What the 2024 data says about substance use in America and why it matters for care delivery, access, and support
Each year, SAMHSA’s National Survey on Drug Use and Health (NSDUH) gives us the most comprehensive picture of how substance use is evolving across the U.S. Based on responses from more than 70,000 people aged 12 and older, the newly released 2024 data highlights both progress and persistent gaps.
Here’s what we learned, and what it means for anyone invested in health, wellness, and behavioral health benefits.
1. Most people with a substance use disorder (SUD) don’t think they need help
According to the survey, 48.4 million people aged 12 and older met criteria for a SUD. But here’s the staggering part: 95.6% didn’t believe they needed treatment. That’s more than 42 million people living with an SUD who see no reason to seek care.
That belief isn’t just about access. It’s a mindset gap shaped by denial, stigma, and the belief that “I can handle it on my own.” In fact, three out of four adults who recognized a need for treatment still believed they should manage it themselves. Many weren’t ready to stop, feared judgment, or didn’t know where to go.
These invisible barriers are where traditional care models fall short and where proactive education and earlier engagement matter most. In Pelago’s own program data, we’ve seen that participants who engage earlier and often experience better outcomes and drive meaningful cost savings. For employers and health plans, it’s a reminder that risk doesn’t always look like a crisis, and that care needs to start before people ask for it.
2. Cannabis use is rising, but treatment hasn’t caught up
In 2024, cannabis was the most commonly used illicit drug in the U.S. More than 64 million people aged 12 and older (22.3%) used it in the past year, up from 19% in 2021.
Use is especially high among adults with co-occurring mental health conditions, and rates continue to rise among older adults. But while cannabis is increasingly legal and socially accepted, the risks tied to heavy or habitual use are often overlooked. With conflicting information about benefits, risks, and changing laws, it’s become harder to recognize when use becomes problematic.
For those who struggle, support is often limited. An estimated 7.1% of people aged 12 and older (more than 20 million individuals) met criteria for cannabis use disorder (CUD) and could benefit from treatment. Yet few treatment models address it in a meaningful way, it’s often missing from many EAPs and traditional behavioral health programs.
For organizations focused on comprehensive behavioral health coverage, this represents a significant gap in an increasingly relevant area.
3. SUD care still lags far behind mental health care
More than 48 million people met the criteria for a SUD in 2024, but only 12.3% received treatment. That leaves more than 42 million people without formal care, a treatment gap nearly four times larger than mental health.
By comparison, over half of those with a mental health illness received treatment, and the rate was even higher for those with serious conditions. Even among individuals with both conditions, 69% received mental health treatment only. That means their substance use needs were left unaddressed even when they were already engaged in care.
This disparity represents a massive opportunity for differentiation. While mental health investment has advanced significantly, substance use still requires dedicated solutions and specialized approaches.
4. Proven tools like MAT and telehealth are still underused
Medication-assisted treatment (MAT) is the gold standard for opioid use disorder (OUD). Yet only 17% of people with OUD received medication in 2024. And while telehealth adoption has grown overall, just 5.4% of people with an SUD received care virtually, compared to nearly 13% of those with mental health conditions.
These are missed opportunities for better outcomes and cost savings. Virtual care helps overcome stigma, eliminates pharmacy and transportation barriers, and improves long-term engagement. For many individuals, the flexibility and privacy of telehealth makes the difference between staying in treatment and dropping out entirely.
Organizations that prioritize evidence-based treatments and flexible delivery models see measurably better results and ROI.
5. Some trends are improving, but care gaps remain
The 2024 survey revealed some positive signs such as past-year use of alcohol, tobacco, and opioids declining slightly; these improvements may reflect the early impact of prevention, expanded access to care, and open conversations around substance use. However, significant gaps persist, especially among young adults. Just 11.3% of 18–25 year olds with substance use needs received care — one of the lowest engagement rates across all age groups.
This matters for workforce planning and long-term cost management. Early intervention not only prevents escalation to more severe and costly conditions, but this demographic makes up a growing share of the workforce. There’s a clear opportunity for organizations to support younger employees and help them access care before issues become more risky, costly, and complex.
The 2024 NSDUH results are a reminder that while some substance use patterns may be shifting, the deeper care gaps remain. Millions of people are still navigating substance use alone and not because they don’t need help, but because the right kind of help is hard to find, hard to access, or not built for them. For benefit leaders and health plans, this data is a chance to ask: are we doing enough to meet people where they are, and to offer support before a crisis?
Say hello to brighter days together
Get started quickly. Save costs. Change lives forever.