There is a need to understand the determinants of both substance use and criminal activity in rural areas to design appropriate treatment interventions for these linked problems. The present study drew on a predominant model used to assess and treat offenders—the risk–need–responsivity (RNR) model—to examine risk factors for substance use and criminal activity in a rural drug using sample. This study extends the RNR model’s focus on offenders to assessing rural-dwelling individuals using stimulants (N = 462). We examined substance use and criminal justice outcomes at 6-month (91%) and 3-year (79%) follow-ups, and used generalized estimating equations to examine the extent to which RNR criminogenic need factors at baseline predicted outcomes at follow-ups. Substance use and criminal justice outcomes improved at 6 months, and even more at 3 years, postbaseline. As expected, higher risk was associated with poorer outcomes. Antisocial personality patterns and procriminal attitudes at baseline predicted poorer legal and drug outcomes measured at subsequent follow-ups. In contrast, less connection to antisocial others and fewer work difficulties predicted lower alcohol problem severity, but more frequent alcohol use. Engagement in social-recreational activities was associated with fewer subsequent arrests and less severe alcohol and drug problems. The RNR model’s criminogenic need factors predicted drug use and crime-related outcomes among rural residents. Services adapted to rural settings that target these factors, such as telehealth and other technology-based resources, may hasten improvement on both types of outcomes among drug users.