Substance Use Disorder Statistics in North Carolina

Substance Use Disorder (SUD) represents a significant public health challenge in North Carolina, with prevalence rates that surpass national averages. In 2023, an estimated 48.5 million Americans aged 12 or older met the criteria for a substance use disorder^[5]. North Carolina ranks 12th highest among contiguous U.S. states for SUD prevalence, reflecting systemic issues such as economic stress, social isolation, and gaps in the healthcare infrastructure^[6][1]. The following data provides a snapshot of how SUD and related mental health conditions affect various populations across the state.

While much focus is on illicit drugs, alcohol use continues to be a primary driver of substance-related harm in North Carolina. Despite the state having lower rates of adult drinking compared to the national average, the consequences remain severe^[6]. Approximately 4.1 million adults in the state consume alcohol, and among them, one in four engage in binge drinking and one in ten drink heavily^[3]. This high-risk consumption contributes to thousands of preventable deaths, strains the healthcare system, and results in significant economic costs each year.

Substance use disorder does not affect all North Carolinians equally. Significant disparities exist across racial, geographic, and age groups, often stemming from complex societal factors like historical underinvestment in minority communities and differences in healthcare access^[1]. Adolescents are particularly vulnerable due to developmental factors, peer pressure, and adverse family environments^[15]. Prolonged use in youth can lead to dependency, poor academic performance, and deteriorating health^[3]. Understanding these differences is crucial for developing equitable and effective interventions.

The most tragic consequence of the substance use epidemic is the staggering number of overdose deaths. This crisis has been exacerbated in the post-COVID era by increased isolation and stress^[2], and opioid-related deaths increased by nearly 22% during the pandemic^[4]. The intersection with other challenges is clear: one in four people who died from an overdose also had a mental health disorder, and over 25% of deaths among North Carolina's homeless population were due to overdose^[2]. The data below illustrates the scale and trajectory of this ongoing emergency.

Despite the clear need, many North Carolinians with SUD face significant barriers to receiving care. Only about 35% of individuals with SUD are reported to have received any treatment in the past year, leaving a substantial portion of the population without support^[1]. This treatment gap is driven by a shortage of providers, especially in rural areas, which are often designated as mental health Health Professional Shortage Areas (HPSAs)^[2]. Adolescents face unique obstacles, including rigid age restrictions and unsympathetic treatment environments that deter them from seeking help^[4].

In response to the crisis, North Carolina has implemented several strategies aimed at improving prevention, treatment, and harm reduction. The North Carolina Opioid and Substance Use Action Plan, updated in 2021, guides the state's efforts by focusing on community-based solutions and support for individuals with lived experience^[17]. Innovative approaches, such as mobile opioid treatment programs (OTPs) in Wake County and Greensboro, are bringing medication-assisted treatment directly to underserved areas^[3]. Furthermore, legislative changes that suspend rather than terminate Medicaid for incarcerated individuals aim to ensure continuity of care upon reentry, a critical time for overdose risk^[18]. These efforts have contributed to a 12% increase in treatment access rates since 2020^[1].