Key Points

  • SAMHSA’s 2025 National Survey on Drug Use and Health found that nearly 45 million Americans (15.3%) met diagnostic criteria for a substance use disorder in the past year, while alcohol use disorder fell from 10.6% in 2021 to 8.9% in 2025.
  • An estimated 21.4 million people used cannabis on 20 or more days in the previous month, compared to 17.2 million who drank alcohol at the same frequency. Alcohol still has roughly three times as many total users, but the frequency gap has reversed.
  • The widely reported claim that daily cannabis use now exceeds daily cigarette smoking relies on different definitions: NSDUH measures cigarette use on all 30 days, while cannabis and alcohol use the 20-day threshold. The cannabis-versus-alcohol frequency gap holds up under the same definition.
  • There is no FDA-approved medication for cannabis use disorder. Treatment relies primarily on behavioral approaches like cognitive behavioral therapy, which differs from the medication-assisted care available for alcohol and opioid use disorders.
  • Among 12-to-17-year-olds, rates of tobacco, alcohol, binge drinking, and illicit drug use all declined from 2021 to 2025. Adolescents are now more likely than adults to have received mental health treatment in the past year (27.6% vs. 21.6%).
  • Nicotine vaping among people aged 12 and older rose from 8.3% in 2022 to 10.1% in 2025, and roughly four in five adults did not receive any mental health treatment last year.

Addiction News Weekly Episode 1.11

In This Episode:

Episode Transcript

Welcome to Addiction News Weekly by Rehab.com, where we break down the biggest stories in addiction, recovery, and public health.

The 2025 NSDUH: America’s Annual Behavioral Health Checkup

This week, the country got its annual checkup. SAMHSA released the 2025 National Survey on Drug Use and Health on July 27th.1 The NSDUH has run in some form since 1971, reaching tens of thousands of people aged 12 and older every year, asking about alcohol, tobacco, and illicit drug use, about mental health symptoms, and about whether they sought or received care. It is the primary data set that federal agencies, state health departments, insurers, and treatment providers use to plan services, which means these numbers shape which programs exist in your community a year from now.

Among people aged 12 and older, 56 percent, about 162.8 million people, used tobacco, vaped nicotine, drank alcohol, or used an illicit drug in the past month.1 Alcohol remains by far the most widely used at 129.1 million past-month users, and 56.8 million of those, about 44 percent, reported binge drinking. Nearly 45 million people, 15.3 percent, met diagnostic criteria for a substance use disorder in the past year.1

The clearest movement in the five-year window is alcohol. Alcohol use disorder came down from 10.6 percent of the population in 2021 to 8.9 percent in 2025, a drop from nearly 29.7 million people to 25.7 million.1 The rate of drug use disorder was largely unchanged over the same period, so the top-line story is that fewer people are meeting criteria for alcohol use disorder while the drug picture itself holds steady. And as we will get to, the composition of that drug picture is changing.

Daily Cannabis Use Now Rivals Daily Drinking

One finding from the SAMHSA survey traveled further than the rest and deserves a careful read. An estimated 21.4 million people aged 12 and older used cannabis on 20 or more of the previous 30 days in 2025, and an estimated 17.2 million drank alcohol that often.1 Both figures use the same 20-day threshold, which makes that a direct comparison, and daily or near-daily cannabis use has grown by nearly 4 million people since 2021.

Significant coverage has also reported that daily cannabis use now exceeds daily cigarette smoking, at 21.4 million against 19.9. That comparison is shakier than it looks. The NSDUH measures daily cigarette smoking as use on all 30 days, a stricter bar than the 20-day standard applied to cannabis and alcohol. Measured at 20 days, the cigarette number would be higher.

The cannabis-versus-alcohol frequency gap, though, survives scrutiny. An analysis published in the journal Addiction found that daily cannabis use first passed daily drinking back in 2022, and total prevalence still points the other way: 129.1 million people drank in the past month against 43.8 million who used cannabis, roughly three times as many.2 What changed is frequency, not head count. That same analysis found the median cannabis user reported using on 15 to 16 days a month against 4 to 5 days for the median drinker.2

What Cannabis Use Disorder Treatment Actually Looks Like

For what that frequency actually means clinically, here is Rehab.com Chief Medical Officer Dr. Sylvie Stacy. Prevalence tells you how many people have tried something, but frequency is actually a different number, and it is also one that I care about. Regular daily or near-daily use of a substance is what drives tolerance and withdrawal symptoms, and those are features that often contribute to turning substance use into a substance use disorder.

When I see that the median cannabis user is consuming 15 or 16 days a month, while the median drinker is at 4 or 5, that is a significant clinical difference. That difference exists even though alcohol has three times as many users overall. I have had patients tell me that their use is not a problem, and the reason that they give is along the lines of a friend or family member drinking more than they, the patient, smoke, but that comparison is not really useful in a clinical setting.

A pattern of regular and frequent cannabis use is important from the viewpoint of a medical provider or another clinician, even when it may seem unremarkable compared to somebody else’s drinking, and even when it has not caused an obvious crisis or problems yet in the person’s life. Another thing I want people to understand is how different cannabis is to treat compared to other substances. There is no FDA-approved medication for cannabis use disorder.

For alcohol and opioids and nicotine, we do have medications with pretty strong evidence behind them to use alongside counseling, but for cannabis, care is typically behavioral approaches like cognitive behavioral therapy. We do sometimes use medications off-label alongside therapy, but there is somewhat limited evidence from research to really support those quite yet, and that is not a reason to be pessimistic. Behavioral treatment like therapy does work very well, and medication does help for certain patients, but it means that the treatment plan really does look different than it typically does for other substances, specifically alcohol or opioids.

Many addiction treatment programs are structured primarily around alcohol and opioids because that is where historically the funding and medications have been focused. So if cannabis is the concern in a patient, I urge someone to ask directly whether a program treats cannabis use disorder specifically and which therapies that they use for it. A program that can answer that concretely is more likely to be up-to-date with current evidence and to have individualized treatment plans that they provide.

Going back to the new data and looking beyond those cannabis numbers, the 2025 survey shows another finding in young people worth mentioning. We are seeing drops in alcohol use, in binge drinking, and nicotine vaping among adolescents and young adults, and that is encouraging. But when you look at the subset of teens and young adults dealing with moderate to severe anxiety or depressive episodes, their rates of substance use and co-occurring disorders are quite a bit higher than their peers. They are likely turning to substances to self-medicate their underlying distress in many cases. There are a lot of medical practices and treatment programs that unfortunately still try to treat mental health and substance use separately when it is important to address them together because these conditions are very intertwined. They can sometimes feed off of each other and can make one another worse. So it is important that we integrate care as much as possible.

Young People Are Using Less, With One Clear Exception

Our final story is the youth picture, and it is mostly encouraging. Among 12-to-17-year-olds, the survey recorded declines in past-month tobacco use, alcohol use, and binge drinking, along with a drop in past-year illicit drug use.1 For 18-to-25-year-olds, the pattern was similar and somewhat broader, adding declines in nicotine products and cigarettes and in past-year prescription stimulant or opioid use.

ABC News asked researchers what was driving that. Daniel Kruger, a research associate professor at the University at Buffalo, said younger cohorts are simply taking fewer risks across the board, and less risk-taking has come with less substance use.3 He pointed to a longer runway into adulthood, with young people driving later and moving out later, and to more supervised and online time, leaving fewer of the unstructured hours when substance use has typically happened. He said basic information about risks and harm, rather than dramatic scare-based programming, appears to be what is working.

The second encouraging finding is about care. SAMHSA reported that 27.6 percent of adolescents received mental health treatment in the past year, compared to 21.6 percent of adults 18 and older.1 Adolescents are now more likely than adults to have received mental health care, and for that age group, substance use and treatment engagement are moving in the same direction.

The exception is vaping and cannabis. Dennis Hien, who directs the Rutgers Center of Alcohol and Substance Use Studies, described the trend shifting toward higher vaping and higher cannabis use, which may amount to a substitution rather than a straightforward decline.3 Past-month nicotine vaping among people age 12 and older rose from 8.3 percent in 2022 to 10.1 percent in 2025.1 Hien attributed part of that to perception, saying young people may view alcohol and nicotine as dangerous while seeing cannabis and vaping as comparatively harmless.

There are two practical takeaways. For families, the substance most likely to bring a young person into care is not what it was a decade ago. It is less likely to be alcohol and more likely to be cannabis or nicotine, which affects which programs actually fit since not every facility has real experience with cannabis use disorder or nicotine dependence in adolescents. It also affects timing because falling alcohol numbers can make a family slower to recognize a problem that is real but looks different from the one they were watching for.

And for adults, flip that treatment comparison around. The useful reading is not that teens are doing well. It is that roughly four in five adults did not receive mental health treatment in the past year. Two caveats there. The survey does not explain why the rates differ by age, and these are self-reported treatment figures rather than measures of need. Part of the gap is probably structural since adolescents are often routed toward help by a parent, a pediatrician, or a school, while adults have to build that path themselves. What it suggests is that for most adults not in care, the barrier is logistical rather than a lack of options. Verifying coverage before you start calling programs changes which facilities are realistic, and asking whether a program treats co-occurring mental health conditions matters because a substance use disorder and a mental health condition frequently appear together and are better handled by one team rather than by two.

Conclusion

One survey, and the findings do not all point the same way. Alcohol use disorder is down. Young people are drinking, smoking, and using illicit drugs less than they were five years ago, and more of them are getting mental health care than adults are. At the same time, adult cannabis use is climbing in both reach and frequency, and this is a substance with no approved medication. Youth vaping and cannabis are rising while everything else falls, and four in five adults did not receive any mental health treatment last year.

Good data does not hand you a single story. It tells you where to look next.

If you or someone you love is looking for treatment, Rehab.com lists thousands of verified centers across the country, and free, confidential support is available anytime through the SAMHSA National Helpline at 1-800-662-4357. And if you are in crisis, you can call or text 988 at any time.

Those are the top stories in the news. For more, visit Rehab.com. We will be back next week. I’m Kay, and thank you for listening.

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Sources in This Episode

  1. Substance Abuse and Mental Health Services Administration. 2025 National Survey on Drug Use and Health (NSDUH): Key Substance Use and Mental Health Indicators. Published July 27, 2026. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2025. Accessed August 11, 2026.
  2. Caulkins JP. Changes in self-reported cannabis use in the United States from 1979 to 2022. Addiction. 2024;119(9):1648-1652.
  3. Why alcohol and drug use may be declining among young Americans. ABC News. Published July 2026. https://abcnews.com/Health/alcohol-drug-declining-young-americans/story?id=135240157. Accessed August 11, 2026.
Dr. Sylvie Stacy
By Dr. Sylvie Stacy
Published on August 11, 2026
Sylvie Stacy, MD, MPH, Medical Officer at Rehab.com, is a board-certified addiction medicine specialist with over a decade of experience treating individuals with addictions in diverse clinical settings including residential treatment programs, detox centers, outpatient clinics, and correctional facilities.