2025 National Survey Shows Declines in Substance Use Disorders, while Significant Treatment Gaps Remain

The Substance Abuse and Mental Health Services Administration (SAMHSA) released findings from the 2025 National Survey on Drug Use and Health (NSDUH), providing the latest national data on substance use, mental health, treatment, and recovery in the United States.

In 2025, 44.6 million people ages 12 or older—15.3% of the U.S. population—had a substance use disorder (SUD). This total included 25.7 million people with alcohol use disorder (AUD), 26 million with drug use disorder involving substances other than alcohol, and 7.1 million with both alcohol and drug use disorders. Overall SUD prevalence declined from 16.8% in 2024 to 15.3% in 2025.

Among the 44.6 million people with a past-year SUD, more than half (54.1%) had a mild SUD, while one in five (22.5%) had a severe disorder. Severity levels are based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a standardized framework used to diagnose and classify mental health and substance use disorders.

Despite the decline in past-year SUD prevalence, a substantial gap remains between the number of people who need treatment and those who receive it. In 2025, an estimated 47.2 million people needed SUD treatment. This figure includes the 44.6 million people who met the criteria for a past-year SUD, as well as 2.7 million people who received treatment but did not meet past-year SUD criteria. Including this latter group recognizes that some individuals may no longer meet diagnostic criteria because they are actively receiving treatment. Despite this need, only 16% (7.6 million people), or approximately one in six individuals who needed treatment, received any substance use treatment in the past year.

Access to medications for substance use disorders also remained limited. Among the 4 million people with opioid use disorder (OUD), only 15.7% (623,000 people) received medication treatment. Among the 25.7 million people with alcohol use disorder (AUD), just 2.6% (679,000 people) received medication treatment.

People who recognized a need for treatment reported several reasons for not receiving care. Common barriers included believing they should be able to manage their alcohol or drug use on their own, not being ready to stop or reduce their use, not being ready to begin treatment, lacking time for treatment, and worrying about what others might think or say.

Key Findings from the 2025 NSDUH Report

Substance Use Disorders

In 2025, 44.6 million people aged 12 or older had a substance use disorder, including:

• Alcohol use disorder: 25.7 million people

• Drug use disorder: 26 million people

  • Marijuana use disorder: 19.3 million people

  • Stimulant use disorder: 4.5 million people

  • Opioid use disorder: 4.0 million people

Substance Use Treatment

• Need for Treatment: 47.2 million people

• Received Treatment: 7.6 million people

• Did Not Receive Treatment: 39.6 million people

Types of Substance Use Treatment Received

• Outpatient treatment: 4.4 million people

• Telehealth treatment: 3.6 million people

• Inpatient treatment: 2.2 million people

• Treatment in a prison, jail, or juvenile detention center: 649,000 people

Access to Medications for Addiction Treatment

• Medications for opioid use disorder: 2.1 million people

• Medications for alcohol use disorder: 1.1 million people

Other Substance Use Services Received

• Support groups: 2.9 million people

• Peer support specialists or recovery coaches: 1.6 million people

• Emergency room services: 1.3 million people

• Withdrawal management services: 989,000 people

• Overdose reversal medicine: 406,000 people

Perceived Unmet Need for Substance Use Treatment

• 95.1% of adolescents aged 12 to 17 (1.4 million people) and 94.5% of adults aged 18 or older (34.9 million people) with an SUD did not seek treatment or did not think they should get it.

• The most common reasons for not receiving treatment among adults aged 18 or older with SUD were:

  • Believing they should be able to manage their alcohol or drug use on their own. (82.5%)

  • Not being ready to stop or cut back on using alcohol or drugs (68.4%)

  • Not being ready to start treatment (67.7%)

  • Not having enough time for treatment (54.3%)

  • Being worried about what people would think or say if they got treatment (41.4%)

  • Not knowing how or where to get treatment (40.5%)

  • Fear of consequences if others learned they were receiving treatment, such as losing a job, home, or custody of their children (34.9%)

  • Not having enough health insurance coverage to pay for the costs of treatment (30.4%)

Recovery

• 22.3 million people aged 18 or older considered themselves to be in recovery or to have recovered from a substance use disorder.

Access the 2025 National Survey on Drug Use and Health here.