By 1820, it was one of the largest and wealthiest towns west of the Allegheny Mountains. So cultured was its lifestyle, Lexington gained the nickname "Athens of the West." One early prominent citizen, John Wesley Hunt, became the first millionaire west of the Alleghenies. Slaves were widely held and used as laborers, field hands and domestic servants in Kentucky. In 1850, 1/5 of the state's population were slaves, and Lexington had the highest concentration of slaves in the state. However, the state attempted to remain neutral during the Civil War. Not only were both Abraham Lincoln and Confederate President Jefferson Davis born in Kentucky (less than one year and 100 miles apart), but both had spent time in Lexington. Davis attended Transylvania University in 1823 and 1824. Lincoln's wife, Mary Todd Lincoln, was born and raised in Lexington; the couple visited the city several times after their marriage in 1842.

Lexington hosted one of the first drug rehabilitation clinics, known as the "Addiction Research Center," which opened in 1935 . It also has a Federal Prison. The first alcohol and drug rehabilitation hospital in the United States of America was also know as "Narco" of Lexington, as well as the "Addiction Research Center". It is now home of a Federal Prison.

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