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    NSDUH: 2025 substance use trends

    By Robyn Oster
    July 2026

    The Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of the 2025 National Survey on Drug Use and Health, an annual national survey that measures the prevalence of substance use, substance use disorder, treatment receipt, recovery, and other measures.

    The TLDR: Most key measures decreased or remained stable 2021-2025.

    • Past-month tobacco use, cigarette use, alcohol use, binge alcohol use, and heavy alcohol use all decreased, along with past-year prescription opioid and prescription tranquilizer misuse, substance use disorder, alcohol use disorder, and opioid use disorder. Adolescent tobacco, alcohol, marijuana, and illicit drug use, SUD, and initiation of alcohol, vaping, and marijuana use also decreased.
    • But past-month nicotine vaping and marijuana use and past-year illicit drug use, marijuana use, hallucinogen use, and marijuana use disorder increased.
    • The bottom line: Decreasing use of many substances, particularly among young people, is encouraging. But too few people who need treatment receive it. Ongoing investment in prevention is needed to continue this trend, and efforts must address the many barriers to treatment.

    The details:

    Substance Use:

    • Total substance use: More than half (56%) of people aged 12+ used tobacco/nicotine products, alcohol, or an illicit drug in the past month. This includes 11.9% of adolescents 12-17, 57.2% of young adults 18-25, and 60.8% of adults 26+.
    • Most common substances: Alcohol, nicotine, and marijuana remain the most commonly used substances.
    • Tobacco/nicotine: Cigarette use in the past month declined between 2021 and 2025 but remained stable for underage youth (12-20). Nicotine vaping increased, but underage nicotine vaping decreased (to about 12%).
    • Alcohol: Past-month alcohol use, binge drinking, heavy alcohol use, and underage alcohol use decreased 2021-2025. 13.7% of individuals 12-20 used alcohol in the past month.
    • Illicit drugs: About 1 in 4 Americans reported illicit drug use in the past year. Illicit drug use increased 2021-2025, largely driven by increases in marijuana use among adults 26+ (but decreased from 2024). In 2025, more than 1 in 10 adolescents and more than 1 in 3 young adults used illicit drugs in the past year, a decrease from 2021.
    • Marijuana: Past-year marijuana use among individuals 12+ increased between 2021 and 2025 (21.2% used in the past year in 2025). Marijuana use is highest among young adults, about a third of whom used marijuana in the past year.
    • Other illicit drugs: Among individuals 12+, past-year use of hallucinogens also increased between 2021 and 2025, while misuse of prescription opioids and prescription tranquilizers/sedatives decreased.

    Substance Use Disorder:

    • Nearly 45 million Americans (15.3%) had a substance use disorder (SUD) in the past year, 25.7 million of which had an alcohol use disorder and 26 million of which had a drug use disorder.
    • Marijuana use disorder was the most common drug use disorder (19.3 million), followed by stimulant use disorder (4.5 million) and opioid use disorder (4 million).
    • Between 2021 and 2025, drug use disorders remained stable, while alcohol use disorders decreased, resulting in a decrease in overall substance use disorders. However, marijuana use disorder increased.

    Co-occurring MH/SUD:

    • For both adults and adolescents with mental health challenges, the prevalence of substance use was higher compared to those without mental health challenges. For example, adolescents with a past-year major depressive episode (MDE) used illicit drugs in the past year at more than twice the rate of adolescents without a MDE (21.7% vs. 9.1%). The differences existed for most substances and among adults, as well.
    • 2.5% of adolescents had a co-occurring MDE and SUD in the past year, a decrease from 2021. There was no change in co-occurring mental illness and SUD among adults, with 7% having co-occurring disorders in 2025.

    Treatment:

    • SUD treatment: Only 1 in 6 (16%) people who needed SUD treatment received treatment in the past year. Treatment receipt was highest among adolescents (22.8% of those needing treatment received it), followed by those 26+ (17.1%) and young adults 18-25 (9.6%).
    • Medications: Among people with past-year alcohol use disorder (AUD), 2.6% received medications for AUD. Among people with past-year opioid use disorder (OUD), 15.7% received medications for OUD in the past year.
    • Co-occurring treatment: Among adolescents with co-occurring MDE and SUD in the past year, 75.4% received either substance use or mental health treatment, 14.3% received both types of treatment, and 24.6% received neither type of treatment. Most who received treatment received only mental health treatment. Among adults with co-occurring mental illness and SUD, 57.4% received either treatment, but only 12.7% received both, and 42.6% received no treatment for either condition.
    • Other supports: Among people with a past-year SUD, 9.6% received other services (not counted in the substance use treatment). 0.9% received overdose reversal medication, 2.2% received withdrawal management services, 2.8% were seen in an emergency room, 3.5% received services from a peer support specialist or recovery coach, and 6.4% participated in a support group. But 86.4% of people with SUD received neither treatment nor other supports in the past year.

    Recovery:

    • Among adults who perceived that they ever had a substance use problem, 73% (22.3 million) considered themselves to be in recovery or to have recovered.

    Read more: Federal survey shows promising trends for youth mental health and drug use