This report examines alcohol, tobacco, and other drug use in rural parts of Indiana, as well as public and private initiatives to reduce these problems. The report is based on epidemiological, health, and criminal justice indicators; focus groups; and in-depth interviews with local officials, researchers, service providers, and civic leaders. Chapters 1-2 outline key findings, provide a profile of rural Indiana, and characterize state and local agencies and state priorities. Chapter 3 reports on substance abuse in rural Indiana: use of tobacco, alcohol, illicit drugs, prescription drugs, and over-the-counter drugs; availability of drugs; perceptions and attitudes; and prevention needs and services. Chapter 4 discusses crime: drug offenders, use among arrestees, drinking and driving, drug seizures, tobacco sales to minors, treatment for criminals, and drug courts. Chapter 5 reports on the impact on health: deaths; newborns; HIV/AIDS; and treatment services, needs, and utilization. Chapter 6 lists costs of substance abuse related to tobacco, newborn care, alcohol-related crashes, HIV/AIDS, welfare, foster care, treatment and prevention, and prisons. Rural issues, local leadership, youth prevention, treatment, criminal justice, and tobacco control are discussed in the final chapter on looking to the future. Separate sections within some chapters profile specific prevention, criminal justice, treatment programs, and collaborative ventures. Key findings focus on high rates of substance use among rural youth; needs for alcohol and drug treatment in prisons; lack of information on the effectiveness of classroom prevention and other programs; rural transportation obstacles to treatment; the ineffectiveness of local coordinating councils; and inconsistent reporting practices. Contains 73 references. An appendix lists Indiana resources, publicly-funded managed care providers for addiction treatment, county risk factors and programs, and local coordinating councils by county. (SAS)