SAMHSA released the findings of the 2024 National Survey on Drug Use and Health (NSDUH), a key 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 2021-2024.

• Past-month tobacco use, cigarette use, binge alcohol use, and heavy alcohol use all decreased, along with past-year cocaine use, prescription opioid misuse, and alcohol use disorder. Youth nicotine and alcohol use also decreased.
• But past-year illicit drug use, marijuana use, hallucinogen use, drug use disorder, and marijuana use disorder increased.

The details:

Substance Use:

• Total substance use: 58.3% of people aged 12+ (168 million) used tobacco products, vaped nicotine, used alcohol, or used an illicit drug in the past month. This includes 13.3% of adolescents 12-17, 58.9% of young adults 18-25, and 63.3% 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 2024 but remained stable for underage youth (12-20). Nicotine vaping increased 2023-2024, but underage nicotine vaping decreased. Around 12% of individuals 12-20 used nicotine products (tobacco products or vaped nicotine) in the past month, but 71.5% of adolescents who used nicotine products only vaped (did not use tobacco products).
• Alcohol: There was no change in past month alcohol use from 2021-2024, but binge drinking, heavy alcohol use, and underage alcohol use decreased. 13.3% of individuals 12-20 used alcohol in the past month.
• Illicit drugs: 1 in 4 Americans reported illicit drug use in the past year. Illicit drug use increased 2021-2024, largely driven by increases in marijuana use among adults 26+. In 2024, more than 1 in 10 adolescents and nearly 2 in 5 young adults used illicit drugs in the past year, though there was no change 2021-2024.
• Marijuana: Past-year and past-month marijuana use among individuals 12+ increased between 2021 and 2024 (22% used in the past year in 2024). There was no change in underage marijuana use, with 10.5% of individuals ages 12-20 using marijuana in the past month. About 1 in 20 adolescents and 1 in 4 young adults used marijuana in the past month.
• Other illicit drugs: Among individuals 12+, past-year use of hallucinogens also increased, while use of cocaine and misuse of prescription opioids decreased 2021-2024. Cocaine use in the past year increased slightly among adolescents (to 0.3%).

Substance Use Disorder:

• Nearly 50 million Americans (16.8%) had a SUD in the past year, 27.9 million of which had an alcohol use disorder and 28.2 million of which had a drug use disorder.
• Marijuana use disorder was the most common drug use disorder (20.6 million), followed by opioid use disorder (4.8 million).
• Between 2021 and 2024, drug use disorders increased (from 8.7% to 9.8% of individuals 12+), while alcohol use disorders decreased (from 10.6% to 9.7%). Overall substance use disorders did not change. The increase in drug use disorders was driven by increases in marijuana use disorder among adults 26+.

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, 33% of adolescents with a past-year major depressive episode (MDE) used illicit drugs in the past year, compared to 12% of adolescents without a MDE. The differences existed for most substances and among adults, as well.
• 3.2% of adolescents had a co-occurring major depressive episode and SUD in the past year. That’s a decrease from 4.1% in 2021. There was no change in co-occurring mental illness and SUD among adults 18+, with 8% having co-occurring disorders in 2024.

Treatment:

• SUD treatment: Approximately 1 in 5 (19.3%) people who needed SUD treatment received treatment in the past year. Treatment receipt was highest among adolescents (30.2% of those needing treatment received it), followed by those 26+ (20.5%) and young adults 18-25 (11.3%).
• Medications: Among people with past-year alcohol use disorder, 2.5% received medications for AUD. Among people with past-year opioid use disorder, 17% received medications for OUD in the past year.
• Co-occurring treatment: Among adolescents with co-occurring MDE and SUD in the past year, 72.1% received either substance use or mental health treatment, 18.1% received both types of treatment, and 27.9% received neither type of treatment. Most who received treatment received only mental health treatment. Among adults with co-occurring mental illness and SUD, 58.8% received either treatment, but only 14.5% received both, and 41.2% received no treatment for either condition.
• Other supports: While not counted in the substance use treatment numbers, 0.6% of people reported receiving overdose reversal medication (1.8 million) and being seen in an emergency room (1.7 million). 2.1% (6.1 million) participated in a support group, and 0.8% (2.2 million) received services from a peer support specialist or recovery coach.

Recovery:

• Among adults who perceived that they ever had a substance use problem, 74.3% (23.5 million) considered themselves to be in recovery or to have recovered.