A newly released national survey has revealed a modest but notable drop in the number of Americans living with a substance use disorder, even as the gap between people who need help and those who actually receive it remains stubbornly wide.

The 2025 National Survey on Drug Use and Health (NSDUH), published by the Substance Abuse and Mental Health Services Administration (SAMHSA), found that 44.6 million people aged 12 or older, around 15.3% of the population, had a substance use disorder in the past year. That figure marks a decline from 16.8% in 2024, offering a rare glimmer of encouraging news in a field where progress is often measured in inches rather than miles.

A Closer Look at the Numbers

Of those 44.6 million people, the survey found 25.7 million had alcohol use disorder, 26 million had a drug use disorder involving substances other than alcohol, and 7.1 million were dealing with both at once. Marijuana use disorder affected an estimated 19.3 million people, while 4.5 million had a stimulant use disorder and 4 million had an opioid use disorder, underlining just how varied the picture of drug and alcohol addiction can be across different communities and age groups.

Severity varied considerably too. More than half of those with a substance use disorder, 54.1%, were classed as having a mild form under DSM 5 criteria, while roughly one in five, 22.5%, were living with a severe disorder, the kind most likely to disrupt work, relationships and physical health.

The Substance Use Disorder Treatment Gap Widens

Yet the encouraging headline figure sits alongside a far less reassuring one. According to the survey, 47.2 million people needed treatment for a substance use disorder in 2025. Of those, only 7.6 million, or about one in six, actually received any form of treatment in the past year. That leaves an estimated 39.6 million people without the support they needed, a gap that has changed little in recent years despite growing awareness of drug and alcohol addiction as a public health concern.

Access to medication assisted treatment, widely regarded as one of the most effective tools for tackling drug and alcohol addiction, also remained limited. Among the 4 million people with opioid use disorder, just 15.7%, or 623,000 people, received medication treatment. The picture was even starker for alcohol use disorder, where only 2.6%, or 679,000 of the 25.7 million affected, received medication support.

Where treatment was accessed, outpatient care remained the most common route, reaching 4.4 million people, followed by telehealth at 3.6 million and inpatient care at 2.2 million. A further 649,000 people received treatment while in prison, jail or a juvenile detention centre, a reminder that substance use disorder often intersects with the criminal justice system.

Why So Many People Go Without Help

Perhaps the most striking finding concerns why so many people go without help at all. Among adults with a substance use disorder, 94.5%, roughly 34.9 million people, either did not seek treatment or did not believe they needed it. Among adolescents aged 12 to 17, that figure was even higher, at 95.1%.

The reasons people gave for avoiding treatment paint a familiar picture. 82.5% believed they should be able to manage their alcohol or drug use on their own, 68.4% said they were not ready to stop or cut back, and 67.7% simply were not ready to begin treatment. Others cited a lack of time (54.3%), fear of judgement from others (41.4%), not knowing where to turn (40.5%), worry about losing a job, home or custody of their children (34.9%), and insufficient insurance coverage (30.4%).

A Note of Hope in the Recovery Numbers

There was better news on the recovery front. An estimated 22.3 million adults now consider themselves to be in recovery from, or to have fully recovered from, a substance use disorder, a figure that speaks to the possibility of real change even for those who have struggled for years.

Taken together, the findings suggest that while fewer people are developing a substance use disorder in the first place, the systems meant to catch those who do are still falling short. Experts point to the barriers people describe, from stigma to simply not knowing where to start, as evidence that earlier conversations about risk, support and healthy choices could make as much difference as treatment itself in keeping drug and alcohol addiction from taking hold. For families, schools and communities, the message from this year’s data is less about crisis and more about closing the distance between the people who need help and the help that is available.

Source: dbrecoveryresources