America's substance abuse epidemic has come to rural America. Adults in small metropolitan and rural areas are just as likely as those in urban America to use and abuse illegal drugs, alcohol, and tobacco. Young teens in small metropolitan and rural areas are more likely to abuse substances than those in large metro areas. Based on a wide variety of national and state data, interviews, and a literature review, this report is the first comprehensive assessment and comparison of the incidence of substance abuse by population centers. Chapter 1 outlines statistics on the use of various illicit drugs, alcohol, and tobacco in 1998-99 by eighth-graders and adults in large metro, small metro, and rural areas; trends from 1975-99 in the use of marijuana, cocaine, and heroin; rural-urban differences in risk factors linked to substance abuse; and the supply of drugs in metro and rural areas. Chapter 2 focuses on methamphetamine, which has been spreading rapidly into rural America. This chapter outlines meth use among youth and adults, trends, regional differences, and supply characteristics. Chapter 3 addresses the consequences of substance abuse in terms of crime, health, worker productivity, families, and impact on governmental systems, and the lack of services and resources in small cities and rural areas to deal with substance abuse and its consequences. Chapter 4 describes promising strategies in raising public awareness, making better use of local resources, and improving prevention and treatment. Chapter 5 outlines the need for federal aid. (Contains extensive references.) (SV)