The prevalence of substance use disorder (SUD) and alcohol use disorder (AUD) declined in the US from 2021 to 2025, with particularly encouraging trends among adolescents and young adults.

New data from the 2025 National Survey on Drug Use and Health (NSDUH) showed that among 

people aged 12 years or older, the prevalence of past-year SUD decreased from 16.7% in 2021 to 15.3% in 2025, while AUD declined from 10.6% to 8.9%. Over the same period, marijuana and hallucinogen use increased, prescription opioid misuse declined, and illicitly manufactured fentanyl use remained unchanged.

In 2025, 11.2% of adolescents aged 12-17 years engaged in nonsuicidal self-harm in the past year — the first time the survey assessed this behavior.

Among both adolescents and young adults, the prevalence of serious thoughts of suicide, making a suicide plan, and attempting suicide declined from 2021 to 2025. Both age groups also saw declines in several measures of substance use, including past-month alcohol and marijuana use.

“Building on encouraging trends first reported in the 2024 NSDUH, in 2025, adolescents aged 12-17 and young adults aged 18-25 continued to show downward or stable trends in most behavioral health indicators over the past 5 years,” Substance Abuse and Mental Health Services Administration (SAMHSA) Principal Deputy Assistant Secretary Christopher Carroll, said in a news release.

The report was published online on July 27.

Marijuana, Hallucinogen Use Increases

The data consist of self-reported responses from over 60,000 people aged 12 years or above in the US and serves as an overview of trends in mental health and substance use over time.

In 2025, approximately 1 in 4 people reported using an illicit drug. Marijuana was the most used illicit substance, with 21.2% of people aged 12 years or older, or 61.6 million people, reporting past-year use.

Illicit drug use in general increased from 2021 to 2025, mostly due to the increase in marijuana use.

From 2021 to 2025, past-month alcohol consumption fell among people aged 12 years or older, and the percentage of people who had a past year AUD decreased by 1.7%. The prevalence of past-year opioid use disorder (OUD) also decreased.

In the past year, 9.1 million people used hallucinogens (0.4% increase from 2021), 6.9 million misused prescription opioids (0.6% decrease from 2021), and 4.9 million used cocaine (no change).

In terms of access, 16% of people who were identified as needing substance abuse treatment received that treatment, leaving 84%, or approximately 39 million people, who did not receive treatment.

The most common reason for not seeking treatment was the belief that they could handle their substance use on their own.

In 2025, 27.6% of adolescents and 21.6% of adults accessed mental health treatment.

Approximately 1 in 5 teenagers reported moderate or severe symptoms of generalized anxiety disorder in the past 2 weeks. In the past year, roughly 1 in 7 had a major depressive episode.

Among the 54.6 million adults with any mental illness, around half accessed mental health treatment in the past year. For the 18.2 million adults with serious mental illness, two thirds accessed treatment.

In 2025, 13.9 million adults had serious thoughts of suicide, 4.9 million made a suicide plan, and 2.3 million attempted suicides.

Over the last 5 years, the number of adults aged 26 years or older who had serious thoughts of suicide, made a suicide plan, or attempted suicide increased.

The opposite was true among adolescents, with declines across all three measures: 2.5 percentage points for suicidal ideation, 1.1 percentage points for suicide planning, and 0.7 percentage points for suicide attempts.