About 17.7% of Americans aged 12 and older, roughly 48.4 million people, had a substance use disorder in 2023. That figure includes both drug and alcohol addiction. When looking at drug use disorders alone (excluding alcohol), 9.8% of people aged 12 or older met the criteria in 2024, up from 8.7% in 2021. These numbers come from the federal government’s largest annual survey on substance use, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA).
What Counts as Addiction
The clinical term is “substance use disorder,” and it’s diagnosed on a spectrum of mild, moderate, or severe based on how many of 11 behavioral signs a person meets. Those signs include things like using more of a substance than intended, unsuccessfully trying to cut back, spending a lot of time obtaining or recovering from a substance, experiencing cravings, and continuing to use despite clear harm to relationships, work, or health. Tolerance (needing more to get the same effect) and withdrawal symptoms also count.
Someone with two or three of these signs has a mild disorder. Six or more puts them in the severe category, which is closest to what most people mean when they say “addiction.” The survey data captures all three levels, so the headline percentages include people across that full range.
Drug Addiction vs. Alcohol Addiction
Drug and alcohol addiction rates in the U.S. have essentially converged. In 2024, 9.8% of people aged 12 or older had a drug use disorder, while 9.7% had an alcohol use disorder. That’s a notable shift from just three years earlier, when alcohol use disorder was more common at 10.6% and drug use disorder sat at 8.7%. Alcohol problems have been declining slightly while drug problems have been climbing.
Many people have both. About one in five American adults uses more than one substance, and those who do are far more likely to develop a disorder. Among people using multiple drugs, 17.6% had a likely substance use disorder, compared to just 4.1% of those who stuck to a single substance.
Which Age Groups Are Hit Hardest
Young adults aged 18 to 25 have the highest rates by a wide margin. In 2023, 27.1% of that age group (9.2 million people) had a substance use disorder. That’s more than one in four. Adults 26 and older came in at 16.6%, or about 37 million people. Adolescents aged 12 to 17 had the lowest rate at 8.5%, representing 2.2 million teens.
The young adult spike reflects a period of life where experimentation is common and the brain is still developing its impulse control systems. It also captures college-age drinking and the early stages of opioid or stimulant misuse that may have started with prescription medications.
Opioids by the Numbers
Opioids remain a major driver of the crisis. In 2024, 2.7% of people aged 12 or older (7.8 million people) misused opioids in the past year, whether heroin or prescription painkillers. Among those with an opioid use disorder, 37.1% had a severe disorder and 42.4% had a mild one.
The consequences are stark. In 2024, 79,384 Americans died from drug overdoses, a rate of 23.1 deaths per 100,000 people. Synthetic opioids, primarily fentanyl, account for the majority of those deaths. While the overdose death toll has begun to decline slightly from its peak, it remains historically catastrophic, far exceeding car accident fatalities in most years.
The Treatment Gap
Perhaps the most striking number in all of this data is how few people get help. In 2022, an estimated 40.3 million Americans had a substance use disorder, yet only 6.5% received any form of treatment. That means more than 37 million people with a diagnosable addiction went without professional care in a single year.
The reasons are layered: cost, stigma, lack of available programs, long wait times, and the fact that many people with a substance use disorder don’t recognize it as one, particularly at the mild end of the spectrum. Insurance coverage for addiction treatment has expanded in recent years, but access still varies dramatically by state and income level.
The Economic Toll
Substance use disorders cost the U.S. economy over $532 billion a year, according to Georgetown University’s Health Policy Institute. That figure includes tobacco, alcohol, and illicit drugs combined, and it represents nearly 6% of the nation’s total income. The costs show up in healthcare spending, lost workplace productivity, criminal justice expenses, and the ripple effects on families and communities. For context, that’s more than the federal government spends on education in a typical year.