Substance Use and Misuse in Rural Areas – Models and Innovations

Evidence-Based Examples

keepin' it REAL Rural

Updated/reviewed March 2026

• 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.

PROSPER Partnerships

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.

Effective Examples

Parent Partners

Updated/reviewed March 2026

• 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.

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder

Updated/reviewed November 2025

• Need: To 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.

Project Lazarus

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

Contingency Management Smoking Cessation in Appalachia

Updated/reviewed March 2026

• Need: To reduce smoking rates of pregnant adult and adolescent women in Appalachian regions of eastern Kentucky and Ohio.
• Intervention: In 2009, a web-based smoking cessation program offered monetary incentives to reduce smoking.
• Results: Participants significantly reduced smoking rates or quit altogether.

Nurse Navigator and Recovery Specialist Outreach Program

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.

Communities that Care Coalition

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.

Cross-Walk: Integrating Behavioral Health and Primary Care

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.

Other Project Examples

ASPIN's Certified Recovery Specialist Program

Updated/reviewed September 2026

• Need: Indiana's rural communities face significant behavioral health and primary care shortages. Providers require trained frontline workers who can support care navigation, address social drivers of health, and expand access to prevention, intervention, and recovery services.
• Intervention: A statewide training and workforce development model that certifies Community Health Workers (CHWs) and dual CHW/PRSS (Peer Recovery Support Specialists) to serve in rural settings.
• Results: ASPIN has trained and certified 2,235 Community Health Workers, expanded PRSS training opportunities, and supported rural partners statewide through CHW training and workforce development programs.

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