Substance Use and Misuse in Rural Areas – Models and Innovations

Evidence-Based Examples

keepin' it REAL Rural

Updated/reviewed March 2024

• Need: A drug and alcohol prevention program for middle school students that is specific to rural culture.
• Intervention: An adaptation of the evidence-based keepin' it REAL curriculum was customized for rural middle school students.
• Results: Students showed a reduction in all substance use and less personal acceptability of substance use.

Helping Kids PROSPER

Updated/reviewed January 2023

• Need: An approach to support sustained, quality delivery of evidence-based programs for youth and families in rural communities.
• Intervention: PROSPER, a program delivery system, guides communities in implementing evidence-based programs that build youth competencies, improve family functioning, and prevent risky behaviors, particularly substance use.
• Results: Youth in PROSPER communities reported delayed initiation of a variety of substances, lower levels of other behavioral problems, and improvements in family functioning and other life skills.

Effective Examples

Parent Partners

Updated/reviewed March 2024

• Need: To support parents whose children have been removed from the home so that the parents can make the changes needed for the children to return safely home.
• Intervention: A statewide program in Iowa pairs these parents with mentors who have successfully navigated their own child welfare cases.
• Results: Participants' children were more likely to return home than non-participants' children and participants were less likely to have another child removal within a year of the child coming home.

Strong African American Families-Teen Program

Updated/reviewed May 2023

• Need: There is a lack of interventions that addresses teenager behavioral problems, particularly for rural African American adolescents.
• Intervention: Rural, locally trained leaders administered five 2-hour meetings for teenagers and their primary caregivers. Trainings focused on reducing risks that prevent positive development, specifically sexual risk-taking that can lead to HIV and other STIs.
• Results: Teens reported reduced conduct problems, depressive symptoms, and substance abuse. Families were strengthened, and SAAF-T reduced unprotected intercourse and increased condom efficacy.

Project Lazarus

Updated/reviewed November 2021

• Need: To reduce overdose-related deaths among prescription opioid users in rural Wilkes County, North Carolina
• Intervention: Education and tools are provided for prescribers, patients and community members to lessen drug supply and demand, and to reduce harm in prescription opioid use
• Results: Opioid overdose death rates have decreased in Wilkes County

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder

Updated/reviewed August 2020

• Need: Increase access to medication-assisted treatment for opioid use disorder in rural Vermont.
• Intervention: Statewide hub-and-spoke treatment access system.
• Results: Increased treatment capacity and care coordination.

Midcoast Maine Prescription Opioid Reduction Program

Updated/reviewed May 2020

• Need: Reduction in the number of emergency department dental patients abusing opioid prescriptions in rural southeastern Maine.
• Intervention: Using a one-page opioid prescription guideline, opioid prescribing and emergency room visits for dental pain decreased.
• Results: The rate of opioid prescription dropped nearly 20% after implementation, and in comparing the 12-month period before and after implementation, dental pain emergency department visits decreased from 26 to 21 per 1,000.

Promising Examples

Communities that Care Coalition

Updated/reviewed April 2023

• Need: To improve the health, well-being, and equity of young people in the rural area of Massachusetts's Franklin County and North Quabbin, and to reduce youth drug and alcohol use.
• Intervention: A community-based prevention coalition was formed to improve youth health, well-being, and equity and reduce youth drug and alcohol use use. The coalition brings together stakeholders from across the community and uses the Communities That Care evidence-based community planning system.
• Results: CTC has seen significant reductions in substance abuse among local youth in the 30 rural towns they serve.

Nurse Navigator and Recovery Specialist Outreach Program

Updated/reviewed November 2022

• Need: To properly address and treat patients who have concurrent substance use and chronic healthcare issues.
• Intervention: A referral system utilizes community health workers (CHWs) in a drug and alcohol treatment setting. A registered nurse helps with providers' medication-assisted treatment programs.
• Results: This program has reduced hospital emergency visits and hospital readmissions for patients since its inception.

Contingency Management Smoking Cessation in Appalachia

Updated/reviewed June 2022

• Need: To reduce smoking rates of pregnant women and adolescents in Appalachian regions of eastern Kentucky and Ohio.
• Intervention: A web-based smoking cessation program that offered monetary incentives to reducing smoking.
• Results: Participants significantly reduced smoking rates or quit altogether.

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