Construction Worker Substance Abuse Statistics 2026: Current National Numbers and the New England Data Nobody Publishes

Construction pays a price that rarely makes it onto a safety poster. Federal mortality data shows construction and extraction workers die of drug overdoses at the highest rate of any occupation group in America, and die by suicide at nearly twice the rate of working men overall. Yet most of the statistics repeated across the internet are ten to fifteen years old and presented as if they were current.

This page does two things differently. Every statistic carries its actual data year and a source you can open, and it adds the state-level picture for New Hampshire and Massachusetts, where the data now shows a genuine turn for the better.

Key numbers at a glance

Every figure below links to its primary source, with its actual data years noted inline.

• Construction and extraction workers died of drug overdoses at 162.6 per 100,000 workers, the highest rate of any U.S. occupation group and nearly four times the 42.1 all-worker average (CDC National Vital Statistics Reports, 2020 data from 46 states and New York City, published 2023).
• About 15,900 construction workers aged 16 to 64 died of a drug overdose in 2023, down 6.7 percent from roughly 17,500 in 2022 (CPWR analysis of CDC mortality data, published 2025).
• More than 1 in 6 Americans aged 16 to 64 who died of an overdose was a construction worker, while construction makes up only about 7.5 percent of the civilian labor force (CPWR, 2022 data, published 2024).
• 11,831 construction and extraction workers died of synthetic opioid-involved overdoses in 2022, more than any other named occupation group, and 55.6 percent of those deaths also involved stimulants (CDC MMWR, 2022 data, published 2025).
• 14.3 percent of construction workers had a past-year substance use disorder, versus 9.5 percent across all industries (SAMHSA, 2008-2012 data, published 2015, still the most recent federal by-industry analysis).
• 16.5 percent of construction workers reported past-month heavy alcohol use, second only to mining and nearly double the 8.7 percent all-industry rate (SAMHSA, 2008-2012 data, published 2015).
• Male construction and extraction workers died by suicide at 49.4 per 100,000, the highest of any occupational group and nearly twice the 27.4 rate among all working men (CDC MMWR, 2016 data from 32 states, published 2020).
• Massachusetts construction workers died of opioid-related overdoses at 228.9 per 100,000, about five times the state's 46.1 all-worker rate (Massachusetts DPH, 2016-2017 data, published 2021).
• Massachusetts recorded 978 opioid-related overdose deaths in 2025, its first year under 1,000 since 2013 (Massachusetts DPH, June 2026).
• New Hampshire's provisional drug overdose deaths fell to 268 in 2025, down from 484 in 2022 (CDC provisional data, accessed July 2026).

How many construction workers have a substance use disorder?

The prevalence figures quoted almost everywhere come from a single federal analysis: SAMHSA's Substance Use and Substance Use Disorders by Industry, published in 2015 using combined 2008-2012 National Survey on Drug Use and Health (NSDUH) data. That report found:

• 14.3 percent of full-time construction workers had a past-year substance use disorder, second highest of any industry (behind accommodations and food services at 16.9 percent) and well above the 9.5 percent all-industry average.
• 11.6 percent reported past-month illicit drug use, versus 8.6 percent across all industries.

Those numbers remain the newest federal by-industry prevalence estimates available. No successor analysis has replaced them, which is worth stating plainly because many articles present them as current-year findings. They are a 2008-2012 snapshot. The closest thing to an update is the analysis behind the NORC at the University of Chicago and National Safety Council employer cost calculator, which found that about 19 percent of construction workers, roughly one in five, have a substance use disorder, among the highest of any industry alongside mining and service occupations.

For current national context, the 2024 NSDUH, published in 2025, found that 16.8 percent of all Americans aged 12 or older (48.4 million people) had a past-year substance use disorder. That figure is not industry-specific, and because NSDUH was redesigned in 2021, it cannot be trended against the 2008-2012 industry numbers.

One more widely repeated number deserves accurate dating: the claim that 1.3 percent of construction workers have an opioid use disorder, nearly twice the national average, comes from a 2017 analysis commissioned by the National Safety Council with NORC at the University of Chicago. It is a useful benchmark, but it is a 2017 estimate, not a current measurement. Nationally, the 2024 NSDUH estimated 4.8 million Americans aged 12 or older had a past-year opioid use disorder.

Alcohol in the trades: heavy drinking in construction

The same 2008-2012 SAMHSA analysis measured past-month heavy alcohol use, defined as binge drinking on five or more days in the past month. Construction ranked second of all industries:

• Mining: 17.5 percent (2008-2012)
• Construction: 16.5 percent (2008-2012)
• All industries: 8.7 percent (2008-2012)

Notably, SAMHSA found construction's elevated drinking rates were not explained away by the industry's demographics. Even accounting for the fact that construction skews young and male, two groups with higher baseline drinking rates, the industry's heavy alcohol use stood out.

Nationally, heavy drinking has declined since those data years: the 2024 NSDUH found 5.0 percent of Americans aged 12 or older (14.5 million people) engaged in past-month heavy alcohol use, down from 5.7 percent in 2021. No current federal data can say whether the trades have followed that curve, which is exactly why the dated labels matter.

The injury-to-opioid pipeline

It starts with the body

Construction remains one of the most dangerous industries in the country. CPWR's April 2025 Data Bulletin, built on Bureau of Labor Statistics data, counted 982 fatal on-the-job injuries among construction workers aged 16 to 64 in 2023, and construction accounted for nearly one-fifth of all U.S. workplace deaths that year. The same bulletin counted roughly 84,400 nonfatal on-the-job construction injuries in the 2021-2022 survey period, most commonly contact incidents, falls, slips, trips, and overexertion. The construction workforce numbered about 11.8 million people in 2022, including the self-employed, per CPWR's analysis of Current Population Survey data, so injuries touch a meaningful share of the workforce every year.

Injuries mean pain, and for two decades pain has frequently meant opioid prescriptions. Workers facing return-to-work pressure, no-work-no-pay economics, and a culture of toughing it out have strong incentives to take the prescription and get back on the scaffold rather than rest and rehabilitate.

From prescription to dependence

Peer-reviewed claims data quantify each step of the pipeline. A study of 19,909 construction workers' union health claims published in the American Journal of Industrial Medicine found chronic musculoskeletal disorders in 42.8 percent of workers per year; among those workers, 24.1 percent received new opioid prescriptions and 6.3 percent received long-term opioid prescriptions each year. Workers receiving opioids for chronic musculoskeletal pain had 4.7 times the odds of a future opioid use disorder, and workers prescribed long-term opioids in any quarter had nearly 10 times the odds (Dale et al., 2021). The authors' conclusion: musculoskeletal pain from physically demanding work is likely one driver of the opioid epidemic in occupations like construction.

Population evidence points the same way. Massachusetts health officials, covered in depth below, found that workers who had been injured on the job died of opioid-related overdoses at a significantly elevated rate over the following decade. Recognizing the signs of opioid addiction early, in yourself or a crew member, is one of the few interventions that costs nothing and can change the entire trajectory. Specialized opioid addiction treatment exists precisely because opioid dependence that begins with a legitimate prescription responds to medical care, not willpower alone.

The fentanyl era changed the stakes

A 2025 CDC MMWR report, Synthetic Opioid and Stimulant Co-Involved Overdose Deaths by Occupation and Industry, analyzed 2022 death certificates and found 11,831 synthetic opioid-involved overdose deaths among construction and extraction workers, the largest count of any named occupation group. Among those deaths, 55.6 percent also involved stimulants, and 33.0 percent involved psychostimulants such as methamphetamine specifically, one of the highest co-involvement rates of any occupation.

The report's authors note that workers in construction and landscaping report using methamphetamine to push through pain and long hours in labor-intensive jobs. In the fentanyl era, that combination is lethal: a contaminated stimulant supply and an opioid supply dominated by fentanyl mean there is no longer a reliably "safer" substance on a job site.

In my experience, the story almost always starts with an injury, a prescription, and a worker who could not afford to stay home. Nobody sets out to develop a dependence; they set out to make it to Friday. Safer pain management for tradespeople means treating the pain, the sleep, and the pressure to return to work as one problem instead of three.

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

Overdose deaths by occupation: what the current federal data shows

For years, articles about addiction in construction cited "CDC data" without a year or a report. The actual current federal source is CDC's National Vital Statistics Reports volume 72, number 7, Drug Overdose Mortality by Usual Occupation and Industry, published in August 2023 using 2020 death certificates from 46 states and New York City. Its findings:

• Construction and extraction occupations had the highest drug overdose death rate of any occupation group: 162.6 deaths per 100,000 workers, versus 42.1 per 100,000 among all workers aged 16 to 64.
• The construction industry group had the highest industry-level rate: 130.9 per 100,000, versus 41.3 across all industries.
• The disparity held on proportionate mortality as well, meaning overdose claims a far larger share of all deaths among construction workers than among workers generally.

CPWR's analyses of the CDC's mortality files carry the count forward. In 2023 there were about 15,900 overdose deaths among construction workers aged 16 to 64, down from roughly 17,500 in 2022. Synthetic opioids, chiefly illicit fentanyl, were involved in three out of four of those deaths. For perspective, overdoses killed about 16 times as many construction workers in 2023 as on-the-job injuries did.

Only a small fraction of these deaths happen at work (109 at-work overdoses in 2023, per CPWR), which is why NIOSH frames this as a workforce health crisis rather than a job-site safety statistic. NIOSH also reports that workplace deaths from unintentional overdose rose almost 500 percent between 2012 and 2020, so the job site is not immune either.

The stat freshness table: what everyone quotes vs. what is current

Most pages about construction and addiction recycle the same handful of figures without dates. This table pairs each recycled number with its true vintage and its current successor, as of mid-2026.

Massachusetts: the injured-worker data nobody else publishes

Massachusetts has produced some of the best occupational overdose data in the country, and it tells the injury-to-addiction story with unusual clarity.

Injured workers die of overdoses at elevated rates

A 2024 Massachusetts Department of Public Health analysis, Opioid-Related Overdose Deaths Among Injured Workers in Massachusetts, linked workers' compensation claims to death records for 2011 through 2020. Among the findings:

• Of the 4,304 working-age residents who died in that window and had at least one prior workplace injury claim, 741 (17.2 percent) died of an opioid-related overdose.
• That share was 35 percent higher than the share among all working-age residents in the state.
• Construction and extraction workers accounted for 28.2 percent of those 741 deaths, the largest share of any occupation group.

Construction's share of the state's opioid deaths

An earlier DPH report, Opioid-Related Overdose Deaths in Massachusetts by Industry and Occupation, 2016-2017, published in 2021, found the construction industry accounted for 28.3 percent of the state's opioid-related overdose deaths with a known industry. The industry's death rate was 228.9 per 100,000 workers, roughly five times the statewide all-worker rate of 46.1, and an 83 percent increase over construction's own 2011-2015 rate of 124.9.

The trend has finally reversed

In June 2026, Massachusetts DPH announced that 2025 saw 978 confirmed and estimated opioid-related overdose deaths, the first year below 1,000 since 2013 (992 deaths), and a decline of nearly 60 percent from the state's 2022 peak of 2,364. The state credits a combination of naloxone saturation, fentanyl test strips, expanded treatment access, and a changing street supply. The occupational breakdown of the 2025 deaths has not yet been published, so whether construction's share of the burden has shrunk remains an open question.

New Hampshire: a hard-hit state turning the corner

New Hampshire was among the states with the highest per-capita overdose death rates through the late 2010s. The state's Drug Monitoring Initiative publishes monthly surveillance reports, and its Substance Misuse Data Page aggregates the state picture.

CDC provisional counts, accessed July 2026, trace the statewide trajectory of drug overdose deaths (12-month totals ending December of each year):

That is a decline of roughly 45 percent from the 2022 peak, with 2025 coming in below 2024, per CDC's Vital Statistics Rapid Release data. The state's own confirmed counts tell the same story: the Drug Monitoring Initiative confirmed 287 overdose deaths for 2024, the lowest total in roughly a decade, and its January 2026 report counted 256 confirmed deaths for 2025 with 13 cases still pending, running below the prior year's pace.

The city-level data matters for the trades because Manchester and Nashua anchor much of the state's construction employment. In January 2026, the Governor's office reported year-end emergency medical services data from American Medical Response: Manchester recorded 371 suspected opioid overdoses in 2025, a 30 percent reduction from 2024 and 54 percent over two years, while Nashua recorded 155, down 16 percent year over year and 35 percent over two years. Both figures are the lowest since AMR began tracking in 2015.

The New England trades picture in one table

No single agency publishes a combined New England occupational view, so the table below compiles the Massachusetts and New Hampshire findings above into one fentanyl-era snapshot. Each row carries its own source and data years; this compilation is original to Clear Steps Recovery.

The takeaway: deaths are falling across New England, but every occupational breakdown that exists still shows the trades carrying a disproportionate share of the burden. Falling statewide totals are not evidence that construction's problem is solved.

Suicide, mental health, and dual diagnosis in construction

Overdose is only half of the mortality story. CDC's analysis of suicide rates by industry and occupation, using 2016 data from 32 states, found male construction and extraction workers died by suicide at 49.4 per 100,000, the highest rate of any occupational group and nearly double the 27.4 rate among all working men. The construction industry as a whole showed a male rate of 45.3 per 100,000.

CPWR's mortality tracking shows the problem persists: about 5,200 construction worker suicides in 2022 and 5,100 in 2023. Combined, suicides and overdoses killed more than 20 times as many construction workers in 2023 as job-site accidents did.

The mental health picture underneath those numbers is stark. CPWR's September 2024 Data Bulletin found 15.4 percent of construction workers reported anxiety or depression in 2021, and 84.3 percent of those workers had not seen a mental health professional in the previous year.

Clinically, this is the territory of dual diagnosis: a substance use disorder occurring alongside depression, anxiety, PTSD, or another mental health condition. Chronic pain feeds depression, depression feeds self-medication, and substances worsen both, a loop that integrated mental health treatment is designed to break by treating both conditions at once rather than sequentially.

When a tradesperson finally comes in, we rarely find a substance problem by itself. There is usually pain underneath it, and often depression or anxiety that has never been named out loud. If you screen a worker only for substance use, you miss half the picture, and treatment that addresses only half the picture tends not to hold.

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

If you or someone on your crew is in crisis, call or text 988 (Suicide and Crisis Lifeline) or contact SAMHSA's free, confidential National Helpline.

Veterans in the trades

Construction is one of the industries where veterans land after service. Per the Bureau of Labor Statistics Employment Situation of Veterans (2024 annual averages, published 2025), 6.4 percent of all employed veterans work in construction, roughly 520,000 people, making it one of the larger civilian industries for former service members.

That overlap matters because veterans bring their own elevated risk profile, layered on top of construction's occupational risks. Pooled 2022-2024 survey data show about 1 in 4 veterans who served in a combat zone reported past-month binge drinking, and about 1 in 8 had a past-year alcohol use disorder (SAMHSA NSDUH veterans spotlight, published 2025). More than 1 in 10 veterans have been diagnosed with a substance use disorder, and 65 percent of veterans entering treatment report alcohol as their most frequently misused substance (NIDA, 2019). A veteran working the trades in New England can often use VA Community Care to cover addiction treatment at a community provider when VA care is not readily accessible, and dedicated veterans rehab programming exists to work within that pathway. No national statistics page in this topic area currently connects these two populations, which is a disservice to a half-million-person workforce.

What substance use costs employers and crews

The business case for supporting recovery is better documented than most contractors realize. In the updated analysis behind their substance use cost calculator, originally released in 2017, NORC at the University of Chicago and the National Safety Council found that each employee with an untreated substance use disorder costs an employer an average of $8,817 per year, while each employee who recovers saves their employer over $8,500 per year on average, driven by avoided turnover, absenteeism, and healthcare costs. Workers in recovery miss 13.7 fewer workdays per year than workers with an untreated substance use disorder. In a National Safety Council survey cited by NIOSH, 75 percent of employers said opioid use had impacted their workplace, yet only 17 percent felt extremely well prepared to deal with it.

The National Safety Council's drugs-at-work data hub maintains employer-facing calculators and industry breakdowns, and NIOSH recommends employers adopt Workplace Supported Recovery programs: policies that make it safe to ask for help, reasonable accommodations during treatment, and second-chance agreements instead of automatic termination. In an industry where an experienced worker is genuinely hard to replace, retention through recovery is not charity; it is math.

Why the numbers look this way

No single cause explains construction's outsized numbers, but the research points to a consistent cluster of risk factors:

• Physical toll and chronic pain. High injury rates and cumulative wear create legitimate pain that outlasts prescriptions.
• Return-to-work pressure. Many tradespeople are paid only when working. Taking six weeks to rehabilitate an injury can mean losing a truck payment, so pain gets medicated instead of treated.
• Seasonal and project-based insecurity. Layoffs between projects and winters remove structure, income, and employer-linked insurance exactly when risk peaks.
• Job-site culture and stigma. A workforce that prizes toughness makes it costly to admit struggling, which helps explain why more than 8 in 10 construction workers with anxiety or depression saw no professional (CPWR, 2021 data).
• Self-medication for performance. CDC's 2025 occupational overdose report documents workers using stimulants to push through pain and long hours, a pattern that turns deadly when the supply is contaminated with fentanyl.
• Demographics only partly explain it. Construction skews young and male, but SAMHSA's by-industry analysis found the elevated rates persisted even after accounting for that.

None of this is a character flaw of people who build things. It is a predictable outcome of pain, pressure, and access meeting an unforgiving drug supply.

Treatment that fits a work schedule

The most common reason working tradespeople give for avoiding treatment is that they cannot afford to stop working, and nationally, treatment reach remains thin: among Americans who needed substance use treatment in 2024, only 19.3 percent received it (2024 NSDUH). The levels of care built for working adults directly answer that barrier:

• Evening intensive outpatient programs. An intensive outpatient program delivers structured group and individual therapy several evenings a week, after the workday ends, so treatment does not require leaving a job.
• Virtual IOP. For workers on remote sites or with long commutes, virtual IOP brings the same clinical programming to a phone or laptop.
• Medication-assisted treatment. MAT pairs FDA-approved medications such as buprenorphine or naltrexone with counseling. Office-based prescribing and monthly injectable options mean a tradesperson does not necessarily need a daily clinic visit to stay in treatment.
• Referral-based detox first when needed. When medically supervised withdrawal is necessary, outpatient centers such as Clear Steps Recovery arrange it through trusted referral partners rather than providing it on site, then continue care once withdrawal is complete.

Realistic recovery for someone in the trades has to survive contact with a work schedule. That is exactly what evening and virtual programs are for: a person can keep their job, keep their income, and still do serious clinical work. Recovery is not a promise anyone can make for you, but I have watched a great many working people build it around a full-time job.

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

For workers and families in New Hampshire and Massachusetts, Clear Steps Recovery provides these outpatient levels of care in Londonderry, New Hampshire and Needham, Massachusetts, with scheduling designed around working adults.

Methodology and source notes

This page was compiled and fact-checked in July 2026. National overdose mortality figures come from CDC's National Vital Statistics Reports volume 72, number 7 (2020 death certificates, 46 states and New York City, published 2023) and CDC MMWR's occupational analysis of synthetic opioid and stimulant co-involved deaths (2022 data, published 2025). Annual construction worker overdose and suicide counts come from CPWR Data Bulletins (April 2025 and September 2024), which analyze CDC mortality files. By-industry prevalence figures come from SAMHSA's analysis of combined 2008-2012 NSDUH data (published 2015); they appear only as dated baselines because no newer federal by-industry analysis exists, and the survey's 2021 redesign prevents trending them against current releases. National context comes from the 2024 NSDUH annual report (published 2025), and the injury-to-opioid pipeline findings come from a peer-reviewed claims study of 19,909 construction workers (Dale et al., American Journal of Industrial Medicine, 2021). Veteran employment figures come from the BLS Employment Situation of Veterans (2024 annual averages), and veteran substance use figures come from SAMHSA's 2022-2024 NSDUH veterans spotlight and NIDA. Massachusetts findings come from the state DPH injured-worker linkage study (2011-2020 data, published 2024), its industry and occupation report (2016-2017 data, published 2021), and its June 2026 annual release. New Hampshire figures come from CDC provisional overdose counts accessed July 2026 (2024-2025 counts are provisional and subject to revision), the NH Drug Monitoring Initiative's confirmed counts through its January 2026 monthly report, and the Governor's office January 2026 release of AMR emergency response data. The New England compilation table is an original synthesis of those public sources by Clear Steps Recovery. Every statistic is reported with its original data-collection years, which may differ from publication years. No figure on this page was sourced from treatment industry blogs or aggregator sites, and every citation was verified live before publication. This page was medically reviewed by Dr. Richard Marasa and last reviewed on July 3, 2026.