The treatment gap for American adults with substance use disorders (SUDs) who did not receive treatment widened slightly from 94.7% in 2023 to 95.6% in 2024. That’s according to the Substance Abuse and Mental Health Services Administration (SAMHSA) annual survey and report, released on July 28. But for youth between 12-17, the treatment gap shrank, with more seeking out SUD treatment than the year prior.
Across the board, substance misuse rates for alcohol, tobacco and opioids decreased year over year, the latest National Survey on Drug Use and Health revealed. At the same time, use of marijuana and nicotine vaping rose for all ages.
Use of hallucinogenic drugs also increased, but other illicit drug use – specifically for fentanyl – was essentially flat. 
The above trends were true for multi-year data comparisons between 2021 and 2024, as well. Among the 70,000 respondents to the survey, 75.5% of individuals cited “thinking they should have been able to handle their alcohol or drug use on their own” as the primary reason for not seeking treatment. Other barriers were not being ready to start treatment, not being ready to cut back on drug or alcohol use, thinking the cost of treatment was too high, and being worried about the stigma related to receiving treatment, according to the report.
Only 32.4% cited “not having health insurance coverage” as a reason for not seeking SUD treatment. For adolescents who had both a mental health disorder and an SUD, 73.6% only received help for their mental health rather than for substance use – and nearly 28% received neither type of treatment.
Adults with a mental health disorder and co-occurring SUD were worse off. Around 69.8% received mental health treatment over substance use treatment and 41.2% did not receive treatment for either. Adults with SUDs and serious mental illnesses (SMIs) like schizophrenia or bipolar disorder were more likely to engage in some kind of help, with only 29.9% not receiving treatment for either mental health or SUDs.
Adults over the age of 26 were also more likely to identify as being in recovery after having a substance use disorder compared to young adults between 18-25. Young adults were also less likely to self-report having a substance use problem. Only 8.2% of individuals in this group self-reported SUDs compared to 12.8% of adults over the age of 26, according to the data.
Year over year, this indicates that there are still fewer youth receiving needed care and declining treatment uptake among adults as well. While strides were made in the decline of alcohol and some forms of drug use for all age groups, marijuana use disorder, nicotine use and hidden risks with illegally made fentanyl persist.
Particularly among young adults and adolescents, the initiation of use in the past year was highest for nicotine vaping, alcohol and marijuana. Almost 35% of people who began nicotine vaping in the last year did so before age 21, compared with 70.7% of individuals who initiated alcohol use. More than half – 52% – of individuals initiated marijuana use before age 21.
2024 National Survey on Drug Use and Health; SAMHSA12 or Older; 2024
Across all age groups, 55.8% report their SUD severity as mild, while around 1 in 5 report having a severe disorder. These percentages were nearly identical to the rates reported in 2023.
