Over 48 Million People Have a Diagnosable Substance Use Disorder in the United States

In 2024, 48.4 million people in the U.S. ages 12 and older – about 1 in 6 people– met the criteria for a substance use disorder, according to the most recent National Survey on Drug Use and Health (NSDUH) released by SAMHSA. The annual report provides nationally representative data on substance use (e.g., tobacco, alcohol, illicit drugs, misuse of prescription drugs), substance use disorders, treatment receipt, recovery, and related behavioral health indicators.

Of the 48.4 million people with a substance use disorder in 2024, 27.9 million people had an alcohol use disorder, and 28.2 million people had a drug use disorder. In the report, a “drug use disorder” was defined as meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)—a standardized manual used by clinicians, researchers, policymakers, and insurance companies worldwide for diagnosing mental health disorders—criteria for one or more of the following drugs: marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, or prescription psychotherapeutic drugs (e.g., stimulants, tranquilizers or sedatives, and pain relievers). 

The DSM-5 outlines 11 criteria, or symptoms, for substance use disorders that encompass four key domains: impaired control, social impairment, risky use, and physical dependence (tolerance and withdrawal).¹ A diagnosis is based on the number of criteria met within a 12-month period, with severity classified as mild (2-3 symptoms), moderate (4-5 symptoms), or severe (6 or more symptoms). This framework provides a standardized approach for clinicians to assess the spectrum of substance-related problems, supporting accurate diagnosis, treatment planning, and research consistency.

Key findings from the NSDUH report include:

*It is important to note that the data from the report indicates that many individuals used more than one substance. Therefore, estimates for specific substances or disorders often overlap, and the totals should not be interpreted as mutually exclusive categories.

Substance Use Disorders

In 2024, 48.4 million people aged 12 or older had a substance use disorder, including: 

• Alcohol Use Disorder (27.9 million people)

• Drug Use Disorder (28.2 million people)

  • Marijuana Use Disorder (20.6 million people)

  • Stimulant Use Disorder (4.3 million people)

  • Opioid Use Disorder (4.8 million people)

Underage Age Substance Use

Young people under age 21 are using marijuana more frequently than alcohol and tobacco or nicotine products, despite all being illegal for this age group. Among people aged 12-20 in 2024: 

• Marijuana (6.4 million young people)

• Alcohol (5.1 million young people)

• Tobacco or Nicotine Vaping (4.5 million young people)

Past Month Substance Use 

Respondents were asked about their tobacco, vaped nicotine, alcohol, or illicit drug use in the 30 days before the interview. Among those aged 12 and older:

• Alcohol (134.3 million people)

• Tobacco or Nicotine Vaping (63.7 million people)

• Marijuana (44.3 million people)

• Hallucinogens (2.8 million people)

• Prescription Pain Reliever Misuse (2.1 million people)

• Cocaine (1.7 million people)

• Rx Tranquilizer or Sedative Misuse (1.5 million people)

• Methamphetamine (1.4 million people)

• Rx Stimulant Misuse (1.2 million people)

• Inhalants (1.1 million people)

• Heroin (259,000 people) 

Past Year Illicit Substance Use

Respondents were asked about their illicit drug use in the 12 months before the interview. Among people aged 12 or older, 73.6 million people used illicit drugs in the past year in 2024, which included:  

• Marijuana use (64.2 million people)

• Hallucinogens (10.4 million people)

• Prescription Pain Reliever Misuse (7.6 million people)

• Rx Tranquilizer or Sedative Misuse (4.6 million people)

• Cocaine (4.3 million people)

• Rx Stimulant Misuse (3.9 million people)

• Inhalants (3.2 million people)

• Methamphetamine (2.4 million people)

• Fentanyl (816,000 people)

• Heroin (556,000 people)

Substance Use Treatment

In 2024, 52.6 million people were in need of substance use treatment, but about 1 in 5 (10.2 million people) received any treatment, including:

• Outpatient Treatment (7.1 million people)

• Telehealth Treatment (3.6 million people)

• Inpatient Treatment (2.6 million people)

• Medications for Opioid Use Disorder (2.2 million people)

• Medications for Alcohol Use Disorder (1.3 million people)

• Prison, jail, or juvenile detention center (819 thousand people)

Receipt of other substance use services includes:

• Support groups (6.1 million people)

• Peer support specialists or recovery coaches (2.2 million people)

• Overdose reversal medicine (1.8 million people)

• Emergency room (1.7 million people)

• Withdrawal management services (955,000 people)

Perceived Unmet Need for Substance Use Treatment 

• Among the 1.7 million adolescents aged 12 to 17 who had a substance use disorder and did not receive substance use treatment, 93.3% (or 1.5 million people) did not seek treatment or did not think they should get it.

• Among the 40.7 million adults aged 18 or older who had a substance use disorder and did not receive substance use treatment, 95.6% (or 38.1 million people) did not seek treatment or did not think they should get it.

• The most common reasons for not receiving treatment among adults with a substance use disorder were:

  • Thinking they should have been able to handle their alcohol or drug use on their own (75.5%)

  • Not being ready to start treatment (65.0%)

  • Not being ready to stop or cut back on using alcohol or drugs (59.5%)

Recovery

• 23.5 million people considered themselves to be in recovery or to have recovered from a substance use disorder.

Notable Changes from 2021 to 2024

This report marks the first year since 2020 in which four years of comparable data (2021-2024) are available for many outcomes. The following are notable changes in trends among people aged 12 or older:

	2021	2022	2023	2024	Trend
Alcohol Use Disorder	29.7 million (10.6%)	29.5 million (10.5%)	28.9 million (10.2%)	27.9 million (9.7%)	Decrease
Drug Use Disorder	24.5 million (8.7%)	27.2 million (9.7%)	27.2 million (9.6%)	28.2 million (9.8%)	Increase
Any Illicit Drug Use	62.0 million (22.2%)	70.3 million (24.9%)	70.5 million (24.9%)	73.6 million (25.5%)	Increase
Marijuana Use	53.2 million (19.0%)	61.9 million (22.0%)	61.8 million (21.8%)	64.2 million (22.3%)	Increase
Cigarette Use	44.8 million (16.0%)	41.1 million (14.6%)	38.7 million (13.7%)	37.8 million (13.1%)	Decrease
Nicotine Vaping	N/A	23.5 million (8.3%)	26.6 million (9.4%)	27.7 million (9.6%)	Increase
Heavy Alcohol Use	16.1 million (5.7%)	16.1 million (5.7%)	16.4 million (5.8%)	14.5 million (5%)	Decrease
Cocaine Use	4.8 million (1.7%)	5.3 million (1.9%)	5.0 million (1.8%)	4.3 million (1.5%)	Decrease
Opioid Use	9.1 million (3.2%)	8.4 million (3.0%)	8.5 million (3.0%)	7.8 million (2.7%)	Decrease
Underage Alcohol Use	6.1 million (15.6%)	5.8 million (15.1%)	5.6 million (14.6%)	5.1 million (12.3%)	Decrease

Access the 2024 National Survey on Drug Use and Health here.

References

1. American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787