# Suburbia’s Dirty Little Secret: Drug Addiction

In a single month in the United States, **168 million** people **aged 12 or older**(**58**.**3%** of the surveyed population) vaped nicotine or used tobacco, consumed alcohol, or used an illicit drug. And almost 10% of the population currently suffers from a substance use disorder.

The American drug crisis is a broad national problem, with drug addiction in the suburbs as big an issue as anywhere else in the country. This study will closely consider the states with the highest rates of drug abuse and the demographic groups most affected. We’ll also consider which drugs are involved and to what extent, drug overdose fatality rates, and racial disparities regarding drug use.

Let’s first take a closer look at what that alarming figure (168 million) actually means by breaking down the numbers.

## Monthly Substance Use Across America

A single month of U.S. substance use data uncovers a telling story. During one such month in 2024, a broad variety of surveyed Americans confirmed the extent of the national drug problem. 

**And of the 168 million people**(**58**.**3%**of the population) who said they’d used at least one substance during that month, **134**.**3 million** cited **alcohol**. Alcohol’s social prevalence is such that many Americans struggle to perceive it as a drug to compare with more illicit drugs and substances, such as marijuana. Yet it’s a drug that causes enormous levels of addiction, chronic disease, and preventable death. 

**Illicit drugs and tobacco products** are effectively tied for second place, with around **48 million**Americans (**16**.**7%** of the population) using both. Clearly, both remain deeply entrenched, despite decades of sustained and targeted public health campaigns.

**Marijuana** (counted separately, although often classed as ‘illicit’) accounted for **44**.**3 million**monthly users, a figure that has since risen steadily due to its widening legalization and depreciating stigma.

The increase is driven almost entirely by adults aged **26 and older**: this group’s use of the drug rose from **27**.**1 million in 2021 to 34**.**3 million in 2024**, contradicting the long-held assumption that marijuana use is primarily a youthful pursuit. As restrictions relax, older adults increasingly incorporate marijuana into their routines.

And this is a shift that will have long-term implications regarding how the health system monitors and responds to cannabis-related dependence, impairment, and drug interactions across an aging population.

**Cigarettes**account for **37**.**8 million** users, a number that continues the drug’s long-term popularity decline: traditional tobacco consumption has already partly given way to **nicotine vaping**, now regularly used by **27**.**7 million people**.

The vaping rise is largely due to younger Americans: data suggests that **23**.**7%** of adults aged **18 to 25** vape nicotine at least once a month, a rate nearly **three times** the national average. 

Among adolescents aged **12 to 17**,**71**.**5%**of those who used any nicotine product in the past month reported **vaping** exclusively, further indicating a move away from cigarettes to an alternative delivery system that’s ultimately harder to regulate.

Despite this shift, widespread nicotine dependence endures, with important long-term healthcare permutations, and added worries around unique vaping health issues. 

Vaping while driving occupies a legal gray area that’s become a road safety concern. While no federal law specifically bans vaping while driving, the physical distraction of handling a vaping device, and the added potential for limited visibility due to vapor clouds, can give police officers grounds to issue penalties of up to $2,500 under existing distracted driving legislation.

Although 3,275 people were killed in distraction-affected crashes in 2023, experts note that true figures may be significantly higher due to underreporting.

Overall, this monthly data snapshot confirms that substance use is a routine part of millions of American lives, with the line between use and disorder both blurred and far more widely crossed than most public conversations acknowledge.

## Substance Use Disorder

Although there is a difference between substance use and substance use disorder, around a sixth (**16.8%** of the population aged 12 or older, or **48**.**4 million** people) of Americans have moved from drug use to problematic drug abuse and dependency.

According to the **DSM**–**5**, a **substance use disorder** is diagnosed when an individual meets at least two of eleven criteria within twelve months, across four core factors: **impaired control over use**, **social impairment**,**risky use**, and **pharmacological dependence**. The criteria threshold is deliberately broad and is designed to capture the full spectrum of dysfunction that substance use can cause long before a person reaches a definite crisis. 

These factors are not restricted to stereotypical, marginal victims. Substance use disorders affect the functioning professional who drinks too much to unwind, the college student whose marijuana use has quietly become an addiction, the chronic pain patient whose use of prescription opioids has spiraled out of control, and all other types of drug users.

Study data makes it clear that tens of millions of Americans regularly move beyond the clinical threshold without receiving a diagnosis or seeking help.

Alcohol use disorder is the leading single-substance disorder, both in terms of raw numbers and as a percentage. **27**.**9 million** people are affected (**9**.**7%**of the population aged **12 or older**) or roughly **one in every ten** Americans.

Despite such elevated numbers, alcohol disorder is among the least treated drug problems, and the data reveals why the treatment gap is so persistent: the majority of alcohol use disorder cases are classified as ‘mild’, meaning those affected may underappreciate their affliction. Any drug use classed as a disorder means there is clear clinical dysfunction. Additionally, without any intervention, mild disorders can quickly deteriorate.

**Drug use disorder**(as an umbrella term comprising all drugs other than alcohol) affects **28**.**2 million**Americans (**9**.**8%**, up from **8**.**7%** in 2021). 

**Of the 28**.**2 million**,**Marijuana** use disorder is an issue for **20**.**6 million** Americans,  **7**.**1%** of the population, a figure that steadily rose between 2021 and 2024. 

familiar severity pattern applies: most marijuana use disorder cases are classified as ‘mild’, which means millions of people continue to function with a diagnosable condition they’re unlikely to recognize or address.

**Opioid use disorder** affects **4**.**8 million** people, with nearly one in five opioid use disorder cases classified as ‘severe’ (that’s **932**,**000**people suffering with active, high-risk dependence).

And only **17%** of those with opioid use disorder received medication-assisted treatment in 2024. Given that medication-assisted treatment is the most evidence-supported intervention available (and has been shown to reduce overdose deaths by nearly **70%**), the fact that **83%** of those who need it most are denied this intervention is one of the most consequential public health failures reflected in this dataset.

**CNS stimulant use disorder** (which encompasses cocaine, methamphetamine, and prescription stimulant misuse) affects **4**.**3 million** Americans and carries the most alarming severity profile of any disorder on this list.

Nearly **38%** of CNS stimulant use disorder cases are classified as severe, compared to roughly **20%** for alcohol and marijuana. That ratio reflects the neurological reality of stimulant addiction, the onset of which is often rapid and relatively more resistant to treatment than other substance use disorders.

It also reflects the growing presence of fentanyl, a phenomenon that has blurred the line between stimulant use and opioid exposure and contributed to the recent and dramatic rise in polysubstance overdose deaths. 

Finally, **7**.**7 million** Americans meet the criteria for both **alcohol*****and*****drug use disorder**. For those suffering, that means compounded risk: higher rates of combined, exacerbated mental health issues, lower treatment engagement, and a significantly elevated overdose and mortality risk compared to those with a single disorder. 

Combined, the data describes a clear public health emergency that involves a wide cross-section of society suffering high levels of insufficient (or nonexistent) treatment. And it’s a problem that disproportionately affects U.S. states.

Although we’ve established that the national average substance use disorder rate is **16**.**8%**, that burden is unevenly distributed between states. 

In 2024, in the **District of Columbia**,**Colorado**,**and Maine**, more than **22%** of residents aged 12 or older met the clinical criteria for a substance use disorder. 

Colorado’s percentage means around **1**.**3 million** of its residents suffer from a substance use disorder, while **Nevada**‘**s 21**.**74% rate** translates to an estimated **691**,**300** people.

The states dominating this list skew heavily toward the **Mountain West** and **New England**, a geographic pattern that diverges sharply from the opioid use disorder map, which has **Mississippi** (**3**.**07%**)**and West Virginia**(**2**.**99%**) leading the nation. 

That contrast reflects two fundamentally different substance crises. The top substance use disorder states are largely driven by marijuana and alcohol use, while the top opioid disorder states are defined by decades of prescription drug oversaturation and healthcare failures that have blighted recovery for the people most in need of help.

Tragically, many drug users ultimately take a fatal overdose, as the following statistics underline.

### U.S. Drug Overdose Deaths

For over a decade, drug overdose deaths in the U.S. followed an upward trajectory. By **2022,** the country had peaked with **107**,**941** overdose deaths, with the age-adjusted death rate having climbed to **32**.**6 per 100**,**000**, figures that put drug overdoses among the leading causes of death for Americans under the age of 45. 

The first hint at a reversal came in **2023**, when the number of deaths modestly declined to **105**,**007**. Yet **2024** marked what public health officials described as a historic and unprecedented turning point.

Data from the CDC’s National Vital Statistics System confirmed 79,384 drug overdose deaths in 2024: a decrease of **26**.**2%** from 2023 numbers and the single largest year-over-year percentage decline of overdoses on modern record. 

The 2024 figure also represents the lowest annual overdose death toll since 2019, and translates to more than **80 fewer lives lost every single day** compared to 2023. 

Additionally, the age-adjusted death rate fell from **31**.**3 per 100**,**000 in 2023 to 23**.**1 in 2024**, a decline that nonetheless still represents a death toll far in excess of pre-pandemic norms and which still demands sustained attention.

**74**,**189**men (who bear the disproportionate burden (69%) of drug overdose fatalities) died in**2023**; in **2024,** the figure was **55**,**076**, a decrease of**27**.**3%**. For women, fatalities dropped from **30**,**818 to 24**,**308,** a **23% decline**.

By drug type, synthetic opioids excluding methadone (primarily fentanyl and fentanyl analogs) remained the dominant driver of overdose deaths despite a **35**.**6% decline**, falling from **72**,**776 deaths in 2023 to 47**,**735 in 2024**. 

Cocaine deaths dropped **26**.**7% to 21**,**945**, while methamphetamine and other psychostimulant deaths declined **19**.**8% to 28**,**722**. 

The breadth of improvement across drug types suggests that systemic forces, including expanded naloxone distribution, greater access to medications for opioid use disorder, and a reduction in fentanyl supply from key source countries, are beginning to reap life-saving rewards.

Whether 2024 marks the beginning of a sustained reversal or a temporary plateau will depend almost entirely on whether public health investments are maintained and expanded in the coming years.

Let’s look at a breakdown of overdose death figures by key categories.

## Overdose Fatalities: Demographic Categories

### Age Groups

In 2024, drug overdose death rates declined across every age group (compared to 2023 figures). The extent of the decline across different age groups tells an invaluable story about where the crisis has hit hardest and where recovery is moving fastest. 

Adults aged**35 to 44** continued to carry the highest overdose death rate of any age group (**44**.**2 per 100**,**000**), recording **20**,**116 deaths** despite a **27**.**4%** decline from 2023 figures. This reflects a persistent pattern: many years of high exposure to fentanyl and stimulants during the peak years of the crisis. 

The steepest improvement came among the youngest age group: adults aged **15 to 24**were subject to a **37% decline**, with deaths falling from **5**,**926 to 3**,**810**. This high percentage drop clearly indicates that prevention and harm reduction efforts targeting younger Americans are gaining real traction. 

Adults aged **25 to 34** were subject to a 33.3% fatality decline to **14**,**131 deaths,** while those in the **45 to 54 and 55 to 64** brackets saw more moderate improvements of **23**.**1% and 21**.**5%,** respectively. 

The smallest decline (and the most concerning outlier) involved adults aged **65 and older,** for whom the death toll fell just **8**.**8%**,**from 8**,**694 to 8**,**195,** while the death rate moved from **14**.**7 to 13**.**4 per 100**,**000**.

Such a muted improvement reflects a fundamentally different overdose profile regarding older adults, one driven more by prescription opioids, benzodiazepines, and polypharmacy than by illicit fentanyl.

### Relationships

Of the nearly 50 million Americans who met the diagnostic criteria for a substance use disorder in 2024, many are in a relationship. Research consistently shows that couples featuring one partner misusing substances report significantly lower relationship satisfaction than those seeking help for marital problems alone.

### Race

Drug overdose death rates declined across every racial and ethnic group in 2024, but the disparities between groups bearing remain striking. 

**American Indian and Alaska Native** people carry the highest death rate by a significant margin: **51**.**6 per 100**,**000**.  **1**,**237 deaths**in 2024 (down from 1,548 in 2023)  represent a rate more than double the national average (23.1 per 100,000) and more than eleven times that of **Asian** people, who recorded the lowest rate (**4**.**4 per 100**,**000** across **1**,**044 deaths**).

This disparity is rooted in long-term disproportionate healthcare infrastructure, geographic isolation, and comparatively high rates of untreated substance use disorders. Overall, it represents one of the most persistent and least-addressed inequities in American public health.

**Black Americans** saw the largest fatality decline of any group (**30**.**9%**), with deaths falling from **21**,**547 to 15**,**228**, a significant shift after many years of disproportionate impact driven by fentanyl issues. 

**White Americans**account for the largest absolute number of deaths at **48**,**436**,**down from 63**,**659 in 2023**. That’s a**25**.**4**% decline that closely mirrors **Hispanic American**trends (from **14**,**520 fatalities to 11**,**239**). 

**Native Hawaiian and Pacific Islander** deaths declined from **174 to 142**,**a 21**.**8%** reduction. 

Although broad improvement across all groups is clear, long-term structural inequities still persist. Even better results seem possible with adequate funding across all racial and ethnic groups, and more parity regarding treatment availability across all national states. With that aspect in mind, it’s worth taking a look at which areas rely most on substance use care.

### Substance Use Treatment Availability in the United States

Of all 50 U.S. states, Alaska leads in substance use treatment, with **5**.**55% of the population reliant on care**. That might seem a surprising figure for such a geographically isolated state with a limited healthcare infrastructure. Yet it reflects the extent to which available treatment is utilized by a population with few options. 

**Tennessee** (**5%**) also features an especially high proportion of its population reliant on substance use care. Along with other high-ranking states, **West Virginia**,**Ohio**,**Alabama**,**Louisiana**,**Kentucky**,**and Mississippi**, Tennessee is an epicenter for opioid issues, stimulant use, and substance use disorder.

High treatment rates in high-disorder states often reflect the severity of the crisis as much as the adequacy of treatment availability, and the two are easy to confuse.

A state doesn’t earn a high treatment ranking by solving its substance use problem: it’s often a case of having generated the right level of infrastructure to address it. 

**Ohio**‘**s** raw substance use treatment estimate of **561**,**200**is the single highest figure in the top 10. And that’s a direct result of a state that has spent decades building crisis response capacity under enormous pressure. 

North Carolina (**449**,**400**) and Tennessee (**356**,**500**) reflect similar dynamics: large populations carrying large burdens, with treatment systems straining to accommodate need.

And needs are often not met. In 2024 in **Tennessee**, nearly **3 in 4**residents (**73**.**60%**) who needed treatment never received any. In **West Virginia**, that figure is slightly higher than 3 in 4 (**75**.**42%**).

Leading the nation on treatment access may still mean leaving the vast majority of people who need help without it. In **Alaska**, for example, **72**.**88%** of people who needed help never received it.

**Missouri**‘**s 79**.**36%** unmet need rate, the highest state score, means that roughly **4 in 5** Missourians who qualified for treatment in 2024 went without it.

Yet according to SAMHSA’s newly released 2024 National Survey on Drug Use and Health, **80%** of Americans who needed treatment for a substance use disorder in 2024 did not receive it. Just **3**.**5%** (**10**.**2 million** people) received substance use treatment in 2024, down from 4.6% in 2023.

## Areas With A Substance Use Issue: The Economic Toll

When drug activity takes root in a neighborhood, as well as losing their sense of safety, homeowners also lose measurable financial value.

Research consistently shows that concentrated crime activity drives down adjacent property values, with studies finding that an increase in property crime can reduce home values by as much as **3%**. Violent crime associated with drug activity, robberies, assaults, and homicides can dent values even further. 

In communities already dealing with the human toll of addiction, the damage to property values adds another layer of harm that often means low-income homeowners struggle to build vital savings cushions, lower levels of local reinvestment, and entire neighborhoods caught in a cycle as economic as it is social.

## Substance Abuse: An American Crisis

The substance use crisis in America in 2024 affects a national majority. In a single month, **168 million**people aged 12 or older (**58**.**3%** of the surveyed population) used tobacco, nicotine, alcohol, or an illicit drug. 

Alcohol dominates drug usage and does so by an enormous margin, with **134**.**3 million** monthly users. Marijuana is used by **44**.**3 million people,** a number driven by adults aged 26 and older as legalization expands and social stigma erodes. 

***Drug use disorder***(***as an umbrella term comprising all drugs other than alcohol***)***affects 28***.***2 million Americans***(***9***.***8%***,***up from 8***.***7% in 2021***)

Of the **168 million** Americans reportedly using a substance during a single month, nearly **48**.**4 million**(**16**.**8%**) of all Americans aged 12 or older met the clinical diagnostic criteria for a substance use disorder. That number comprises myriad different types of American people – not just those who fit a time-honored stereotype. 

Alcohol use disorder leads on numbers with 27.9 million affected: drug use disorder (28.2 million) covers numerous different drug types. Marijuana disorder affects 20.6 million; opioid use disorder, which affects 4.8 million, involves the most acute severity profile.

Regarding CNS stimulant use disorder (4.3 million), nearly 38% of cases are classified as severe, the most alarming concentration of high-acuity dependence in the entire dataset.

The overdose picture was subject to a welcome trend reversal in 2024. Final CDC data confirmed 79,384 drug overdose deaths, a 26.2% drop on 2023 numbers and the single largest year-over-year percentage drop in the modern history of the overdose crisis. Overdoses due to synthetic opioids (primarily fentanyl) declined 35.6% to 47,735 deaths, while cocaine and stimulant deaths also fell. 

Yet the national rate of 23.1 overdose deaths per 100,000 still far exceeds pre-pandemic norms, and the demographic picture reveals clear ethnic disparities. American Indian and Alaska Native people died at a rate of 51.6 per 100,000, more than double the national average and more than eleven times the rate recorded among Asian Americans.

And there are still significant drug use treatment issues. Of the estimated 18.25% of Americans classified as needing substance use treatment in 2024, 4 in 5 never received it. Even states like Tennessee, which ranks very high for treatment percentages, were unable to treat 3 in 4 eligible residents. 

And the cost of drug use disorder reaches far beyond the individual. The vast majority of the nearly 50 million Americans with a substance use disorder are in a family, a relationship, and regularly work. In the U.S. in 2022, drug use caused an estimated $4 trillion in societal and economic damage. 

Drug use and drug use disorders in the U.S. are not marginal problems. The American drug problem affects all ages, income levels, genders, races, ethnicities, and states.  And in far too many cases, despite improving numbers in some respects, too many Americans still cannot access the help they need, with often devastating consequences.

People trust medical professionals to care for them in their most vulnerable state. However, doctors sometimes make choices that result in harm or even death to their patients.

If you suffered an injury or lost someone you love because of a healthcare professional’s negligence, Utah civil court allows you an avenue through personal injury law to seek compensation for your losses.

While you are entirely within your rights to represent yourself, your chances of a successful outcome significantly improve with the help of a Siegfried & Jensen [Utah medical malpractice lawyer](https://siegfriedandjensen.com/utah/medical-malpractice-lawyer/).

---

Source: https://siegfriedandjensen.com/research/drug-addiction-in-the-suburbs/