Post-COVID Rise in Substance Abuse in America: Causes, Trends, and Solutions (2026 Update)
Updated: Sep 30
Written by Dr. Charles Drew, Lead Pharmaceutical Content Specialist & Clinical Drug Information Reviewer
Reviewed for medical accuracy under the Ivermectinkart Editorial Policy
Introduction
The post-COVID rise in substance abuse in America is real in some important measures, but the 2026 picture is more complicated than a continuing nationwide increase in every type of substance use. During the first pandemic years, drug overdose deaths rose sharply, alcohol-related deaths increased, and many Americans reported using more substances to cope with stress or difficult emotions. Since then, several indicators have improved: overdose deaths fell substantially in 2025, while alcohol use disorder and opioid use disorder were less common in 2025 than in 2021. At the same time, cannabis use and cannabis use disorder have increased in some adult groups, and millions of Americans continue to live with a substance use disorder. Clinically, “substance use disorder,” or SUD, is now generally preferred to the older term “substance abuse” because it describes a medical condition without labeling the person. This 2026 update explains what changed during the pandemic, which trends remain important, why some people remain vulnerable, and which treatment and prevention approaches can help.
Is the Post-COVID Rise in Substance Abuse in America Still Continuing in 2026?
Not uniformly. The pandemic period was associated with major increases in overdose and alcohol-related harm, but the newest national data show improvement in several areas alongside continued problems in others.
CDC estimated 93,331 drug overdose deaths in 2020, nearly 30% more than the 72,151 predicted for 2019. The estimated number increased again to 107,622 in 2021.
The direction has changed more recently. Provisional CDC data estimated 69,973 U.S. drug overdose deaths in 2025, almost 14% fewer than in 2024. Opioid-involved overdose deaths fell from an estimated 55,296 in 2024 to 44,564 in 2025.
More recent surveillance available in August 2026 predicted 67,798 overdose deaths during the 12 months ending March 2026, a 12.3% decrease from the corresponding previous period. These numbers remain provisional and may be revised. Patients and families can review current U.S. overdose trends through CDC's Overdose Prevention Data Channel.
Substance use disorders remain common despite this improvement. SAMHSA estimated that 44.6 million Americans aged 12 or older—15.3% of that population—had an SUD during 2025. That was lower than 16.7% in 2021.
What major U.S. substance-use indicators show in the latest available data
Indicator | Earlier pandemic or 2021 measure | Latest measure | What it means |
Drug overdose deaths | Estimated 93,331 in 2020; 107,622 in 2021 | Estimated 69,973 in 2025 | Overdose mortality has fallen substantially from pandemic-era highs, but remains a major public-health problem |
Any past-year substance use disorder | 16.7% in 2021 | 15.3% in 2025 | Overall SUD prevalence decreased |
Alcohol use disorder | 10.6% in 2021 | 8.9% in 2025 | AUD decreased across the 2021–2025 period |
Opioid use disorder | 1.9% in 2021 | 1.4% in 2025 | OUD decreased overall |
Cannabis use disorder | 6.0% in 2021 | 6.7% in 2025 | Cannabis use disorder increased overall |
An important limitation is that SAMHSA advises against directly comparing 2021–2025 NSDUH estimates with 2020 or earlier survey results because the pandemic coincided with major changes in how the survey was conducted. This means there is no single perfectly comparable national survey line running from immediately before COVID through 2025.
The phrase “post-COVID rise in substance abuse” describes an important historical shift, but it should not be interpreted as meaning every substance-use indicator is still rising in 2026. Current evidence shows a mixed picture: falling overdose mortality and lower overall SUD prevalence alongside persistent treatment gaps and increases in some forms of cannabis use.
Why Did Substance Use and Overdose Harm Increase During the COVID-19 Period?
There was no single cause. Evidence points to an overlapping combination of psychological stress, social disruption, changes in treatment access, economic pressures, and an increasingly dangerous illicit drug supply.
Stress, anxiety, isolation, and loss
COVID-19 affected daily routines, employment, relationships, caregiving, health, and bereavement. In a CDC survey conducted in June 2020, 13.3% of U.S. adults reported that they had started or increased substance use specifically to cope with pandemic-related stress or emotions.
The same survey found high levels of anxiety, depression, trauma-related symptoms, and suicidal thoughts. These findings do not prove that emotional distress caused addiction in every affected person, but they show how closely behavioral health and substance use were connected during the early pandemic.
Disrupted access to treatment
Lockdowns, staffing pressures, transportation difficulties, infection concerns, and service changes made treatment harder to reach for some people. In the 2021 NSDUH, 7.1% of people who had used alcohol or illicit drugs during the previous year reported treatment appointments being delayed or cancelled, while others reported difficulty accessing prescriptions or needed care.
Telehealth helped compensate for part of that disruption. The percentage of substance-use treatment facilities offering telemedicine rose from 27.5% in 2019 to 58.6% in 2020.
A more dangerous illegal drug supply
The pandemic overlapped with an already rapidly evolving fentanyl crisis. Illegally manufactured fentanyl spread through heroin markets and counterfeit tablets and was increasingly found together with stimulants.
That distinction matters because overdose mortality can rise even without an equivalent increase in the total number of people using drugs. Potency, unpredictable contamination, polysubstance exposure, reduced tolerance, and using drugs alone can all make an individual episode of use more dangerous.
Alcohol-related harm also increased
CDC estimated an average of approximately 178,000 deaths per year from excessive alcohol use during 2020–2021, about 29% more than during 2016–2017. CDC identified several possible contributors, including alcohol availability, mental-health problems, and difficulty obtaining healthcare.
These mortality figures do not mean alcohol use continued rising after the pandemic. SAMHSA's newer survey data show that past-month alcohol use, binge drinking, heavy drinking, and alcohol use disorder all declined between 2021 and 2025.
Which Substance-Use Trends Matter Most in 2026?
The major 2026 trend is divergence rather than one universal pattern. Alcohol and opioid disorder indicators have recently moved downward, cannabis has increased in some adult groups, and fentanyl continues to make the illicit drug environment unusually hazardous.
SAMHSA's 2025 National Survey on Drug Use and Health findings provide the latest nationally representative estimates for the civilian, noninstitutionalized U.S. population aged 12 or older.
Alcohol use and alcohol use disorder
In 2025, 44.4% of Americans aged 12 or older reported drinking alcohol during the previous month. Past-month alcohol use declined from 47.4% in 2021 to 44.4% in 2025, while binge drinking declined from 21.7% to 19.5%.
Alcohol use disorder also decreased, from 10.6% in 2021 to 8.9% in 2025. Nevertheless, SAMHSA estimated that 25.7 million people still met criteria for AUD during 2025.
Cannabis use
Cannabis shows a different pattern. Past-month marijuana use among people aged 12 or older increased from 13.2% in 2021 to 15.1% in 2025. Past-year cannabis use disorder increased from 6.0% to 6.7%.
Age matters. Past-month marijuana use decreased among adolescents and adults aged 18–25 but increased among adults aged 26 or older. This is one reason broad statements about a nationwide “rise” can hide important differences between age groups.
Opioids and fentanyl
SAMHSA estimated that 4.0 million people had opioid use disorder in 2025, down from 5.2 million in 2021. Yet opioid overdose remains dangerous because illegally manufactured fentanyl continues to circulate in the drug supply.
CDC emphasizes that fentanyl can be present in counterfeit pills and other drugs and cannot reliably be identified by sight, taste, or smell. Naloxone can reverse an opioid overdose, including one involving fentanyl.
Stimulants and polysubstance use
Cocaine and methamphetamine remain important because overdoses frequently involve more than one substance. During the pandemic, stimulant-involved deaths increased substantially and commonly overlapped with illicit fentanyl.
In 2025, SAMHSA estimated 4.5 million people had a central nervous system stimulant use disorder. The percentage of Americans with this type of disorder showed no significant change from 2021 to 2025.
How Can You Recognize When Substance Use Has Become a Disorder?
Substance use becomes a medical concern when it begins causing significant problems or becomes difficult to control. A diagnosis is based on a pattern of symptoms rather than simply whether someone has ever used alcohol, cannabis, opioids, or another drug.
Possible warning signs include:
Repeatedly using more of a substance than intended
Trying to cut down but being unable to do so
Strong cravings
Spending substantial time obtaining, using, or recovering from a substance
Missing responsibilities at home, work, or school
Continuing use despite relationship, health, financial, or legal problems
Giving up important activities because of substance use
Using substances in dangerous situations
Developing tolerance or withdrawal
Continuing use even after recognizing that it is causing harm
Tolerance or physical dependence by themselves do not always establish a substance use disorder. For example, physical dependence can develop during medically supervised treatment with certain prescription medicines.
Mental health also matters. In 2025, 7.8 million U.S. adults had both a serious mental illness and an SUD, showing why assessment should often consider depression, anxiety, trauma, sleep, and other behavioral-health concerns alongside substance use.
A clinician can determine whether symptoms meet diagnostic criteria and whether the condition is mild, moderate, or severe.
What Treatments and Solutions Work for Substance Use Disorder?
Substance use disorders are treatable, but the most effective approach depends on the substance, severity, medical history, mental health, previous treatment, and the patient's goals. Treatment can include medication, behavioral therapy, peer or recovery support, treatment of co-occurring mental-health conditions, and practical help with housing, employment, or other barriers.
SAMHSA's evidence-based substance use disorder treatment options include medication and behavioral approaches selected according to the condition being treated.
Treatment for opioid use disorder
FDA-approved medications for opioid use disorder include buprenorphine, methadone, and naltrexone. These medicines work differently, so treatment should be selected and monitored by an appropriate healthcare professional.
Medication treatment is not simply replacing one addiction with another. Evidence-based medication can reduce withdrawal and cravings, improve treatment retention, and reduce the risk of opioid overdose death.
Treatment for alcohol use disorder
FDA-approved medications used for AUD include naltrexone, acamprosate, and disulfiram. Medication can be combined with counseling, behavioral treatment, and mutual-support or recovery programs according to individual needs.
People who drink heavily should not assume that suddenly stopping is always safe. Alcohol withdrawal can occasionally become medically dangerous, particularly after prolonged heavy use.
Treatment for stimulant use disorder
There is currently no FDA-approved medication specifically for stimulant use disorder. Behavioral treatment therefore plays a particularly important role.
SAMHSA identifies contingency management—a structured approach that provides meaningful incentives for treatment-related goals—as a particularly effective intervention for stimulant use disorders. Cognitive behavioral therapy, motivational approaches, and community reinforcement may also be used.
Evidence-based solutions for common substance-use problems
Problem | Treatment or prevention approach | Important patient point |
Opioid use disorder | Buprenorphine, methadone, or naltrexone; behavioral and recovery support | Medication can reduce overdose risk and support recovery |
Alcohol use disorder | Naltrexone, acamprosate, or disulfiram; behavioral treatment | Medical assessment is important, especially when withdrawal may occur |
Stimulant use disorder | Behavioral treatments, particularly contingency management | No FDA-approved medication currently exists specifically for stimulant use disorder |
Co-occurring mental-health condition | Integrated assessment and treatment | Depression, anxiety, trauma, and other conditions may need treatment alongside SUD |
Opioid overdose risk | Naloxone and emergency response planning | Naloxone can temporarily reverse an opioid overdose |
Difficulty accessing treatment | Primary care, addiction services, telehealth, specialty programs, and treatment locators | Treatment setting can be matched to the person's medical and practical needs |
A major challenge remains getting treatment to the people who need it. In 2025, SAMHSA estimated that only 16% of people classified as needing substance-use treatment actually received treatment during the year.
What Can Patients, Families, and Communities Do to Reduce Harm?
Reducing substance-related harm requires more than telling someone to stop using a drug. Practical prevention combines early recognition, accessible treatment, overdose preparedness, mental-health support, safer prescribing, and reduced stigma around seeking care.
For individuals and families, useful steps include:
Talk openly about changes in drinking or drug use without using shame or degrading labels.
Ask a healthcare professional about assessment when substance use is becoming difficult to control.
Keep naloxone available when opioid exposure or overdose risk is possible.
Never take pills obtained outside a licensed pharmacy assuming their contents are known.
Avoid mixing opioids with alcohol or other sedating substances because breathing suppression can become more dangerous.
Store prescription medications securely and dispose of medicines that are no longer needed.
Address depression, anxiety, trauma, chronic pain, and sleep problems rather than treating substance use in isolation.
Encourage continued treatment after setbacks rather than treating recurrence of use as proof that recovery is impossible.
For people who may encounter illicit fentanyl, CDC notes that fentanyl test strips can detect fentanyl in different types of drugs, although a negative result cannot guarantee that a substance is safe.
Treatment access is another part of the solution. Telehealth, integration of addiction treatment into regular healthcare, recovery support, and expanded access to medications for OUD and AUD can help reduce barriers for people who cannot easily enter a traditional residential program.
When Should You Seek Urgent Medical or Addiction Help?
Call 911 for a suspected overdose, severe breathing difficulty, loss of consciousness, seizure, severe confusion, or a person who cannot be awakened. If opioid overdose is possible, give naloxone if it is available and follow emergency instructions.
Urgent medical assessment may also be needed when someone develops serious alcohol or sedative withdrawal symptoms. Severe shaking, hallucinations, seizures, marked confusion, or rapidly worsening illness should not be managed alone at home.
For non-emergency help, contact a healthcare professional if you:
Cannot control how much or how often you use a substance
Experience withdrawal when trying to stop
Have had an overdose
Keep using despite medical, work, family, or financial consequences
Combine multiple substances regularly
Are worried that a prescription medicine is becoming difficult to control
Have depression, anxiety, trauma symptoms, or suicidal thoughts alongside substance use
In the United States, SAMHSA's confidential treatment and referral resources include FindTreatment.gov and the National Helpline at 1-800-662-HELP (4357), available 24 hours a day.
Anyone experiencing a suicidal or emotional crisis can call or text 988. A suspected medical overdose remains a 911 emergency.
Conclusion
The post-COVID rise in substance abuse in America left a lasting public-health burden, but the 2026 evidence also shows genuine improvement. Overdose deaths, alcohol use disorder, and opioid use disorder have declined from recent levels, while cannabis-related disorders and major treatment gaps remain important concerns. The most useful response is not fear or stigma but earlier recognition, safer substance use and prescribing practices, naloxone access, mental-health care, and evidence-based addiction treatment.
If substance use is becoming difficult to control or causing harm, seek professional assessment rather than trying to manage severe dependence or withdrawal alone. This article provides general education and does not replace individualized medical care.
Frequently Asked Questions
1 . Did substance abuse really increase because of COVID-19?
Substance-related harm increased sharply during the pandemic, but COVID-19 cannot be considered the only cause. Stress, isolation, disrupted healthcare, economic pressures, and the expanding fentanyl supply all contributed. CDC surveys also found some adults specifically reported increasing substance use to cope with pandemic-related stress.
2 . Are drug overdose deaths still increasing in America in 2026?
Nationally, no. CDC provisional data estimated 69,973 overdose deaths in 2025, almost 14% fewer than in 2024, and newer surveillance continued to show a decline. These figures remain provisional, and trends can differ substantially between states and communities.
3 . What is the most common substance use disorder in the United States?
Alcohol use disorder remains very common. SAMHSA estimated that 25.7 million people aged 12 or older had AUD in 2025, while 26.0 million had a drug use disorder; some people had both. These categories overlap, so their totals should not simply be added together.
4 . Is cannabis addiction becoming more common?
Cannabis use disorder increased overall between 2021 and 2025, from 6.0% to 6.7% of people aged 12 or older. The pattern differed by age, with increases particularly evident among adults aged 26 or older rather than adolescents or young adults.
5 . Can substance use disorder be treated with medication?
Yes, for some disorders. FDA-approved medicines are available for opioid use disorder and alcohol use disorder, while no FDA-approved medication currently exists specifically for stimulant use disorder. Behavioral therapies, mental-health treatment, peer support, and recovery services may also form part of an individualized treatment plan.
6 . Where can someone find addiction treatment in the United States?
SAMHSA's FindTreatment.gov lists treatment providers, and its National Helpline at 1-800-662-HELP provides free, confidential referrals 24/7 in English and Spanish. For an immediate overdose or other medical emergency, call 911; for suicidal or emotional crisis support, call or text 988.
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