In the United States, an estimated 16.8% of people aged 12 and older — about 48.4 million people — had a substance use disorder in the past year, according to the 2024 National Survey on Drug Use and Health (SAMHSA, 2024). That makes substance use disorder one of the most common categories of health condition in the country, affecting roughly one in six people old enough to be surveyed.
This is a 2026 roundup of the most recent data available, and “most recent” means two things. The newest national prevalence survey is the 2024 NSDUH, released in 2025; there is no newer household survey. The newest final mortality data covers 2024 and was published by the CDC in early 2026. Where a figure is still provisional — as with 2025 overdose counts — it is labeled as such throughout.
The headline story of the past two years is the sharp reversal in overdose deaths. After climbing above 105,000 in 2023, U.S. drug overdose deaths fell to 79,384 in 2024 — a 26.2% drop and the largest single-year decline on record (CDC, 2024). At the same time, survey data show a stable-to-rising burden of drug use disorders even as alcohol use disorder edged down. This article walks through both sides of the picture: who has a disorder, how many use substances, how few get treatment, and how the death toll is changing.
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Key numbers (2024 data unless noted):
- Substance use disorder, ages 12+: 16.8% / 48.4 million (SAMHSA, 2024)
- Alcohol use disorder: 9.7% / 27.9 million
- Drug use disorder: 9.8% / 28.2 million
- Marijuana use disorder: 7.1% / 20.6 million
- Only 12.3% of people with a substance use disorder received treatment
- Drug overdose deaths, 2024 final: 79,384 (down 26.2% from 2023)
Substance Use Disorder Overall
A substance use disorder (SUD) is a clinical diagnosis defined by continued use of alcohol, drugs, or both despite significant harm — not simply by how often someone uses. In 2024, 16.8% of people aged 12 and older, an estimated 48.4 million, met criteria for a past-year SUD (SAMHSA, 2024). Because a person can have an alcohol use disorder, a drug use disorder, or both, the alcohol and drug figures below overlap and do not add up to the 48.4 million total.
| Disorder (ages 12+, 2024) | Prevalence | People affected |
|---|---|---|
| Any substance use disorder | 16.8% | 48.4 million |
| Alcohol use disorder | 9.7% | 27.9 million |
| Drug use disorder | 9.8% | 28.2 million |
| Marijuana use disorder | 7.1% | 20.6 million |
Rates and risk vary widely by age, family history, mental health, and environment. Our guide to substance use disorder risk factors covers what drives that variation in more detail.
Alcohol Use Disorder
Alcohol remains the most common single substance behind an SUD. In 2024, 9.7% of people 12 and older — about 27.9 million — had an alcohol use disorder (SAMHSA, 2024). That is down from 10.6%, or 29.7 million people, in 2021, one of the few substance measures to move clearly in a favorable direction over that period.
The decline in alcohol use disorder stands in contrast to the drug figures below, which have moved the other way. It is worth noting that a lower disorder rate does not mean drinking is harmless: alcohol still contributes to a large share of the binge-drinking numbers discussed later in this roundup.
Drug Use Disorder
Drug use disorder — covering illicit drugs and the misuse of prescription medications, but not alcohol — affected 9.8% of people 12 and older in 2024, an estimated 28.2 million (SAMHSA, 2024). That is up from 8.7%, or 24.5 million people, in 2021. In other words, the number of Americans with a drug use disorder rose by roughly 3.7 million over three years even as alcohol use disorder fell.
For the first time in the recent series, drug use disorder (9.8%) slightly edged out alcohol use disorder (9.7%) as the more prevalent category — a shift driven largely by cannabis, discussed next.
Marijuana (Cannabis) Use Disorder
Marijuana is the single largest driver of drug use disorder. In 2024, 7.1% of people 12 and older — about 20.6 million — had a marijuana use disorder (SAMHSA, 2024). That makes cannabis, by itself, responsible for the majority of the drug use disorder total, and it accounts for much of the gap between the drug and alcohol figures.
A marijuana use disorder does not require daily use or physical dependence in the way often assumed; like other SUDs, it is defined by continued use despite meaningful problems in a person’s health, relationships, or responsibilities.
Co-occurring Mental Illness and Substance Use
Substance use and mental illness frequently travel together. Among adults 18 and older in 2024, 8.1% — an estimated 21.2 million — had both any mental illness and a substance use disorder in the same year (SAMHSA, 2024). The overlap is tighter still at the severe end: 2.6% of adults, about 6.9 million, had both a serious mental illness and an SUD.
This co-occurrence matters because it complicates treatment — each condition can worsen the other, and effective care usually has to address both at once. For the broader mental health context behind these figures, see our 2026 mental health statistics roundup.
Illicit Drug Use and Binge Drinking
Disorder rates capture only the clinical tip of a much larger pattern of use. In 2024, 25.5% of people 12 and older — about 73.6 million — used an illicit drug in the past year, and 16.7% (48.2 million) did so in the past month (SAMHSA, 2024). Most people who use drugs do not develop a disorder, but past-year use of this scale is the pool from which disorders and overdoses emerge.
Alcohol use is more widespread still at the heavy-use level. In 2024, 20.1% of people 12 and older — an estimated 57.9 million — reported binge alcohol use in the past month (SAMHSA, 2024). Binge drinking is a leading behavioral risk factor for both alcohol use disorder and alcohol-related harm.
| Use measure (ages 12+, 2024) | Rate | People |
|---|---|---|
| Past-year illicit drug use | 25.5% | 73.6 million |
| Past-month illicit drug use | 16.7% | 48.2 million |
| Past-month binge alcohol use | 20.1% | 57.9 million |
The Treatment Gap
The single most striking statistic in the survey is not a use rate — it is how few people receive care. Of the 48.4 million people with a past-year substance use disorder in 2024, only 12.3% (about 5.9 million) received any substance use treatment. The other 87.7% — roughly 42.4 million people — did not (SAMHSA, 2024).
That means nearly nine in ten people with a diagnosable SUD went untreated in a single year. The gap dwarfs the equivalent shortfall for most mental health conditions and reflects a mix of stigma, cost, limited treatment capacity, and the fact that many people with an SUD do not perceive a need for care. Our overview of the mental health treatment gap examines the structural barriers that keep these numbers so high.
Overdose Deaths: A Record Decline
For the first time in years, the mortality data bring good news. Drug overdose deaths reached a final total of 79,384 in 2024, an age-adjusted rate of 23.1 per 100,000 (CDC, 2024). That is down 26.2% from the 105,007 deaths recorded in 2023 (rate 31.3) — the largest single-year decline on record.
The improvement was driven overwhelmingly by a drop in synthetic opioid deaths. Deaths involving fentanyl and other synthetic opioids fell to 47,735 in 2024, down 35.6% from 72,776 in 2023 (CDC, 2024). Even after that decline, fentanyl was still involved in roughly 60% of all overdose deaths, underscoring how central it remains to the crisis. The scale of opioid harm and how it varies geographically is covered in our opioid use disorder explainer and our state-by-state look at the opioid crisis by state.
| Drug type involved (2024 final) | Overdose deaths |
|---|---|
| Any opioid | 54,045 |
| Synthetic opioids (e.g., fentanyl) | 47,735 |
| Psychostimulants (e.g., methamphetamine) | 28,722 |
| Cocaine | 21,945 |
| All drug overdose deaths | 79,384 |
Because many deaths involve more than one substance, these categories overlap and do not sum to the total. The stimulant and cocaine figures are a reminder that the overdose crisis is no longer only an opioid story.
Early signs suggest the decline continued into 2025. Provisional CDC data — not yet finalized — put 2025 drug overdose deaths at 69,973, about 14% below the 2024 total (CDC, 2025). Provisional counts are typically revised as more death certificates are processed, so this figure should be read as a preliminary trend rather than a settled number.
Frequently Asked Questions
How many people have a substance use disorder in 2026?
The most recent data, from the 2024 National Survey on Drug Use and Health, show 16.8% of people aged 12 and older — about 48.4 million — had a substance use disorder in the past year (SAMHSA, 2024). This is the newest available national estimate; there is no separate 2026 survey.
Are overdose deaths going up or down?
Down, sharply. Final data show 79,384 U.S. drug overdose deaths in 2024, a 26.2% drop from 105,007 in 2023 and the largest single-year decline on record (CDC, 2024). Provisional 2025 data suggest the decline continued, to about 69,973 deaths, though that figure is not yet final (CDC, 2025).
What is the most common substance use disorder?
Alcohol use disorder is the most common single-substance disorder, affecting 9.7% of people 12 and older (27.9 million) in 2024. Marijuana use disorder is the largest drug category at 7.1% (20.6 million), and drug use disorder overall (9.8%) narrowly exceeds alcohol use disorder (SAMHSA, 2024).
How many people with a substance use disorder get treatment?
Very few. Of the 48.4 million people with a past-year substance use disorder in 2024, only 12.3% — about 5.9 million — received any treatment, while 87.7% (roughly 42.4 million) did not (SAMHSA, 2024).
How many overdose deaths involve fentanyl?
In 2024, synthetic opioids such as fentanyl were involved in 47,735 overdose deaths — roughly 60% of all overdose deaths — down 35.6% from 72,776 in 2023 (CDC, 2024).
Is substance use disorder linked to mental illness?
Frequently. In 2024, 8.1% of adults (21.2 million) had both any mental illness and a substance use disorder, and 2.6% (6.9 million) had both a serious mental illness and an SUD (SAMHSA, 2024). These co-occurring conditions typically need to be treated together.
Sources
- Substance Abuse and Mental Health Services Administration. Results from the 2024 National Survey on Drug Use and Health: Annual National Report. SAMHSA; 2025. https://www.samhsa.gov/data/report/2024-nsduh-annual-national-report
- Centers for Disease Control and Prevention, National Center for Health Statistics. Drug Overdose Deaths in the United States, 2023-2024. NCHS Data Brief No. 549. CDC; 2026. https://www.cdc.gov/nchs/products/databriefs/db549.htm
- Centers for Disease Control and Prevention, National Center for Health Statistics. Provisional Drug Overdose Death Counts (2025). CDC; 2026. https://www.cdc.gov/nchs/pressroom/releases/20260513.html