Logo image
Back
National- and state-level burdens of substance use disorders in the USA, 1990–2023, with forecasts up to 2050: Global Burden of Disease Study 2023
Journal article   Peer reviewed

National- and state-level burdens of substance use disorders in the USA, 1990–2023, with forecasts up to 2050: Global Burden of Disease Study 2023

Jiseung Kang, Hyeon Jin Kim, Min Seo Kim, Aidin Abedi, Dmitry Abramov, Meshack Achore, Oluwatobi E. Adegbile, David Adzrago, Ali Ahmed, Hany Aly, …
Med (New York, N.Y. : Online), Vol.7(6), 101139
06/12/2026
DOI: 10.1016/j.medj.2026.101139
PMID: 42285039

View Online

Abstract

While the United States of America (USA) faces a substantial substance use disorder (SUD) burden on a global scale, relatively little is known about the current trends and future trajectories at both national and state levels. Using the Global Burden of Disease Study 2023, we examined estimates of prevalence and disability-adjusted life years (DALYs) for SUDs in the USA, including alcohol use disorders (AUDs) and drug use disorders (DUDs), across all 50 states and Washington, DC, from 1990 to 2023 and forecasted trends to 2050. In 2023, the USA had the highest age-standardized prevalence of SUDs across the globe. Overall, age-standardized SUD prevalence increased from 4,664.6 (95% uncertainty interval, 4,076.4–5,333.3) estimated rates per 100,000 people in 1990 to 6,430.1 (5,871.7–7,056.3) per 100,000 people in 2023, representing an increase of 37.9%. At the state level in 2023, broader geographical variations were observed in terms of estimated age-standardized DALYs for SUDs. At both the national and state levels, the age-standardized prevalence and burden of DUDs have outpaced and surpassed the increase in AUDs over time. By 2050, if existing trends continue, the age-standardized prevalence of SUDs is projected to rise to 8,956.0 (7,478.8–10,118.4) per 100,000 people, driven primarily by increasing age-standardized prevalence of DUDs, while age-standardized prevalence of AUDs is predicted to increase slightly. These findings suggest that current interventions have been insufficient to curb the SUD crisis. Without urgent, evidence-based reforms, the SUD burden will continue to increase and deepen health disparities across the USA. This work was funded by the Gates Foundation. [Display omitted] •Age-standardized SUD prevalence and DALYs in the USA increased from 1990 to 2023•Opioid use disorder was the main driver, with increases observed across all states•SUD prevalence is projected to rise through 2050, primarily driven by drug use disorders•Drugs contributing to projected increases through 2050 varied by sex and age Substance use disorders (SUDs) have emerged as a growing public health concern in the USA, with opioids, cannabis, and alcohol contributing substantially to morbidity and mortality. Using data from the Global Burden of Disease Study 2023, this analysis provided a comprehensive assessment of national- and state-level trends in the prevalence and burden of SUDs from 1990 to 2023 and projected future trends to 2050. The findings highlighted persistent increases in SUD prevalence and disability-adjusted life years (DALYs), particularly driven by drug use disorders, underscoring the need for evidence-based and proactive interventions to address the increasing burden. Using GBD 2023 data, this study quantifies SUD prevalence and DALYs across USA states in 1990–2023, with projections to 2050. Burden has risen markedly, with substantial interstate variation. Drug use disorders are projected to drive continued growth through 2050, highlighting the urgency of sustained public health action.
 GBD 2023 global burden of disease substance use disorders United States of America

Details

Metrics

1 Record Views
Logo image