Top 10 Most Common Drug Addictions

What Are the Most Common Addictions?

Addiction or Substance Use Disorder (SUD) describes the compulsive use of a substance regardless of social, legal, or health consequences. People struggling with this brain disorder are often psychologically and/or physically dependent on the substance or behavior, making it difficult to stop their addiction.

While we often associate addiction with drugs or alcohol, certain behaviors like gambling, problematic pornography use, and excessive internet/gaming can present similar symptoms. It’s crucial to remember that individuals struggling with addiction often have very little control over these compulsions.

Though we frequently hear about drug statistics related to opioids or heroin, this doesn’t always provide a complete picture of addiction in the U.S. Many people envision “hard drugs,” but commonly normalized substances like nicotine and alcohol are often overlooked.

Regardless of how harmless some items on this list may seem, each carries inherent dangers and risks. Educating loved ones about the serious risks of both illicit substances and common behaviors is vital.

The Top 10 Most Common Addictions in the U.S.

Based on recent prevalence data and significant societal impact, here are the leading addictions in the United States:

1. Alcohol Use Disorder (AUD)

Alcohol Use Disorder (AUD) continues to be one of the most widespread and impactful addictions in the United States.

• In 2023, an estimated 28.9 million Americans aged 12 and older (10.2% of this demographic) experienced an AUD in the past year.
• Among individuals who consumed alcohol monthly, a significant 21.5% met criteria for AUD.
• Prevalence is notably high among college students, with 14% of those aged 18-24 meeting AUD criteria in 2023.

The human cost of alcohol abuse is substantial, with approximately 140,557 Americans dying from alcohol-related causes annually. Tragically, 3,983 Americans under 21 die each year due to excessive alcohol use, primarily from acute causes like suicide or motor vehicle accidents. Chronic misuse accounts for 53.7% of alcohol-related deaths, with alcoholic liver disease being the leading cause.

What is Alcohol?

Alcohol, a legal ingredient in beer, wine, and liquor, is a central nervous system depressant. It enters the bloodstream and is metabolized by the liver, which can only process small amounts at a time, making it easy for the body to become overwhelmed by large quantities.

Effects of Alcohol

People with an addiction to alcohol or Alcohol Use Disorder (AUD) often put themselves at risk by drinking too much alcohol. Alcohol interferes with the brain’s communication pathways and can make it harder for the brain to control functions like balance, memory, speech, and judgment. These issues with brain function can lead to serious injury and negative health effects.

Alcohol Abuse and Risks

Alcohol abuse comes with significant consequences to both safety and health. For example, in 2019, alcohol-impaired driving fatalities accounted for 10,142 deaths (28% of overall driving fatalities).

It’s important to know the difference between alcohol abuse and alcoholism. Long-term health risks of alcohol abuse include:

• Liver disease
• Heart disease
• Depression
• Stroke
• Stomach bleeding
• Head and neck cancers
• Diabetes
• High blood pressure
• Sleep disorders

2. Marijuana Use Disorder

Marijuana remains the most commonly used federally illegal drug in the U.S.

• In 2023, an estimated 61.8 million Americans aged 12 or older (21.8% of the population) reported past-year use.
• Among monthly users, a substantial 44% may experience some degree of marijuana use disorder.
• Use increased by 16.2% among Americans aged 12+ from 2021 to 2023, and one in six individuals who start before age 18 risk developing addiction.
• College students show particularly high rates, with 39.5% reporting use in 2023.

Regarding consumption methods, a 2022 survey indicated that 15.3% of adults reported current cannabis use, with smoking being the predominant route (79.4%). However, other methods such as eating (41.6%), vaping (30.3%), and dabbing (14.6%) are also common, with approximately half of current users reporting multiple routes of administration.

Marijuana use can directly impact critical brain functions, including memory, learning, attention, decision-making, coordination, emotion, and reaction time. Long-term or frequent cannabis use has also been linked to an increased risk of psychosis or schizophrenia in certain individuals.

What is Marijuana?

Marijuana (cannabis) consists of the dried leaves, flowers, stems, and seeds of the Cannabis sativa or indica plant. It contains THC, the mind-altering chemical often used medicinally for chronic pain, anxiety, PTSD, and seizure disorders.

Effects of Marijuana

The THC in marijuana activates brain receptors, causing a “high” with altered senses, difficulty with thinking, impaired movement, and hallucinations at high doses. Medicinal use aims to leverage these symptoms for health benefits under prescription.

Marijuana Abuse and Risks

Marijuana’s recreational abuse carries risks. The long-term health risks of smoking marijuana include breathing problems, increased heart rate, and intense nausea/vomiting.

General long-term health risks of marijuana abuse include:

• Memory impairment
• Temporary hallucinations and paranoia
• Worsening symptoms in patients with schizophrenia
• Congenital disabilities or stillbirth
• Cannabinoid Hyperemesis Syndrome (CHS)—a rare condition of severe nausea, vomiting, and dehydration

3. Nicotine Dependence (Tobacco Products & Vaping)

Nicotine dependence, from traditional tobacco to vaping, remains a pervasive public health concern.

• In 2023, a substantial 64.4 million people in the U.S. reported using tobacco or nicotine vaping products in the past month.
• More specifically, in 2024, 27.7 million individuals aged 12 or older reported vaping nicotine monthly.
• As of 2020, 8.5% of people aged 12 or older (23.6 million individuals) had nicotine dependence in the past 30 days.

Youth nicotine consumption patterns are shifting. In 2024, 8.1% (2.25 million) of all students reported current use of tobacco products. While e-cigarette use among middle and high school students slightly decreased to 5.9% (1.63 million) in 2024, traditional cigarette smoking hit its lowest recorded level (1.4%). However, the emergence of new products such as nicotine pouches shows a 1.8% current use rate among students. Nicotine vaping accounts for the highest number of new initiates among all substances, with 5.4 million new users in 2024, or approximately 14,800 new users daily.

What is Nicotine?

Nicotine is the primary psychoactive ingredient in legal tobacco products (cigarettes, cigars, snuff, chewing tobacco). Many e-cigarette manufacturers also add nicotine to vape cartridges.

Effects of Nicotine

Nicotine acts as a stimulant, releasing endorphins in the brain’s reward circuits, causing a slight, brief euphoria. Repeated exposure leads to long-term brain changes, forming dependence and addiction.

Nicotine Abuse and Risks

Nicotine withdrawal symptoms can appear quickly, making cessation difficult. Users often experience irritability, craving, depression, anxiety, cognitive deficits, sleep disturbances, and increased appetite.

Long-term health risks of consuming nicotine include:

• Stroke
• Cancer
• Blindness, cataracts (eye diseases)
• Congenital disabilities (“birth defects”)
• Periodontitis (yellowing teeth, gum disease)
• Heart disease
• Pneumonia and respiratory conditions
• Diabetes
• Ectopic pregnancy
• Male sexual dysfunction
• Rheumatoid arthritis
• Reduced immune function

4. Opioid Use Disorder (OUD)

Opioid Use Disorder (OUD) continues to be a profound public health crisis.

• In 2023, an estimated 8.9 million Americans aged 12 and older (3.4% of the population) reported misusing opioids in the past year. Of these, 5.9 million individuals (2.1%) met diagnostic criteria for OUD.
• A significant 90% of opioid misusers (5.3 million people) reported misusing prescription pain relievers.
• Hydrocodone was the most frequently misused prescription opioid (3.6 million misusers).

The lethality of opioids, especially synthetic variants, is alarmingly high. In 2023, 79,358 drug overdose deaths were opioid-related (75.6% of all overdose fatalities). Fentanyl was involved in 72,776 deaths, highlighting its dominant role. Prescription opioid-related deaths accounted for 13,026 fatalities, and heroin-related deaths accounted for 3,984 deaths. Nearly 70% of stimulant-involved overdose deaths in 2023 also involved illicitly manufactured fentanyl.

What are Opioid Painkillers?

Opioids are a class of drugs derived from the opium poppy plant, or lab-made, like fentanyl and methadone. Common prescribed opioids (e.g., Codeine, Vicodin, Morphine, OxyContin) treat pain. While safe for short-term pain relief, they are highly addictive and can be fatal when misused.

Effects of Opioid Painkillers

Opioids bind to and activate receptors in the brain and body, blocking pain signals and releasing large amounts of dopamine. This pleasurable feeling strongly reinforces drug-taking behavior, leading to repeated use.

Opioid Painkiller Abuse and Risks

OUD has unfortunately become a massive problem in the U.S. Roughly 80% of new heroin users in the U.S. report prescription pills as their initiation to opioid use. Long-term use and withdrawal symptoms of opioid abuse include:

• Constipation, nausea, vomiting, dry mouth
• Dizziness and confusion
• Sexual dysfunction
• Slowed breathing
• Depression
• Hypoxia (too little oxygen to the brain)

5. Cocaine Use Disorder

Cocaine use and its harms are a significant public health concern.

• In 2023, 5.0 million Americans aged 12+ (1.8% of the population) used cocaine in the past year.
• Approximately 1.3 million (0.4%) struggled with a cocaine use disorder.
• Cocaine-related overdose deaths are troubling. In 2023, nearly one in five drug overdose deaths involved cocaine. The age-adjusted death rate rose 4.9% from 2022 to 2023. American Indian and Alaska Native populations experienced the highest rates.

What is Cocaine?

Cocaine is an illegal stimulant from the coca plant. Sold as a white powder, it’s often mixed with fillers or other drugs (like fentanyl), making it extremely dangerous. It can be snorted, rubbed on gums, injected, or smoked as crack, which has faster and more potent effects.

Effects of Cocaine

Cocaine rapidly increases dopamine levels in the brain’s pleasure circuits, causing intense happiness, energy, mental alertness, and increased sensitivity. The high is short-lived, leading to repeated use. Continued use adapts the brain, requiring higher doses for the same effect.

Cocaine Abuse and Risks

Cocaine is highly addictive due to its short high and rapid dependence. Unknown additives like fentanyl create serious overdose risks.

Long-term health risks of cocaine abuse include:

• Constricted blood vessels, nausea
• Raised body temperature and blood pressure
• Fast or irregular heartbeat
• Tremors and muscle twitches

Long-term risks by method of use:

• Snorting: loss of smell, nosebleeds, runny nose, and swallowing problems.
• Smoking: cough, asthma, respiratory distress, and increased risk of pneumonia.
• Consumption by mouth: severe bowel decay.
• Needle injection: higher risk for HIV, hepatitis C, bloodborne diseases, infections, scarring, or collapsed veins.

6. Methamphetamine Use Disorder

Methamphetamine use remains a critical public health issue marked by significant harms and a concerning trend in overdose fatalities.

• In 2023, 2.6 million individuals aged 12 years and older (0.9% of the population) reported past-year methamphetamine use.
• Methamphetamine’s impact on overdose mortality is substantial. Drug overdose deaths involving psychostimulants with abuse potential, a category that includes methamphetamine, increased by 1.9% from 2022 to 2023.
• Alarmingly, nearly 70% of stimulant-involved overdose deaths in 2023 also involved illicitly manufactured fentanyl (IMF).

What is Methamphetamine?

Methamphetamine, initially a prescription for depression and weight loss, is now primarily an illicit street drug (crystal meth) with no medical use. It’s typically snorted, smoked, swallowed, or injected. Its dangerous manufacturing process in “meth labs” poses explosion risks.

Effects of Methamphetamine

Methamphetamine boosts brain dopamine, causing increased energy, decreased appetite, and a rush of euphoria. Its short-lived high often leads to a “binge and crash” pattern, with some users engaging in multi-day “runs” without eating or sleeping.

Methamphetamine Abuse and Risks

Studies have shown that continued methamphetamine use causes brain changes, leading to reduced coordination and impaired verbal learning. In addition, individuals who abuse meth have an increased risk of HIV/AIDS and Hepatitis due to needle sharing and risky behavior. Meth abuse can also worsen existing HIV/AIDS symptoms.

Long-term health risks of meth abuse include:

• Extreme weight loss
• Severe dental problems and tooth loss
• Intense itching, leading to skin sores
• Liver damage, nerve damage
• Increased risk of HIV/AIDS and Hepatitis
• Memory loss
• Hallucinations, paranoia, and psychosis
• Stroke, death

7. Prescription Stimulant Misuse

Prescription stimulant misuse is a significant concern, especially among specific demographics, due to academic pressures.

• In 2023, 1.4% of adults aged 18+ and 0.9% of youth aged 12-17 reported misusing prescription stimulants.

While often not directly fatal, misuse contributes to rising psychostimulant-involved overdose deaths, frequently co-occurring with fentanyl. College students are a notable demographic, with approximately 9.9% reporting Adderall abuse in the past year, often primarily as a “study aid.”

What are Prescription Stimulants?

Prescription stimulants, such as Adderall, Ritalin, and Vyvanse, increase alertness, attention, and energy. Primarily prescribed for ADHD and narcolepsy, their abuse potential stems from their ability to induce euphoria and intense focus when misused.

Effects of Prescription Stimulants

Prescription stimulants work by increasing the levels of dopamine and norepinephrine in the brain, thereby improving wakefulness, concentration, and inducing a sense of euphoria. Misuse intensifies these effects, leading to a sought-after “high.”

Prescription Stimulant Abuse and Risks

The misuse of prescription stimulants carries significant risks, including the potential for addiction, cardiovascular problems, and psychiatric issues. Long-term abuse can lead to severe health consequences:

• Heart problems (e.g., irregular heartbeat, high blood pressure, heart attack)
• Stroke
• Psychosis, paranoia, and hallucinations
• Anxiety and panic attacks
• Severe depression during withdrawal
• Malnutrition and extreme weight loss
• Seizures
• Overdose, especially when combined with other substances

8. Prescription Tranquilizer/Sedative Misuse (including Benzodiazepines & Barbiturates)

The misuse of prescription tranquilizers and sedatives (benzodiazepines and, to a lesser extent, barbiturates) is a significant yet often underestimated public health challenge.

• In 2021, 1.7% of individuals aged 12+ (4.9 million people) reported misusing prescription tranquilizers or sedatives.
• Specifically, 3.9 million people aged 12+ abused benzodiazepines in the past year, and 2.2 million had a tranquilizer/sedative use disorder.
• In 2023, 0.3% of youth (12-17) and 0.4% of adults (18+) used prescription sedatives.
• Barbiturate use is less common now, with 405,000 Americans aged 12+ reporting use and 32,000 misusing them in 2018.

Harms are severe, especially when combined with other depressants. Over 12,000 overdose deaths involved benzodiazepines in 2021. Co-ingestion with alcohol or opioids dramatically increases overdose risk. Physical dependence and severe withdrawal symptoms affect 40-90% of long-term benzodiazepine patients.

What are Benzodiazepines and Barbiturates?

Benzodiazepines (“benzos”) are CNS depressants like Valium, Xanax, and Klonopin.

They are commonly prescribed for anxiety or panic disorders. Barbiturates are also CNS depressants, less widely prescribed now due to higher abuse and side effect risks, but historically used for anxiety and insomnia. They may still be used for seizures or as pre-anesthesia sedation.

Effects of Benzodiazepines and Barbiturates

Both increase GABA neurotransmitter activity, inhibiting brain activity and producing calming effects, drowsiness, and euphoria. While safe as prescribed, their sedating effects can lead to abuse. Barbiturates have a narrower therapeutic window, increasing overdose risk with slight dosage increases.

Benzodiazepine and Barbiturate Abuse and Risks

A significant risk of long-term benzo and barbiturate abuse is the risk of seizures if use is abruptly stopped, necessitating medically supervised tapering. Mixing these depressants with alcohol or opiates significantly increases the risk of coma or death.

Long-term health risks include:

• Mania, psychosis, anxiety
• Sleep disorders
• Difficulty breathing, muscle spasms
• Seizures
• Coma, death

9. Inhalant Use Disorder

Inhalant use disorder, though often overlooked in broader addiction discussions, presents unique and severe public health challenges, particularly due to its accessibility and impact on vulnerable populations.

• In 2020, 2.4 million people aged 12+ reported past-year inhalant use.
• While overall disorder prevalence is relatively low, with only 0.1% of people over age 12 (335,000 individuals) classified with the disorder in 2021, harms are disproportionately severe.

Acute and chronic harms are profound. Approximately 200 U.S. deaths annually are from inhalant abuse, often from “sudden sniffing death” due to cardiac arrest. Long-term effects include irreversible brain damage (muscle control, memory, learning), and severe organ damage (heart, kidneys, lungs). 50-80% of regular abusers experience cognitive impairment, and 38% of chronic users report co-occurring anxiety and depression.

What are Inhalants?

Inhalants are solvents, aerosols, gases, or nitrites inhaled for a high, known as “sniffing,” “bagging,” or “huffing.” Common examples include paint thinners, gasoline, glue, hair sprays, whipped cream aerosols, chloroform, and nitrous oxide.

Effects of Inhalants

Most inhalants depress the central nervous system (CNS), slowing brain activity. Users report slurred speech, lack of coordination, dizziness, and euphoria. Nitrites, however, relax blood vessels and are often used to enhance sexual pleasure.

Inhalant Abuse and Risks

The most significant risk is from other toxins in abused household products. Highly concentrated chemicals can cause irregular heart rhythms, leading to fatal heart failure within minutes—known as “sudden sniffing death.”

Long-term health risks include:

• Liver and kidney damage
• Hearing loss, bone marrow damage
• Loss of coordination and limb spasms
• Delayed behavioral development
• Brain damage
• Asphyxiation or choking on vomit
• Convulsions or seizures
• Coma, death

10. Heroin Addiction

Considered one of the most addictive drugs, heroin addiction can entirely consume its victims. Heroin, an opioid derived from morphine, provides intense pleasure and euphoria.

• In 2023, 660,000 Americans aged 12+ (0.2% of the population) reported past-year heroin use, with 3,984 heroin-related deaths that year.

Regular users quickly develop tolerance, requiring higher and more frequent doses to achieve the same high.

What is Heroin?

Heroin is an illegal opioid drug made from morphine, typically sold as a white or brown powder or black sticky “black tar heroin.” Purer forms are snorted or smoked, while impure black tar heroin is usually dissolved and injected. The abuse of prescription opioids may often lead to heroin use, as it can be cheaper and easier to obtain.

Effects of Heroin

Heroin activates mu-opioid receptors (MORs) in the brain’s reward center, releasing dopamine and causing a surge of pleasurable sensations. This ‘high’ is incredibly addictive, leading to rapid dependence and escalating dosage needs.

Heroin Abuse and Risks

Repeated heroin use alters the brain’s physical structure and physiology, affecting decision-making, behavior regulation, and stress responses due to white matter deterioration. Withdrawal can occur hours after last use, bringing restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes. Injecting heroin carries risks of HIV/AIDS, Hepatitis B and C, and other infectious agents from needle sharing.

Long-term health risks of heroin abuse include:

• Insomnia, constipation, cramping
• Collapsed veins (injection), damaged nasal tissue (snorting)
• Infection of the heart lining and valves, abscesses
• Liver and kidney disease, lung complications (pneumonia)
• Sexual dysfunction in men
• Hypoxia, coma

Bonus Addictions: Emerging Behavioral Health Concerns

While not substance-based, these behavioral addictions share fundamental characteristics with substance use disorders, including impaired control, compulsive engagement, and significant negative impacts on an individual’s life. Their increasing prevalence and societal consequences warrant their inclusion as critical public health concerns.

1. Gambling Disorder

Gambling disorder is the only behavioral addiction recognized in the DSM-5.

Recent 2024 data indicate that 8% of American adults (nearly 20 million individuals) reported at least one problematic gambling behavior in the past year.

Approximately 5 million Americans meet the criteria for compulsive gambling.

The rise of online gambling and high-risk betting is exacerbating this issue.

• Online gambling participation increased from 15% in 2018 to 22% in 2024, and parlay betting nearly doubled among sports bettors (17% in 2018 to 30% in 2024).
• The risk of gambling addiction reportedly surged by 30% in three years following the 2018 Supreme Court decision allowing expanded sports betting.
• Financial consequences are severe, with up to 23 million Americans accumulating debt from gambling, averaging a loss of $55,000 per person.

Despite its clinical recognition, only 39% of Americans view gambling addiction as “very serious” compared to drug or alcohol addiction. Over 80% of individuals with gambling addiction never seek treatment.

Learn more about Gambling Addiction.

2. Problematic Pornography Use (PPU) / Compulsive Sexual Behavior Disorder (CSBD)

Problematic pornography use (PPU) and compulsive sexual behavior disorder (CSBD) are growing behavioral health concerns marked by distress and functional impairment.

• Studies show 7% of U.S. adult internet pornography viewers report addiction (11% of men vs. 3% of women).
• Overall, probable CSBD prevalence is estimated at 10.8% in community samples, with 8-13% of men and 5-7% of women meeting diagnostic criteria in Western countries.
• Pornography consumption shows significant gender and age differences. Men consume substantially more (69% annually) than women (40%). Young adults (18-25) exhibit higher monthly use (57%) compared to those aged 25 and above (29%).
• Disturbingly, research indicates that children are often first exposed between the ages of 9 and 13 (93% of teen boys, 62% of teen girls).

Negative impacts include increased divorce rates, decreased sexual satisfaction, and links to mental health issues like loneliness, stress, anxiety, and depression. CSBD frequently co-occurs with other mental health conditions and substance use disorders (34-71% have a lifetime history of SUDs). Despite the impact, only 14% of individuals with CSBD seek treatment.

Learn more about Sex Addiction and Compulsive Sexual Behavior.

3. Internet Gaming Disorder (IGD) / Problematic Internet Use (PIU) / Social Media Addiction (SMA)

The widespread adoption of digital technologies has given rise to new behavioral health concerns: Internet Gaming Disorder (IGD), Problematic Internet Use (PIU), and Social Media Addiction (SMA). These are characterized by excessive, compulsive digital engagement leading to significant impairment.

• In 2023, 95% of teenagers (13-17) used social media, with over one-third reporting “almost constant” usage (doubled from 24% in 2015).
• 54% of teens would find it hard to give up social media.
• Among U.S. adults, a 2022 survey found 48% considered themselves addicted or somewhat addicted to digital devices.

Prevalence estimates vary: over half of 18-to 25-year-olds in one study met the criteria for PIU. IGD prevalence is estimated at 6.7% (based on a global meta-analysis), with a 12-month recurrence rate of 0.8% reported in a 2021 study. SMA prevalence was reported at 3.42% in one study.

Youth are particularly impacted: 8th and 10th graders average 3.5 hours daily on social media, with 25% exceeding 5 hours. Screen media over 8 hours daily increased from 29% (2019) to 41% (2021) for teens. Social media harms body image for 46% of teens. These behavioral addictions are frequently linked to anxiety, depression, and loneliness, and often co-occur with substance use disorders.

Learn more about Social Media Addiction.

Getting Help for Addiction

If you or a loved one struggles with addiction to one or more of these substances or behaviors, effective treatment options are available. Just as each individual is unique, the treatment plan can vary.

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