While about 19% of Americans use drugs to relax almost every day, a nation-leading 28% of West Virginians report near-daily drug use.

The Gallup-Healthways Well-Being Index, which measures a range of metrics to determine the well-being of Americans, includes a measure of near-daily drug use. Residents of each state were asked how frequently they use drugs or medications, including prescription drugs, that affect their mood or help them relax.

The interpretation of the description of mood-altering drugs could also include alcohol and nicotine. However, a review of the Well-Being Index suggests survey-participants reported predominantly prescription and recreational drug use, according to Dan Witters, research director of the Gallup-Healthways Well-Being Index.

Click here to see the states using the most mind-altering drugs. 

More frequent drug use counts against the state’s well-being index score. It is not surprising, therefore, six of the states where residents are using drugs most frequently are also among the states with the lowest well-being scores. In fact, drug usage and a number of well-being measures are closely related to one another. Witters explained that high drug use can be both an outcome and a factor in well-being as many of the outcomes and factors are often related.

For example, physical pain will increase the likelihood of drug use. More prevalent physical pain, in turn, can be the result of poor health conditions. And while using drugs to relax may alleviate pain, high levels of drug use can increase the likelihood of negative outcomes.

Witters noted using drugs frequently can lower the chances of graduating high school or pursuing further education. Less than 85% of adults in five of the the states using the most mind-altering drugs had attained at least a high school diploma, lower than the national attainment rate of 86.6%. Similarly, while nearly 30% of Americans had at least a bachelor’s degree in 2013, less than 25% of adults in six of these 10 states had done so.

As a result, according to Witters, many people who use drugs frequently may also be less employable. The unemployment rate in six of the states using the most mood-altering drugs exceeded the national annual rate of 7.4% in 2013.

And this relationship goes the other way as well. “If I’m in a rotten job where I don’t like what I do each day and I’m trapped in it and I can’t leave cause I can’t find another job, then that might increase the chances that I’ll want to go use drugs,” said Witters.

Residents in these states also tended to have lower incomes than in many other states. Only Rhode Island — one of just two states where more than one-quarter of residents reported near daily drug use — had a higher household median income than the national figure of $52,250.

To determine the states using the most mind-altering drugs, 24/7 Wall St. reviewed the percentage of state residents reporting near-daily drug use to relax based on interviews conducted between January and December 2014 for the latest Gallup-Healthways Well-Being Index. We also considered data from the U.S. Census Bureau’s 2013 American Community Survey, including median household income, poverty rate, and adult educational attainment rates. From the Bureau of Labor Statistics, we reviewed annual state unemployment rates from 2013. We also reviewed 2013 obesity and teen pregnancy rates from the Centers for Disease Control and Prevention. Incidence of heart disease in 2013 is from the Kaiser Family Foundation. Cancer deaths and the number of years lost due to premature death are from the United Health Foundation. Admittances to drug rehabilitation centers are from the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration.

These are the states using the most mind-altering drugs.

10. Oregon
> Pct. of population using mind-altering drugs almost every day: 21.9%
> Median household income: $50,251 (23rd lowest)
> Poor mental health days in past 30 days: 4.3 (7th highest)
> 2013 unemployment rate: 7.7% (15th highest)

Nearly 22% of Oregon residents said they used mood-affecting drugs or medications nearly every day, the 10th highest share of all states. Frequent drug use may be tied to negative health outcomes. In Oregon, however, there were 210 cardiovascular-related deaths per 100,000 state residents from 2010 through 2012, the fifth lowest rate in the country. This was also the only such rate among the states using the most mind-altering drugs not to exceed the national rate of 251.4 cardiovascular deaths per 100,000 people. Similarly, 26.5% of Oregon residents were obese in 2013, the 15th lowest rate and exceptionally low compared to other states with high drug use. In November 2014, Oregon voters approved a ballot measure legalizing marijuana for recreational use effective July 1, 2015.

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9. Indiana
> Pct. of population using mind-altering drugs almost every day: 22.1%
> Median household income: $47,529 (17th lowest)
> Poor mental health days in past 30 days: 4.0 (11th highest)
> 2013 unemployment rate: 7.5% (18th highest)

Indiana was the most populous of the 10 states where residents acknowledged using drugs most frequently. Indiana also had the third lowest well-being score in the Gallup-Healthways index, which takes into account drug use. Indiana has been struggling economically. The state’s 7.5% unemployment rate was higher than the national rate, and its poverty rate of 15.9% was also relatively high. In addition to the relatively high level of drug use in Indiana, Hoosiers also have relatively high rates of obesity, nearly 32%, and cancer deaths, 208.2 per 100,000 — each ninth highest in the country — which may lead to or be caused by frequent drug use.

8. Missouri
> Pct. of population using mind-altering drugs almost every day: 22.2%
> Median household income: $46,931 (14th lowest)
> Poor mental health days in past 30 days: 3.8 (21st highest)
> 2013 unemployment rate: 6.5% (18th lowest)

Drug use is a major factor in the well-being of a state’s residents. Missouri had the 10th lowest well-being score in the Gallup-Healthways index. As Witters suggested, frequent drug use and financial well-being are closely related. Missouri residents have relatively low incomes. A typical household earned less than $47,000 in 2013, one of the lower incomes nationwide. As in most states reporting high levels of drug use, more than 22% of Missouri adults reported a smoking habit, versus 18.2% of Americans. Both factors contributed to Missouri having the 10th highest rate of cardiovascular-related deaths. Researchers linked both smoking and drug abuse to the disease.

7. Mississippi
> Pct. of population using mind-altering drugs almost every day: 22.3%
> Median household income: $37,963 (the lowest)
> Poor mental health days in past 30 days: 4.3 (7th highest)
> 2013 unemployment rate: 8.6% (6th highest)

Low income can increase the likelihood of drug use. With the lowest median annual household income in the country, Mississippi also has the seventh highest rate of adults using mood-altering drugs almost daily, at 22.3%. Mississippi had the highest poverty rate in the country at 24.0%, and the sixth highest unemployment rate at 8.6%. Mississippi is one of the least educated states in the country with only 82.4% of adults having completed high school, third lowest nationwide. Negative health outcomes are also fairly common in the state. More than 35% of Mississippi residents were obese in 2013, the highest in the country. In addition, the state had the second highest cancer rate, at 223.7 per 100,000 residents, and the highest rate of cardiovascular deaths, at 346 per 100,000. Using drugs daily can increase the likelihood of these poor health outcomes, just as poor physical health can increase the likelihood of frequent drug use. Mississippians had the highest rate of premature death before age 75, with an estimated total of more than 10,300 years of potential life lost per 100,000 residents.

6. South Carolina
> Pct. of population using mind-altering drugs almost every day: 22.8%
> Median household income: $44,163 (7th lowest)
> Poor mental health days in past 30 days: 3.8 (21st highest)
> 2013 unemployment rate: 7.6% (16th highest)

South Carolina residents had the nation’s seventh lowest median annual household income at $44,163. The state’s 18.6% poverty rate was the country’s ninth highest. Economic factors such as these may have contributed to 22.8% of adults acknowledging near daily use of mind-altering drugs. South Carolina’s 31.7% obesity rate was the 10th highest rate in the country and could be a cause or result of the high rate of drug use. South Carolina had the ninth highest rate of premature death — before age 75 — in the country with an estimated total of more than 8,600 years of potential life lost per 100,000 residents. While the state reported a relatively high level of drug use, it reported only six hospital admissions per 100,000 residents aged 12 and older for heroin abuse in 2011, the fifth lowest number of admissions per 100,000 in the country. By contrast, the national rate is 105 per 100,000 residents.

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5. Louisiana
> Pct. of population using mind-altering drugs almost every day: 22.9%
> Median household income: $44,164 (8th lowest)
> Poor mental health days in past 30 days: 4.2 (8th highest)
> 2013 unemployment rate: 6.2% (15th lowest)

Like many of the states with high rates of drug use, Louisiana had both a relatively low median annual household income and a high poverty rate. Louisiana’s 2013 median income of $44,164 was about $8,000 below the national median income and eighth lowest of all states. The 19.8% of residents living below the poverty line was four percentage points above the national rate and third highest of all states. Obesity can increase the likelihood of drug use just as it is often a side-effect of many prescription medications. In Louisiana, about 33.1% of residents were obese, sixth highest in the country. Other negative health outcomes were also common. There were 217.4 cancer deaths per 100,000 people in the state, the fourth highest rate in the country, and the death rate from cardiovascular disease was 307.5 per 100,000, also the fourth highest in the country.

4. Alabama
> Pct. of population using mind-altering drugs almost every day: 24.2%
> Median household income: $42,849 (4th lowest)
> Poor mental health days in past 30 days: 4.4 (4th highest)
> 2013 unemployment rate: 6.5% (18th lowest)

As in most states reporting frequent drug use, high levels of drug usage in Alabama is associated with negative socio-economic and health outcomes. Alabama had the fourth lowest median income in the country, almost $10,000 below the national median. The state’s 18.7% poverty rate in 2013 was fifth highest in the country and almost three percentage points above the national rate. About 40.3% of Alabama residents suffer from high blood pressure, the second highest rate of any state in the country. Also, the state’s obesity rate of 32.4% was eighth highest. Both conditions, while sometimes cited as outcomes of drug use, can also result in frequent drug use.The cancer death rate, at 211.5 per 100,000 residents, was also eighth highest in the country. The heart-disease related death rate of more than 329 per 100,000 residents was the second highest rate nationwide and considerably higher than the national rate of just over 251 per 100,000 Americans.

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3. Kentucky
> Pct. of population using mind-altering drugs almost every day: 24.5%
> Median household income: $43,399 (5th lowest)
> Poor mental health days in past 30 days: 4.5 (the highest)
> 2013 unemployment rate: 8.3% (7th highest)

Kentucky, with the third highest rate of frequent use of mind-altering drugs, had the fifth lowest median annual household income in the country in 2013 at $43,339, about $9,000 below the national median income. It also had the sixth highest poverty rate, 18.8%, and the fourth highest percentage of food stamp recipients, 17.4%. Together with the state’s 8.3% unemployment rate in 2013, Blue Grass State residents faced financial challenges which may partly explain why 41.2% of residents reported getting fewer than seven hours of sleep per night. The percentage of residents getting insufficient sleep was second only to Hawaii’s 41.5%. The state also had the highest rate of cancer deaths in the nation at 228.3 per 100,000 residents, perhaps a result of having the second highest rate of adult smokers. Smoking and the state’s 33.2% obesity rate — fifth highest in the country — could also have contributed to Kentucky’s relatively high rate of cardiovascular deaths at more than 297 per 100,000, eighth worst in the country.

2. Rhode Island
> Pct. of population using mind-altering drugs almost every day: 25.9%
> Median household income: $55,902 (18th highest)
> Poor mental health days in past 30 days: 3.8 (21st highest)
> 2013 unemployment rate: 9.5% (2nd highest)

Rhode Island is the only Northeastern state among the 10 states with the highest near daily mood-altering drug use. More than a quarter of residents reported such drug use. Although it had a 9.5% unemployment rate in 2013, second highest in the country, Rhode Island does not fit the general pattern of any of the other top 10 drug-use states in other ways. The state’s median annual household income was higher than the national median income, and it is the only state among the top 10 to have a lower poverty rate than the national rate. Unlike most states with the highest levels of drug usage, Rhode Island residents also do not report especially poor health outcomes. The state’s cancer death rate of 189.9 per 100,000 residents was inline with the national rate. The cardiovascular death rate of 229.1 per 100,000 was below the nation’s 251.4 deaths per 100,000 residents. The premature death rate before age 75 amounted to 6,049 years of potential life lost per 100,000 residents, below the national comparable rate of 6,976 years per 100,000.

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1. West Virginia
> Pct. of population using mind-altering drugs almost every day: 28.1%
> Median household income: $41,253 (3rd lowest)
> Poor mental health days in past 30 days: 4.4 (4th highest)
> 2013 unemployment rate: 6.5% (18th lowest)

West Virginia had the highest percentage of residents reporting near daily mood altering drug use at 28.5%, more than 2 percentage points higher than second ranking Rhode Island. The Mountaineer State faces some of the most difficult economic challenges in the nation. It had the third lowest median annual household income at $41,253, more than $10,000 below the national median. It also had one of the highest poverty rates at 18.5%, and the 10th highest percentage of food stamp recipients at 16.2%. West Virginians demonstrated a number of unhealthy habits, which, combined with the high rate of near daily drug use, could produce negative outcomes. The state, for example, had the highest smoking rate of any state at 27.3% of adults, much higher than the national 18.2% rate. Like many of the states with high rates of near daily drug use, West Virginia had a high obesity rate at 35.1%, matching Mississippi for worst in the nation. It also had the largest percentage of residents with high blood pressure at 41%. West Virginia also had the third highest cancer death rate and the sixth highest rate of cardiovascular deaths.

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