by Rachael Zimlich, RN, Contributing Writer

Substance use problems affect a significant portion of individuals with mental health disorders, and this link can be more pronounced in areas where support systems and access to care are limited. A new report examines state and regional trends in mental health, substance use and care access, in the hope of leading the way to increased advocacy and intervention.

Michele Hellebuyck, a program manager at Mental Health America, says the State of Mental Health in America 2018 report was compiled by calculating weighted scores of measures from the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Use and Health (NSDUH). Mental Health America’s analysis includes measures of alcohol dependence, marijuana use, heroin use and cocaine use over the past year in both adults and youths.

The report notes that 18% of adults nationally have a mental health condition, and about half of them have a concurrent substance use disorder. Half of adults with mental health disorders go without treatment for their mental health problem.

States with higher rankings in the report had better outcomes in most measures, meaning these states had lower rates of mental illness and substance use, and better access to care. Massachusetts, South Dakota and Minnesota had the highest ranking overall in mental health for both adults and youths, while Arizona, Mississippi and Nevada had the lowest, according to the report.

Substance use rankings were compiled similarly. The states with the highest rankings—and better outcomes/lower usage rates—for alcohol dependence and illicit drug use combined were Mississippi, Utah and Iowa. The states with the lowest rankings—with higher usage or dependence rates—were Vermont, Alaska and the District of Columbia.

Individual substances

Here are the report’s findings by individual substance examined:

  • For adult alcohol dependence, the highest/best rankings were found in Maine, Alabama and Utah, while the lowest were noted in Colorado, the District of Columbia and New Mexico. Youth rankings were highest in Maryland, Tennessee and Alabama, and lowest in Colorado, Texas and New Mexico.
  • Rankings for marijuana use among adults were highest in Mississippi, Iowa and Utah, and lowest in Alaska, Colorado and the District of Columbia. The report notes that use rates among adults were affected by regulation, with affordability and accessibility of marijuana higher in the 29 states that allow medical use of marijuana. The highest/best rankings for marijuana use in youths were in Utah, Iowa and Mississippi, and lowest in Oregon, Colorado and Alaska.
  • Heroin use patterns among adults were characterized by a large range, with use in the lower-ranking states roughly 4.5 times greater than in higher-ranking states. Texas, Iowa and Kansas had the highest/best rankings, while Maryland, Delaware and Alaska had the lowest/worst. For youths, rankings were highest in the District of Columbia, Wyoming and Louisiana, and lowest in Vermont, Arizona and New Hampshire.
  • Cocaine use was lowest in Utah, Mississippi and South Dakota for adults and in the District of Columbia, Mississippi and Utah in youths. Higher usage rates among adults were reported in Colorado, New Hampshire and the District of Columbia, and for youths in Arizona, California and Colorado.

Regionally, Hellebuyck tells Addiction Professional, Southern states had lower rates of alcohol dependence and drug use among adults, while Northeastern and some Western states had the highest rates.

The report also details usage of mental health services, revealing a workforce crisis created by increased access through the Affordable Care Act coupled with low compensation and high turnover for providers. Rural and low-income areas are most affected, according to the report.

The state-level data provide insight that could be useful in advocacy efforts, according to Mental Health America. “State-level data allows for a more nuanced look at the mental health disparities that are often shrouded by data presented through a national lens,” Hellebuyck says.

She cautions that the results of the study should not be viewed categorically, but from a larger perspective given the association among substance use, mental health and access to care.

“We cannot solely focus on the ranking of a state as it relates to one indicator, but step back and assess the bigger picture,” she says. “For example, despite some states holding a higher rank in the alcohol dependence and illicit drug use, they hold an overall lower rank—higher prevalence of mental illness and lower rates of access to care—when we consider other indicators. These are the distinctions that we do not want to overlook.”

She adds, “The State of Mental Health in America Report is a publication that serves as a call to action. In addition to tracking changes in prevalence rates and access to mental health care, we are understanding how these trends are affected by legislation and policy. Through this report, Mental Health America seeks to increase the dialogues and improve the outcomes for individuals and families with mental health needs.”


18% of the US have mental health issues with about half that number receiving treatment.  Pretty sobering.

Dr. Raymond Oenbrink