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People are increasingly turning to online services for help with substance use concerns. There has, however, been limited research on the use of online substance use services by regional and rural populations. This study explored: (1) the experiences of care of regional and rural clients of an Australian national online text-based substance use counseling service,  Counselling Online ; (2) their reasons for accessing the service; and (3) their interaction with the counselor. We thematically analyzed transcripts of 31 online counseling sessions involving regional and rural clients seeking help for their alcohol, cannabis or amphetamine use. Regional and rural clients commonly experienced difficulties accessing local services, were often in distress, and were navigating rurally-influenced social challenges.  Counselling Online  provided support, education and helped clients explore their substance use. Clients generally found  Counselling Online  beneficial, however some counselors were unaware of the unique issues affecting regional and rural clients, such as transportation barriers and geographical isolation. Online substance use services provide useful support to regional and rural clients, however we identified several opportunities for improving the service experience for regional and rural clients. These include training online counselors on the unique experiences of regional and rural clients, adapting referrals to match client preferences, and encouraging counselors to ask about the physical location in which clients are using the service.

Regional and rural clients’ presenting concerns and experiences of care when engaging with an online substance use counseling service