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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

keepin' it REAL Rural
Updated/reviewed March 2022
  • 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.
Helping Kids PROSPER
Updated/reviewed June 2019
  • 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
Added March 2022
  • 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.
Project Lazarus
Updated/reviewed November 2021
  • 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
Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder
Updated/reviewed August 2020
  • Need: Increase access to medication-assisted treatment for opioid use disorder in rural Vermont.
  • Intervention: Statewide hub-and-spoke treatment access system.
  • Results: Increased treatment capacity and care coordination.
Midcoast Maine Prescription Opioid Reduction Program
Updated/reviewed May 2020
  • 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.
Strong African American Families-Teen Program
Updated/reviewed April 2019
  • 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.
funded by the Federal Office of Rural Health Policy Madison Outreach and Services through Telehealth (MOST) Network
Updated/reviewed December 2018
  • 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.

Promising Examples

Contingency Management Smoking Cessation in Appalachia
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 reducing smoking.
  • Results: Participants significantly reduced smoking rates or quit altogether.
funded by the Federal Office of Rural Health Policy Nurse Navigator and Recovery Specialist Outreach Program
Updated/reviewed November 2021
  • Need: To properly address and treat patients who have concurrent substance use 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.

Last Updated: 6/3/2022