And, those with substance abuse problems avoid coming forward to their GP, My GP Tamworth doctor Casey Sullivan said.

"There is a strong drinking culture in Australia and alcohol is associated with pleasure, celebration and 'rites of passage'," she said.

"There's a lot of stigma and often people don't realise they have an issue or are embarrassed to come forward due to the perception that Aussie's can handle their liquor, so why can't I?"

A quarter of people who sought help in rural areas had to travel more than an hour to do so, the report showed.

At least 8 per cent of rural people drink every day at a level that puts them at long-term risk of harm, compared to just 5 per cent of city counterparts.

For some using alcohol is a way to deal with the isolation that comes with rural life, Dr Sullivan said.

"Access is the major barrier for seeking assistance in Tamworth," she said.

"Mental health is common with depression and anxiety both caused by drug and alcohol abuse and also an important cause of drug and alcohol abuse."

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There is a drug and alcohol service at Tamworth hospital and Rosalie House which provides day programs for patients.

There are no long-term rehabilitation facilities in Tamworth, the closest is Freeman House in Armidale but patients can face long wait times.

Drug use is common in the city and country, but people are doing different types.

Ecstasy and cocaine use is more prevalent in the city, slightly more people die as a result of drug-taking in metropolitan areas.

Dr Sullivan finds many patients use illicit drugs to self-medicate for depression, post-traumatic stress and personality disorders in the hope it will make them feel "normal".

"Not realising they are spiralling into addiction until it's too late," she said.

Alcohol and drug abuse can result in psychosis, obesity, liver disease and other medical conditions, she said.

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