Colorado stands out as the only state which is a top consumer of all four substances. The state’s heavy consumption of marijuana is predictable given that the drug is legal there. The other three legalization states are heavy consumers of pot, too (Washington, Alaska and Oregon; the latter is also a leader in non-medical use of prescription opioids). But residents of the mile-high state are also heavy consumers of all non-marijuana intoxicants as well.
Northern New England is another notable concentration of heavy use, with a cluster of states that are top consumers of multiple substances. Although the opioid overdose crisis in that part of the country has attracted extensive attention, none of the New England states is among the nation’s highest for non-medical consumption of prescription painkillers. Instead, Vermont, Massachusetts and New Hampshire are leading consumers of alcohol, marijuana and cocaine, with Maine and Connecticut also being leaders in two of those three. New York, in contrast, is a top consumer of only cocaine.
Like Colorado, Washington, D.C., is a center of extensive substance use despite not being in a particularly heavy-consuming part of the country. Despite being different from northern New England in almost every respect, the District has similar substance consumption patterns, ranking among the nation’s leaders for cocaine, alcohol and marijuana use.
As the most religious region of the country, the Southeast and Bible Belt have long tended to have lower consumption of intoxicating substances — particularly alcohol — than the rest of the country. Yet non-medical painkiller use is an exception to this general rule, with most of its top consumers being in or near this region: Oklahoma, Arkansas, Louisiana, Alabama, Virginia, Maryland and Ohio.
The Midwest and Plains states are not leading consumers of any of the three illicit drugs. But Wisconsin, Minnesota and North Dakota are all national leaders in their proportion of drinkers, continuing a pattern established during the period of heavy migration from Scandinavia and beer-loving, beer-brewing Germany.
Turning to the west, three neighboring states are notable for their substantial consumption of cocaine (California, Arizona and New Mexico), which is likely facilitated by their being on the border across which the bulk of this drug is imported into the United States. Arizona is also a leader in non-medical use of opioid painkillers.
The variation in substance use pattern across states is produced by differences in state laws, industry regulations, localized traditions, regional illegal drug market dynamics, cultural and religious norms, and the racial, ethnic and economic characteristics of populations. The optimistic implication is that since cultural and political forces have the power to shape substance consumption patterns, they almost certainly also have the ability to limit the extent to which substance use results in harm to users and those around them.
Keith Humphreys is a professor of psychiatry at Stanford University.