucester Police Department initiated an opioid outreach program to help facilitate treatment for people suffering from addiction.
  • Results: The ANGEL program has referred over 400 people to treatment facilities, reduced the cost of overnight incarcerations, and has developed a new bond with the community in the fight against opioid abuse.
Isanti County SafeCab Program
Updated/reviewed August 2017
  • Need: To reduce the number of deaths and injuries caused by drunk driving in Isanti County.
  • Intervention: The SafeCab program provides alternative transportation home for bar patrons who would otherwise drive impaired.
  • Results: The program is credited with a significant decrease in DUI (Driving Under the Influence) arrests and the lower average corresponding BAC (Blood Alcohol Content) levels in Isanti County.
funded by the Federal Office of Rural Health Policy MIST: Mothers and Infants Sober Together
Updated/reviewed August 2017
  • Need: To address the needs of pregnant women who are using substances and infants born into drug-positive families.
  • Intervention: The Mothers and Infants Sober Together (MIST) program assisted mothers who used substances get treatment and provide a safe, drug-free home for themselves and their newborn.
  • Results: MIST has helped mothers find treatment and education and has helped children grow up in safe and healthy homes.
Morrison County Accountable Community for Health
Added August 2017
  • Need: To combat prescription drug misuse in rural Morrison County, Minnesota.
  • Intervention: The Morrison County ACH brings together primary care, social services, law enforcement, and other partners to make sure that patients receive treatment and support.
  • Results: One pharmacy saw a 20% reduction in the number of prescribed opioids, and the ACH was able to taper 127 patients off opioids completely.
Spit It Out-West Virginia
Updated/reviewed August 2017
  • Need: McDowell County, West Virginia, had high rates of tobacco use.
  • Intervention: The Spit It Out-West Virginia program (2008-2010) was created to increase access to tobacco cessation and prevention resources.
  • Results: Hundreds of people were provided with tobacco cessation efforts, 5 workplaces became tobacco free, and tobacco control efforts continue today.
Staggered Sentencing for Repeat Drunk Driving Offenders
Updated/reviewed August 2017
  • Need: To reduce the incidences of repeat drunk driving.
  • Intervention: Repeat DWI (driving while intoxicated) offenders were given a staggered sentence, allowing them to serve their sentence in segments of time, typically separated by several months to a year. The offender was able to file a motion to request a waiver for the remaining sentence period(s), if able to show that he/she maintained sobriety.
  • Results: The incidence of recidivism, or crime relapse, has been reduced among offenders given staggered sentences, by comparison to offenders given traditional DWI sentences. The program has also reduced the average cost of jail time that otherwise would have been served from a full sentence.
Contingency Management Smoking Cessation in Appalachia
Updated/reviewed July 2017
  • Need: To reduce smoking rates of pregnant women and adolescents in Appalachian regions of Eastern Kentucky and Ohio.
  • Intervention: A web-based smoking cessation program that offered monetary incentives to reducing smoking.
  • Results: Participants significantly reduced smoking rates or quit altogether.
funded by the Federal Office of Rural Health Policy MaineGeneral Harm Reduction Program
Added July 2017
  • Need: To reduce deaths from opioid overdoses in rural Maine.
  • Intervention: The MaineGeneral Harm Reduction Program provides community education and training for healthcare staff and first responders in rural Kennebec and Somerset counties.
  • Results: During the grant period, MaineGeneral trained 45 deputies and 246 healthcare staff and educated 60 community members.
funded by the Federal Office of Rural Health Policy Project Renew
Added July 2017
  • Need: To reduce deaths due to opioid overdose in rural southeast West Virginia.
  • Intervention: Project Renew trains and certifies first responders, healthcare staff, and laypeople in naloxone administration.
  • Results: Project Renew has saved 10 lives since its inception.
Project VISION
Updated/reviewed July 2017
  • Need: To reduce opioid use and increase quality of life in Rutland, Vermont.
  • Intervention: Project VISION works to reduce opioid use through community engagement.
  • Results: Since 2012, Project VISION has collected and disposed of 550 pounds of unused medications and reduced burglaries by 58%.
funded by the Federal Office of Rural Health Policy SLV N.E.E.D.: Naloxone Education Empowerment Distribution Program
Updated/reviewed July 2017
  • Need: Growing concern in rural Colorado communities regarding prescription and illegal opioid overdoses.
  • Intervention: Education efforts for health workers and the larger community, in addition to establishing a naloxone overdose reversal drug program.
  • Results: Nearly all first responders are now trained to administer naloxone, participating pharmacies keep adequate naloxone stock, and ongoing service region dialogue to address opioid abuse.
funded by the Federal Office of Rural Health Policy ASPIN Network: Community Health Worker Program
Updated/reviewed June 2017
  • Need: Improved approach in addressing the behavioral health and primary care disparities of Indiana’s underserved rural counties by increasing access through health insurance enrollment and providing health literacy education.
  • Intervention: A network was established to address behavioral health integration, which included the use of dually trained community health workers (CHW) and certified health insurance enrollment navigators.
  • Results: Creation of a certification process, the “Indiana Integrated Care Training Program: Community Health Worker/Certified Recovery Specialist,” for CHWs and cross-training of mental health peers to also work as CHWs
The Dawn Center Intensive Outpatient Program
Updated/reviewed June 2017
  • Need: To treat substance addiction in rural South Carolina avoiding expensive inpatient facilities, including a treatment aim of keeping patients in their home communities.
  • Intervention: The Dawn Center offers an outpatient program for patients with substance abuse and addiction.
  • Results: Patients can receive counseling and treatment closer to home while becoming a part of the local recovery community.
Pathways Vermont Housing First Program
Updated/reviewed February 2017
  • Need: To provide housing for the chronically homeless who face mental health and/or substance abuse challenges in the rural areas of Vermont.
  • Intervention: Pathways Vermont initiated a rural version of the Housing First program that provides access to permanent rental housing and numerous services to help sustain housing stability.
  • Results: Participants reported decreased time spent homeless, a significant improvement in their standard of living, and hundreds of thousands of dollars were saved on behalf of Vermont.
funded by the Federal Office of Rural Health Policy Addiction Recovery Mobile Outreach Team (ARMOT)
Added December 2016
  • Need: To reduce the number of overdoses and overdose-related deaths from opioids in rural Pennsylvania.
  • Intervention: ARMOT provides 1) case management and recovery support services to individuals with substance use disorders and 2) education and support to rural hospital staff, patients, and their loved ones.
  • Results: In the first 18 months of its grant cycle, ARMOT made 254 referrals.
funded by the Federal Office of Rural Health Policy Nevada Rural Opioid Overdose Reversal (NROOR)
Added November 2016
  • Need: To reduce the number of overdoses and deaths related to opioid overdose in rural Nevada.
  • Intervention: The Nevada Rural Opioid Overdose Reversal (NROOR) Program, led by a Critical Access Hospital (CAH), furnishes naloxone and provides education on prescription opioid use and overdose.
  • Results: EMTs greatly appreciated the naloxone training and the naloxone kits.
Futuro Claro - Yuma County, Arizona
Updated/reviewed February 2016
  • Need: The Hispanic population in south Yuma County is at high risk for the negative effects of tobacco use.
  • Intervention: Campesinos Sin Fronteras implemented Futuro Claro (“Clear Future” in English), which was a two-year, culturally-tailored tobacco use prevention and cessation project that uses Promotores de Salud, also known as lay health educators.
  • Results: Thousands of young farmworkers living near the U.S.-Mexico border were educated on their way to or at their worksites about the negative effects of tobacco use and were provided with information about cessation techniques. Many agriculture companies also began to enforce existing smoking laws or adopt new ones in their workplaces. An anti-tobacco youth coalition was formed to create smoke-free regulations in local parks.
Recovery-Oriented System of Care (ROSOC)
Updated/reviewed January 2016
  • Need: To serve adults in Mendocino County, California with chronic substance use disorders, mental health diagnoses, and/or complex medical conditions who frequently utilize emergency departments and jail services.
  • Intervention: A safety net organization was formed that works with medical providers and law enforcement to reduce the high cost of caring for frequent utilizers through intensive care coordination activities.
  • Results: Greater overall stability in the lives of clients, with less utilization of low-efficacy, crisis-oriented services, hospitalizations, and incarcerations.
funded by the Federal Office of Rural Health Policy On the Move: Unlawful Narcotics Investigations, Treatment & Education (Operation UNITE)
Added October 2015
  • Need: Illicit drug and alcohol use continued to increase in the Central Appalachian region of Kentucky where many schools had no type of prevention curriculum.
  • Intervention: Using engaging simulations and presentations, the program delivered substance abuse education to middle school and high school students.
  • Results: Post-test surveys showed that thousands of students were reached through the On the Move project and gained positive knowledge on the dangers of substance abuse.

Last Updated: 11/13/2017