Top 10 US States For Drug And Alcohol Abuse
By: Brendon Rowe
Published: August 16, 2023

The abuse of drugs and alcohol has long been a concern in the United States. In the past, substance abuse has often been considered a personal vice or moral failing, but we now have a better understanding of the complex interaction between genetics, environment, and social factors that contribute to addiction. Today, drug and alcohol abuse remain a significant public health issue in the U.S. 

According to a study examining drug abuse across the 50 states and District of Columbia, using 20 key metrics such as arrest rates, overdose rates, opioid prescriptions, and employee drug testing laws, the following are the top ten states most at risk for drug and alcohol abuse



New Merxico Desert

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1.     New Mexico

The situation regarding drug abuse and alcohol-related fatalities in New Mexico is alarming. 

Like many other places in The United States, New Mexico faces a serious issue with drug use and overdoses, with an alarming figure of 51.6 fatal overdoses per 100,000 individuals within its population.  

In 2021 in New Mexico, 750 individuals lost their lives to opioid overdoses. This was 71% of all drug-related fatalities in the state for that year.

Alcohol is also a problem in New Mexico. On average, five individuals lose their lives daily as a result of complications and accidents stemming from alcohol abuse. 

State Action 

The New Mexico Opioid State Targeted Response (STR) Grant is aimed at tackling opioid misuse in the state. Funded by New Mexico’s Human Services Department’s Behavioral Health Services Division (HSD/BHSD), it has five main goals

  •     Increase the number of people who receive treatment for opioid use disorder (OUD)
  •     Increase the number of people who receive recovery services for OUD 
  •     Expand Medication-Assisted Treatment (MAT) provider numbers
  •     Increase the number of specialists qualified to treat opioid disorders
  •     Reduce opioid misuse and death 

While New Mexico has been actively working on strengthening its DUI laws to mitigate the state’s considerable alcohol problem, it appears other potential policy solutions have not received equal attention. This could be due in part to resistance from powerful players in the organized alcohol industry opposing proposals for raising taxes on alcoholic beverages. 



West Virginia

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2.     West Virginia 

Excessive alcohol use leads to a significant loss of life in West Virginia, around 28,285 people per year.

Additionally, West Virginia has seen escalating drug issues over the years. Overdose death rates have almost tripled from 36.3 per 100,000 individuals in 2011 to a high of 90.9 by the end of 2021. Specifically focusing on opioid-overdoses, 83% of all drug-related fatalities were attributed to opioids. 

This epidemic has given rise to health dangers including infectious diseases like Hepatitis B and C, liver disease, and Neonatal Abstinence Syndrome – a withdrawal syndrome in newborns resulting from maternal drug use during pregnancy. West Virginia leads nationally for Hepatitis B and C rates and houses 28 of the top 220 ‘at-risk’ counties nationwide.  

State Action 

The Office of the Attorney General in West Virginia is tackling substance abuse by devising a comprehensive approach. This includes collaborating with the U.S. Attorney’s Office to take legal action against drug-related crimes, as well as reinforcing consumer protection laws that regulate how prescription drugs are distributed. 

There’s also an ongoing effort towards establishing best practices which aim at promoting responsible opioid usage, striking a balance between pain management needs and mitigating risks tied to potential dependency or addiction.



Washington District Of Columbia

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3.     District of Columbia

Excessive alcohol use leads to an alarmingly high annual death rate of 392 people in Washington D.C., which is rising faster than anywhere else in the U.S. To put this in perspective, for every 1,759 individuals aged 18 and above, there is an average of one death attributed to excessive alcohol consumption.

Additionally, the opioid epidemic has not spared D.C. The enhanced role of fentanyl in drug overdoses within Washington, D.C., over recent years is extremely alarming. Back in 2017, this potent synthetic opioid was implicated in roughly 72% of the overdose cases registered across the city. By 2022, it is said that 96% of overdoses in D.C. involved fentanyl. 

State Action

Pooling collective efforts from both public authorities and non-government bodies, LIVE. LONG. DC. is an initiative squarely aimed at fighting the opioid crisis. 

The collaboration emphasizes strategy development for shaping perceptions, attitudes, conditions, and behaviors that have potential to indirectly fuel opioid use in the community.

Importantly, it advocates for the implementation of harm reduction services, including syringe service programs and distributing free naloxone. Additionally, they’re committed to providing high quality treatment access to all who need it. 



Louisiana Swamp

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4.     Louisiana 

In Louisiana, alcohol and drug abuse is a severe issue that needs immediate and serious attention. In 2021, opioids caused 1,384 deaths in Louisiana. All drugs, including opioids, caused 2,722 deaths, bringing the drug overdose death rate to 55.9 per 100,000 people. 

The situation with alcohol-related fatalities is no different – there are a startling number of alcohol-related deaths each year –  2,278.

State Action

The Office of Behavioral Health (OBH) in Louisiana fights against addictive disorders like opioid use. They provide prevention services in each district across the state. OBH considers the impact on families, not just individuals. They use cost-effective, science-supported methods to track and ensure progress.



Colorado Mountains

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5.     Colorado 

In Colorado, around 2,623 deaths each year are due to excessive alcohol use. In these cases, approximately two-thirds (67.7%) are males. Meanwhile, a small portion, 2.78%, are under 21.

The deaths due to fentanyl poisoning increased slightly in 2022 to 920 from 912 in 2021. The rate of death from drug overdoses in Colorado is 31.4 per 100,000 people. 

State Action

The Community Prevention and Early Intervention Program funds local communities in Colorado to implement proven prevention programs. The goal is to reduce substance misuse and increase wellness. These programs focus on preventing the misuse of all substances, both legal and illegal, and reducing risks while increasing protective measures. 



Louisiana Missouri City Center

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6.     Missouri 

Approximately 2,877 deaths each year in Missouri are caused by excessive alcohol use. Of these, 3.72% are under 21 years old.

Among the adult population (18 and older), there is an average of one death from excessive alcohol use for every 2,139 people, or about 6.02 deaths for every 10,000 adults.

In Missouri, the top cause of death for adults aged 18 to 44 is drug overdose, with over 70% involving opioids. The drug overdose death rate is 36.5 per 100,000 people. 

State Action

The Division of Behavioral Health (DBH) in Missouri offers statewide programs for people dealing with substance use disorders or mental illnesses. These programs cater to different age groups, from youth to adults. The cost of the services depends on what the individual can afford. Priority for substance use treatment is given to pregnant women, intravenous (IV) drug users, and certain referrals from other state agencies.



Little Rock Arkansas At Night

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7.     Arkansas 

Around 1,407 deaths per year in Arkansas are caused by excessive alcohol use. For every 2,140 adults aged 18 and older, there is an average of one alcohol-related death.

In 2021, Arkansas recorded 386 opioid overdose deaths, making up 61% of all drug overdose deaths. The rate of drug overdose deaths in the state increased from 12.6 per 100,000 people in 2011 to 22.3 per 100,000 in 2021. 

State Action

In 2019, Act 964 was approved by the General Assembly in Arkansas. This law stops healthcare insurers, including Arkansas Medicaid, from requiring prior authorization for medication-assisted treatment for opioid addiction.

In 2021, the General Assembly continued to address substance abuse. They passed Act 651 which demands healthcare providers to co-prescribe an opioid antagonist, like naloxone, under specific conditions when they prescribe opioids. This law helps to prevent fatal overdoses from opioid use.



Nevada Desert

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8.     Nevada 

Around 1,548 deaths a year in Nevada are caused by excessive alcohol use. Roughly 2.39% of these deaths are people under the age of 21.

Meanwhile, opioid-related overdose deaths have shown an increase in the state. The rate rose by 5% from 16.2 per 100,000 residents to 16.9. This indicates a growing concern over opioid use in Nevada. 

State Action

The Overdose Data to Action Program helps Nevada gather and analyze data on opioid prescribing and mortality. This information drives the state’s prevention efforts. 

Four major goals guide this program:

  1. Use high-quality data to make better decisions, allocate resources efficiently, and develop effective intervention strategies.
  2.  Improve the Prescription Drug Monitoring Program for evidence-based prescribing while sharing data to boost prevention efforts.
  3.  Streamline referral processes so more individuals can access health services from clinical or community-based settings for substance use issues including opioid use.
  4. Raise public awareness about opioid use risks, stigma related to Opioid Use Disorder (OUD), as well as treatment options and recovery paths available in communities across Nevada.=



Oklahoma Planes

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9.     Oklahoma 

Each year in Oklahoma, about 2,104 deaths are due to excessive alcohol use. Most of these (85.0%) occur in adults aged 35 years and older, while 2.76% happen to those under the age of 21.

The number of fentanyl overdose deaths witnessed a significant six-fold increase from 2019 to 2021 – going up from just 47 cases to 297. In 2021, nearly three out of four opioid-related overdose deaths involved fentanyl. The drug overdose death rate is 4.4 per 100,000 people.

State Action

The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) supports programs that aim to prevent substance abuse and mental health problems among the state’s youth.

2Much2Lose (or 2M2L) is one such initiative focused on curbing underage drinking in Oklahoma. ODMHSAS aids in setting up local school or community-based 2M2L Chapters. These Chapters are driven by youth and work towards preventing underage alcohol consumption as well as other community challenges.




Photo by Brad West on Unsplash

10.  Michigan

Each year around 4,548 deaths in Michigan are due to excessive alcohol use. Of these deaths, about 84.44% are adults aged over 35 while a much smaller percentage (2.57%) is comprised of individuals under the age of 21.

Between 1999 and 2021, opioid overdose deaths in Michigan increased from 118 to 2,809. In fact, in 2018, more people died from drug overdoses than car accidents. The drug overdose death rate is 31.5 per 100,000 people.

State Action

The Michigan Department of Health and Human Services is actively addressing this problem. They provide naloxone nasal spray – a life-saving drug that can reverse opioid overdoses – to jails, law enforcement, and community organizations.

Further tackling the opioid crisis, Governor Gretchen Whitmer signed laws in 2022 investing $800 million into treatment and prevention efforts and mental health support. The legislation also oversees the use of lawsuit settlement funds related to opioids and establishes an advisory commission for policy creation.

There are many other states that didn’t make the list – like New York – but still have serious issues with substance abuse. The significance of understanding and discussing the topic of drug and alcohol abuse cannot be overstated. The United States has been battling the issue of substance abuse for decades, and while much progress has been made in recent years, there is still a long way to go. Just know that no matter what state you’re located in, there is help available