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Rural Substance Abuse

No longer a "city problem," rural substance abuse has risen in recent decades, with increasing rates of opioid, alcohol, and meth abuse, crime, and fatal overdose.

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Rural Health and Substance Abuse

The epidemic of rural substance abuse has long been overshadowed by the sensational headlines and drug busts of major American cities like New York City, Miami, and Los Angeles. Throughout much of the 20th century, as already densely-populated centers grew, rates of drug addiction and crime climbed simultaneously. However, starting in 2006, rural rates of fatal drug overdose surpassed those of urban areas. Even as micropolitan and major metropolitan areas were hard hit by the effects of the Opioid Epidemic, rural regions continued to experience higher and higher rates of substance abuse – particularly to alcohol and methamphetamines.

The drug overdose death rate in rural areas is higher than in urban areas. We need to understand why this is happening so that our work with states and communities can help stop illicit drug use and overdose deaths in America.

- CDC Director Branda Fitzgerald, M.D., Centers for Disease Control and Prevention, 2017

Factors Contributing to Rural Substance Abuse

Almost one in five Americans live in rural communities, defined as an area with fewer than 2,500 people. Yet, rural communities make up 97% of the country’s total land area. Typically, people in rural communities are older and in poorer health than those in urban centers, amplifying the effects of substance abuse.

The five main factors currently contributing to rural substance abuse are:

  • Poverty
  • Unemployment
  • Risky behavior
  • Isolation
  • Low educational completion

Additionally, rural residents smoke more cigarettes, weigh more, and even report lower seatbelt use (all categorized as risky behavior by the Centers for Disease Control, or CDC). When combined with comparatively higher rates of its population living in poverty, limited access to healthcare, and the reduced likelihood of carrying health insurance, it is not surprising that rural residents have shorter lifespans. The spread of substance abuse in rural areas can also be linked to a number of changing aspects of American society, including inflation, shrinking rural populations, inadequate access to treatment, and overall less leisure time.

Rural Substance Abuse Statistics



49.5% of patients at rural addiction treatment centers reported the primary abuse of alcohol.


meth lab incidents

Between 2010 and 2014, Missouri averaged 1,728 meth lab incidents each year.



Over 60% of rural counties in the US have no physician with a DEA waiver to prescribe buprenorphine for opioid addiction treatment.

Alcohol Abuse in Rural Communities

Rural Americans lead the pack in the five major causes of death compared to those living in cities. According to the CDC, “many deaths among rural Americans were potentially preventable, including 25,000 from heart disease, 19,000 from cancer, 12,000 from unintentional injuries, 11,000 from chronic lower respiratory disease, and 4,00 from stroke” in 2014. Because rates of heavy drinking, including binge drinking, are much higher in many rural areas and the effects of excessive alcohol consumption are so damaging to the body, a portion of these deaths are likely closely linked to alcohol abuse.

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Alcohol-Related Crime in Rural Areas

Two of five youths between the ages of 12 and 20 report underage drinking in rural communities. In many rural families, underage drinking is not a chief concern among parents, and alcohol is easier to obtain – in homes, bars, and liquor stores. Rural teens also drive drunk more frequently and have higher rates of DUIs than urban teens. In fact, motor vehicle accidents are the leading cause of death among people between 12 and 19 years-old. Furthermore, these teens are more likely to participate in regular binge drinking and, subsequently, become adults with an alcohol use disorder.

Additionally, rural adults commit felonious drunk driving at higher rates than their urban equivalents. Rural motor vehicle fatalities involving drunk driving killed 4,915 people in 2013, representing 48% of all driving fatalities that year nationally. Of all types of car accidents in rural areas, a third involved alcohol. One explanation for such high rates of drunk driving fatalities may be a lack of public transportation. This leaves many to make the criminal decision to get behind the wheel to get home.

Moreover, the effects of alcohol abuse on society can be more pronounced in rural areas because of their low populations. For instance, in 2018 a drunk truck driver was responsible for the deaths of 15 junior league hockey players from a Canadian town of less than 6,000 people. That’s like Billings, Montana, losing 424 people in a single drunk driving accident. Common alcohol-related crimes such as burglary or theft, vandalism, assault, and murder have also proven to have lasting impacts on small-town communities.

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Illicit Substance Abuse in Rural Communities

While much of the country grapples with the effects of the Opioid Epidemic, an estimated 4% of people ages 12 and up misuse prescription opioids in rural areas. States with predominantly rural populations have experienced notably higher rates of fatal opioid overdose (such as Kentucky, West Virginia, Alaska, and Oklahoma). Yet, average rates of opioid abuse are within a 2% difference between rural and urban adults. The difference in fatal overdoses between the two is generally explained as an issue of access to life-saving treatment (such as Narcan).

Research shows high rural rates of overdose are due to a number of factors, including the rise of heroin use as an alternative to painkillers and:

  • Detox services or addiction treatment is limited (or unavailable) in many rural areas
  • Patients needing treatment may have to travel too far to get help
  • Emergency medical services (especially volunteers) may have limited experience treating overdoses
  • Smaller law enforcement departments must cover large areas
  • The stigma of addiction treatment may be higher in small communities

Currently, local and federal authorities name meth abuse as the number one drug problem in most rural communities. Previously, various west coast biker gangs and random clandestine labs cooked and distributed meth. Today, the majority of meth in the US comes from Mexican drug cartels, where it is mass-produced. Once the euphoric effects of meth wear off, individuals often feel depressed, paranoid, and sometimes violent. This has led to a sharp increase in crime in many rural areas (particularly assault and the theft of construction and farming equipment).

Young adults in rural areas between the ages of 18 and 25 are six times more likely to abuse methamphetamines than those in urban areas.

For years, starting in the 2000s, Missouri was home to more meth lab incidents than any other state. In 2011, the state averaged almost 6 meth lab incidents per day, according to Missouri State Highway Patrol. Since, Indiana and Tennessee have overtaken the Show Me State in number of meth-related incidents.

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Difficulty Finding Treatment in Rural America

The primary roadblock many rural Americans face when seeking addiction treatment is access to services. 82% of people living in rural counties have no access to detox services within their area. This means individuals in need of treatment must travel long distances (often multiple times a week) to recover from a drug or alcohol addiction. Moreover, many people suffering from addiction have either inadequate means of transportation and/or funds to pay for treatment.

Exacerbating the problem is the availability of addiction treatment medication from even local healthcare providers. Over 60% of rural counties (a majority falling between North Dakota and Texas) have zero physicians with a waiver to prescribe buprenorphine (or Suboxone) for opioid addiction treatment. Also, studies show that many physicians with waivers are not prescribing addiction treatment medications at all.

Traveling for Rehab

The Substance Abuse and Mental Health Services Administration (SAMHSA) believes that access to proper substance abuse care is vital for reversing the tide of overdose deaths across the country. While the Affordable Care Act has increased the availability of treatment options and reduced drug and alcohol rehab costs for many, rural areas still lack many necessary treatment options. For some, traveling for rehab is the best way to begin recovery. This allows individuals to be more selective when choosing a rehab center. Then, individuals are able to free themselves of hometown triggers for substance abuse and focus on healing once they arrive.

The cost of rehab may be mitigated by insurance (private or publicly-funded) or sliding fee scales. The cost of addiction, however, may be a life. If you’re considering rehab but would like more information on your options across the country, speak with a treatment provider today.