Despite having the highest rate of abstinence from alcohol (compared to suburban and urban regions), rural America also has the highest lifetime prevalence of AUD. This is because rural America has a much more "all-or-nothing" approach to alcohol consumption than other regions. Fewer people are drinking, but the people who do drink are much more likely to report binge/heavy drinking.

In many rural areas, binge/heavy drinking is normalized, but seeking help for it carries a stigma. Smaller populations lead to less anonymity in peer support groups, making it seem more daunting to potentially face judgment from the community. There is also a "tough it out" mindset that can be discouraging. AUD is not treated with the same severity as other substance use disorders even though the impact can be just as severe.

• Insurance: Rural areas have the highest rate of self-employment, meaning many people do not have health insurance and even if they do, many health insurance providers do not cover behavioral therapy.

• Transportation: A lack of public transit options and long distances to local support.

• Anonymity: Smaller communities lead to less privacy in support groups.

• Awareness of options: Many people are not aware that there are medications to treat AUD and think recovery has to be done alone.

• Awareness of consequences: It is a common misconception that the liver is the only organ impacted by heavy drinking. 

• Online Peer Support: If an in-person support group is too public or transportation is an issue, find an online support community! There are chat-based and video call options offering an accessible and private alternative.

• Community Education: Encourage open dialogue about AUD. Reducing stigma around seeking help and educating about long-term consequences of heavy drinking starts on an individual level.

• Social Alternatives: Normalize social activities that do not involve drinking, de-centering alcohol makes it easier not to fall into unhealthy habits.