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South Dakota faces unique challenges in addressing substance use disorders due to its vast rural geography, limited behavioral health infrastructure, and significant Native American population that has been historically underserved. While the state’s overall population is small, overdose deaths have increased in recent years, largely driven by methamphetamine, fentanyl, and alcohol.
According to the South Dakota Department of Health, meth remains the most prevalent illicit substance, particularly in rural counties and on tribal lands. Fentanyl, while less common historically, has begun to appear more frequently in overdose cases, contributing to a rising death toll.
Access to addiction treatment is highly centralized in cities like Sioux Falls and Rapid City, where services include detox facilities, inpatient programs, outpatient clinics, and some MAT (medication-assisted treatment) options. However, many rural residents must travel great distances to receive care, and waitlists can be long.
South Dakota has not expanded Medicaid, leaving many low-income individuals without affordable insurance options for treatment. As a result, community health centers, church-based programs, and tribal health organizations often serve as frontline providers, despite limited funding and workforce shortages.
Telehealth has grown significantly, especially since the COVID-19 pandemic, helping to bring counseling and MAT maintenance to remote areas, though access remains inconsistent due to broadband limitations and technology barriers.
South Dakota’s Native American tribes—including the Oglala Sioux, Rosebud Sioux, and Cheyenne River Sioux—experience disproportionately high rates of substance use disorders, compounded by poverty, trauma, and systemic neglect. Some tribes operate their own treatment centers and integrate traditional healing practices, but underfunding and staffing constraints hinder capacity.
Harm reduction services in the state are minimal, with naloxone distribution available through public health channels, but syringe exchange programs are extremely limited due to political and cultural resistance. Faith-based recovery programs are widespread and often provide the only option in small towns, though not all are clinically based or evidence-informed.
Youth prevention is an area of concern, particularly with rising rates of vaping and alcohol use among teenagers. School-based programs are being implemented, but rural districts often lack the personnel or funding to deliver them effectively.
South Dakota’s criminal justice system has begun to explore alternative sentencing and drug courts in select counties, but incarceration remains a common outcome for drug-related offenses.
Addressing addiction in South Dakota will require investment in rural healthcare, expansion of culturally competent services, stronger support for tribal communities, and a shift toward public health-based approaches over punitive models..
 | Addiction Recovery Centers of Black HillsAddiction Recovery Centers of the Black Hills, located in Rapid City, SD, is dedicated to providing comprehensive recovery services for individuals battling substance use disorders. Our center offers a range of evidence-based treatment options, including detoxification, inpatient and outpatient programs, counseling, and aftercare support. We understand that recovery is a personal journey, and our compassionate team is here to provide guidance, support, and resources tailored to each individual’s needs. At Addiction Recovery Centers of the Black Hills, we believe in empowering our clients to reclaim their lives and build a sustainable path to wellness. Contact us today to learn more about our services and how we can assist you on your recovery journey. 1520 Haines Ave #6, Rapid City, SD 57701 | Levels of Care:outpatient Payment Options:Private Insurance Self-Pay Options Financial Aid Medicaid Military Insurance | ||
 | Alcoholism Southern HillsAlcoholism Southern Hills, located in Custer, SD, is dedicated to providing effective treatment services for individuals struggling with alcohol use disorders. Our compassionate team offers a range of programs, including detoxification, individual and group therapy, and aftercare support, all designed to promote healing and recovery. We understand that each person’s journey to sobriety is unique, and we are committed to creating a personalized treatment plan that addresses the specific needs of each client. At Alcoholism Southern Hills, we strive to create a supportive environment where individuals can regain control of their lives and embark on a path to lasting recovery. Contact us today to learn more about our services and how we can assist you on your journey to wellness. 124 N 6th St, Custer, SD 57730 | Levels of Care:Inpatientoutpatient Payment Options:Medicaid Private insurance Self-Pay Options Financial Aid Medicare Military Insurance | ||
 | Arch Residential Treatment CenterArch Residential Treatment Center, located in Sioux Falls, SD, is dedicated to providing specialized residential care for youth facing mental health challenges and emotional difficulties. Our facility offers a structured and supportive environment where young individuals can receive comprehensive treatment tailored to their unique needs. With a focus on therapeutic interventions, skill development, and family involvement, we aim to empower youth to overcome their challenges and achieve lasting wellness. Our experienced team of professionals is committed to fostering a sense of safety and belonging, guiding each resident towards a brighter future. Contact us today to learn more about our programs and how we can support your child\'s journey to recovery. 516 W 12th St, Sioux Falls, SD 57104 | Levels of Care:DetoxInpatientoutpatient Payment Options:Private Insurance Self-Pay Options | ||
 | Avera Behavioral Health HospitalAvera Behavioral Health Hospital, located in Sioux Falls, SD, is a leading facility dedicated to providing comprehensive mental health care and addiction treatment. Our hospital offers a wide range of services, including inpatient and outpatient programs, psychiatric assessments, and specialized therapies tailored to meet the unique needs of each patient. With a focus on holistic healing and recovery, our experienced team of professionals is committed to supporting individuals and families on their journey to improved mental well-being. At Avera, we believe in fostering a safe and compassionate environment where patients can find hope, healing, and lasting change. Contact us today to learn more about our services and how we can help you or a loved one. 4400 W 69th St, Sioux Falls, SD 57108 | Levels of Care:Inpatientoutpatient Payment Options:Private Insurance Self-Pay Options Financial Aid Medicare Military Insurance Medicaid | ||
 | Avera Medical Group Behavioral Health409 Summit Street Suite 3200 Yankton SD, 57078 | Payment Options:Self-pay options Financial aid Employee Assistance Program Medicaid Military insurance Medicare Private insurance | ||
 | Avera Medical Group Behavioral Health — BrookingsAvera Medical Group Behavioral Health Clinic, located at 1024 6th Street, Suite B, Brookings, SD 57006, offers quality mental health services to individuals seeking support for various behavioral health challenges. The clinic provides a range of services, including individual therapy, group counseling, and psychiatric assessments, delivered by a compassionate team of mental health professionals. Committed to promoting mental wellness, Avera Medical Group focuses on creating a safe and supportive environment where clients can work towards their recovery goals. Explore the comprehensive resources available and take the first step toward a healthier mind at Avera Medical Group Behavioral Health Clinic. 1024 6th St Suite B, Brookings, SD 57006 | Levels of Care:Inpatientoutpatient Payment Options:Medicaid Private insurance Self-Pay Options Financial Aid Medicare Military Insurance | ||
 | Avera Medical Group Behavioral Health ClinicAvera Medical Group Behavioral Health Clinic, located at 2412 South Cliff Avenue, Suite 200, Professional Plaza, Sioux Falls, SD 57105, provides expert mental health services tailored to meet the needs of individuals and families. The clinic offers a variety of services, including therapy, counseling, and psychiatric evaluations, delivered by a team of experienced professionals committed to fostering mental wellness. With a focus on holistic care, Avera Medical Group aims to create a supportive environment where clients can address their mental health challenges and work towards recovery. Explore the comprehensive resources available and take the first step towards improved mental health at Avera Medical Group Behavioral Health Clinic. 2412 S Cliff Ave Suite 200, Sioux Falls, SD 57105 | Levels of Care:outpatient Payment Options:Medicaid Private insurance Self-Pay Options Financial Aid Medicare Military Insurance | ||
 | Avera Medical Group Family Health Center1900 Cabela Drive Mitchell SD, 57301 | Payment Options:Self-pay options Financial aid Employee Assistance Program Medicaid Military insurance Medicare Private insurance | ||
 | Avera Medical Group Family Health Center2100 South Marion Road Sioux Falls SD, 57106 | Payment Options:Self-pay options Financial aid Employee Assistance Program Medicaid Military insurance Medicare Private insurance | ||
Avera St. Lukes - Worthmore Addiction Services1206 South Main Street Aberdeen SD, 57401 | Payment Options:Self-pay options Financial aid Employee Assistance Program Medicaid Military insurance Medicare Private insurance | |||
 | BAART Programs Sioux FallsBAART Programs Sioux Falls, located in Sioux Falls, SD, specializes in providing comprehensive substance use treatment services tailored to meet the needs of individuals and families. Our team offers a variety of evidence-based programs, including medication-assisted treatment, counseling, and support services designed to promote recovery and improve overall well-being. We understand that each persons journey is unique, and we are dedicated to creating a supportive and non-judgmental environment for all clients. At BAART Programs, we aim to empower individuals to achieve lasting recovery and rebuild their lives. Contact us today to learn more about our programs and how we can support you or your loved ones on the path to recovery. 2519 W 8th St, Sioux Falls, SD 57104 | Levels of Care:Detoxoutpatient Payment Options:Self-Pay Options Private insurance Medicaid Medicare | ||
 | Bartels Counseling Services, Inc.Bartels Counseling Services, Inc., located in Sioux Falls, SD, provides professional counseling and therapy services tailored to meet the diverse needs of individuals, couples, and families. Our experienced team of licensed counselors is dedicated to fostering a supportive environment where clients can explore their thoughts, feelings, and behaviors. We offer a range of services, including individual therapy, couples counseling, family therapy, and specialized programs for anxiety, depression, and trauma. At Bartels Counseling Services, we believe in empowering our clients to achieve personal growth and emotional well-being. Reach out today to learn more about our services and how we can assist you on your journey towards healing. 7520 S Grand Arbor Ct Ste 145, Sioux Falls, SD 57108 | Levels of Care:outpatient Payment Options:Private Insurance Self-Pay Options Financial Aid Medicaid | ||
Behavior Management System3 Canyon View Circle Hot Springs SD, 57747 | Payment Options:Medicaid Private insurance Self-pay options Financial aid Financing available Sliding scale payment assistance Medicare Military insurance | |||
 | Behavior Management System623 Dahl Road Spearfish SD, 57783 | Payment Options:Medicaid Private insurance Self-pay options Financial aid Sliding scale payment assistance Medicare Military insurance | ||
 | Behavior Management Systems - Crisis Care Center121 North Street Rapid City SD, 57701 | Payment Options:Medicaid Private insurance Self-pay options Sliding scale payment assistance Medicare Military insurance | ||
 | Behavior Management Systems - Elk Street350 Elk Street Rapid City SD, 57701 | Payment Options:Medicaid Private insurance Self-pay options Financial aid Sliding scale payment assistance Medicare Military insurance | ||
 | Behavior Management Systems - North Street111 North Street Rapid City SD, 57701 | Payment Options:Medicaid Private insurance Self-pay options Sliding scale payment assistance Medicare Military insurance | ||
Bluebonnet Trails Community Services Bluebonnet275 East Ellinger Eagle Butte SD, 78945 | ||||
Capital Area Counseling Service115 South Huron Street Pierre SD, 57501 | Payment Options:Medicaid Private insurance Self-pay options Financial aid Financing available Medicare Military insurance | |||
Capital Area Counseling Services803 East Dakota Avenue Pierre SD, 57501 | Payment Options:Medicaid Private insurance Self-pay options Financial aid Financing available Sliding scale payment assistance Medicare Military insurance |
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