84% of Americans Who Need Addiction Treatment Don't Receive It, SAMHSA Survey Finds

Only 16 percent of Americans who needed substance use disorder treatment received it in 2025, leaving approximately 39 million people—84 percent of those with clinical need—without care, according to new data from the National Survey on Drug Use and Health released by the Substance Abuse and Mental Health Services Administration.

The finding, reported in the survey's latest release, documents a stark disconnect between the scale of addiction in the United States and the capacity of the healthcare system to respond. Despite declining rates of substance use disorders overall and encouraging trends among adolescents, the persistence of what researchers call the "treatment gap" suggests that policy efforts to expand access have not yet reached the vast majority of those affected.

The most common barrier: "I can handle it myself"

When survey respondents who needed but did not receive treatment were asked why, the most frequently cited reason was a belief that they could manage their substance use without professional help. This self-reliance—whether stemming from stigma, lack of awareness about effective treatments, or genuine uncertainty about whether their use qualified as problematic—emerges as the single largest obstacle to closing the treatment gap.

Other barriers tracked in previous surveys, such as cost concerns, lack of insurance coverage, and inability to find appropriate services, undoubtedly continue to play significant roles. But the prominence of "handling it alone" as the primary reason points to a fundamental challenge in addiction policy: convincing people who meet clinical criteria for substance use disorders that they have a condition warranting intervention, and that evidence-based treatments can help.

Declining disorders, persistent unmet need

The 2025 NSDUH data, drawn from self-reported responses by more than 60,000 Americans aged 12 and older, shows that the prevalence of substance use disorders did decline modestly over the past five years. Among people aged 12 or older, past-year substance use disorder fell from 16.7 percent in 2021 to 15.3 percent in 2025. Alcohol use disorder showed a more substantial decrease, dropping from 10.6 percent to 8.9 percent over the same period.

Yet the absolute numbers remain enormous. In 2025, 44.6 million Americans met clinical criteria for at least one substance use disorder. Even with the decline, the 39 million people who needed but did not receive treatment represent a population larger than the state of California—a reminder that percentage-point improvements at the national level still leave tens of millions without care.

What people are using—and what's changing

The survey documents shifting patterns of substance use that complicate the treatment landscape. Marijuana use continued to rise, with 21.2 percent of Americans aged 12 or older—61.6 million people—reporting past-year use. Daily or near-daily marijuana use now exceeds daily cigarette smoking for the first time in the survey's four-decade history, with 21.4 million daily cannabis users compared to 19.9 million daily smokers.

Hallucinogen use also increased slightly, with 9.1 million people reporting past-year use, up 0.4 percent from 2021. By contrast, prescription opioid misuse declined by 0.6 percent, with 6.9 million people misusing these medications in 2025. Illicitly manufactured fentanyl use remained unchanged, while cocaine use held steady at 4.9 million people.

The rise in marijuana use disorders—now affecting an estimated 19.3 million Americans—presents particular challenges for treatment access. Unlike opioid use disorder, for which medication-assisted treatment with buprenorphine or methadone is well-established, or alcohol use disorder, which responds to both medications and behavioral therapies, cannabis addiction lacks FDA-approved pharmacological treatments. Behavioral interventions for marijuana use disorder exist but are less widely available and less standardized than those for other substances.

Youth trends offer a different picture

The survey's most encouraging findings center on adolescents and young adults, who showed declines across nearly every measured substance use category. Past-month tobacco, alcohol, binge drinking, and marijuana use all fell among 12- to 17-year-olds from 2021 to 2025. Mental health indicators similarly improved, with reductions in major depressive episodes, serious suicidal thoughts, suicide planning, and actual attempts.

"Building on encouraging trends first reported in the 2024 NSDUH, in 2025, adolescents aged 12-17 and young adults aged 18-25 continued to show downward or stable trends in most behavioral health indicators over the past 5 years," said SAMHSA Principal Deputy Assistant Secretary Christopher Carroll in a news release accompanying the data.

These improvements among youth, however, have not yet translated into reduced unmet need among adults aged 26 and older, who showed increased rates of serious suicidal thoughts, suicide planning, and attempts over the five-year period.

The math of the gap

The 16 percent treatment rate documented in the 2025 survey represents a slight improvement over some previous estimates but remains far below what public health experts consider adequate. For comparison, roughly 27.6 percent of adolescents and 21.6 percent of adults with mental health needs accessed treatment in 2025—still concerning gaps, but smaller than those for substance use disorders.

The persistence of the treatment gap comes despite significant policy efforts over the past decade. The elimination of the X-waiver requirement for buprenorphine prescribing was intended to expand access to medication-assisted treatment. State Opioid Response grants have directed billions toward treatment infrastructure. Medicaid expansion in most states has increased insurance coverage for addiction services. Yet these systemic changes appear to have reached only a fraction of those in need.

The survey data suggests that addressing the treatment gap will require more than expanding capacity—it will require changing perceptions. As long as the most common reason for not seeking treatment remains the belief that one can handle it alone, outreach and education may be as important as new clinics and prescribers.