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Rural Health Information Hub
Rural Health Information Hub

Substance Use and Misuse 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

Updated/reviewed June 2025

  • 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.

Updated/reviewed April 2025

  • Need: A drug and alcohol prevention program for middle school students that is specific to rural culture.
  • 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.

Effective Examples

Updated/reviewed November 2025

  • Need: In the early 2010s, needed increase access to medication treatment for opioid use disorder in rural Vermont.
  • Intervention: 2012-2016 implementation of a statewide hub-and-spoke treatment access system.
  • Results: The original system's increased treatment capacity and care coordination successes now are a permanent system of integrated care overseen by the Vermont state health department and Vermont Blueprint for Health.

Updated/reviewed April 2025

  • Need: To support parents whose children have been removed from the home so that the parents can make the changes needed for the children to return safely home.
  • Intervention: A statewide program in Iowa pairs these parents with mentors who have successfully navigated their own child welfare cases.
  • Results: Participants' children were more likely to return home than non-participants' children, and participants were less likely to have another child removal within a year of the child coming home.

Updated/reviewed May 2024

  • 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

Updated/reviewed December 2025

  • Need: To properly address and treat patients who have concurrent substance use disorders and chronic healthcare issues.
  • Intervention: A referral system utilizes community health workers (CHWs) in a drug and alcohol treatment setting. A registered nurse helps with providers' medication-assisted treatment programs.
  • Results: This program has reduced hospital emergency visits and hospital readmissions for patients since its inception.

Updated/reviewed September 2025

  • Need: To improve the health and well-being of young people in the rural area of Massachusetts's Franklin County and North Quabbin, and to reduce youth drug and alcohol use.
  • Intervention: A community-based prevention coalition was formed to improve youth health and well-being and reduce youth drug and alcohol use. The coalition brings together stakeholders from across the community and uses the Communities That Care evidence-based community planning system.
  • 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

Updated/reviewed May 2024

  • Need: To address and treat substance use disorder (SUD) 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 primary care patients were referred to a behavioral health specialist.

Updated/reviewed June 2022

  • 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 reduce smoking.
  • Results: Participants significantly reduced smoking rates or quit altogether.

Other Project Examples

Added February 2026

  • Need: To help Federally Qualified Health Centers (FQHCs) and home visiting programs reduce smoking rates in rural Yuba County, California.
  • Intervention: A five-year initiative helped FQHCs with integrating tobacco user identification and cessation referral protocols and helped home visiting programs with tobacco screening and family wellness education.
  • Results: FQHCs and family-serving agencies achieved systems-level change through comprehensive tobacco-free policies, human resources procedures, and client screening protocols.
Last Reviewed: 6/28/2023