Epidemiology of substance abuse: trends, prevalence, and future predictions

Epidemiology of substance abuse refers to the study of the nature of substance addiction, its prevalence in various population groups, etiology, prevention, and treatment strategies.

The latest trends in substance abuse are an increase in drug use and drug overdose fatalities, the emergence of novel synthetic opioids and an ongoing opioid crisis, and the growing use of substances like stimulants and ketamine. Other trends include an increased prevalence of cannabis vaping among adolescents and a growing number of deaths linked to polysubstance abuse.

The prevalence of substance abuse among US individuals 12 years or older is 48.5 million in 2023. The emerging trends in substance abuse are increased acceptance and legalization of marijuana, the emergence of designer drugs or new psychoactive substances, and the rise of a new wave of opioid crisis being driven by the abuse of new synthetic opioids and diverted prescription medications.

What does epidemiology of substance abuse mean?

Epidemiology of substance abuse means studying how often substance addiction occurs among multiple demographic categories and its etiology with the aim of preventing and treating it. Epidemiological studies are the foundation of public health.

Epidemiology of substance use disorder aims to determine the nature of the disease, the characteristics of the population affected by the condition, and the physiological, biological, behavioral, and environmental factors associated with its development and progression. This field of study primarily assesses two dimensions of substance-use behaviors: the frequency of substance use and the degree and nature of social and health problems associated with drug and alcohol addiction.

Why is the epidemiology of substance abuse important for public health?

Epidemiology of substance abuse is important for public health because it promotes and enhances the understanding of the causes and risk factors for addiction, directs research efforts, helps formulate and assess public health interventions, and monitors the effects of these interventions. Epidemiological studies help in the formulation of evidence-backed policies and practices that increase and enhance access to addiction treatment, improve the quality of therapeutic services, and promote improved outcomes for all members of the public. These benefits additionally save societies billions of dollars every year in healthcare expenses, lost productivity, and criminal justice efforts.

What are the latest trends in substance abuse?

The latest trends in substance abuse are listed below.

• Increase in drug use: In 2022, nearly 292 million, or 1 in 18, individuals used a drug, as reported in the Key Findings and Conclusions: Drug Use Harms and Impacts booklet of theWorld Drug Report 2024, published by the United Nations Office on Drugs and Crime (UNODC). This number is 20% more than the number a decade earlier and comprises 5.6% of the global population aged 15-64 years.
• Increase in drug overdose deaths: Globally, there has been an increase in the number of drug overdose deaths in the decade leading up to 2022. In the US, the age-adjusted rate of deaths from a drug overdose increased from 8.2 deaths per 100,000 standard population in 2002 to 32.6 in 2022, according to a March 2024 report by Spencer et al., published by the Centers for Disease Control and Prevention (CDC), titled “Drug Overdose Deaths in the United States, 2002–2022.”
• Emergence of novel synthetic opioids: The European Union Drugs Agency notes that the emergence of highly potent synthetic opioids, such as fentanyl and its analogues, and isotonitazene, is likely to increase potentially fatal overdoses. Drug dealers mix fentanyl with other drugs, such as heroin, to create potent, addictive formulations. Fentanyl mixed with xylazine has been declared an emerging drug threat by the Office of the National Drug Policy of the White House due to its life-threatening effects on breathing.Fentanyl and its analogues are implicated in 17% of deaths in opioid overdoses, according to a 2017 article by Prekupec et al., published in the Journal of Addiction Medicine, titled “Misuse of Novel Synthetic Opioids: A Deadly New Trend.”
• Emergence of the opioid epidemic: The opioid abuse epidemic is a major public health crisis globally. In the US and Canada, almost 6,00,000 individuals have died from an opioid overdose in the past two decades, according to a March 2022 editorial article published in The Lancet Public Health, titled “Opioid overdose crisis: time for a radical rethink.” Of the 1,05,000 drug overdose deaths in 2023, nearly 80,000 (76%) involved opioids, according to a web release by the CDC titled “Understanding the Opioid Overdose Epidemic” published on 9 June 2025. However, other classes of drugs, too, have been implicated in opioid overdose deaths. For instance, in 2023, an estimated 47% of drug overdose fatalities involved opioids and stimulants.
• Increase in the use of psychostimulants after the COVID-19 pandemic: There has been an increase in the use of stimulant drugs like cocaine and ecstasy after the COVID-19 pandemic, according to findings published in the World Drug Report 2024 by the UNODC. The use of cocaine globally is at an all-time high, while that of “ecstasy” or “molly” (MDMA or 3,4-methylenedioxymethamphetamine and similar substances) has increased in Western and Central Europe, Australia, and New Zealand after 2022. For instance, there has been an 80% increase in the use of cocaine in Western, Central, and South-Eastern Europe since 2011. In Western and Central Europe, the number of individuals seeking treatment for “crack” cocaine use disorders has tripled during the period from 2014 to 2019. In the US, stimulant misuse has increased by 8.63% from 2021 to 2022, according to a fact sheet released by The Pew Charitable Trusts,titled “Stimulant Use Is Contributing to Rising Fatal Drug Overdoses,” last updated on 23 August 2024. Stimulant drug abuse involves cocaine, methamphetamine, and medications that are primarily prescribed for attention deficit/hyperactivity disorder (ADHD). There has been a substantial increase in the use of prescription stimulant medications among adults between the years 2016 and 2020, according to a March 2023 report by the CDC, titled “Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021.” It has been found that 25.3% of US adults aged 18-64 years misused prescription stimulants and 9% had a prescription stimulant use disorder (PSUD), according to a 2025 article by Han et al., published in the journal JAMA Psychiatry, titled “Prescription Stimulant Use, Misuse, and Use Disorder Among US Adults Aged 18 to 64 Years.” The prevalence of misuse was 3.1 times higher, and that of PSUD was 2.2 times higher in individuals using prescription amphetamines than in those using methylphenidate.
• Increase in the use of ketamine: The use of ketamine has been increasing in Western and Central Europe, the UK, Australia, and Singapore, according to the World Drug Report 2024 published by the UNODC. Overall, ketamine use has increased 81.8% from 2015 to 2019 and by 40% from 2021 to 2022, according to a 2025 article by Yang et al., published in the Journal of Affective Disorders, titled “Trends and characteristics in ketamine use among US adults with and without depression, 2015–2022.” From 2015 to 2019, its use among adults with depression increased by 139.3% and by 66.7% among those without depression. However, from 2021 to 2022, the increase in the use of ketamine (by 38.9%) was observed only among adults without depression, indicating a tendency to use the substance for recreational purposes.
• Increase in fatalities related to polysubstance use: In 2022, nearly half of all drug overdose fatalities in the US involved polysubstance use, according to a CDC publication titled “Polysubstance Use Facts,” last updated on 2 April 2024. There has been an increase in the number of such deaths. For instance, the state of Texas has witnessed a rise in the number of fatalities involving multiple substances of abuse from 629 in 2016 to 1,921 by 2022, according to a 2025 article by Nicanord et al., published in the journal Cureus, titled “Trends in Drug and Polysubstance-Related Deaths in the State of Texas: County Comparisons.” In the state of North Carolina, the percentage of fatalities from polysubstance use increased from 2.9 to 12.1 per 100,000 individuals during the period 2009-2018, according to a 2021 article by Figgatt et al., published in the journal Drug and Alcohol Dependence, titled “Trends in unintentional polysubstance overdose deaths and individual and community correlates of polysubstance overdose, North Carolina, 2009-2018.” The monthly percentage of deaths in the US involving illegally manufactured fentanyl with xylazine increased from 3% in January 2019 to 11% in June 2022, according to a publication by the CDC titled “Polysubstance Overdose,” published on 8 May 2024.
• Increasing prevalence of cannabis vaping among adolescents: According to the World Drug Report 2024 by the UNODC, the past-month prevalence of cannabis vaping among adolescents in the US and Canada has increased twofold or more since 2017. Authors Keyes et al., in their 2022 article published in the journal Addiction, titled “Frequency of adolescent cannabis smoking and vaping in the United States: Trends, disparities and concurrent substance use, 2017–19,” report that frequent cannabis use (six or more times per 30 days) with vaping among adolescents has increased from 2017 to 2019. The increase is consistent across the majority of all adolescent demographic groups. The prevalence of cannabis use disorder among individuals aged 12 years or older has increased from 3% in 2019 to 5.8% in 2021, according to a 2024 article by Temourian et al., published in the Journal of Adolescent Health, titled “Marijuana and E-cigarette Initiation Among Adolescents: A Survival Analysis.”

What is the prevalence of substance abuse?

The prevalence of substance abuse among Americans aged 12 and older in 2023 is 48.5 million, or 17.1% of the population, according to a release by the CDC titled “Substance Use and Substance Use Disorders in Travelers” published 23 April 2025. Cannabis is the most commonly used illegal drug in the US, with 52.5 million users taking the drug at least once in 2021, according to a CDC release titled “Cannabis Facts and Stats” published on 7 March 2025.

An estimated 2.4 million users in the US aged 12 and older misused prescription pain medicine in the past month in 2022, according to the findings reported in the Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (NSDUH) published by the Substance Abuse and Mental Health Services Administration (SAMHSA) published in November 2023. The figures for the past month use of hallucinogens, cocaine, methamphetamine, and heroin, in 2022, among this demographic group are 2.3 million, 2.0 million, 1.7 million, and 7,09,000, respectively. An estimated 29.5 million individuals had an alcohol use disorder, and about 27.2 million had a drug use disorder. An estimated 8.0 million individuals had both an alcohol use disorder and a drug addiction.

In the current context of the opioid epidemic, it is worth noting that, in 2023, among all American individuals aged 12 and above who used (not just misused) prescription opioids or heroin in the past year, 5.7 million users were found to have an opioid use disorder (CDC, 2025).

What is the prevalence of substance abuse among different age groups?

The prevalence of substance abuse among different age groups in the US reveals alcohol and marijuana to be the most commonly used substances, according to the findings reported in the Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health, published by the SAMHSA in November 2023. The numbers are noted in the table below.

What is the prevalence of substance abuse among men and women?

The prevalence of substance abuse among men and women reflects the greater use of all drugs of abuse among males compared to females, according to the World Drug Report 2024 published by the UNODC. These numbers are plotted in the table below.

What are the emerging patterns in drug and alcohol use by gender?

The emerging patterns in drug and alcohol use by gender suggest that the patterns of alcohol and prescription medication use among women are converging with those of men. On the whole, men consume more alcohol and experience more alcohol-related morbidities than women do. However, these gaps have been lessening. Among adolescents and young adults, these gaps have narrowed largely because alcohol use in males has decreased more than that in females. Among adults, alcohol use among women has increased more than that of men.

Authors Verplaetse et al., in their 2025 article titled “Gender differences in alcohol use disorder trends from 2009–2019: An intersectional analysis” published in the journal Alcohol suggest that Black women, women aged 50 years or more, single or married women, women with low socio-economic status, less- and highly-educated women, and women living in urban areas have greater prevalence of alcohol use disorder than men in similar demographic categories.

Women are also more likely to relapse than men in the presence of a trigger or following a stressful period, according to a 2022 article by Goh et al., published in the International Journal of Mental Health and Addiction, titled “Gender Differences in Alcohol Use: a Nationwide Study in a Multiethnic Population.” Women are more likely to misuse prescription drugs than men, according to a 2024 article by Mohammad Saleem and Touseef Rizvi published in the journal Archives of Psychiatric Nursing, titled “Gender differences in prescription misuse intention among university students: Insights from the theory of planned behaviour.”

However, men are more likely than women to misuse prescription opioids recreationally, such as to derive a “high.” Women, typically, misuse these drugs to self-medicate symptoms of pain, distress, or anxiety. Men are more likely than women to mix prescription opioids with other substances of abuse, like alcohol. There has been a greater decline in tobacco consumption in men than women, thereby closing the gender gap, according to an April 2020 report by the National Institute on Drug Abuse, titled “Substance Use in Women Research Report: Sex Differences in Substance Use.” However, the prevalence of smoking tobacco is still marginally higher in men than in women.

What is the prevalence of substance abuse among different racial and ethnic groups?

The prevalence of substance abuse among individuals aged 12 years or older across different racial and ethnic groups in the US reveals that a high percentage of American Indians or Alaskan Natives who are not Latino or Hispanic are affected, according to the findings reported in the Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health published by the SAMHSA in November 2023. The numbers are noted in the table below.

What is the prevalence of substance abuse across various socio-economic statuses?

The prevalence of substance abuse across various socio-economic statuses in the US is understood from the percentage of users aged 18 or more who reported having substance-use related problems–an indicator of abuse–in the past year, as noted in the 2013 National Survey on Drug Use and Health, published by the SAMHSA. These numbers are shown in the table below.

How does socio-economic status impact the prevalence of substance abuse over time?

Socio-economic status impacts the prevalence of substance abuse over time by influencing the age of initiation of alcohol or a drug, the type of substance abused, and the pattern of consumption. A greater frequency of drunkenness and consumption of stimulants, cocaine, and marijuana compared to norms has been observed in upper-middle-class youth. Individuals from this demographic category also exhibit a higher rate of lifetime diagnosis for alcohol and/or drug dependence compared to norms. Individuals belonging to high-income families have an increased ability to access and purchase substances of abuse as well as more social connections with others with similar means.

Children from high-income families have a greater risk of anxiety- and depression-triggered substance use because they experience greater pressure to perform. They are isolated from their parents, who tend to be hyper-busy professionals. Besides a lack of or minimal parental supervision, these young individuals also grow up having been exposed to tolerant attitudes toward substance abuse. It has been observed that the lower the family income, the greater the incidence of cigarette smoking and heavy episodic alcohol consumption. Individuals from lower-income families with no or limited access to recreational activities tend to use substances as a means to cope with stress.

What is the prevalence of substance abuse across various states and regions in the United States?

The prevalence of substance abuse across various states and regions in the United States reveals that states like Alaska, Colorado, Maine, Nevada, New Mexico, Oregon, Rhode Island, Vermont, Washington, and the District of Colombia have the highest magnitude of illicit drug users, according to the 2021 National Survey on Drug Use and Health National Maps of Prevalence Estimates, by State, published by the SAMHSA. The rates of substance use in US states are plotted in the table below.

What are the global prevalence rates of substance abuse?

The global prevalence rates of substance abuse reveal the most commonly used illicit substances in the world, per the statistics provided by the World Drug Report 2024 published by the UNODC. The number of users of the most commonly abused drugs, worldwide, is plotted in the table below.

What are the most commonly abused substances worldwide?

The most commonly abused substances worldwide are listed below.

• Alcohol: In 2019, an estimated 400 million individuals worldwide aged 15 years or more had alcohol use disorder and nearly 209 million individuals lived with alcohol dependence, according to a June 2024 publication by the World Health Organization titled “Alcohol.”
• Bath salts (synthetic cathinones): Bath salts are man-made stimulants that are designed to mimic the effects produced by cocaine, MDMA, and methamphetamine.
• Cannabis: Cannabis is a mind-altering drug derived from the Cannabis sativa plant. It affects brain regions associated with pleasure, memory, thoughts, focus, coordinated movements, and the perception of time and sensations.
• Club drugs: These are a class of psychoactive drugs that are typically used by teenagers and young adults at parties, bars, nightclubs, and concerts to increase energy, stamina, sociability, and sexual arousal. Club drugs include MDMA (ecstasy), gamma-hydroxybutyrate (GHB), ketamine, and Rohypnol (flunitrazepam).
• Cocaine: The stimulant cocaine produces an intense euphoria and is known to have a high potential for causing dependence and addiction. It is typically snorted, injected, or smoked.
• Opioids: Opioids are natural, synthetic, or semi-synthetic drugs and include both prescription pain medications and the illicit drug heroin. The majority of individuals dependent on opioids use heroin. The principal effects of opioids are reducing pain and producing feelings of pleasure and calmness.
• Inhalants: Inhalants produce intoxicating vapors that users breathe in through the mouth or the nose. Common examples of inhalants are glues, correction fluids, felt-tip markers, spray paints, and cleaning fluids.
• Prescription drugs and cold medicines: The most commonly abused prescription drugs include opioid painkillers, stimulants, and sedatives/tranquilizers. Over-the-counter cold medicines like dextromethorphan or DXM, when abused in high doses, create a euphoric or hallucinogenic effect similar to that produced by ecstasy.
• Steroids (anabolic): Anabolic-androgenic steroids are a class of appearance and performance-enhancing drugs. Both high-performance athletes and the non-athlete population are known to abuse these substances.
• Tobacco: The most common method of consuming tobacco is by smoking cigarettes. Flavored cigars, hookah, and electronic delivery devices (e-cigarettes) are the other methods of using tobacco.

What are the emerging trends in substance abuse?

The emerging trends in substance abuse include a growing acceptance and legalization of marijuana, the emergence and the subsequent rise in the use of designer drugs and novel or new psychoactive substances (NPSs), and the prominence of a new wave of opioid consumption patterns driving the ongoing opioid crisis in the US. The number of states in the US legalizing recreational marijuana has been increasing, according to a 2024 article by Yang et al., published in the journal Pediatric Reports, titled “Trends in Marijuana Use among Adolescents in the United States.” Legalization has driven a shift in attitude toward the consumption of this substance.

Author Jonathan P. Caulkins, in a 2024 article titled “Changes in self-reported cannabis use in the United States from 1979 to 2022,” published in the journal Addiction, reports that there was a 15-fold increase in the rate of individuals reporting daily or near-daily use of marijuana during the period from 1999 to 2022. Designer drugs and NPSs are regarded as emerging drugs that are chemically similar to or whose effects typically mimic those produced by existing prescription and illegal opioids, benzodiazepines, and stimulants. However, the precise health effects of NPSs are unknown, making them potential public health hazards.

NPSs include synthetic opioids like nitazenes, synthetic cannabinoids, synthetic cathinones or “bath salts,” and synthetic benzodiazepines. The opioid crisis in North America is now being driven by the misuse of diverted prescription opioids and new synthetic opioids (NSOs). This wave is different from the previous three ones that were driven by prescription opioids (methadone and natural and semi-synthetic opioids), heroin, and synthetic opioids, particularly illegally made fentanyl and fentanyl analogs. NSOs include benzimidazole opioids (BOs) that are more potent than fentanyl.