The current state of substance use disorders in the U.S.

In 2023, 70 million Americans dealt with substance use disorder (specifically alcohol and opioid use).

It is an alarmingly common condition—nearly everybody has been impacted by a substance use disorder in some way, whether they’ve struggled with addiction themselves or know someone who has.

Substance use disorder is more understood than ever before, but finding and accessing the right treatment options—let alone affording them—can still be challenging. Here’s a look at the current state of substance use disorders and treatment.

What is a substance use disorder?

Substance use disorder (SUD) is a medical condition where a person is unable to control their use of a substance, even when using it causes significant negative consequences in their lives.

Put simply, their substance use becomes a pattern. And the more they continue to use, the more negative impacts they deal with—potentially even impairing their ability to function in their daily lives.

Substance use is a broad category that includes a number of different types of substances including:

• Alcohol
• Caffeine
• Nicotine/tobacco
• Illegal drugs (e.g., cocaine)
• Prescription drugs (e.g., opioids like Vicodin, Percocet, and OxyContin)

Alcohol use disorder is the most common type of SUD in the United States. However, people might also use several different types of substances simultaneously. In 2023, 7.5 million Americans struggled with both alcohol and drug use disorders simultaneously.

Repeated substance use brings many detrimental consequences and side effects—and, in many cases, even death. According to the CDC, the age-adjusted rate of drug overdose deaths rose from 8.2 deaths per 100,000 in 2002 to 32.6 in 2022. Additionally, the CDC names “unintentional injury” (which includes overdoses) as the leading cause of death in people under age 44.

Substance use disorder is also frequently referred to as substance abuse, dependence, or addiction. However, substance use disorder is the preferred term among clinicians and experts.

Prevalence of substance use disorders

While many people might have preconceived notions about who struggles with substance use disorder, statistics show it’s surprisingly prevalent:

• 22% of males and 17% of females used illegal drugs or misused prescription drugs within the last year
• 20.4% of people who drink alcohol have an alcohol use disorder
• 46% of U.S. adults have a family member or close friend who is addicted to one or more drugs

Substance use disorders are widespread, but research does indicate that this disorder is more common in small towns and rural communities. In one study, rural participants were five times more likely than urban participants to have misused prescription opioids.

Treatment for substance use disorders

Because substance use disorders have become so widespread, treatment options have increased. There are several different programs available, based on the type and intensity of care a person requires:

• Detoxification: Also referred to as “detox,” this provides supervision and medical assistance for people who need to withdraw from substances and manage any related symptoms. This is typically the first step in substance use treatment programs.
• Inpatient or residential programs: With this option, people admit themselves and stay in a controlled treatment center to receive round-the-clock support and care. The length of the stay depends on the person’s needs and can range from weeks to months.
• Outpatient or intensive outpatient programs (IOP): This is a treatment option that provides care without 24-hour supervision and often fewer restrictions than inpatient programs. People receive treatment for several hours a day a few days per week, but begin to resume their daily activities outside of that.
• Partial hospitalization programs: This is a type of IOP where people receive treatment all day in a hospital or clinic setting and then return home in the evenings. These are also often called “day programs.”

People might use a variety of treatment options. For example, they could start with detoxification and an inpatient program before moving to an outpatient option. The journey is not the same for everyone.

5 reasons those struggling with substance use don’t get treatment

Unfortunately, 94% of people with a substance use disorder don’t receive treatment. But why—especially when there’s this variety of options available? Several barriers prevent people from finding and getting the care they need.

1. Cost

Substance use treatment is expensive. According to one study, the average daily cost per day of treatment was $878, and 48% of facilities required partial or full payment upfront.

Costs really start to rise when looking at inpatient and residential programs. The same study found that the quoted cost of a month’s stay at a residential treatment facility was over $26,000. Separate research found that the total average residential addiction treatment cost is $42,500.

It’s also difficult to find treatment options that accept the right insurance—especially for people who have Medicaid. Those that do accept Medicaid are often booked. In the same study, 57% of facilities that accepted Medicaid reported a waitlist compared to 19% of facilities that did not accept Medicaid.

2. Lack of access

Speaking of waitlists, access is another major roadblock for people who need treatment.

In one study, researchers found that only 54% of the residential treatment facilities they contacted had a bed immediately available. For the facilities with a waitlist, the average estimated time before a bed opened was 28 days.

Nearly one-third of states have less than 25 beds for substance use treatment per 100,000 people, meaning there’s simply not enough care available for people who need it.

3. Insufficient facilities

It’s not just the amount of care that’s the problem—it’s the quality of care. Substance use treatment facilities are largely unmonitored, which means many get away with providing inferior care.

In one 2017 study, only half (or fewer) of the facilities in online directories offered services that are considered indicative of higher-quality addiction treatment. These services include mental health assessments, self-help groups, employment or transportation assistance, medications for opioid use disorder, and testing for hepatitis C, HIV, and STDs.

4. Complexity

When someone realizes and accepts that they need substance use treatment, they likely feel overwhelmed and scared. Then they need to navigate a complex system and determine what treatment they need, where and how to get it, whether it’s available, and how to pay.

67% of U.S. adults say they think it’s harder to find a mental healthcare provider than it is to find a physical healthcare provider. Even further, 81% of adults who received substance use care say they had trouble getting that care.

5. Stigma

There’s a lot of stigma attached to substance use disorders, and people fear judgment and mistreatment, even in a medical setting.

Research shows that many health professionals maintain a negative attitude toward patients with substance use disorders and also lack relevant education, training, and resources to work with this group—which makes treatment less successful.

Substance use disorders require compassion and care

Substance use disorders are surprisingly common, yet stigma is still strong. That sense of judgment and shame makes it even tougher for people who are struggling to admit they have a problem. And when they do? Adequate care is still hard for many people to come by.

Persistent substance use shouldn’t be chalked up as a bad choice or a lost cause. It’s a mental health disorder that—much like any other disease—warrants accessible, compassionate, and high-quality care.

Learn more about Carrum Health’s new value-based substance use treatment program. 

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.