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Approximately 49 million people in the U.S. population aged 12 or older had a substance use disorder in 2021鈥攁nd most went without treatment.

That amounted to living with these disorders, according to 2022 Substance Abuse and Mental Health Services Administration data released in November 2023. These sometimes deadly disorders are on the rise: The share of Americans with substance use disorders jumped by nearly a percentage point from 2021 to 2022, per SAMHSA data. Reported are also rising compared to historical levels, reaching nearly 106,000 in the 12 months ending in September 2023, compared to just under 69,000 during the same period in 2019.

In Vermont, there were about 7,210 people in substance use treatment in 2021, or 1,114 for every 100,000 residents. It ranks #3 among states for the share of its population seeking treatment, and has 45 substance use treatment facilities. Other SAMSHA data suggests that about 21.2% of the state's population has a substance use disorder, ranking #3 among U.S. states and D.C. The 2021 SAMHSA survey used official diagnostic criteria to determine estimates of the prevalence of substance use disorder, basing questions on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

The survey showed that most who didn't receive treatment believed they didn't need it. But there are many other reasons people don't seek treatment, including a lack of facilities, long waiting lists, and high expenses. There are exceedingly low vacancies at residential substance use rehab facilities, so help isn't always available for those who seek it.

Treatment for substance use disorders can save lives鈥攂ut treatment options aren't universally accessible. identified the being treated at substance use treatment facilities鈥攁nd further analyzed treatment within Vermont鈥攁s of the 2022 , the most recent and comprehensive data available. For this analysis, statistics are mapped as the number of patients per capita within each state.

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Regional differences in substance use treatment

There is a relatively weak correlation between and the share of residents in treatment. However, there are some standouts within the data.

For instance, in Washington D.C., SAMHSA estimates that about 23%, or nearly 1 in 4 residents, have substance use disorders鈥攖he highest in the nation. However, the district has one of the lowest concentrations of residents in treatment. On the other hand, West Virginia, Maine, and Arizona have high concentrations of people in treatment but relatively average prevalence of the disorders.

Some states reinforce the correlation: Vermont, for example, has the third-highest rate of substance use disorders but also the third-highest rate of people in treatment for those disorders. Texas and Hawaii both have low rates of substance use disorder and low concentrations of people in treatment. SAMHSA provides to dive deeper into the volume and types of services each state offers.

Since substance use disorder has been more widely viewed as a treatable disease, and in the 13 years since opioid use specifically was declared an epidemic, treatment options and humane care have grown. Still, research has found that there are still high volumes of unmet need nationwide.

The federal government is continually rolling out resources to address this need. In early February 2024, SAMHSA to expand treatment within adult and family treatment drug courts and among pregnant and postpartum people. Last year, the agency awarded tens of millions in grants toward , connecting people to , and expanding access to . Some of these have focused on funding state solutions, allowing states to develop services specific to their populations' needs.

This story features data reporting and writing by Paxtyn Merten and is part of a series utilizing data automation across 51 states.