By: Libby Jones, Associate Vice President, Global Health Advocacy Incubator, Overdose Prevention Initiative
Lower numbers do not mean the job is done. The 2025 National Survey on Drug Use and Health (NSDUH) shows that opioid use disorder declined, but only one in six people who needed substance use treatment received it. That is not simply a troubling statistic. It is a warning that millions of people remain unable to reach proven, effective care.
The annual survey provides one of the clearest national pictures of substance use, substance use disorders, treatment and recovery among people aged 12 or older. In 2025, an estimated 4 million people had opioid use disorder, down from 4.8 million the year before. Substance use disorder overall, which covers alcohol and other drugs as well as opioids, fell to 44.6 million people in 2025 from 48.4 million in 2024.
This progress is important, but the treatment results carry a warning.
Among the 47.2 million people aged 12 or older classified as needing substance use treatment in 2025, only 16 percent, or 7.6 million people, received it. In 2024, 19.3 percent received treatment. Fewer people were classified as needing care, but an even smaller share received it. Nearly 40 million people who needed care remained outside of treatment.
A lower prevalence rate is not the same as a treatment system that reaches people. The country should recognize progress without allowing national numbers to obscure the size of the treatment gap. The findings focusing on recovery show how lives are saved closing that treatment gap. Among adults who said they had ever experienced a problem with alcohol or drugs, 73 percent considered themselves recovered or in recovery. Recovery is common, not exceptional. People can and do find recovery.
The question remains whether effective care is available when they are ready for it.
For people with opioid use disorder, that means access to evidence-based, proven treatment, including methadone and buprenorphine, without avoidable delays or interruptions. It also means maintaining the coverage, workforce and community programs that allow people to begin treatment and remain connected to it.
The wrong conclusion from the results would be that an improving national picture justifies a smaller response. The share of people receiving treatment moved in the wrong direction. The response should become more focused, not smaller.
That treatment gap is why the Overdose Prevention Initiative remains wholly committed to a clear goal: making high-quality, evidence-based treatment easier to reach and easier to stay in.
Progress should be measured in two ways, whether fewer people experience substance use disorders and whether more people who need treatment receive it. The 2025 results show movement on the first measure and a warning on the second.
