Substance Use Disorder, Mental Health, and Treatment Access in America

01  Overview

Addiction, Mental Health, and Treatment Access

Substance use disorders and mental health conditions affect tens of millions of Americans each year — yet most people who need treatment never receive it. The size of that gap, and how it varies from state to state, is one of the central public health challenges in the United States.

This resource pulls together the most recent national and state-level data on the prevalence of substance use and mental health conditions, their overlap with suicide risk and childhood adversity, and the structural reasons treatment so often goes unreceived. It is intended as a neutral reference for students, educators, clinicians, and researchers.

Sources: SAMHSA, National Survey on Drug Use and Health (2024); Mental Health America, State of Mental Health in America (2025).

02  State-by-State Treatment Gap

How Access Varies Across the States

Where a person lives strongly shapes whether they can get behavioral health care. Mental Health America's annual State of Mental Health in America report ranks all 50 states and the District of Columbia across 17 measures of prevalence and access. The map below shows each state's 2025 overall rank, where 1 indicates lower prevalence of illness and higher access to care and 51 indicates the opposite.

The disparities behind these rankings are concrete. In Texas, Mississippi, and Tennessee, roughly one in five adults with mental illness were uninsured, compared with about 4% in Vermont, Maryland, and Rhode Island. And while about 13–16% of adults with mental illness in Maine and Arkansas reported not getting needed care, that figure approached 40% in Wisconsin, Utah, and Wyoming. Southern and more rural states consistently show the widest gaps.

03  Substance Use & Mental Health Data

Prevalence and the Overlap of Conditions

In 2024, nearly 50 million Americans aged 12 or older — about 16.8% — met diagnostic criteria for a substance use disorder in the past year. Of these, roughly 27.9 million had an alcohol use disorder and 28.2 million a drug use disorder (the totals overlap). In the same period, 23.4% of adults experienced any mental illness, equivalent to more than 60 million people.

These conditions frequently co-occur. SAMHSA reports that people with mental health conditions often also face substance use challenges, and vice versa. Among adolescents with a major depressive episode, nearly one in five also had a substance use disorder. Treating the two in isolation is a recurring weakness in the care system, which is why integrated "dual diagnosis" care has become a clinical priority.

The single largest gap is in addiction care: roughly 80% of people who needed substance use treatment in 2024 did not get it. By comparison, the mental health gap, while still substantial, is narrower — a difference that reflects both stigma and the uneven availability of addiction-specific services. Nationally, there is approximately one mental health provider for every 320 people.

04  Suicide Risk & Substance Use

A Closely Linked Risk

In 2023, 49,316 Americans died by suicide, a rate of about 14.1 per 100,000. Suicidal thinking is far more widespread than the death toll alone suggests: in 2023, an estimated 12.8 million adults (5.0%) reported serious thoughts of suicide, 3.7 million made a plan, and 1.5 million attempted. Among adolescents, about 10% reported serious thoughts of suicide in 2024 — close to 3 million young people.

CDC data indicate that opioids are present in roughly 20% of suicide deaths and that about one in five suicide decedents have a blood alcohol concentration at or above the legal limit. Taken together with overdose mortality, the toll is staggering: more than 200,000 Americans died from alcohol, drug overdose, or suicide in 2023. Drug overdose remains the leading cause of death for Americans aged 18 to 44.

There is also recent, fragile progress. Provisional CDC data show drug overdose deaths fell about 27% — from roughly 110,000 in 2023 to about 80,400 in 2024 — the lowest level since 2019. Public health agencies attribute the decline to expanded prevention, naloxone access, and treatment, and warn that the gains depend on sustained investment.

05  Children, ACEs & Family Impact

Childhood Adversity as an Upstream Driver

Adverse childhood experiences (ACEs) — abuse, neglect, and household dysfunction such as living with substance use or untreated mental illness — are among the strongest predictors of later addiction and mental health conditions. They are also common. Per CDC data, about three in four high school students report at least one ACE, and one in five report four or more. Among adults, roughly two thirds report at least one ACE and one in six report four or more.

The link to substance use is direct: children who grow up in a household affected by substance use are several times more likely to develop substance problems as adults, and people with four or more ACEs are roughly four times as likely to experience alcohol or drug problems. ACEs do not respect state lines evenly — the share of adults reporting four or more ranges from about 11.9% in New Jersey to 22.7% in Oregon.

Because ACEs are preventable and their effects can be buffered, they represent one of the highest-leverage points for reducing addiction and mental illness at the population level — and a reason family-centered and trauma-informed approaches matter in treatment.

06  Why People Don't Receive Treatment

The Anatomy of the Treatment Gap

The gap between need and care is not mainly about unwillingness — it is built from cost, coverage, awareness, and workforce shortages. Cost is the most cited obstacle: in 2023, nearly 60% of adults with a mental illness who needed care said they did not get it because they believed it would cost too much.

Coverage and awareness barriers have eased somewhat: the share of people citing "didn't know where to go" fell from 48.9% (2022) to 37.1% (2023), and those reporting their insurance didn't cover addiction treatment fell from 40.1% to 28.6%. But about 9% of adults with mental illness — over 5 million people — remained uninsured, and roughly one in four with 14+ poor-mental-health days a month could not see a doctor because of cost. Workforce shortages compound all of this, especially in rural areas.

07  Data Sources & Methodology

How This Resource Was Compiled

All figures on this page are drawn from federal surveys and peer-reviewed or government public health reporting. National prevalence and treatment estimates come from SAMHSA's annual National Survey on Drug Use and Health (NSDUH), which surveys the civilian, non-institutionalized population aged 12 and older. State-level rankings come from Mental Health America's State of Mental Health in America, which combines 17 federal measures, with most reflecting 2022–2023 data. Mortality figures come from the CDC's National Center for Health Statistics. ACEs data come from CDC's Behavioral Risk Factor Surveillance System and Youth Risk Behavior Survey.

Key limitations

NSDUH and similar surveys exclude people experiencing unsheltered homelessness, those on active military duty, and people who are incarcerated or institutionalized — populations with elevated rates of behavioral health conditions. Reported figures therefore likely understate true prevalence and unmet need. Self-reported data are also subject to recall and stigma effects. State rankings are relative measures and should be compared among similar states; year-to-year survey methodology changes can limit direct comparison.

Primary sources

• SAMHSA — Key Substance Use and Mental Health Indicators: Results from the 2023 & 2024 NSDUH. samhsa.gov/data
• Mental Health America — The State of Mental Health in America 2025. mhanational.org
• CDC / NCHS — Provisional drug overdose death estimates, 2023–2024; suicide mortality (FastStats). cdc.gov/nchs
• CDC — Adverse Childhood Experiences; 2023 Youth Risk Behavior Survey (MMWR). cdc.gov/aces
• NIDA — Drug Overdose Death Rates. nida.nih.gov
• NIAAA — Alcohol-Related Emergencies and Deaths in the United States. niaaa.nih.gov
• Trust for America's Health — Pain in the Nation 2025. tfah.org

08  Student & Family Resources

Where to Find Help and Information

The following are free, national, non-commercial resources for individuals, families, students, and educators seeking support or reliable information.

• 988   988 Suicide & Crisis Lifeline — call or text 988, 24/7, free and confidential. 988lifeline.org
• 1-800-662-4357   SAMHSA National Helpline — 24/7 treatment referral and information (English & Spanish). samhsa.gov
• FindTreatment.gov — SAMHSA's confidential, searchable directory of treatment facilities. findtreatment.gov
• NAMI (National Alliance on Mental Illness) — education, support groups, and a HelpLine (1-800-950-6264). nami.org
• Campus & collegiate recovery — many universities host collegiate recovery programs; the Association of Recovery in Higher Education maintains a directory. collegiaterecovery.org
• For educators & researchers — SAMHSA's data portal and CDC WONDER provide downloadable, citable datasets for coursework and analysis.

09  Downloads & Citation Guide

Reuse, Cite, and Share

Students and educators are welcome to cite and link to this resource. A companion dataset is available for analysis and classroom use.

Suggested citation

When citing specific statistics, please also cite the underlying primary source (e.g., SAMHSA NSDUH 2024, CDC, or Mental Health America 2025) listed in Section 07.