Illicit Drug Usage in the United States

10 minutes

Illicit drug usage continues to be a public health crisis in the United States, with profound consequences not only for individuals and families but also for communities, healthcare systems, and society at large. For mental health professionals, understanding the scope of illicit drug usage is critical. Substance misuse often intersects with mental health conditions, trauma histories, and social stressors, making it essential for clinicians to stay informed about current drug trends, patterns of misuse, and effective approaches to care. 

This article provides mental health practitioners with: 

  • An overview of national patterns of illicit drug usage 
  • Emerging challenges 
  • Strategies for clinical assessment and intervention 

The goal is to strengthen providers’ ability to recognize warning signs, respond effectively, and advocate for holistic care that addresses both substance use and mental health needs. 

Related CE for behavioral health professionals: Illicit Drug Usage in the United States 

Severity of illicit drug usage in the US 

Drug abuse refers to the use of illegal, prescription drugs, or over-the-counter medications for purposes other than those intended or using them in ways that are harmful or detrimental. A substance use disorder, or addiction, is a medical condition that refers to compulsive and continued use of substances despite negative impacts on health, relationships, and responsibilities. The definition of addiction also includes dependence and tolerance. 

The impact of drug abuse 

Illicit drug abuse remains one of the most pressing public health concerns in the United States, affecting tens of millions of people each year. The scale of the problem is staggering, and mental health professionals are often on the front lines of its impact. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2023, about 17% of the population aged 12 or older had been diagnosed with an SUD in the past year, with 27.2 million of those being people with a drug use disorder. 

In terms of illicit drug usage, in 2023, 70.5 million people, aged 12 or older, used illicit drugs in the past year. The most common being marijuana, at 61.8 million people. After that, 8.8 million people used hallucinogens, and 8.6 million people misused prescription pain relievers.  

Related CE course for behavioral health professionals: Substance Use Disorders: Assessment and Treatment 

The toll of overdose 

Overdose deaths highlight the devastating consequences of drug misuse. After 110,037 deaths in 2023, the number declined in 2024 to around 80,391—an almost 27% decrease. While this decline is encouraging, drug overdoses remain one of the leading causes of death in the United States.  

COVID-19’s lasting impact 

The COVID-19 pandemic significantly reshaped patterns of drug use and overdose. Isolation, stress, and disrupted access to treatment during lockdowns fueled a sharp rise in substance misuse, with many individuals using drugs to cope with uncertainty and trauma. Overdose deaths increased during the height of the pandemic, with fentanyl-related fatalities climbing especially quickly.  

Even as the nation moves on from the pandemic, the ripple effects remain: many communities still face heightened rates of misuse, and some clients continue to carry pandemic-related stressors that increase their vulnerability to relapse. 

What this means for clinicians 

Taken together, these statistics point to a crisis that is both urgent and complex. Illicit drug usage is not an isolated issue. It is closely tied to mental health, trauma, and social stressors. For clinicians, every client encounter carries the possibility of uncovering a dual-diagnosis challenge. Awareness, routine screening, and readiness to provide or connect clients with integrated care approaches are critical tools in the ongoing effort to respond effectively to this national emergency. 

What are illicit drugs? 

When people think of “illicit drugs,” they often imagine substances bought and sold illegally on the street. While that’s true, the definition is broader. Illicit drugs include both illegal substances—like heroin, cocaine, or ecstasy—and the misuse of legal medications, such as prescription opioids or stimulants, when taken without a prescription or outside medical guidance. 

For mental health professionals, understanding the distinction is crucial. Clients may arrive in treatment using drugs from either category, often without recognizing the full risks involved. Here are some examples of illicit drugs: 

Club drugs 

Club drugs are most often associated with nightlife, parties, or rave culture. They’re sought after for their euphoric or hallucinogenic effects but carry high risks for dependency, neurotoxicity, and unsafe behaviors. 

Common examples and their street names include: 

  • MDMA (Ecstasy, Molly): Heightens mood and sensory experiences. 
  • Ketamine (Special K, Kit Kat): A dissociative anesthetic that alters perception and consciousness. 
  • GHB (Liquid Ecstasy): A depressant sometimes used as a “date rape” drug. 
  • LSD (Acid, Dots): A hallucinogen that powerfully distorts reality. 
  • Methamphetamine (Crystal, Ice, Gak): A highly addictive stimulant producing intense euphoria. 

Prescription drug misuse 

Unlike club drugs, prescription medications begin in legitimate medical contexts but can easily slide into misuse. This form of abuse often feels less obvious to clients, since the substances are “doctor-prescribed,” yet the risks are equally severe. 

  • Opioids (e.g., oxycodone, hydrocodone, fentanyl): Misused for pain relief and euphoria; central to the ongoing overdose epidemic. 
  • Stimulants (e.g., Adderall, Ritalin): Commonly prescribed for ADHD, but misused for focus, energy, or weight loss. 
  • Depressants (e.g., Xanax, Valium, Ambien): Taken for anxiety or sleep, but often misused recreationally or in combination with alcohol, creating dangerous interactions. 

Emerging drug trends 

The drug landscape evolves constantly, making it vital for clinicians to stay alert to new substances shaping use patterns. Three trends currently drawing attention include: 

  1. Synthetic cannabinoids (“Spice,” “K2”): Marketed as marijuana substitutes but far more unpredictable and harmful. 
  2. Illicit fentanyl combinations: Fentanyl is being increasingly mixed with stimulants like cocaine or meth, drastically raising overdose risk. 
  3. Designer benzodiazepines: Unregulated sedatives that mimic prescription benzos, often more potent and lethal when combined with opioids. 

Related CE course for behavioral health professionals: Overdose: Pain Pills, Heroin, Fentanyl and Beyond 

Understanding what falls under the umbrella of “illicit drugs” allows providers to spot risks even when clients use slang, downplay their consumption, or believe their misuse of prescriptions is harmless. With drug culture shifting quickly, clinicians who stay fluent in both terminology and emerging trends are better equipped to assess, build trust, and intervene effectively. 

Clinical assessment & care priorities 

When a client presents with a history of drug abuse, the clinician’s role goes far beyond identifying the substance in question. Effective care begins with a careful assessment that not only uncovers patterns of use but also addresses the psychological, social, and medical aspects of the client’s life. Here are the steps clinicians should take: 

Building safety and rapport 

The first priority is creating a safe, nonjudgmental environment. Many clients enter treatment feeling shame or fear of being labeled, which can block honest disclosure. Establishing rapport early on allows the clinician to gather accurate information about frequency of use, contexts, and perceived benefits without triggering defensiveness. Trauma-informed communication is essential, since substance misuse often intersects with histories of adversity. 

Assessing risk and immediate needs 

Not all drug use carries the same level of urgency. Clinicians should quickly determine: 

  • Whether the client is at risk for acute withdrawal, which may require medical supervision. 
  • The presence of suicidal thoughts, psychosis, or overdose history necessitates urgent intervention. 
  • Whether the client has access to safe housing and supportive networks that can help reduce the risk of relapse. 

These safety considerations guide the decision on whether referral to detoxification, inpatient care, or outpatient treatment is most appropriate. 

Comprehensive screening and history 

A thorough assessment should explore: 

  • Substance use history, such as age of first use, patterns of frequency, type, and combinations of drugs, and prior attempts to quit. 
  • Medical and psychiatric history. Co-occurring conditions like depression, anxiety, or PTSD that may fuel or result from use. 
  • Social and environmental factors, such as peer influence, family dynamics, housing stability, employment, and legal issues. 
  • Risk behaviors such as unsafe sexual practices, needle sharing, or polysubstance use. 

Standardized screening tools (e.g., ASSIST, CAGE-AID, or AUDIT for alcohol-related concerns) can help structure the process and reduce clinician bias. 

Integrated, person-centered care 

Drug misuse rarely exists in isolation. Many clients are dealing with co-occurring mental health disorders, trauma, or chronic stressors. Priorities in care should include: 

  • Dual-diagnosis treatment that addresses both substance use and mental health symptoms simultaneously. 
  • Motivational interviewing to enhance readiness for change. 
  • Harm reduction strategies, such as naloxone education for those at risk of opioid overdose. 
  • Collaborative planning that engages the client’s support system when appropriate. 

The goal is not just cessation of drug use, but improved overall functioning, quality of life, and resilience. 

Ongoing monitoring and support 

Assessment doesn’t end at intake. Substance use patterns often shift during treatment, requiring ongoing screening and flexibility in the care plan. Regular check-ins, urine drug screens (when clinically indicated), and revisiting goals can help track progress. Just as importantly, clinicians should validate small steps forward and frame relapse as a learning opportunity rather than a failure. 

By integrating empathy, structured tools, and evidence-based interventions, clinicians can meet clients where they are and guide them toward safer, healthier futures. 

Elements of the national drug control strategy 

The National Drug Control Strategy provides a federal roadmap for addressing substance use across the United States. While comprehensive, several core elements are particularly relevant to clinicians: 

  1. Prevention and education: Expanding community and school-based programs to reduce initiation of drug use, with a focus on youth and vulnerable populations. 
  1. Treatment and recovery access: Enhancing the availability of evidence-based treatment, integrating mental health and substance use care, and promoting long-term recovery services. 
  1. Supply reduction: Targeting the trafficking of illicit drugs, especially synthetic opioids like fentanyl, through domestic enforcement and international cooperation. 

Together, these priorities underscore the need for a balanced approach—reducing supply while also addressing demand through prevention, treatment, and recovery support. 

Clinical implications for mental health providers 

Illicit drug usage in the United States remains a complex and urgent public health challenge, one that touches nearly every community and intersects deeply with mental health. For mental health professionals, the takeaways are clear: understanding the categories of illicit drugs, recognizing current trends, and applying comprehensive assessment strategies are essential to effective care.  

With substance use disorders so often intertwined with depression, anxiety, trauma, and other psychiatric concerns, integrated and person-centered approaches are vital. Ultimately, awareness of national strategies can help guide clinical practice, reminding providers that their work is part of a broader effort to reduce harm and promote recovery. 

References 

  • Ghose, R., Forati, A. M., & Mantsch, J. R. (2022). Impact of the covid-19 pandemic on opioid overdose deaths: A spatiotemporal analysis. Journal of Urban Health, 99(2), 316–327. https://doi.org/10.1007/s11524-022-00610-0  
  • Gouzoulis-Mayfrank, E., & Daumann, J. (2009). Neurotoxicity of drugs of abuse – the case of methylenedioxy amphetamines (MDMA, ecstasy ), and amphetamines. Dialogues in Clinical Neuroscience, 11(3), 305–317. https://doi.org/10.31887/dcns.2009.11.3/egmayfrank  
  • van Amsterdam, J., & van den Brink, W. (2025). Designer benzodiazepines: Availability, motives, and fatalities. A systematic narrative review of human studies. Drug and Alcohol Dependence, 272, 112708. https://doi.org/10.1016/j.drugalcdep.2025.112708  

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Editor’s note: this post was originally published on and updated on .

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