SAMHSA: 44.6 Million Americans Have Substance Use Disorder, Marijuana Addiction Now Second Most Common

The Substance Abuse and Mental Health Services Administration released its 2025 National Survey on Drug Use and Health on Monday, revealing that 44.6 million Americans aged 12 or older—15.3 percent of the population—met clinical criteria for at least one substance use disorder last year. The comprehensive federal assessment, based on responses from more than 60,000 individuals, documents a complex landscape of shifting addiction patterns: declining alcohol use disorders alongside rising marijuana dependence, persistent treatment gaps affecting tens of millions, and notable improvements among adolescents that offer cautious optimism for prevention efforts.

Marijuana Use Disorder Surges to Second Most Common Addiction

Perhaps the most striking finding in the 2025 survey involves cannabis. Nearly 19.3 million Americans now meet clinical criteria for marijuana use disorder, placing it second only to alcohol as the nation's most prevalent substance addiction. This figure represents a significant increase from previous years and underscores the evolving nature of substance use as marijuana becomes increasingly accessible through state legalization and commercial expansion.

The daily use statistics reveal an even more dramatic shift. For the first time in the survey's four-decade history, daily or near-daily marijuana users (21.4 million) now outnumber daily cigarette smokers (19.9 million) and exceed daily alcohol consumers (17.2 million). This reversal of long-standing patterns reflects both declining tobacco use and the normalization of cannabis as a regular fixture in millions of Americans' daily routines.

Marijuana's reach extends broadly across the population, with 43.8 million people reporting past-month use—approximately 21 percent of Americans aged 12 and older. By comparison, just 3 percent used hallucinogens and 2 percent misused prescription opioids, highlighting how cannabis has become the dominant illicit substance in American life.

Alcohol Use Disorder Shows Meaningful Decline

While marijuana-related problems have increased, the survey offers encouraging news regarding alcohol. The overall rate of substance use disorders fell from 16.7 percent (46.8 million people) in 2021 to 15.3 percent (44.6 million) in 2025, driven largely by reductions in alcohol use disorder. Alcohol-related addiction declined from 10.6 percent (29.7 million people) in 2021 to 8.9 percent (25.7 million) in 2025—a substantial improvement that public health experts attribute to shifting generational attitudes, expanded treatment access, and evolving social norms around drinking.

The breakdown of substance use disorders reveals the complex interplay between different substances. Among the 44.6 million Americans with substance use disorders, 25.7 million had alcohol use disorder, 26 million had drug use disorders, and 7.1 million experienced both alcohol and drug use disorders simultaneously. These overlapping conditions highlight the challenges faced by individuals with multiple substance dependencies and the need for integrated treatment approaches.

Illicit Drug Use Rises Despite Declining Overdose Deaths

The survey documents a significant increase in overall illicit drug use, rising from 22.2 percent (62 million people) in 2021 to 24 percent (69.8 million) in 2025—an increase of 7.8 million Americans. This rise in use comes even as overdose deaths have declined nationally for three consecutive years, suggesting that harm reduction strategies, expanded naloxone distribution, and improved treatment access may be decoupling drug use from fatal outcomes.

Marijuana drives much of this increase in illicit drug use, though the survey also tracks ongoing challenges with other substances. Past-month alcohol use remains the most common substance behavior, with 129.1 million Americans reporting consumption, followed by 46.9 million using tobacco products and 29.3 million vaping nicotine.

Adolescent Trends Offer Hope for Prevention

The survey's most encouraging findings center on young people. Adolescents aged 12 to 17 showed declines across nearly every measured substance use category, including past-month tobacco, alcohol, binge drinking, and marijuana use. Fewer teens initiated alcohol consumption or vaping, and fewer developed substance use disorders of any type compared to previous years.

Mental health indicators among youth similarly improved. Major depressive episodes declined among adolescents, alongside reductions in serious suicidal thoughts, suicide planning, and actual attempts. These positive trends extend to young adults aged 18 to 25, suggesting that prevention efforts and shifting social norms may be creating lasting behavioral changes among younger generations.

However, the survey also reveals persistent underlying vulnerabilities. Nearly 20 percent of adolescents reported moderate or severe anxiety symptoms in the previous two weeks—a rate nearly three times higher than adults over 18. While acute crises appear to be declining, the foundation of mental health challenges among young people remains elevated.

The Persistent Treatment Gap

Despite the wealth of data on substance use prevalence, the survey's most concerning finding involves treatment access. Well over 80 percent of Americans who needed substance use disorder treatment did not receive it in the past year—let alone quality, evidence-based care. This gap persists even as the nation has expanded Medicaid coverage for addiction services, eliminated the X-waiver requirement for buprenorphine prescribing, and invested billions in State Opioid Response grants.

The disconnect between need and care reflects persistent barriers including stigma, workforce shortages, geographic disparities in treatment availability, and systemic gaps in the healthcare system's capacity to address addiction. For the millions of Americans with marijuana use disorder, treatment options remain particularly limited, as cannabis addiction has received less attention and fewer dedicated resources compared to opioid or alcohol use disorders.

Implications for Policy and Practice

The 2025 NSDUH findings carry significant implications for policymakers, healthcare providers, and communities grappling with substance use challenges. The rise of marijuana use disorder to become the nation's second most common addiction suggests that public health infrastructure must adapt to address cannabis-related problems with the same seriousness applied to other substances. As more states legalize recreational use and commercial markets expand, prevention and treatment capacity for cannabis use disorder will require corresponding investment.

The decline in alcohol use disorder offers a model for what sustained public health attention can achieve. Decades of education campaigns, policy interventions, and treatment expansion have demonstrably reduced alcohol-related addiction. Similar sustained focus on emerging challenges like marijuana use disorder could yield comparable improvements over time.

For the addiction treatment field, the survey underscores the continued need for expanded capacity, workforce development, and innovative service delivery models. With 44.6 million Americans experiencing substance use disorders and the vast majority not receiving care, the gap between need and available services remains the defining challenge in addressing the nation's addiction crisis.

The complete 2025 National Survey on Drug Use and Health, including detailed demographic breakdowns and methodological information, is available through SAMHSA's Center for Behavioral Health Statistics and Quality.