Rural Health And Substance Abuse

The epidemic of rural substance abuse has occasionally been overshadowed by sensational headlines and drug busts in 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 hit hard by the effects of the Opioid epidemic, rural regions continued to experience higher and higher rates of substance abuse — particularly when it came 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 1 in 5 Americans lives 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; this can amplify the negative effects of substance abuse.

Some of the main factors currently contributing to rural substance abuse are:

  • Poverty
  • Cultural disconnection
  • 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 and Prevention (CDC). When these behaviors are combined with comparatively higher rates of the population living in poverty, limited access to healthcare, and a reduced likelihood of carrying health insurance, it is not surprising to see 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 less overall 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 5 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 4,000 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.

Alcohol-Related Crime In Rural Areas

In rural communities, 2 out of every 5 youths between the ages of 12 and 20 report underage drinking. In many rural families, underage drinking is not a chief concern among parents; alcohol is easily obtained in homes, bars, and liquor stores. Rural teens also drive drunk more frequently and have higher rates of DUI 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; subsequently, they’re also more likely to become adults with an alcohol use disorder (AUD).

Additionally, rural adults commit felonious drunk driving at a higher rate 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 a high rate of drunk driving fatalities may be a lack of public transportation. This leaves many to make the criminal decision to drink and then get behind the wheel in order to get home.

Moreover, the effects of alcohol abuse on society can be more pronounced in rural areas because of their lower populations. Common alcohol-related crimes such as burglary or theft, vandalism, assault, and murder have also proven to have lasting impacts on small-town communities.

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 populations is partially an issue of access to life-saving treatment (such as Narcan).

Research shows high rural rates of overdose are due to a number of other factors as well, including:

  • The use of Heroin as an alternative to Painkillers in rural areas
  • The fact that emergency medical services (especially volunteers) may have limited experience treating overdoses
  • The notion that smaller law enforcement departments must cover larger areas
  • The unfortunate reality that the stigma of addiction treatment may be higher in smaller 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 scattered clandestine labs cooked and distributed Meth. The majority of Meth in the US today comes from Mexican drug cartels, who mass-produce the substance. 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 6 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. The state averaged almost 6 Meth lab incidents per day in 2011, according to Missouri State Highway Patrol. Since then, Indiana and Tennessee have overtaken the Show Me State in number of Meth-related incidents.

Difficulty Finding Treatment In Rural America

The primary roadblock many rural Americans face when seeking addiction treatment is access to services. In fact, 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 inadequate means of transportation and/or funds to pay for treatment.

Exacerbating the problem is the lack of availability of addiction treatment medication from local healthcare providers. Over 60% of rural counties (a majority of them falling between North Dakota and Texas) have 0 physicians with a waiver to prescribe Buprenorphine (or Suboxone) for Opioid addiction treatment. Additionally, studies show that many physicians with waivers are not prescribing addiction treatment medications at all.

Finding treatment in rural areas can be difficult, but thankfully online therapy options can bring licensed, professional addiction counselors to even the most remote parts of the country. These services are confidential, flexible, and are often covered by many insurance providers.

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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. 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 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.