Nearly one in five U.S. residents lives in a rural area. According to most estimates, individuals living in rural locations experience mental and substance use disorders at rates that are similar to (and sometimes higher than) those of their urban counterparts.

Despite having a similar need for services, people in rural areas have less access to the behavioral health continuum of care than do people in urban areas.  Although funding cuts, workforce shortages, and other systemic issues hinder access to timely and appropriate behavioral health treatment and services in urban and rural areas alike, people in rural areas face additional barriers, such as a lack of adequate internet infrastructure, a need to travel long distances to see specialty providers, and a lack of anonymity about receiving treatment. - SAMHSA

The CSG Justice Center reports that there are few rural specific evidence based practices, or resources to establish them.

  • Few resources exist in rural systems to facilitate change and innovation.

  • Rural areas suffer from chronic shortages of mental health professionals.

  • Specialty providers highly unlikely to be available in rural areas.

  • Comprehensive services often not available.

Substance abuse can be especially hard to combat in rural communities due to limited resources for prevention, treatment, and recovery. According to The 2014 Update of the Rural-Urban Chartbook, the substance abuse treatment admission rate for nonmetropolitan counties was highest for alcohol as the primary substance, followed by marijuana, stimulants, opiates, and cocaine.

Factors contributing to substance abuse in rural America include:

  • Low educational attainment

  • Poverty

  • Unemployment

  • High-risk behaviors

  • Isolation

Rural communities have been especially affected in the past few years by rising rates of poverty and unemployment, two key community-level risk factors for addiction and mental illness. Getting treatment in rural communities is much harder than in urban areas. There is limited access to evidence-based tools that help treat addiction in rural areas because of stigma, misunderstanding, and a lack of accessibility.

There has been an increase in overdoses and where the rates of overdose deaths are now higher than in urban communities.


A 2015 American Journal of Drug and Alcohol Abuse article, Rural Substance Use Treatment Centers in the United States: An Assessment of Treatment Quality by Location, reports that rural substance abuse treatment centers had a lower proportion of highly educated counselors, compared to urban centers. Rural treatment centers were found to offer fewer wraparound services and specialized treatment tracks.