Substance Use Statistics
Substances of Misuse - Data
The following statistics provide an overview of alcohol and drug use in the adult population of the United States. Data specific to legal professionals are found at Lawyer Statistics and Studies. The data cited was derived, unless otherwise noted, from information gathered in 2019. Subsequent data has been generated, but our review indicates that the effects of the Covid-19 pandemic may have temporally and materially skewed 2020 and 2021 data sets. We've opted to present 2019 data given its good fit with pre-pandemic historical trends.
The data below is from the Substance Abuse and Mental Health Data Archive (SAMHDA). The Substance Abuse and Mental Health Services Administration (SAMHSA) compiled the data through its annual survey of 70,000 US households - The National Survey on Drug Use and Health (NSDUH). The latest published data set, used in the analysis below, is from 2019, before the commencement of the Covid-19 pandemic. While a robust data set analyzing the effect of the Covid pandemic is not yet available, preliminary sampling and analysis suggest that alcohol and drug use have increased significantly since the beginning of the pandemic.
A few caveats before we delve further, as Mark Twain said - "There are three kinds of lies: lies, damned lies, and statistics." SAMHSA's statistical methodology is well accepted in the scientific community, and the NSDUH is generally considered to contain good data, but some limitations need to be considered in formulating a reasoned interpretation. The survey format (often involving an in-home visit from an interviewer) and the stigma associated with drug use, coupled with the debilitating nature of certain drugs of abuse, probably contribute to use underreporting of certain substances.
For example, the survey data pertaining to heroin significantly undercount actual heroin use and addiction. SAMDHA's extrapolation estimates 447,544 active-use heroin addicts in the US in 2019. Treatment admissions for heroin addiction were 438,288 in 2019. Treatment admission data are known numbers. In contrast, extrapolations calculated from the NSDUH rely upon a good survey sample to accurately calculate estimates. We know that 97.93% of the estimated heroin addicts in the US were not admitted to treatment in 2019. The actual number of heroin addicts is far higher. The undercounting of this particular cohort is potentially due to the debilitating nature of heroin addiction. The NSDUH sample is pulled using a random address methodology. A significant number of heroin addicts don't have addresses. Sadly, many live on the fringes of society and are homeless, incarcerated, or otherwise not amenable to engaging in a survey of this kind. Heroin also has a high stigma value which may result in underreporting.
The farther one goes down the stigma scale on the drugs of misuse, the greater the potential that the NSDUH data is skewed toward underrepresentation. Methamphetamine is another debilitating drug with a high stigma factor that also tends to quickly marginalize users. Meth users may also be underrepresented in the sample. Another concern is that the survey questions relating to misuse of pharmaceutical opioids and sedatives may skew towards underreporting. Many who misuse prescription drugs often discount their overconsumption because these drugs are prescribed by a physician and not viewed as "drugs" per se.
Another limitation of the NSDUH is the exclusion of the prison and military populations in the survey. It also doesn't count those attending inpatient residential treatment for drug and alcohol addiction. There are approximately 2 million adults in the US who attend a treatment program each year. Roughly 65% of the two million-plus incarcerated population in the US meets the DSM criteria for SUD, while an additional 20% of the prison population is incarcerated for criminal behavior directly related to alcohol or other psychoactive substances. The exclusion of these high-use cohorts likely skews the NSDUH numbers lower.
Despite the potential shortcomings of the NSDUH, it is the best, nationally comprehensive data set available. It also correlates well with other corroborative measures used to estimate alcohol consumption and tobacco use.
Overview of Psychoactive Substance Consumption in the US - 2019
The data presented below is in tabular and graphical form. Opioids and sedatives are most often prescription pharmaceuticals. The vast majority of these substances are consumed for valid medical purposes and not misused. The tabulated data represents the misuse of these drugs and doesn't include approved medical use. Opioids are prescribed for pain relief and include drugs with brand names: Vicodin, Percocet, Oxycontin, Hydrocodone, and others. Sedatives are prescribed as short-term anti-anxiety medications. These drugs include benzodiazepines: Valium, Xanax, Klonopin, Atavan, and others. They also include sedative-hypnotics and sleep aids, Ambien being the most well-known.
Estimated percentages of the American adult population - Those over 12 years of age in 2019 (275,221,248), who consumed a particular substance. Lifetime denotes those who have consumed the listed substance at any point in their lives. Year refers to the use of the identified substance within the last 12 months. Month refers to use occurring within the last month. Addiction refers to the percentage of people with substance abuse and/or substance dependence. Substance abuse is the continual overconsumption of a substance that prevents one from meeting responsibilities at work, school, or home; or places one in physical peril. Substance dependence is increased tolerance to a substance so that more is required to achieve the desired effect or to feel normal. Not using leads to physical withdrawal. Substance abuse and substance dependence often coexist, depending on the stage of disease progression, and are colloquially known as addiction. Addiction is considered to be severe, or later stage, substance use disorder.
Estimated numbers of the American adult population - Those over 12 years of age in 2019 (275,221,248) who consumed a particular substance. Lifetime denotes those who have consumed the listed substance at any point in their lives. Year refers to the use of the identified substance within the last 12 months. Month refers to use occurring within the last month. Addiction refers to the percentage of people with substance abuse and/or substance dependence. Substance abuse is the continual overconsumption of a substance that prevents one from meeting responsibilities at work, school, or home; or places one in physical peril. Substance dependence is increased tolerance to a substance so that more is required to achieve the desired effect or feel normal. Not using leads to physical withdrawal. Substance abuse and substance dependence often coexist, depending on the stage of disease progression, and are colloquially known as addiction. Addiction is considered to be severe, or later stage, substance use disorder.
Treatment Statistics
The data above categorize treatment admittance by reported "primary" substance of abuse. Many addicts are poly-substance abusers. Virtually all cohorts who are addicted to a drug, other than alcohol, also abuse alcohol. As noted above, the data concerning heroin likely indicates a significant underestimate of heroin users and addicts in the NSDUH survey estimate. The TEDS (Treatment Episode Data Set) is derived from known numbers of patients admitted to treatment in 2019, whereas the estimated Number of Addicts is extrapolated from NSDUH survey data. We know that 97.93% of all heroin addicts in the US in 2019 didn't enter treatment that year.
The numbers above are based on reports of "primary" substance of abuse at the initiation of treatment. Many who suffer from SUD are poly-substance abusers. As set forth above, the numbers admitted to treatment for a primary heroin addiction are likely accurate, while the data on the estimated number of heroin addicts is probably significantly underrepresented.
Life Expectancy and Addiction
We have compiled data based upon studies from the Centers for Disease Control (CDC), National Institute of Health (NIH), and academic studies. The data is not broken out by gender, and there is variability relative to standard error mean. Data also includes deaths caused by intoxication in those who don't meet the diagnostic criteria for SUD. Pharmaceutical pain killers (opioids) and sedatives were omitted. We deemed the information generated by our meta-review of studies in relation to these drugs to be too variable to accurately determine causal rates relating death to addiction for these substances. Additionally, marijuana is shown as having no appreciable effect on life expectancy. Marijuana is likely the least physically toxic of all the drugs of misuse, but we would like to see studies delve deeper into the role that cannabis intoxication plays in accidental death. While marijuana may have little deleterious effect on life expectancy, chronic use does have profound effects on cognition, memory, and motivation.
The data show the average life expectancy of the general population and the average life expectancy of one addicted to a particular substance.
The Good News
While addiction is exceptionally destructive at the individual, familial, professional, and societal levels, it is one of the most treatable mental illnesses. If treated appropriately, most who suffer from SUD do recover. The crux to solving the problem is doing it the right way. The one critical missing piece in the standard treatment model has been the absence of structured aftercare and abstinence monitoring in the critical early period of establishing abstinence. The pilots and the physicians have proven appropriate protocols work.