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In the context of an ongoing opioid crisis, the authors used The Calculating for an Adequate Systems Tool (CAST) to help quantify the rural community preparedness to care of people with substance use disorders (SUDs.)


CAST was developed by Green and associates in 2017. CAST uses demographics, social, and community indicators to produce a global risk score for hospitalization due to SUDs and highlights which SUD care system resource areas in the studied community are lacking or redundant. There are no human subjects involved; the majority of the required data for CAST is freely available on official national databases, making the tool accessible and low-cost. When specific data was not available through online resources, the study authors worked with key community leaders and the CAST authors to develop proxies to adapt the tool to match the data available for the subject. The study, done in 2019, used CAST on the rural community of Towner County, ND, which had been reportedly successful in terms of the opioid epidemic.


Surprisingly, the calculated hospitalization risk level was medium. Among the studied factors, however, several in the referral and recovery category were below calculated need, and most in all categories were meeting or exceeding need.


A limitation of this study is proxy development due to lack of specific data- a widespread problem in rural health. CAST and most of its required data are available online, making it an effective tool to help optimize resource allocation in the care of people with SUD.

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Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.