The prevalence of substance abuse among rural adolescents has equaled or surpassed rates in urban youth, but rural substance abusers go untreated at rates twice that of urban populations. Cultural norms adverse to help-seeking, and low availability and accessibility of substance treatment in rural areas may effect treatment utilization. The primary purpose of this study was to assess rural adolescents’ substance problem recognition and perceptions of substance abuse treatment availability and accessibility.

Participants were selected from 9th and 12th grades at Purchase Line Junior/Senior High School, in a rural county of Pennsylvania. Students were asked to complete a survey assessing their substance problem recognition, perceptions of treatment availability and accessibility, and help-seeking behavior.

Results supported the hypothesis that rural adolescents would condone relatively high levels of substance use before perceiving a need for professional help, with drug use more readily tolerated than alcohol use. However, rural adolescents had difficulty differentiating levels of substance use in vignettes. Instead, type of substance, followed closely by amount of substance used and amount of trouble that substance use caused in the life of the user, were the primary influences in determining the seriousness of a substance use problem. In accordance with hypotheses, rural adolescents also strongly perceived obstacles to obtaining treatment, especially maintaining privacy. Support for the hypothesis that rural adolescents would choose non-professional over professional sources of help, was mixed. However, a trend toward avoiding resources associated with school was observed. Furthermore, results indicated that 12th grade participants were significantly more aware of substance treatment resources. However, overall familiarity with treatment resources was relatively low, especially for more serious medical resources, and resources not directly introduced to them in school.

Recommendations include increasing the variety of treatment resources introduced to rural adolescents in school, and emphasizing components related to rights to confidentiality. It is also recommended that future research be done to explore the approximately 25% of rural adolescents who report being least likely to seek professional treatment. Research should also be done with larger samples to better examine the effect of Short Understanding of Substance abuse Survey category on treatment-seeking and utilization.