The Crisis, By the Numbers· Pillar

The U.S. Substance Use Crisis in 2026: By The Numbers

48.5 million Americans have a substance use disorder. Overdose deaths are finally declining. Here's what the data actually shows.

ByThe Rize NewsroomMay 8, 20262 min read

Body: America is living through a rare moment — the first meaningful decline in overdose deaths in more than a decade. CDC provisional data shows approximately 72,000 projected drug overdose deaths for the 12 months ending October 2025, a 17% decline from the 2023 peak of ~107,000. It’s the most hopeful number the field has seen since before fentanyl took over the illicit opioid supply. But that hope is fragile: the decline has been slowing, and 5 states (Alaska, Montana, Nevada, South Dakota, Utah) still saw overdose deaths rise.

The crisis is wider than overdose deaths. 48.5 million Americans aged 12+ had a substance use disorder in 2023, according to SAMHSA’s National Survey on Drug Use and Health — nearly double the prevalence of 2013. Only about 15% received any treatment. That’s the central failure of the system Rize exists to fix.

Fentanyl is still driving the numbers

Synthetic opioids are involved in roughly 69–75% of all overdose fatalities. Even as totals decline, fentanyl remains the dominant killer — and its supply is getting more complex, increasingly cut with xylazine, nitazenes, and medetomidine. → See Fentanyl, Still Driving Overdose Deaths in 2026.

The polysubstance picture

Stimulant-involved deaths (meth + cocaine) hit 57,500 in 2022, with ~70% also involving fentanyl. Overdose is now usually a multi-drug event.

Alcohol is the quieter epidemic

Alcohol-induced deaths reached 105,400 in 2022, up ~30% since the pandemic. Alcohol now kills roughly as many Americans annually as drugs. → See Alcohol: America’s Quieter Epidemic.

The treatment gap

Only about 15% of people with SUD received any treatment. Prevalence nearly doubled 2013–2023; treatment capacity did not. → See The Treatment Gap: Why Only 1 in 7 Get Help.

Why this matters for people in recovery

The numbers are not abstract. For anyone navigating recovery in 2026, three things are truer than they were a year ago: the supply is more dangerous than ever even as deaths fall, help exists but is hard to find, and policy is in unprecedented flux. Rize is built to shorten the distance between “I need help” and “I’m getting it.” → Find treatment now.

Sources Cited

01.A
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htmCDC NCHS
02.A
https://www.samhsa.gov/data/release/2023-national-survey-drug-use-and-health-nsduh-releasesSAMHSA NSDUH

Filed Under

OverdoseThe Treatment GapGovernment DataFederal

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