Untreated substance use disorder (SUD) costs the U.S. $400 billion annually in healthcare, justice, and employment.
The cost of SUD treatment depends on the medical setting, intensity of medical care, and length of treatment.
SUD treatment saves $7 for every $1 spent by decreasing healthcare and legal costs while increasing workplace productivity.
Substance use disorder (SUD) is a medical condition where the recurrent use of alcohol or drugs leads to health problems, disability, or an inability to meet responsibilities at work and home (Office of the Surgeon General 2018, Goplerud et al. 2017). In 2024, 48 million Americans over the age of 12 met the criteria for SUD (Substance Abuse and Mental Health Services Administration (SAMHSA) 2025).
The annual economic impact of untreated SUD in the U.S. exceeds $400 billion (Lines 2024, Goplerud et al. 2017). SUD-related hospital and emergency department visits alone cost $13 billion annually (Lines 2024, Prevention Technology Transfer Center Network (PTTCN) 2024). Law enforcement and incarceration expenses for substance-related crimes total about $61 billion per year (Florence et al. 2016, National Drug Intelligence Center (NDIC) 2011). Reduced performance, missed work, and disability cost $157 billion each year (Ghimire et al. 2026, Florence et al. 2016).
SUD treatments are medical interventions that help individuals stop compulsive substance use and restore productive functioning in their families and communities (Office of the Surgeon General 2018, Goplerud et al. 2017). The treatment setting, intensity of medical intervention and program duration contributes to the total costs (Wagener 2026, Davenport et al. 2019).
Less intensive services are typically delivered in outpatient or primary care settings (PTTCN 2024, Horn et al. 2017). Prevention services, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT), address risky substance use before a disorder develops and cost between $25 and $175 per person. Standard outpatient treatment consists of fewer than nine hours of weekly counseling while the patient lives at home and costs about $3,000 annually (Wagener 2026, Davenport et al. 2019). Intensive outpatient programs provide nine to 20 hours of weekly counseling in a nonresidential setting and cost approximately $5,000 per year (Davenport et al. 2019).
More intensive services are delivered in residential or inpatient settings and are typically higher cost (Wagener 2026, Davenport et al. 2019). Residential treatment is 24 hour clinical care in a nonhospital facility for 30 to 90 days, with an average cost of about $16,000 per stay. Medical detoxification occurs in hospital settings to manage acute physical withdrawal over three to seven days and costs between $3,000 and $10,000 per stay.
Medication-assisted treatment (MAT) combines medications with counseling to manage cravings and withdrawal symptoms (National Academies of Sciences, Engineering and Medicine (NASEM) 2019). MAT may be delivered across outpatient, residential, or hospital settings, depending on patient needs, and typically cost between $4,000 and $6,000 annually (Davenport et al. 2019).
For every $1 spent on SUD treatment and prevention, studies estimate $7 are saved through reduced healthcare and criminal justice use and employee absenteeism and turnover (PTTCN 2024, Ettner et al. 2006, Figure 1). Healthcare and criminal justice costs make up 43% of the economic burden of SUD, but treatment reduces these expenses by decreasing hospital stays and arrests (PTTCN 2024, Horn et al. 2017, Florence et al. 2016). For employers, each recovering worker saves the company $8,500 through improved attendance and an additional $8,000 in turnover and replacement costs (National Opinion Research Center (NORC) n.d.).
These estimates have documented limitations (PTTCN 2024, Ettner et al. 2006). The $7-to-$1 ratio comes from short-term, self-reported studies from specific regions rather than long-term, national studies (Ettner et al. 2006). Individual studies use different data sources, include different substances, and do not reflect rising healthcare costs (SAMHSA 2025, Gloppen et al. 2022, Manthey et al 2021, Davenport et al. 2019). Most cost estimates do not include non-financial effects, such as personal pain, emotional suffering, or the multi-generational impact of SUD on families (Davenport et al. 2019, Florence et al. 2016).
Figure 1. The Ratio of Substance Use Disorder (SUD) treatment costs ($1) to societal savings ($7). For every $1 spent on SUD treatment, there is a $7 reduction in cost related to crime, healthcare, and the workplace (Ettner et al. 2006). The three bright green dollars represent the 43% of savings from healthcare and criminal justice sectors. The remaining four icons represent additional society benefits like increased worker productivity and reduced employee turnover (NORC n.d.).
References
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