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 2010 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 25.5%, small metropolitan areas was 27.4%, large metropolitan areas was 25.9%. People aged 12 or older showed the rate of past month alcohol use in nonmetropolitan areas at 46.2%, small metropolitan areas 50.6%, and large metropolitan areas 54.1%.
- Rates of binge alcohol use among youths aged 12 to 17 were 8.5% in nonmetropolitan areas, 7.7% in small metropolitan areas, and 7.8% in large metropolitan areas.
- Rates of illicit drug use was 9.4% in large metropolitan counties, 8.8% in small metropolitan counties, and 7.5% in nonmetropolitan counties as a group. Within nonmetropolitan areas, the rate was 8.7% in urbanized counties, 7.1% in less urbanized counties, and 3.7% in completely rural counties.
- Cigarette smoking rates in nonmetropolitan areas were 26.0%, small metropolitan areas 23.5%, and large metropolitan areas 21.7%.
- Rates of smokeless tobacco use in nonmetropolitan areas were 6.5%, small metropolitan areas 4.0%, and large metropolitan areas 2.3%.
- Rates of substance dependence or abuse among nonmetropolitan counties was 7.6%, compared to 8.9% in small metropolitan counties and 8.9% in large metropolitan counties.
Sources
2010 National Survey on Drug Use and Health
Related Guides
Frequently Asked Questions
Tools
Co-Occurring and Homeless Activities Branch (CHAB)
Web site
Helps SAMHSA grantees, health professionals, and the public address problems of homelessness and co-occurring substance abuse and mental health disorders through a web site providing documents, tools, and contacts, including resources specific to rural America.
Communities That Care Youth Survey
Web site
Measures the incidence and prevalence of substance use, delinquency, and related problem behaviors and the risk and protective factors that predict those problems in communities.
DUI Foundation: Education & Prevent
Web site
Serves as a database of resources covering health issues, legal information, current news and events, details on support programs and research to educate and prevent against the dangers of driving under the influence of alcohol and other impairing substances.
Maximizing Your Role as a Teen Influencer: What You Can Do To Help Prevent Teen Prescription Drug Abuse
Web site
A workshop module designed to educate and equip teen influencers, for example: parents, grandparents, teachers, coaches, community and school-based healthcare providers, with information about teen prescription drug abuse and strategies for preventative actions. Website also outlines the prescription abuse problem and presents details on its associated dangers.
Mental Health Services Locator
Web site
Provides state-specific information about mental health services, substance abuse treatment programs and resources nationwide for professionals, consumers and their families, and the public.
National Registry of Evidence-based Programs and Practices (NREPP)
Database
Searchable database of interventions for the prevention and treatment of mental and substance use disorders. Includes option to focus on interventions used in a rural or frontier setting.
National Substance Abuse Index
Web site
Provides a directory for resources related to dealing with addiction. Provides drug climate information for each state.
OAS States in Brief Reports
Web site
Contains reports that summarize substance abuse and mental health issues within the designated state. Includes the prevalence of substance use and abuse, treatment resources, mental health indicators, and SAMHSA (Substance Abuse and Mental Health Services Administration) grant funding. Browse by state or topic to access reports.
Office of Applied Studies: Substance Abuse and Mental Health Statistics
Database
Provides the latest national data on alcohol, tobacco, marijuana and other drug abuse; drug related emergency department episodes and medical examiner cases; and the nation's substance abuse treatment system.
Office of National Drug Control Policy: State and Local Resources
Web site
Site provides access to state and local profiles, contacts, and resources regarding drug use statistics and drug prevention efforts.
Parents: The Anti-Drug
Web site
Part of the National Youth Anti-Drug Media Campaign. Provides information on drug prevention for parents, faith-based groups, teachers, and community involvement.
Partners for Recovery
Web site
Facilitates communication and resource-sharing for organizations and groups that help individuals and families achieve and maintain recovery. Includes information on recovery, cross-systems collaboration, stigma reduction, workforce and leadership development.
Recovery Month
Web site
A public education effort which brings more awareness of substance abuse treatment issues to communities. Includes resources, publications, news, and events. September is designated as Recovery Month.
Resources on Substance Abuse and Mental Health for Military Families
Web site
Provides information for returning veterans on accessing mental health and substance abuse services and for military families on coping with trauma.
Rural Communities Initiative: Enforcing Underage Drinking Laws
Web site
A guide for use in searching for ways to enforce underage drinking laws in rural communities. Describes the experiences of two pilot sites that used Rural Communities Initiative (RCI) grants to develop a prevention program.
Rural Health Research: Substance Abuse
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of substance abuse, produced by the Office of Rural Health Policy's funded rural health research centers.
SAMHSA Disaster Technical Assistance Center (DTAC)
Web site
Supports SAMHSA's efforts to prepare States, Territories, and local entities to deliver an effective mental health and substance abuse (behavioral health) response during disasters through resource collections, toolkits, and a quarterly e-newsletter.
SAMHSA-HRSA Center for Integrated Health Solutions
Web site
Promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings.
SAMHSA: Health System Reform
Web site
Offers access to information on healthcare reform and how its provisions affect substance abuse entities and programs.
Substance Abuse Treatment Facility Locator
Database
Locates drug and alcohol abuse treatment programs and substance abuse agencies in each state.
Too Smart to Start
Web site
Works to help communities prevent underage alcohol use and its related problems. Provides programs and strategies, downloadable materials, plus interactive games and exercises.
Maps & Map Collections
Tobacco Policy Map
Interactive
Geographic coverage: United States
Interactive map represents smoke-free laws, cigarette tax rates, and tobacco control spending by year and state.
Date: 2010
Regulations, Forms & Other Useful Documents
2007 Report to the Secretary: Rural Health and Human Service Issues
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
Report to the Secretary of the U.S. Department of Health and Human Services. Examines three key topics in health and human services and their effects in rural areas: Medicare Advantage in Rural Communities, Head Start in Rural Communities, and Substance Abuse in Rural America. Includes recommendations to address these topics.
Date: 01 / 2007
2010 National Survey on Drug Use and Health
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Access reports based on the 2010 survey of the use of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of youth and adults. Statistics are available according to region and by county geographic type (metropolitan and nonmetropolitan areas).
Date: 08 / 2011
Addressing Suicidal Thoughts And Behaviors in Substance Abuse Treatment: A Treatment Improvement Protocol (TIP) Series 50
Sponsoring organization: Substance Abuse and Mental Health Services Administration
A manual designed to assist substance abuse counselors working with adult clients who may be suicidal, and to help clinical supervisors and administrators support the work of substance abuse counselors. Includes case studies of patients living in rural areas.
Date: 2009
Alcohol Treatment: Need, Utilization, and Barriers
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Examines the demographics of persons in the general population aged 12 or older who met criteria for needing alcohol treatment and for those who received alcohol treatment. This Report is based on data from SAMHSA's National Survey on Drug Use & Health (NSDUH).
Date: 04 / 2009
Alcohol Use Among Youth
Author(s): Andrew R. Sommers, Ramya Sundararaman
Sponsoring organization: Congressional Research Service
Describes the extent of underage alcohol use, recent legislative activity on this issue, and various policy implications.
Date: 04 / 2007
Availability, Characteristics, and Role of Detoxification Services in Rural Areas
Author(s): Jennifer D. Lenardson, Melanie M. Race, John A. Gale
Sponsoring organization: Maine Rural Health Research Center
Indicates that few detox providers serve rural America and that 82% of rural residents live in a county without a detox provider.
Date: 12 / 2009
Distribution of Substance Abuse Treatment Facilities Across the Rural – Urban Continuum (Research & Policy Brief)
Author(s): Jennifer Lenardson, John A. Gale
Sponsoring organization: Maine Rural Health Research Center
Highlights findings from a study examining the distribution of substance abuse treatment facilities in rural and urban counties and identifying the type and intensity of services provided.
Date: 02 / 2008
Few and Far Away: Detoxification Services in Rural Areas (Research & Policy Brief)
Author(s): Jennifer D. Lenardson, Melanie M. Race, John A. Gale
Sponsoring organization: Maine Rural Health Research Center
Indicates that most rural residents live in a county without a detox provider and that rural providers are concentrated in large rural towns.
Date: 12 / 2009
Monitoring the Future: National Results on Adolescent Drug Use Overview of Key Findings, 2010
Sponsoring organization: National Institute on Drug Abuse
Results of the national survey which interviews 50,000 8th, 10th, and 12th grade students in over 400 secondary schools nationwide. Highlights recent trends in the use of licit and illicit drugs, as well as trends in the levels of perceived risk and personal disapproval associated with each drug.
Date: 02 / 2011
Montana Meth Project: Graphic Ad Campaign Helps Reduce Meth Use
Author(s): Angela Lutz
Sponsoring organization: National Rural Health Association
Highlights the Montana Meth Project, which is trying to keep rural teens off drugs and reduce crime.
Journal citation: Rural Roads
Date: 04 / 2011
National Drug Threat Assessment 2010
Sponsoring organization: National Drug Intelligence Center
Describes the status and outlook of the drug threat to rural and suburban America. Covers the trafficking and abuse patterns associated with substances such as cocaine, methamphetamine, marijuana, heroin, MDMA (ecstasy), pharmaceutical drugs.
Date: 02 / 2010
National Rural Alcohol and Drug Abuse Network Awards for Excellence 2004: Submitted and Award-Winning Papers
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Describes effective and innovative models of substance abuse treatment and prevention services in rural populations. Includes seven papers submitted to the 2004 National Rural Alcohol and Drug Abuse Network (NRADAN) Awards for Excellence.
Date: 2006
Reports on Rural America: Substance Abuse in Rural and Small Town America
Author(s): Karen Van Gundy
Sponsoring organization: Carsey Institute
Discusses patterns of substance abuse, especially methamphetamine; recommendations for programs and policies; and provides rural and urban data.
Date: 2006
Results from the 2009 National Survey on Drug Use and Health: Mental Health Findings
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Presents results pertaining to mental health from the 2009 National Survey on Drug Use and Health (NSDUH), focusing on trends between 2008 and 2009 and differences across population subgroups in 2009. Includes statistical breakdowns between large, small, and nonmetropolitan counties.
Date: 12 / 2010
Rural Healthy People 2010: Substance Abuse - Trends in Rural Areas
Author(s): Linnae Hutchison, Craig Blakely
Sponsoring organization: Southwest Rural Health Research Center
Addresses rural health issues associated
with the Healthy People 2010 focus area on
substance abuse.
Date: 2003
Rural Healthy People 2010: Substance Abuse - Trends in Rural Areas: A Literature Review
Author(s): Linnae Hutchison, Craig Blakely
Sponsoring organization: Southwest Rural Health Research Center
Detailed literature review of rural health issues associated with the Healthy People 2010 focus area on substance abuse.
Date: 2003
Rural Healthy People 2010: Tobacco Use in Rural Areas
Author(s): Stacey Stevens, Brian Colwell, Linnae Hutchison
Sponsoring organization: Southwest Rural Health Research Center
Addresses rural health issues associated
with the Healthy People 2010 focus area on
tobacco use.
Date: 2003
Rural Healthy People 2010: Tobacco Use in Rural Areas: A Literature Review
Author(s): Stacey Stevens, Brian Colwell, Linnae Hutchison
Sponsoring organization: Southwest Rural Health Research Center
Detailed literature review of rural health issues associated with the Healthy People 2010 focus area on tobacco use.
Date: 2003
Rural Substance Abuse: Overcoming Barriers to Prevention and Treatment
Author(s): Rebecca Clay
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Describes factors that make providing substance abuse prevention and treatment services in rural areas difficult.
Journal citation: SAMHSA News Volume 15 Issue 4
Date: 08 / 2007
State Estimates of Drunk and Drugged Driving
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Access statistics and data regarding rates of drunk and drugged driving of persons aged 16 or older. See how your rural state ranks.
Date: 12 / 2010
State Estimates of Substance Use from the 2007-2008 National Surveys on Drug Use and Health
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Presents state estimates for 23 measures of substance use or mental health problems based on the 2007 and 2008 National Surveys on Drug Use and Health (NSDUHs).
Date: 06 / 2010
State Mandates for Treatment for Mental Illness and Substance Use Disorders
Author(s): Gail K. Robinson, Jerome B. Connolly, Melanie Whitter, Candy A. Magaña
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Reports on state-mandated benefits, state laws regulating mental health and addiction treatment workers, and state-recognized mental health clinicians with authority to prescribe psychotropic medications.
Date: 2007
Substance Abuse Among Rural Youth: A Little Meth and a Lot of Booze
Sponsoring organization: Maine Rural Health Research Center
Research and policy brief examining substance abuse among rural youth, with rural-urban comparisons methamphetamine, OxyContin, and alcohol abuse.
Date: 06 / 2007
Substance Abuse and Suicide Prevention: Evidence and Implications: A White Paper
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Explores the role of substance abuse in the interplay of factors that result in a greater risk for suicidal behaviors.
Date: 11 / 2008
Substance Abuse in Rural America
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
Chapter from the 2007 Report to the Secretary: Rural Health and Human Service Issues. Addresses rural access to substance abuse services, with a focus on alcohol, methamphetamine and narcotics addiction.
Date: 01 / 2007
Substance Abuse Treatment Facilities Serving American Indians and Alaska Natives
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Examines the characteristics of the 335 substance abuse treatment facilities and the services they provided to American Indian/Alaska Native populations in 2007.
Date: 07 / 2009
Substance Use Among American Indian or Alaska Native Adults
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Study reveals that the rate of past month alcohol use among American Indian or Alaska Native adults is significantly lower than the national average for adults (43.9 percent versus 55.2 percent).
Date: 06 / 2010
Substate Estimates from the 2006-2008 National Surveys on Drug Use and Health
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Uses maps and charts to present estimates of the prevalence of substance use in the civilian, noninstitutionalized population aged 12 or older by both substate and census regions.
Date: 07 / 2010
Tobacco Control in Rural America
Sponsoring organization: Legacy
Examines tobacco-related disparities facing rural areas, socioeconomic and cultural conditions that cause these disparities, challenges to tobacco control and prevention efforts, and explores effective strategies that have shown measurable outcomes for tobacco control in rural America.
Date: 07 / 2009
Tobacco Control State Highlights, 2010
Sponsoring organization: Centers for Disease Control and Prevention
Outlines state-by-state tobacco control programs and describes other strategies, such as MPOWER, that could be used to establish, implement, and evaluate effective control programs.
Date: 2010
Treatment Episode Data Set (TEDS) Highlights - 2007: National Admissions to Substance Abuse Treatment Services
Sponsoring organization: Substance Abuse and Mental Health Services Administration
Provides information on the demographic and substance abuse characteristics of the 1.8 million annual admissions to treatment for abuse of alcohol and drugs in facilities that report to individual State administrative data systems.
Date: 02 / 2009
Urbanity, Rurality, and Adolescent Substance Use
Author(s): Jeremy M. Wilson, Joseph F. Donnermeyer
Sponsoring organization: RAND Corporation
Reports the results of a study on substance abuse among adolescents in a Southwestern state of the U.S. Examines whether there are differences in the association between peer
and family factors with use between youth living in rural and urban areas.
Journal citation: Criminal Justice Review Volume 31 Issue 4 Pages: 337-356
Date: 12 / 2006
Organizations
2-1-1
Nonprofit/Foundation
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.
Drug Abuse Resistance Education (D.A.R.E.)
Nonprofit/Foundation
Teaches kids how to recognize and resist the direct and subtle pressures that influence them to experiment with alcohol, tobacco, marijuana, and other drugs.
Legacy
National organization
The Legacy is dedicated to building a world where young people reject tobacco and anyone can quit. The foundation is a 501(c)(3) organization that was established in March 1999 as a result of the Master Settlement Agreement (MSA) between a coalition of attorneys general in 46 states and five U.S. territories and the tobacco industry, and is funded primarily by payments designated by the settlement.
National Alliance for Drug Endangered Children (DEC)
National organization
Supports a nationwide network of professionals serving drug endangered children by providing referrals to experts, updated research on topics concerning drug endangered children, and best practice information.
National Center on Addiction and Substance Abuse at Columbia University (CASA)
National organization
Conducts research on substance abuse and addiction, works with schools, conducts surveys, and hosts conferences.
National Crime Prevention Council (NCPC)
National organization
Enables people to create safer and more caring communities by addressing the causes of crime and violence (such as drug abuse) and reducing the opportunities for crime to occur.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
National organization
Provides leadership in the effort to reduce alcohol-related problems by conducting and supporting research, coordinating and collaborating with other research institutes, and disseminating research findings to health care providers, researchers, policymakers, and the public.
National Institute on Drug Abuse (NIDA)
Federal government
Provides education resources and materials on drugs of abuse, information & facts, curriculum guides, classroom tools, grants & funding, research, clinical trials, and meetings.
National Rural Institute on Alcohol and Drug Abuse (NRI)
National organization
Provides rural alcohol and drug abuse information to rural alcohol and drug abuse professionals, federal agency representatives, and nationally known institute faculty and resource persons.
Office of Safe and Drug-Free Schools (OSDFS)
Federal government
Administers, coordinates, and recommends policy for improving quality and excellence of programs and activities for drug and violence prevention that promote the health and well being of students in elementary and secondary schools, and institutions of higher education.
Partnership for a Drug-Free America
Nonprofit/Foundation
Consists of a coalition of communication, health, medical and educational professionals working to reduce illicit drug use and help people live healthy, drug-free lives. Provides research-based, educational campaigns, state offices, events, personal stories, and articles.
Substance Abuse and Mental Health Services Administration (SAMHSA)
Federal government
Works to improve the quality and availability of prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses. Part of the U.S. Department of Health & Human Services.
Substance Abuse and Mental Health Services Administration Faith-Based and Community Initiatives (SAMHSA FBCI)
Federal government
Supports faith-based and community organizations that benefit people with or at risk for mental and substance abuse disorders.
UCLA Integrated Substance Abuse Programs (ISAP)
Academic/Research
Coordinates substance abuse research to develop, evaluate, and initiate treatment programs for substance abuse disorders.
White House Office of National Drug Control Policy (ONDCP)
Federal government
Establishes policies, priorities, and objectives for the Nation's drug control program. Works to reduce illicit drug use, manufacturing, and trafficking, drug-related crime and violence, and drug-related health consequences.
Terms & Acronyms
Addict A person who is controlled by a drug or substance.
Addiction Compulsive continued use of a drug or substance and a complete inability to stop.
Detoxification Physical withdrawal from a substance.
Recovery Process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Substance Abuse Misuse of medications, alcohol or other illegal substances.
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