Vaping Up Slightly While Heavy Alcohol Use Down a Little, SAMHSA Report Finds

MEDPAGE TODAY ^ | July 28, 2025 | Joyce Frieden

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Nicotine vaping has increased slightly over the past few years in the U.S., while binge drinking and heavy alcohol use were both slightly down, according to a report from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The percentage of people ages 12 years and older who said they had vaped nicotine in the past month increased from 8.3% in 2022 to 9.6% in 2024, according to the National Survey on Drug Use and Healthopens in a new tab or window (NSDUH).

Meanwhile, those who said they participated in binge drinking dropped from 21.7% in 2021 to 20.1% in 2024, and those who said they were "heavy" alcohol users -- defined as binge drinking on 5 or more days in the past 30 days -- declined from 5.7% in 2021 to 5.0% in 2024, the survey found.

Overall, among people ages 12 or older in 2024, 58.3% (168 million people) used tobacco, vaped nicotine, used alcohol, or used an illicit drug in the past month; 46.6% (or 134.3 million people) drank alcohol in the past month; 16.7% (or 48 million people) used a tobacco product in the past month; 9.6% (or 27.7 million people) vaped nicotine in the past month; and 16.7% (or 48.2 million people) used an illicit drug in the past month, the report said, noting that "Estimates for tobacco use, nicotine vaping, alcohol use, or illicit drug use are not mutually exclusive because respondents could have used more than one type of substance."

During the past year, 25.5% of people 12 and older used an illicit drug, including 2.7% who misused opioids and 0.3% who misused fentanyl, the survey showed.

On the mental health side, 23.4% of adults 18 and older (61.5 million) had any mental illness in the past year, while 5.6% (14.6 million) had a severe mental illness. Both percentages have been virtually unchanged since 2021, according to the survey. Respondents were also asked about whether, in the past 12 months, they had had a major depressive episode, which was defined as at least one period of 2 weeks or longer, for most of the day nearly every day, when they felt depressed or lost interest or pleasure in daily activities; and also problems with sleeping, eating, energy, concentration, self-worth, or having recurrent thoughts of death or recurrent suicidal ideation. Among adults 18 and older, 8.2% had had such an episode, compared with 8.5% in 2021.

One interesting thing about the report is that the data are from 2024, "before Jan. 20, 2025," Robert Trestman, MD, PhD, chair of the American Psychiatric Association's Council on Healthcare Systems and Financing, said during an online interview at which a public relations person was present. "I think comparator data may reflect substantial changes."

Trestman was referring to the date that President Trump was inaugurated. "There's a lot more uncertainty [now]," he said. "People are uncertain about their jobs and uncertain about their futures. If they're from a minority population, they're even more anxious about going outside. Millions are at risk of losing their insurance. With the growth of immigration agents going around masked, there is lots of concern about personal safety. I think that nationally there are going to be substantial changes in day-to-day experience ... From my own observation, I worry about that a lot."

On the other hand, since the advent of the COVID pandemic, "people have become more comfortable talking about mental illness, its symptoms, and about addiction," he said. "The stigma associated with either has decreased to some degree, allowing people to feel more comfortable acknowledging what they've been experiencing. So that increased not the underlying frequency of the illness, but the honest fact that people are talking about it more and are willing to seek care. Those are substantial benefits in terms of people wanting to lead healthier lives."

Unfortunately, however, many of those with mental illness are still not getting the care they need, said Hannah Wesolowski, MPA, chief advocacy officer for the National Alliance on Mental Illness in Washington. "There has been a slight increase in treatment rates (52.1% for any mental illness in 2024 vs 47.2% in 2021; 70.8% for serious mental illness in 2024 vs. 65.4% in 2021)," she said in an email, citing the survey. "But that still means that nearly half of people with a mental health condition aren't getting treatment, a number that threatens to get worse after recently passed Medicaid cuts. Everyone who needs mental health care and support should be able to get it, and we should not be satisfied with half of people with a mental health condition unable to do so."

The low treatment rates for substance use disorders (SUDs) are also concerning, Stephen Taylor, MD, MPH, president of the American Society of Addiction Medicine, said in an email to MedPage Today. "According to the survey, nearly 90% of people aged 12 or older with an SUD in the past year received no treatment for it, illustrating a persistent and staggering treatment gap that demands urgent policy reforms that facilitate respectful and evidence-based identification, engagement, treatment, and support of more people in need. The nation's health and wellbeing depend on our ability to narrow this treatment gap dramatically."

Wesolowski also noted that suicide rates continue to be "extremely high. The report shows that 10.1% of adolescents (12-17) had serious thoughts of suicide. While this is down a bit from 2021, we cannot accept that one in 10 of our kids are having serious thoughts of suicide. This points to a dangerous and urgent need for more action." Unfortunately, she added, "this year's report does not highlight race or ethnic breakdowns for any of the data, so it is hard to know if we are making progress among communities who are most underserved."

The survey was based on self-reported responses from 70,000 people. In addition, "2024 marks the first year since 2020 in which there are at least four years of comparable data for key NSDUH outcomes, adjusting for survey design changes since 2020, enabling reporting of trends for the first time since 2019," SAMHSA said in a press releaseopens in a new tab or window.

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