SAMHSA’s 2024 national survey reveals overlapping alcohol, drug, marijuana, and opioid disorders — and challenges simplistic border-focused addiction narratives.
The president has taken up the mantle of blaming other countries for the addiction plaguing the United States. His theory is simple: if drugs stop coming in, Americans will stop using them.
This aphorism sounds logical, but when we consider the latest major opioid addiction, that logic is completely irrelevant. Its use spread due to the indiscriminate prescriptions that doctors and the pharmaceutical industry began writing. These medications had something in common: they were prone to becoming addictive.
In 2024 (the most recent figure), 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)
