Rural Addiction Support Guide

Olivia Pennelle
Calendar icon Last Updated: 03/26/2024

Reading Time: 10 minutes

A small town farmhouse with a rustic fenced in field

Rural substance abuse has been on the rise in recent years, with overdose deaths surpassing urban areas, but these communities have been overlooked in favor of the impactful headlines of addiction ravaging — particularly around the opioid crisis — major cities across the nation. While the media presents addiction to be concentrated in inner cities, research shows that substance use and misuse have long been prevalent in rural areas. Public health experts say the lack of recovery resources for rural communities makes addiction especially hard to combat. This guide provides an overview of substance abuse in rural communities, including key statistics, the unique challenges faced by rural populations, and a substantial list of rural substance abuse support resources.

Understanding substance abuse in rural areas

Experts say that substance use and misuse in rural areas is a problem, with certain substances being consumed at higher rates than in cities. There are several factors that contribute to higher rates of substance misuse in rural areas, which we’ll explore in more detail.

Statistics and prevalence of substance abuse in rural settings

Public health expert bodies, such as the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2022 National Survey on Drug Use and Health, the Rural Health Information Hub, and the Centers for Disease Control and Prevention, demonstrate startling statistics about the prevalence of substance abuse in rural settings:

  • Opioid use: rural opioid use, like heroin, is marginally less than cities, with 3.0 percent of rural areas reporting opioid use, compared to 3.2 percent in cities. However, small towns used opioids at the same rate
  • Rural fentanyl use: use of fentanyl in rural areas remains lower than in urban areas, with 14.3 percent of rural counties using fentanyl, compared to 18.3 percent in cities. However, it is potentially more deadly (see opioid overdose deaths)
  • Opioid overdose deaths:
    • Was higher for females in rural counties
    • Deaths involving semisynthetic opioids were 13 percent higher than urban counties (4.5 percent compared to 4 percent)
    • Eight states had higher rates of drug overdose, including CA, NV, NH, OH, OK, OR, SD, UT, WA, and WY
  • Rural alcohol abuse: alcohol misuseis a common problem among adults and adolescents:
    • Rural high school students are more likely to participate in binge drinking, with binge alcohol use at 8.7 percent among students in rural areas, compared to 7.7 percent in metro areas
    • Alcohol use by youths (aged 12-20) was reported at 28.8 percent in non-metro areas, 29.4 percent in small metro areas, compared with 27.5 percent in urban areas
  • Tobacco use: was also higher in non-metro (rural areas and small towns) areas with 31.8 percent of 18 to 25 year old’s using tobacco, compared to 22 percent in large metro areas (cities).
  • Methamphetamine use: is also higher, with 1.6 percent of non-metro areas using meth, compared to 0.8 percent in large metro areas
  • Deaths involving psychostimulants: the abuse potential was 31 percent higher in rural areas (9.4 percent) than in urban areas (7.2 percent).

Impact on individuals and communities

The CDC recently reported that drug overdose deaths in rural areas have now surpassed rates in urban areas. While drug use, in some areas, is lower the effects are greater with the number of individuals reporting illicit drug use being like large metropolitan areas. According to the CDC, in 2015, the rural overdose death rate had been higher than the urban rate since 2006.

The impact is greater for several reasons:

  • Most overdose deaths occur in homes where relatives and loved ones have limited knowledge about life-saving drug Narcan, the opioid overdose reversal drug
  • Access to Narcan is limited with some states still failing to pass Good Samaritan laws
  • Limited access to treatment, if any, with treatment facilities being sparse and miles away from the person’s home
  • Most rural admissions are criminal justice-related (51.6 percent versus 28.4 percent), than self-referral (22.8 percent).
  • Treatment like medication-assisted treatment is limited due to the need for healthcare providers to receive a DEA and SAMHSA waiver, and a shortage of physicians who administer MAT. In 2016, 60.1 percent of rural areas still had no waivered providers
  • There are limited recovery resources
  • Substance use disorders are linked to increased criminal justice involvement, with higher instances of crime
  • Social health consequences, due to the greater stigma associated with substance use, and the association of substance use in adults linked to negative impacts on children and fetuses
  • Lack of training among first responders to deal with the effects of substance use

Unique challenges faced by rural populations

There are several factors contributing to rural substance abuse, including:

  • Poverty
  • Low educational attainment
  • Lack of access to mental healthcare
  • Isolation
  • A sense of hopelessness
  • Unemployment
  • Distance to help, with individuals having to travel long distances to limited treatment facilities, and they may not have transportation
  • Little to no mental health and detox services readily available
  • Lack of access to technology to access digital addiction treatment services
  • The cost of treatment, with many rural populations facing unemployment and poverty may mean a lack of insurance and the financial means to pay for treatment
  • Fear of discrimination among LBTQIA individuals

Signs of substance abuse in rural settings

Individuals often hide substance abuse or downplay their problem for a while. It can come as a surprise to family members when loved ones seek help. However, there are warning signs to look out for if you are worried about a friend or family member misusing substances:

  • Unusual smell on their breath or body
  • Changes to eyes: bloodshot or small/larger pupils
  • Sudden weight loss or weight gain
  • Slurred speech
  • Runny nose or sniffing
  • Deterioration in appearance
  • Acting secretively
  • Financial problems or asking to borrow money
  • Legal concerns
  • Not following through with responsibilities
  • Using more frequently, or seeing signs of more consumption like more bottles/hidden containers
  • Taking time off work or school
  • Social isolation
  • Loss of interest in activities they once enjoyed
  • Mood swings: irritability, angry outbursts, or attitude
  • Increased nervousness or anxiety
  • Paranoia
  • Seeming tired or spaced out

Recovery resources for rural communities

While this list provides mental health, addiction treatment, and other resources for rural communities, many of these organizations are national. Meaning, they can be accessed 24 hours a day, seven days a week, which may not be available locally due to limited resources in rural areas. These organizations can help you find community-based support and guidance on locating and joining local support groups.

Helplines & online services

These helplines help to prioritize rural patients and those with marginalized identities, who are often unsupported in rural locations.

  • SAMHSA: This national helpline provides free, confidential, 24/7 treatment referral support for individuals across the nation (including rural areas). Call 1-800-662-4357
  • Farmer-specific resources: mental health resources & hotlines for every state in the US and Canada
  • LGBTQ Resources: while not specific to rural areas, these national helplines can be reached 24/7 and provide support for LGBTQ individuals who live in rural areas (you can also access our LGBTQ Addiction & Mental Health Resources Guide):
    • LGBT National Help Center: This center serves gay, lesbian, bisexual, transgender and questioning people with free and confidential peer-support and local resources.
      • LGBT National Hotline: 888-843-4564
      • LGBT National Youth Talkline: 800-246-7743
      • LGBT National Senior Hotline: 888-234-7243
    • Trans Lifeline: This grassroots hotline provides direct emotional and financial support to trans people in crisis. It offers peer support for trans individuals given by trans individuals
    • The Trevor Project: This organization provides confidential support for LGBTQ+ youth in crisis, 24 hours a day, 7 days a week:
      • TrevorLifeline 866-4-U-TREVOR (1-866-488-7386): Crisis intervention and suicide prevention phone service available 24/7/365
      • TrevorChat: Confidential online instant messaging with a Trevor counselor, available 24/7. Access via computer.
      • TrevorText – Text START to 678-678: Confidential text messaging with a Trevor counselor, available 24/7/365. Standard messaging rates may apply
  • Al-Anon and Ala-Teen: peer-based support for teens and adults of loved ones struggling with substance use. Call 1-800-356-9996.
  • Drugfree.org: education, support, and guidance about substance use and what to do next. Call 855-378-4373, or text 55753
  • National Alliance on Mental Illness: provides support, resources, and guidance on mental health and conditions. Call 1-800-950-6264, or text “Helpline” to 62640
  • Suicide and Crisis Lifeline: Supports individuals in crisis or emotional distress and provides suicide prevention guidance. Call or text 988

Treatment locator

Rural support groups

Virtual and in-person meeting groups:

Virtual peer support services

Peer support is a critical component of finding and sustaining recovery from addiction. Peers are individuals with lived experience of addiction and recovery. You can find peer support in recovery meetings and in professional peer services, like those listed below. Certified peers have been through a peer training program and have been credentialed by the state. Peers can help with recovery planning, setting goals, and accessing resources.

  • RecoveryLink: a nationwide network of peer support workers and digital recovery meetings
  • WeConnect Health: national online peer support that helps individuals build healthy routines and access meetings

State specific rural recovery resources:

Many of these resources will include information on financial assistance or insurance guidance for addiction treatment in rural communities.

Coalition: Provides a detox facility, inpatient treatment, and recovery housing via a collaboration between the government, a nonprofit, and faith-based organizations

You can also access links to every state’s Rural Health Plan, via the Rural Health Information Hub, which includes information about their plan, vision, resources, accessibility, and health services.

Telehealth for substance abuse

Telehealth options are critical for individuals in rural areas seeking treatment for addiction. They can provide immediate access to treatment that might otherwise take time and travel to access. Telehealth treatment includes:

  • Individual and group therapy
  • Medication management
  • Recovery support groups
  • Doctors’ visits
  • Outpatient detoxification

Not all telehealth providers require an internet connection and could provide text-based, or telephone support. Many of these providers now have mobile apps, enabling individuals to access treatment at the touch of their phone, monitor progress in real-time, receive text support, and even a virtual recovery community.

Support systems for loved ones

If you are the friend or family member of someone struggling with addiction, know you are not alone. There are millions of Americans who support individuals seeking and maintaining their recovery. There are several ways you can show your support:

  • Educate yourself about addiction as a chronic mental health condition
  • Learn ways to communicate with compassion and empathy
  • Know that you cannot control when they seek treatment, but you can support them and set healthy boundaries
  • You can find support for yourself through communities like Al-Anon and Ala-Teen

Recognizing the need for professional help

Substance use disorder is a chronic condition that can be fatal. If a person has been using substances regularly, using higher risk drugs like opioids, or alcohol, it is important that they seek professional help to discuss the appropriate treatment options under the guidance of a medical support team.

While living in a rural area does present unique challenges and limited treatment options, there is help available. People find recovery every day in the face of numerous barriers. With the right support, resources, and appropriate treatment it is possible to find recovery in rural areas and small towns. Reach out today if you, or your loved one, needs support.

Pen iconAuthor
Olivia Pennelle
Olivia Pennelle, BA, MSW
Counselor, Expert Author, Podcaster
Located in Portland, OR, Olivia Pennelle (Liv) is an author, journalist & content strategist. She's the founder of Liv’s Recovery Kitchen, a popular site dedicated to providing the ingredients for a fulfilling life in recovery. Liv also co-founded the podcast Breaking Free: Your Recovery, Your Way. She found recovery in 2012 & her pathway is a fluid patchwork of what works for her.