Workplace Substance Abuse Statistics 2026: What Addiction Actually Costs Employers, Industry by Industry

Most workplace substance abuse statistics circulating online are stale, uncited, or quietly mislabeled: the same few numbers copied from page to page with no year attached and no source linked. This page takes the opposite approach. Every statistic below is dated, tied to a primary source you can open in one click, and scoped so you know exactly what it does and does not count.

Key numbers at a glance

• About 29 million employed US adults had a substance use disorder in the past year, based on 2024 data: 22.8 million full-time workers plus 6.3 million part-time workers (SAMHSA, 2024 NSDUH Detailed Tables, released 2025).
• 18.8 percent of adults employed full time had a past-year substance use disorder in 2024, nearly one in five (SAMHSA, 2024 NSDUH).
• An employee with an untreated substance use disorder costs an employer roughly $8,255 to $8,817 per year on average (National Safety Council and NORC analyses, published 2020).
• Each employee who reaches recovery saves a company more than $8,500 per year on average (NORC at the University of Chicago and the National Safety Council, 2020).
• Medical care for substance use disorders cost the employer-sponsored insurance population $35.3 billion in a single year, $15,640 per affected enrollee (Li et al., JAMA Network Open, 2023, analyzing 2018 claims).
• 4.4 percent of more than 8 million workforce urine drug tests were positive in 2024, down from 4.6 percent in 2023 (Quest Diagnostics Drug Testing Index, 2025).
• 410 US workers died of unintentional overdose on the job in 2024, down from 512 in 2023 (Bureau of Labor Statistics, Census of Fatal Occupational Injuries, released 2026).
• Accommodations and food service has the highest industry rate of past-year substance use disorder, 16.9 percent; mining (17.5 percent) and construction (16.5 percent) lead in past-month heavy alcohol use (SAMHSA industry report, pooled 2008-2012 data, published 2015).
• New Hampshire recorded 282 confirmed drug overdose deaths in 2024, down about 35 percent from 2023 and the lowest total in a decade (NH Drug Monitoring Initiative, 2025).
• Massachusetts recorded 978 opioid-related overdose deaths in 2025 by preliminary count, the first year under 1,000 since 2013 (Massachusetts Department of Public Health, June 2026).

How many US workers have a substance use disorder?

The most current answer comes from the 2024 National Survey on Drug Use and Health detailed tables, released by SAMHSA in 2025. Among adults aged 18 or older, 22.75 million full-time workers and 6.26 million part-time workers met criteria for a past-year substance use disorder, about 29 million employed adults in total.

As a share of each group, that is 18.8 percent of full-time workers and 19.3 percent of part-time workers in 2024. The rate among unemployed adults was higher, at 28.1 percent, but because far more people work than are unemployed, most adults with a substance use disorder are in the workforce. CDC's National Institute for Occupational Safety and Health makes the same point with 2022 data: of roughly 46 million adults with a substance use disorder that year, nearly two thirds, about 30.1 million, were employed.

The outdated "13.5 million workers" figure, corrected

Many pages still claim that about 13.5 million employed adults have a substance use disorder, usually with no year attached. That figure predates 2021, when NSDUH redesigned its methodology and moved to DSM-5 criteria; post-redesign surveys count substantially more people, which is why current employed-adult estimates run near 30 million. The jump reflects a measurement change, not a sudden doubling of addiction in the workforce, and the two eras are not trend-comparable. The 2023 survey put the employed figure at about 30.1 million, so 2024's 29 million is stable year over year.

Substance use on the job: what the classic research actually shows

The most quoted numbers about drinking and drug use during work hours come from two national surveys by researcher Michael Frone, both published in 2006. They are solid studies, but they are two decades old, and most pages that cite them never say so.

On alcohol, Frone's national survey of 2,805 employed adults in the Journal of Studies on Alcohol (2006) estimated that workplace alcohol use and impairment directly affected about 15 percent of the US workforce, roughly 19.2 million workers at the time:

• 1.83 percent (2.3 million workers) drank within two hours of reporting to work.
• 7.06 percent (8.9 million) drank during the workday.
• 1.68 percent (2.1 million) worked while under the influence of alcohol.
• 9.23 percent (11.6 million) worked with a hangover.

On illicit drugs, Frone's companion survey in the Journal of Applied Psychology (2006) estimated that 14.1 percent of employed adults (17.7 million) used illicit drugs in the preceding year, and 3.1 percent (3.9 million) used illicit drugs in the workplace itself.

No federal survey has replicated Frone's on-the-clock impairment measures since, which is why these 2006 figures keep circulating undated. Treat them as a well-built snapshot of the early 2000s; for current signals, use the NSDUH figures above and the drug-testing and overdose data below.

What substance abuse costs employers: reconciling the numbers everyone quotes

Search this topic and you will meet four very different dollar figures, usually presented interchangeably and almost never with their scope attached. Here is each one, named, dated, and scoped.

The $249 billion figure (Sacks et al., 2015, on 2010 data) is routinely misframed as a workplace cost. It is actually the total cost of excessive alcohol consumption to the entire US economy, about $2.05 per drink, with government paying 40.4 percent and binge drinking driving 76.7 percent of it. Lost workplace productivity is one component alongside health care, crashes, and criminal justice, so quoting the full figure as what alcohol "costs employers" overstates the employer share several times over.

The $35.3 billion figure is the opposite: a deliberately narrow, CDC-authored estimate published in JAMA Network Open in 2023. Examining 2018 claims for 162 million people with employer-sponsored coverage, Li and colleagues found 2.3 million enrollees (1.4 percent) with a diagnosed substance use disorder, at an attributable medical cost of $15,640 per affected enrollee per year; alcohol use disorder accounted for $10.2 billion and opioid use disorder for $7.3 billion. The authors state plainly that this is the minimum direct cost employers and insurers face, since it counts only diagnosed cases and excludes absenteeism, presenteeism, job retention, and mortality.

The per-employee range comes from the National Safety Council and NORC at the University of Chicago: NORC's 2020 analysis put employer spending on each employee with an untreated substance use disorder at $8,817 per year on average, while the Department of Labor's Recovery-Ready Workplace hub and the NSC's employer pages carry the companion $8,255 figure. The same research found that about one in twelve workers has an untreated substance use disorder.

"Untreated substance use disorder rarely stays contained to one line item. In my experience it compounds: emergency visits, injuries that heal slowly, blood pressure and diabetes that stop responding to management, and claims that climb year after year. The least expensive moment to intervene is early, in outpatient care, before the crisis that everyone remembers."

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

Per-employee costs and the return on recovery

The NSC/NORC research is the only major analysis that prices both sides of the ledger: what untreated addiction costs, and what recovery gives back.

• Workers in recovery miss 13.7 fewer workdays per year than workers with an untreated substance use disorder, and 3.6 fewer days than the average employee (NORC/NSC, 2020).
• Each employee in recovery helps an employer avoid about $8,175 in turnover, replacement, and health care costs (NORC/NSC, 2020).
• Netted out, supporting one employee into recovery saves a company more than $8,500 per year on average (NORC/NSC, 2020).

That $8,500 recovery-savings figure appears on many websites with no attribution. It belongs to the NORC and National Safety Council analysis published in 2020, which updated a calculator methodology first published in the Journal of Occupational and Environmental Medicine in 2017; employers can run their own numbers, by state and industry, through the NSC/NORC Substance Use Cost Calculator. Because the underlying cost data predate recent inflation, these figures likely understate today's costs. Employees who look fine on paper are part of this math too; our guide to high-functioning professionals and addiction explains why strong performers are often the last to be noticed.

Substance use by industry: who is most affected

The last full federal breakdown of substance use by industry is a SAMHSA report published in 2015, pooling NSDUH interviews from 2008 through 2012. We state those dates because most pages that quote these figures do not: the rankings remain the standard reference, but the percentages describe the workforce of more than a decade ago. From that report:

• Past-month heavy alcohol use was highest in mining (17.5 percent) and construction (16.5 percent), against an all-industry average of 8.7 percent.
• Past-month illicit drug use was highest in accommodations and food service (19.1 percent), followed by arts, entertainment, and recreation (13.7 percent).
• Past-year substance use disorder was highest in accommodations and food service (16.9 percent), construction (14.3 percent), and arts, entertainment, and recreation (12.9 percent), against an all-industry average of 9.5 percent.

The newer NSC/NORC analysis (2020) confirms the same pattern at the top: roughly one in five construction workers, about 19 percent, has a substance use disorder, the highest share of any industry examined. The gradient shows up in death data too: NIOSH notes that construction and extraction occupations have among the highest drug overdose death rates at work. The industry mix matters locally, because construction, hospitality, and food service are large employers in both New Hampshire and Massachusetts.

Absenteeism, presenteeism, and turnover

The day-to-day cost mechanism behind the annual figures is missed and diminished work, and the peer-reviewed version of the NSC/NORC calculator methodology (Goplerud et al., Journal of Occupational and Environmental Medicine, 2017) quantifies it:

• Workers with a substance use disorder missed 14.8 days a year of unscheduled leave, nearly 50 percent more than their peers, who averaged 10.5 days.
• Workers in recovery missed the fewest days of any group, 9.5 per year, less than the general workforce.
• 36 percent of workers with a substance use disorder reported having more than one employer in the past year, roughly double the turnover signal of unaffected peers.
• The annual cost of a single employee with an untreated substance use disorder ranged from about $2,600 in agriculture to more than $13,000 in information and communications, driven by avoidable health care, absenteeism, and turnover.

Absences are only the visible part. Presenteeism, being at work but impaired, hungover, or preoccupied, is harder to measure, and Frone's 2006 survey found working hungover (9.23 percent of the workforce) far more common than working under the influence itself. Add the recruiting and retraining cost of turnover, and retention tends to beat termination on pure cost.

Workplace drug testing: what 8 million lab results show

The largest current dataset on drugs in the US workforce is the Quest Diagnostics Drug Testing Index. The 2025 edition, published in September 2025 from more than 8 million urine tests performed in 2024, found:

• Overall positivity in the combined US workforce was 4.4 percent in 2024, down slightly from 4.6 percent in 2023.
• Marijuana remained the most commonly detected substance, holding at 4.5 percent in the general workforce, and post-accident marijuana positivity was 7.3 percent, just below 2023's record 7.5 percent.
• Amphetamines positivity rose to 1.7 percent, from 1.5 percent in 2023.
• Fentanyl positivity in the general workforce was about seven times higher in random tests (1.13 percent) than in pre-employment tests (0.14 percent).
• A majority of fentanyl-positive tests also showed other drugs, and 22 percent were also positive for marijuana, double the share in 2020.

The random-versus-pre-employment fentanyl gap is the finding employers should sit with: people generally pass the test they can see coming, which is the argument for pairing testing policies with genuine treatment pathways.

Overdose deaths at work

The Bureau of Labor Statistics counts workplace deaths each year in its Census of Fatal Occupational Injuries. In the 2024 census, released in early 2026, unintentional overdoses from nonmedical use of drugs or alcohol killed 410 people at work, down from 512 in 2023 and a record 525 in 2022, the second consecutive annual decline.

The longer arc is what makes this series worth tracking. NIOSH reports that workplace overdose deaths rose about 500 percent between 2012 and 2020, tracking the national fentanyl wave, and even after two years of improvement the 2024 total remains several times the level of the early 2010s. Overdose is now a real category of occupational fatality that safety programs, naloxone policies, and supervisor training have to account for.

New Hampshire and Massachusetts: the state numbers employers ask about

National statistics hide the state story, and in northern New England the state story is currently one of hard-won progress.

New Hampshire: the first Recovery Friendly Workplace state

New Hampshire launched the nation's first statewide Recovery Friendly Workplace initiative in 2018 under Governor Chris Sununu; it is administered by Granite United Way and continues under Governor Kelly Ayotte. Participating employers get training, a dedicated Recovery Friendly Advisor, and connections to resources such as The Doorway NH and 211 NH. As of mid-2026, more than 400 New Hampshire workplaces participate and just over 300 hold the official designation, listed in the initiative's public directory. The initiative's 2024-2025 participant survey with the Behavioral Health Improvement Institute at Keene State College, released in June 2025, found that 91 percent of responding workplaces reported positive changes over the past year and 95 percent felt better equipped to address substance use concerns.

On cost, a 2017 PolEcon Research analysis cited in the initiative's materials put substance misuse's annual cost to New Hampshire at more than $2.36 billion, with $1.56 billion borne by businesses through impaired productivity and absenteeism. On outcomes, the NH Drug Monitoring Initiative and the state medical examiner recorded 282 confirmed drug overdose deaths in 2024, down about 35 percent from 2023 and the lowest annual total in a decade; fentanyl alone accounted for 135 of those deaths.

Massachusetts: overdose deaths below 1,000 for the first time since 2013

The Massachusetts Department of Public Health, which publishes some of the most detailed state opioid statistics in the country, recorded 1,336 opioid-related overdose deaths in 2024, a 36 percent drop from 2023 and far below the 2022 record of 2,364. Preliminary 2025 data, announced in June 2026, count 978 deaths, 27 percent below 2024 and the first annual total under 1,000 since 2013.

Massachusetts is also the state that proved how unevenly workplace risk is distributed. A DPH analysis of opioid-related overdose deaths by industry and occupation (2011-2015 data, published 2018) found that construction workers accounted for more than 24 percent of opioid-related deaths among employed residents and died of opioid overdose at about six times the rate of the average Massachusetts worker. For Boston-area employers and employees, our guide to alcohol rehab in the Boston area covers what outpatient care looks like on the Massachusetts side.

What untreated substance use disorder plausibly costs NH and MA employers

No agency publishes a state-level employer cost figure, so we computed one from the NSC/NORC methodology's own inputs: current state payroll employment, times the one-in-twelve untreated share, times the per-employee cost range. This is Clear Steps Recovery's own calculation, with assumptions below the table.

Assumptions and limits: jobs are not identical to people (multiple jobholders are counted more than once); the one-in-twelve untreated share predates the 2021 NSDUH redesign, so it is conservative next to the 2024 finding that 18.8 percent of full-time workers have a past-year substance use disorder, a basis that would put the affected headcount near 133,000 in New Hampshire and 698,000 in Massachusetts; and the per-employee cost basis is 2020-era and not inflation-adjusted, which also pushes the totals downward. The broader PolEcon estimate for New Hampshire ($1.56 billion borne by businesses) counts productivity losses from all substance misuse, not only untreated diagnosed disorder, which is why it runs higher than our floor. The point is scale, not precision: even on the most conservative defensible inputs, untreated addiction is a nine-figure annual cost to New Hampshire employers and a ten-figure one in Massachusetts.

Veterans in the workforce and dual diagnosis

Two groups of working adults are consistently missing from workplace addiction roundups: veterans, and employees with co-occurring mental health conditions.

On veterans, SAMHSA's 2022-2024 pooled NSDUH spotlight (published 2025) found that 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, both significantly higher than among veterans who did not serve in one. Past-year substance use disorder stood at 17.5 percent among combat-zone veterans versus 15.4 percent among other veterans, a difference the survey did not find statistically significant. NIDA adds that more than 1 in 10 veterans have been diagnosed with a substance use disorder, with alcohol involved most often. Many of these veterans are on payrolls in construction, transportation, healthcare, and protective services right now, which is why Clear Steps Recovery runs a dedicated VA rehab program built around VA Community Care referrals.

On co-occurring conditions, the 2024 NSDUH annual report found that 21.2 million adults had both a mental illness and a substance use disorder in the past year, nearly half of the 46.3 million adults with a substance use disorder. Close to half the time, the employee struggling with alcohol or drugs is also managing depression or anxiety, and treating one without the other tends not to hold. Our overview of dual diagnosis treatment for depression, anxiety, and addiction explains how integrated care works.

"High-functioning employees are often the last people anyone suspects, because performance is the last thing to go. What supervisors and colleagues genuinely notice first is quieter: withdrawal from the team, irritability, a pattern of Monday absences. And in working adults, co-occurring anxiety or depression is the rule in my practice, not the exception, which is why screening for one without the other misses so much."

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

Getting treatment without leaving your job

The most consequential misunderstanding in this topic is that treatment means disappearing from work for a month. For most working adults, it does not. The treatment gap is enormous: in the 2024 NSDUH, only about 1 in 5 people who needed substance use treatment received it in the past year.

The standard evidence-based option is an intensive outpatient program. In the research literature, IOPs offer a minimum of 9 hours of service per week, typically in three 3-hour sessions, and a systematic review in Psychiatric Services (McCarty et al., 2014) rated the evidence as high that IOPs are as effective as inpatient treatment for most individuals seeking care. Because sessions can run in the evening, a full-time employee can complete an intensive outpatient program around a standard shift, and virtual IOP removes the commute entirely. When more support is needed, day treatment provides a fuller weekday schedule while still letting the person live at home, and when medically supervised detox is needed first, outpatient providers coordinate a referral to a licensed detox facility before stepdown care begins.

Legal protections: FMLA and the ADA

Employees seeking treatment have more legal protection than most realize.

Under the Family and Medical Leave Act, eligible employees of covered employers can take up to 12 weeks of unpaid, job-protected leave per year for a serious health condition, and treatment for a substance use disorder provided by a health care provider qualifies. The protection covers leave taken for treatment, not absences caused by substance use itself.

Under the Americans with Disabilities Act, as ADA.gov and the EEOC's guidance explain, employees in recovery who are not currently using illegal drugs are generally protected from discrimination, including people treating opioid use disorder with prescribed medications such as buprenorphine or methadone, and they may be entitled to reasonable accommodations such as a schedule adjusted for treatment sessions. Alcohol use disorder can also qualify; our guide to whether alcoholism is a disability walks through what that does and does not require of an employer.

Employee assistance programs sit alongside these protections: a typical EAP offers confidential assessment, short-term counseling, and referral at no cost, often the lowest-friction first call for someone not ready to name the problem to a supervisor.

"Most of the working adults I treat do better when they keep the job. The routine, the identity, and the paycheck are not obstacles to recovery; handled well, they are part of it. Evening and virtual programs exist precisely so treatment can fit around a shift instead of replacing it."

Dr. Richard Marasa, Medical Director, Clear Steps Recovery

What employers can do

The data above point to a short, practical playbook.

1. Make the workplace recovery friendly. New Hampshire's Recovery Friendly Workplace initiative provides a tested model: leadership commitment, supervisor training, and visible signaling that seeking help will not end a career. Employers elsewhere can draw on the Department of Labor's Recovery-Ready Workplace hub.
2. Adopt a workplace supported recovery approach. NIOSH recommends employers prevent substance use harm, lower barriers to treatment, and actively support workers in recovery.
3. Pair testing with pathways. The Quest data show screening alone misses the riskiest use. Testing works better when a positive result routes to assessment and treatment rather than automatic termination.
4. Publicize the EAP and the legal facts. Employees who know about FMLA protections, ADA accommodations, and confidential EAP access seek help earlier, and earlier help is cheaper for everyone.
5. Consider second-chance hiring. The finding that workers in recovery miss fewer days than average employees, replicated in the 2017 journal study and the 2020 NSC/NORC update, undercuts the standard hesitation about hiring people with a treatment history.

Methodology and source notes

This page was compiled in July 2026 and uses the newest release of each dataset available at that time: the 2024 NSDUH detailed tables (released 2025) for prevalence by employment status, the 2025 Quest Diagnostics Drug Testing Index (2024 specimens) for testing, the 2024 BLS Census of Fatal Occupational Injuries (released 2026) for workplace overdose deaths, and 2025-2026 state releases for New Hampshire and Massachusetts. Cost figures are presented with their scope: $35.3 billion covers medical costs only, in the employer-sponsored insurance population, from 2018 claims; the $8,255 to $8,817 per-employee range comes from NSC/NORC analyses published in 2020; and $249 billion is an economy-wide excessive-alcohol cost from 2010, included only to correct its common mislabeling as a workplace cost. The New Hampshire and Massachusetts employer cost table is Clear Steps Recovery's own computation, with assumptions stated in that section. Figures with no surviving primary source, like the NCADD-era $81 billion, are identified as such rather than repeated, and industry statistics are dated to their underlying survey years. Every citation was verified live before publication. Dr. Richard Marasa, Medical Director of Clear Steps Recovery, reviewed this article for clinical accuracy.

If you or a colleague is in immediate distress, call or text 988, the Suicide and Crisis Lifeline, any time.

If the numbers on this page describe someone at your company, or you, the next step is smaller than it feels: a confidential conversation about evening or virtual outpatient options that fit around a job in New Hampshire or Massachusetts.