Substance Use Disorders and the Role of the States

Millions of Americans have substance use disorders, yet experts estimate that the vast majority of those in need of treatment do not receive any care. These disorders often result in not only serious harm to the health of the individuals, but also enormous financial and social consequences that go beyond the health care system—including the loss of economic productivity due to withdrawal from the workforce and increased rates of crime, disability, and death. According to the National Institute on Drug Abuse, the combined direct and indirect costs of substance use disorder reaches into the hundreds of billions of dollars annually.

Researchers from the State Health Care Spending Project—a collaboration between The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation—sought to better understand the country’s substance use disorder challenges and, in particular, the states’ role in addressing them. 

Read the full report.

Key Findings

  • 21.6 million Americans aged 12 and older had a substance use disorder in 2013

    According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), of those who used alcohol or illicit drugs, 21.6 million people (8.2 percent of the population aged 12 or older) met the criteria for having a substance use disorder (substance abuse or dependence) in the past year, a percentage that has remained stable for at least a decade. During 2012 and 2013, the most recent years state-specific data are available, the rate of substance use disorder ranged from 7.1 percent of residents aged 12 or older (Utah) to 13.8 percent (District of Columbia).

  • 18% of Americans with a substance use disorder received treatment in 2013

    In 2013, 4.1 million people 12 and older received treatment for a problem related to the use of alcohol or illicit drugs—an estimated 18 percent of those who needed it. Several factors contributed to the gap between those who needed treatment and those who received it. Most influential and nearly universal (96 percent) was the perception by the 20.2 million Americans who needed treatment but did not receive it at a specialty facility—such as an inpatient general hospital, a drug or alcohol rehabilitation facility, or a mental health center—that they did not actually require care. And only one-third of those who recognized a need for treatment but did not receive it had made an effort to access it. The most commonly cited reasons for not receiving care among those in this group was a lack of insurance coverage and an inability to afford the cost.

  • 69% of spending on substance use disorder treatments was by public sources in 2009

    In 2009, the most recent year for which comprehensive data are available, the United States spent $24 billion on substance use disorder treatment. Most of the spending—69 percent—came from public sources, such as state and local governments, Medicaid, Medicare, and federal grants. Private sources, including health insurance and individual out-of-pocket spending, made up the difference.

  • $9.4 billion is what states and localities spent on substance use disorder treatments in 2009

    States and localities have historically been the largest source of spending on substance use disorder treatment. In 2009, the latest year for which data are available, their funds covered $7.6 billion—nearly a third—of total spending on substance use disorder treatment. This total does not include state and local Medicaid expenditures. Adding those contributions brings total state and local spending up to $9.4 billion. Spending from substance use disorder agencies across the 50 states and the District of Columbia accounted for $2.3 billion of state and local dollars in state fiscal year 2009.


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