Federal: Other MH Policy

Date: July 27, 2026 Categories: Substance Use, Mental Health By: Timothy Westlake, M.D., FACEP, Chief of Staff, Substance Abuse and Mental Health Services Administration Substance use, addiction, and mental health affect many aspects of daily life in America and touch every community across our nation. During the past two decades, over 1.5 million lives have been lost to drug overdose and suicide, and many millions more have struggled with mental illness and addiction and their related health, social, and economic impacts. Substance use and mental illness are also a key driver of the chronic disease crisis impacting our nation. Research shows that substance use and health risk behaviors that emerge during childhood are strongly linked to risk for physical health conditions, addiction, and mental illness later in life. Thus, prioritizing the work of behavioral health is a lynchpin to achieving President Trump’s directive to Make America Healthy Again and celebrate the Great American Recovery. Fortunately, there are a range of evidence-based prevention, treatment, and recovery strategies that can be implemented in states and communities to prevent substance use in the first place, effectively treat addiction and mental illness, and support people in achieving long-term recovery and healing. But a critical ingredient to successfully deploying evidence-based strategies is having timely data to understand the problem, who is impacted, how the problem is changing, and where gaps in care and services exist. For more than four decades, SAMHSA’s National Survey on Drug Use and Health (NSDUH) has been the federal government’s trusted source of information on substance use and mental health patterns and trends in the U.S. Today, SAMHSA is releasing the 2025 NSDUH results which provide the latest information on trends and patterns of substance use and mental health among Americans. The 2025 NSDUH marks the first year since 2020 in which five consecutive years of data are available to assess trends across most key substance use and mental health indicators, and assess our progress between 2021 and 2025 and identify opportunities for action moving forward. In addition, today’s release represents the earliest release of the annual NSDUH report, delivering on SAMHSA’s commitment to timely, data-driven policy making and leading with gold-standard science. Additional information, data, and resources can be found on the NSDUH webpage. ## Substance Use Among Americans 12 Years or Older Alcohol, nicotine and marijuana remain the most commonly used substances among Americans. In 2025, 129.1 million people aged 12 years or older reported alcohol use in the past month, followed by 46.9 million using tobacco products, 43.8 million using marijuana, and 29.3 million vaping nicotine. Among the 129.1 million people reporting past month alcohol use, 56.8 million (44.0%) reported binge drinking in the past month. Past month use of other illicit substances such as hallucinogens, cocaine, and methamphetamine as well as misuse of prescription medications such as prescription pain relievers and stimulants were far less common compared to alcohol, nicotine, and marijuana (Figure 1). Figure 1. Number of Americans 12 Years or Older Reporting Past Month Use of Specific Substances, 2025 When examining use of illicit drugs in the past year, approximately 1 in 4 Americans 12 years or older (69.8 million; 24.0%) reported illicit drug use in 2025 (Figure 2). This included 61.6 million people using marijuana, 9.1 million using hallucinogens, 6.9 million misusing prescription opioids, 4.9 million misusing prescription tranquilizers or sedatives, and 4.2 million using cocaine. Figure 2. Number of Americans 12 Years or Older Reporting Use of Specific Illicit Drugs in the Past Year, 2025 In addition to past month and past year use, NSDUH captures the number of people in the U.S. who reported using specific drugs, alcohol, or nicotine for the first time in the past year (Figure 3). Alcohol (4.3 million new initiates), nicotine vaping (4.2 million new initiates), and marijuana (2.4 million new initiates) were the most common substances used for the first time in the past year. These annual numbers translate to approximately 11,800 new users of alcohol, 11,500 new users of nicotine vaping, and 6,600 new users of marijuana each day in the U.S. in 2025. Figure 3. Past Year Initiates of Specific Substances Among People 12 Years or Older, 2025 ## Substance Use Disorders Among Americans 12 Years or Older In 2025, nearly 45 million Americans, 15.3% of people 12 years or older, met diagnostic criteria for a substance use disorder in the past year (Figure 4). Of these individuals, 26.0 million had a drug use disorder and 25.7 million had an alcohol use disorder. About 1 in 6 people with a past year substance use disorder (16.0% or 7.1 million people) had both an alcohol use disorder and a drug use disorder in the past year. Marijuana use disorder was the most common drug use disorder (19.3 million), followed by central nervous system (CNS) stimulant use disorder (4.5 million) and opioid use disorder (4.0 million). Figure 4. Past Year Substance Use Disorders Among People 12 Years or Older, 2025 ## Key Substance Use Prevalence Trends From 2021 to 2025 Based on linear trend testing, most key substance use indicators either decreased or remained stable between 2021 and 2025 among people aged 12 or older and among specific age groups: 12 to 17, 18 to 25 and 26 or Older (Table 1). Table 1. Key Substance Use Prevalence Trends from 2021 to 2025 Substance Use Indicator12-1718-2526 or OlderOverallPast Month Nicotine Product Use*StableDecreaseStableStablePast Month Tobacco UseDecreaseDecreaseDecreaseDecreasePast Month Cigarette UseStableDecreaseDecreaseDecreasePast Month Vaping*StableDecreaseIncreaseIncreasePast Month Alcohol UseDecreaseDecreaseDecreaseDecreasePast Month Binge DrinkingDecreaseDecreaseDecreaseDecreasePast Month Marijuana UseDecreaseDecreaseIncreaseIncreasePast Year Illicit Drug UseDecreaseDecreaseIncreaseIncreasePast Year Marijuana UseDecreaseDecreaseIncreaseIncreasePast Year Cocaine UseStableDecreaseStableStablePast Year Methamphetamine UseStableStableStableStablePast Year Hallucinogen UseStableDecreaseIncreaseIncreasePast Year Rx Stimulant MisuseStableDecreaseStableStablePast Year Rx Tranquilizer or Sedative MisuseStableDecreaseStableDecreasePast Year Rx Opioid MisuseStableDecreaseDecreaseDecreasePast Year Initiation of Alcohol UseDecreaseStableStableStablePast Year Initiation of Nicotine Vaping*DecreaseDecreaseDecreaseDecreasePast Year Initiation of Marijuana UseDecreaseStableStableDecreasePast Year Initiation of Cigarette UseStableIncreaseStableIncreasePast Year Substance Use DisorderDecreaseDecreaseDecreaseDecreasePast Year Alcohol Use DisorderDecreaseDecreaseDecreaseDecreasePast Year Drug Use DisorderDecreaseStableStableStablePast Year Marijuana Use DisorderStableStableIncreaseIncreasePast Year Opioid Use DisorderStableStableDecreaseDecreasePast Year CNS Stimulant Use DisorderStableStableStableStable* Comparison is trend from 2022 to 2025 ## Mental Health Among Adults 18 Years or Older Among adults 18 years or older in the U.S., 6.6% had moderate or severe symptoms of anxiety and 14.3% had mild symptoms based on the GAD-7 scale (Figure 5). Moderate to severe symptoms were more common among 18 to 25 year-olds (12.2%) compared to adults 26 to 49 year-olds (8.1%) and adults 50 years or older (3.7%). Figure 5. Generalized Anxiety Symptom Severity in the Past 2 Weeks Among Adults 18 Years Older, 2025 Among adults 18 years or older, 7.4% (19.7 million) had a past year major depressive episode (MDE). The percentage of adults aged 18 or older who had a past year MDE with severe impairment was 5.2% (13.8 million) in 2025. As with generalized anxiety disorder symptoms, a larger percentage of adults 18 to 25 years old had MDE and MDE with severe impairment (14.2% and 10.2%, respectively) compared to adults aged 26 to 49 (9.1% and 6.7%) and 50 or older (4.0% and 2.5%). About 1 in 5 adults 18 years or older (20.6%; 54.6 million) had any mental illness (AMI) in the past year (Figure 6). The percentage of adults 18 to 25 years old with AMI was 28.6%, followed by 27.1% of adults 26 to 49 years old, and 12.8% of adults 50 or older. In 2025, 6.9% (18.2 million) of adults aged 18 years or older had serious mental illness (SMI) in the past year. Among adult age groups, SMI was highest among 18 to 25 year olds (12.1%), followed by 26 to 49 year olds (9.6%), and adults 50 years or older (3.0%). Figure 6. Percentage of Adults with Any Mental Illness and Serious Mental Illness in the Past Year, 2025 ## Suicidal Thoughts, Plans, and Attempts Among Adults Among adults 18 years or older in 2025, 5.3% (13.9 million) reported serious thoughts of suicide in the past year, 1.8% (4.9 million) made a suicide plan, and 0.9% (2.3 million attempted suicide (Figure 7). Figure 7. Suicidal Thoughts, Plans, and Attempts Among Adults, 2025 ## Adolescent Mental Health Among adolescents aged 12 to 17 in 2025, about 1 in 5 (18.0%; 4.6 million) had moderate or severe symptoms of anxiety and about 1 in 4 adolescents (23.6%; 6.0 million) had mild symptoms of anxiety (Figure 8). Figure 8. Generalized Anxiety Symptom Severity in the Past 2 Weeks Among Adolescents Aged 12 to 17 Years Old, 2025 Among adolescents aged 12 to 17, 15.1% (3.7 million) had a past year major depressive episode (MDE) and 11.0% (2.7 million; 73.8% of those with MDE) had a past year MDE with severe impairment in 2025 (Figure 9). Figure 9. Number and Percentage of Adolescents with Major Depressive Episode and Major Depressive Episode with Severe Impairment, 2025 ## Suicidal Thoughts, Plans, and Attempts Among Adolescents In 2025, 2.6 million (10.4%) adolescents reported serious thoughts of suicide, 1.3 million (5.1%) made a suicide plan, and 738,000 (2.9%) attempted suicide (Figure 10). Figure 10. Suicidal Thoughts, Plans, and Attempts Among 12 to 17 Years Old, 2025 ## Non-suicidal Self-Harm Among Adolescents For the first time in 2025, NSDUH included questions to assess non-suicidal self-harm among adolescents aged 12 to 17. Respondents were asked whether, during the past 12 months, they intentionally harmed themselves without trying to kill themselves, such as by cutting, burning, or bruising themselves. In 2025, 11.2% (2.8 million) of adolescents aged 12 to 17 engaged in non-suicidal self-harm in the past year. In addition, 2.9% (735,000) reported there were unsure or did not know whether they had intentionally harmed themselves without trying to kill themselves, and 5.6% (1.4 million) did not want to report whether they had engaged in these behaviors. ## Key Mental Health Prevalence Trends From 2021 to 2025 - Adolescents Among adolescents aged 12 to 17, prevalence for all key indicators declined between 2021 and 2025. This included declines in major depressive episode (MDE), MDE with severe impairment, co-occurring MDE and substance use disorder (SUD), co-occurring MDE with severe impairment and SUD, serious thoughts of suicide, making a suicide plan, and suicide attempt in the past year (Table 2). Table 2. Key Mental Health Prevalence Trends from 2021 to 2025 - Adolescents Mental Health Indicator12 to 17Major Depressive Episode (MDE)DecreaseMajor Depressive Episode (MDE) with Severe ImpairmentDecreaseCo-Occurring MDE and Substance Use Disorder (SUD)DecreaseCo-Occurring MDE with Severe Impairment and SUDDecreaseSerious Thoughts of SuicideDecreaseSuicide PlanDecreaseSuicide AttemptDecrease ## Key Mental Health Prevalence Trends From 2021 to 2025 - Adults Among adults 18 or older, most mental health indicators remained stable or declined between 2021 and 2025, although there were notable differences by age groups. Specifically, all indicators declined among adults 18 to 25, whereas most indicators for adults 26 to 49 and 50 or older remained stable. However, all three suicide indicators increased from 2021 to 2025 among adults 26 to 49 and those 50 or older (Table 3). Table 3. Key Mental Health Prevalence Trends from 2021 to 2025 – Adults Mental Health Indicator18 to 2526 to 4950 or Older18 or OlderMajor Depressive Episode (MDE)DecreaseStableStableDecreaseMajor Depressive Episode (MDE) with Severe ImpairmentDecreaseStableDecreaseDecreaseCo-Occurring MDE and SUDDecreaseStableStableDecreaseCo-Occurring MDE with Severe Impairment and SUDDecreaseStableStableDecreaseAny Mental IllnessDecreaseStableStableStableSerious Mental IllnessDecreaseStableStableDecreaseCo-Occurring AMI and SUDDecreaseStableStableStableCo-Occurring SMI and SUDDecreaseStableStableDecreaseSerious Thoughts of SuicideDecreaseIncreaseIncreaseStableSuicide PlanDecreaseIncreaseIncreaseIncreaseSuicide AttemptDecreaseIncreaseIncreaseIncrease ## Treatment for Substance Use Disorders and Mental Illness In 2025, fewer than 1 in 5 people (16.0%) who needed substance use treatment received treatment in the past year. Treatment receipt was highest among adolescents aged 12 to 17 years (22.8% of those needing treatment reported receiving treatment in the past year), followed by those 26 years or older (17.1%) and those 18 to 25 years old (9.6%) (Figure 11). Figure 11. Receipt of Substance Use Treatment in the Past Year Among People Aged 12 or Older Who Needed Substance Use Treatment in the Past Year, 2025 In 2025, among the 7.6 million Americans who received substance use treatment in the past year, most received outpatient treatment (4.4 million), followed by telehealth treatment (3.6 million), and inpatient treatment (2.2 million) (Figure 12). Figure 12. Types and Locations of Substance Use Treatment Received in the Past Year Among People Aged 12 or Older, 2025 In 2025, among adults with any mental illness and those with serious mental illness, the majority received mental health treatment in the past year. Overall, 50.9% of adults with any mental illness and 67.7% of those with serious mental illness received mental health treatment. There were small variations in treatment receipt by age groups (Figure 13). Figure 13. Receipt of Mental Health Treatment in the Past Year Among People Adults 18 or Older with Any Mental Illness or Serious Mental Illness in the Past Year, 2025 Among the 3.7 million adolescents aged 12 to 17 in 2025 that had a past year major depressive episode, 57.7% (2.1 million) reported receiving mental health treatment in the past year (Figure 14). Figure 14. Types and Locations of Mental Health Treatment in the Past Year Among Adolescents Aged 12 to 17 with a Past Year Major Depressive Episode (MDE), 2025 ## Substance Use and Mental Health Recovery In 2025, among adults 18 or older, 22.3 million considered themselves to be in recovery or to have recovered from their drug or alcohol use problem. Similarly, 44.1 million adults aged 18 or older considered themselves to be in recovery or to have recovered from their mental health issue (Figure 15). Figure 15. Recover [Truncated]