July 29, 2025
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Release of the 2024 National Survey on Drug Use and Health: Leveraging the Latest Substance Use and Mental Health Data to Make America Healthy Again

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Release of the 2024 National Survey on Drug Use and Health: Leveraging the Latest Substance Use and Mental Health Data to Make America Healthy Again


Mental health, substance misuse, addiction, and their related health and social impacts such as overdose and suicide are dynamic and evolving.

With the ready availability of illicitly made fentanyl and other potent synthetic opioids such as nitazenes, the emergence of substances like xylazine, medetomidine, and illicit benzodiazepines, and increasing polysubstance use, Americans face an illicit drug supply that is more toxic, unpredictable, and dangerous than ever. In addition, the proliferation of social media and other technology that is inundating America’s young people coupled with other social stressors in homes and communities across the Nation have contributed to declining mental health and well-being and rising rates of suicide in the past two decades.

We know that mental health and substance use conditions are part of the chronic disease crisis plaguing our nation. Research shows that substance misuse and early health risk behaviors that take root during childhood and adolescence are closely linked to risk for chronic disease, substance use disorders, and mental health conditions later in life and contribute to a significant proportion of the health and social costs associated with chronic disease. By addressing mental health and substance misuse head-on through a comprehensive approach in partnership with states, communities, and tribes, we can help to achieve the Administration’s goal of Making America Health Again (MAHA) (PDF | 3.8 MB).

As we embark on a bold new path to MAHA, having timely data to inform policy, program and practice are essential. For more than four decades, SAMHSA’s National Survey on Drug Use and Health (NSDUH) has been the federal government’s trusted source of information on substance use and mental health.

Today, SAMHSA is releasing the 2024 NSDUH results which provide key insights into the latest trends and patterns of substance use and mental health among Americans. Of note, the 2024 NSDUH marks the first year since 2020 in which there are at least four years of comparable data for key NSDUH outcomes, enabling reporting of trends from 2021 to 2024 for many substance use and mental health measures. Linear tests of were conducted to determine whether an outcome of interest showed a statistically significant change from 2021 through 2024.

Today’s release represents the earliest release of the annual NSDUH report, delivering on the Trump Administration’s promise of greater efficiency and transparency in data-driven policy making. Detailed below are some of the key findings from the 2024 NSDUH. Additional information, data, and resources can be found on the NSDUH webpage.

Substance Use Among Americans 12 Years or Older

Alcohol, nicotine and marijuana remain the most commonly used substances among Americans (Figure 1). In 2024, 134.3 million people aged 12 years or older reported using alcohol in the past month, followed by 48.0 million using tobacco products, 44.3 million using marijuana, and 27.7 million vaping nicotine.

Figure 1. Number of Americans 12 Years or Older Reporting Past Month Use of Specific Substances, 2024

Figure 1. This horizontal bar graph has a value axis ranging from 0 to 150 million and a vertical axis showing labels for substances. Numbers are 134.3 million for alcohol use, 48.0 million for tobacco product use, 27.7 million for nicotine vaping, 44.3 million for marijuana use, 2.8 million for hallucinogen use, 2.1 million for prescription pain reliever misuse, 1.7 million for cocaine use, 1.5 million for prescription tranquilizer or sedative misuse, 1.4 million for methamphetamine use, 1.2 million for prescription stimulant misuse, 1.1 million for inhalant use, and 259,000 for heroin use.

In 2024, approximately 1 in 4 Americans 12 years or older (73.6 million; 25.5%) reported illicit drug use in the past year (Figure 2). This included 64.2 million that reported past year use of marijuana, 10.4 million that used hallucinogens, 7.6 million misusing prescription opioids, 4.6 million misusing prescription tranquilizers or sedatives, and 4.3 million using cocaine.

Figure 2. Number of Americans 12 Years or Older Reporting Use of Specific Illicit Drugs in the Past Year, 2024

Figure 13. This figure is a pie chart connected to a horizontal bar graph. The pie chart on the left shows that 214.6 million people (74.5 percent) did not use illicit drugs in the past year, and 73.6 million people (25.5 percent) did use illicit drugs in the past year. The horizontal bar graph on the right shows the numbers of past year illicit drug use among people aged 12 or older. The value axis ranges from 0 to 75 million, and the vertical axis shows labels for illicit drug use. Of the 73.6 million people who used illicit drugs in the past year, 64.2 million used marijuana, 10.4 million used hallucinogens, 7.6 million misused prescription opioids, 4.6 million misused prescription tranquilizers or sedatives, 4.3 million used cocaine, 3.9 million misused prescription stimulants, 3.2 million used inhalants, 2.4 million used methamphetamine, and 556,000 used heroin.

In addition to past month and past year use, NSDUH captures the number of people in the U.S. who reported using specific drugs, alcohol, or nicotine for the first time in the past year (Figure 3). Nicotine vaping (5.4 million new initiates), alcohol use (4.2 million new initiates), and marijuana use (2.9 million new initiates) were most common substances. These annual numbers translate to approximately 14,800 new users of nicotine vaping, 11,500 new users of alcohol, 7,900 new users of marijuana each day in 2024.

Figure 3. Past Year Initiates of Specific Substances Among People 12 Years or Older, 2024

Figure 31. This horizontal bar graph has a value axis ranging from 0 to 6 million and a vertical axis showing labels for substances. Numbers are 5.4 million for nicotine vaping initiates, 4.2 million for alcohol use initiates, 1.6 million for cigar use initiates, 1.5 million for cigarette use initiates, 2.9 million for marijuana use initiates, 1.6 million for hallucinogen use initiates, 1.5 million for prescription pain reliever misuse initiates, 704,000 for prescription tranquilizer misuse initiates, 688,000 for inhalant use initiates, 619,000 for prescription stimulant misuse initiates, 426,000 for cocaine use initiates, 205,000 for prescription sedative misuse initiates, 104,000 for methamphetamine use initiates, and 30,000 for heroin use initiates.

Substance Use Disorders Among Americans 12 Years or Older

In 2024, nearly 50 million Americans, 16.8% of people 12 years or older, met diagnostic criteria for a substance use disorder in the past year (Figure 4). Of these individuals, 27.9 had an alcohol use disorder, 28.2 million had a drug use disorder. About 1 in 6 people with a past year substance use disorder (16.0% or 7.7 million people) had both an alcohol use disorder and a drug use disorder in the past year. Marijuana use disorder was the most common drug use disorder (20.6 million), followed by opioid use disorder (4.8 million), and central nervous system stimulant use disorder (4.3 million)

Figure 4. Past Year Substance Use Disorders Among People 12 Years or Older, 2024

Figure 35. This pie chart is connected to a horizontal bar graph. The pie chart on the left shows 239.9 million people (83.2 percent) did not have an SUD in the past year, and 48.4 million people (16.8 percent) did have an SUD in the past year. The horizontal bar graph on the right shows the numbers for SUDs among people aged 12 or older. The value axis ranges from 0 to 30 million, and the vertical axis shows labels for specific SUDs. Of the 48.4 million people who had an SUD in the past year, 28.2 million had a drug use disorder, 27.9 million had an alcohol use disorder, 20.6 million had a marijuana use disorder, 4.8 million had an opioid use disorder, 4.3 million had a central nervous system stimulant use disorder, and 2.1 million had a tranquilizer or sedative use disorder. There are superscripted numbers 1, 2, and 3 associated with drug use disorder, opioid use disorder, and central nervous system stimulant use disorder, respectively, to direct readers to the text for footnotes 1, 2, and 3.

Mental Health Among Adults 18 Years or Older

For the first time in 2024, the NSDUH included the Generalized Anxiety Disorder (GAD-7) scale, a validated self-report measure to screen for and assess symptoms of GAD in the past two weeks. Among adults 18 years or older in the U.S., 7.4% had moderate or severe symptoms of anxiety and 14.3% had mild symptoms (Figure 5). Moderate to severe symptoms were more common among 18 to 25 year-olds (14.5%) compared to 26 to 49 year-olds (9.0%) and adults 50 years or older (3.9%).

Figure 5. Generalized Anxiety Symptom Severity in the Past 2 Weeks Among Adults 18 Years Older, 2024

Figure 46. This vertical stacked bar graph has a value axis ranging from 0 to 100 percent and a horizontal axis showing labels for four age groups (18 or older, 18 to 25, 26 to 49, and 50 or older). Each bar includes a top section representing moderate or severe symptoms, a middle section representing mild symptoms, and bottom section representing no or minimal symptoms. Percentages for 18 or older are 7.4 for moderate or severe symptoms, 14.3 for mild symptoms, and 78.3 for no or minimal symptoms. Percentages for 18 to 25 are 14.5 for moderate or severe symptoms, 22.0 for mild symptoms, and 63.4 for no or minimal symptoms. Percentages for 26 to 49 are 9.0 for moderate or severe symptoms, 17.1 for mild symptoms, and 73.9 for no or minimal symptoms. Percentages for 50 or older are 3.9 for moderate or severe symptoms, 9.6 for mild symptoms, and 86.5 for no or minimal symptoms.

Among adults 18 years or older, 8.2% (21.4 million) had a past year major depressive episode (MDE). The percentage of adults aged 18 or older who had a past year MDE with severe impairment was 5.6% (14.7 million). As with generalized anxiety disorder symptoms, a larger percentage of adults 18 to 25 years old had MDE and MDE with severe impairment (15.9% and 11.5%, respectively) compared to adults aged 26 to 49 (10.0% and 7.0%) and 50 or older (4.4% and 2.6%).

About 1 in 4 adults 18 years or older (23.4%; 61.5% million) had any mental illness (AMI) in the past year (Figure 6). The percentage of adults 18 to 25 years old with AMI was 33.2%, followed by 29.7% of adults 26 to 49 years old, and 15.2% of adults 50 or older. In 2024, 5.6% (14.6 million) of adults aged 18 years or older had serious mental illness (SMI) in the past year. Among adult age groups, SMI was highest among 18 to 25 year olds (9.4%), followed by 26 to 49 year olds (7.5%), and adults 50 years or older (2.8%).

Figure 6. Percentage of Adults with Any Mental Illness and Serious Mental Illness in the Past Year, 2024

Figure 6. This vertical clustered bar graph has a value axis ranging from 0 to 35 percent and a horizontal axis showing labels for any mental illness and serious mental illness. Each cluster includes a first bar representing people 18 or older, a second bar representing people 18 to 25, and third bar representing people 26 to 49, and a last bar representing people 50 or older. Percentages for any mental illness were 23.4 for people 18 or older, 33.2 for people 18 to 25, 29.7 for people 26 to 49, and 15.2 for people 50 or older. For serious mental illness percentages were 5.6 for people 18 or older, 9.4 for people 18 to 25, 7.5 for people 26 to 49, and 2.8 for people 50 or older.

Suicidal Thoughts, Plans, and Attempts Among Adults

Among adults 18 years or older in 2024, 5.5% (14.3 million) reported serious thoughts of suicide in the past year, 1.8% (4.6 million) made a suicide plan, and 0.8% (2.2 million attempted suicide (Figure 7).

Figure 7. Suicidal Thoughts, Plans, and Attempts Among Adults, 2024

Figure 62. This Venn diagram of three overlapping circles shows that among 14.9 million adults aged 18 or older who had serious thoughts of suicide, made a suicide plan, or attempted suicide in the past year, 14.3 million had serious thoughts of suicide, including 9.8 million who had serious thoughts of suicide only. The smaller overlapping circle on the right shows that 4.6 million adults made a suicide plan, including 281,000 who made a suicide plan only and 2.6 million who had serious thoughts of suicide and made a suicide plan, but did not attempt suicide. The smallest overlapping circle on the lower right shows that 2.2 million adults attempted suicide, including 155,000 who attempted suicide only; 269,000 who had serious thoughts of suicide and attempted suicide, but did not make a suicide plan; 113,000 who made a suicide plan and attempted suicide, but did not have serious thoughts of suicide; and 1.7 million who had serious thoughts of suicide, made a suicide plan, and attempted suicide.

Adolescent Mental Health

Among adolescents aged 12 to 17 in 2024, about 1 in 5 (18.8%; 4.9 million) had moderate or severe symptoms of GAD; about 1 in 4 adolescents (23.1%; 6.0 million) had mild symptoms (Figure 8).

Figure 8. Generalized Anxiety Symptom Severity in the Past 2 Weeks Among Adolescents Aged 12 to 17 Years Old, 2024

Figure 45. This pie chart shows the percentages are 58.1 for no or minimal symptoms, 23.1 for mild symptoms, and 18.8 for moderate or severe symptoms.

Among adolescents aged 12 to 17, 15.4% (3.8 million) had a past year MDE and 11.3% (2.8 million) had a past year MDE with severe impairment in 2024 (Figure 9).

Figure 9. Number of Percentage of Adolescents with Major Depressive Episode and Major Depressive Episode with Severe Impairment, 2024

Figure 47. This figure is a nested three-circle diagram representing 26.0 million adolescents. The largest circle shows 21.2 million adolescents who had no MDE (84.6 percent of all adolescents). The second largest circle shows 3.8 million adolescents who had an MDE (with or without severe impairment) (15.4 percent of all adolescents). The smallest circle shows 2.8 million adolescents who had an MDE with severe impairment (11.3 percent of all adolescents and 74.1 percent of adolescents who had an MDE).

In 2024, 2.6 million (10.1%) adolescents reported serious thoughts of suicide, 1.2 million (4.6%) made a suicide plan, and 700,000 (2.7%) attempted suicide (Figure 10).

Figure 10. Suicidal Thoughts, Plans, and Attempts Among 12 to 17 Years Old, 2024

Figure 67. This vertical clustered bar graph has a value axis ranging from 0 to 12 percent and a horizontal axis showing labels for three suicidal thoughts or behaviors. Each cluster includes a first bar representing a yes response, a second bar representing a not sure/don’t know response, and a last bar representing those who didn’t want to answer or refused to respond. Percentages for adolescents who had serious thoughts of suicide were 10.1 who responded yes, 6.7 who responded not sure/don’t know, and 6.8 who didn’t want to answer or refused to respond. Percentages for adolescents who made a suicide plan were 4.6 who responded yes, 2.6 who responded not sure/don’t know, and 5.7 who didn’t want to answer or refused to respond. Percentages for adolescents who attempted suicide were 2.7 who responded yes, 1.7 who responded not sure/don’t know, and 4.8 who didn’t want to answer or refused to respond.

Treatment for Substance Use Disorders and Mental Illness

In 2024, approximately 1 in 5 people (19.3%) who needed substance use treatment, actually received treatment in the past year. Treatment receipt was highest among adolescents aged 12 to 17 years (30.2% of those needing treatment reported receiving treatment in the past year), followed by those 26 years or older (20.5%) and those 18 to 25 years old (11.3%) (Figure 11).

Figure 11. Receipt of Substance Use Treatment in the Past Year Among People Aged 12 or Older Who Needed Substance Use Treatment in the Past Year, 2024

Figure 71. This vertical bar graph has a value axis ranging from 0 to 40 percent and a horizontal axis showing labels for four age groups. Percentages are 19.3 for 12 or older, 30.2 for 12 to 17, 11.3 for 18 to 25, and 20.5 for 26 or older.

In 2024, among adults with any mental illness and those with serious mental illness in the past year, most received mental health treatment in the past year. Overall, 52.1% of adults with any mental illness and 70.8% of those with serious mental illness reported receiving mental health treatment in the past year (Figure 12).

Figure 12. Receipt of Mental Health Treatment in the Past Year Among People Adults 18 or Older with Any Mental Illness or Serious Mental Illness in the Past Year, 2024

Figure 77. This vertical clustered bar graph has a value axis ranging from 0 to 80 percent and a horizontal axis showing labels for any mental illness (with or without serious mental illness) and serious mental illness. Each cluster includes four bars representing the age groups 18 or older, 18 to 25, 26 to 49, and 50 or older. Percentages for any mental illness (with or without serious mental illness) were 52.1 for 18 or older, 49.9 for 18 to 25, 53.0 for 26 to 49, and 52.0 for 50 or older. Percentages for serious mental illness were 70.8 for 18 or older, 71.3 for 18 to 25, 69.0 for 26 to 49, and 74.4 for 26 or older.

Among the 3.8 million adolescents aged 12 to 17 in 2024 that had a past year major depressive episode, 60.6% (2.3 million) reported receiving mental health treatment in the past year (Figure 13).

Figure 13. Types and Locations of Mental Health Treatment in the Past Year Among Adolescents Aged 12 to 17 with a Past Year Major Depressive Episode (MDE), 2024

Figure 75. This horizontal bar graph has a value axis ranging from 0 to 70 percent and a vertical axis showing labels for mental health treatment types and locations. Percentages are 60.6 for mental health treatment; 50.8 for outpatient; 33.2 for telehealth treatment; 31.2 for prescription medication; 7.1 for inpatient; and 2.9 for prison, jail, or juvenile detention center.

In 2024, among adults 18 or older, 12.2% (31.7 million) perceived they ever had a problem with their use of drugs or alcohol. Among these adults, 74.3% (23.5 million) considered themselves to be in recovery or to have recovered from their drug or alcohol use problem. Similarly, 26.1% of adults (67.8 million) perceived they ever had a problem with their mental health. Among these adults, 66.9% (45.0 million) considered themselves to be in recovery or to have recovered from their mental health issue (Figure 14).

Figure 14. Substance Use and Mental Health Recovery Among Adults 18 Years or Older, 2024

Figure 14. This vertical clustered bar graph has a value axis ranging from 0 to 80 million and a horizontal axis showing labels for substance use and menta health. Each cluster includes a first bar representing Ever Had a Problem/Issue and a second bar representing Recovered or in Recovery. For substance use, the number for ever had a problem/issue is 31.7 million and the number for recovered or in recovery is 23.5 million. For mental health, the number for ever had a problem/issue is 67.8 million and the number for recovered or in recovery is 45.0 million.

Key Substance Use and Mental Health Trends From 2021 to 2024

Among people 12 years or older, based on linear trend testing, most key outcome measures either decreased or remained stable between 2021 and 2024 (Figure 15).

Figure 15. Key Substance Use and Mental Health Trends from 2021 to 2024

Figure 15 (see attached for pic). This slide presents information on whether the trend for a particular substance use or mental health was decreased, no change, or increased between 2021 and 2024. Past month tobacco use, decreased Past month cigarette use, decreased Past month alcohol use, no change Past month binge alcohol use, decreased Past month heavy alcohol use, decreased Past year illicit drug use, increased Past year marijuana use, increased Past year cocaine use, decreased Past year methamphetamine use, no change Past year hallucinogen use, increased Past year Rx stimulant misuse, no change Past year Rx tranquilizer or sedative misuse, no change Past year Rx opioid misuse, decreased Past year substance use disorder, no change Past year alcohol use disorder, decreased Past year drug use disorder, increased Past year marijuana use disorder, increased Past year CNS stimulant use disorder, no change Past year opioid use disorder, no change Major depressive episode 12-17 year olds, decreased Major depressive episode with severe impairment 12-17 year olds, decreased Co-occurring major depressive episode and substance use disorder 12-17 year olds, decreased Co-occurring major depressive episode with sever impairment and substance use disorder 12-17 year olds, no change Serious thoughts of suicide 12-17 year olds, decreased Made a suicide plan 12-17 year olds, decreased Attempted suicide 12-17 year olds, decreased Major depressive episode 18 or older, no change Major depressive episode with severe impairment 18 or older, no change Any mental illness 18 or older, no change Serious mental illness 18 or older, no change Co-occurring any mental illness and substance use disorder 18 or older, no change Co-occurring serious mental illness and substance use disorder 18 or older, no change Serious thoughts of suicide 18 or older, no change Made a suicide plan 18 or older, increased Attempted suicide 18 or older, no change

Using the 2024 NSDUH To Drive Policy, Program, and Practice Strategies

The 2024 NSDUH identifies areas of progress in our work to address substance use and mental illness as well as key opportunities as we move forward our MAHA agenda and goals.

On the progress front, we see from the NSDUH that the percentage of people 12 years or older reporting use of most substances either decreased or remained stable between 2021 and 2024, with decreases in past month use of tobacco, cigarettes, binge and heavy drinking as well as decreases in past year use of cocaine, misuse of prescription opioids, and past year alcohol use disorder.

We also saw declines in a number of adolescent mental health measures between 2021 and 2024, including major depressive episode with and without severe impairment, co-occurring major depressive episode and substance use disorder, and all three measures of suicide – serious thoughts of suicide, suicide plans, and suicide attempts.

In addition, the high percentage of American adults that report being in recovery – 74.3% of those who perceived they ever had a problem with their use of drugs or alcohol and 66.9% of those who perceived they ever had a problem with their mental health – is a statistic to highlight and to help spread hope about the power and healing of recovery.

But the NSDUH also identifies trends heading in the wrong direction. This includes past year illicit drug use, marijuana use, and hallucinogen use and past year drug use disorder and marijuana use disorder. Among adults, we also saw that the percentage of people 18 or older that reported making a suicide plan increased between 2021 and 2024.

Of note, the increases in past-year illicit drug use and past-year drug use disorders are largely driven by increases in marijuana use and marijuana use disorder among adults 26 years or older. Although marijuana use and use disorder trends remained stable among adolescents and young adults between 2021 and 2024, the increase in adult use is important to inform prevention and treatment activities given changing attitudes around marijuana use and the shifting state policy landscape which has increased risk for marijuana use and use disorder among young people, and enabled the ready availability of high-potency marijuana products linked to negative health impacts in communities across the country.

A key pattern that has emerged in recent years is the prominence of vaping, especially among young people. In the 2024 NSDUH we find that among past month users of tobacco or nicotine products, 71.5% of 12 to 17 year-olds and 50.3% of 18 to 25 year-olds reported only vaping nicotine in contrast to 18.0% among adults 26 or older. For past month users of marijuana, 71.1% of 12 to 17 year-olds and 52.0% of 18 to 25 year-olds reported vaping marijuana compared to 33% among those 26 or older (Figure 16).

Figure 16. Routes of Nicotine and Marijuana Use Among Past-Month Users of Each Substance, 2024

Figure 3. This vertical stacked bar graph has a value axis ranging from 0 to 100 percent and a horizontal axis showing labels for four age groups. Each age group bar includes a top section representing only nicotine vaping, a middle section representing nicotine vaping and tobacco product use, and a bottom section representing only tobacco product use. Percentages for 12 or older are 24.6 for only nicotine vaping, 18.9 for nicotine vaping and tobacco product use, and 56.5 for only tobacco product use. Percentages for 12 to 17 are 71.5 for only nicotine vaping, 19.6 for nicotine vaping and tobacco product use, and 8.9 for only tobacco product use. Percentages for 18 to 25 are 50.3 for only nicotine vaping, 31.9 for nicotine vaping and tobacco product use, and 17.9 for only tobacco product use. Percentages for 26 or older are 18.0 for only nicotine vaping, 16.3 for nicotine vaping and tobacco product use, and 65.6 for only tobacco product use.

Figure 12. This vertical stacked bar graph has a value axis ranging from 0 to 100 percent and a horizontal axis showing labels for four age groups. Each age group bar includes a top section representing marijuana use but not marijuana vaping and a bottom section representing marijuana vaping. Percentages for 12 or older are 62.0 for marijuana use but not marijuana vaping and 38.0 for marijuana vaping. Percentages for 12 to 17 are 28.9 for marijuana use but not marijuana vaping and 71.1 for marijuana vaping. Percentages for 18 to 25 are 48.0 for marijuana use but not marijuana vaping and 52.0 for marijuana vaping. Percentages for 26 or older are 67.0 for marijuana use but not marijuana vaping and 33.0 for marijuana vaping.

The NSDUH also highlights the substantial overlap between substance use and mental health. Although mental health and substance use funding and treatment systems have historically often been separate, the NSDUH clearly demonstrates that in reality, people with substance use disorders and those with mental health challenges often have co-occurring conditions.

For both adults and adolescents with mental health challenges, the prevalence of substance use is higher compared to those without mental health challenges. As shown in Figure 17, whether it is adolescents with major depressive episode or moderate or severe anxiety symptoms, the prevalence of each substance use measure is significantly higher among those with mental health challenges.

Figure 17. Prevalence of Substance Use Among Adolescents 12 to 17 by Mental Health Status, 2024

Figure 55. This horizontal clustered bar graph has a value axis ranging from 0 to 40 percent and a vertical axis showing labels for five types of substance use or misuse. Each cluster includes a first bar representing those who had an MDE and a second bar representing those who did not have an MDE. Tests of statistical significance at the .05 level were performed between adolescents who did not have an MDE and adolescents who had an MDE; significant results are indicated where appropriate. Percentages for past year illicit drug use were 32.6 for adolescents who had an MDE and 11.8 for adolescents who did not have an MDE. The difference between these is statistically significant at the .05 level. Percentages for past year marijuana use were 25.0 for adolescents who had an MDE and 7.8 for adolescents who did not have an MDE. The difference between these is statistically significant at the .05 level. Percentages for past year opioid misuse were 2.8 for adolescents who had an MDE and 1.3 for adolescents who did not have an MDE. The difference between these is statistically significant at the .05 level. Percentages for past month binge alcohol use were 6.2 for adolescents who had an MDE and 3.0 for adolescents who did not have an MDE. The difference between these is statistically significant at the .05 level. Percentages for past month tobacco product use or nicotine vaping were 16.9 for adolescents who had an MDE and 4.7 for adolescents who did not have an MDE. The difference between these is statistically significant at the .05 level.

Figure 56. This horizontal clustered bar graph has a value axis ranging from 0 to 30 percent and a vertical axis showing labels for five types of substance use or misuse. Each cluster includes a first bar representing those who had moderate or severe anxiety symptoms and a second bar representing those who had no or minimal anxiety symptoms. Tests of statistical significance at the .05 level were performed between adolescents who had moderate or severe anxiety symptoms and adolescents who had no or minimal anxiety symptoms; significant results are indicated where appropriate. Percentages for past year illicit drug use were 25.6 for adolescents who had moderate or severe anxiety symptoms and 10.1 for adolescents who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level. Percentages for past year marijuana use were 17.5 for adolescents who had moderate or severe anxiety symptoms and 6.7 for adolescents who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level. Percentages for past year opioid misuse were 2.9 for adolescents who had moderate or severe anxiety symptoms and 1.2 for adolescents who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level. Percentages for past month binge alcohol use were 5.5 for adolescents who had moderate or severe anxiety symptoms and 2.4 for adolescents who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level. Percentages for past month tobacco product use or nicotine vaping were 12.8 for adolescents who had moderate or severe anxiety symptoms and 4.3 for adolescents who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level.

The same is true for adults with any mental illness and serious mental illness as well as adults with moderate or severe anxiety symptoms (Figure 18).

Figure 18. Prevalence of Substance Use Among Adults 18 or Older by Mental Health Status, 2024

Figure 60. This horizontal clustered bar graph has a value axis ranging from 0 to 60 percent and a vertical axis showing labels for five types of substance use or misuse. Each cluster includes a first bar representing adults who had any mental illness (with or without serious mental illness), a second bar representing adults who had serious mental illness, and a third bar representing adults who had no mental illness. Tests of statistical significance at the .05 level were performed between adults who had no mental illness and adults who had any mental illness (with or without serious mental illness); significant results are indicated where appropriate. Tests of statistical significance at the .05 level were also performed between adults who had no mental illness and adults who had serious mental illness; significant results are indicated where appropriate. Percentages for past year illicit drug use were 44.1 for adults who had any mental illness (with or without serious mental illness), 57.4 for adults who had serious mental illness, and 21.2 for adults who had no mental illness. The difference between adults who had any mental illness (with or without serious mental illness) and adults who had no mental illness was statistically significant at the .05 level. The difference between adults who had serious mental illness and adults who had no mental illness was statistically significant at the .05 level. Percentages for past year marijuana use were 38.7 for adults who had any mental illness (with or without serious mental illness), 50.5 for adults who had serious mental illness, and 18.8 for adults who had no mental illness. The difference between adults who had any mental illness (with or without serious mental illness) and adults who had no mental illness was statistically significant at the .05 level. The difference between adults who had serious mental illness and adults who had no mental illness was statistically significant at the .05 level. Percentages for past year opioid misuse were 5.5 for adults who had any mental illness (with or without serious mental illness), 9.5 for adults who had serious mental illness, and 2.0 for adults who had no mental illness. The difference between adults who had any mental illness (with or without serious mental illness) and adults who had no mental illness was statistically significant at the .05 level. The difference between adults who had serious mental illness and adults who had no mental illness was statistically significant at the .05 level. Percentages for past month binge alcohol use were 25.5 for adults who had any mental illness (with or without serious mental illness), 26.8 for adults who had serious mental illness, and 20.6 for adults who had no mental illness. The difference between adults who had any mental illness (with or without serious mental illness) and adults who had no mental illness was statistically significant at the .05 level. The difference between adults who had serious mental illness and adults who had no mental illness was statistically significant at the .05 level. Percentages for past month tobacco product use or nicotine vaping were 33.9 for adults who had any mental illness (with or without serious mental illness), 41.4 for adults who had serious mental illness, and 20.5 for adults who had no mental illness. The difference between adults who had any mental illness (with or without serious mental illness) and adults who had no mental illness was statistically significant at the .05 level. The difference between adults who had serious mental illness and adults who had no mental illness was statistically significant at the .05 level.

Figure 61. This horizontal clustered bar graph has a value axis ranging from 0 to 60 percent and a vertical axis showing labels for five types of substance use or misuse. Each cluster includes a first bar representing those who had moderate or severe anxiety symptoms and a second bar representing those who had no or minimal anxiety symptoms. Tests of statistical significance at the .05 level were performed between adults who had moderate or severe anxiety symptoms and adults who had no or minimal anxiety symptoms; significant results are indicated where appropriate. Percentages for past year illicit drug use were 48.9 for adults who had moderate or severe anxiety symptoms and 22.0 for adults who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level. Percentages for past year marijuana use were 43.1 for adults who had moderate or severe anxiety symptoms and 19.5 for adults who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level. Percentages for past year opioid misuse were 7.2 for adults who had moderate or severe anxiety symptoms and 2.1 for adults who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level. Percentages for past month binge alcohol use were 27.6 for adults who had moderate or severe anxiety symptoms and 20.5 for adults who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level. Percentages for past month tobacco product use or nicotine vaping were 41.2 for adults who had moderate or severe anxiety symptoms and 21.0 for adults who had no or minimal anxiety symptoms. The difference between these is statistically significant at the .05 level.

We see a similar pattern when we look at the overlap of substance use disorders and any mental illness and serious mental illness (Figure 19). Among the 61.5 million adults with any mental illness in the past year in 2024, 21.2 million (34.5%) also had a substance use disorder. Among the 14.6 million adults with serious mental illness in the past year in 2024, 6.9 million (47.3%) also had a substance use disorder. Among the 46.3 million adults with a substance use disorder in the past year in 2024, 45.8% had any mental illness and 14.9% had serious mental illness.

Figure 19. Any Mental Illness, Serious Mental Illness, and Substance Use Disorder Among Adults 18 or Older, 2024

Figure 57. This figure has two side-by-side Venn diagrams, each with two overlapping circles. The first diagram shows that among 86.6 million adults aged 18 or older who had either an SUD or AMI (with or without SMI), 46.3 million had an SUD, including 25.1 million who had an SUD but not AMI. The larger overlapping circle above the first one shows that 61.5 million adults had AMI (with or without SMI), including 40.3 million who had AMI (with or without SMI) but not an SUD and 21.2 million who had an SUD and AMI (with or without SMI). The second diagram shows that among 54.0 million adults aged 18 or older who had either an SUD or SMI, 46.3 million had an SUD, including 39.4 million who had an SUD but not SMI. The smaller overlapping circle above the first one shows that 14.6 million adults had SMI, including 7.7 million who had SMI but not an SUD and 6.9 million who had an SUD and SMI.

The final opportunity clearly identified in the 2024 NSDUH is the need to increase access to and utilization of treatment for substance use disorders and mental illness. The statistics are clear – 80% of people who needed treatment for a substance use disorder in 2024 did not get treatment. Although the gap for mental health treatment receipt is better – 40% of adolescents with major depressive episode did not receive treatment along with 48% of adults with any mental illness and 30% of adults with serious mental illness not receiving mental health treatment in the past year, there are opportunities to close this treatment gap.

And as we work together to improve access to treatment, we have to be strategic and intentional in developing systems of care that will meet the needs of individuals with behavioral health conditions, recognizing that more often than not, people struggling with mental health issues also have substance use challenges and those with substance use challenges also have mental health challenges. Yet, despite data showing this to be the case, we see that both adolescents and adults with substance use and mental health conditions rarely receive treatment for both.

For example, among adolescents with major depressive episode and substance use disorder in 2024, 27.9% received no treatment, and only a small percentage, 18.1% received both substance use and mental health treatment. Most often, 53.0% these adolescents only received mental health treatment (Figure 20).

Figure 20. Receipt of Substance Use Treatment or Mental Health Treatment in the Past Year Among Adolescents Aged 12 to 17 with Past Year Substance Use Disorder and Major Depressive Episode, 2024

Figure 79. This pie chart shows that among 792,000 adolescents who had a substance use disorder and an MDE in the past year, 221,000 (27.9 percent) did not receive treatment, and 571,000 (72.1 percent) received either substance use treatment or mental health treatment, of whom 8,000 (1.0 percent) received substance use treatment but no mental health treatment, 143,000 (18.1 percent) received both substance use treatment and mental health treatment, and 420,000 (53.0 percent) received mental health treatment but no substance use treatment.

A similar pattern emerges for adults with substance use disorder and any mental illness. In 2024, among the 21.2 million adults with co-occurring mental illness and substance use disorder, 41.2% received neither substance use or mental health treatment and only 14.5% received treatment for both substance use and mental health. As with adolescents, mental health treatment but not substance use treatment (41.0%) was most common (Figure 21).

Figure 21. Receipt of Substance Use Treatment or Mental Health Treatment in the Past Year Among Adults 18 or older with Past Year Substance Use Disorder and Any Mental Illness, 2024

Figure 80. This pie chart shows that among 21.2 million adults with a substance use disorder and any mental illness in the past year, 8.8 million (41.2 percent) did not receive treatment while 12.5 million (58.8 percent) received either substance use treatment or mental health treatment, of whom 681,000 (3.2 percent) received substance use treatment but no mental health treatment, 3.1 million (14.5 percent) received both substance use treatment and mental health treatment, and 8.7 million (41.0 percent) received mental health treatment but no substance use treatment.

The reality is we are facing unique addiction and mental health challenges in our country. But we have the data, tools, and resolve to get ahead of these challenges. By addressing mental health and addiction head-on we can make real, tangible progress in achieving our MAHA goals and realize a future where individuals, families, and communities are healthy and thriving.

At SAMHSA, we are committed partners in this effort and our work will continue to strategically leverage our data, expertise, resources, training, and technical assistance to:

  • Identify and address emerging behavioral health threats
  • Prevent substance misuse in the first place
  • Promote mental health and well-being
  • Expand crisis intervention care and services
  • Improve access to treatment for mental health and substance use conditions
  • Help individuals achieve long-term recovery

Conducted by the federal government since 1971, the NSDUH is a primary source of statistical information on self-reported substance use and mental health. The NSDUH report provides nationally representative data on the self-reported use of tobacco, alcohol, and illicit drugs; substance use disorders; mental health conditions; suicidal thoughts and behaviors; and substance use and mental health treatment and recovery among the civilian, noninstitutionalized population aged 12 or older in the United States. The annual NSDUH report is a statistical product from SAMHSA’s Center for Behavioral Health Statistics and Quality, one of 16 Federal Statistical Units.



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