Substance Abuse Patient Rates Ranked From Highest to Lowest in Each State
Approximately 195 of every 100,000 Americans are in rehabilitation centers for substance abuse. However, the exact rate varies significantly among some states. The Freedom Center ran a study to determine the states with the greatest and fewest number of substance abuse patients.
Extracting data from the National Substance Abuse and Mental Health Services Administration (SAMHSA), The Freedom Center was able to determine the states with the highest ratio of substance abuse patients in treatment. The data includes patients using alcohol and non-alcoholic substances.
These are the results, starting with states that have the highest rate of substance abuse patients.
1: Iowa
Iowa has the greatest number of substance abuse patients seeking treatment in the U.S., with 426 patients per 100,000 residents. Given the national average of 195 patients, that means Iowa has 117% more patients in substance abuse treatment centers. Sadly, Iowa isn’t a stranger to substance abuse; research published in PubMed dates back to 1983 discussing the issue.
2: Arizona
Arizona’s numbers look relatively good compared to Iowa’s, as the Grand Canyon State has 373 patients in substance abuse treatment centers compared to Iowa. Nevertheless, that amounts to a nearly 92% higher rate of patients in treatment compared to the national average.
3: Connecticut
According to the SAMHSA data that The Freedom Center analyzed, Connecticut has the third-highest rate of substance abuse patients in rehab. Out of every 100,000 Connecticuters, 353 are in treatment.
4: North Dakota
North Dakota is practically tied with Connecticut, with 352 patients in substance abuse treatment centers per 100,000 residents. That means North Dakota’s rehab centers see about 80.5% more patients than the national average.
5: Massachusetts
In the Bay State, 335 patients per 100,000 Massachusetts seek help in substance abuse centers. According to AdCare Treatment Centers, cities and towns in Massachusetts that have the highest rates of substance abuse are those with higher rates of poverty, unemployment, and homelessness.
6: New Mexico
There are 318 substance abuse patients in New Mexico for every 100,000 residents. That’s a nearly 48% higher rate than the country’s average.
7: Kentucky
Kentucky clings right beneath New Mexico, with the Bluegrass State having 317 patients in substance abuse treatment centers for every 100,000 Kentuckians. According to Kentucky’s Office of the Attorney General, overdose fatalities have increased by more than 60% since 2019.
8: Oregon
For every 100,000 residents in Oregon, 304 attend substance abuse treatment centers. In 2020, a law decriminalizing the use of hard drugs was passed. In January of this year, the local government declared a 90-day state of emergency in central Portland because of issues stemming from hard substances.
9: West Virginia
West Virginia has 303 substance abuse patients for every 100,000 residents. During the pandemic in 2020, West Virginia experienced almost three times the overdose fatalities as the national average.
10: Delaware
Delaware is the first state to drop out of the 300s for its number of substance abuse patients (294 per 100,000 residents). However, this is still a significantly higher number than the U.S. average of 195.
11: Maine
With 294 substance abuse patients per 100,000 residents, Maine has similar numbers to its northeastern Delaware counterpart. In 2022, Senator Collins quoted Dr. Marci Sorg from the University of Maine as calling Maine’s overdose epidemic “the worst it’s ever been.”
12: Indiana
For every 100,000 Indianans, an average of 285 attend substance abuse clinics. As is the case in many parts of the country, the pandemic didn’t help the situation, with Indiana experiencing a 41% increase in overdose fatalities in 2020 alone.
13: Michigan
Michigan has 274 patients in substance abuse rehab for every 100,000 residents. That’s a near-identical number to the following two states that rank below it.
14: Utah
In the Beehive State, 273 out of every 100,000 Utahans are in treatment at a substance abuse clinic. Salt Lake City has among the highest prescription drug abuse rates in the United States.
15: Ohio
Ranking just beneath Utah, Ohio has 272 patients in substance abuse rehab per 100,000 residents. According to the Columbus Recovery Center, Ohio has the fourth-highest rate of overdose fatalities in the U.S.
16: North Carolina
For every 100,000 North Carolinians, 261 patients are in treatment for substance abuse. Although harder substances often make the news these days, alcohol is also a major issue; there were 421 alcohol-impaired driving fatalities in 2018 alone.
17: New Hampshire
New Hampshire has 260 substance abuse patients per 100,000 residents. Aware Recovery Care points much of the finger at physicians who’ve prescribed high rates of opioid drugs as a reason for the Granite State’s substance abuse problem.
18: Wyoming
There’s an average of 247 Wyomingites seeking treatment in substance abuse centers for every 100,000 residents. In 2021, 65% of all drug overdose fatalities in Wyoming were at the hands of opioid overdoses.
19: Vermont
In the Green Mountain State, 237 patients per 100,000 residents are in substance abuse rehabilitation centers. Vermont has higher drinking rates compared to the national average.
20: Montana
Montana has 218 substance abuse patients in rehab for every 100,000 residents. Sadly, like much of the U.S., over 90% of Montanans don’t receive treatment for their substance abuse disorders.
21: Maryland
The Free State has 214 patients in substance abuse treatment centers per 100,000 Marylanders. Baltimore City has disproportionate issues with the opioid epidemic compared to many other parts of Maryland and the nation.
22: New York
New York is the last state to have a greater number of substance abuse patients in rehab compared to the national average. There are 212 patients for every 100,000 residents.
23: Colorado
Colorado marks the start of states with lower substance abuse patients in treatment than the national average, with 191 per 100,000 Coloradans. That said, a lower rate of patients in treatment doesn’t necessarily correspond with lower substance abuse rates in a state.
24: Rhode Island
For every 100,000 Rhode Islanders, 183 are in rehabilitation for substance abuse. An increase in local lethal substance supplies are one of the leading causes of overdose fatalities in the Ocean State.
25: South Dakota
South Dakota has 177 patients in substance abuse centers. There’s been positive progress with South Dakota’s substance abuse issue in recent years; in 2017, it started seeing a mostly downward trend of substance use disorder in grownups.
26: Washington
For every 100,000 Washington residents, 174 are in a center seeking treatment for substance abuse. To help reduce the chances of Washington youth falling into the more than 14% of American teenagers who use alcohol or other substances, the Washington State Division of Behavioral Health and Recovery started the Community Prevention and Wellness Initiative.
27: Minnesota
An average of 171 per 100,000 Minnesotans are patients in substance abuse centers. As MinnPost published, substance abuse and mental health often go hand-in-hand, with many Minnesotans and Americans as a whole using substances to help them cope.
28: Alaska
Alaska takes a relatively steep drop, with there being 153 substance abuse patients for every 100,000 residents. The Drug Enforcement Administration (DEA) points out that due to how dispersed Alaska’s population is and its geographic location, preventing substance addiction and the crime that can come with it is more challenging.
29: Tennessee
The Volunteer State has 149 patients in substance abuse centers for every 100,000 residents. According to the Tennessee Bureau of Investigation, 80% of crimes in Tennessee have some relation to drugs.
30: Idaho
There are 139 substance abuse patients for every 100,000 residents in Idaho. While overdose fatalities from substance abuse in Idaho has increased over the years, it’s remained at a lower rate than the national average.
31: Wisconsin
An average of 136 people per 100,000 residents attend substance abuse clinics in Wisconsin. According to the Wisconsin Department of Health Services, alcohol is the most common addictive substance that Wisconsinites use.
32: Pennsylvania
Pennsylvania’s rate of patients in substance abuse centers is 134 for every 100,000 residents. Overdose fatality rates are high in Pennsylvania, with 36.1 fatalities per 100,000 people.
33: New Jersey
For every 100,000 residents in New Jersey, 124 attend substance abuse rehabilitation centers. In July 2023, CBS News reported that first responders use overdose-reversing drug naloxone approximately three times per day.
34: Louisiana
There are 119 patients getting support in a substance abuse clinic for every 100,000 Louisiana residents. In early 2024, Louisiana lawmakers enacted policy changes that allow people receiving Medicaid to get support for controlling their opioid addiction.
35: Arkansas
The Natural State has 112 patients in substance abuse clinics per 100,000 residents. In January 2024, the state of Arkansas announced that it would invest $30 million into substance abuse treatment and mental health services.
36: Missouri
Missouri joins Arkansas in having 112 patients receiving substance abuse support in rehabilitation centers for every 100,000 residents. Researchers at the University of Missouri received a USDA grant to help five rural Missouri counties juggling the highest overdose fatality rates in the state to receive intervention specifically related to childhood trauma.
37: Virginia
An average of 111 residents per 100,000 Virginians attend a substance abuse rehabilitation center. Of the people 18 years and older who participated in a Virginia Behavioral Risk Factor Surveillance Survey, 16% reported binge drinking.
38: South Carolina
There are 108 South Carolina patients who attend substance abuse rehab clinics for every 100,000 residents. Studies show that 23% of South Carolina students in grades 9-12 had drank alcohol in the past month, and steps are being taken to educate parents on how to talk with their kids about substance abuse.
39: Nebraska
Nebraska has 107 patients in substance abuse rehabilitation centers per 100,000 residents. University of Nebraska sociologist Kimberly Tyler launched a National Institutes of Health-funded pilot project to support homeless youth facing substance abuse via text message. It was a success, with participants in the study saying that their cell phones served as their lifeline.
40: Georgia
Of every 100,000 residents, the Peach State has 106 patients in substance abuse treatment centers. Georgia is working hard to destigmatize addiction, which the government believes will make it easier to connect with substance abuse individuals and help get them treatment.
41: Illinois
Illinois ties with Georgia in having 106 substance abuse patients per 100,000 residents. Approximately one in six Illinoisans struggle with a substance use disorder.
42: Oklahoma
Oklahoma ranks number nine for the state with the fewest number of patients in substance abuse treatment centers. It has 105 patients per 100,000 residents.
43: Kansas
There are 100 substance abuse patients getting treatment for every 100,000 Kansans. In December 2023, the Kansas Department of Health and Environment revealed that it would be using a $2 million grant to help children who’ve been exposed to drugs.
44: Florida
Florida is the first state to drop from a triple to a double-digit number of substance abuse patients: 99 patients per 100,000 residents. But even one person struggling with a substance use disorder is one too many.
45: Nevada
For every 100,000 Nevadans, 98 are seeking treatment in substance abuse rehabilitation clinics. According to Pew Research Center, the average American 21 years and older consumed almost three gallons of alcohol in 2021. However, Nevadans averaged almost four gallons each.
46: Hawaii
The Aloha State has 93 patients in substance abuse clinics per 100,000 residents. In an article titled “New drugs, old problems with illegal substance abuse” published on KITV, reporter Paul Drewes talks about how illegal substances being added to traditional hard drugs are compounding Hawaii’s substance abuse issues.
47: Mississippi
Mississippi’s substance abuse facility treatment rate is 83 patients for every 100,000 residents. In 2023, a new Mississippi law went into effect that allows the Mississippi Department of Mental Health in charge of developing school programs to help prevent youth from becoming addicted to drugs.
48: Alabama
Alabama has the third-lowest rate of patients in substance abuse rehab centers, with 76 per 100,000 people. Of the women who seek treatment, some may find themselves at A Reprieve for Women, which is just like it sounds: A woman-focused substance abuse center.
49: California
For every 100,000 Californians, 64 attend a substance abuse treatment center. In 2023, California started an unconventional Medicaid-supported program to try to help those struggling with substance abuse to stay sober; letting them earn gift cards when testing negative.
50: Texas
Texas has the lowest rate of patients in substance abuse rehabilitation centers, with 28 patients per 100,000 residents. If you’re wondering whether that has to do with a low number of rehabilitation centers, that’s not the case; Statista reports that there are 509 substance abuse treatment facilities in Texas, among the highest in the nation. California has the highest number (1,734), and Delaware has the lowest (49).
A Painful Story
Between 1999 and 2014, the number of opioids sold in the U.S. increased by nearly four times. The problem? Researchers couldn’t find a correlation with the overall amount of pain that patients were reporting.
Getting Help
If you or someone you know needs help with substance abuse rehabilitation, contact the SAMHSA National Helpline for free, confidential support at 1-800-662-4357. You can also use FindTreatment.gov to find a rehabilitation center near you.
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