Substance use disorder is one of the most common health conditions in the United States — and one of the most undertreated. According to the most recent national survey, roughly 48.4 million Americans aged 12 and older had a substance use disorder in 2024. Yet only about 10.2 million received any form of substance use treatment that year. That means approximately 4 in 5 people who needed help didn't get it.
This article explains what's behind that gap, what treatment actually looks like, and — most importantly — what you or someone you love can do right now to find care.
SAMHSA's 2024 National Survey on Drug Use and Health (NSDUH), released in July 2025, found that the number of people receiving substance use treatment fell from about 13.1 million in 2023 to 10.2 million in 2024, even as the total number of people with a substance use disorder held roughly steady. The treatment gap for American adults grew slightly wider from one year to the next.
Younger adults aged 18–25 face the steepest access barriers — only about 11% of young adults who needed treatment received it. Adolescents aged 12–17 fared somewhat better (about 30%), and adults 26 and older had a receipt rate of around 20%.
Barriers to treatment are real and often compounding. The most common reasons people cite for not receiving treatment include:
Under the Affordable Care Act (ACA), mental health and substance use disorder treatment is a required Essential Health Benefit in every individual and small-group plan sold through the Health Insurance Marketplace. That means if you have ACA-compliant insurance, your plan must cover things like counseling, detox, and rehabilitation services.
The Mental Health Parity and Addiction Equity Act (MHPAEA) goes further: it requires that insurance coverage for mental health and substance use disorder treatment be comparable to coverage for physical health care. In 2024, federal agencies issued a major final rule strengthening parity enforcement, requiring health plans to document and justify any restrictions they place on behavioral health benefits.
If you've been denied coverage for addiction treatment, you have the right to appeal. Your state insurance commissioner can also help you file a complaint.
Addiction treatment is not one-size-fits-all. The right level of care depends on the substance involved, a person's health, their living situation, and their personal goals. Common options include:
For years, prescribing buprenorphine required a special federal waiver (the "X-waiver"), which limited the number of providers who could offer this life-saving medication. In late 2022, Congress eliminated the X-waiver requirement as part of the Consolidated Appropriations Act. Today, any licensed clinician with a standard DEA registration can prescribe buprenorphine for opioid use disorder — the same as any other controlled medication.
This is a meaningful expansion. It means your primary care doctor, an urgent care clinic, or a telehealth provider may now be able to help you start medication treatment without a lengthy referral chain.
You don't have to figure out the system alone. These free resources can help:
You are not alone — and help is available right now. For immediate support or to find treatment near you, call or text 988 (Suicide and Crisis Lifeline — also for substance use crises), or call SAMHSA's free National Helpline at 1-800-662-4357, available 24 hours a day, 7 days a week, in English and Spanish. In an emergency, call 911.
Decades of research show that treatment for substance use disorder is effective. People who complete treatment reduce their substance use, improve their health, and rebuild their lives. Relapse — like in other chronic conditions such as diabetes or hypertension — is common and does not mean treatment has failed; it means care may need to be adjusted. The goal is long-term health, not perfection.
At Empower Next Project, connecting people to care is at the heart of everything we do. If you or someone you love is struggling, please reach out — to us, to SAMHSA, or to a local provider. The gap between needing help and getting it should never be someone's story.
This article is educational and is not a substitute for professional medical or clinical advice. Treatment needs vary by individual; please consult a licensed healthcare provider to determine the most appropriate care. In an emergency, call 911.