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There isn’t a single “number-one” state across every substance. By prevalence, the North-East leads for opioid use, with Mizoram at the top (≈6.9% of people 10–75 using opioids), and high rates also seen in Sikkim, Arunachal Pradesh, Nagaland and Manipur per the Government of India’s AIIMS-led national survey. For alcohol, Arunachal Pradesh records the highest proportion of drinkers in national datasets (men ~53%, women ~24%). In absolute numbers, large states like Uttar Pradesh and Maharashtra house the most people needing help, while Punjab consistently shows a heavy opioid burden and the highest recent heroin seizures.
India’s national survey (AIIMS–NDDTC, 2019) found opioid use ≈2.1% nationally. The highest state-level prevalence clusters in the North-East; analyses of the survey show Mizoram ≈6.9%, followed by Nagaland, Manipur, Arunachal Pradesh and Sikkim. These are many times the national average.
Multiple datasets (NFHS-5 reporting; press analyses) indicate Arunachal Pradesh has the highest proportion of drinkers among both men (~53%) and women (~24%). Earlier summaries also listed Chhattisgarh, Tripura, Punjab and Goa among the higher-prevalence states.
When you shift from “rate” to how many people need help, large states dominate: government assessments identify Uttar Pradesh and Maharashtra (along with Punjab, Haryana, Delhi, Andhra Pradesh) as housing the largest numbers of people with opioid-use problems.
Enforcement data aren’t the same as use, but they show pressure points. In 2024, Punjab accounted for ~44.5% of India’s heroin seizures despite being only 2.3% of the population—highlighting a serious corridor of supply and harm.`
If a loved one needs help in Mumbai or from anywhere in India, centres such as Veda Rehabilitation & Wellness offer medically supervised detox, evidence-based therapy (CBT/DBT), family counselling and relapse-prevention in a private, green setting—useful whether the concern is alcohol, opioids, or prescription-drug dependence.
Bottom line: Mizoram leads on opioid prevalence, Arunachal Pradesh on alcohol prevalence; Uttar Pradesh and Maharashtra have the largest affected populations, and Punjab shows the heaviest recent heroin seizure footprint. Different “highest” answers reflect different measures of drug harm
