Substance use stayed at high levels in 2023, while vaping increased and smoking fell

Rates of mental illness and substance use remained largely stable in 2023, according to federal data, underscoring the severity of the long-running U.S. mental health crisis and worst-in-the-world rates of illicit drug use.

And while overall rates of nicotine use also remained roughly even, the way people consumed it shifted slightly. Overall, slightly more Americans vaped nicotine, while slightly fewer smoked cigarettes.

The survey, released Tuesday by the Substance Abuse and Mental Health Services Administration, serves as a reminder of the severity of the nation’s ongoing substance use and mental health crises. And it highlights, too, that even for those seeking help for a substance use or mental health disorder, treatment is often unavailable.

“This data tells us that we have much work to do across the spectrum of behavioral health,” said Miriam Delphin-Rittmon, the SAMHSA director. “It also tells us to spread the message that treatment is available and recovery is possible.”

While the survey detailed some slight changes in substance use trends, overall, the survey showed that use of alcohol, opioids, and stimulants like cocaine or methamphetamine were largely steady in 2023.

Nearly half of survey respondents 12 years and older reported drinking alcohol in the last 30 days, and 5.7% reported heavy drinking. Rates of binge drinking were identical to 2022 and 2021: In the past 30 days, 21.7% of Americans had engaged in binge drinking — defined by five drinks in a day for men and four drinks in a day for women.

Rates of marijuana and other illicit drug use, including stimulants and opioids, were also roughly the same as the year before. Fentanyl misuse ticked downward from 0.4% of the population to 0.3% — a small change that nonetheless represents roughly 160,000 fewer people misusing the powerful synthetic opioid.

Overall, 17.1% of the population, or 48.5 million people, met the criteria for a substance use disorder at some point in the past year. Yet fewer than 1 in 4 classified as requiring addiction treatment received medical care relating to their substance use.

One area of slight change was nicotine: 9.4% of Americans over 12 reported consuming nicotine by vape last year, an increase of over 1% from the year before. Similarly, 13.7% reported smoking cigarettes, a decrease of just under 1%.

Notably, though, the trend among underage nicotine consumers — between ages 10 and 20 — was the opposite. While totals held mostly steady, teens constituted a slightly larger share of cigarette smokers in 2023 compared to the year before, and a slightly smaller share of vapers.

Nearly one-quarter of all Americans were estimated to have a mental illness at some point in 2023, and 5.7% of the population reported a serious mental illness that “substantially interfered” with their day-to-day life.

The mental health crisis among adolescents remained severe, too. Nearly 1 in 3 Americans between 12 and 17 received some form of mental health treatment in the past year, an increase of roughly half a million. But SAMHSA officials cast the increase as a positive development, arguing it mostly reflected increased treatment availability and reduced stigma, rather than an overall decline in teen mental health.

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.