Rural Substance Abuse

Substance abuse has long been perceived to be a problem of the inner city. However, alcohol abuse is also a problem in rural areas and illicit drugs have infiltrated towns of every size. Today, adults and young teens in rural areas are just as likely to abuse substances as those in larger metropolitan areas. The problems may be the same, but smaller communities have limited resources to deal with the consequences of substance abuse.

Factors contributing to substance abuse in rural America include poverty, unemployment, underemployment and the isolation of rural areas. Substance abuse results in crime including buying and selling drugs, driving while intoxicated, and disorderly conduct, as well as poor grades in school and other serious complications. Substances abused include, but are not limited to, alcohol, drugs, prescription medications, over-the-counter drugs and cigarettes.

According to the 2012 National Survey on Drug Use and Health, substance abuse dependence for persons 12 years or older (unless age is otherwise noted) varied by geographic area:

  • Underage alcohol use rate in nonmetropolitan areas was 22.6%, small metropolitan areas was 24.4%, large metropolitan areas was 24.7%.
  • Rates of past month alcohol use were 45.6% in nonmetropolitan areas, 53.1% in small and 53.5% in large metropolitan areas.
  • Rates of binge alcohol use among youths aged 12 to 17 were 9.2% in nonmetropolitan areas, 6.8% in small metropolitan areas, and 6.9% in large metropolitan areas.
  • Rates of illicit drug use was 6.8% in nonmetropolitan counties as a group, 9.2% in small metropolitan counties, and 9.9% in large metropolitan counties. Within nonmetropolitan areas, the rate was 8.3% in urbanized counties, 5.9% in less urbanized counties, and 4.8% in completely rural counties.
  • Cigarette smoking rates in nonmetropolitan areas were 27.4%, small metropolitan areas 23.2%, and large metropolitan areas 19.9%.
  • Rates of smokeless tobacco use during the past month in nonmetropolitan areas were 7.1%, small metropolitan areas 3.9%, and large metropolitan areas 2.1%.
  • Rates of substance dependence or abuse among nonmetropolitan counties was 7.4%, compared to 8.8% in small metropolitan counties and 8.7% in large metropolitan counties.

Sources: 2012 National Survey on Drug Use and Health


Drug Enforcement Office in your state: click on your state to find the best number for your location

National Alcohol and Substance Abuse Information Call Center
Hotline Call Center is available 24 hours a day, seven days a week at 800.784.6776

National Network of Tobacco Cessation Quitlines
Reaches professionals in every state that work to help in cessation efforts of tobacco users. Call 800.QUIT.NOW (800.784.8669)  / TTY 800.332.8615

SAMSHA's Substance Abuse Treatment Locator
Find a treatment center in your area

There are more organizations related to Substance Abuse in the organizations section.

Frequently Asked Questions

What is substance abuse?

Substance abuse is the use of a mood or behavior-altering substance resulting in significant impairment or distress. It includes the misuse of medications, alcohol or other illegal substances. This abuse can affect a person’s physical health and personal or social functioning. Substance abuse can include regular, excessive, compulsive drinking of alcohol, and the habitual use of illegal drugs.

What are signs of substance abuse?

  • Failure to fulfill major role obligations at work, school, or home
  • Repeated absences or poor work performance
  • Neglect of children or household
  • Driving an automobile or operating a machine when impaired
  • Arrests for substance-related disorderly conduct
  • Interference with sleeping or eating
  • Avoiding people or places
  • Outbreaks of temper
  • General changes in overall attitude
  • Deterioration of physical appearance and grooming
  • Wearing of sunglasses at inappropriate times
  • Continual wearing of long-sleeved garments particularly in hot weather or reluctance to wear short sleeved attire when appropriate
  • Association with known substance abusers
  • Unusual borrowing of money from friends, co-workers or parents
  • Stealing small items from employer, home or school
  • Secretive behavior regarding actions and possessions; poorly concealed attempts to avoid attention and suspicion such as frequent trips to storage rooms, restroom, basement, etc.

How do I find a substance abuse treatment center in my rural area?

Family doctors, pastors, local social service agencies, or local mental health centers may be available for delivering substance abuse treatment or support. The following are additional sources:

  • SAMHSA’S Substance Abuse Treatment Locator
    Provides comprehensive information about drug and alcohol abuse treatment programs nearest you. Select your state for treatment facilities and support services in your area.
  • 2-1-1
    A telephone number that, where available, connects people with important community services and volunteer opportunities. 2-1-1 is lead by United Ways and information and referral agencies in states and local communities.
  • National Hotline Call Center for Alcohol and Drug Abuse
    Call 1.800.784.6776 to receive information about alcohol and drug abuse and the location of treatment centers. Staff is on duty 24 hours a day, 7 days a week. This service and website also supplies information regarding interventions, detox, treatment, plus rehab and specialty programs.
  • Become An Ex
    By the National Alliance for Tobacco Cessation and its partners offers information about resources that aid in smoking cessation. Links to state and national resources and programs are available on their website.
  • Alcoholics Anonymous
    Has a website containing phone numbers for groups and meetings in your area.
  • Narcotics Anonymous
    Toll-free at 1.818.733.9999.
  • National Drug and Alcohol Treatment Referral Service
    Toll-free at 1.800.662.4357.
  • National Youth Crisis Hotline
    Toll-free at 1.800.422.4663.
  • Mother's Against Drunk Drivers (MADD)
    Has a 24 hour help line offering emotional support, guidance, and referrals to victims/survivors of drunk driving at 1.877.623.3435
  • Two national suicide prevention toll free telephone services are available 24 hours a day:
  • QuitNet
    Offers a database where you can search for existing quit smoking programs by state or ZIP code.

What effects does substance abuse have on a community?

Substance abuse can cause these problems in communities:

  • Increased crime
  • Increased violence, including domestic and child abuse
  • Accidents caused by drunk driving
  • Increase in out-of-wedlock pregnancies
  • Increased dependence on government assistance programs
  • Family and social problems
  • Deaths due to alcoholism, or overdose from drug use
  • Fetal alcohol syndrome in children
  • Spread of infectious diseases such as HIV/AIDS, STDs, and Hepatitis C either through sharing of drug paraphernalia or unprotected sex
  • Homelessness
  • Unemployment

How can communities combat substance abuse?

Here are things communities can do to help control substance abuse:

  • Holding community or town hall meetings
  • Inviting speakers to talk to school-aged children
  • Inviting parents into schools to meet with teachers
  • Working together with law enforcement in your community
  • Collaborating with churches in your area
  • Forming a community coalition
  • Being good role models

Are there disparities in the rates of substance abuse by Native Americans vs. the general rural population?

Health disparities exist in Native American populations.  According to the January 2005 IHS publication, Disparities, compared to the general U.S. population, American Indians and Alaska Natives die at higher rates than other Americans from chronic liver disease and cirrhosis (368% higher), diabetes mellitus (177% higher), unintentional injuries (138% higher), assault/homicide (82% higher), intentional self-harm/suicide (65% higher), and chronic lower respiratory diseases (59% higher).

For further information, including statistics and data, see:

Does health insurance pay for substance abuse treatment?

It is best to contact your insurance plan and ask for a description of what coverage is provided for behavioral health treatments. SAMHSA’S Mental Health Information Center provides information on what mental health and substance abuse services may be covered under insurance. 

What can be done to discourage children from using drugs and alcohol?

Everyone can help educate children on the dangers of illegal drugs and alcohol.  In particular, reducing the availability of alcohol, promoting responsible adult behavior, holding adults accountable when providing alcohol to minors, enforcing laws designed to stop drinking among children and adults, and changing social norms about what children see in their homes as well as in the media regarding drugs and alcohol, all lend a hand to this cause.

  • Leadership to Keep Children Alcohol Free
    An initiative to prevent the use of alcohol by children ages nine to 15.  This program provides information for parents, teachers, signs for health care workers to look for, legislative action, reports and more
  • National Institute on Drug Abuse
    Lists websites and materials that parents and teachers can use for educating children and teens.
  • Underage Drinking Enforcement Training Center
    Works to support, improve, and increase the ability of states and communities to enforce underage drinking laws, prevent underage alcohol use, and remove the affects of underage drinking by conducting training and offering technical assistance.

What are illicit drugs?

Illicit drugs are drugs which are used in an unlawful manner for purposes other than those for which they are indicated or in a manner or in quantities other than directed. They can be over-the-counter medications or prescription medication. Illicit drugs can include sleeping pills, alcohol, heroin, marijuana, narcotics, cocaine, steroids, inhalants, methamphetamine, amphetamines, and hallucinogens.

Why is underage drinking and binge drinking so prevalent in rural communities?

Binge drinking is defined as drinking five or more drinks at the same time or within a couple of hours of each other on at least one day in the past 30 days.  It can also be defined as drinking with the intent of getting drunk, often mixing drinks, drinking as much as possible in a short period of time, and drinking to the point at which one loses control.

Causes of underage and binge drinking in rural areas can be, but not limited to: economic factors, lack of employment, lack of involvement in school activities, lack of community activities, no parental supervision or have parents who drink, being predisposed to alcoholism, media, and peer pressure.

40% of a national sample of pediatricians and family doctors reported that they screened their adolescent patients for alcohol use and only 52% provided alcohol education (Marcell et al. 2002). The situation is worse in rural areas where primary care may be less available and the need to deliver early adolescent prevention services greater.

What is methamphetamine and what are the side effects?

Methamphetamine is an addictive stimulant drug that strongly activates the central nervous system. It can be smoked, snorted, orally ingested, and injected. It is available in many different forms and may be identified by color, which can range from white to yellow to darker colors such as red and brown. Methamphetamine comes in a powder form that looks like granulated crystals and in a rock form known as "ice," which is the smokeable version of methamphetamine.

Side effects of using meth include convulsions, dangerously high body temperature, stroke, cardiac arrhythmia, stomach cramps, and shaking. Chronic abuse can lead to psychotic behavior including intense paranoia, visual and auditory hallucinations, and out-of-control rages. Chronic users develop sores on their bodies from scratching at "crank bugs," which describes the common delusion that bugs are crawling under the skin. Long-term use may result in anxiety, insomnia, and addiction.

After methamphetamine use is stopped, several withdrawal symptoms can occur, including depression, anxiety, fatigue, paranoia, aggression, and an intense craving for the drug. Psychotic symptoms can sometimes persist for months or years after use has ceased. Meth mouth is on the increase, particularly in jails where prisoners who have used methamphetamines have severe dental problems caused by this drug.

Why is methamphetamine use such a problem in rural areas?

Problems with methamphetamine use in rural areas are many:

  • In rural areas, there are many abandoned buildings such as farm houses and barns on remote roads. Some of these buildings house methamphetamine labs, which operate undetected.
  • Anhydrous ammonia is one of the key ingredients in producing meth. It is readily available in rural areas as farmers use this chemical as fertilizer. Thefts of anhydrous ammonia storage units have prompted law enforcement officials in some areas to urge farmers to lock their tanks.
  • Rural areas are dealing with the cleanup of toxic methamphetamine lab sites which have a severe impact on the environment. Each pound of methamphetamine produced releases poisonous gas into the atmosphere and creates five to seven pounds of toxic waste. In addition, many meth laboratory operators dump the toxic waste down household drains, in fields and yards, or on rural roads.
  • Children are endangered by methamphetamine production. Children that are around areas of methamphetamine labs get exposed to toxic chemicals thus presenting health and environmental risks. Children removed from lab sites have been shown to have methamphetamine in their systems. For further information, see Dangers to Children Living at Meth Labs.
  • Meth orphans are children who are in foster care due to one or both parents being either in jail or dead due to methamphetamine use or children being born to mothers addicted to the drug. A large number of grandparents raise their grandchildren due to problems that methamphetamine use can cause with one or both parents.
  • Injury to EMS personnel can occur when first responders arrive at a meth site and deal with hazardous substances as well as people under the influence of meth who may be violent, agitated, and unpredictable. The most common symptoms suffered by meth users are respiratory and eye irritations, headaches, dizziness, nausea, and shortness of breath.
  • Law enforcement personnel are overworked. Methamphetamine lab manufacturers avoid police because labs can be portable and so are easily dismantled, stored, or moved. Those that are arrested fill up already crowded jails and strain limited police resources.
  • The ingredients that are used to make methamphetamine can be purchased at local stores. These ingredients are cheap. Meth can be cooked at home in kitchens and garages.
  • Methamphetamine abuse during pregnancy causes prenatal complications such as increased rates of premature delivery, abnormal reflexes and extreme irritability, and may be linked to congenital deformities. Methamphetamine abuse by those who inject the drug and share needles can increase users' risks of contracting HIV/AIDS and hepatitis B and C.
  • Treatment for meth use may be hard to find in small towns. Rural communities often have fewer health facilities and treatment options. Meth users may find it difficult to get the help they need.

What are states doing to help combat the rural methamphetamine problem?

Communities everywhere are attempting to stop the spread of methamphetamine use through education programs, increased law enforcement efforts, and addiction treatment programs. Forming partnerships with local and state agencies to help combat methamphetamine use is beneficial.

The Meth Watch Program is designed to help stop the theft and suspicious sales of pseudoephedrine products, as well as other common household products used in the illicit manufacturing of methamphetamine in small, toxic labs. A key goal of this program is to promote cooperation between retailers and law enforcement to prevent the diversion of legitimate products for illegal use.

Several states have started their own Meth Watch programs and other prevention strategies, including but not limited to: California, Colorado, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Maine, Montana, Nebraska, North Dakota, Oregon, Central Oregon, Tennessee, Texas, and Wyoming.

Many states have established Drug Endangered Children (DEC) Programs which work to coordinate the efforts of law enforcement, medical services, and child welfare workers to ensure that children found in these environments receive appropriate attention and care.

The Office of National Drug Control Policy also has information on drug prevention approaches.

What is the Methamphetamine Production Prevention Act of 2008?

The Methamphetamine Production Prevention Act of 2008 became law October 16, 2008. This act replaces the Combat Meth Act of 2005 by requiring electronic logbooks be kept rather than written logbooks. These logbooks contain information related to the sale of drugs commonly found as meth ingredients, such as, pseudoephedrine. Individuals can purchase limited amounts of this drug, and they must present a government issued photo id and sign the sellers logbook after they have reviewed it to verify its accuracy.