Every year, the federal government asks tens of thousands of Americans about their health, and every year the same hard truth surfaces: a substance use disorder is common, treatment is not. In 2024, an estimated 48.4 million people in the United States aged 12 or older, about 1 in 6, met the clinical criteria for a substance use disorder. Only 10.2 million received any substance use treatment that year.
That distance, between the number of people who have a substance use disorder and the far smaller number who receive care, is what researchers call the "treatment gap." Understanding it is the first step toward closing it. This article draws entirely on public federal data to explain how large the gap is, why it persists, and how a person can find licensed help. You can read more about how we source our data.
48.4 million
Americans aged 12+ had a substance use disorder in 2024 (16.8%, roughly 1 in 6). Only 10.2 million (3.5%) received substance use treatment.
Source: SAMHSA, 2024 National Survey on Drug Use and Health (NSDUH).
How common is substance use disorder in the United States?
The National Survey on Drug Use and Health (NSDUH) is the country's primary source for these numbers. Its most recent release, published in July 2025, covers 2024. It found that 48.4 million people aged 12 or older, or 16.8% of that population, had a past-year substance use disorder. For context, the same survey estimated that 73.6 million people (25.5%) used an illicit drug in the past year, and that 61.5 million adults (23.4%) experienced any mental illness, disorders that frequently co-occur with substance use.
A substance use disorder is a medical condition, not a moral failing. It ranges from mild to severe, it is diagnosable, and, importantly, it is treatable. Yet the treatment numbers tell a different story.
The size of the treatment gap
NSDUH classifies people as "needing" substance use treatment if they had a substance use disorder in the past year or received treatment during that time. By that measure, 52.6 million people (18.2%) needed treatment in 2024. Just 10.2 million received it, roughly 1 in 5 of those who needed care.
Put another way, more than 38 million people who had a substance use disorder in 2024 did not receive any treatment for it. That is the treatment gap, and it has been stubbornly wide for as long as the survey has measured it.
1 in 5
Of the 52.6 million people who needed substance use treatment in 2024, only about 1 in 5 received it.
Source: SAMHSA, 2024 NSDUH.
Why don't more people get treatment?
It is tempting to assume the barrier is a shortage of programs, or cost, or insurance. Those matter. But the survey points to something more fundamental: most people with an untreated substance use disorder do not believe they need care.
Among people with a substance use disorder who did not receive treatment in 2024, an estimated 95.6% of adults and 93.3% of adolescents did not seek treatment and did not think they should. Only 4.4% of adults (about 1.8 million people) and 6.7% of adolescents (about 111,000) who went untreated felt they should have gotten help.
When people did explain why they held back, the reasons were revealing. Among adults with a substance use disorder who did not get treatment, about 3 in 4 (75.5%) felt they could handle the problem on their own, and roughly 6 in 10 (59.5%) said they were not ready to stop using. These are not logistical hurdles; they are perceptions, and perceptions can change with education, outreach, and compassionate conversation.
95.6% of adults
Among people with an untreated substance use disorder in 2024, 95.6% of adults and 93.3% of adolescents did not seek treatment or did not think they needed it.
Source: SAMHSA, 2024 NSDUH.
This does not mean structural barriers are unimportant. Cost, insurance coverage, stigma, long waitlists, transportation, and simply not knowing where to look all keep people from care, especially those who are ready to seek it. But the data make clear that closing the gap requires two parallel efforts: making treatment easier to reach, and helping people recognize when a substance use disorder has become something they cannot, and should not have to, manage alone.
What treatment actually looks like
For those who do seek help, a real system exists. The National Substance Use and Mental Health Services Survey (N-SUMHSS) counts the facilities that provide it. In 2023, 14,620 substance use treatment facilities responded to the survey, and on a single reference day, March 31, 2023, they reported serving 1,592,193 clients.
Treatment is more varied than the word "rehab" suggests. According to the 2023 survey, 83% of these facilities offered outpatient care, 24% offered residential care, and 7% offered hospital inpatient care. Many people never need to leave home for weeks; they receive care while continuing to work and live.
Crucially, 59.4% of substance use treatment facilities offered medications for opioid use disorder, such as buprenorphine, methadone, or extended-release naltrexone. These medications are among the most evidence-based tools in addiction medicine, and their availability has expanded, though it remains far from universal.
A reason for hope
The stakes of the treatment gap are measured in lives. But the most recent federal data also carry genuinely encouraging news. According to the CDC's National Center for Health Statistics, drug overdose deaths fell from 105,007 in 2023 to 79,384 in 2024, a 26.2% decline and the first major drop in decades. Deaths involving synthetic opioids such as illicitly made fentanyl fell even faster, with that death rate down 35.6%. Provisional CDC data indicate the decline continued into 2025, with an estimated 69,973 overdose deaths.
Researchers attribute the turnaround to a mix of factors, including wider access to naloxone, expanded treatment, and shifts in the drug supply. Whatever the cause, overdose deaths have started to fall for a third straight year, and the trend shows that outcomes can improve, and that connecting more people to care is a public-health strategy that works.
Finding licensed treatment
If you or someone you care about is ready to look for help, free and trustworthy resources exist. The federal government operates FindTreatment.gov, a searchable directory of licensed facilities, and the SAMHSA National Helpline (1-800-662-HELP / 4357) offers free, confidential, 24/7 referrals in English and Spanish. If there is any risk of immediate harm, call or text 988 to reach the Suicide and Crisis Lifeline. Peer support is also widely available; our support groups directory lists national mutual-aid organizations and how to find a meeting.
Rehab Connect is a free, independent directory that mirrors the licensed facilities in SAMHSA's FindTreatment.gov data. It lets you browse programs by state and by the services you need, with no lead forms and no referral fees, so you can contact facilities directly. It exists to make the same public data easier to navigate, nothing more.
The treatment gap is large, but it is not fixed. Behind every statistic is a person who could get better, and treatment, once found, changes the odds.
Sources
- SAMHSA, Key Substance Use and Mental Health Indicators in the United States: Results from the 2024 National Survey on Drug Use and Health (NSDUH), released July 2025. samhsa.gov/data/report/2024-nsduh-annual-national-report
- SAMHSA, National Substance Use and Mental Health Services Survey (N-SUMHSS), 2023. samhsa.gov/data/report/2023-n-sumhss-annual-report
- CDC / National Center for Health Statistics, Drug Overdose Deaths in the United States, 2023–2024, NCHS Data Brief No. 549. cdc.gov/nchs/products/databriefs/db549.htm
- CDC / NCHS, U.S. Overdose Deaths Decrease in 2025 (provisional data, May 2026). cdc.gov/nchs/pressroom/releases/20260513.html
- SAMHSA, FindTreatment.gov. findtreatment.gov
All figures come from publicly available U.S. federal data — SAMHSA's NSDUH (2024) and N-SUMHSS (2023), and the CDC's NCHS (2023–2025). Estimates are reported as published; survey figures carry sampling error, and 2025 overdose totals are provisional.