That's the key finding from the most comprehensive report on rural drug abuse to date: "No Place to Hide: Substance Abuse in Mid-Size Cities and Rural America." The report was funded by the Drug Enforcement Administration with support from the National Institute on Drug Abuse.

For many years a lack of data has perpetuated the myth that small towns are isolated havens of sobriety and that drug abuse is a problem confined to big cities. But "No Place to Hide" undercuts that myth. Authors of the report discovered that:

• Eighth-graders in rural America are 83 percent more likely than those in urban areas to use crack cocaine, 43 percent more likely to smoke marijuana, and 29 percent more likely to drink alcohol.
• Except for Ecstasy (MDMA) and marijuana, tenth-graders in rural America use drugs at higher rates than tenth-graders in urban areas.
• Twelfth-graders in rural America use cocaine, amphetamines, inhalants, alcohol, cigarettes, and smokeless tobacco at higher rates than their urban counterparts.
• Adults in rural areas and large urban areas abuse alcohol and other drugs at about the same rates. Tobacco use was more prevalent in mid-size cities and rural areas than in large urban areas.

One reason for the high rate of rural drug abuse is international drug trafficking. For example, Mexican drug dealers have been strong suppliers in the heroin and methamphetamine markets of big cities. But increased competition and law enforcement in large urban areas has forced these dealers into rural areas, searching for new and lucrative markets.

Drugs are also produced and distributed within our own borders -- increasingly from rural bases. In 1994, for example, the Drug Enforcement Administration (DEA) seized 263 labs for producing methamphetamines. In 1998, the DEA seized 1,627 such labs -- a sixfold increase with most seizures in less populated areas of the West and Midwest.

What's more, illicit drugs come to rural and urban areas alike because demand for them is high. "You could build a fortified wall around the United States and you'd still have clandestine drugs coming in," says Larry Monson, president of the National Rural Alcohol and Drug Abuse Network in Toni, Wis. "As long as there's demand, there will be some kind of drug abuse."

Other factors that contribute to substance abuse in rural America include poverty, unemployment, underemployment, and the isolation or rural areas, says Monson.

Increasing treatment for drug abuse is one way to reduce substance abuse. But this requires extra money that many local governments and rural communities don't have. Dwindling populations of rural communities means that treatment providers cannot spread out their overhead costs over a large number of clients. Depressed economic conditions and lack of health insurance in these communities also erect barriers to treatment.

The attitudes and beliefs of rural people deter many from seeking help. Rural America tends to view addiction as a moral weakness, instead of the chronic disease that it is, says Monson. Thus, there's a strong stigma attached to addiction and fewer people tend to seek treatment.

Yet rural Americans are creating new ways to curb drug abuse. Improving case management is one way to cope with budget constraints. Rural areas are attempting to network and integrate their services to maximize the use of their treatment resources, adds Monson. Mental health and substance abuse providers need to screen for co-occurring disorders in patients. For instance, people who are treated for depression need to be assessed for addiction as well.

Extra law enforcement can also help. Under the Mobile Enforcement Team Program, for instance, the DEA sends a team of trained agents to rural areas to stop violent drug organizations.

"No Place to Hide" concludes that the most powerful solution of all is prevention -- programs that highlight the risks of illicit drug use. Monson agrees: "If we can reduce the drug supply, fine. And if we can't, we have to take away the appeal of drugs and show people that the alternatives are better."

The Center for Substance Abuse Prevention provides a national registry of effective prevention programs at http://www.modelprograms.samhsa.gov/. The National Rural Alcohol and Drug Abuse Network offers education and training for professionals addressing addiction in rural areas. For more information, call 715-532-9030.

--Published June 2, 2003