The Economic Cost of Addiction in the U.S.: 2026 Statistics, How to Read the Trillion-Dollar Estimates, and What It Costs New Hampshire and Massachusetts

How much does addiction cost the United States? Ask four federal sources and you will get four very different answers: more than $700 billion, $1.02 trillion, nearly $1.5 trillion, and $2.7 trillion. All four are real, published government figures, and none contradicts the others, because each counts different substances, different costs, and different ways of valuing a human life.

This page assembles the current, verifiable numbers in one place: what each headline estimate includes, the breakdown by substance and by cost component, what the opioid crisis specifically costs, and the burden in New Hampshire and Massachusetts, two states that have carried among the heaviest per-person costs in the country. Every statistic links to a primary source and is labeled with the year of its data.

Key numbers at a glance

• Use and misuse of alcohol, nicotine, and illicit drugs, and misuse of prescription drugs, cost Americans more than $700 billion a year in increased health care costs, crime, and lost productivity (NIDA, Drugs, Brains, and Behavior: The Science of Addiction).
• Illicit opioids cost Americans an estimated $2.7 trillion in 2023 alone, in December 2024 dollars, equal to 9.7 percent of GDP; deaths account for $1.1 trillion of that, lost quality of life for $1.34 trillion, and health care, lost productivity, and crime for $277 billion (White House Council of Economic Advisers, 2025).
• Opioid use disorder and fatal opioid overdose cost the U.S. an estimated $1.02 trillion in 2017: $471 billion for opioid use disorder plus $550 billion for fatal overdose (CDC MMWR, 2021).
• The opioid epidemic's toll reached nearly $1.5 trillion in 2020, up 37 percent from 2017 (Joint Economic Committee, 2022).
• Substance use disorder caused an estimated $92.65 billion in morbidity-related productivity losses among U.S. adults in 2023, about $3,703 per adult with a substance use disorder (Ghimire, Florence, and Guy, American Journal of Preventive Medicine, published 2025).
• Excessive alcohol use cost the U.S. about $249 billion in 2010, roughly $2.05 per drink, in the most recent CDC national estimate (CDC, Data on Excessive Alcohol Use).
• Cigarette smoking cost the U.S. more than $600 billion in 2018, including more than $240 billion in health care spending (CDC, Economic Trends in Tobacco).
• Opioid costs hit New Hampshire at $5,953 per resident in 2017, the third highest rate among the 38 states plus DC in the CDC's analysis, and Massachusetts at $5,381 per resident, the fifth highest (CDC MMWR, 2021).
• Preliminary CDC data predict 69,147 U.S. drug overdose deaths for the 12 months ending January 2026, a 13.2 percent decline from the year before (CDC, provisional data released June 2026).
• The average addiction treatment episode cost about $1,583 and produced about $11,487 in societal benefit, a greater than 7 to 1 return (Ettner et al., Health Services Research, 2006).

Why the headline estimates disagree: $700 billion to $2.7 trillion

When a journalist, policymaker, or family member asks what addiction costs the country, the honest first answer is a question back: which substances, and which costs? The most-cited national estimates differ on both. The table below reconciles them so you can cite the right number for the claim you are making.

Three rules of thumb make sense of the spread. First, scope: the NIDA and AJPM figures cover all substances, while the trillion-dollar estimates are opioid-specific. Second, components: any estimate that assigns dollars to deaths and diminished quality of life will dwarf one that counts only bills paid and wages lost. Third, methodology: the federal value-of-statistical-life approach is what pushes the CDC and CEA numbers into the trillions.

The 2025 CEA analysis shows how much detail sits under a headline number. Its $2.7 trillion breaks into $1.1 trillion for the 74,702 deaths attributed to illicit opioids in 2023, $1.34 trillion in lost quality of life across an estimated 5.7 million people living with opioid use disorder, $107 billion in added health care costs, $107 billion in lost labor productivity, and $63 billion in crime-related costs (CEA, 2025).

The $1.1 trillion misreading to avoid

Several recent articles quote the 2025 White House estimate as "$1.1 trillion." That is a misreading of the source: the Council of Economic Advisers' release puts the 2023 total at $2.7 trillion, and $1.1 trillion is the deaths component alone, 41 percent of the total (CEA, 2025). If you cite one opioid number in 2026, $2.7 trillion is the current federal total.

Where the famous $740 billion figure came from

For years, articles and reference sites have quoted "$740 billion" as the annual cost of substance use, usually attributed to NIDA. That figure came from a NIDA statistics page that assembled separate component studies (data years 2007 to 2013) and that no longer exists on NIDA's site. NIDA's current, live language is "more than $700 billion" a year across alcohol, nicotine, illicit drugs, and misused prescription drugs (NIDA, Science of Addiction, Introduction). Pages still presenting "$740 billion" as a current, single-study figure are recycling a retired citation.

Other numbers still circulating that you should not cite as current

Because addiction economics is updated rarely and quoted often, several outdated or unsourced figures keep circulating. A $532 billion societal-cost figure traces to data from 1995 through 1998. An "$820 billion per year" total circulates with no published source at all. Component figures of $120 billion in lost productivity, $61 billion in criminal justice costs, and $11 billion in health care are often presented as current; they are 2007 values from a Department of Justice report discussed below. And an "$891.8 billion" tobacco figure appears in at least one reference database without a traceable primary source, far above the CDC's own estimate. When in doubt, use the reconciliation table above and link the primary source.

"The spread between these estimates is not statistical noise, and it should not make anyone distrust the numbers. They are answering different questions. As a physician, the version of this question I actually face is smaller and more concrete: what does one person's untreated addiction cost their health, their family, and their work this year? That cost compounds quietly, and it is the reason early outpatient care is almost always the cheapest point of intervention."

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

The cost of addiction by substance

Alcohol: $249 billion, and a 15-year-old number

The most recent national estimate of what excessive alcohol use costs the United States is $249 billion, for 2010 (CDC, Data on Excessive Alcohol Use; underlying study Sacks et al., American Journal of Preventive Medicine, 2015). That works out to about $2.05 per drink consumed, or roughly $807 per person in the U.S. The CDC attributes 72 percent of the total to lost workplace productivity, 17 percent to property damage, crashes, and criminal justice, and 11 percent to health care for alcohol-related injuries. Governments paid about $2 of every $5 of it.

The vintage of that estimate is itself worth reporting: the federal government has not published a newer national alcohol cost figure in more than 15 years, even though excessive drinking now kills about 178,000 Americans per year based on 2020 to 2021 data, a 29 percent increase over 2016 to 2017 (CDC, 2024). Any larger alcohol cost figure you see quoted today is an adjustment or projection, not a new federal measurement.

Tobacco: more than $600 billion

Cigarette smoking cost the United States more than an estimated $600 billion in 2018, the most recent CDC accounting (CDC, Economic Trends in Tobacco). That total includes more than $240 billion in health care spending. It also includes nearly $185 billion in lost productivity from smoking-related illness. Lost productivity from smoking-related premature death adds nearly $180 billion more, and premature deaths from secondhand smoke exposure about $7 billion.

Illicit drugs and opioids

The last comprehensive federal costing of illicit drug use across all drug types found a total of more than $193 billion for 2007, including $120.3 billion in lost productivity, $61.4 billion in crime-related costs, and $11.4 billion in health costs (U.S. Department of Justice, National Drug Intelligence Center, 2011). Those component figures still circulate widely, sometimes presented as current; they are 2007 data, they predate the fentanyl era entirely, and the agency that produced them no longer exists.

For opioids specifically, CDC researchers put prescription opioid overdose, abuse, and dependence at $78.5 billion for 2013, including $28.9 billion in increased health care and substance use treatment costs (Florence et al., Medical Care, 2016). The far larger opioid figures in the reconciliation table reflect broader scope (all opioids, including illicitly manufactured fentanyl), rising death counts, and the inclusion of mortality and quality-of-life valuation.

Why gambling and other behavioral addictions are not in these numbers

Every headline figure on this page measures substance-related costs only. The federal cost literature is built substance by substance: NIDA's statement covers alcohol, nicotine, and drugs; the CDC, JEC, and CEA estimates cover opioids; the AJPM study covers substance use disorders as defined in the national survey. No federal agency currently publishes a comparable national cost estimate for gambling disorder or other behavioral addictions, so dollar figures for those conditions typically trace to older academic studies or advocacy estimates. If your claim is about "addiction" in the broad sense, cite the substance-specific numbers and note that behavioral addictions would add to them.

The cost of addiction by component

Health care

Health care is the most visible cost lane: emergency department visits, hospitalizations, infections, and treatment itself. Smoking alone accounts for more than $240 billion in annual health care spending (2018 data, CDC). Prescription opioid misuse added $28.9 billion in health care and treatment costs in 2013 (Florence et al., 2016), and the CEA's 2023 analysis puts opioid use disorder at about $19,000 per affected person per year in added health care costs (CEA, 2025). The health care line also runs deeper than addiction treatment itself: among Medicaid beneficiaries with behavioral health conditions, those who also had a substance use disorder generated significantly higher spending on physical health care in five of six states studied (Clark et al., Psychiatric Services, 2009).

Lost productivity

The newest component estimate is a CDC-authored study published in the American Journal of Preventive Medicine in December 2025: substance use disorder cost U.S. adults $92.65 billion in morbidity-related productivity losses in 2023 (Ghimire, Florence, and Guy; full text at PubMed Central). The breakdown, each figure from the same study:

• Inability to work: $45.25 billion
• Absenteeism (missed work days): $25.65 billion
• Presenteeism (reduced performance while at work): $12.06 billion
• Lost household productivity: $9.68 billion

Averaged across everyone affected, that is $3,703 per adult with a substance use disorder per year, and these figures count morbidity only; they exclude the much larger productivity losses from premature death.

Criminal justice

Crime-related costs of illicit drug use totaled $61.4 billion in the last full federal accounting (2007 data, DOJ National Drug Intelligence Center, 2011), and the CEA's 2023 opioid estimate put crime-related costs at $63 billion (CEA, 2025). The population behind those numbers is striking: research compiled by NIDA indicates an estimated 65 percent of the U.S. prison population has an active substance use disorder, and another 20 percent were under the influence of drugs or alcohol at the time of their crime (NIDA, Criminal Justice DrugFacts).

Mortality and the value of a statistical life

The component that separates the billion-dollar estimates from the trillion-dollar ones is death. Federal cost analyses value mortality using the value of a statistical life, a standard method that converts fatal risk into dollars, the same tool used to evaluate highway and environmental safety rules. In the CDC's 2017 opioid analysis, the value of statistical life lost accounted for $4.28 billion of New Hampshire's cost and $19.32 billion of Massachusetts' cost, exceeding every tangible component combined (CDC MMWR, 2021). Dividing the CDC's published state fatal-overdose costs by each state's deaths implies roughly $11.5 million per fatal opioid overdose in 2017 dollars (our arithmetic from the MMWR tables). The 2025 CEA analysis works the same way at national scale: $1.1 trillion of its $2.7 trillion total is deaths, and another $1.34 trillion is lost quality of life. Reasonable people can debate whether valued lives belong in an "economic cost" headline, which is exactly why this page separates tangible-cost estimates from comprehensive ones.

The economic cost of the opioid crisis over time

Laid end to end, the federal opioid estimates trace the crisis itself:

• 2013: $78.5 billion, prescription opioids only (Florence et al., 2016)
• 2017: $1.02 trillion, all opioids, adding quality-of-life and mortality valuation (CDC MMWR, 2021; Florence, Luo, and Rice, Drug and Alcohol Dependence, 2021)
• 2020: nearly $1.5 trillion, up 37 percent from 2017, reflecting the pandemic-era surge in deaths (Joint Economic Committee, 2022)
• 2023: $2.7 trillion, illicit opioids, primarily fentanyl (CEA, 2025)

Read that sequence carefully: it is not a like-for-like inflation series. The jump from $78.5 billion to $1.02 trillion mostly reflects broader scope and the addition of mortality and quality-of-life valuation, not a thirteen-fold explosion in spending. The epidemic genuinely worsened, and the later studies also count more; honest citation notes both.

The human denominator has finally started to improve. Preliminary CDC data predict 69,147 drug overdose deaths for the 12 months ending January 2026, a 13.2 percent decline from the year before (CDC, provisional data released June 17, 2026). Meanwhile, an estimated 4.8 million Americans aged 12 or older had an opioid use disorder in 2024 (SAMHSA, 2024 NSDUH), so the living costs of the crisis continue even as deaths fall.

What substance use costs employers and the workplace

Most of the workplace numbers that circulate online date to the early 2000s. The current, citable core is the 2023 productivity analysis above: $25.65 billion in absenteeism plus $12.06 billion in presenteeism lands directly on employers, and the $45.25 billion in inability to work shrinks the labor force employers hire from (AJPM, published 2025). Per affected adult, productivity losses averaged $3,703 per year, higher for men ($4,242) than women ($2,969), per the same study.

Alcohol remains the workplace's biggest substance cost driver: 72 percent of the $249 billion national alcohol cost, roughly $179 billion by the CDC's published share, came from lost workplace productivity (2010 data, CDC). And because many adults with a substance use disorder are steadily employed and outwardly successful, employers rarely see the cost line until a crisis. With 48.4 million Americans living with a substance use disorder in 2024 (SAMHSA, 2024 NSDUH), statistically almost every sizable workforce includes them. Our guide to high-functioning professionals and addiction covers what that pattern looks like before it reaches the cost data.

What addiction costs New Hampshire and Massachusetts

No national number lands harder than the local one. The CDC's state-level analysis of 2017 opioid costs, the only per-state federal costing published to date, put northern New England at the expensive end of the national table (CDC MMWR, 2021).

Source: CDC MMWR 70(15), Tables 1 and 2. New Hampshire's per-resident cost trailed only West Virginia and Ohio, and Maine and Connecticut also ranked in the top eight, a direct reflection of how hard the fentanyl era hit New England. The same tables show where the money went in 2017: tangible costs (health care, substance use treatment, criminal justice, and lost productivity, including the tangible costs of fatal overdoses) came to about $1.1 billion in New Hampshire and $5.3 billion in Massachusetts, while reduced quality of life and the value of statistical life lost made up about 86 percent of each state's total (our arithmetic from Table 2).

What the burden looks like now

Both states have bent the curve since 2017, and the direction is hopeful. CDC provisional counts report 266 drug overdose deaths in New Hampshire for the 12 months ending January 2026, down about 44 percent from 478 in calendar 2017, and 1,324 in Massachusetts, down about 38 percent from 2,138 (CDC Vital Statistics Rapid Release, accessed July 2026). Detailed state reporting continues in the New Hampshire Drug Monitoring Initiative (NH DHHS) and the Massachusetts DPH Current Opioid Statistics series.

A clearly labeled projection, our own calculation and not a government figure: applying the CDC's 2017 per-death cost of roughly $11.5 million to the current provisional death counts implies a mortality cost alone of roughly $3.1 billion per year in New Hampshire and $15.3 billion in Massachusetts, in 2017 dollars, before counting any of the living costs of opioid use disorder. Restating those figures in 2024 dollars using Bureau of Labor Statistics CPI-U annual averages (a 28 percent increase from 2017) puts them near $3.9 billion and $19.6 billion. The method and its limits are in the methodology note below. Either way, the takeaway holds: even after a decline in deaths of more than a third, each state's annual burden remains measured in billions.

"State cost tables read as abstractions until you translate them into treatment-access math. From where we practice, in Londonderry and in Needham, those per-resident figures describe real waiting rooms: every person who cannot get into care this month is quietly accruing the health care, work, and family costs these tables add up. The encouraging part is that the same math runs in reverse when people do get in."

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

The economic cost of addiction among veterans

Veterans appear almost nowhere in the economic coverage of addiction, even though federal survey data describe their burden in detail. Pooled 2022 to 2024 national survey data show 17.5 percent of veterans who served in a combat zone had a past-year substance use disorder, versus 15.4 percent of veterans who did not serve in one, a difference the survey did not find statistically significant (SAMHSA NSDUH veterans spotlight, published 2025). Where combat-zone service shows up unmistakably is alcohol: 12.3 percent of combat-zone veterans had a past-year alcohol use disorder versus 8.9 percent of other veterans, about 1 in 4 reported past-month binge drinking versus about 1 in 5, and heavy drinking ran 8.7 percent versus 6.1 percent, each a statistically significant gap, per the same spotlight.

The cost arithmetic follows directly from the national figures: each adult with a substance use disorder represents, on average, $3,703 per year in lost productivity (2023 data, AJPM), and for opioid use disorder the CEA's 2023 analysis adds about $19,000 per person per year in health care costs plus $234,478 per person per year in lost quality of life (CEA, 2025). With roughly one in six veterans meeting substance use disorder criteria in a given year, those per-person costs land in exactly the population with a dedicated federal payment pathway: VA Community Care allows eligible veterans to receive addiction treatment from community providers. Our overview of veterans' addiction treatment through VA Community Care explains eligibility and referrals, and our VA rehab program works within that pathway in both states.

The economics of dual diagnosis

Co-occurring mental illness multiplies both the human and the financial cost of addiction, and it is common: 21.2 million U.S. adults, 8.1 percent of all adults, had both a mental illness and a substance use disorder in the past year in 2024, and 41.2 percent of them received no treatment for either condition (SAMHSA, 2024 NSDUH). SAMHSA's national report states plainly that co-occurring disorders bring more profound functional impairment, worse treatment outcomes, higher morbidity and mortality, increased treatment costs, and higher risk of homelessness and incarceration than either condition alone.

The peer-reviewed cost evidence is consistent with that. Among Medicaid beneficiaries with behavioral health conditions, adding a substance use disorder significantly raised medical spending in five of six states studied, with roughly half of the additional spending going to physical health care rather than behavioral care (Clark, Samnaliev, and McGovern, Psychiatric Services, 2009; 1999 claims data, still the most direct published test of this question). In a study of more than 52,000 Massachusetts Medicaid members with opioid use disorder, co-occurring alcohol use disorder quadrupled relapse risk, other non-opioid substance use roughly doubled it, and serious mental illness added 80 percent (Clark et al., Journal of Substance Abuse Treatment, 2015). Relapse is where costs concentrate: emergency care, hospitalization, and lost work. The economic implication matches the clinical one: treating only one half of a dual diagnosis leaves the other half generating costs.

The cost of inaction versus the cost of treatment

Every figure above is, in accounting terms, the price of untreated addiction. The published evidence on treatment tells the other side of the ledger.

What inaction costs, per the sources above. About $3,703 per adult with a substance use disorder per year in lost productivity alone (2023 data, AJPM). About $19,000 per person per year in added health care costs for opioid use disorder, plus $234,478 per person per year in lost quality of life (2023 data, CEA). Roughly $11.5 million per fatal overdose in the CDC's 2017 valuation.

What treatment returns, by the peer-reviewed record.

• Treatment in general: a benefit-cost analysis in Health Services Research found the average treatment episode cost about $1,583 and generated about $11,487 in societal benefit, a greater than 7 to 1 return, driven mostly by reduced crime and increased employment earnings (2006). Outpatient treatment episodes in that study averaged $838.
• Level of care: a systematic review in Psychiatric Services rated the evidence as high that intensive outpatient programs produce outcomes comparable to inpatient or residential care for most people seeking treatment (McCarty et al., 2014), which matters economically because outpatient care lets people keep working during treatment. Our partial hospitalization program in New Hampshire adds day-treatment intensity without an overnight stay.
• Medication: in the Massachusetts Medicaid study, treatment episodes that included methadone or buprenorphine ran $153 to $233 per month lower in total health care spending than treatment without medication, while roughly halving relapse risk (Clark et al., 2015). Medication-assisted treatment pairs those medications with counseling.
• Expanding access is itself cost-effective: a JAMA Health Forum modeling study found that a combined strategy of expanding buprenorphine treatment, including telehealth, cost $19,381 per quality-adjusted life year gained, far below the thresholds typically used to judge health spending worthwhile (Claypool et al., 2023).
• Telehealth specifically: among Medicare beneficiaries with opioid use disorder, receiving opioid-related telehealth services was associated with 27 percent higher odds of staying on medication and 33 percent lower odds of a medically treated overdose (Jones et al., JAMA Psychiatry, 2022). A comparison of virtual, hybrid, and in-person intensive outpatient treatment found no significant differences in abstinence or quality of life three months after discharge (JMIR Formative Research, 2022), and in a 2021 to 2023 cohort of 4,724 telehealth IOP patients, about 80 percent remained engaged at 30 days and 91 percent achieved at least 30 consecutive days of abstinence during treatment (Healthcare, 2024).

Cost should never be the reason someone stays untreated: insurance typically covers outpatient addiction treatment, and public options exist for people without coverage; our guide to who qualifies for free rehab maps them. Because recovery is a chronic-condition process, the relapse statistics are worth reading alongside this page: continuing care is what protects both the clinical and the financial gains.

"Families rarely experience addiction as one big invoice. They experience it as years of small ones: a missed promotion, a totaled car, an emergency room copay, savings that quietly drain. By the time a case appears in the national cost data as a hospitalization or a court date, the family has usually been paying down this bill for a long time. Structured outpatient treatment is, among everything else it does, how you stop those payments."

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

What these numbers mean for families in New Hampshire and Massachusetts

Behind every figure on this page is the same practical arithmetic a family faces at a kitchen table: the cost of acting now versus the compounding cost of waiting. The data say waiting is the expensive choice. Clear Steps Recovery provides outpatient addiction treatment, including day treatment, intensive outpatient care, medication-assisted treatment, and virtual options, in Londonderry, New Hampshire and Needham, Massachusetts. Our admissions team can verify insurance and explain options in one confidential call at (603) 769-8981. If you or someone you love is in immediate crisis, call or text 988 for the Suicide and Crisis Lifeline.

Methodology and sourcing notes

Every statistic on this page comes from a federal agency (CDC, NIDA, SAMHSA, the U.S. Department of Justice, the White House Council of Economic Advisers, the U.S. Congress Joint Economic Committee) or a peer-reviewed journal, with each figure labeled by its data year in the text. No statistic was sourced from treatment industry blogs or aggregator sites, and every citation URL was verified as live before publication. Dollar figures are in the dollars of their source year unless stated otherwise. Three calculations are Clear Steps Recovery's own and are labeled where they appear: (1) the per-death cost of roughly $11.5 million divides the CDC's published 2017 state fatal-overdose costs by each state's death count (New Hampshire and Massachusetts agree to three significant figures); (2) the directional projection for New Hampshire (roughly $3.1 billion) and Massachusetts (roughly $15.3 billion) multiplies that 2017 per-death cost by each state's provisional overdose death count for the 12 months ending January 2026, with an optional inflation restatement to 2024 dollars using Bureau of Labor Statistics CPI-U annual averages (a 28 percent increase from 2017); (3) the 86 percent intangible share sums each state's reduced-quality-of-life and value-of-statistical-life components from MMWR Table 2. The projection counts mortality only, excludes all costs of nonfatal opioid use disorder, and applies an opioid-derived per-death cost to all-drug death counts; it is a directional read, not a government estimate. Provisional CDC overdose counts may be revised as records are finalized. This page reports population-level statistics, not a prediction of any individual's outcomes or costs. Medically reviewed by Dr. Richard Marasa. Last reviewed July 3, 2026.