Substance Abuse Statistics in the US 2026 | Key Facts

Substance Abuse in the US 2026

Substance abuse in the United States remains one of the nation’s most pressing public health challenges, affecting millions of Americans across all age groups, geographic regions, and demographic categories. The 2024 National Survey on Drug Use and Health (NSDUH), released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in July 2025, provides the most comprehensive and current snapshot of substance use patterns, revealing that 168 million people aged 12 or older—representing 58.3% of this population—used tobacco, vaped nicotine, used alcohol, or used an illicit drug in the past month. This marks the first year since 2020 with at least four years of comparable data, enabling researchers and policymakers to identify emerging trends in America’s ongoing battle with substance use disorders. The survey, based on responses from nearly 70,000 individuals, demonstrates both encouraging improvements and concerning setbacks in the nation’s behavioral health landscape.

The substance use disorder statistics in US 2024 reveal that 48.4 million people aged 12 or older—approximately 16.8% of this population—met diagnostic criteria for a substance use disorder (SUD) in the past year, including 27.9 million with alcohol use disorder, 28.2 million with drug use disorder, and 7.7 million with both conditions. Despite the availability of evidence-based treatments, a staggering 80% of people who needed treatment for substance use disorders did not receive it, with only 10.2 million people (or 19.3% of those needing treatment) actually receiving care in 2024. This enormous treatment gap, combined with rising rates of certain substance use categories including marijuana, hallucinogens, and drug use disorders, underscores the complexity of addressing substance abuse in contemporary America. This article presents verified, comprehensive statistics from US government sources to illuminate the current state of substance abuse, treatment access, recovery patterns, and the co-occurrence of mental health issues that characterizes the substance abuse crisis in US 2026.

Key Substance Abuse Facts and Latest Statistics in the US 2024-2026

Data Source: SAMHSA 2024 National Survey on Drug Use and Health (NSDUH) Key Indicators Report (July 2025); SAMHSA Press Release (July 28, 2025); SAMHSA Proclamation on SUD Treatment Month (January 2026)

The comprehensive substance abuse statistics in US 2024-2026 paint a complex picture of a nation grappling with multiple overlapping substance use challenges. The most commonly used substance remains alcohol, with 134.3 million Americans reporting past-month use, making it far more prevalent than any other psychoactive substance. Tobacco product use showed encouraging declines, dropping from 20.1% of the population in 2021 to 16.7% in 2024, representing significant progress in reducing combustible tobacco consumption through public health campaigns, taxation policies, and expanded cessation support. Conversely, marijuana use demonstrated a concerning upward trajectory, rising from 13.2% in 2021 to 15.4% in 2024, with 44.3 million Americans using marijuana in the past month—an increase that public health experts attribute to expanding legalization, decreased risk perception, and commercialization of cannabis products in states that have enacted adult-use policies.

The substance use disorder burden affecting 48.4 million Americans represents an enormous public health challenge, with drug use disorders increasing from 8.7% in 2021 to 9.8% in 2024 while alcohol use disorders decreased from 10.6% to 9.7% during the same period. The catastrophic treatment gap, with 80% of people needing substance use disorder treatment failing to receive it, stands as perhaps the most damning indictment of America’s behavioral health system. Only 10.2 million people out of 52.6 million who needed treatment actually received care in 2024, leaving 42.4 million Americans with unmet treatment needs. Common barriers include stigma surrounding addiction, prohibitive costs, lack of knowledge about available resources, insufficient health insurance coverage, geographic barriers in rural areas, shortage of qualified treatment providers, and waiting lists at treatment facilities. The co-occurrence of substance use disorders and mental illness affects 21.2 million adults, with 34.5% of adults with any mental illness also meeting criteria for substance use disorder, highlighting the interconnected nature of behavioral health conditions that demands integrated treatment approaches.

Substance Use by Type in the US 2024-2026

Data Source: SAMHSA 2024 NSDUH Key Indicators Report; SAMHSA NSDUH Press Release (July 2025); SAMHSA Blog Post on 2024 NSDUH Results

Substance use patterns by type in the US 2024-2026 demonstrate the dominance of legal substances, with alcohol and tobacco products accounting for the vast majority of substance use, though marijuana’s rising prevalence is narrowing historical gaps. Alcohol consumption at 134.3 million past-month users makes it by far the most widely used psychoactive substance, deeply embedded in American social, cultural, and recreational contexts despite its association with significant health harms including liver disease, cardiovascular problems, accidents, and alcohol use disorders. Tobacco product use, while declining overall, still affects 48.0 million Americans monthly, with cigarettes remaining the predominant form at 37.8 million users, though alternative products like e-cigarettes, smokeless tobacco, and cigars account for millions of additional users.

Marijuana use continues its upward trajectory as more states legalize adult recreational use, with 44.3 million Americans using in the past month and 64.2 million using in the past year. The past-month marijuana use rate of 15.4% represents a significant increase from 13.2% in 2021, reflecting changing legal landscapes, decreased risk perception among users, aggressive commercial marketing in legal states, and expanded product diversity including edibles, vapes, concentrates, and beverages. Smoking remains the most common mode of marijuana consumption even as vaping, eating, and other methods gain popularity. Hallucinogen use has increased significantly, with 10.4 million past-year users, driven partially by renewed clinical and public interest in psychedelic-assisted therapy, de-stigmatization, and increased availability of substances like psilocybin mushrooms, LSD, MDMA (Ecstasy), and ketamine.

Prescription drug misuse affects millions, with 7.6 million people misusing prescription opioids in the past year despite dramatic reductions in prescribing rates, 4.6 million misusing prescription tranquilizers or sedatives like benzodiazepines, and 3.9 million misusing prescription stimulants including medications for ADHD like Adderall and Ritalin. The prescription stimulant category excludes illicit methamphetamine unless users specifically obtained prescription Desoxyn. Cocaine use at 4.3 million past-year users remains substantial, though its prevalence is far below peak levels from the 1980s. These patterns of illicit drug use, affecting 73.6 million Americans (25.5%) in the past year, demonstrate that approximately one in four Americans aged 12 or older used an illicit substance within the survey period, highlighting the widespread nature of drug use beyond alcohol and tobacco.

Substance Abuse by Age Group in the US 2024-2026

Data Source: SAMHSA 2024 NSDUH Key Indicators Report; SAMHSA 2024 NSDUH Detailed Tables; SAMHSA Press Release (July 2025)

Age-specific substance abuse patterns in the US 2024-2026 reveal dramatic differences across the lifespan, with young adults aged 18-25 experiencing the highest rates of substance use across virtually every category while also being the least likely age group to receive treatment when they develop substance use disorders. Among adolescents aged 12-17, the 2024 NSDUH documented encouraging trends, with substance use initiation reaching historic lows for many substances as prevention efforts targeting youth have proven remarkably effective. Only 6.1% of adolescents reported illicit drug use in the past month, representing continued progress in reducing youth substance use. However, among the adolescents who did develop co-occurring major depressive episodes and substance use disorders, an encouraging 72.1% received either substance use treatment or mental health treatment in the past year, though 27.9% received neither type of care.

Young adults face exceptional vulnerability to both substance use and substance use disorders, with this age group consistently demonstrating the highest prevalence rates for marijuana, hallucinogens, cocaine, prescription drug misuse, and binge alcohol use. The substance use disorder rate of 11.8% among young adults (calculated from adult-specific data showing higher rates in this demographic) exceeds the national average, reflecting the developmental period when many individuals experiment with substances, struggle with impulse control, face social pressures, navigate independence, and have not yet experienced significant health or social consequences from substance use. Paradoxically, young adults are the least likely to receive treatment among all age groups, attributed to factors including perceived invincibility, lack of health insurance after aging off parents’ policies, prioritizing education or career over health, unfamiliarity with treatment systems, and insufficient outreach tailored to their specific needs.

Adults aged 26 and older demonstrated increasing marijuana use rates, with past-month use rising from 12.3% in 2021 to higher percentages by 2024, reflecting changing social norms and expanded legalization. The overall drug use disorder rate of 9.8% for all ages 12 and older represents a significant increase from 8.7% in 2021, indicating that despite declines in some substance categories like cigarette smoking and improvements in overdose deaths, the overall burden of drug use disorders continues expanding. Treatment receipt among adults varies considerably depending on the specific substance use disorder, insurance status, geographic location, and co-occurring conditions, with adults generally more likely than youth to access treatment but still facing massive gaps between need and service delivery.

Substance Use Disorders and Diagnostic Criteria in the US 2024-2026

Data Source: SAMHSA 2024 NSDUH Report; SAMHSA SUD Treatment Month Proclamation (January 2026); SAMHSA Press Release (July 2025)

Substance use disorders in the US 2024-2026, diagnosed using DSM-5 criteria that assess impaired control, social impairment, risky use, and pharmacological indicators like tolerance and withdrawal, affect 48.4 million Americans aged 12 or older, representing 16.8% of this population. The diagnosis of substance use disorder requires meeting at least two of eleven criteria within a 12-month period, with severity classified as mild (2-3 criteria), moderate (4-5 criteria), or severe (6 or more criteria). The 27.9 million Americans with alcohol use disorder represent a slight decrease from the 10.6% prevalence in 2021 to 9.7% in 2024, possibly reflecting declining alcohol consumption among younger cohorts, increased awareness of alcohol harms, and the “sober curious” movement gaining cultural traction.

Conversely, drug use disorders increased substantially from 8.7% in 2021 to 9.8% in 2024, affecting 28.2 million people—an alarming trend that public health officials attribute to several factors including rising marijuana use disorders as legalization expands and potency increases, ongoing challenges with opioid use disorders despite overdose death declines, stimulant use disorders involving methamphetamine and cocaine, and prescription drug misuse transitioning to dependence. The 7.7 million Americans with both alcohol and drug use disorders simultaneously face particularly complex treatment needs, often requiring integrated approaches that address polysubstance dependence, higher relapse risks, and more severe withdrawal syndromes.

Marijuana use disorder, while not separately quantified in published 2024 figures, is increasing in parallel with rising marijuana use rates, with research suggesting that approximately 10% of marijuana users develop use disorders characterized by inability to quit despite wanting to, tolerance requiring more product to achieve effects, withdrawal symptoms when stopping, and interference with daily functioning. Prescription opioid use disorder remains a critical concern despite dramatic reductions in prescribing, as individuals who developed dependence during the prescription opioid epidemic continue struggling with addiction, and new users still emerge from legitimate medical prescriptions that transition to misuse. Stimulant use disorders involving methamphetamine and cocaine present particular treatment challenges as no FDA-approved medications exist for these conditions, unlike opioid use disorders which can be treated with buprenorphine, methadone, or naltrexone.

Treatment Access and Barriers in the US 2024-2026

Data Source: SAMHSA 2024 NSDUH Key Indicators Report; SAMHSA Blog on 2024 Results; National Association of Counties Analysis (August 2025)

The catastrophic treatment gap for substance use disorders in the US 2024-2026 represents one of America’s most severe public health failures, with 80.6% of the 52.6 million people classified as needing substance use treatment failing to receive any care. Only 10.2 million people—barely one in five of those needing treatment—actually received substance use treatment in 2024, leaving 42.4 million Americans with unmet treatment needs that perpetuate cycles of addiction, increase overdose risk, strain families and communities, and generate enormous societal costs. This treatment gap dramatically exceeds the mental health treatment gap, where approximately 40% of adolescents with major depressive episodes and 48% of adults with any mental illness do not receive treatment—still concerning but not approaching the 80% figure for substance use disorders.

Among the 21.2 million adults with co-occurring substance use disorders and any mental illness, 41.2% received neither substance use treatment nor mental health treatment, highlighting catastrophic failures in identifying and engaging this high-need population. Only 14.5% received treatment for both conditions, despite overwhelming evidence that integrated treatment addressing both mental health and substance use simultaneously produces far better outcomes than treating each condition in isolation. The most common pattern was receiving mental health treatment but not substance use treatment (41.0%), suggesting that mental health systems are somewhat better at engaging patients than substance use treatment systems, but often fail to address co-occurring substance use disorders even when documented.

Barriers to treatment identified by individuals who recognized they needed care but did not receive it include pervasive stigma surrounding addiction that prevents help-seeking, prohibitive costs of treatment even for insured individuals facing high deductibles and co-pays, lack of knowledge about available resources and how to access treatment, insufficient health insurance coverage or being uninsured entirely, geographic barriers particularly in rural areas with limited providers, shortage of qualified treatment providers including psychiatrists and addiction medicine specialists, waiting lists at treatment facilities sometimes extending weeks or months, employment concerns about job loss or discrimination, childcare responsibilities without support, and transportation challenges. The 1.8 million adults and 111,000 adolescents who acknowledged they should have received treatment but didn’t represent individuals with insight into their conditions yet still unable to access care, underscoring that removing barriers is not just about awareness but fundamentally about system capacity and accessibility.

Alcohol Use and Alcohol Use Disorders in the US 2024-2026

Data Source: SAMHSA 2024 NSDUH Key Indicators Report; SAMHSA 2023 NSDUH Report; SAMHSA Detailed Tables 2024

Alcohol use in the US 2024-2026 remains the most prevalent form of substance use, with 134.3 million Americans aged 12 or older—representing 46.6% of this population—reporting alcohol consumption in the past month. Despite alcohol’s legal status for adults aged 21 and older and deep integration into American social life, it generates enormous public health burdens including approximately 140,000 deaths annually from alcohol-related causes, millions of cases of alcohol use disorder, drunk driving fatalities, alcohol-related violence, fetal alcohol spectrum disorders, and chronic health conditions like cirrhosis, cardiomyopathy, and pancreatitis. Binge alcohol use, defined as consuming five or more drinks for males or four or more drinks for females on the same occasion on at least one day in the past 30 days, affects millions and substantially increases risks of accidents, injuries, alcohol poisoning, and long-term health consequences.

Heavy alcohol use, defined as binge drinking on five or more days in the past 30 days, represents the most severe pattern of drinking and predicts highest risk for developing alcohol use disorder, experiencing medical complications, and requiring treatment interventions. The 27.9 million Americans with alcohol use disorder in 2024 represent a slight decrease from the 10.6% prevalence in 2021 to 9.7% in 2024, a positive trend public health experts attribute to several factors including declining alcohol consumption among Gen Z and younger Millennials who drink less than previous generations, growing awareness of alcohol’s health harms through movements like “Dry January” and “sober curious,” expanded availability of non-alcoholic beverage alternatives, and increased acceptance of sobriety as a lifestyle choice rather than marker of problem drinking.

Racial and ethnic disparities in alcohol use reflect complex interactions of cultural norms, discrimination, socioeconomic factors, and genetic variations in alcohol metabolism. White Americans demonstrated the highest past-month alcohol use at 50.6% (2023 data), significantly exceeding Hispanic (41.2%), Black (42.5%), Asian (32.5%), and American Indian/Alaska Native (30.0%) populations. However, these consumption patterns do not directly correlate with alcohol-related harms, as some populations with lower overall consumption rates experience disproportionate consequences from alcohol use disorder, alcohol-related mortality, and medical complications—patterns explained by differential access to treatment, healthcare disparities, higher rates of binge drinking within overall lower consumption, and social determinants of health.

Marijuana Use and Marijuana Use Disorders in the US 2024-2026

Data Source: SAMHSA 2024 NSDUH Key Indicators Report; SAMHSA 2023 NSDUH Report; SAMHSA Press Release (July 2025)

Marijuana use in the US 2024-2026 has increased substantially, with 44.3 million Americans aged 12 or older—15.4% of this population—reporting past-month use, up from 13.2% (or 37.0 million people) in 2021. This represents an increase of 7.3 million users in just three years, a trend public health researchers attribute primarily to rapidly expanding legalization of adult recreational marijuana use, with more than half of US states having enacted such laws by the end of 2023. Past-year marijuana use at 64.2 million people indicates that approximately one in four Americans aged 12 or older used marijuana at least once in the survey year, demonstrating the substance’s widespread integration into American recreational and medicinal substance use patterns.

Modes of marijuana consumption have diversified beyond traditional smoking, though combustion of cannabis flower remains the most common method. The 2024 NSDUH documented various consumption patterns including smoking, vaping marijuana-specific products, dabbing waxes and concentrates, eating marijuana-infused edibles and beverages, using sublingual drops or sprays, applying topical lotions and patches, taking pills, and other methods. Marijuana vaping has grown substantially as a consumption mode, particularly among younger users, driven by perceptions that vaping is less harmful than smoking, discreet odor profiles, and aggressive marketing of vape products in legal markets. The commercial marijuana industry in legal states has developed increasingly potent products with THC concentrations far exceeding historical levels, raising concerns among addiction specialists and public health officials about heightened risks for marijuana use disorders, psychotic episodes, and other adverse outcomes.

Marijuana use disorders, while not separately quantified in published 2024 aggregate statistics, are increasing in parallel with rising use rates. Research consistently demonstrates that approximately 10% of marijuana users develop use disorders characterized by unsuccessful attempts to quit or reduce use, tolerance requiring more product to achieve desired effects, withdrawal symptoms including irritability and sleep disturbance when stopping, spending excessive time obtaining or using marijuana, and continued use despite negative consequences. Concerningly, youth marijuana use has shown declining trends despite expanding adult legalization, a pattern attributed to successful prevention messaging targeting adolescents, strict regulation of legal markets that limits youth access more effectively than illegal markets did, and possibly displacement of marijuana experimentation by other substances like vaping nicotine or using prescription drugs—though overall adolescent substance use remains at historic lows across most categories.

Tobacco and Nicotine Use in the US 2024-2026

Data Source: SAMHSA 2024 NSDUH Key Indicators Report; SAMHSA 2024 NSDUH Detailed Tables

Tobacco and nicotine use in the US 2024-2026 demonstrated encouraging declining trends, with past-month tobacco product use dropping from 20.1% of the population aged 12 or older in 2021 to 16.7% in 2024, representing 48.0 million current users down from 56.2 million in 2021—a reduction of 8.2 million tobacco users in three years. This substantial progress reflects decades of comprehensive tobacco control efforts including taxation increases, smoke-free laws, graphic warning labels, mass media campaigns documenting tobacco harms, cessation support through quitlines and counseling, and restricted marketing particularly to youth. When combining both traditional tobacco products and nicotine vaping, a total of 63.7 million people (22.1% of ages 12+) used some form of nicotine product in the past month.

Cigarette smoking remains the predominant form of tobacco use despite dramatic declines from peak rates, with 37.8 million current smokers representing the majority of the 48.0 million tobacco users. Daily cigarette smoking, a marker of nicotine dependence and highest health risk, comprises a subset of overall cigarette users and continues declining as younger cohorts initiate smoking at much lower rates than previous generations. Combustible tobacco products including cigarettes cause more than 480,000 deaths annually in the United States through lung cancer, cardiovascular disease, chronic obstructive pulmonary disease, stroke, and dozens of other conditions, making tobacco use the leading cause of preventable death despite remarkable progress in reducing prevalence.

Nicotine vaping affects 27.7 million Americans aged 12 or older (9.6% of this population), representing a substantial and relatively recent phenomenon that has generated intense public health debate. While some public health experts view e-cigarettes as potentially valuable harm reduction tools for adult smokers seeking to quit combustible tobacco, others emphasize concerns about youth vaping initiation, unknown long-term health effects, nicotine addiction among never-smokers, and aggressive marketing that has attracted adolescents.

Disclaimer: This research report is compiled from publicly available sources. While reasonable efforts have been made to ensure accuracy, no representation or warranty, express or implied, is given as to the completeness or reliability of the information. We accept no liability for any errors, omissions, losses, or damages of any kind arising from the use of this report.

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