Alcohol use disorder is the most common substance use disorder in the United States, affecting roughly 27.9 million people ages 12 and older in 2024. That said, the gap has narrowed significantly in recent years. Drug use disorders collectively affected a nearly equal share of the population, rising from 8.7% in 2021 to 9.8% in 2024, while alcohol use disorder actually declined from 10.6% to 9.7% over the same period. In total, about 48.4 million Americans (16.8% of people 12 and older) had some form of substance use disorder in the past year.
Alcohol Use Disorder by the Numbers
Alcohol use disorder (AUD) has held the top spot for decades, largely because alcohol is legal, socially normalized, and widely available. As of 2022, more than 29 million people ages 12 and up met the criteria. The 2024 numbers from SAMHSA’s national survey show a slight decline to 27.9 million, suggesting a modest downward trend even as overall substance use disorder rates climb.
Despite its prevalence, AUD is dramatically undertreated. Among those 27.9 million people, only about 2.5% (roughly 697,000) received medications specifically designed to treat alcohol use disorder. That treatment gap is far wider than for other substances. Many people with AUD never seek help because they don’t recognize their drinking as disordered, or because cultural attitudes treat heavy drinking as normal.
Where Other Substances Rank
After alcohol, the most commonly diagnosed substance use disorders involve tobacco, cannabis, and opioids. Tobacco use disorder peaks around age 27 and affects a large share of the population, though it’s sometimes discussed separately from other substance use disorders in public health data. Cannabis use disorder tends to be highest at age 18, with rates declining steeply through the twenties.
Opioid use disorder gets the most public attention due to overdose deaths, and the numbers are substantial. An estimated 4.8 million people had a past-year opioid use disorder in the 2024 survey, and a separate CDC analysis estimated that about 9.4 million U.S. adults needed opioid use disorder treatment in 2022. Treatment uptake is better than for alcohol but still low: only 17% of people with opioid use disorder received targeted medications.
Age and Demographics Shape the Pattern
Substance use disorders are not evenly distributed across age groups. Nearly every type peaks in the twenties and declines from there, though the specific timing varies. Alcohol use disorder hits its highest rates around age 25 for men (32%) and age 22 for women (24%), then drops steadily. Very few people over 75 meet the criteria for AUD. Cannabis use disorder starts high at 18 and falls off sharply by 30. Opioid use disorder also trends downward with age, but with an interesting wrinkle: men have higher rates in young adulthood, while women actually surpass men at older ages, roughly between 68 and 77.
Race and ethnicity influence patterns as well. White Americans have the highest peak rates of alcohol use disorder (around 32%) compared to Black (23%) and Latino (23%) Americans. But these differences shift with age. For tobacco use disorder, a crossover occurs around age 60, where Black Americans develop higher rates than White Americans. Cannabis use disorder is more prevalent among Black Americans from ages 20 through 66 compared to other groups. These patterns reflect complex interactions between social environment, economic factors, and access to substances rather than biological differences.
How Substance Use Disorder Is Diagnosed
Clinicians use a set of 11 criteria to diagnose any substance use disorder, regardless of the substance involved. Meeting 2 or 3 of these criteria qualifies as mild, 4 or 5 as moderate, and 6 or more as severe. The criteria fall into four categories that capture how the disorder disrupts a person’s life.
The first group involves loss of control: using more than you intended, wanting to cut back but not being able to, spending large amounts of time obtaining or recovering from the substance, and experiencing cravings. The second group covers social consequences, like failing to meet responsibilities at work or home, continuing to use despite relationship problems, or dropping activities you used to enjoy. The third involves risky behavior, such as using in physically dangerous situations or continuing despite knowing the substance is harming your health. The final two criteria are tolerance (needing more to get the same effect) and withdrawal (feeling physically ill when you stop).
These same 11 criteria apply whether the substance is alcohol, opioids, cannabis, or anything else. The diagnosis changes only in which substance is involved and how many criteria the person meets.
The Role of Co-Occurring Mental Health Conditions
Substance use disorders rarely exist in isolation. About 36.5% of people with any substance use disorder also have a co-occurring psychiatric condition, a situation often called dual diagnosis. That overlap isn’t coincidental. People with dual diagnosis tend to face compounding disadvantages: poor mental health-related quality of life, childhood trauma (including neglect and sexual abuse), homelessness, incarceration, and limited social support. Having more than one substance use disorder diagnosis also increases the likelihood of a co-occurring mental health condition.
This overlap matters practically because treating one condition without addressing the other tends to produce poor outcomes. Someone managing depression alongside alcohol use disorder, for example, often finds that each condition fuels the other. Integrated treatment that addresses both simultaneously in an accessible setting produces better results than treating them separately.
Why the Gap Between Alcohol and Drug Disorders Is Closing
The convergence of alcohol and drug use disorder rates reflects two simultaneous trends. Alcohol use disorder has been gradually declining, possibly due to shifting drinking habits among younger adults, who report drinking less than previous generations. At the same time, drug use disorders have been climbing, driven in part by the ongoing opioid crisis and increased availability of synthetic drugs. Between 2021 and 2024, drug use disorder prevalence jumped by more than a full percentage point while alcohol use disorder dropped by nearly a point. If these trends continue, drug use disorders collectively could overtake alcohol as the most common category within a few years, even though no single drug comes close to alcohol’s individual prevalence.