Key Substance Use and Mental Health Indicators in the United States:
Results from the 2025 National Survey on Drug Use and Health

Introduction

Substance use and mental health conditions have significant impacts on individuals, families, communities, and societies.^1,2,3 The National Survey on Drug Use and Health (NSDUH), conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides nationally representative data on the use of tobacco, alcohol, and other substances, including illicit drugs; substance use disorders; receipt of substance use treatment; mental health conditions; and receipt of mental health treatment among the civilian, noninstitutionalized population aged 12 or older in the United States. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health.

Historically, NSDUH collected data via in‑person interviews; however, the 2021 to 2025 NSDUHs used multimode data collection, in which respondents completed the survey in person or via the web. Methodological investigations led to the conclusion that estimates based on multimode data collection in 2021 and subsequent years are not comparable with estimates from 2020 or prior years.⁴

This report examines changes in substance use and mental health estimates from 2021 to 2025 for those estimates that can be compared for at least 4 years. Results from the 2025 National Survey on Drug Use and Health: Detailed Tables also show comprehensive estimates related to substance use and mental health for 2024 and 2025 and selected estimates for 2021 to 2025.⁵ The 2025 Companion Infographic Report: Results from the 2021 to 2025 National Surveys on Drug Use and Health shows selected estimates from 2021 to 2025.⁶

Survey Background

NSDUH is an annual survey sponsored by SAMHSA within the U.S. Department of Health and Human Services (HHS). NSDUH covers residents of households and people in noninstitutional group settings (e.g., shelters, boarding houses, college dormitories, halfway houses). The survey excludes people with no fixed address (e.g., people who are homeless and not in shelters), military personnel on active duty, and residents of institutional group settings, such as jails, nursing homes, mental health institutions, and long‐term care facilities.

NSDUH employs a probability sample designed to be representative of both the nation as a whole and for each of the 50 states and the District of Columbia.⁷ The 2025 NSDUH used multimode data collection throughout the year, in which respondents completed the survey in person or via the web. In‑person data collection commenced after potential respondents first were given the opportunity to complete the survey via the web. Respondents could choose whether to complete screenings or interviews via the web or in person. Respondents also could transition between data collection modes for screening and interviewing (e.g., completing household screening via the web and the main interview in person).⁸

A full sample was available from all 4 quarters in 2025. Screening was completed for 180,506 addresses, and the final sample consisted of 60,447 completed interviews. Based on information from the household screenings, there were 10,933 interviews from adolescents aged 12 to 17 and 49,514 interviews from adults aged 18 or older.⁹ Overall, 44.3 percent of interviews were completed via the web, and 55.7 percent were completed in person. Weighted response rates for household screening and for interviewing were 15.8 and 53.8 percent, respectively, for an overall response rate of 8.5 percent for people aged 12 or older. The weighted interview response rates were 39.3 percent for adolescents and 55.2 percent for adults.^10,11

Further information about the 2025 NSDUH design and methods can be found in the 2025 National Survey on Drug Use and Health (NSDUH): Methodological Summary and Definitions report.¹¹

Data Presentation and Interpretation

This report focuses on substance use and mental health indicators in the United States based on NSDUH data from 2021 to 2025. All estimates (e.g., percentages and numbers) presented in the report are derived from survey data that are subject to sampling errors and have met the criteria for statistical precision.¹² In addition, the analysis weights for 2021 were adjusted to allow estimates for 2021 to be compared with those in later survey years.⁷ Consequently, estimates for 2021 in this report may differ from previously published estimates.

Estimates of substance use, substance use disorders, and related treatment are presented for people aged 12 or older, including adolescents and adults.¹³ However, estimates of mental health conditions are presented separately for adolescents aged 12 to 17 and adults aged 18 or older because only adults were asked questions to estimate any mental illness (AMI) or serious mental illness (SMI). Although adolescents and adults in 2025 were asked the same questions about treatment for mental health conditions, estimates are also presented separately for adolescents and adults because estimates are available specifically for treatment among adults with AMI or SMI.

Appendix A contains tables of estimates by age group. Because some estimates in these appendix tables may not be found in the 2025 NSDUH Detailed Tables, the appendix tables include standard errors for the associated estimates.¹⁴

Statistical tests were conducted for comparisons discussed in this report according to procedures described in the 2025 Methodological Summary and Definitions report.¹⁵ Based on results of linear tests of trends involving 4 or more years of data, the report summarizes whether an outcome of interest showed a statistically significant change from the baseline year (e.g., 2021) through 2025. Linear trend testing indicates whether estimates have decreased, increased, or showed no change over the period of interest. Statistically significant differences are described using terms such as “higher,” “lower,” “more likely,” “less likely,” “increased,” or “decreased.” Statements use terms such as “similar,” “did not change,” or “showed no change” when a difference was not statistically significant. When estimates are presented without reference to differences across years or groups, statistical significance is not implied.

General Substance Use in the Past Month

This section provides an overview of estimates according to whether respondents aged 12 or older reported using nicotine products (i.e., tobacco products or vaping nicotine with e‑cigarettes or other vaping devices), reported using alcohol, or reported using illicit drugs in the 30 days before the NSDUH interview (i.e., in the past month, also referred to as “current use”). Additional information on tobacco product use, nicotine vaping, alcohol use, and illicit drug use, including prescription drug misuse, is provided in other sections of this report.¹⁴

Past month tobacco use includes any use of these tobacco products: cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, and pipe tobacco. Past month nicotine vaping refers to the use of an e‑cigarette or other vaping device to vaporize (i.e., vape) nicotine. Past month alcohol use refers to having more than a sip or two of any type of alcoholic drink (e.g., a can or a bottle of beer or hard seltzer, a glass of wine or a wine cooler, a shot of liquor, or a drink with liquor in it). Past month illicit drug use includes any use of marijuana or cannabis products (including smoking, vaping, and other modes of use), cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine, as well as misuse of prescription stimulants, tranquilizers or sedatives (e.g., benzodiazepines), or pain relievers. (See the Misuse of Prescription Psychotherapeutic Drugs section for the definition of “misuse.”)

Among people aged 12 or older in 2025, 56.0 percent (or 162.8 million people) used tobacco, vaped nicotine, used alcohol, or used an illicit drug in the past month; 44.4 percent (or 129.1 million people) drank alcohol in the past month; 16.2 percent (or 46.9 million people) used a tobacco product in the past month; 10.1 percent (or 29.3 million people) vaped nicotine in the past month; and 16.4 percent (or 47.5 million people) used an illicit drug in the past month (Figure 1 and Table A.1B). Estimates for tobacco use, nicotine vaping, alcohol use, or illicit drug use are not mutually exclusive because people could have used more than one type of substance (e.g., tobacco products and alcohol) in the past month.

Nicotine Product Use in the Past Month

As noted in the section on General Substance Use in the Past Month, past month tobacco use in NSDUH includes any use of these tobacco products: cigarettes, smokeless tobacco (such as snuff, dip, chewing tobacco, or snus), cigars, and pipe tobacco. Past month nicotine vaping refers to the use of an e‑cigarette or other vaping device to vape nicotine. Aggregate estimates for past month (i.e., current) nicotine product use are presented for people who used any of these tobacco products or vaped nicotine (or both) in the past month. The estimates for nicotine vaping in 2025 may be compared with those from the 2022 to 2024 NSDUHs. However, because the nicotine vaping questions were modified for 2022, estimates from 2022 to 2025 should not be compared with estimates from 2021.¹⁶ Estimates for nicotine product use and nicotine vaping in 2022 to 2024 may differ from previously published estimates because of updates to nicotine vaping measures.¹⁷

Among people aged 12 or older in 2025, 22.1 percent (or 64.2 million people) used nicotine products in the past month (Figure 2 and Table A.1B), including 36.1 million people who smoked cigarettes and 29.3 million people who vaped nicotine. Smaller numbers of people used cigars, smokeless tobacco, or pipe tobacco in the past month.

Among people aged 12 or older in 2025 who used nicotine products in the past month, 54.4 percent used only tobacco products, and 27.0 percent only vaped nicotine products (Figure 3 and Table A.2B). Among people who used nicotine products in the past month, the percentage who only vaped nicotine was highest among adolescents aged 12 to 17 (70.8 percent), followed by young adults aged 18 to 25 (49.4 percent), then by adults aged 26 or older (21.2 percent). In contrast, almost two thirds of adults aged 26 or older who used nicotine products in the past month used only tobacco products (62.6 percent), compared with 20.1 percent of young adults and 8.2 percent of adolescents who used nicotine products in that period.

Any Nicotine Product Use

The percentage of people aged 12 or older who used nicotine products in the past month showed no change from 2022 to 2025 (Figure 4 and Table A.3B).¹⁷ Among adolescents aged 12 to 17 and adults aged 26 or older, the percentages who used nicotine products in the past month also showed no change from 2022 to 2025 (Tables A.4B and A.6B). However, the percentage of young adults aged 18 to 25 who used nicotine products in the past month decreased from 30.0 percent (or 10.4 million people) in 2022 to 27.9 percent (or 10.1 million people) in 2025 (Table A.5B).

Figure 4 Table. Past Month Nicotine Product Use: Among People Aged 12 or Older; Percentages, 2022‑2025

Age Group	2022	2023	2024	2025	Trend
12 or Older	22.7	22.7	22.1	22.1	No Change
12 to 17	7.3	7.4	6.6	6.9	No Change
18 to 25	30.0	30.0	28.9	27.9	Decreased
26 or Older	23.3	23.4	22.8	22.9	No Change
Note: Some 2022‑2024 estimates may differ from previously published estimates due to updates to the editing procedures for nicotine vaping.

In 2025, the percentage of people who used nicotine products in the past month was highest among young adults aged 18 to 25 (27.9 percent or 10.1 million people), followed by adults aged 26 or older (22.9 percent or 52.4 million people), then by adolescents aged 12 to 17 (6.9 percent or 1.8 million people) (Figure 4 and Table A.1B).

Tobacco Product Use

Among people aged 12 or older, the percentage who used tobacco products in the past month decreased from 20.1 percent (or 56.2 million people) in 2021 to 16.2 percent (or 46.9 million people) in 2025 (Figure 5 and Table A.3B). Percentages also decreased from 2021 to 2025 for people in each age group (Tables A.4B, A.5B, and A.6B). For example, the percentage of adults aged 26 or older who used tobacco products in the past month decreased from 22.5 percent (or 49.6 million people) in 2021 to 18.0 percent (or 41.3 million people) in 2025.

Figure 5 Table. Past Month Tobacco Product Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	20.1	18.1	17.6	16.7	16.2	Decreased
12 to 17	2.9	2.0	1.9	1.9	2.0	Decreased
18 to 25	17.5	15.4	15.7	14.4	14.1	Decreased
26 or Older	22.5	20.4	19.7	18.7	18.0	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who used tobacco products in the past month was highest among adults aged 26 or older (18.0 percent or 41.3 million people), followed by young adults aged 18 to 25 (14.1 percent or 5.1 million people), then by adolescents aged 12 to 17 (2.0 percent or 513,000 people) (Figure 5 and Table A.1B).

Among people aged 12 or older in 2025 who used any tobacco product in the past month (regardless of whether they vaped nicotine), the following percentages of people used different types of tobacco products:

• 63.5 percent smoked cigarettes but did not use other tobacco products,
• 13.4 percent smoked cigarettes and used some other type of tobacco product, and
• 23.0 percent used only other tobacco products but not cigarettes (Table A.7B).

The remainder of this section on tobacco use focuses on cigarette smoking, because most current tobacco users aged 12 or older were cigarette smokers (i.e., 36.1 million of the 46.9 million current tobacco users aged 12 or older). Information on the use of smokeless tobacco, cigars, and pipe tobacco in the past month among people aged 12 or older and by age group can be found in Tables A.1B, A.3B, A.4B, A.5B, and A.6B.

Cigarette Use

Among people aged 12 or older, the percentage who smoked cigarettes in the past month decreased from 16.0 percent (or 44.8 million people) in 2021 to 12.4 percent (or 36.1 million people) in 2025 (Figure 6 and Table A.3B). Among young adults aged 18 to 25 and adults aged 26 or older, the percentages who smoked cigarettes in the past month also decreased from 2021 to 2025 (Tables A.5B and A.6B). For example, the percentage of adults aged 26 or older who smoked cigarettes in the past month decreased from 18.3 percent (or 40.4 million people) in 2021 to 14.1 percent (or 32.2 million people) in 2025. Among adolescents aged 12 to 17, the percentage who smoked cigarettes in the past month showed no change from 2021 to 2025 (Table A.4B).

Figure 6 Table. Past Month Cigarette Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	16.0	14.6	13.7	13.1	12.4	Decreased
12 to 17	1.7	1.2	1.3	1.2	1.3	No Change
18 to 25	11.8	10.7	10.6	9.6	9.8	Decreased
26 or Older	18.3	16.7	15.5	15.0	14.1	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who smoked cigarettes in the past month was highest among adults aged 26 or older (14.1 percent or 32.2 million people), followed by young adults aged 18 to 25 (9.8 percent or 3.5 million people), then by adolescents aged 12 to 17 (1.3 percent or 340,000 people) (Figure 6 and Table A.1B).

Daily Cigarette Use

Among the 36.1 million current cigarette smokers aged 12 or older in 2025 (see the section on Cigarette Use), 19.9 million people (or 55.1 percent) were daily cigarette smokers (Table A.3B). Among people aged 12 or older, the percentage of current cigarette smokers who were daily cigarette smokers decreased from 61.5 percent (or 27.5 million people) in 2021 to 55.1 percent (or 19.9 million people) in 2025. Among young adults aged 18 to 25 and adults aged 26 or older who were current smokers, the percentage who smoked cigarettes daily also decreased from 2021 to 2025 (Tables A.5B and A.6B). The trend for daily cigarette smoking among adolescents aged 12 to 17 who were current cigarette smokers was not tested because estimates in some years could not be calculated with sufficient precision (Table A.4B).¹²

Among current cigarette smokers in 2025, the percentage who smoked cigarettes daily was highest among adults aged 26 or older (60.4 percent), followed by young adults aged 18 to 25 (12.4 percent), then by adolescents aged 12 to 17 (1.9 percent) (Table A.1B). In 2025, 35.8 percent of current daily cigarette smokers (or 7.1 million people) smoked one or more packs of cigarettes per day (Table A.3B). The percentage of current daily cigarette smokers who smoked one or more packs of cigarettes per day was higher among adults aged 26 or older (36.2 percent or 7.0 million people) than among young adults aged 18 to 25 (17.1 percent or 74,000 people) (Tables A.5B and A.6B). The estimate in 2025 for smoking one or more packs of cigarettes per day in the past month among current daily smokers aged 12 to 17 could not be calculated with sufficient precision (Table A.4B).¹²

Nicotine Vaping

The percentage of people aged 12 or older who vaped nicotine in the past month increased from 8.3 percent (or 23.5 million people) in 2022 to 10.1 percent (or 29.3 million people) in 2025 (Figure 7 and Table A.3B).¹⁷ Among adults aged 26 or older, the percentage who vaped nicotine in the past month also increased from 6.0 percent (or 13.4 million people) in 2022 to 8.6 percent (or 19.6 million people) in 2025 (Table A.6B). The percentages among young adults aged 18 to 25 who vaped nicotine in the past month decreased from 24.0 percent (or 8.4 million people) in 2022 to 22.3 percent (or 8.0 million people) in 2025 (Table A.5B). Among adolescents aged 12 to 17, the percentage who vaped nicotine in the past month showed no change from 2022 to 2025 (Table A.4B).

Figure 7 Table. Past Month Nicotine Vaping: Among People Aged 12 or Older; Percentages, 2022‑2025

Age Group	2022	2023	2024	2025	Trend
12 or Older	8.3	9.4	9.6	10.1	Increased
12 to 17	6.8	6.8	6.0	6.3	No Change
18 to 25	24.0	24.1	23.7	22.3	Decreased
26 or Older	6.0	7.4	7.8	8.6	Increased
Note: Some 2022‑2024 estimates may differ from previously published estimates due to updates to the editing procedures for this measure.

In 2025, the percentage of people who vaped nicotine in the past month was highest among young adults aged 18 to 25 (22.3 percent or 8.0 million people), followed by adults aged 26 or older (8.6 percent or 19.6 million people), then by adolescents aged 12 to 17 (6.3 percent or 1.6 million people) (Figure 7 and Table A.1B).

Underage Nicotine Product Use

The percentage of underage people aged 12 to 20 who used nicotine products in the past month decreased from 13.4 percent (or 5.2 million people) in 2022 to 12.1 percent (or 4.8 million people) in 2025 (Table A.8B).¹⁷ In 2025, underage people aged 12 to 20 were more likely to have vaped nicotine (10.6 percent or 4.2 million people) than to have used other types of nicotine products in the past month. In comparison, 3.4 percent of underage people smoked cigarettes in the past month. Smaller percentages of underage people smoked cigars, used smokeless tobacco, or smoked pipe tobacco in the past month.

Alcohol Use in the Past Month

As noted in the section on General Substance Use in the Past Month, NSDUH asked respondents aged 12 or older about their alcohol use in the 30 days before the interview, including binge alcohol use and heavy alcohol use in that period. Binge drinking for males was defined as drinking five or more drinks¹⁸ on the same occasion on at least 1 day in the past 30 days. Binge drinking for females was defined as drinking four or more drinks on the same occasion on at least 1 day in the past 30 days. This definition of binge alcohol use is consistent with federal definitions.¹⁹ Heavy alcohol use was defined as binge drinking on 5 or more days in the past 30 days based on the thresholds previously described for males and females.

Among the 129.1 million current alcohol users aged 12 or older in 2025, 56.8 million people (or 44.0 percent) were past month binge drinkers (Figure 8). Among past month binge drinkers, 14.5 million people were past month heavy drinkers. The 14.5 million heavy drinkers represent 25.6 percent of current binge drinkers and 11.3 percent of current alcohol users.

Any Alcohol Use

Among people aged 12 or older, the percentage who used alcohol in the past month decreased from 47.4 percent (or 132.5 million people) in 2021 to 44.4 percent (or 129.1 million people) in 2025 (Figure 9 and Table A.3B). Percentages also decreased from 2021 to 2025 for people in each age group (Tables A.4B, A.5B, and A.6B). For example, the percentage of young adults aged 18 to 25 who used alcohol in the past month decreased from 50.9 percent (or 17.0 million people) in 2021 to 46.2 percent (or 16.7 million people) in 2025.

Figure 9 Table. Past Month Alcohol Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	47.4	48.7	47.5	46.6	44.4	Decreased
12 to 17	7.2	6.8	6.9	6.6	5.9	Decreased
18 to 25	50.9	50.2	49.6	47.5	46.2	Decreased
26 or Older	51.5	53.4	51.9	51.0	48.4	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who used alcohol in the past month was higher among adults aged 26 or older (48.4 percent or 110.9 million people) than among young adults aged 18 to 25 (46.2 percent or 16.7 million people). The percentage was lowest among adolescents aged 12 to 17 (5.9 percent or 1.5 million people) (Figure 9 and Table A.1B).

Binge Alcohol Use

Among people aged 12 or older, the percentage who engaged in binge drinking in the past month decreased from 21.7 percent (or 60.6 million people) in 2021 to 19.5 percent (or 56.8 million people) in 2025 (Figure 10 and Table A.3B). Percentages also decreased from 2021 to 2025 for people in each age group (Tables A.4B, A.5B, and A.6B). For example, the percentage of young adults aged 18 to 25 who engaged in binge drinking in the past month decreased from 30.0 percent (or 10.0 million people) in 2021 to 26.7 percent (or 9.6 million people) in 2025.

Figure 10 Table. Past Month Binge Alcohol Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	21.7	21.7	21.7	20.1	19.5	Decreased
12 to 17	4.0	3.2	3.9	3.5	3.0	Decreased
18 to 25	30.0	29.5	28.7	26.7	26.7	Decreased
26 or Older	22.5	22.6	22.7	21.0	20.2	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons. Note: Binge Alcohol Use is defined as drinking five or more drinks (for males) or four or more drinks (for females) on the same occasion on at least 1 day in the past 30 days.

In 2025, the percentage of people who engaged in binge drinking in the past month was higher among young adults aged 18 to 25 (26.7 percent or 9.6 million people) than among adults aged 26 or older (20.2 percent or 46.4 million people). The percentage was lowest among adolescents aged 12 to 17 (3.0 percent or 753,000 people) (Figure 10 and Table A.1B).

Heavy Alcohol Use

Among people aged 12 or older, the percentage who were heavy alcohol users in the past month decreased from 5.7 percent (or 16.1 million people) in 2021 to 5.0 percent (or 14.5 million people) in 2025 (Figure 11 and Table A.3B). Among young adults aged 18 to 25 and adults aged 26 or older, the percentages who were heavy alcohol users in the past month also decreased from 2021 to 2025 (Tables A.5B and A.6B). For example, the percentage of young adults aged 18 to 25 who were heavy alcohol users in the past month decreased from 7.1 percent (or 2.4 million people) in 2021 to 6.3 percent (or 2.3 million people) in 2025. Among adolescents aged 12 to 17, the percentage who were heavy alcohol users in the past month showed no change from 2021 to 2025 (Table A.4B).

Figure 11 Table. Past Month Heavy Alcohol Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	5.7	5.7	5.8	5.0	5.0	Decreased
12 to 17	0.4	0.2	0.5	0.4	0.3	No Change
18 to 25	7.1	7.6	6.9	6.0	6.3	Decreased
26 or Older	6.2	6.0	6.2	5.4	5.3	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons. Note: Heavy Alcohol Use is defined as binge drinking on the same occasion on 5 or more days in the past 30 days; all heavy alcohol users are also binge alcohol users. (Binge Alcohol Use is defined as drinking five or more drinks [for males] or four or more drinks [for females] on the same occasion on at least 1 day in the past 30 days.)

In 2025, the percentage of people who were heavy alcohol users was higher among young adults aged 18 to 25 (6.3 percent or 2.3 million people) than among adults aged 26 or older (5.3 percent or 12.2 million people). The percentage was lowest among adolescents aged 12 to 17 (0.3 percent or 81,000 people) (Figure 11 and Table A.1B).

Underage Alcohol Use

The percentage of people aged 12 to 20 who used alcohol in the past month decreased from 15.6 percent (or 6.1 million people) in 2021 to 13.7 percent (or 5.4 million people) in 2025 (Figure 12 and Table A.8B). However, percentages for binge and heavy alcohol use in the past month among underage people showed no change from 2021 to 2025. In 2025, 7.9 percent of underage people (or 3.1 million people) engaged in binge drinking in the past month, and 1.8 percent (or 701,000 people) were heavy alcohol users in that period.

Figure 12 Table. Underage Alcohol Use, Binge Alcohol Use, or Heavy Alcohol Use in the Past Month: Among People Aged 12 to 20; Percentages, 2021‑2025

Level of Use	2021	2022	2023	2024	2025	Trend
Alcohol Use	15.6	15.1	14.6	13.3	13.7	Decreased
Binge Alcohol Use	8.6	8.2	8.6	7.6	7.9	No Change
Heavy Alcohol Use	1.6	1.7	1.7	1.5	1.8	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons. Note: Binge Alcohol Use is defined as drinking five or more drinks (for males) or four or more drinks (for females) on the same occasion on at least 1 day in the past 30 days. Heavy Alcohol Use is defined as binge drinking on the same occasion on 5 or more days in the past 30 days; all heavy alcohol users are also binge alcohol users.

Marijuana Use and Marijuana Vaping in the Past Month

The NSDUH questionnaires from 2022 to 2025 included questions to assess the different ways that people use marijuana. Respondents who reported using marijuana in the past month or past year were asked to report ways they used marijuana in these time periods, such as smoking, vaping, and eating. These NSDUH questionnaires also included questions about the use of cannabidiol (CBD) or hemp products and the use of marijuana or cannabis products that were recommended by a doctor or other health professional (i.e., medical marijuana use); however, presentation of these estimates is beyond the scope of this report. Additional information about the use of CBD can be found in Section 8 of the 2025 Detailed Tables.²⁰

This section presents estimates for any marijuana use in the past month regardless of the mode of use, as well as estimates specifically for marijuana vaping. Estimates for additional modes of marijuana use in the past year are discussed in the Marijuana Use section.

Among people aged 12 or older, the percentage who used marijuana in the past month increased from 13.2 percent (or 37.0 million people) in 2021 to 15.1 percent (or 43.8 million people) in 2025 (Figure 13 and Table A.3B). Among adults aged 26 or older, the percentage who used marijuana in the past month also increased from 2021 to 2025 (Table A.6B). However, the percentages among adolescents aged 12 to 17 and young adults aged 18 to 25 who used marijuana in the past month decreased from 2021 to 2025 (Tables A.4B and A.5B). For example, the percentage of adolescents who used marijuana in the past month decreased from 6.1 percent (or 1.6 million people) in 2021 to 5.0 percent (or 1.3 million people) in 2025.

Figure 13 Table. Past Month Marijuana Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	13.2	15.0	15.4	15.4	15.1	Increased
12 to 17	6.1	6.4	6.0	6.0	5.0	Decreased
18 to 25	24.6	25.9	25.2	24.1	23.3	Decreased
26 or Older	12.3	14.3	15.0	15.1	14.9	Increased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who used marijuana in the past month was highest among young adults aged 18 to 25 (23.3 percent or 8.4 million people), followed by adults aged 26 or older (14.9 percent or 34.1 million people), then by adolescents aged 12 to 17 (5.0 percent or 1.3 million people) (Figure 13 and Table A.1B).

About two fifths (37.1 percent) of current marijuana users aged 12 or older in 2025 vaped marijuana in the past month (Figure 14 and Table A.9B). Among people in 2025 who used marijuana in the past month, the percentage who vaped it was highest among adolescents aged 12 to 17 (69.8 percent or 893,000 people), followed by young adults aged 18 to 25 (54.3 percent or 4.6 million people), then by adults aged 26 or older (31.6 percent or 10.8 million people).

Illicit Drug Use in the Past Year

Past year illicit drug use includes any use of marijuana or cannabis products (including smoking, vaping, and other modes of use), cocaine (including crack), heroin, hallucinogens, inhalants, and methamphetamine, as well as misuse of prescription stimulants, tranquilizers or sedatives (e.g., benzodiazepines),²¹ or pain relievers (see the section on the Misuse of Prescription Psychotherapeutic Drugs for the definition of “misuse”). Misuse of prescription pain relievers includes the misuse of pain relievers that are classified as prescription opioids and pain relievers that are not opioids. Misuse of prescription opioids reflects misuse of the subset of prescription pain relievers that were classified as prescription opioids.

This report presents estimates of past year illicit drug use (rather than past month use) because of low prevalence estimates for some illicit drugs (e.g., heroin). Moreover, the 2025 NSDUH collected only past year (rather than past month) data on the misuse of benzodiazepines and specific subtypes of prescription pain relievers (e.g., hydrocodone products).

Among people aged 12 or older in 2025, 69.8 million people used illicit drugs in the past year (Figure 15). The most commonly used illicit drug in the past year was marijuana, which was used by 61.6 million people. In the past year, 9.1 million people used hallucinogens, and 6.9 million people misused prescription opioids (shown as “Rx Opioid Misuse” in the figure). Smaller numbers of people were past year users or misusers of the other illicit drugs shown in Figure 15.²²

Any Illicit Drug Use

Among people aged 12 or older, the percentage who used illicit drugs in the past year increased from 22.2 percent (or 62.0 million people) in 2021 to 24.0 percent (or 69.8 million people) in 2025 (Figure 16 and Table A.10B). This increase is largely tied to the increase in marijuana use in the past year (see the next section on Marijuana Use).

Figure 16 Table. Past Year Illicit Drug Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	22.2	24.9	24.9	25.5	24.0	Increased
12 to 17	14.6	14.3	14.7	15.1	11.2	Decreased
18 to 25	39.0	40.9	39.0	38.1	36.3	Decreased
26 or Older	20.5	23.7	23.9	24.8	23.5	Increased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

The percentage of people who used illicit drugs in the past year also increased among adults aged 26 or older, from 20.5 percent (or 45.2 million people) in 2021 to 23.5 percent (or 53.8 million people) in 2025 (Figure 16 and Table A.13B). Percentages decreased from 2021 to 2025 for adolescents aged 12 to 17 and young adults aged 18 to 25 (Tables A.11B and A.12B). For example, the percentage of adolescents aged 12 to 17 who used illicit drugs in the past year decreased from 14.6 percent (or 3.8 million people) in 2021 to 11.2 percent (or 2.9 million people) in 2025.

Because the question wording for inhalants changed for 2025 (see the Inhalant Use section), trends also were evaluated for the use of illicit drugs in the past year excluding inhalants. Those trends were the same as the trends described previously for any use of illicit drugs that included inhalants. Therefore, the change to the questions for inhalants in 2025 was assumed not to have affected overall trends for any illicit drug use in the past year.

In 2025, the percentage of people who used illicit drugs in the past year was highest among young adults aged 18 to 25 (36.3 percent or 13.1 million people), followed by adults aged 26 or older (23.5 percent or 53.8 million people), then by adolescents aged 12 to 17 (11.2 percent or 2.9 million people) (Figure 16 and Tables A.11B, A.12B, and A.13B).

Marijuana Use

Any Marijuana Use

Among people aged 12 or older, the percentage who used marijuana in the past year increased from 19.0 percent (or 53.2 million people) in 2021 to 21.2 percent (or 61.6 million people) in 2025 (Figure 17 and Table A.10B). The percentage also increased among adults aged 26 or older, from 17.3 percent (or 38.2 million people) in 2021 to 20.6 percent (or 47.2 million people) in 2025 (Table A.13B). Percentages decreased from 2021 to 2025 for both adolescents aged 12 to 17 and young adults aged 18 to 25 (Tables A.11B and A.12B). For example, the percentage of adolescents aged 12 to 17 who used marijuana in the past year decreased from 10.9 percent (or 2.8 million people) in 2021 to 8.7 percent (or 2.2 million people) in 2025.

Figure 17 Table. Past Year Marijuana Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	19.0	22.0	21.8	22.3	21.2	Increased
12 to 17	10.9	11.5	11.2	10.4	8.7	Decreased
18 to 25	36.3	38.2	36.5	35.0	33.7	Decreased
26 or Older	17.3	20.6	20.8	21.7	20.6	Increased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (33.7 percent or 12.2 million people), followed by adults aged 26 or older (20.6 percent or 47.2 million people), then by adolescents aged 12 to 17 (8.7 percent or 2.2 million people) (Figure 17 and Tables A.11B, A.12B, and A.13B).

Modes of Marijuana Use

As noted previously for marijuana use in the past month, the NSDUH questionnaires from 2022 to 2025 included questions to assess the variety of methods that people use to consume marijuana or other cannabis products. Estimates for the use of CBD or hemp products are not included in this report. The NSDUH questionnaire presented the following modes of marijuana use to respondents who reported using marijuana in the past year or past month:

• smoking;
• vaping;
• dabbing waxes, shatter, or concentrates;
• eating or drinking;
• putting drops, strips, lozenges, or sprays in their mouth or under their tongue;
• applying lotion, cream, or patches to their skin;
• taking pills; or
• using it in some other way.

Respondents could report that they used marijuana in more than one way in the past year or past month. For example, respondents could report that they smoked marijuana and vaped it in the past year. Also, if respondents did not report a particular mode of use (e.g., vaping) in the past year but reported it as a mode of use for the past month, then these respondents were inferred to have used marijuana in that specific way in the past year.

Among people aged 12 or older in 2025 who used marijuana in the past year, the most common mode of marijuana use was smoking (74.8 percent or 46.1 million people), followed by eating or drinking (49.2 percent or 30.3 million people); vaping (39.2 percent or 24.2 million people); and dabbing waxes, shatter, or concentrates (14.5 percent or 8.9 million people) (Figure 18 and Table A.14B). Smaller percentages and numbers of people who used marijuana in the past year used it in other ways.

Smoking also was the most common mode of marijuana use in 2025 among young adults aged 18 to 25 and adults aged 26 or older who used marijuana in the past year (Table A.14B). Among people in these adult age groups who used marijuana in the past year, 82.7 percent of young adults and 72.6 percent of adults aged 26 or older smoked marijuana. However, smoking (79.5 percent) and vaping (74.0 percent) were the two most common modes of marijuana use in 2025 among adolescents aged 12 to 17 who used marijuana in the past year.

Other common modes of marijuana use in 2025 among past year marijuana users varied by age group (Table A.14B). Among adolescents aged 12 to 17 who used marijuana in the past year, about two fifths (36.6 percent) ate or drank marijuana, followed by about one sixth who dabbed waxes, shatter, or concentrates (16.8 percent). Among young adults aged 18 to 25 who used marijuana in the past year, more than half vaped marijuana (57.4 percent), followed by about half who ate or drank it (46.5 percent), then by about one fourth (23.1 percent) who dabbed waxes, shatter, or concentrates. Among adults aged 26 or older who were past year marijuana users, about half (50.5 percent) ate or drank it, followed by about one third (32.9 percent) who vaped it, then by about one eighth (12.1 percent) who dabbed waxes, shatter, or concentrates. Other modes of marijuana use were less common across all three age groups.

Cocaine Use

Cocaine use includes the use of crack cocaine. Among people aged 12 or older, the percentage who used cocaine in the past year showed no change from 2021 to 2025 (Figure 19 and Table A.10B). In 2025, 1.7 percent of people aged 12 or older (or 4.9 million people) used cocaine in the past year. Percentages also showed no change from 2021 to 2025 for adolescents aged 12 to 17 and adults aged 26 or older (Tables A.11B and A.13B). However, the percentage among young adults aged 18 to 25 decreased from 3.7 percent (or 1.2 million people) in 2021 to 2.6 percent (or 950,000 people) in 2025 (Table A.12B).

Figure 19 Table. Past Year Cocaine Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	1.7	1.9	1.8	1.5	1.7	No Change
12 to 17	0.1	0.2	0.2	0.3	0.2	No Change
18 to 25	3.7	3.7	3.1	2.3	2.6	Decreased
26 or Older	1.6	1.8	1.7	1.5	1.7	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who used cocaine in the past year was highest among young adults aged 18 to 25 (2.6 percent or 950,000 people), followed by adults aged 26 or older (1.7 percent or 3.9 million people), then by adolescents aged 12 to 17 (0.2 percent or 57,000 people) (Figure 19 and Tables A.11B, A.12B, and A.13B).

Heroin Use

Among people aged 12 or older in 2025, 0.2 percent (or 581,000 people) used heroin in the past year (Figure 15 and Table A.10B). The percentage of people in 2025 who used heroin in the past year was higher among adults aged 26 or older (0.3 percent or 574,000 people) than among young adults aged 18 to 25 (less than 0.1 percent or 6,000 people) and adolescents aged 12 to 17 (less than 0.1 percent or fewer than 1,000 people) (Tables A.11B, A.12B, and A.13B).

Methamphetamine Use

Although methamphetamine is legally available by prescription (Desoxyn^®), most methamphetamine used in the United States is produced and distributed illicitly rather than through the pharmaceutical industry. Therefore, the 2021 to 2025 NSDUH questionnaire includes separate sections for methamphetamine use and the use and misuse of prescription stimulants.

Among people aged 12 or older, the percentage who used methamphetamine in the past year showed no change from 2021 to 2025 (Figure 20 and Table A.10B). In 2025, 0.9 percent of people aged 12 or older (or 2.7 million people) used methamphetamine in the past year. Percentages also showed no change from 2021 to 2025 for each age group (Tables A.11B, A.12B, and A.13B).

Figure 20 Table. Past Year Methamphetamine Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	0.9	1.0	0.9	0.8	0.9	No Change
12 to 17	0.1	0.1	0.2	0.2	0.1	No Change
18 to 25	0.5	0.5	0.3	0.5	0.4	No Change
26 or Older	1.1	1.1	1.1	1.0	1.1	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who used methamphetamine in the past year was highest among adults aged 26 or older (1.1 percent or 2.5 million people), followed by young adults aged 18 to 25 (0.4 percent or 145,000 people), then by adolescents aged 12 to 17 (0.1 percent or 32,000 people) (Figure 20 and Tables A.11B, A.12B, and A.13B).

Hallucinogen Use

Several drugs are grouped under the category of hallucinogens, including LSD, PCP, peyote, mescaline, psilocybin mushrooms, “Ecstasy” (MDMA or “Molly”), ketamine, DMT/AMT/“Foxy,” and Salvia divinorum.²³ Beginning in 2025, the NSDUH questionnaire included questions about the most recent use of each of these specific hallucinogens, in addition to the most recent use of any hallucinogen.²⁴ Preliminary analysis of 2025 NSDUH data suggested that questionnaire changes for hallucinogens did not affect the comparability of the estimates for the use of hallucinogens in the past year. Therefore, this report presents trends in the past year use of hallucinogens for 2021 to 2025. Estimates for the use of specific hallucinogens (e.g., LSD, psilocybin, Ecstasy) can be found in the 2025 Detailed Tables.²⁰

Among people aged 12 or older, the percentage who used hallucinogens in the past year increased from 2.7 percent (or 7.6 million people) in 2021 to 3.1 percent (or 9.1 million people) in 2025 (Figure 21 and Table A.10B). The percentage also increased among adults aged 26 or older, from 2.1 percent (or 4.7 million people) in 2021 to 2.9 percent (or 6.6 million people) in 2025 (Table A.13B). The percentage decreased among young adults aged 18 to 25, from 7.4 percent (or 2.5 million people) in 2021 to 6.0 percent (or 2.2 million people) in 2025 (Table A.12B). Percentages showed no change from 2021 to 2025 for adolescents aged 12 to 17 (Table A.11B).

Figure 21 Table. Past Year Hallucinogen Use: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	2.7	3.0	3.1	3.6	3.1	Increased
12 to 17	1.4	1.4	1.5	1.6	1.4	No Change
18 to 25	7.4	7.7	6.7	6.8	6.0	Decreased
26 or Older	2.1	2.5	2.7	3.4	2.9	Increased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who used hallucinogens in the past year was highest among young adults aged 18 to 25 (6.0 percent or 2.2 million people), followed by adults aged 26 or older (2.9 percent or 6.6 million people), then by adolescents aged 12 to 17 (1.4 percent or 360,000 people) (Figure 21 and Tables A.11B, A.12B, and A.13B).

Inhalant Use

Inhalants include volatile solvents (e.g., paint thinners and removers, dry cleaning fluids, degreasers, gasoline, glues, shoe polish, correction fluids, felt‐tip markers), aerosols (e.g., spray paints, deodorant and hair sprays, fabric protector sprays, computer keyboard cleaner), gases (e.g., ether, halothane, nitrous oxide, butane, propane), and nitrites (e.g., amyl nitrite, “poppers,” locker room odorizers, Rush). As in prior years, NSDUH respondents in 2025 were instructed not to include accidental inhalation of a substance. For the 2025 NSDUH, respondents were asked to report the use of inhalants “to get high” instead of “for fun or to get high.” This change in the questionnaire wording appeared to have affected the reporting of the use of inhalants in the past year, especially among adolescent respondents aged 12 to 17. Therefore, estimates for the use of inhalants in the past year are presented only for 2025.

In 2025, 0.8 percent of people aged 12 or older (or 2.4 million people) used inhalants in the past year (Figure 22 and Table A.10B). The percentage of people who used inhalants in the past year was lower among adults aged 26 or older (0.6 percent or 1.4 million people) than among young adults aged 18 to 25 (1.8 percent or 636,000 people) or adolescents aged 12 to 17 (1.4 percent or 360,000 people) (Tables A.11B, A.12B, and A.13B).

Misuse of Prescription Psychotherapeutic Drugs

NSDUH assessed the use and misuse of psychotherapeutic drugs currently or recently available by prescription in the United States, including prescription stimulants, tranquilizers or sedatives (e.g., benzodiazepines), and pain relievers. As discussed in the section on Prescription Opioid Misuse, NSDUH respondents were asked about their misuse of prescription pain relievers, but the specific pain relievers in the NSDUH questionnaire are opioid pain relievers. In NSDUH, misuse of prescription drugs was defined as use in any way not directed by a doctor, including use without a prescription of one’s own; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Misuse of over‐the‐counter drugs was not included.

Of the prescription drugs presented in Figure 15, prescription opioids were the most commonly misused prescription drug by people aged 12 or older. The 12.8 million people in 2025 who misused prescription psychotherapeutic drugs in the past year included 6.9 million people who misused prescription opioids, 4.2 million people who misused prescription tranquilizers or sedatives, and 3.9 million people who misused prescription stimulants.

Prescription Stimulant Misuse

The 2021 to 2025 NSDUHs assessed the misuse of prescription stimulants in the following categories: amphetamine products, methylphenidate products, anorectic (weight‐loss) stimulants, Provigil^®, or any other prescription stimulant. The amphetamine and methylphenidate products included in the NSDUH questionnaire are primarily prescribed for the treatment of attention‐deficit/hyperactivity disorder (ADHD). Methamphetamine is not included as a prescription stimulant, unless respondents specified the prescription form of methamphetamine (Desoxyn^®) as some other stimulant they had misused in the past year.²⁵

Among people aged 12 or older, the percentage who misused prescription stimulants in the past year showed no change from 2021 to 2025 (Figure 23 and Table A.10B). In 2025, 1.4 percent of people aged 12 or older (or 3.9 million people) misused prescription stimulants in the past year. Percentages also showed no change from 2021 to 2025 for adolescents aged 12 to 17 and adults aged 26 or older (Tables A.11B and A.13B). Among young adults aged 18 to 25, however, the percentage who misused prescription stimulants in the past year decreased from 4.1 percent (or 1.4 million people) in 2021 to 2.7 percent (or 978,000 people) in 2025 (Table A.12B).

Figure 23 Table. Past Year Prescription Stimulant Misuse: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	1.4	1.5	1.4	1.4	1.4	No Change
12 to 17	1.2	0.9	0.9	0.8	0.8	No Change
18 to 25	4.1	3.7	3.1	2.8	2.7	Decreased
26 or Older	1.0	1.3	1.2	1.2	1.2	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who misused prescription stimulants in the past year was highest among young adults aged 18 to 25 (2.7 percent or 978,000 people), followed by adults aged 26 or older (1.2 percent or 2.7 million people), then by adolescents aged 12 to 17 (0.8 percent or 216,000 people) (Figure 23 and Tables A.11B, A.12B, and A.13B).

Prescription Tranquilizer or Sedative Misuse

Estimates of the misuse of prescription tranquilizers or sedatives are presented together because prescription drugs in both categories have a common effect on specific activity in the brain. Prescription tranquilizers include benzodiazepine tranquilizers (e.g., as alprazolam, lorazepam, clonazepam, or diazepam products), muscle relaxants, or any other prescription tranquilizer. Prescription sedatives include zolpidem products, eszopiclone products, zaleplon products, benzodiazepine sedatives (e.g., as flurazepam, temazepam products, or triazolam products), barbiturates, or any other prescription sedative.

Among people aged 12 or older, the percentage who misused prescription tranquilizers or sedatives in the past year decreased from 1.7 percent (or 4.8 million people) in 2021 to 1.5 percent (or 4.2 million people) in 2025 (Figure 24 and Table A.10B). Among young adults aged 18 to 25, the percentage who misused prescription tranquilizers or sedatives in the past year also decreased from 2.7 percent (or 916,000 people) in 2021 to 1.6 percent (or 582,000 people) in 2025 (Table A.12B). However, the percentages for adolescents aged 12 to 17 and adults aged 26 or older who misused prescription tranquilizers or sedatives in the past year showed no change from 2021 to 2025 (Tables A.11B and A.13B).

Figure 24 Table. Past Year Prescription Tranquilizer or Sedative Misuse: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	1.7	1.7	1.7	1.6	1.5	Decreased
12 to 17	1.0	0.5	0.7	0.7	0.6	No Change
18 to 25	2.7	2.4	1.7	1.6	1.6	Decreased
26 or Older	1.7	1.7	1.8	1.7	1.5	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who misused prescription tranquilizers or sedatives in the past year was lower among adolescents aged 12 to 17 (0.6 percent or 141,000 people) than among young adults aged 18 to 25 (1.6 percent or 582,000 people) or adults aged 26 or older (1.5 percent or 3.5 million people) (Figure 24 and Tables A.11B, A.12B, and A.13B).

Prescription Opioid Misuse

The 2021 to 2025 NSDUHs assessed the misuse of prescription pain relievers in the following categories: products containing hydrocodone, oxycodone, tramadol, codeine, morphine, prescription fentanyl,²⁶ buprenorphine, oxymorphone, and hydromorphone, as well as Demerol^®, methadone, or any other prescription pain reliever. Except for “any other prescription pain reliever,” the pain relievers mentioned in the preceding sentence are opioids that are available by prescription in the United States, subsequently referred to as “prescription opioids.”

This section provides estimates for the misuse of prescription opioids, including specific subtypes of prescription opioids. Of an estimated 7.2 million people aged 12 or older in 2025 who misused prescription pain relievers in the past year, 6.9 million people misused prescription opioids, or approximately 96 percent of the people who misused prescription pain relievers.²⁰ Respondents were not counted as having misused prescription opioids in the past year if they reported the misuse of only other prescription pain relievers, and the other prescription pain relievers they misused in the past year were all nonopioids.

The percentage of people aged 12 or older who misused prescription opioids in the past year decreased from 3.0 percent (or 8.5 million people) in 2021 to 2.4 percent (or 6.9 million people) in 2025 (Figure 25 and Table A.10B). The percentages among young adults aged 18 to 25 and adults aged 26 or older who misused prescription opioids in the past year also decreased from 2021 to 2025 (Tables A.12B and A.13B). For example, the percentage of young adults aged 18 to 25 who misused prescription opioids in the past year decreased from 3.0 percent (or 989,000 people) in 2021 to 2.0 percent (or 733,000 people) in 2025. Among adolescents aged 12 to 17, the percentage who misused prescription opioids in the past year showed no change from 2021 to 2025 (Table A.11B).

Figure 25 Table. Past Year Prescription Opioid Misuse: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	3.0	2.8	2.9	2.6	2.4	Decreased
12 to 17	2.0	1.5	2.0	1.5	1.6	No Change
18 to 25	3.0	3.0	2.4	2.6	2.0	Decreased
26 or Older	3.2	3.0	3.1	2.8	2.5	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who misused prescription opioids in the past year was higher among adults aged 26 or older (2.5 percent or 5.7 million people) than among young adults aged 18 to 25 (2.0 percent or 733,000 people) or adolescents aged 12 to 17 (1.6 percent or 402,000 people) (Figure 25 and Tables A.11B, A.12B, and A.13B).

Misuse of Subtypes of Prescription Opioids

The 2025 NSDUH asked respondents to identify specific prescription pain relievers they used in the past year, then asked whether they misused those prescription pain relievers in the past year. As noted previously, the specific pain relievers in the NSDUH questionnaire were prescription opioids. These specific prescription opioids that people misused in the past year were categorized into subtypes. For example, respondents who reported misusing Vicodin^® or hydrocodone were classified as misusers of hydrocodone products.

This section presents two ways of examining the misuse of subtypes of prescription opioids in 2025. First, it presents estimates of the misuse of subtypes among people aged 12 or older who misused any prescription opioid in the past year. Then, it presents estimates of the misuse of subtypes of prescription opioids among people who used that opioid subtype for any reason in the past year (i.e., not necessarily misuse). See the Misuse of Prescription Psychotherapeutic Drugs section for the definition of misuse.

Among the 6.9 million people aged 12 or older in 2025 who misused prescription opioids in the past year, 41.8 percent (or 2.8 million people) misused hydrocodone products in the past year (Figures 15 and 26 and Table A.15B). In addition, 31.7 percent (or 2.1 million people) of past year misusers of prescription opioids misused oxycodone products in the past year, including OxyContin^®, Percocet^®, Percodan^®, Roxicodone^®, and generic oxycodone. More than 1 in 4 people aged 12 or older who misused prescription opioids in the past year were misusers of codeine products in the past year (27.8 percent or 1.9 million people). These products also have been commonly prescribed opioids.²⁷

Although hydrocodone products were the most commonly misused prescription opioid subtype in the past year, 8.6 percent of people aged 12 or older in 2025 who used hydrocodone products for any reason in the past year misused them in that period (Figure 27 and Table A.15B).

Among people aged 12 or older in 2025 who used buprenorphine products for any reason in the past year, 18.5 percent misused them and 81.5 percent did not (Figure 27 and Table A.15B). Stated another way, about four fifths of past year buprenorphine users did not misuse it in that period. Data from the 2015 to 2019 NSDUHs indicated that adults aged 18 or older who misused buprenorphine products were more likely to have used them without a prescription of their own compared with adults who misused prescription opioids other than buprenorphine products.²⁸

Opioid Misuse

Opioids are a group of chemically similar drugs that include heroin and prescription opioids, such as hydrocodone (e.g., Vicodin^®), oxycodone (e.g., OxyContin^®), codeine, and morphine. In this report, opioid misuse includes the misuse of prescription opioids or the use of heroin. Respondents were not counted as having misused opioids in the past year if they reported only the misuse of other prescription pain relievers, and the other pain relievers they misused in the past year were all nonopioids.

In this report, opioid misuse does not include use of illegally made fentanyl (IMF). For additional information on estimates of opioid misuse that do include use of IMF, see Section 1 of the 2025 Detailed Tables.²⁰

Among people aged 12 or older in 2025, 2.4 percent (or 7.1 million people) misused opioids in the past year (Figure 28 and Table A.10B). The vast majority of these people who misused opioids in the past year misused prescription opioids (Table A.16AB), but they did not use heroin. Specifically, 6.9 million people misused prescription opioids in the past year, of whom 6.5 million people did not use heroin. An estimated 382,000 people misused prescription opioids and used heroin in the past year.

Among people aged 12 or older, the percentage who misused opioids in the past year decreased from 3.2 percent (or 9.1 million people) in 2021 to 2.4 percent (or 7.1 million people) in 2025 (Figure 29 and Table A.10B). The percentages of young adults aged 18 to 25 and adults aged 26 or older who misused opioids in the past year also decreased from 2021 to 2025 (Tables A.12B and A.13B). For example, the percentage of young adults aged 18 to 25 who misused opioids in the past year decreased from 3.0 percent (or 1.0 million people) in 2021 to 2.0 percent (or 736,000 people) in 2025. Among adolescents aged 12 to 17, the percentage who misused opioids in the past year showed no change from 2021 to 2025 (Table A.11B).

Figure 29 Table. Past Year Opioid Misuse: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	3.2	3.0	3.0	2.7	2.4	Decreased
12 to 17	2.0	1.5	2.0	1.5	1.6	No Change
18 to 25	3.0	3.0	2.4	2.6	2.0	Decreased
26 or Older	3.4	3.1	3.2	2.8	2.6	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons. Note: Estimates include the use of heroin or the misuse of prescription opioids in the past year. Estimates for 2021‑2023 may differ from previously published estimates because they do not include the misuse of only nonopioid pain relievers.

In 2025, the percentage of people who misused opioids in the past year was higher among adults aged 26 or older (2.6 percent or 5.9 million people) than among young adults aged 18 to 25 (2.0 percent or 736,000 people) or adolescents aged 12 to 17 (1.6 percent or 403,000 people) (Figure 29 and Tables A.11B, A.12B, and A.13B).

Central Nervous System Stimulant Misuse

Central nervous system (CNS) stimulants are a group of drugs that include cocaine, methamphetamine, and prescription stimulants. These drugs act in similar ways to stimulate the brain. They produce stimulant effects, such as increased alertness, wakefulness, or energy. They also can produce physical side effects of rapid or irregular heartbeat or increased blood pressure and body temperature.^29,30,31 In this report, CNS stimulant misuse includes the use of cocaine or methamphetamine or the misuse of prescription stimulants.

Of the 9.5 million people aged 12 or older in 2025 who misused CNS stimulants in the past year, most (7.6 million people) misused only one type of CNS stimulant, including 3.4 million people who used cocaine only, 2.6 million who misused prescription stimulants only, and 1.7 million people who used methamphetamine only (Figure 30 and Table A.17AB).³² An estimated 188,000 people used or misused all three CNS stimulants in the past year (2.0 percent of people who misused CNS stimulants).

Among people aged 12 or older, the percentage who misused CNS stimulants in the past year showed no change from 2021 to 2025 (Figure 31 and Table A.10B). In 2025, 3.3 percent of people aged 12 or older (or 9.5 million people) misused CNS stimulants in the past year. Percentages also showed no change from 2021 to 2025 for adolescents aged 12 to 17 and adults aged 26 or older (Tables A.11B and A.13B). Among young adults aged 18 to 25, however, the percentage who misused CNS stimulants in the past year decreased from 6.7 percent (or 2.2 million people) in 2021 to 4.7 percent (or 1.7 million people) in 2025 (Table A.12B).

Figure 31 Table. Past Year Central Nervous System Stimulant Misuse: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	3.4	3.6	3.4	3.1	3.3	No Change
12 to 17	1.3	1.1	1.1	1.1	0.9	No Change
18 to 25	6.7	6.5	5.6	4.7	4.7	Decreased
26 or Older	3.1	3.5	3.3	3.1	3.3	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who misused CNS stimulants in the past year was highest among young adults aged 18 to 25 (4.7 percent or 1.7 million people), followed by adults aged 26 or older (3.3 percent or 7.6 million people), then by adolescents aged 12 to 17 (0.9 percent or 241,000 people) (Figure 31 and Tables A.11B, A.12B, and A.13B).

Illegally Made Fentanyl Use

The use of IMF is of particular interest because of its involvement in fatal overdoses in the past decade.^33,34,35 Although the number of drug overdose deaths overall and the number involving IMF or fentanyl analogues, such as carfentanil, started to decline in the United States in late 2023, overdose deaths remain high.³⁶ In 2024, most people who misused any fentanyl product had used IMF; misuse of fentanyl products includes misuse of prescription forms of fentanyl or use of IMF.³⁷

Fentanyl is 50 to 100 times stronger than morphine. Therefore, the risks for overdose or other adverse effects are substantially increased when people use IMF, especially among people whose bodies are not accustomed to the effects of opioids. IMF is sometimes present in products that are sold as heroin or in counterfeit prescription drugs that are made to look like commonly misused prescription opioids. Some people who use IMF are not aware they are doing so.^38,39,40,41 The physical appearance or taste of a product or the purchase of drugs from a known source are not reliable indicators of whether they contain IMF. A drug product’s physical effects can be a better but not completely reliable indicator of whether the product contains IMF, especially if people have had substantial experience using opioids, such as heroin. Because people who used IMF may have been unaware that they used it, caution must be taken in interpreting estimates of IMF use; these estimates are almost certainly an underestimate of true IMF use.

Among people aged 12 or older, the percentage who used IMF in the past year showed no change from 2021 to 2025 (Table A.18B). In 2025, 0.3 percent of people aged 12 or older (or 768,000 people) used IMF in the past year. Percentages also showed no change from 2021 to 2025 for each age group.

In 2025, the percentage of people who used IMF in the past year did not differ significantly by age group. Percentages ranged from 0.1 percent (or 34,000 people) among adolescents aged 12 to 17 to 0.3 percent (or 676,000 people) among adults aged 26 or older. An estimated 0.2 percent of young adults aged 18 to 25 (57,000 people) used IMF in the past year (Table A.18B).

Initiation of Substance Use

NSDUH included questions to measure the initiation of substance use—that is, the first use of particular substances during a person’s lifetime.⁴² This report presents estimates for people aged 12 or older who initiated the use or misuse of a particular substance in the 12 months before the NSDUH interview.^43,44,45 See the section on the Misuse of Prescription Psychotherapeutic Drugs for the definition of “misuse” of prescription drugs.

This report highlights estimates and trends for past year initiation of the five substances with the largest numbers of people aged 12 or older in 2025 who initiated use in the past year: alcohol use, nicotine vaping, marijuana use, cigar use, and cigarette use. Estimates for initiation of the use or misuse of additional substances are also presented in figures and tables.

It is important to note the relationship between an aggregate measure of substance use (i.e., a measure including a group of substances) and the individual drugs that make up that aggregate measure. For example, crack (an individual drug) is a form of cocaine (a combined measure including crack and other forms of cocaine). If a person first used crack in the past year but first used other forms of cocaine more than 12 months ago, that person would be a past year initiate of crack use but would not be a past year initiate of cocaine use.

These relationships are especially important to consider for the aggregate measure for the initiation of misuse of prescription psychotherapeutic drugs. There is potential for respondents to underreport lifetime (but not past year) misuse of prescription drugs.⁴⁶ This potential for underreporting could affect the accuracy of aggregate initiation estimates that include prescription psychotherapeutics, such as initiation of the use of any illicit drug. Therefore, this report does not present estimates for past year initiation that include prescription psychotherapeutics, such as central nervous system (CNS) stimulant misuse (cocaine, methamphetamine, or prescription stimulants) or any illicit drug use (including prescription drug misuse).⁴⁷

In addition, NSDUH respondents are asked how old they were when they first used or misused a substance. Respondents who first used (or misused) a substance in the past year would need to recall only whether this event happened at their current age or at the age that was 1 year less than their current age. Information on the age when past year initiates first used alcohol or nicotine products is useful for estimating whether past year initiation of use occurred before age 21 or at age 21 or older.

Figure 32 and Table A.19A provide an overview of the numbers of people aged 12 or older in 2025 who were past year initiates of the use or misuse of the substances discussed in this section. In the past 12 months, 4.3 million people used alcohol for the first time, 4.2 million people vaped nicotine for the first time, 2.4 million people used marijuana for the first time, 1.8 million people tried cigars for the first time, and 1.7 million people tried a cigarette for the first time. Smaller numbers of people initiated the use or misuse of other substances shown in Figure 32.

Initiation of Alcohol Use

Among people aged 12 or older, the percentage who initiated alcohol use in the past year—meaning they had never had more than a sip or two from a drink before the past 12 months—showed no change from 2021 to 2025 (Figure 33 and Table A.20B). In 2025, 1.5 percent of people aged 12 or older (or 4.3 million people) initiated alcohol use in the past year. Percentages also showed no change from 2021 to 2025 for young adults aged 18 to 25 and adults aged 26 or older (Tables A.22B and A.23B). Among adolescents aged 12 to 17, however, the percentage who initiated alcohol use in the past year decreased from 7.1 percent (or 1.8 million people) in 2021 to 6.2 percent (or 1.6 million people) in 2025 (Table A.21B).

Figure 33 Table. Past Year Alcohol Use Initiates: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	1.5	1.5	1.5	1.5	1.5	No Change
12 to 17	7.1	7.0	7.0	6.4	6.2	Decreased
18 to 25	6.2	6.5	6.7	6.7	7.1	No Change
26 or Older	0.1	0.1	<0.1	0.1	0.1	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentages of people who initiated alcohol use in the past year were higher among young adults aged 18 to 25 (7.1 percent or 2.6 million people) or adolescents aged 12 to 17 (6.2 percent or 1.6 million people) than among adults aged 26 or older (0.1 percent or 117,000 people) (Figure 33 and Tables A.21B, A.22B, and A.23B). Approximately 7 in 10 of the 4.3 million people in 2025 who initiated alcohol use in the past year did so before age 21 (70.1 percent or 3.0 million people) (Figure 34 and Table A.24AB).

Initiation of Nicotine Vaping

Among people aged 12 or older, the percentage who initiated nicotine vaping in the past year—meaning they had never vaped nicotine before the past 12 months—decreased from 2.1 percent (or 5.9 million people) in 2022 to 1.5 percent (or 4.2 million people) in 2025 (Figure 35 and Table A.20B). Percentages also decreased from 2022 to 2025 for people in each age group (Tables A.21B, A.22B, and A.23B). For example, the percentage of young adults aged 18 to 25 who first vaped nicotine in the past year decreased from 4.1 percent (or 1.4 million people) in 2022 to 2.7 percent (or 982,000 people) in 2025. Note that estimates in 2022 to 2024 for the initiation of nicotine vaping in the past year may differ from previously published estimates because of updates to nicotine vaping measures.¹⁷

Figure 35 Table. Past Year Nicotine Vaping Initiates: Among People Aged 12 or Older; Percentages, 2022‑2025

Age Group	2022	2023	2024	2025	Trend
12 or Older	2.1	2.0	1.8	1.5	Decreased
12 to 17	5.5	5.4	4.2	3.8	Decreased
18 to 25	4.1	3.9	3.2	2.7	Decreased
26 or Older	1.4	1.3	1.3	1.0	Decreased
Note: Some 2022‑2024 estimates may differ from previously published estimates due to updates to the editing procedures for this measure.

In 2025, the percentage of people who initiated nicotine vaping in the past year was highest among adolescents aged 12 to 17 (3.8 percent or 968,000 people), followed by young adults aged 18 to 25 (2.7 percent or 982,000 people), then by adults aged 26 or older (1.0 percent or 2.3 million people) (Figure 35 and Tables A.21B, A.22B, and A.23B). Among the 4.2 million people who initiated nicotine vaping in the past year, about one third (35.9 percent or 1.5 million people) did so before age 21, and about two thirds (64.1 percent or 2.7 million people) did so at age 21 or older (Figure 34 and Table A.24AB).

Initiation of Marijuana Use

Among people aged 12 or older, the percentage of people who initiated marijuana use in the past year decreased from 1.0 percent (or 2.7 million people) in 2021 to 0.8 percent (or 2.4 million people) in 2025 (Figure 36 and Table A.20B). The percentage of adolescents aged 12 to 17 who initiated marijuana use in the past year also decreased from 3.5 percent (or 913,000 people) in 2021 to 2.4 percent (or 615,000 people) in 2025 (Table A.21B). Percentages showed no change from 2021 to 2025 for young adults aged 18 to 25 and adults aged 26 or older (Tables A.22B and A.23B).

Figure 36 Table. Past Year Marijuana Use Initiates: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	1.0	1.3	1.2	1.0	0.8	Decreased
12 to 17	3.5	4.8	4.5	3.5	2.4	Decreased
18 to 25	3.5	3.4	3.5	2.9	3.2	No Change
26 or Older	0.3	0.6	0.5	0.4	0.3	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who initiated marijuana use in the past year was highest among young adults aged 18 to 25 (3.2 percent or 1.1 million people), followed by adolescents aged 12 to 17 (2.4 percent or 615,000 people), then by adults aged 26 or older (0.3 percent or 593,000 people) (Figure 36 and Tables A.21B, A.22B, and A.23B).

Initiation of Cigar Use

Among people aged 12 or older, the percentage who initiated cigar use in the past year showed no change from 2021 to 2025 (Figure 37 and Table A.20B). Percentages also showed no change from 2021 to 2025 for adolescents aged 12 to 17 and young adults aged 18 to 25 (Tables A.21B and A.22B). Among adults aged 26 or older, the percentage who initiated cigar use in the past year increased from 0.1 percent (or 315,000 people) in 2021 to 0.4 percent (or 829,000 people) in 2025 (Table A.23B).

Figure 37 Table. Past Year Cigar Use Initiates: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	0.5	0.6	0.7	0.5	0.6	No Change
12 to 17	1.1	0.9	0.9	0.9	0.7	No Change
18 to 25	2.4	2.4	3.1	2.5	2.3	No Change
26 or Older	0.1	0.2	0.3	0.2	0.4	Increased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who initiated cigar use in the past year was highest among young adults aged 18 to 25 (2.3 percent or 823,000 people), followed by adolescents aged 12 to 17 (0.7 percent or 185,000 people), then by adults aged 26 or older (0.4 percent or 829,000 people) (Figure 37 and Tables A.21B, A.22B, and A.23B). About two thirds of the 1.8 million people who initiated cigar use in the past year did so at age 21 or older (68.6 percent or 1.3 million people) (Figure 34 and Table A.24AB).

Initiation of Cigarette Use

Among people aged 12 or older, the percentage who initiated cigarette use in the past year increased from 0.4 percent (or 1.2 million people) in 2021 to 0.6 percent (or 1.7 million people) in 2025 (Figure 38 and Table A.20B). The percentage also increased among young adults aged 18 to 25, from 2.2 percent (or 736,000 people) in 2021 to 3.2 percent (or 1.1 million people) in 2025 (Table A.22B). Percentages showed no change from 2021 to 2025 for adolescents aged 12 to 17 and adults aged 26 or older (Tables A.21B and A.23B).

Figure 38 Table. Past Year Cigarette Use Initiates: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	0.4	0.5	0.5	0.5	0.6	Increased
12 to 17	1.5	1.7	1.7	1.3	1.4	No Change
18 to 25	2.2	2.3	2.8	2.9	3.2	Increased
26 or Older	<0.1	0.1	<0.1	0.1	0.1	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who initiated cigarette use in the past year was highest among young adults aged 18 to 25 (3.2 percent or 1.1 million people), followed by 1.4 percent of adolescents aged 12 to 17 (or 363,000 people), then by 0.1 percent of adults aged 26 or older (or 152,000 people) (Figure 38 and Tables A.21B, A.22B, and A.23B). Nearly two thirds of the 1.7 million people who initiated cigarette use in the past year did so before age 21 (65.7 percent or 1.1 million people) (Figure 34 and Table A.24AB).

Substance Use Disorders in the Past Year

Substance use disorders (SUDs) are characterized by impairment caused by the recurrent use of alcohol or other drugs (or both), such as health problems; disability; or failure to meet major responsibilities at work, school, or home. NSDUH has included a series of questions to estimate the percentage of the population aged 12 or older who had at least one SUD in the past 12 months (subsequently referred to as “an SUD” or “a past year SUD”). The SUD questions assess the presence of an SUD in the past 12 months based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM‑5).^48,49 Respondents were asked about their SUD symptoms for any alcohol or drugs they used in the 12 months prior to the survey. Drugs include marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, methamphetamine, and any use of prescription stimulants, tranquilizers or sedatives (e.g., benzodiazepines), and pain relievers. The DSM‑5 SUD criteria for prescription drugs apply to people who used prescription drugs for any reason in the past year. Therefore, NSDUH respondents in 2025 who reported any use of prescription psychotherapeutic drugs (i.e., pain relievers, tranquilizers, stimulants, or sedatives) in the past year (i.e., not just misuse of prescription drugs) were asked the respective SUD questions for that category of prescription drugs. Beginning with the 2024 NSDUH, however, respondents were not counted as having an opioid use disorder if the prescription pain relievers they reported using in the past year were not opioids, and they did not use heroin in the past year.

In addition, questions about the use of illegally made fentanyl (IMF) have appeared after SUD questions in the NSDUH questionnaire since 2022. For this reason, overall SUD, drug use disorder, and opioid use disorder measures do not capture disorders arising solely from the use of IMF. As discussed in the Illegally Made Fentanyl Use section, however, the estimate of IMF use in the past year among people aged 12 or older was low in 2025 (0.3 percent or 768,000 people). For data from people who used IMF in the past year to affect SUD estimates in NSDUH, respondents would need to have used only IMF or to have attributed their SUD symptoms to IMF and not to their use of other substances. Fewer than 15 respondents in 2025 reported using IMF in the past year but did not report using alcohol or other drugs in the past year.

DSM‑5 includes the following SUD criteria (as measured in the 2025 NSDUH):

1. The substance is often taken in larger amounts or over a longer period than intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. There is a craving, or a strong desire or urge, to use the substance.
5. There is recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
6. There is continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
8. There is recurrent substance use in situations in which it is physically hazardous.
9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. There is a need for markedly increased amounts of the substance to achieve intoxication or the desired effect, or markedly diminished effect with continued use of the same amount of the substance (i.e., tolerance).
11. For substances other than hallucinogens and inhalants that have a withdrawal criterion, there are two components of withdrawal symptoms, either of which meet the overall criterion for withdrawal symptoms:
    1. There is a required number of withdrawal symptoms that occur when substance use is cut back or stopped following a period of prolonged use.⁵⁰
    2. The substance or a related substance is used to get over or avoid withdrawal symptoms.⁵¹

Table 1 shows how these 11 DSM‑5 SUD criteria apply to substances in NSDUH. For prescription opioids, tranquilizers, stimulants, and sedatives, Table 1 also shows how these criteria apply if respondents misused prescription drugs or if they simply used but did not misuse prescription drugs in the past year. For consistency with the DSM‑5 criteria, NSDUH respondents were classified as having an SUD in the past year if they met two or more of the applicable criteria for a given substance in the 12‐month period before the interview. NSDUH does not measure whether respondents met criteria for an SUD prior to the past 12 months. Thus, some respondents could have received treatment for SUDs that occurred more than 12 months before the interview, but they did not have active SUD symptoms in the past 12 months.

For alcohol, marijuana, cocaine, heroin, and methamphetamine in Table 1, respondents were classified as having an SUD in the past year if they met 2 or more of the 11 criteria in the 12‑month period before the interview. However, respondents were classified as having a hallucinogen use disorder or an inhalant use disorder if they met 2 or more of the first 10 criteria in the past 12 months; the withdrawal criterion does not apply to hallucinogens and inhalants.

For the use or misuse of prescription drugs in Table 1, the number of applicable DSM‑5 criteria for classifying respondents as having an SUD depends on whether respondents misused prescription drugs, or they used prescription drugs in the past year, but they did not misuse them. If respondents misused prescription drugs in the past year, they were classified as having an SUD if they met 2 or more of the 11 criteria shown in Table 1. However, if respondents used prescription drugs in the past year but did not misuse them, they were classified as having an SUD if they met two or more of the first nine criteria shown in Table 1. Criteria 10 (tolerance) and 11 (withdrawal) do not apply to respondents who used but did not misuse these prescription drugs in the past year; tolerance and withdrawal can occur as normal physiological adaptations when people use these prescription drugs appropriately under medical supervision.⁵²

Substances and types of use or misuse that are included in selected SUD measures in the 2025 NSDUH are as follows:

• Any SUD in the past year includes data from past year users of alcohol, marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, and methamphetamine, and any past year users of prescription psychotherapeutic drugs.⁵³
• Alcohol use disorder includes only data from past year users of alcohol.⁵³
• Drug use disorder includes data from past year users of marijuana,⁵³ cocaine, heroin, hallucinogens, inhalants, and methamphetamine, and any past year users of prescription psychotherapeutic drugs. It does not include people who had only an alcohol use disorder in the past year.

In addition, NSDUH asked respondents about SUD symptoms that respondents specifically attributed to their use in the past year of cocaine, heroin, methamphetamine, prescription pain relievers, prescription tranquilizers, prescription stimulants, and prescription sedatives. However, DSM‑5 groups these substances into a smaller set of categories for classifying people as having SUDs.

• Cocaine, methamphetamine, and prescription stimulants are included in an overall category for stimulants (referred to in NSDUH as CNS stimulants to differentiate between stimulants that are available by prescription and those that are not).
• Heroin and prescription pain relievers that are opioids are included in an overall category for opioids.
• Prescription tranquilizers and sedatives are included in an overall category for sedatives, hypnotics, and anxiolytics (referred to in NSDUH as prescription tranquilizer or sedative use disorder).

Therefore, this report does not focus on SUDs arising from the use of specific substances, such as heroin or prescription opioids. Rather, the report focuses on estimates for CNS stimulant use disorder, opioid use disorder, and prescription tranquilizer or sedative use disorder that align with DSM‑5 categories.

In 2025, 44.6 million people aged 12 or older (or 15.3 percent of the population) had an SUD in the past year, including 25.7 million people who had an alcohol use disorder and 26.0 million people who had a drug use disorder (Figure 39 and Tables A.25AB and A.26B). People who had an SUD in the past year tended to have an alcohol use disorder only or a drug use disorder only. About 1 in 6 people with a past year SUD (16.0 percent or 7.1 million people) had both an alcohol use disorder and a drug use disorder in the past year.

Among people aged 12 or older, the percentage who had a past year SUD decreased from 16.7 percent (or 46.8 million people) in 2021 to 15.3 percent (or 44.6 million people) in 2025 (Figure 40 and Table A.26B). Percentages also decreased from 2021 to 2025 for each age group (Tables A.27B, A.28B, and A.29B). For example, the percentage of young adults aged 18 to 25 who had a past year SUD decreased from 26.2 percent (or 8.8 million people) in 2021 to 23.8 percent (or 8.6 million people) in 2025.

Figure 40 Table. Past Year Substance Use Disorder: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	16.7	17.3	17.1	16.8	15.3	Decreased
12 to 17	9.2	8.7	8.5	7.8	7.4	Decreased
18 to 25	26.2	27.8	27.1	25.9	23.8	Decreased
26 or Older	16.2	16.6	16.6	16.4	14.9	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who had a past year SUD was highest among young adults aged 18 to 25 (23.8 percent or 8.6 million people), followed by adults aged 26 or older (14.9 percent or 34.1 million people), then by adolescents aged 12 to 17 (7.4 percent or 1.9 million people) (Figure 40 and Tables A.27B, A.28B, and A.29B).

Alcohol Use Disorder

Respondents who used alcohol on 6 or more days in the past 12 months were classified as having an alcohol use disorder if they met two or more of the DSM‑5 criteria for alcohol use disorder. Relevant criteria for alcohol use disorder can be found in the 2025 Methodological Summary and Definitions report.¹¹

Among people aged 12 or older, the percentage who had a past year alcohol use disorder decreased from 10.6 percent (or 29.7 million people) in 2021 to 8.9 percent (or 25.7 million people) in 2025 (Figure 41 and Table A.26B). Percentages also decreased from 2021 to 2025 for each age group (Tables A.27B, A.28B, and A.29B). For example, the percentage of young adults aged 18 to 25 who had a past year alcohol use disorder decreased from 15.5 percent (or 5.2 million people) in 2021 to 13.1 percent (or 4.7 million people) in 2025.

Figure 41 Table. Alcohol Use Disorder in the Past Year: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	10.6	10.5	10.2	9.7	8.9	Decreased
12 to 17	3.7	2.9	2.9	3.0	2.8	Decreased
18 to 25	15.5	16.4	15.1	14.4	13.1	Decreased
26 or Older	10.7	10.4	10.3	9.7	8.9	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who had a past year alcohol use disorder was highest among young adults aged 18 to 25 (13.1 percent or 4.7 million people), followed by adults aged 26 or older (8.9 percent or 20.3 million people), then by adolescents aged 12 to 17 (2.8 percent or 710,000 people) (Figure 41 and Tables A.27B, A.28B, and A.29B).

Drug Use Disorder

This section presents overall estimates for drug use disorder, then provides estimates for selected specific drugs. As discussed previously, drug use disorder was defined as meeting DSM‑5 SUD criteria for one or more of the following drugs that were used in the past year: marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, or prescription psychotherapeutic drugs (i.e., stimulants, tranquilizers or sedatives, and pain relievers). Measures for prescription drug use disorders for 2025 were based on data from all past year users of prescription drugs, not just misusers. Relevant SUD definitions and criteria for specific drugs can be found in Table 1 and in the 2025 Methodological Summary and Definitions report.¹¹

Among people aged 12 or older, the percentage who had a past year drug use disorder showed no change from 2021 to 2025. In 2025, 8.9 percent of people aged 12 or older (or 26.0 million people) had a past year drug use disorder (Figure 42 and Table A.26B). Percentages for young adults aged 18 to 25 and adults aged 26 or older also showed no change from 2021 to 2025 (Tables A.28B and A.29B). Among adolescents aged 12 to 17, the percentage who had a past year drug use disorder decreased from 7.3 percent (or 1.9 million people) in 2021 to 5.9 percent (or 1.5 million people) in 2025 (Table A.27B).

Figure 42 Table. Past Year Drug Use Disorder: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	8.7	9.7	9.6	9.8	8.9	No Change
12 to 17	7.3	7.0	6.9	6.6	5.9	Decreased
18 to 25	16.6	18.6	18.0	17.8	15.9	No Change
26 or Older	7.7	8.5	8.6	8.9	8.2	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who had a past year drug use disorder was highest among young adults aged 18 to 25 (15.9 percent or 5.7 million people), followed by adults aged 26 or older (8.2 percent or 18.7 million people), then by adolescents aged 12 to 17 (5.9 percent or 1.5 million people) (Figure 42 and Tables A.27B, A.28B, and A.29B).

Marijuana (Cannabis) Use Disorder

Among people aged 12 or older, the percentage who had a past year marijuana (cannabis) use disorder increased from 6.0 percent (or 16.7 million people) in 2021 to 6.7 percent (or 19.3 million people) in 2025 (Figure 43 and Table A.26B). The percentage of people who had a past year marijuana use disorder also increased among adults aged 26 or older, from 4.7 percent (or 10.4 million people) in 2021 to 5.7 percent (or 13.1 million people) in 2025 (Table A.29B). Percentages showed no change from 2021 to 2025 for adolescents aged 12 to 17 and young adults aged 18 to 25 (Tables A.27B and A.28B).

Figure 43 Table. Past Year Marijuana Use Disorder: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	6.0	6.7	6.8	7.1	6.7	Increased
12 to 17	5.2	5.1	4.7	4.7	4.4	No Change
18 to 25	14.7	16.5	16.6	15.8	14.1	No Change
26 or Older	4.7	5.4	5.5	6.1	5.7	Increased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who had a past year marijuana use disorder was highest among young adults aged 18 to 25 (14.1 percent or 5.1 million people), followed by adults aged 26 or older (5.7 percent or 13.1 million people), then by adolescents aged 12 to 17 (4.4 percent or 1.1 million people) (Figure 43 and Tables A.27B, A.28B, and A.29B).

Central Nervous System Stimulant Use Disorder

Central nervous system (CNS) stimulant use disorder included data from people who used cocaine, methamphetamine, or prescription stimulants in the past year. NSDUH respondents were counted as having a CNS stimulant use disorder if they met two or more of the DSM‑5 criteria shown in Table 1 for cocaine, methamphetamine, or prescription stimulants in the past year, including situations in which respondents met SUD criteria for more than one of these substances. Respondents were not counted as having a CNS stimulant use disorder if they did not meet the full SUD criteria individually for cocaine, methamphetamine, or prescription stimulants.

Among people aged 12 or older, the percentage who had a past year CNS stimulant use disorder showed no change from 2021 to 2025 (Figure 44 and Table A.26B). In 2025, 1.5 percent of people aged 12 or older (or 4.5 million people) had a past year CNS stimulant use disorder. Percentages also showed no change from 2021 to 2025 for each age group (Tables A.27B, A.28B, and A.29B).

Figure 44 Table. Past Year Central Nervous System (CNS) Stimulant Use Disorder: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	1.5	1.6	1.5	1.5	1.5	No Change
12 to 17	1.1	1.0	1.0	0.8	0.8	No Change
18 to 25	1.9	2.2	1.5	2.1	1.6	No Change
26 or Older	1.5	1.6	1.6	1.5	1.6	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of people who had a past year CNS stimulant use disorder was higher among young adults aged 18 to 25 and adults aged 26 or older (1.6 percent for each age group, or 591,000 young adults and 3.7 million adults aged 26 or older) than among adolescents aged 12 to 17 (0.8 percent or 213,000 people) (Figure 44 and Tables A.27B, A.28B, and A.29B).

Opioid Use Disorder

Opioid use disorder included data from people who used heroin or prescription opioids in the past year. NSDUH respondents were counted as having an opioid use disorder if they met two or more of the DSM‑5 criteria shown in Table 1 for heroin or prescription opioids in the past year, including situations in which respondents met SUD criteria for both substances. Respondents were not counted as having an opioid use disorder if they did not meet the full SUD criteria individually for heroin or prescription opioids. As noted previously, respondents also were not counted as having an opioid use disorder if the prescription pain relievers they reported using in the past year were not opioids, and they did not use heroin in the past year. Additionally, questions about the use of IMF were asked in the 2025 NSDUH following the SUD questions; hence, the opioid use disorder estimates do not capture symptoms that arose solely from the use of IMF in the past year. However, fewer than 30 respondents in 2025 reported use of IMF in the past year but did not report use of heroin or any use of prescription opioids in that period.

Among people aged 12 or older, the percentage who had a past year opioid use disorder decreased from 1.9 percent (or 5.2 million people) in 2021 to 1.4 percent (or 4.0 million people) in 2025 (Figure 45 and Table A.26B). The percentage of people who had a past year opioid use disorder also decreased among adults aged 26 or older, from 2.1 percent (or 4.6 million people) in 2021 to 1.5 percent (or 3.4 million people) in 2025 (Table A.29B). Percentages showed no change from 2021 to 2025 for adolescents aged 12 to 17 and young adults aged 18 to 25 (Tables A.27B and A.28B).

Figure 45 Table. Past Year Opioid Use Disorder: Among People Aged 12 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
12 or Older	1.9	2.0	1.8	1.7	1.4	Decreased
12 to 17	0.9	0.9	0.9	1.0	0.8	No Change
18 to 25	1.2	1.1	1.0	1.0	0.9	No Change
26 or Older	2.1	2.3	2.0	1.9	1.5	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons. Note: Estimates for 2021‑2023 may differ from previously published estimates for opioid use disorder because they do not include the use of only nonopioid pain relievers.

In 2025, the percentage of people who had a past year opioid use disorder was higher among adults aged 26 or older (1.5 percent or 3.4 million people) than among young adults aged 18 to 25 (0.9 percent or 337,000 people) or adolescents aged 12 to 17 (0.8 percent or 207,000 people) (Figure 45 and Tables A.27B, A.28B, and A.29B).

Substance Use Disorder Severity

The DSM‑5 SUD criteria include a severity level classification. People who meet two or three criteria are considered to have a “mild” disorder, those who meet four or five criteria are considered to have a “moderate” disorder, and those who meet six or more criteria are considered to have a “severe” disorder. For SUD measures that were aggregated across more than one substance (e.g., any SUD, drug use disorder), mild SUD meant that people had only mild SUDs. Moderate SUD meant that people had at least one moderate SUD but did not have severe SUDs. Severe SUD meant that people had a severe SUD for at least one substance.

Highlights from Figure 46 and Table A.30B for severity levels among people aged 12 or older in 2025 who had a past year SUD, drug use disorder, marijuana use disorder, or alcohol use disorder include the following:

• Among the 44.6 million people aged 12 or older who had a past year SUD (Figure 39 and Table A.25AB), most (54.1 percent) had a mild disorder, and about 1 in 5 (22.5 percent) had a severe disorder.
  • A similar pattern occurred among each age group.
  • Percentages of people with a past year SUD who had a severe disorder did not differ significantly by age group and ranged from 22.0 percent among adults aged 26 or older to 25.1 percent among adolescents aged 12 to 17.
• The percentages for severity among people aged 12 or older who had a past year drug use disorder followed a general pattern similar to that for any SUD in that period.
  • Among the 26.0 million people aged 12 or older who had a drug use disorder (Figure 39 and Table A.25AB), most (53.0 percent) had a mild disorder, and about 1 in 5 (22.1 percent) had a severe disorder.
  • Among people with a past year drug use disorder, percentages who had a severe disorder were higher among adolescents aged 12 to 17 (28.1 percent) and young adults aged 18 to 25 (25.3 percent) than among adults aged 26 or older (20.6 percent).
• The percentages for severity among people who had a marijuana use disorder in the past year followed a general pattern similar to that for any SUD among people aged 12 or older, young adults aged 18 to 25, and adults aged 26 or older.
  • Among the 19.3 million people aged 12 or older who had a marijuana use disorder (Figure 39), most (53.4 percent) had a mild disorder, and about 1 in 6 (18.0 percent) had a severe disorder.
  • A slightly different pattern occurred among adolescents aged 12 to 17. Among adolescents who had a marijuana use disorder, about one third (35.7 percent) had a mild disorder, and one third (33.4 percent) had a severe disorder.
  • Among all people who had a marijuana use disorder, the percentage who had a severe disorder was highest among adolescents aged 12 to 17 (33.4 percent), followed by young adults aged 18 to 25 (25.3 percent), then by adults aged 26 or older (13.8 percent).
• The percentages for severity among people aged 12 or older who had a past year alcohol use disorder followed a general pattern similar to that for any SUD in that period.
  • Among the 25.7 million people aged 12 or older with a past year alcohol use disorder (Figure 39 and Table A.25AB), most (57.6 percent) had a mild disorder, compared with about 1 in 5 (20.7 percent) who had a severe disorder.
  • Among people with a past year alcohol use disorder, percentages who had a severe disorder did not differ significantly by age group and ranged from 14.5 percent among adolescents aged 12 to 17 to 21.6 percent among adults aged 26 or older.

In summary, the majority of people aged 12 or older who had an SUD, a drug use disorder, an alcohol use disorder, or a marijuana use disorder had a mild disorder, and only about 1 in 5 people with these disorders had a severe disorder. These patterns differ from those described next for people with a CNS stimulant use disorder due to their misuse of CNS stimulants and for people with an opioid use disorder due to their misuse of opioids.

Among the estimated 4.5 million people aged 12 or older in 2025 who had a CNS stimulant use disorder in the past year (Figure 39), about 2 in 5 (40.7 percent) had a mild disorder, and about 2 in 5 (39.1 percent) had a severe disorder (Figure 47 and Table A.31B).

• Among people who had a CNS stimulant use disorder in the past year that was due to their misuse of CNS stimulants in the past year (i.e., use of cocaine or methamphetamine⁵⁴ or misuse of prescription stimulants), 29.8 percent had a mild disorder, and about half (47.9 percent) had a severe disorder (Table A.31B).
• In comparison, among people whose CNS stimulant use disorder was due only to their use but not misuse of prescription stimulants in the past year, 82.5 percent had a mild disorder, and 5.4 percent had a severe disorder (Table A.31B).

Among the estimated 4.0 million people aged 12 or older in 2025 who had an opioid use disorder in the past year (Figure 39), about 3 in 5 (58.9 percent) had a mild disorder, and about 1 in 5 (20.3 percent) had a severe disorder (Figure 48 and Table A.31B).

• Among people who had an opioid use disorder in the past year that was due to their misuse of opioids in the past year (i.e., use of heroin⁵⁴ or misuse of prescription opioids), 32.0 percent had a mild disorder, and 38.4 percent had a severe disorder (Table A.31B).
• In comparison, among people whose opioid use disorder was due only to their use but not misuse of prescription opioids in the past year, 82.6 percent had a mild disorder, and 4.3 percent had a severe disorder (Table A.31B).

Symptoms of Generalized Anxiety Disorder in the Past 2 Weeks

The seven‐item GAD‑7 scale has been included in the NSDUH questionnaire since 2024 for adolescents aged 12 to 17 and adults aged 18 or older. The GAD‑7 is a validated self‐report measure that is used to screen for generalized anxiety disorder (GAD) and assess the severity of symptoms of GAD in the past 2 weeks.⁵⁵ Although the GAD‑7 captures recent symptoms, it does not estimate the prevalence of GAD because diagnostic criteria for GAD require a longer pattern of symptoms and impairment.⁴⁸ Symptoms assessed in the GAD‑7 questions include feeling nervous or on edge, excessively worrying about different things, having difficulty controlling thoughts of worry, having trouble relaxing, being restless, feeling irritable, and feeling that something awful might happen. As shown in Table 2, GAD‑7 scores range from 0 to 21, with higher scores indicating greater symptom severity. NSDUH respondents with scores of 0 to 4 were classified as having no or minimal symptoms of GAD, 5 to 9 as having mild symptoms, 10 to 14 as having moderate symptoms, and 15 to 21 as having severe symptoms.⁵⁶

Symptoms of Anxiety among Adolescents

Among adolescents aged 12 to 17 in 2025, about 1 in 5 (18.0 percent or 4.6 million people) had moderate or severe symptoms of GAD, including 10.6 percent (or 2.7 million people) who had moderate symptoms and 7.4 percent (or 1.9 million people) who had severe symptoms (Figure 49 and Table A.32B). The majority of adolescents (58.4 percent or 14.9 million people) had no or minimal symptoms, and the remainder had mild symptoms (23.6 percent or about 6.0 million people).

Substance Use among Adolescents with Moderate or Severe Anxiety Symptoms

In 2025, adolescents aged 12 to 17 who had moderate or severe symptoms of anxiety in the past 2 weeks were more likely to have used some substances in the past year or past month compared with their counterparts who had no or minimal symptoms in the past 2 weeks. Adolescents with moderate or severe symptoms were more likely than adolescents with no or minimal symptoms to have used illicit drugs in the past year (17.7 vs. 8.2 percent), used marijuana in the past year (12.9 vs. 6.7 percent), or misused opioids (i.e., used heroin or misused prescription opioids) in the past year (2.6 vs. 1.0 percent) (Figure 50 and Table A.33B). Adolescents who had moderate or severe symptoms were more likely than those with no or minimal symptoms to have engaged in binge alcohol use in the past month (4.8 vs. 2.4 percent). In addition, adolescents with moderate or severe symptoms were more likely than those with no or minimal symptoms of anxiety to have used nicotine products in the past month (11.0 vs. 5.2 percent). Adolescents with moderate or severe symptoms of anxiety also were more likely than those with no or minimal symptoms to have used most of the other substances in the past year or past month that are shown in Table A.33B.

Symptoms of Anxiety among Adults

Among adults aged 18 or older in 2025, 6.6 percent (or 17.5 million people) had moderate or severe symptoms of GAD in the past 2 weeks, including 4.2 percent (or 11.2 million people) who had moderate symptoms and 2.4 percent (or 6.3 million people) who had severe symptoms (Figure 51 and Table A.34B). About 8 in 10 adults (79.1 percent or 209.6 million people) had no or minimal symptoms, and the remainder had mild symptoms (14.3 percent or about 37.9 million people).

In 2025, the percentage of adults who had moderate or severe symptoms was highest among young adults aged 18 to 25 (12.2 percent or 4.4 million people), followed by adults aged 26 to 49 (8.1 percent or 8.5 million people), then by adults aged 50 or older (3.7 percent or 4.6 million people) (Figure 51 and Table A.34B).

Substance Use among Adults with Moderate or Severe Anxiety Symptoms

In 2025, adults aged 18 or older who had moderate or severe symptoms of anxiety in the past 2 weeks were more likely to have used some substances in the past year or past month compared with their counterparts who had no or minimal symptoms. Adults with moderate or severe symptoms were more likely than adults with no or minimal symptoms to have used illicit drugs in the past year (47.8 vs. 21.0 percent), used marijuana in the past year (42.1 vs. 18.4 percent), or misused opioids (i.e., used heroin or misused prescription opioids) in the past year (7.6 vs. 1.8 percent) (Figure 52 and Table A.35B). Adults who had moderate or severe symptoms were more likely than those with no or minimal symptoms to have engaged in binge alcohol use in the past month (25.5 vs. 20.0 percent). In addition, adults with moderate or severe symptoms were more likely than those with no or minimal symptoms to have used nicotine products in the past month (37.4 vs. 21.4 percent). Adults with moderate or severe symptoms also were more likely than those with no or minimal symptoms of anxiety in the past 2 weeks to have used most of the other substances in the past year or past month that are shown in Table A.35B. For example, 5.0 percent of adults (or 875,000 people) with moderate or severe symptoms of anxiety misused prescription tranquilizers or sedatives in the past year, compared with 1.0 percent of adults (or 2.0 million people) with no or minimal symptoms.

Major Depressive Episode in the Past Year

NSDUH respondents were classified as having had a major depressive episode (MDE) in the past 12 months if (1) they had at least one period of 2 weeks or longer in the past year when, for most of the day nearly every day, they felt depressed or lost interest or pleasure in daily activities; and (2) they also had problems with sleeping, eating, energy, concentration, self‐worth, or having recurrent thoughts of death or recurrent suicidal ideation. The MDE questions are based on diagnostic criteria from the DSM‑5, which requires the presence of five or more symptoms during the same 2‐week period.⁴⁸ The wording for some depression questions asked of adolescent respondents aged 12 to 17 differed from the wording for similar questions asked of adult respondents aged 18 or older. Therefore, the MDE estimates for adolescents and adults are not directly comparable and are presented separately.^14,57,58

NSDUH also collected data on whether an MDE in the past year caused respondents to experience severe impairment in four major life activities or role domains. These domains were defined separately for adolescents aged 12 to 17 and adults aged 18 or older to reflect the different roles associated with the two age groups. Adolescents were classified as having an MDE with severe impairment if their depression caused severe problems with their ability to (1) do chores at home, (2) do well at work or school, (3) get along with their family, or (4) have a social life. Adults aged 18 or older were classified as having an MDE with severe impairment if their depression caused severe problems with their ability to (1) manage tasks at home, (2) manage tasks at work, (3) have relationships with others, or (4) have a social life.

Web‐based interviewing affected the number of adult respondents aged 18 or older in 2025 who provided usable information on their substance use⁵⁹ but did not complete the mental health or later questions (i.e., “break‐offs”). To reduce the potential for bias, missing data for measures of MDE and MDE with severe impairment among adults aged 18 or older were statistically imputed for 2021 to 2025.⁶⁰

MDE and MDE with Severe Impairment among Adolescents

Among adolescents aged 12 to 17 in 2025, 15.1 percent (or 3.7 million people) had a past year MDE (Figure 53 and Table A.36B). An estimated 11.0 percent of adolescents in 2025 (or 2.7 million people) had a past year MDE with severe impairment. Among adolescents who had a past year MDE, about three fourths (73.8 percent) had an MDE with severe impairment.

Among adolescents aged 12 to 17, the percentage who had a past year MDE decreased from 20.8 percent (or 5.2 million people) in 2021 to 15.1 percent (or 3.7 million people) in 2025 (Figure 54 and Table A.36B). Similarly, the percentage of adolescents who had a past year MDE with severe impairment decreased from 15.2 percent (or 3.8 million people) in 2021 to 11.0 percent (or 2.7 million people) in 2025.

Figure 54 Table. Major Depressive Episode (MDE) or MDE with Severe Impairment in the Past Year: Among Adolescents Aged 12 to 17; Percentages, 2021‑2025

MDE	2021	2022	2023	2024	2025	Trend
MDE	20.8	19.5	18.1	15.4	15.1	Decreased
MDE with Severe Impairment	15.2	14.6	13.5	11.3	11.0	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

Co‑Occurring MDE and SUD among Adolescents

NSDUH provides information on whether adolescents aged 12 to 17 had both a past year MDE and a past year substance use disorder (SUD) (i.e., drug use disorder, alcohol use disorder, or both). However, NSDUH does not capture information to measure whether criteria for an MDE and an SUD were met at the same point in time during the past 12 months. Among adolescents aged 12 to 17 in 2025, 20.1 percent (or 5.0 million people) had either an MDE or an SUD in the past year (Figure 55 and Table A.37AB). Among the 1.9 million adolescents who had an SUD in the past year, about one third (604,000 people) also had a past year MDE. Among the 3.7 million adolescents who had a past year MDE, however, most (3.1 million people) did not have an SUD because most adolescents did not use alcohol or drugs in the past year and therefore did not have an SUD.

Among adolescents aged 12 to 17, the percentage who had an MDE and SUD in the past year decreased from 4.1 percent (or 1.0 million people) in 2021 to 2.5 percent (or 604,000 people) in 2025 (Figure 56 and Table A.38B). The percentage of adolescents who had an MDE with severe impairment and an SUD in the past year also decreased from 3.1 percent (or 781,000 people) in 2021 to 1.9 percent of adolescents (or 467,000 people) in 2025.

Figure 56 Table. Co‑Occurring Past Year Major Depressive Episode (MDE) and Substance Use Disorder (SUD) or Co‑Occurring Past Year MDE with Severe Impairment and SUD: Among Adolescents Aged 12 to 17; Percentages, 2021‑2025

MDE and SUD	2021	2022	2023	2024	2025	Trend
Co‑Occurring MDE and SUD	4.1	3.7	3.4	3.2	2.5	Decreased
Co‑Occurring MDE with Severe Impairment and SUD	3.1	3.0	2.9	2.5	1.9	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

Substance Use among Adolescents with an MDE

In 2025, adolescents aged 12 to 17 who had a past year MDE were more likely to have used some substances in the past year or past month compared with their counterparts who did not have an MDE in the past year. Adolescents with a past year MDE were more likely than adolescents without a past year MDE to have used illicit drugs in the past year (21.7 vs. 9.1 percent), used marijuana in the past year (17.5 vs. 7.0 percent), or misused opioids (i.e., used heroin or misused prescription opioids) in the past year (2.7 vs. 1.2 percent) (Figure 57 and Table A.39B). Adolescents with a past year MDE also were more likely than those without a past year MDE to have engaged in binge alcohol use in the past month (4.8 vs. 2.6 percent) or to have used nicotine products in the past month (13.0 vs. 5.7 percent). In addition, adolescents with a past year MDE were more likely than those without a past year MDE to have used most of the other substances in the past year or past month that are shown in Table A.39B.

MDE and MDE with Severe Impairment among Adults

Among adults aged 18 or older, the percentage who had a past year MDE decreased from 8.5 percent (or 21.6 million people) in 2021 to 7.4 percent (or 19.7 million people) in 2025 (Figure 58 and Table A.40B). In addition, among young adults aged 18 to 25, the percentage who had a past year MDE decreased from 19.3 percent (or 6.4 million people) in 2021 to 14.2 percent (or 5.1 million people) in 2025. Among adults aged 26 to 49 and adults aged 50 or older, however, the percentages who had a past year MDE showed no change from 2021 to 2025. In 2025, the percentage of adults aged 18 or older who had a past year MDE was highest among young adults aged 18 to 25 (14.2 percent or 5.1 million people), followed by adults aged 26 to 49 (9.1 percent or 9.6 million people), then by adults aged 50 or older (4.0 percent or 4.9 million people).

Figure 58 Table. Major Depressive Episode (MDE) in the Past Year: Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	8.5	8.8	8.5	8.2	7.4	Decreased
18 to 25	19.3	20.1	17.5	15.9	14.2	Decreased
26 to 49	9.6	9.7	10.2	10.0	9.1	No Change
50 or Older	4.5	4.6	4.5	4.4	4.0	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

The percentage of adults aged 18 or older who had a past year MDE with severe impairment also decreased from 5.9 percent (or 14.9 million people) in 2021 to 5.2 percent (or 13.8 million people) in 2025 (Figure 59 and Table A.40B). Among young adults aged 18 to 25 and adults aged 50 or older, the percentages who had a past year MDE with severe impairment also decreased from 2021 to 2025. For example, the percentage of young adults who had a past year MDE with severe impairment decreased from 13.8 percent (or 4.6 million people) in 2021 to 10.2 percent (or 3.7 million people) in 2025. Among adults aged 26 to 49, the percentages who had a past year MDE with severe impairment showed no change from 2021 to 2025.

Figure 59 Table. Major Depressive Episode (MDE) with Severe Impairment in the Past Year: Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	5.9	6.2	5.9	5.6	5.2	Decreased
18 to 25	13.8	14.7	12.9	11.5	10.2	Decreased
26 to 49	6.6	6.9	7.4	7.0	6.7	No Change
50 or Older	3.0	3.1	2.7	2.6	2.5	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of adults aged 18 or older who had a past year MDE with severe impairment was highest among young adults aged 18 to 25 (10.2 percent or 3.7 million people), followed by adults aged 26 to 49 (6.7 percent or 7.0 million people), then by adults aged 50 or older (2.5 percent or 3.1 million people) (Figure 59 and Table A.40B).

Co‑Occurring MDE and SUD among Adults

NSDUH provides information on whether adults aged 18 or older had both a past year MDE and a past year SUD (i.e., drug use disorder, alcohol use disorder, or both). However, NSDUH does not capture information to measure whether criteria for an MDE and an SUD were met at the same point in time during the past 12 months. Among adults aged 18 or older in 2025, 20.8 percent (or 55.1 million people) had either an MDE or an SUD in the past year, including 2.8 percent (or 7.3 million people) who had an MDE and an SUD in the past year (Figure 60 and Tables A.41A and A.41B). The percentage of adults aged 18 or older who had either an MDE or an SUD in the past year was highest among young adults aged 18 to 25 (32.2 percent or 11.6 million people), followed by adults aged 26 to 49 (25.7 percent or 27.1 million people), then by adults aged 50 or older (13.2 percent or 16.3 million people).

Among the 42.7 million adults aged 18 or older in 2025 who had an SUD in the past year (Figure 60), most (35.4 million people) did not have a past year MDE (Table A.41A). Likewise, among the 19.7 million adults who had a past year MDE, most (12.4 million people) did not have a past year SUD.

Among adults aged 18 or older, the percentage who had an MDE and an SUD in the past year decreased from 3.2 percent (or 8.2 million people) in 2021 to 2.8 percent (or 7.3 million people) in 2025 (Figure 61 and Table A.42B). The percentage of young adults aged 18 to 25 who had an MDE and an SUD in the past year also decreased from 7.5 percent (or 2.5 million people) in 2021 to 5.7 percent (or 2.1 million people) in 2025. The percentages of adults aged 26 to 49 or aged 50 or older who had an MDE and an SUD in the past year showed no change from 2021 to 2025.

Figure 61 Table. Co‑Occurring Past Year Major Depressive Episode (MDE) and Substance Use Disorder (SUD): Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	3.2	3.6	3.4	3.4	2.8	Decreased
18 to 25	7.5	8.9	7.9	7.2	5.7	Decreased
26 to 49	4.1	4.2	4.4	4.4	3.7	No Change
50 or Older	1.3	1.7	1.4	1.4	1.1	No Change
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of adults aged 18 or older who had an MDE and an SUD in the past year was highest among young adults aged 18 to 25 (5.7 percent or 2.1 million people), followed by adults aged 26 to 49 (3.7 percent or 3.9 million people), then by adults aged 50 or older (1.1 percent or 1.3 million people) (Figure 61 and Table A.42B).

The percentage of adults who had an MDE with severe impairment and an SUD in the past year decreased from 2.5 percent (or 6.4 million people) in 2021 to 2.1 percent (or 5.5 million people) in 2025. The percentage of adults who had an MDE with severe impairment and an SUD in the past year also decreased from 2021 to 2025 for young adults aged 18 to 25 and adults aged 50 or older. For example, the percentage of young adults aged 18 to 25 who had an MDE and an SUD in the past year decreased from 5.7 percent (or 1.9 million people) in 2021 to 4.4 percent (or 1.6 million people) in 2025. Among adults aged 26 to 49, the percentages showed no change from 2021 to 2025 (Table A.42B).

In 2025, the percentage of adults in 2025 who had an MDE with severe impairment and an SUD in the past year was highest among young adults aged 18 to 25 (4.4 percent or 1.6 million people), followed by adults aged 26 to 49 (2.9 percent or 3.0 million people), then by adults aged 50 or older (0.7 percent or 891,000 people) (Table A.42B).

Substance Use among Adults with an MDE

In 2025, adults aged 18 or older who had a past year MDE were more likely to have used some substances in the past year or past month compared with their counterparts who did not have an MDE in the past year. Adults with a past year MDE were more likely than adults without a past year MDE to have used illicit drugs in the past year (49.6 vs. 23.3 percent), used marijuana in the past year (43.8 vs. 20.7 percent), or misused opioids (i.e., used heroin or misused prescription opioids) in the past year (6.1 vs. 2.2 percent) (Figure 62 and Table A.43B). Adults with a past year MDE also were more likely than those without a past year MDE to have engaged in binge alcohol use in the past month (25.9 vs. 20.7 percent). In addition, adults with a past year MDE were more likely than those without a past year MDE to have used nicotine products in the past month (33.0 vs. 22.8 percent). Adults with a past year MDE also were more likely than those without a past year MDE to have used most of the other substances in the past year or past month that are shown in Table A.43B.

Any or Serious Mental Illness among Adults in the Past Year

NSDUH provides estimates of any mental illness (AMI) and serious mental illness (SMI) for adults aged 18 or older. Beginning with the 2025 NSDUH, adults aged 18 or older were classified as having AMI if they had any mental, behavioral, or emotional disorder in the past year of sufficient duration to meet criteria from the DSM‑5, excluding developmental disorders and SUDs.⁶¹ The Mental Illness Calibration Study (MICS) was conducted as part of the 2023 and 2024 NSDUHs and included clinical interviews to assess whether adult respondents met clinical criteria for specific mental disorders based on DSM‑5 criteria. The MICS was used to develop model‐based estimates to predict whether adults in 2021 to 2025 had AMI or SMI according to DSM‑5 criteria. Consequently, estimates of AMI and SMI in 2021 to 2024 that are presented in this report may differ from previously published estimates, which were developed using the previous Mental Health Surveillance Study in 2007 to 2012 based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM‑IV).^62,63

Adults aged 18 or older who were classified as having AMI were further classified as having SMI if they had any mental, behavioral, or emotional disorder that substantially interfered with or limited one or more major life activities.⁶⁴ Statistical prediction models that were developed using the MICS clinical interview data from a subset of NSDUH adult respondents aged 18 or older in 2023 and 2024 were used to classify whether respondents in the adult samples for 2021 to 2025 had AMI or SMI in the past year. Source variables were statistically imputed for the prediction models used to estimate AMI or SMI.⁶⁵

Any Mental Illness among Adults

Among adults aged 18 or older, the percentage who had AMI in the past year showed no change from 2021 to 2025 (Figure 63 and Table A.44B). In 2025, 20.6 percent of adults aged 18 or older (or 54.6 million people) had AMI in the past year. Percentages of adults aged 26 to 49 or 50 or older who had AMI in the past year also showed no change from 2021 to 2025. The percentage of young adults aged 18 to 25 who had AMI in the past year decreased from 33.2 percent (or 11.1 million people) in 2021 to 28.6 percent (or 10.3 million people) in 2025.

Figure 63 Table. Any Mental Illness (AMI) in the Past Year: Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	21.0	21.3	20.9	21.5	20.6	No Change
18 to 25	33.2	35.2	32.7	31.9	28.6	Decreased
26 to 49	26.2	27.1	27.0	27.7	27.1	No Change
50 or Older	13.1	12.3	12.3	13.2	12.8	No Change
Note: Some 2021‑2024 estimates may differ from previously published estimates due to updates that were made to the mental illness model beginning in 2025.

In 2025, the percentage of adults aged 18 or older who had AMI in the past year was highest among young adults aged 18 to 25 (28.6 percent or 10.3 million people), followed by adults aged 26 to 49 (27.1 percent or 28.5 million people), then by adults aged 50 or older (12.8 percent or 15.8 million people) (Figure 63 and Table A.44B).

Serious Mental Illness among Adults

Among adults aged 18 or older, the percentage who had SMI in the past year decreased from 7.9 percent (or 20.1 million people) in 2021 to 6.9 percent (or 18.2 million people) in 2025 (Figure 64 and Table A.44B). Among young adults aged 18 to 25, the percentage who had SMI in the past year also decreased from 16.8 percent (or 5.6 million people) in 2021 to 12.1 percent (or 4.4 million people) in 2025. Among adults aged 26 to 49 and adults aged 50 or older, however, the percentages who had SMI in the past year showed no change from 2021 to 2025.

Figure 64 Table. Serious Mental Illness (SMI) in the Past Year: Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	7.9	8.4	7.9	7.8	6.9	Decreased
18 to 25	16.8	17.6	15.3	14.1	12.1	Decreased
26 to 49	10.0	10.3	10.6	10.3	9.6	No Change
50 or Older	3.5	4.1	3.5	3.8	3.0	No Change
Note: Some 2021‑2024 estimates may differ from previously published estimates due to updates that were made to the mental illness model beginning in 2025.

In 2025, the percentage of adults aged 18 or older who had SMI in the past year was highest among young adults aged 18 to 25 (12.1 percent or 4.4 million people), followed by adults aged 26 to 49 (9.6 percent or 10.1 million people), then by adults aged 50 or older (3.0 percent or 3.7 million people) (Figure 64 and Table A.44B).

Co‑Occurring Mental Illness and SUD among Adults

NSDUH provides information on whether adults aged 18 or older who had an SUD in the past year could also be classified as having AMI or SMI in the past year. However, statistical prediction models for classifying whether adult respondents had AMI or SMI in the past year cannot establish whether adults met criteria for AMI or SMI and an SUD at the same point in time during the past 12 months.

Co‑Occurring AMI and SUD

Among adults aged 18 or older in 2025, 29.8 percent (or 78.9 million people) had either AMI or an SUD in the past year (Figure 65 and Tables A.45A and A.45B). Among the 42.7 million adults who had an SUD in the past year, about two fifths also had AMI (18.5 million people) in the past year. The 18.5 million adults who had AMI and an SUD in the past year also represent about one third of the 54.6 million adults who had AMI.

In 2025, the percentage of adults aged 18 or older who had AMI or an SUD in the past year was highest among young adults aged 18 to 25 (41.2 percent or 14.9 million people), followed by adults aged 26 to 49 (37.4 percent or 39.4 million people), then by adults aged 50 or older (19.9 percent or 24.6 million people) (Tables A.45A and A.45B).

Among adults aged 18 or older, the percentage who had AMI and an SUD in the past year showed no change from 2021 to 2025 (Figure 66 and Table A.46B). In 2025, 7.0 percent of adults (or 18.5 million people) had AMI and an SUD in the past year. Percentages of adults aged 26 to 49 and 50 or older who had AMI and an SUD in the past year also showed no change from 2021 to 2025. Among young adults aged 18 to 25, however, the percentage who had AMI and an SUD in the past year decreased from 13.3 percent (or 4.4 million people) in 2021 to 11.1 percent (or 4.0 million people) in 2025.

Figure 66 Table. Co‑Occurring Past Year Any Mental Illness (AMI) and Substance Use Disorder (SUD): Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	7.4	8.0	7.6	7.7	7.0	No Change
18 to 25	13.3	14.7	13.7	13.0	11.1	Decreased
26 to 49	10.0	10.8	10.4	10.9	10.0	No Change
50 or Older	3.5	3.6	3.4	3.3	3.2	No Change
Note: Some 2021‑2024 estimates may differ from previously published estimates due to updates that were made to the mental illness model beginning in 2025.

The percentage of adults aged 18 or older in 2025 who had AMI and an SUD in the past year was highest among young adults aged 18 to 25 (11.1 percent or 4.0 million people), followed by adults aged 26 to 49 (10.0 percent or 10.5 million people), then by adults aged 50 or older (3.2 percent or 3.9 million people) (Figure 66 and Table A.46B).

Co‑Occurring SMI and SUD

Among adults aged 18 or older in 2025, 20.0 percent (or 53.1 million people) had either SMI or an SUD in the past year (Figure 67 and Tables A.45A and A.45B). Among the 18.2 million adults who had SMI, about two fifths (7.8 million people) also had an SUD. Among the 42.7 million adults who had an SUD in the past year, however, most (34.9 million people) did not have SMI.

In 2025, the percentage of adults aged 18 or older who had either SMI or an SUD in the past year was highest among young adults aged 18 to 25 (30.5 percent or 11.0 million people), followed by adults aged 26 to 49 (25.6 percent or 26.9 million people), then by adults aged 50 or older (12.3 percent or 15.2 million people) (Tables A.45A and A.45B).

Among adults aged 18 or older, the percentage who had SMI and an SUD in the past year decreased from 3.5 percent (or 8.8 million people) in 2021 to 2.9 percent (or 7.8 million people) in 2025 (Figure 68 and Table A.46B). Among young adults aged 18 to 25, the percentage who had SMI and an SUD in the past year also decreased from 7.6 percent (or 2.5 million people) in 2021 to 5.4 percent (or 2.0 million people) in 2025. However, among adults aged 26 to 49 and adults aged 50 or older, the percentages who had SMI and an SUD in the past year showed no change from 2021 to 2025.

Figure 68 Table. Co‑Occurring Past Year Serious Mental Illness (SMI) and Substance Use Disorder (SUD): Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	3.5	3.8	3.6	3.5	2.9	Decreased
18 to 25	7.6	8.5	7.6	6.9	5.4	Decreased
26 to 49	4.6	4.8	5.0	5.0	4.4	No Change
50 or Older	1.3	1.7	1.2	1.3	1.0	No Change
Note: Some 2021‑2024 estimates may differ from previously published estimates due to updates that were made to the mental illness model beginning in 2025.

In 2025, the percentage of adults aged 18 or older who had SMI and an SUD in the past year was highest among young adults aged 18 to 25 (5.4 percent or 2.0 million people), followed by adults aged 26 to 49 (4.4 percent or 4.6 million people), then by adults aged 50 or older (1.0 percent or 1.2 million people) (Figure 68 and Table A.46B).

Substance Use among Adults, by Mental Illness Status

This section discusses how the prevalence of substance use among adults aged 18 or older differed based on past year mental illness status. In 2025, about one fourth of adults aged 18 or older (25.3 percent or 66.9 million people) used illicit drugs in the past year (Table A.47B). Among adults aged 18 or older in 2025, those with SMI or AMI in the past year were more likely than those without mental illness in the past year to have used illicit drugs in the past year (53.0 percent for SMI and 43.3 percent for AMI vs. 20.6 percent for adults with no mental illness), used marijuana in the past year (46.8 and 38.7 percent vs. 18.2 percent), or misused opioids (i.e., used heroin or misused prescription opioids) in the past year (7.3 and 5.2 percent vs. 1.8 percent) (Figure 69).

In addition, adults aged 18 or older in 2025 with SMI or AMI in the past year were more likely than adults aged 18 or older with no mental illness in the past year to have engaged in binge alcohol use in the past month (26.6 and 25.3 percent vs. 20.0 percent) (Figure 69 and Table A.47B). Adults with SMI or AMI in the past year were more likely to have used nicotine products in the past month than adults with no mental illness in the past year (37.5 and 33.0 percent vs. 21.1 percent). Adults with SMI or AMI in the past year also were more likely than those without mental illness in the past year to have used the other substances in the past year or past month that are shown in Table A.47B.

Suicidal Thoughts and Behaviors among Adults

Suicide is a leading cause of death and an important public health problem in the United States.^66,67 Data from the National Vital Statistics System (NVSS) indicated that in 2024, 48,824 people in the United States died by suicide. This number was slightly lower than the 49,316 deaths by suicide in 2023, but it was greater than the numbers in 2018 to 2021.⁶⁸

In the United States, one person dies by suicide every 11 minutes.⁶⁹ In 2024, suicide replaced coronavirus disease 2019 (COVID‑19) as the 10th leading cause of death among people of all ages in the United States, moving from the 11th leading cause of death in 2023. Suicide was the second leading cause of death in 2024 among people aged 10 to 34 and was among the top five leading causes of death among people aged 35 to 54.⁶⁷ However, people who die by suicide represent a fraction of those who consider or attempt suicide. In 2023, for example, nearly 47,700 adults aged 18 or older died by suicide, compared with 1.5 million adults in the civilian, noninstitutionalized population who were estimated to have made a nonfatal suicide attempt,⁷⁰ or about 31 nonfatal suicide attempts for every death by suicide among adults.⁷¹ Moreover, 1 in 5 people who make a nonfatal suicide attempt will make a future attempt.⁷²

NSDUH respondents aged 18 or older were asked if at any time during the past 12 months they had thought seriously about trying to kill themselves (serious thoughts of suicide). Adults aged 18 or older also were asked whether they made a plan to kill themselves (suicide plan) or tried to kill themselves (suicide attempt) in the past 12 months, regardless of whether they had serious thoughts of suicide in that period.

In 2025, 13.9 million adults aged 18 or older (5.3 percent) had serious thoughts of suicide in the past year, 4.9 million (1.8 percent) made a suicide plan, and 2.3 million (0.9 percent) attempted suicide (Figure 70 and Table A.48AB). An estimated 1.9 million adults (0.7 percent) had serious thoughts of suicide, made a suicide plan, and attempted suicide in the past year. Additional highlights from Figure 70 include the following:

• Among the 13.9 million adults aged 18 or older who had serious thoughts of suicide in the past year, most (9.4 million adults) had serious thoughts of suicide only.
• Among the 4.9 million adults aged 18 or older who made a suicide plan in the past year, about two fifths attempted suicide (i.e., 1.9 million adults had serious thoughts of suicide, made a suicide plan, and attempted suicide, in addition to 88,000 adults who made a suicide plan and attempted suicide but did not have serious thoughts of suicide).
• Attempting suicide without first having serious thoughts of suicide or making a suicide plan was relatively uncommon but was estimated to have occurred (i.e., 139,000 adults).

Serious Thoughts of Suicide among Adults

Among adults aged 18 or older, the percentage who had serious thoughts of suicide in the past year showed no change from 2021 to 2025 (Figure 71 and Table A.49B). In 2025, 5.3 percent of adults aged 18 or older (or 13.9 million people) had serious thoughts of suicide in the past year. Among young adults aged 18 to 25, the percentage who had serious thoughts of suicide in the past year decreased from 13.4 percent (or 4.5 million people) in 2021 to 10.8 percent (or 3.9 million people) in 2025. However, the percentages of adults who had serious thoughts of suicide in the past year increased from 5.5 percent (or 5.6 million people) in 2021 to 6.2 percent (or 6.5 million people) in 2025 among adults aged 26 to 49 and from 2.0 percent (or 2.4 million people) in 2021 to 2.9 percent (or 3.5 million people) in 2025 among adults aged 50 or older.

Figure 71 Table. Had Serious Thoughts of Suicide in the Past Year: Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	4.9	5.2	5.0	5.5	5.3	No Change
18 to 25	13.4	13.6	12.2	12.6	10.8	Decreased
26 to 49	5.5	5.5	5.9	6.1	6.2	Increased
50 or Older	2.0	2.4	2.1	2.9	2.9	Increased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of adults aged 18 or older who had serious thoughts of suicide in the past year was highest among young adults aged 18 to 25 (10.8 percent or 3.9 million people), followed by adults aged 26 to 49 (6.2 percent or 6.5 million people), then by adults aged 50 or older (2.9 percent or 3.5 million people) (Figure 71 and Table A.49B).

Suicide Plans among Adults

Among adults aged 18 or older, the percentage who had made any suicide plans in the past year increased from 1.4 percent (or 3.6 million people) in 2021 to 1.8 percent (or 4.9 million people) in 2025 (Figure 72 and Table A.49B). Percentages also increased from 2021 to 2025 among adults aged 26 to 49 and adults aged 50 or older. For example, the percentage of adults aged 50 or older who made a suicide plan in the past year increased from 0.3 percent (or 405,000 people) in 2021 to 1.1 percent (or 1.3 million people) in 2025. Among young adults aged 18 to 25, the percentage who made a suicide plan in the past year decreased from 5.2 percent (or 1.7 million people) in 2021 to 4.0 percent (or 1.4 million people) in 2025.

Figure 72 Table. Made a Suicide Plan in the Past Year: Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	1.4	1.5	1.4	1.8	1.8	Increased
18 to 25	5.2	4.9	4.2	4.2	4.0	Decreased
26 to 49	1.4	1.3	1.6	1.8	2.0	Increased
50 or Older	0.3	0.6	0.5	1.1	1.1	Increased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of adults aged 18 or older who made a suicide plan in the past year was highest among young adults aged 18 to 25 (4.0 percent or 1.4 million people), followed by adults aged 26 to 49 (2.0 percent or 2.1 million people), then by adults aged 50 or older (1.1 percent or 1.3 million people) (Figure 72 and Table A.49B).

Suicide Attempts among Adults

Among adults aged 18 or older, the percentage who attempted suicide in the past year increased from 0.7 percent (or 1.8 million people) in 2021 to 0.9 percent (or 2.3 million people) in 2025 (Figure 73 and Table A.49B). Among adults aged 26 to 49 and adults aged 50 or older, the percentages who attempted suicide in the past year also increased from 2021 to 2025. Among adults aged 50 or older, for example, the percentage who attempted suicide in the past year increased from 0.2 percent (or 188,000 people) in 2021 to 0.5 percent (or 656,000 people) in 2025. Among young adults aged 18 to 25, the percentage who attempted suicide in the past year decreased from 2.8 percent (or 947,000 people) in 2021 to 1.9 percent (or 672,000 people) in 2025.

Figure 73 Table. Attempted Suicide in the Past Year: Among Adults Aged 18 or Older; Percentages, 2021‑2025

Age Group	2021	2022	2023	2024	2025	Trend
18 or Older	0.7	0.6	0.6	0.8	0.9	Increased
18 to 25	2.8	2.1	2.0	2.0	1.9	Decreased
26 to 49	0.7	0.5	0.6	0.8	0.9	Increased
50 or Older	0.2	0.3	0.2	0.6	0.5	Increased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

In 2025, the percentage of adults aged 18 or older who attempted suicide in the past year was highest among young adults aged 18 to 25 (1.9 percent or 672,000 people), followed by adults aged 26 to 49 (0.9 percent or 956,000 people), then by adults aged 50 or older (0.5 percent or 656,000 people) (Figure 73 and Table A.49B).

Suicidal Thoughts and Behaviors among Adolescents

Trends in suicidal thoughts and behaviors have been increasing among adolescents^73,74,75,76 and remain a major public health concern in the United States.⁷⁷ In 2024, suicide was the second leading cause of death among adolescents aged 10 to 14.⁶⁷ In addition, 1 in 5 high school students in 2023 seriously considered attempting suicide, 1 in 6 made a suicide plan, and nearly 1 in 10 attempted suicide in the past year.⁷⁶ Generally speaking, adolescent populations exposed to adverse childhood experiences (ACEs) are at particular risk of suicide and related behaviors.^78,79

Questions were included in the 2021 to 2025 NSDUHs to better understand suicidal thoughts and behaviors among adolescents aged 12 to 17. Adolescent respondents were asked if they seriously thought about trying to kill themselves, if they made plans to kill themselves, and if they had tried to kill themselves in the past 12 months. Unlike the questions for adults, the questions for adolescent respondents included the response options “I’m not sure” and “I don’t want to answer.”

In 2025, 2.6 million adolescents aged 12 to 17 (10.3 percent) had serious thoughts of suicide in the past year, 1.3 million (5.1 percent) made a suicide plan, and 738,000 (2.9 percent) attempted suicide (Figure 74 and Table A.50AB). An estimated 622,000 adolescents (2.4 percent) had serious thoughts of suicide, made a suicide plan, and attempted suicide in the past year. Additional highlights from Figure 74 include the following:

• Nearly half of the 2.6 million adolescents aged 12 to 17 who had serious thoughts of suicide in the past year also made a suicide plan or attempted suicide, or both.
• Among the 1.3 million adolescents aged 12 to 17 who made a suicide plan, 656,000 adolescents did not attempt suicide (543,000 made a suicide plan and had serious thoughts of suicide but did not attempt suicide, and 113,000 made a suicide plan only). An estimated 633,000 adolescents who made a suicide plan also attempted suicide (622,000 made a suicide plan, had serious thoughts of suicide, and attempted suicide, and 11,000 made a suicide plan and attempted suicide but did not have serious thoughts of suicide).
• Attempting suicide without first having serious thoughts of suicide or making a suicide plan was relatively uncommon among adolescents aged 12 to 17 but was estimated to have occurred (i.e., 24,000 adolescents).

Serious Thoughts of Suicide among Adolescents

Among adolescents aged 12 to 17 in 2025, 10.4 percent (or 2.6 million people) had serious thoughts of suicide in the past year (Figures 74 and 75 and Table A.51B). However, 7.2 percent of adolescents in 2025 (or 1.8 million people) were unsure or did not know whether they had serious thoughts of suicide, and 6.6 percent (or 1.7 million people) did not want to report whether they had these thoughts. These response options in 2025 correspond to approximately 13.8 percent of adolescents overall (or 3.5 million people). Therefore, estimates of adolescents who had serious thoughts of suicide in the past year are likely to be conservative. This information suggests that some adolescents could have had these thoughts but did not feel comfortable disclosing that information.

Among adolescents aged 12 to 17, the percentage who had serious thoughts of suicide in the past year decreased from 12.9 percent (or 3.4 million people) in 2021 to 10.4 percent (or 2.6 million people) in 2025 (Figure 76 and Table A.52B).

Figure 76 Table. Had Serious Thoughts of Suicide, Made a Suicide Plan, or Attempted Suicide in the Past Year: Among Adolescents Aged 12 to 17; Percentages, 2021‑2025

Suicidal Thoughts or Behaviors	2021	2022	2023	2024	2025	Trend
Had Serious Thoughts of Suicide	12.9	13.4	12.3	10.1	10.4	Decreased
Made a Suicide Plan	6.2	6.5	5.6	4.6	5.1	Decreased
Attempted Suicide	3.6	3.7	3.3	2.7	2.9	Decreased
Note: Estimates for 2021 may differ from previously published estimates because the 2021 analysis weights were updated to facilitate between‐year comparisons.

Suicide Plans among Adolescents

In 2025, 5.1 percent of adolescents aged 12 to 17 (or 1.3 million people) made a suicide plan in the past year (Figures 74 and 76 and Table A.51B). Adolescent respondents who reported that they were not sure or did not know whether they made a suicide plan corresponded to a population estimate of 3.0 percent (or 762,000 people). Adolescent respondents who did not want to report whether they made a suicide plan corresponded to a population estimate of 5.6 percent (or 1.4 million people). Therefore, estimates of adolescents who made a suicide plan in the past year are likely to be conservative.

Among adolescents aged 12 to 17, the percentage who had made a suicide plan in the past year decreased from 6.2 percent (or 1.6 million people) in 2021 to 5.1 percent (or 1.3 million people) in 2025 (Figure 76 and Table A.52B).

Suicide Attempts among Adolescents

In 2025, 2.9 percent of adolescents aged 12 to 17 (or 738,000 people) attempted suicide in the past year (Figures 74 and 76 and Table A.51B). Adolescent respondents who reported that they were not sure or did not know whether they attempted suicide corresponded to a population estimate of 1.8 percent (or 463,000 people). Adolescent respondents who did not want to report whether they attempted suicide corresponded to a population estimate of 5.0 percent (or 1.3 million people). Therefore, estimates of adolescents who attempted suicide in the past year are likely to be conservative.

Among adolescents aged 12 to 17, the percentage who attempted suicide in the past year decreased from 3.6 percent (or 940,000 people) in 2021 to 2.9 percent (or 738,000 people) in 2025 (Figure 76 and Table A.52B).

Nonsuicidal Self‐Harm among Adolescents

Nonsuicidal self‐harm, also referred to as nonsuicidal self‐injury, describes deliberate, self‐inflicted damage to one’s body tissue without suicidal intent, most commonly through behaviors such as cutting, scratching, burning, or hitting oneself.⁸⁰ Lifetime prevalence estimates range from 10 to 23 percent, with onset typically occurring between the ages of 12 and 14. Nonsuicidal self‐harm is an important risk factor for suicidal behavior, with previous longitudinal research indicating that it predicts concurrent and future suicide attempts. Moreover, more than half of adolescents who engaged in these behaviors had a history of suicide attempts. These behaviors occur across demographic groups and are more commonly reported among adolescents than adults.⁸⁰

Beginning in 2025, NSDUH added an item to assess nonsuicidal self‐harm among adolescents aged 12 to 17. Respondents were asked whether, during the past 12 months, they intentionally harmed themselves without trying to kill themselves, such as by cutting, burning, or bruising themselves. In addition to the standard “Yes” and “No” response options, adolescents could select “I’m not sure” or “I don’t want to answer” when answering the question.

In 2025, 11.2 percent of adolescents aged 12 to 17 (or 2.8 million people) engaged in nonsuicidal self‐harm in the past year (Table A.53B). However, 2.9 percent of adolescents in 2025 (or 735,000 people) were unsure or did not know whether they had intentionally harmed themselves without trying to kill themselves, and 5.6 percent (or 1.4 million people) did not want to report whether they had engaged in these behaviors. These response options in 2025 correspond to approximately 8.5 percent of adolescents overall (or 2.2 million people). Therefore, these 2025 estimates of adolescents who engaged in nonsuicidal self‐harm in the past year are likely to be conservative.

Substance Use Treatment in the Past Year

Substance use treatment is intended to help people address problems associated with their use of alcohol or drugs, including medical problems associated with the use of alcohol or drugs.⁸¹ NSDUH provides two principal measures related to substance use treatment in the past year: (a) the need for substance use treatment and (b) the receipt of substance use treatment. The survey also collected information on the types of settings where people received treatment and barriers associated with people needing substance use treatment but not receiving it.¹⁴

This report presents estimates for the receipt of substance use treatment only for 2025 because of changes to the questionnaire during the 2024 NSDUH for the receipt of substance use treatment in inpatient or outpatient locations.^82,83 Consequently, 4 years of comparable data are not available to assess trends in the receipt of substance use treatment.

People were classified as having received substance use treatment if they received treatment in the past year for the use of alcohol or drugs in an inpatient location;⁸⁴ in an outpatient location;⁸⁵ via telehealth; or in a prison, jail, or juvenile detention center. People also were classified as having received substance use treatment if they received prescription medication to reduce or stop their use of alcohol or to reduce or stop their use of heroin or prescription pain relievers. Respondents who used heroin or prescription pain relievers in their lifetime were shown a list of medications that are prescribed to treat opioid use disorder. For this reason, respondents who used prescription pain relievers but not heroin in their lifetime and who reported receiving prescription medications in the past year to reduce or stop their use of drugs were assumed to have received medication for the use of opioids.⁸⁶

Since 2022, NSDUH also has collected information on the receipt of other services, such as support services from a support group or from a peer support specialist or recovery coach, services in an emergency room or department, or withdrawal management services. A question about treatment with overdose reversal medicine such as Narcan^® or naloxone was added to the 2024 NSDUH questionnaire. These other services were not classified as “substance use treatment.”⁸⁷

Need for Substance Use Treatment

People were classified as needing substance use treatment in the past year if they had an SUD or if they received substance use treatment in the past year. As noted in the Substance Use Disorders in the Past Year section, NSDUH did not measure whether respondents met criteria for an SUD more than 12 months before the interview. Therefore, the definition of the need for substance use treatment took into account that people may not have met criteria for an SUD in the past year because they were receiving treatment.

Based on this definition, 16.3 percent of people aged 12 or older in 2025 (or 47.2 million people) needed substance use treatment in the past year (Figure 77 and Table A.54AB). The 47.2 million people who needed substance use treatment included 44.6 million people who had an SUD in the past year and 2.7 million people who did not have an SUD in the past year but who received substance use treatment in the past year.

In 2025, the percentage of people needing substance use treatment was highest among young adults aged 18 to 25 (24.3 percent or 8.8 million people), followed by adults aged 26 or older (15.9 percent or 36.4 million people), then by adolescents aged 12 to 17 (8.1 percent or 2.1 million people) (Figure 77 and Table A.54AB).

Receipt of Substance Use Treatment

NSDUH respondents in 2025 who used alcohol or drugs in their lifetime were asked substance use treatment questions. Most questions asked whether respondents received professional counseling, medication, or other treatment for their alcohol or drug use in specific locations in the 12 months prior to the survey interview (i.e., in the past year). Respondents also were asked if they received treatment in the past 12 months via telehealth or if they received prescription medication to reduce or stop their use of alcohol or drugs. Receipt of substance use treatment was defined previously. Note that locations or types of substance use treatment are not mutually exclusive. For example, people could have received substance use treatment in an outpatient setting and in an inpatient setting. As noted previously, the following “other services” were not classified as “substance use treatment”: support services from a support group or from a peer support specialist or recovery coach, services in an emergency room, withdrawal management services, or treatment with overdose reversal medicine.

Among people aged 12 or older in 2025, 2.6 percent (or 7.6 million people) received substance use treatment in the past year (Figure 78 and Table A.55AB). An estimated 4.4 million people aged 12 or older (or 1.5 percent) received outpatient substance use treatment. Of the 4.4 million people who received outpatient substance use treatment, most (4.1 million people or 92.2 percent)⁸⁸ received treatment in an outpatient setting other than a general medical clinic or doctor’s office. Additionally, 1.2 percent (or 3.6 million people) received treatment via telehealth. Smaller numbers of people received other treatment shown in Figure 78.

In 2025, the percentage of adults aged 26 or older who received substance use treatment in the past year (2.7 percent or 6.2 million people) was higher than the percentage among adolescents aged 12 to 17 (1.8 percent or 470,000 people) (Table A.54AB). An estimated 2.3 percent of young adults aged 18 to 25 (or 845,000 people) received substance use treatment in the past year.

Receipt of Substance Use Treatment among People Who Were Classified as Needing Substance Use Treatment in the Past Year

Among people aged 12 or older in 2025 who were classified as needing substance use treatment in the past year, about 1 in 6 (16.0 percent or 7.6 million people) received substance use treatment in the past year (Figure 79 and Table A.54AB). Among people in different age groups in 2025 who needed substance use treatment in the past year, young adults aged 18 to 25 (9.6 percent or 845,000 people) were least likely to have received substance use treatment in the past year, followed by adults aged 26 or older (17.1 percent or 6.2 million people), then by adolescents aged 12 to 17 (22.8 percent or 470,000 people).

An estimated 1.1 percent of people aged 12 or older in 2025 who did not have an SUD in the past year (or 2.7 million people) received substance use treatment in the past year (Table A.54AB). As noted previously, these people were classified as needing substance use treatment and included people who may have had an SUD in the past year had they not been receiving treatment.

Among the estimated 44.6 million people aged 12 or older in 2025 who had an SUD in the past year (Figure 39), 11.0 percent (or 4.9 million people) (Table A.54AB) received substance use treatment in the past year, and 89.0 percent (or 39.7 million people) did not receive substance use treatment in the past year.

Among people who needed substance use treatment because they had an SUD in the past year, the percentage who received treatment was lowest among people with a mild SUD (4.1 percent or 980,000 people), followed by people with a moderate SUD (9.7 percent or 1.0 million people), then by people with a severe SUD (28.9 percent or 2.9 million people) (Table A.54AB). Although the percentage who received substance use treatment was highest among people with a severe SUD, nearly three fourths of this group did not receive substance use treatment in the past year.

Medications for Alcohol Use Disorder or Opioid Use Disorder

Prescription medications are approved by the U.S. Food and Drug Administration for the treatment of alcohol use disorder or opioid use disorder. These medications are often used in combination with counseling and other behavioral therapies to provide a whole‐patient approach to the treatment of these disorders. This section uses the terms “medication for alcohol use disorder (MAUD)” and “medication for opioid use disorder (MOUD)” to discuss treatment with these medications. However, MAUD and MOUD do not include the use of medications that are prescribed to manage withdrawal symptoms or administered to stop a drug overdose. Also, NSDUH respondents may have met criteria for an alcohol use disorder or an opioid use disorder more than 12 months before the interview, but they were not classified as having a disorder in the past year because they were receiving MAUD or MOUD.

In 2025, NSDUH respondents aged 12 or older who reported lifetime alcohol use were asked to report whether they used medication in the past year that was prescribed to them to help reduce or stop their use of alcohol. Respondents also were informed that use of these medications for alcohol use differed from the use of medications to stop an overdose. Examples of medications shown to respondents that are prescribed as a part of MAUD included acamprosate (also known as Campral^®), disulfiram (also known as Antabuse^®), naltrexone pills (also known as ReVia^® or Trexan^®), and injectable naltrexone (also known as Vivitrol^®).

Questions on MOUD were asked of respondents aged 12 or older who reported ever using heroin or prescription pain relievers. These respondents were asked whether they used medication in the past year that was prescribed to them to help reduce or stop their drug use. Respondents also were informed that use of these medications for drug use differed from the use of medications to stop an overdose. Examples of medications shown to respondents that are prescribed as a part of MOUD included methadone, buprenorphine or buprenorphine‐naloxone pills or film taken by mouth (also known as Suboxone^®, Zubsolv^®, Bunavail^®, or Subutex^®), injectable buprenorphine (also known as Sublocade^®), buprenorphine implants (also known as Probuphine^®), naltrexone pills (also known as ReVia^® or Trexan^®), and injectable naltrexone (also known as Vivitrol^®). Because the drugs listed in the questionnaire are approved for treating opioid use disorder, respondents who used prescription pain relievers but not heroin in their lifetime and who reported receiving prescription medication in the past year to help reduce or stop their use of drugs were assumed to have received MOUD for their use of prescription opioids.

Medications for Alcohol Use Disorder

Among people aged 12 or older in 2025, 0.4 percent (or 1.1 million people) received MAUD in the past year (Table A.55AB). Among the 25.7 million people aged 12 or older with a past year alcohol use disorder (see the section on Alcohol Use Disorder), 2.6 percent (or 679,000 people) received MAUD in the past year.

Medications for Opioid Use Disorder

Among people aged 12 or older in 2025, 0.7 percent (or 2.1 million people) received MOUD in the past year (Table A.55AB). Among the 4.0 million people aged 12 or older with a past year opioid use disorder (see the section on Opioid Use Disorder), 15.7 percent (or 623,000 people) received MOUD in the past year.

Receipt of Substance Use Treatment via Telehealth among People with a Substance Use Disorder

Among people aged 12 or older in 2025 who had an SUD in the past year, 5.7 percent (or 2.5 million people) received substance use treatment via telehealth in the past year (Table A.56AB). Percentages of people with an SUD in the past year who received substance use treatment via telehealth in the past year ranged from 3.6 percent of young adults aged 18 to 25 (or 308,000 people) to 8.9 percent of adolescents aged 12 to 17 (or 167,000 people). An estimated 6.0 percent of adults aged 26 or older who had an SUD in the past year (or 2.1 million people) received substance use treatment via telehealth.

Receipt of Other Services for Substance Use

As noted previously, in addition to collecting information on substance use treatment, the 2025 NSDUH collected information on the receipt of other services for people’s use of alcohol or drugs. These other services include support services from a support group or from a peer support specialist or recovery coach, services in an emergency room, withdrawal management services, or treatment with overdose reversal medicine such as Narcan^® or naloxone. NSDUH does not classify these other services as “substance use treatment.”

However, people could have received both substance use treatment and other services in the past year for their use of alcohol or drugs. Therefore, this section presents estimates for the following:

• any receipt of other services,
• receipt of substance use treatment and other services, and
• receipt of other services but not substance use treatment.

Any Receipt of Other Services for Substance Use among All People Aged 12 or Older

In 2025, 2.7 percent of people aged 12 or older (or 7.9 million people) received other services in the past year for their use of alcohol or drugs (Table A.57AB), including 1.5 percent (or 4.5 million people) who received both substance use treatment and other services and 1.2 percent (or 3.4 million people) who received other services but not substance use treatment. Among the estimated 7.9 million people who received other services, more than half (56.4 percent) also received substance use treatment, and the remainder (43.6 percent) received only other services.

Any Receipt of Other Services for Substance Use among People with a Substance Use Disorder

Among the estimated 44.6 million people aged 12 or older in 2025 who had an SUD in the past year (Figure 39), 9.6 percent (or 4.3 million people) received other services in the past year for their use of alcohol or drugs (Table A.57AB), including 6.9 percent (or 3.1 million people) who received both substance use treatment and other services and 2.6 percent (or 1.2 million people) who received other services but not substance use treatment. Among the estimated 4.3 million people who had an SUD and received other services, about three fourths (72.5 percent) also received substance use treatment, and about one fourth (27.5 percent) received only other services.

Receipt of Specific Other Services for Substance Use among People with a Substance Use Disorder

Among people aged 12 or older in 2025 who had an SUD in the past year, estimates for the receipt of specific other services in the past year to help them with their use of alcohol or drugs were as follows:

• 6.4 percent (or 2.9 million people) participated in a support group,
• 3.5 percent (or 1.6 million people) received services from a peer support specialist or recovery coach,
• 2.8 percent (or 1.3 million people) were seen in an emergency room,
• 2.2 percent (or 989,000 people) received withdrawal management services, and
• 0.9 percent (or 406,000 people) received overdose reversal medicine (Tables A.58A and A.58B).

Among people aged 12 or older in 2025 who had an SUD in the past year, most of those who received withdrawal management services or received services from a peer support specialist or recovery coach also received substance use treatment (97.3 and 92.4 percent, respectively) (Table A.58B). In addition, about three fourths of those who participated in a support group (72.8 percent) or were seen in an emergency room (72.7 percent) received substance use treatment. The percentages of people with an SUD who received overdose reversal medicine and did or did not receive substance use treatment could not be calculated with sufficient precision.¹²

No Receipt of Treatment or Other Services for Substance Use among People with a Substance Use Disorder

Previous sections discussed whether people received substance use treatment or other services in the past year for their alcohol or drug use. This section complements the information in those other sections by presenting estimates for people who had an SUD in the past year but received neither substance use treatment nor other services.

Among the estimated 44.6 million people aged 12 or older in 2025 who had an SUD in the past year (Figure 39), 86.4 percent (or 38.5 million people) received neither substance use treatment nor other services to help with their substance use (Table A.59AB). In each age group, about 80 percent or more of people who had an SUD received neither treatment nor other services for their substance use. Young adults aged 18 to 25 were most likely not to have received treatment or other services (90.6 percent or 7.8 million people), followed by adults aged 26 or older (85.7 percent or 29.2 million people), then by adolescents aged 12 to 17 (80.5 percent or 1.5 million people).

As discussed in the next section on the perceived unmet need for substance use treatment, people who had an SUD but received neither substance use treatment nor other services could perceive an unmet need for any professional counseling, medication, or other treatment for their alcohol or drug use but would not have a perceived unmet need for additional help.

Perceived Unmet Need for Substance Use Treatment

NSDUH respondents in 2025 who used alcohol or drugs in their lifetime and did not receive substance use treatment in the past year (i.e., inpatient or outpatient treatment; MAUD or MOUD; telehealth treatment; or treatment in a prison, jail, or juvenile detention center) were asked whether they sought professional counseling, medication, or other treatment in the past year for their alcohol or drug use. Those who did not report seeking treatment were asked whether they thought they should get treatment. Respondents who did not receive substance use treatment in the past year but sought or thought they should get treatment were classified as having a perceived unmet need for treatment. Respondents who received other services (i.e., support services from a support group or from a peer support specialist or recovery coach, services in an emergency room, or withdrawal management services)^87,89 but not substance use treatment were asked if they sought or thought they should get additional professional counseling, medication, or other treatment in the past 12 months for their use of alcohol or drugs; these respondents also were classified as having a perceived unmet need for treatment.

This section presents estimates separately for the perceived unmet need for substance use treatment among adolescents aged 12 to 17 and among adults aged 18 or older. Factors affecting the perception of need for substance use treatment, including how people interpret whether they sought substance use treatment, could differ for adolescents and adults, even if adolescent and adult respondents were asked the same questions about perceived unmet need.

Perceived Unmet Need for Substance Use Treatment among Adolescents

Among the 1.6 million adolescents aged 12 to 17 in 2025 who had an SUD in the past year and did not receive substance use treatment, 95.1 percent (or 1.4 million people) did not perceive that they needed treatment (Figure 80 and Table A.60AB). That is, they did not seek treatment and did not think they should get it. The estimated 4.9 percent of adolescents with an SUD in the past year who did not receive treatment but had a perceived unmet need for treatment corresponds to 74,000 people and includes 0.7 percent (or 11,000 people) who sought treatment and 4.2 percent (or 63,000 people) who did not seek treatment but thought they should get it.

Perceived Unmet Need for Substance Use Treatment among Adults

Among the 38.1 million adults aged 18 or older in 2025 who had an SUD in the past year and did not receive substance use treatment, 94.5 percent (or 34.9 million people) did not perceive that they needed treatment (Figure 81 and Table A.60AB). That is, they did not seek treatment and did not think they should get it. The estimated 5.5 percent of adults with an SUD in the past year who did not receive treatment but had a perceived unmet need for treatment corresponds to 2.0 million people and includes 0.5 percent (or 187,000 people) who sought treatment and 5.0 percent (or 1.9 million people) who did not seek treatment but thought they should get it.

Reasons for Not Receiving Substance Use Treatment

In 2025, questions about reasons for people not receiving substance use treatment were asked only of respondents who reported receiving no treatment in the past year⁸⁹ and who reported either seeking treatment or thinking they should get treatment. For each reason for not receiving treatment, respondents were asked whether that reason was “one of the reasons” or “not one of the reasons” they did not seek or get treatment. If respondents received other services but not treatment to help with their substance use, they were asked whether these were reasons for them not getting additional professional counseling, medication, or other treatment for their alcohol or drug use. Respondents could report more than one reason for not seeking or getting treatment (or additional treatment).

As noted in previous sections, among people who were classified as having an SUD in the past year and who did not receive substance use treatment in the past year, only 4.9 percent of adolescents aged 12 to 17 and 5.5 percent of adults aged 18 or older perceived an unmet need for treatment (Table A.60AB). For people who perceived an unmet need for treatment, information on common reasons for not receiving substance use treatment is important for identifying and addressing barriers to the receipt of treatment.

This section presents estimates only among adults aged 18 or older because estimates among adolescents aged 12 to 17 could not be calculated with sufficient precision.¹² Additionally, even if adolescent and adult respondents were asked the same questions about why they did not receive substance use treatment, adolescent respondents may not have sufficient knowledge to report whether health insurance coverage or cost were important reasons for them not receiving treatment.

Reasons for Not Receiving Substance Use Treatment among Adults Aged 18 or Older

Among adults aged 18 or older in 2025 with a past year SUD who perceived an unmet need for treatment, the following were the four most common reasons for not receiving substance use treatment:

• thinking they should have been able to handle their alcohol or drug use on their own (82.5 percent),
• not being ready to stop or cut back on using alcohol or drugs (68.4 percent),
• not being ready to start treatment (67.7 percent), and
• not having enough time for treatment (54.3 percent) (Table A.61B).

Percentages for additional reasons were not necessarily significantly different from one another. Therefore, ranking of these reasons should not be assumed. Nevertheless, the following were additional common reasons for not receiving substance use treatment:

• being worried about what people would think or say if they got treatment (41.4 percent);
• not knowing how or where to get treatment (40.5 percent);
• thinking that treatment would cost too much (39.2 percent);
• thinking bad things would happen if people knew they were in treatment, such as losing their job, home, or children (34.9 percent);
• not being able to find a treatment program or healthcare professional they wanted to go to (32.7 percent);
• thinking treatment would not help them (31.5 percent); and
• not having enough health insurance coverage to pay for the costs of treatment (30.4 percent) (Table A.61B).

Mental Health Treatment in the Past Year

NSDUH includes questions to estimate the receipt of treatment in the United States to help people with their mental health, emotions, or behavior. Questions apply to the receipt of mental health treatment among the adolescent and adult populations. These questions allow for the estimation of mental health treatment among adolescents aged 12 to 17 overall and among adolescents with a past year MDE. These questions also allow for the estimation of mental health treatment among adults aged 18 or older overall and among adults with an MDE, AMI, or SMI in the past year.¹⁴

This report presents estimates for the receipt of mental health treatment only for 2025 because of changes to the questionnaire during the 2024 NSDUH for the receipt of mental health treatment in inpatient or outpatient locations.^90,91 Consequently, 4 years of comparable data are not available to assess trends in the receipt of mental health treatment.

Since 2022, NSDUH also has collected information on the receipt of other services, such as support services from a support group or from a peer support specialist or recovery coach, or services in an emergency room or department. These other services were not classified as “mental health treatment.”⁹²

In sections that present estimates for adolescents aged 12 to 17, estimates are presented for all adolescents. For sections for adults aged 18 or older, estimates are presented for all adults and among adults aged 18 to 25, 26 to 49, or 50 or older. For adolescents and adults, locations or types of mental health treatment are not mutually exclusive. For example, people could have received mental health treatment in an outpatient setting and taken prescription medication in the past year for their mental health.

Mental Health Treatment among Adolescents

The 2025 NSDUH included questions for adolescents aged 12 to 17 that asked about the receipt of professional counseling, medication, or other treatment they may have received for their mental health. Adolescent respondents were asked whether they received professional counseling, medication, or other treatment for their mental health in an inpatient location;⁹³ in an outpatient location;⁹⁴ via telehealth; or in a prison, jail, or juvenile detention center in the 12 months prior to the survey interview (i.e., in the past year). Respondents also were asked if they took medication in the past year that was prescribed to help with their mental health. Adolescent respondents who reported receiving any of these types of treatment were classified as having received mental health treatment in the past year.

This section first presents estimates for the receipt of mental health treatment in the past year among all adolescents aged 12 to 17, followed by estimates for the receipt of mental health treatment among adolescents who had an MDE in the past year. Measures for AMI or SMI were not created for adolescents.

Receipt of Mental Health Treatment among All Adolescents

In 2025, 27.6 percent of adolescents aged 12 to 17 (or 7.0 million people) received mental health treatment in the past year (Figure 82 and Table A.62B). An estimated 20.3 percent of adolescents (or 5.2 million people) received mental health treatment in an outpatient setting, 13.3 percent (or 3.4 million people) took prescription medication to help with their mental health, and 13.0 percent (or 3.3 million people) received mental health treatment via telehealth. Smaller percentages of adolescents received mental health treatment in the other locations shown in Figure 82.

Receipt of Mental Health Treatment among Adolescents with an MDE

As noted in the section on MDE and MDE with Severe Impairment among Adolescents, an estimated 3.7 million adolescents aged 12 to 17 in 2025 had a past year MDE. Of these adolescents with a past year MDE, 57.7 percent (or 2.1 million people) received mental health treatment in the past year (Figure 83 and Table A.62B), including 48.4 percent (or 1.8 million people) who received mental health treatment in an outpatient setting, 32.8 percent (or 1.2 million people) who received mental health treatment via telehealth, and 28.7 percent (or 1.1 million people) who took prescription medication to help with their mental health. However, about 42.3 percent of adolescents with a past year MDE (or 1.6 million people) did not receive mental health treatment in the past year (Table A.63AB).

Receipt of Other Services among Adolescents to Help with Mental Health

As noted previously, in addition to collecting information on mental health treatment, the 2025 NSDUH collected information on the receipt of other services to help people with their mental health. These other services include support services from a support group or from a peer support specialist or recovery coach, or services in an emergency room. These other services were not classified as “mental health treatment.”

However, adolescents could have received mental health treatment and other services in the past year to help with their mental health. Therefore, this section presents estimates for the following:

• any receipt of other services,
• receipt of mental health treatment and other services, and
• receipt of other services but not mental health treatment.

Any Receipt of Other Services for Mental Health among All Adolescents Aged 12 to 17

In 2025, 9.8 percent of adolescents aged 12 to 17 (or 2.5 million people) received other services in the past year for their mental health (Table A.64AB), including 7.5 percent (or 1.9 million people) who received mental health treatment and other services and 2.3 percent (or 597,000 people) who received other services but not mental health treatment. Among the estimated 2.5 million adolescents who received other services, therefore, about three fourths (76.1 percent) also received mental health treatment, and about one fourth (23.9 percent) received only other services.

Any Receipt of Other Services for Mental Health among Adolescents with a Past Year MDE

Among the estimated 3.7 million adolescents aged 12 to 17 in 2025 who had an MDE in the past year (see the section on MDE and MDE with Severe Impairment among Adolescents), 22.2 percent (or 822,000 people) received other services in the past year to help with their mental health (Table A.64AB), including 20.1 percent (or 744,000 people) who received mental health treatment and other services and 2.1 percent (or 78,000 people) who received other services but not mental health treatment. Among the estimated 822,000 adolescents who had an MDE and received other services, therefore, the vast majority (90.5 percent) also received mental health treatment, and 9.5 percent received only other services.

Receipt of Specific Other Services for Mental Health among Adolescents with a Past Year MDE

Among adolescents aged 12 to 17 in 2025 who had an MDE in the past year, estimates for the receipt of specific other services in the past year to help them with their mental health were as follows:

• 16.3 percent (or 603,000 people) participated in a support group,
• 7.9 percent (or 292,000 people) received services from a peer support specialist or recovery coach, and
• 6.2 percent (or 231,000 people) were seen in an emergency room (Tables A.65A and A.65B).

Among the 822,000 adolescents aged 12 to 17 in 2025 who had an MDE and received specific other services in the past year, the vast majority (744,000 people) also received mental health treatment in that period (Table A.64AB). For example, among the 231,000 adolescents who had an MDE and were seen in an emergency room in the past year, 99.4 percent (or 229,000 people) also received mental health treatment (Tables A.65A and A.65B).

No Receipt of Treatment or Other Services for Mental Health among Adolescents with a Past Year MDE

Previous sections discussed whether adolescents aged 12 to 17 received mental health treatment or other services in the past year to help with their mental health. This section complements the information in those other sections by presenting estimates for adolescents who had an MDE in the past year but received neither mental health treatment nor other services. Among the estimated 3.7 million adolescents aged 12 to 17 in 2025 who had an MDE in the past year (see the section on MDE and MDE with Severe Impairment among Adolescents), 40.2 percent (or 1.5 million people) received neither mental health treatment nor other services to help with their mental health (Table A.66AB).

Perceived Unmet Need for Mental Health Treatment among Adolescents with a Past Year MDE

This section discusses estimates of perceived unmet need for mental health treatment among adolescents aged 12 to 17 with an MDE in the past year who did not receive mental health treatment in the past year. Adolescents in 2025 who did not receive mental health treatment in the past year were asked whether they sought treatment or thought they should get treatment for their mental health. These questions were asked only if adolescents did not report receipt of any mental health treatment as defined previously.

Adolescent NSDUH respondents aged 12 to 17 in 2025 were classified as having a perceived unmet need for mental health treatment if they did not receive mental health treatment in the past year, but they sought treatment or thought they should get treatment in the past 12 months to help with their mental health. Respondents also were classified as having a perceived unmet need for mental health treatment if they received other services in the past 12 months to help with their mental health but not mental health treatment, and they sought or thought they should get additional professional counseling, medication, or other treatment for their mental health.

As noted previously, 1.6 million adolescents aged 12 to 17 in 2025 had a past year MDE and did not receive mental health treatment in the past year (Table A.63AB). Of these 1.6 million adolescents, 41.7 percent (or 651,000 people) perceived an unmet need for mental health treatment, including 6.8 percent (or 107,000 people) who sought treatment and 34.8 percent (or 544,000 people) who did not seek treatment but thought they should get it.

Reasons for Not Receiving Mental Health Treatment among Adolescents with a Past Year MDE and a Perceived Unmet Need

Adolescents aged 12 to 17 in 2025 who had a perceived unmet need for mental health treatment in the past year were asked to report their reasons for not receiving treatment. These questions on reasons for not receiving treatment were the same for adolescents and for adults aged 18 or older. However, reasons for not receiving treatment could differ between adolescents and adults who had a perceived unmet need for treatment; therefore, these reasons are presented separately for adolescents and adults.

Among the 651,000 adolescents aged 12 to 17 in 2025 with a past year MDE who perceived an unmet need for mental health treatment (Table A.63AB), the most common reason for not receiving treatment was that they thought they should have been able to handle their mental health, emotions, or behavior on their own (87.4 percent) (Table A.67B). Percentages for additional reasons were not necessarily significantly different from one another. Therefore, ranking of these reasons should not be assumed. Nevertheless, the following were additional common reasons for not receiving treatment among adolescents with a past year MDE and a perceived unmet need for mental health treatment:

• being worried about what people would think or say if they got treatment (62.8 percent),
• being worried that information they shared would not be kept private (57.2 percent),
• not thinking treatment would help them (53.9 percent),
• not knowing how or where to get treatment (43.2 percent),
• thinking their family, friends, or religious group would not like it if they got treatment (41.7 percent),
• thinking no one would care if they got better (41.4 percent), and
• not being ready to start treatment (41.1 percent).

Mental Health Treatment among Adults

Adult respondents aged 18 or older in 2025 were asked whether they received professional counseling, medication, or other treatment for their mental health in an inpatient location;⁹³ in an outpatient location;⁹⁴ via telehealth; or in a prison, jail, or juvenile detention center in the 12 months prior to the survey interview (i.e., in the past year). Respondents also were asked if they took medication in the past year that was prescribed to help with their mental health. Adult respondents who reported receiving any of these types of treatment were classified as having received mental health treatment in the past year.

This section first presents estimates for the receipt of mental health treatment in the past year among all adults aged 18 or older, followed by estimates for the receipt of mental health treatment among adults who had an MDE, AMI, or SMI in the past year. Estimates are also presented for the receipt of mental health treatment among adults by age group.

Receipt of Mental Health Treatment among All Adults

In 2025, 21.6 percent of adults aged 18 or older (or 57.3 million people) received any of the types of mental health treatment in the past year that were described previously (Figure 84 and Table A.68B). An estimated 16.2 percent of adults (or 43.1 million people) took prescription medication to help with their mental health, and equal percentages received mental health treatment in an outpatient setting and received treatment via telehealth (both 12.3 percent or 32.6 million people). Smaller percentages of adults received mental health treatment in the other locations shown in Figure 84.

The percentage of adults in 2025 who received any mental health treatment in the past year was lower among adults aged 50 or older (17.1 percent or 21.2 million people) than among young adults aged 18 to 25 (24.5 percent or 8.8 million people) or adults aged 26 to 49 (25.9 percent or 27.3 million people) (Table A.68B).

Receipt of Mental Health Treatment among Adults with an MDE

As noted in the section on MDE and MDE with Severe Impairment among Adults, an estimated 19.7 million adults aged 18 or older in 2025 had a past year MDE. Of these adults with a past year MDE, 65.9 percent (or 13.0 million people) received any of the types of mental health treatment in the past year that were described previously (Table A.69B). Among adults who had an MDE in the past year, 51.7 percent (or 10.2 million people) took prescription medication to help with their mental health, 47.6 percent (or 9.4 million people) received mental health treatment in an outpatient setting, and 44.7 percent (or 8.8 million people) received mental health treatment via telehealth. However, about one third of adults who had an MDE in the past year did not receive any mental health treatment in that period.

In 2025, about three fifths of young adults aged 18 to 25 with an MDE in the past year received any mental health treatment in the past year (59.1 percent or 3.0 million people) (Table A.69B). In comparison, 68.6 percent of adults aged 26 to 49 (or 6.6 million people) and 67.6 percent of adults aged 50 or older (or 3.3 million people) with a past year MDE received any mental health treatment in the past year.

Receipt of Mental Health Treatment among Adults with AMI

Among the 54.6 million adults aged 18 or older in 2025 with AMI in the past year (Figure 65), 50.9 percent (or 27.8 million people) received any of the types of mental health treatment in the past year that were described previously (Figure 85 and Table A.70B). Among adults who had AMI in the past year, 39.5 percent (or 21.6 million people) took prescription medication to help with their mental health, 34.2 percent (or 18.7 million people) received outpatient mental health treatment, and 32.8 percent (or 17.9 million people) received mental health treatment via telehealth. However, nearly half of adults who had AMI did not receive any mental health treatment in the past year.

As noted previously, about half of adults aged 18 or older in 2025 who had AMI in the past year received any of these types of treatment in the past year (Figure 85 and Table A.70B). Percentages of adults with AMI who received any mental health treatment in the past year did not differ significantly by age group and ranged from 48.1 percent of adults aged 50 or older (or 7.6 million people) to 52.8 percent of adults aged 26 to 49 (or 15.0 million people). An estimated 49.7 percent of young adults aged 18 to 25 (or 5.1 million people) with AMI received any mental health treatment.

Receipt of Mental Health Treatment among Adults with SMI

Among the 18.2 million adults aged 18 or older in 2025 with SMI in the past year (Figure 67), 67.7 percent (or 12.3 million people) received any of the types of mental health treatment in the past year that were mentioned previously (Figure 85 and Table A.71B). Among adults who had SMI in the past year, 54.1 percent (or 9.8 million people) took prescription medication to help with their mental health, 50.1 percent (or 9.1 million people) received outpatient mental health treatment, and 46.0 percent (or 8.4 million people) received mental health treatment via telehealth. In addition, 7.9 percent of adults who had SMI (or 1.4 million people) received inpatient mental health treatment. However, about 30 percent of adults who had SMI did not receive any mental health treatment in the past year.

Among adults aged 18 or older in 2025 who had SMI in the past year, the percentage who received mental health treatment in the past year was lower among young adults aged 18 to 25 (63.0 percent or 2.8 million people) than among adults aged 26 to 49 (68.5 percent or 6.9 million people) or adults aged 50 or older (71.2 percent or 2.6 million people) (Figure 85 and Table A.71B).

Receipt of Other Services among Adults to Help with Mental Health

As noted previously, the 2025 NSDUH also collected information on the receipt of other services to help people with their mental health, such as support services from a support group or from a peer support specialist or recovery coach, or services in an emergency room. These other services were not classified as “mental health treatment.”

However, adults could have received mental health treatment and other services in the past year to help with their mental health. Therefore, this section presents estimates for the following:

• any receipt of other services,
• receipt of mental health treatment and other services, and
• receipt of other services but not mental health treatment.

Any Receipt of Other Services for Mental Health among All Adults Aged 18 or Older

In 2025, 5.8 percent of adults aged 18 or older (or 15.5 million people) received other services in the past year to help with their mental health (Table A.72AB), including 4.1 percent (or 10.9 million people) who received mental health treatment and other services and 1.7 percent (or 4.6 million people) who received other services but not mental health treatment. Among the estimated 15.5 million adults who received other services, therefore, about 7 in 10 (70.6 percent) also received mental health treatment, and about 3 in 10 (29.4 percent) received only other services.

Any Receipt of Other Services for Mental Health among Adults with a Past Year MDE

Among the estimated 19.7 million adults aged 18 or older in 2025 who had an MDE in the past year (see the section on MDE and MDE with Severe Impairment among Adults), 18.7 percent (or 3.7 million people) received other services in the past year to help with their mental health (Table A.72AB), including 17.3 percent (or 3.4 million people) who received mental health treatment and other services and 1.4 percent (or 284,000 people) who received other services but not mental health treatment. Among the estimated 3.7 million adults who had an MDE and received other services, therefore, about 12 in 13 (92.3 percent) also received mental health treatment, and about 1 in 13 (7.7 percent) received only other services.

Any Receipt of Other Services for Mental Health among Adults with AMI

As noted in the section on Any Mental Illness among Adults, among the estimated 54.6 million adults aged 18 or older in 2025 with AMI in the past year, 14.9 percent (or 8.1 million people) received other services in the past year to help with their mental health (Table A.72AB), including 12.4 percent (or 6.8 million people) who received mental health treatment and other services and 2.4 percent (or 1.3 million people) who received other services but not mental health treatment. Among the estimated 8.1 million adults with AMI and who received other services, therefore, about 5 in 6 (83.6 percent) also received mental health treatment, and about 1 in 6 (16.4 percent) received only other services.

Any Receipt of Other Services for Mental Health among Adults with SMI

As noted in the section on Serious Mental Illness among Adults, among the estimated 18.2 million adults aged 18 or older in 2025 with SMI in the past year, 21.1 percent (or 3.8 million people) received other services in the past year to help with their mental health (Table A.72AB), including 19.7 percent (or 3.6 million people) who received mental health treatment and other services and 1.4 percent (or 247,000 people) who received other services but not mental health treatment. Among the estimated 3.8 million adults with SMI who received other services, therefore, about 19 in 20 (93.6 percent) also received mental health treatment, and about 1 in 20 (6.4 percent) received only other services.

Receipt of Specific Other Services for Mental Health among Adults with a Past Year MDE

Among adults aged 18 or older in 2025 who had an MDE in the past year, estimates for the receipt of specific other services in the past year to help them with their mental health were as follows:

• 14.2 percent (or 2.8 million people) participated in a support group,
• 6.1 percent (or 1.2 million people) were seen in an emergency room, and
• 5.2 percent (or 1.0 million people) received services from a peer support specialist or recovery coach (Tables A.73A and A.73B).

Among adults aged 18 or older who had a past year MDE and participated in a support group, received services from a peer support specialist or recovery coach, or were seen in an emergency room in the past year, the vast majority also received mental health treatment in that period (91.7, 95.1, and 95.6 percent, respectively) (Table A.73B).

Receipt of Specific Other Services for Mental Health among Adults with AMI

Among adults aged 18 or older in 2025 with AMI in the past year, estimates for the receipt of specific other services in the past year to help them with their mental health were as follows:

• 11.5 percent (or 6.3 million people) participated in a support group,
• 4.6 percent (or 2.5 million people) received services from a peer support specialist or recovery coach, and
• 4.3 percent (or 2.4 million people) were seen in an emergency room (Tables A.73A and A.73B).

Most adults aged 18 or older in 2025 with AMI in the past year who participated in a support group, received services from a peer support specialist or recovery coach, or were seen in an emergency room in the past year also received mental health treatment in that period (82.0, 96.3, and 83.7 percent, respectively) (Table A.73B).

Receipt of Specific Other Services for Mental Health among Adults with SMI

Among adults aged 18 or older in 2025 with SMI in the past year, estimates for the receipt of specific other services in the past year to help them with their mental health were as follows:

• 16.0 percent (or 2.9 million people) participated in a support group,
• 8.1 percent (or 1.5 million people) were seen in an emergency room, and
• 6.2 percent (or 1.1 million people) received services from a peer support specialist or recovery coach (Tables A.73A and A.73B).

The vast majority of adults aged 18 or older in 2025 with SMI in the past year who participated in a support group, received services from a peer support specialist or recovery coach, or were seen in an emergency room in the past year also received mental health treatment in that period (93.9, 96.1, and 92.9 percent, respectively) (Table A.73B).

No Receipt of Treatment or Other Services for Mental Health among Adults with a Past Year MDE

Previous sections discussed whether adults received mental health treatment or other services in the past year to help with their mental health. This section complements the information in those other sections by presenting estimates for adults who had an MDE in the past year but received neither mental health treatment nor other services. Among the estimated 19.7 million adults aged 18 or older in 2025 who had an MDE in the past year (see the section on MDE and MDE with Severe Impairment among Adults), about a third (32.7 percent or 6.4 million people) received neither mental health treatment nor other services in the past year to help with their mental health (Table A.74AB). In each age group, about 30 percent or more of adults who had an MDE received neither treatment nor other services for their mental health.

No Receipt of Treatment or Other Services for Mental Health among Adults with AMI

Previous sections discussed whether adults received mental health treatment or other services in the past year to help with their mental health. This section complements the information in those other sections by presenting estimates for adults with AMI in the past year but who received neither mental health treatment nor other services. Among the estimated 54.6 million adults aged 18 or older in 2025 with AMI in the past year (as noted in the section on Any Mental Illness among Adults), about half (46.7 percent or 25.5 million people) received neither mental health treatment nor other services in the past year to help with their mental health (Table A.74AB). In each age group, about 45 percent or more of adults with AMI received neither treatment nor other services for their mental health.

No Receipt of Treatment or Other Services for Mental Health among Adults with SMI

Previous sections discussed whether adults received mental health treatment or other services in the past year for their mental health. This section complements the information in those other sections by presenting estimates for adults with SMI in the past year but who received neither mental health treatment nor other services. Among the estimated 18.2 million adults aged 18 or older in 2025 with SMI in the past year (see the section on Serious Mental Illness among Adults), about a third (31.0 percent or 5.6 million people) received neither mental health treatment nor other services in the past year to help with their mental health (Table A.74AB). In each age group, about 30 percent or more of people with SMI received neither treatment nor other services for their mental health.

Perceived Unmet Need for Mental Health Treatment among Adults with Mental Health Conditions

This section discusses estimates of perceived unmet need for mental health treatment among adults aged 18 or older with an MDE, AMI, or SMI in the past year who did not receive mental health treatment in the past year. The section also discusses the reasons adults aged 18 or older with AMI did not receive treatment in the past year if they had a perceived unmet need.

Adults who did not receive mental health treatment in the past year were asked whether they sought treatment or thought they should get treatment for their mental health. These questions were asked only if adults did not report any receipt of inpatient or outpatient mental health treatment; use of prescription medication to help with mental health; treatment via telehealth; or treatment in a prison, jail, or juvenile detention center.

Adult NSDUH respondents aged 18 or older in 2025 were classified as having a perceived unmet need for mental health treatment if they did not receive mental health treatment in the past year, but they sought treatment or thought they should get treatment in the past 12 months to help with their mental health. Respondents also were classified as having a perceived unmet need for mental health treatment if they received other services in the past 12 months to help with their mental health but not mental health treatment, and they sought or thought they should get additional professional counseling, medication, or other treatment for their mental health.

Perceived Unmet Need for Mental Health Treatment among Adults with a Past Year MDE

As noted in the section on MDE and MDE with Severe Impairment among Adults, an estimated 19.7 million adults aged 18 or older in 2025 had a past year MDE. Of these adults with a past year MDE, about one third (or 6.7 million people) did not receive mental health treatment in the past year (Table A.75A). Among these 6.7 million adults with a past year MDE who did not receive mental health treatment, 36.9 percent (or 2.4 million people) perceived an unmet need for mental health treatment in the past year (Table A.75B). The percentage of adults in 2025 with a past year MDE who did not receive mental health treatment in the past year and who had a perceived unmet need for treatment was higher among young adults aged 18 to 25 (48.1 percent or 989,000 people) than among adults aged 26 to 49 (35.5 percent or 1.0 million people) or adults aged 50 or older (24.7 percent or 385,000 people).

Perceived Unmet Need for Mental Health Treatment among Adults with AMI

Of the 54.6 million adults aged 18 or older in 2025 who had AMI in the past year (Figure 65), slightly less than half (26.9 million people) did not receive mental health treatment in the past year (Table A.76A). Among these 26.9 million adults with AMI in the past year who did not receive mental health treatment, 21.4 percent (or 5.6 million people) perceived an unmet need for mental health treatment in the past year (Figure 86 and Table A.76B). The percentage of adults in 2025 with AMI in the past year who did not receive treatment in the past year and who had a perceived unmet need for mental health treatment was highest among young adults aged 18 to 25 (35.9 percent or 1.8 million people), followed by adults aged 26 to 49 (22.3 percent or 2.9 million people), then by adults aged 50 or older (10.7 percent or 857,000 people).

Perceived Unmet Need for Mental Health Treatment among Adults with SMI

Of the 18.2 million adults aged 18 or older in 2025 who had SMI in the past year (Figure 67), about one third (5.9 million people) did not receive mental health treatment in the past year (Table A.77A). Among these 5.9 million adults with SMI in the past year who did not receive mental health treatment, 40.5 percent (or 2.3 million people) perceived an unmet need for mental health treatment in the past year (Figure 86 and Table A.77B). Percentages of adults in 2025 with SMI in the past year who did not receive mental health treatment and who had a perceived unmet need for treatment were 55.8 percent among young adults aged 18 to 25 (or 889,000 people) and 36.6 percent among adults aged 26 to 49 (or 1.1 million people). Estimates among adults with SMI who did not receive treatment and who had a perceived unmet need for mental health treatment could not be calculated with sufficient precision for adults aged 50 or older.¹²

Reasons for Not Receiving Mental Health Treatment among Adults with AMI and a Perceived Unmet Need

Among adults aged 18 or older in 2025 who had AMI in the past year and a perceived unmet need for mental health treatment in the past year, the most common reason for not receiving treatment was that they thought they should have been able to handle their mental health, emotions, or behavior on their own (72.9 percent) (Table A.78B). The second most common reason for not receiving treatment was thinking treatment would cost too much (61.4 percent).

Percentages for additional reasons were not necessarily significantly different from one another. Therefore, ranking of these reasons should not be assumed. Nevertheless, the following were additional common reasons for not receiving treatment among adults with AMI in the past year and a perceived unmet need for mental health treatment:

• not having enough time for treatment (48.3 percent),
• not being ready to start treatment (47.7 percent),
• not knowing how or where to get treatment (44.9 percent),
• not finding a treatment program or a healthcare professional they wanted to go to (43.2 percent),
• health insurance not paying enough of the costs for treatment (40.3 percent), and
• not having health insurance coverage for mental health treatment (39.0 percent).

In addition, Table 6.40B in the 2025 Detailed Tables contains estimates for adults who had SMI in the past year and had a perceived unmet need for mental health treatment.²⁰ Common reasons for not getting mental health treatment among adults who had SMI and a perceived unmet need for treatment were generally similar to those among adults who had AMI and a perceived unmet need for treatment.

Receipt of Treatment for Co‑Occurring Mental Health Conditions and Substance Use Disorder

The relationship between SUDs and mental disorders is known to be bidirectional.⁹⁵ The presence of a mental disorder may contribute to the development or exacerbation of an SUD. Likewise, the presence of an SUD may contribute to the development or exacerbation of a mental disorder. The combined presence of SUDs and mental disorders (hereafter referred to as co‑occurring disorders) results in more profound functional impairment; worse treatment outcomes; higher morbidity and mortality; increased treatment costs; and higher risk for homelessness, incarceration, and suicide than if people had only one of these disorders.^{95,96,97,98,99} Current treatment guidelines often recommend that people with co‑occurring disorders receive treatment for both disorders.^95,98,99

This section presents estimates of the receipt of treatment among adolescents aged 12 to 17 and adults aged 18 or older with co‑occurring mental health conditions and SUDs. Estimates are first presented for whether people with co‑occurring mental health conditions and an SUD received any treatment for their use of alcohol or drugs or their mental health, or if people received no treatment. If people with co‑occurring mental health conditions and an SUD received treatment for either their substance use or their mental health conditions, estimates are presented for the following:

• mental health treatment but not substance use treatment,
• substance use treatment but not mental health treatment, or
• both substance use treatment and mental health treatment.

Estimates for adults aged 18 or older are presented overall and by age group.

Receipt of Treatment among Adolescents with a Co‑Occurring MDE and an SUD

Among the 604,000 adolescents aged 12 to 17 in 2025 with a co‑occurring MDE and an SUD in the past year (Figure 87), 75.4 percent (or 455,000 people) received either substance use treatment or mental health treatment in the past year (Table A.79B). However, about 1 in 4 adolescents with a co‑occurring MDE and an SUD in the past year (24.6 percent or 148,000 people) did not receive treatment for either condition. An estimated 60.2 percent of adolescents with a co‑occurring MDE and an SUD in the past year (or 364,000 people) received only mental health treatment, and 14.3 percent (or 86,000 people) received both substance use treatment and mental health treatment. A smaller percentage received only substance use treatment.

Among the 455,000 adolescents aged 12 to 17 in 2025 with a co‑occurring MDE and an SUD who received either substance use treatment or mental health treatment in the past year (Figure 87), most received only mental health treatment (79.9 percent), and 18.9 percent received both types of treatment.⁸⁸ The remainder received only substance use treatment.⁸⁸

Receipt of Treatment among Adults with Co‑Occurring AMI and an SUD

Among the 18.5 million adults aged 18 or older in 2025 with co‑occurring AMI and an SUD in the past year (Figure 88), 57.4 percent (or 10.6 million people) received either substance use treatment or mental health treatment in the past year (Table A.80B). However, about 2 in 5 adults aged 18 or older with co‑occurring AMI and an SUD in the past year (42.6 percent or 7.9 million people) did not receive treatment for either condition. An estimated 41.8 percent of adults aged 18 or older with co‑occurring AMI and an SUD in the past year (or 7.7 million people) received only mental health treatment, and 12.7 percent (or 2.3 million people) received both types of treatment. A smaller percentage received only substance use treatment.

Among the 10.6 million adults aged 18 or older in 2025 with co‑occurring AMI and an SUD who received either substance use treatment or mental health treatment in the past year (Figure 88), most received only mental health treatment (72.9 percent), and 22.1 percent received both types of treatment.⁸⁸ The remainder received only substance use treatment.⁸⁸

Percentages of adults aged 18 or older in 2025 with co‑occurring AMI and an SUD in the past year who received either substance use treatment or mental health treatment in the past year ranged from 55.7 percent of adults aged 50 or older (or 2.2 million people) to 58.5 percent of adults aged 26 to 49 (or 6.1 million people) (Table A.80B). An estimated 56.1 percent of young adults aged 18 to 25 with co‑occurring AMI and an SUD in the past year (or 2.3 million people) received either type of treatment.

Receipt of Treatment among Adults with Co‑Occurring SMI and an SUD

Among the 7.8 million adults aged 18 or older in 2025 with co‑occurring SMI and an SUD in the past year (Figure 89), 71.3 percent (or 5.6 million people) received either substance use treatment or mental health treatment in the past year (Table A.80B). However, about 3 in 10 adults aged 18 or older with co‑occurring SMI and an SUD in the past year (28.7 percent or 2.2 million people) did not receive treatment for either condition. An estimated 51.9 percent of adults aged 18 or older with co‑occurring SMI and an SUD in the past year (or 4.0 million people) received only mental health treatment, and 16.4 percent (or 1.3 million people) received both types of treatment. A smaller percentage received only substance use treatment.

Among the 5.6 million adults aged 18 or older in 2025 with co‑occurring SMI and an SUD who received either substance use treatment or mental health treatment in the past year (Figure 89), most received only mental health treatment (72.7 percent), and 23.1 percent received both types of treatment.⁸⁸ The remainder received only substance use treatment.⁸⁸

Among adults aged 18 or older in 2025 with co‑occurring SMI and an SUD in the past year, 65.5 percent of young adults aged 18 to 25 (or 1.3 million people) and 73.8 percent of adults aged 26 to 49 (or 3.4 million people) received either substance use treatment or mental health treatment in the past year (Table A.80B). Percentages could not be calculated with sufficient precision for adults aged 50 or older with co‑occurring SMI and an SUD in the past year.¹²

Recovery

Respondents aged 18 or older were asked whether they thought they ever had a problem with their use of drugs or alcohol or whether they ever had a problem with their mental health. Respondents who reported that they ever had a problem with their drug or alcohol use were asked whether they considered themselves (at the time they were interviewed) to be in recovery or to have recovered from their drug or alcohol use problem. Similarly, respondents aged 18 or older who reported that they ever had a problem with their mental health were asked whether they considered themselves (at the time they were interviewed) to be in recovery or to have recovered from their mental health issue.

Among adults aged 18 or older in 2025, 11.6 percent (or 30.6 million people) perceived that they ever had a problem with their use of drugs or alcohol (Table A.81B). Among the 30.6 million adults in 2025 who perceived that they ever had a substance use problem, 73.0 percent (or 22.3 million people) considered themselves to be in recovery or to have recovered from their drug or alcohol use problem (Table A.82B).

In 2025, 8.0 percent of young adults aged 18 to 25 (or 2.9 million people) and 12.2 percent of adults aged 26 or older (or 27.7 million people) perceived that they ever had a problem with their use of drugs or alcohol (Table A.81B). Among adults who perceived that they ever had a problem with their use of drugs or alcohol, about two thirds of young adults (63.4 percent or 1.8 million people) and about three fourths of adults aged 26 or older (74.0 percent or 20.5 million people) considered themselves to be in recovery or to have recovered from their drug or alcohol use problem (Table A.82B).

In 2025, 24.3 percent of adults aged 18 or older (or 63.8 million people) perceived that they ever had a problem with their mental health (Table A.81B). Among the 63.8 million adults in 2025 who perceived that they ever had a problem with their mental health, 69.4 percent (or 44.1 million people) considered themselves to be in recovery or to have recovered from their mental health issue (Table A.82B).

In 2025, 35.5 percent of young adults aged 18 to 25 (or 12.7 million people) and 22.5 percent of adults aged 26 or older (or 51.1 million people) perceived that they ever had a problem with their mental health (Table A.81B). Among adults who perceived that they ever had a problem with their mental health, 66.4 percent of young adults (or 8.4 million people) and 70.2 percent of adults aged 26 or older (or 35.7 million people) considered themselves to be in recovery or to have recovered from their mental health issue (Table A.82B).

Appendix A: Special Tables of Estimates for Substance Use and Mental Health Indicators in the United States