A new nationwide analysis of addiction treatment infrastructure has revealed dramatic disparities in treatment access across the United States, with some states showing far higher rates of residents relying on care than others.
The research, conducted by Utah law firm Siegfried & Jensen, examined addiction treatment access in all 50 states using federal treatment utilization data and substance use disorder prevalence estimates.
According to the findings, Missouri recorded the highest unmet need in the nation, with roughly 4 in 5 residents (79.36%) who qualified for treatment in 2024 never receiving any help.
- Source: santecenter.com
Alaska stood out as the state with the greatest reliance on treatment, with 5.55% of its population using some form of care – highlighting how unevenly infrastructure is distributed from one state to the next.
Researchers say the findings expose how unevenly addiction treatment infrastructure is distributed throughout the country.
“The scale of the disparity surprised even us,” a spokesperson for Siegfried & Jensen said.
“The data shows that where somebody lives can dramatically affect their ability to access treatment, even when the level of need remains similar.”
The analysis drew on 2024 National Survey on Drug Use and Health estimates published by SAMHSA.
- Source: solsticeclinic.com
Researchers found that approximately 48.4 million Americans – or 16.8% of people aged 12 and over – currently meet the clinical criteria for a substance use disorder.
Despite that figure, just 3.5% of the population (around 10.2 million people) received substance use treatment in 2024, down from 4.6% in 2023.
Several heavily burdened states ranked among those carrying the greatest load relative to their populations in need.
Ohio, for example, recorded the single highest treatment estimate among the top ten states – around 561,200 residents – a direct result of decades spent building crisis response capacity under enormous pressure.
North Carolina recorded 449,400 people in treatment, while Tennessee, with 356,500, reflected a similar dynamic – large populations carrying large burdens, with treatment systems straining to accommodate need.
Researchers argue the findings challenge assumptions that treatment infrastructure naturally scales alongside population growth or addiction prevalence.
“The states with the greatest need are not necessarily the states with the strongest infrastructure,” the spokesperson added.
“In many parts of the country, people seeking treatment may face waiting lists, long travel distances or extremely limited local options.”
The report also pointed to striking regional patterns. The states with the highest substance use disorder rates – including the District of Columbia, Colorado and Maine, where more than 22% of residents meet the clinical criteria – are concentrated in the Mountain West and New England.
That pattern diverges sharply from the opioid use disorder map, which is led by Mississippi (3.07%) and West Virginia (2.99%) – reflecting two fundamentally different crises.
Researchers say the contrast between regions points toward broader structural issues surrounding healthcare distribution, funding priorities and long-term addiction recovery infrastructure in the United States.
The findings come amid continuing national concern around overdose deaths, opioid addiction and long-term recovery access.
While overdose deaths recorded a historic national decline during 2024 – down 26.2%, from 105,007 to 79,384 deaths, the largest year-over-year drop in modern history – researchers say the treatment gap itself remains severe.
Of particular concern, only 17% of people with opioid use disorder received medication-assisted treatment in 2024, despite it being the most evidence-supported intervention available, one shown to reduce overdose deaths by nearly 70%.
The study by Siegfried & Jensen used federal SAMHSA data alongside 2024 substance use disorder prevalence estimates to create the nationwide overview.
The disorders driving the crisis
Behind the access gap lies a population far larger and more varied than most public conversations acknowledge. Alcohol use disorder remains the leading single-substance disorder in the country, affecting 27.9 million people, or roughly one in every ten Americans aged 12 and over. Yet it is among the least treated.
Most cases are classified as “mild,” which means many affected people underestimate the problem – even though any disorder reflects clear clinical dysfunction, and untreated mild cases can deteriorate quickly.
Drug use disorder, an umbrella term covering all substances other than alcohol, affects 28.2 million Americans, up from 8.7% of the population in 2021 to 9.8% in 2024. Within that group, marijuana use disorder accounts for 20.6 million people, a figure that rose steadily over the same period as legalization expanded and stigma faded.
Opioid use disorder affects 4.8 million people, and carries one of the most severe profiles in the dataset, with nearly one in five cases classified as severe – some 932,000 people living with active, high-risk dependence. The fact that 83% of those who need medication-assisted treatment do not receive it stands out as one of the most consequential failures the data reveals.
Most alarming of all is CNS stimulant use disorder, which covers cocaine, methamphetamine and prescription stimulant misuse and affects 4.3 million Americans.
Nearly 38% of these cases are classified as severe – compared to roughly 20% for alcohol and marijuana – reflecting the rapid onset of stimulant addiction and its growing entanglement with fentanyl.
Uneven progress, persistent inequities
The historic 2024 decline in overdose deaths was broad, reaching across every age group and every racial and ethnic group.
The steepest improvement came among the youngest adults, aged 15 to 24, where deaths fell 37%, suggesting that prevention and harm reduction efforts aimed at younger Americans are gaining traction.
The smallest decline involved adults aged 65 and older, whose death toll fell just 8.8%, reflecting an overdose profile driven more by prescription opioids and polypharmacy than by illicit fentanyl.
But the disparities between groups remain striking. American Indian and Alaska Native people continue to carry the highest overdose death rate by a wide margin – 51.6 per 100,000, more than double the national average and more than eleven times the rate recorded among Asian Americans.
Researchers attribute the gap to long-standing shortfalls in healthcare infrastructure, geographic isolation and high rates of untreated substance use disorders – one of the most persistent and least addressed inequities in American public health.
A cost beyond the individual
The damage extends well past those directly affected. The vast majority of Americans living with a substance use disorder are in a family or relationship and regularly work, meaning the consequences ripple outward into households, workplaces and entire communities.
Research consistently shows that concentrated drug activity in a neighborhood drives down adjacent property values, adding an economic layer of harm to communities already absorbing the human toll.
In 2022, drug use was estimated to have caused around $4 trillion in societal and economic damage in the United States.
Taken together, the findings describe a crisis that is neither marginal nor confined to any single group. It reaches across every age, income level, gender, race and region – and, in far too many cases, leaves people unable to access the help they need, with often devastating consequences.
Readers can access the full findings below.
https://siegfriedandjensen.com/research/drug-addiction-in-the-suburbs/
