About 48.4 million people aged 12 or older in the United States had a substance use disorder in 2024, according to SAMHSA’s National Survey on Drug Use and Health. That’s roughly 1 in 6 Americans, or 16.8% of the population in that age range. The number spans alcohol, illegal drugs, and misused prescription medications, with significant overlap between categories.
The Numbers by Substance
Alcohol remains the most common substance involved. In 2024, 27.9 million people had an alcohol use disorder, though that number has actually declined from 29.7 million in 2021. Cannabis use disorder, on the other hand, has moved in the opposite direction, rising from 16.7 million people in 2021 to 20.6 million in 2024. That jump makes cannabis the fastest-growing category of substance use disorder in the country.
Stimulant use disorders, covering cocaine, methamphetamine, and misused prescription stimulants, affected about 4.3 million people in 2024. And while the opioid crisis still drives most of the public conversation around addiction, the landscape has shifted considerably. Adults 26 and older account for roughly 79% of all opioid use disorders, and methamphetamine use disorder among that same age group surged 33% between 2016 and 2018, a trend that predated the pandemic.
These categories overlap. About 7.7 million people had both an alcohol use disorder and a drug use disorder simultaneously in 2024.
Who Is Most Affected
Young adults aged 18 to 25 have historically carried the highest rates of substance use disorders relative to their population size. But the trends within that group are mixed. Opioid use disorders among young adults dropped 40% in recent years, and heroin use disorders in the same group fell by a similar margin. Alcohol use disorders among teens and young adults have also declined significantly.
The more troubling picture is among adults 26 and older. This group has seen rising rates of cannabis and methamphetamine use disorders without meaningful declines in alcohol problems. Because adults over 26 represent the vast majority of the population, even small percentage increases translate into large absolute numbers. Progress in younger age groups has been partially offset by worsening trends in older adults.
Adolescents aged 12 to 17 show the most encouraging trajectory. Rates of alcohol, marijuana, and illicit drug use disorders among teens have all declined in recent years.
Addiction and Mental Health Overlap
About 21.2 million adults in the U.S. had both a mental health condition and a substance use disorder in 2024. This combination, sometimes called dual diagnosis, is extremely common and complicates treatment. Depression, anxiety, PTSD, and bipolar disorder frequently co-occur with addiction, and each condition tends to make the other harder to manage. People with co-occurring disorders often need integrated treatment that addresses both issues at the same time rather than treating them separately.
Most People With Addiction Don’t Get Treatment
The gap between the number of people who need help and the number who receive it is enormous. Of the roughly 48.5 million people who met the criteria for a substance use disorder in 2023, only 14.6% (about 7.1 million people) received any form of substance use treatment. That leaves more than 41 million people who qualified for treatment but didn’t get it.
The reasons are varied: cost, lack of available programs, stigma, not recognizing the problem, and long wait times for treatment slots all play a role. In many rural areas, specialized treatment simply doesn’t exist within a reasonable distance. Even in cities with more resources, insurance coverage for addiction treatment can be limited or difficult to navigate.
Overdose Deaths Are Declining
One of the few clearly positive trends is in overdose mortality. Drug overdose deaths in the U.S. fell roughly 16% in the 12-month period ending November 2025 compared to the same period a year earlier, with an estimated 70,231 deaths. That’s still a staggering number, but it marks a significant reversal after years of relentless increases that peaked above 100,000 annual deaths.
The decline is likely driven by several factors: wider availability of naloxone (the overdose-reversing medication), expanded access to medications for opioid use disorder, and shifts in the illegal drug supply. Still, more than 190 people die from overdoses every day in the U.S., so the crisis is far from over.
The Economic Cost
Beyond the human toll, substance use disorders cost the U.S. economy an estimated $92.65 billion in lost productivity alone in 2023. That breaks down to about $3,700 per adult with a substance use disorder. The largest share, $45.25 billion, came from people being unable to work at all. Another $25.65 billion was lost to missed workdays, and $12 billion to reduced performance while on the job. These productivity losses are roughly comparable to what the country spends on direct healthcare for addiction treatment, effectively doubling the total economic burden.
Men accounted for about two-thirds of the productivity losses ($61.19 billion), reflecting higher rates of substance use disorders among males. But the $31.45 billion attributed to women underscores that addiction affects both sexes at an enormous scale.