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Introduction: Substance abuse treatment centres for Irish rural youth have largely been overlooked in the scientific literature. This study examined data from a substance abuse treatment centre that treats both urban and rural attendees to investigate if there are differences in usage patterns between attendee groups. Methods: A cross-sectional study was done of 436 service-users attending a treatment centre: patient characteristics, treatment referral details and substance history of the attendees from urban and rural areas were compared. Descriptive analysis of the service- user population was performed and recent substance use was investigated. Inferential tests examined for differences between urban and rural service-users. Results: The typical service-user was an Irish male aged between 16 and 17 years, who resided with his parents . A greater percentage of rural service-users were employed (33 .3% vs 22.2%, p =0.015), while a significantly greater percentage of urban service-users were unemployed (10.3% vs 4.1%, p =0.015). A greater proportion of urban service-users had tried multiple substances in their lifetimes (73.7% vs 52.2%, p =0.001) and continued to use multiple substances regularly (49.3% vs 31.3%, p =0.003) compared with their rural counterparts. Conclusions: This is the first Irish study comparing service-users from urban and rural settings. Rural service-users developed more problematic alcohol use, while more urban service-users were referred for benzodiazepine use. Prevention strategies should acknowledge the differences and similarities in urban and rural young people. [ABSTRACT FROM AUTHOR]