The analysis defined substance abuse as involvement with illegal drugs, illegal use of drugs such as alcohol or prescription medicine, or drug use linked to other criminal activity or needing treatment. The survey data reviewed showed that total substance abuse rates are similar in rural and nonrural states and that alcohol is by far the most widely abused substance. However, the use of cocaine appears to be lower and the use of inhalants appears to be higher in rural areas. Arrest rates for substance abuse violations are as high in rural areas as in nonrural areas. In addition, most prison inmates in rural states have abused alcohol, other drugs, or both, but too few treatment services exist for inmates. Results suggested that rural areas should pool resources and coordinate efforts if they are to provide effective drug abuse prevention, treatment, and law enforcement. Footnotes, tables, appended tables, and 70 references