This study describes perceptions and experiences of drug use among 32 women residing in three non-urban counties in eastern North Carolina. Participants described drug use in their families and communities as pervasive, citing both individual (e.g., depression) and systemic (e.g., few opportunity structures) causal factors. Participants with personal drug use histories described factors that helped them reduce drug use as well as the challenges of maintaining recovery in small communities. Contributions of this research include rural women’s assessment and attribution of drug use problems in both their personal lives and larger communities. Recommendations for rural drug treatment providers are offered.

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