As 2025 arrives, I found myself reflecting on 2024's failures and accomplishments to formulate goals for this upcoming year. As I consider my aspirations, one priority has remained constant since starting my addiction clinic: having the greatest impact possible for those seeking recovery. And I believe that the best way to do this, is to share information. I've cared for thousands of patients over my 26-year career. I realize I can't take care of everyone, although I would love to. For those who see me at the methadone, Suboxone, stellate ganglion block, and pain clinics where I work, you know I enjoy what I do. Doing my part to address drug use in America is truly a labor of love for me, and I hope that my work will be lifesaving for you.
Statistics on Addiction
I want to share some information that may surprise you about how widespread drug use is in the United States. I’ve been looking closely at the 2023 National Survey on Drug Use and Health (NSDUH), which is considered one of our most comprehensive sources of data on substance use and mental health. The information from 2023 is the latest report that was released during the summer of 2024. The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the U.S. Department of Health and Human Services (HHS), is the lead agency responsible for the NSDUH. It’s a massive survey—tens of thousands of people, conducted through in-person interviews, all anonymous, so it gives us a pretty accurate picture of what’s really happening out there.
Let’s get into the numbers. According to the NSDUH, nearly 60% of Americans aged 12 and older used some kind of substance in the past month. That includes tobacco products, nicotine through vaping, alcohol, or illicit drugs. This translates to about 167.2 million people. That number alone is pretty high—higher than you probably expected. It is so important to let that sink in because there is so much shaming with addiction. However, the reality is that more often than not, the person who is shaming someone else has an addiction themselves. Even more startling is what is missing from the statistics - food addiction. Food addiction, or even sugar addiction, is not an addiction that is recognized by the DSM V (Diagnostic and Statistical Manual of Mental Disorders - 5th Edition), but if you apply the criteria for substance use, it would apply to most people who are overweight. The NSDUH report doesn't include the age group younger than 12. However, surprisingly, substance use does begin in age groups younger than 12.
Statistics on Alcohol
If we focus on alcohol for a moment, the survey shows that 47.5% of Americans—over 134 million people—consumed alcohol in the past month. But more striking is that 45.6% of those drinkers were binge drinking in that same period, which is over 61 million people. This tells me it’s not always just a single glass of wine at dinner. It often goes well beyond that and might include what is considered alcohol use disorder (AUD).
Now, this is a good time to talk about the difference between use, misuse, and addiction. Simply having a drink or taking a prescribed medication is not automatically a sign of a problem. Misuse happens when someone consumes a substance in a way that wasn’t intended—higher quantities, more often, or using someone else’s prescription. Then there’s addiction, which meets specific clinical criteria: tolerance, withdrawal, and continued use despite harmful consequences. It’s that stage where someone feels powerless to stop even though it’s causing harm in their life. Illicit drug use isn't always required to have an addiction. Alcohol is a legal substance.
Tobacco, Nicotine, Marijuana, and Vaping
Moving on to nicotine, smoking has been a known health issue for a while, but vaping is becoming more and more common, especially among younger people. According to the survey, 24.1% of those aged 18 to 25 reported vaping nicotine in the past month, compared to 7.4% among people 26 and older. Traditional tobacco use is still a concern as well, with 17.6% of Americans aged 12 or older—roughly 50 million people—using some form of tobacco in the past month. Missing from the data is the trend of young adolescents, 10-11 years old, beginning vaping.
Marijuana (cannabis) is another big topic. As more states legalize or decriminalize it, usage has grown. The NSDUH found that 61.8 million people used marijuana in the past year. It’s not just smoking anymore, either—edibles and vaping forms of marijuana are taking off, and younger folks in particular seem to use it this way. Marijuana addiction is a real risk.
Heroin, Cocaine, Methamphetamine, and Prescription Opioid Drug Use in America
Then there’s prescription drug misuse, which is often overlooked. The survey shows 8.6 million people misused pain relievers, 4.7 million misused tranquilizers or sedatives, and 3.9 million misused stimulants in the past year. Hydrocodone and oxycodone are the most frequently misused types of pain relievers. Even if these medications are originally prescribed, they can still be used improperly—taking larger doses, using them more frequently than directed, or using someone else’s prescription.
When we talk about very serious substances, heroin is a key concern. According to the survey, about 660,000 people used heroin in the past year. That might not be as high as some other stats, but heroin is extremely dangerous and addictive, making every case a potential crisis. Cocaine was used by around 5 million people, and methamphetamine by 2.6 million. Hallucinogens came in at 8.8 million people. I have to say that this number was shocking even to me. Even inhalants, often viewed as something teens try, were used by 2.6 million individuals, and that includes adults.
Opioids deserve special mention. Millions of Americans suffer with opioid misuse, which includes pain medications and heroin. Fentanyl has made this even more severe, because it’s extremely potent and often mixed into other drugs without people realizing it. A tiny amount can be deadly, and that’s why it’s such a critical issue.
When Does Drug Use Become An Addiction?
You might be wondering, “How do you tell if it’s a problem?” That’s where those definitions help—use can be fine if the substance has a clinical indication and has no harmful impact. Also, there are legal substances without medical indication that can be used without causing harm. Misuse is when quantity, frequency, or purpose goes beyond what’s safe or intended, and that can lead down the road to addiction. Addiction, or substance use disorder, is the point where the body and mind are so dependent that a person can’t quit even if it’s causing major harm in their life. That harm can end in a drug overdose death. Illegal drugs should not be used in any quantity because of the high risk for addiction, the potential for overdose, and death.
I think we should also note how methods of using substances change over time. Edibles can catch people off guard, because it takes longer to feel an effect, making them consume more than intended. Vaping is often perceived as safer than smoking, but research on the long-term health effects is still emerging. It’s crucial to remember that all of this can affect anyone—people of all ages, backgrounds, and walks of life. This is not someone else’s issue; it’s something that affects every community in one way or another.
Prescription misuse can start innocently—maybe you were prescribed pain meds for a legitimate reason, but you continued to take them even after the pain went away, or you took more than prescribed. Maybe a family member or friend shared their medication with you, thinking it was harmless. Unfortunately, that can be the first step toward serious problems like dependence and withdrawal. ALL of my addiction patients thought, "it could never happen to me."
With all these facts, it’s clear how large and complicated this situation is. Whenever you see the data laid out like this, it’s clear there’s a widespread challenge at hand, including alcohol, nicotine, prescription meds, and illicit drugs like cocaine, heroin, and fentanyl. It’s also important to keep in mind these are real people behind these numbers—neighbors, friends, coworkers, family members.
Summary
So, what’s the takeaway from the drug use statistics? Well, knowing the facts is powerful. If you are dealing with addiction, seeing the numbers let you know that you aren't alone. We are all prone to addiction. If you are one of my patients, you probably heard me say, "if you want to see an addict, just look in the mirror." We all have dopamine in our brains and encountering the right drug will turn us into addicts. The goal is to avoid all drugs and if addiction has already occurred, get help ASAP!!
There are 340 million Americans
167.2 million people used an addictive substance
134 million people consumed alcohol
61.8 million people were marijuana users
50 million used some form of tobacco
8.8 million people used hallucinogens
8.6 million people misused pain relievers
5 million people used cocaine
4.7 million misused sedatives such as benzodiazepines and barbiturates
3.9 million misused stimulants
2.6 million people used methamphetamine
2.6 million people used inhalants
660,000 people used heroin
Use vs. Misuse vs. Addiction (drug abuse)
Use: Consuming a substance as intended. This could be a drink or a prescribed medication used correctly.
Misuse: Going beyond the intended amount or purpose—taking more than prescribed, taking someone else’s prescription, or drinking so heavily that it leads to negative consequences.
Addiction: When someone cannot stop even if it’s causing harm. It often involves tolerance, withdrawal, and a feeling of being unable to control the urge to keep using.
Thank you for spending time reading this article. Over the next several weeks, I will try my best to share all that I know, the groundbreaking new therapies that I find, and hopefully provide some resources for you or a loved one find help. I am working on compiling a database of methadone clinics. Eventually, this database will grow to include a comprehensive list and link to rehab centers around the country.
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist, board certified addiction medicine specialist, and a concierge addiction doctor with over 26 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
*Disclaimer: This blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding your health or a medical condition before making any changes.
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