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Well-being and Workforce Strategy

What is Substance Use Disorder?

Learn what SUD is, why it develops and how it disrupts health, relationships and work.

April 15, 2025

Substance Use Disorder: An Employer's Strategy Resource
This guide aims to help employers understand the impact of substance use disorder (SUD) and strategies for employee support.
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Substance Use Disorder (SUD) is the frequent use of alcohol and/or drugs that leads to a series of impairments to someone’s health and behaviors.1 This disorder negatively impacts an individual’s ability to control emotional responses, maintain positive relationships, manage cravings for drugs and/or alcohol as well as fulfill responsibilities at work, school and home. Of particular concern to employers is the major impact that SUD can have on worker safety, productivity, retention and health care outcomes and costs.

In 2023, there was a decrease in drug overdose deaths in the U.S. for the first time since 2020.2 Still, with an estimated 87,000 deaths, the SUD crisis is far from resolved.3 Employers need to continue being diligent in how they structure benefit design, contracting and workplace policies to mitigate the negative impacts.

Treatment for SUD is chronic and complex. Individuals with SUD often have comorbid anxiety, depression and/or suicidal thoughts, which further complicates treatment strategies. However, the latest data show that of the 54.2 million people in the U.S. with a SUD, only 23% of them received treatment.4

This article presents an overview of SUD, its prevalence and impact on employers. It also includes employer strategies to increase the chances that employees and dependents with SUD receive appropriate, evidence-based treatment with positive outcomes.

What is Substance Use Disorder

SUD is a condition that affects a person’s brain and behavior as a result of recurrent alcohol and/or drug use, leading to:

  • An inability to abstain from addictive substances and intense cravings for them;
  • Neglecting responsibilities at home, work or school;
  • Difficulty in maintaining positive interpersonal relationships; and
  • Dysfunctional emotional responses.5,6

As with other chronic diseases, many people with SUD go through cycles of relapse and remission.

Defining Terms: Addiction vs. Substance Use Disorder

SUDs fall along a severity spectrum depending on the number of impaired behaviors a person exhibits. The most severe SUDs are sometimes called addictions. This article uses “substance use disorder” throughout in recognition of the needs of individuals who may have mild or very minor symptoms. Referring to someone as an “addict” is also stigmatizing, which reduces treatment-seeking behavior.


Contributing Factors to Developing a Substance Use Disorder

There are several factors that influence the likelihood of developing a SUD, including family history, genetics and lived experiences in the community.7 Many of these factors are interconnected, including the following:

  • Genetics and Development: Up to half of an individual’s risk of developing SUD depends on their genetic makeup.8 This is not determinative but is a significant factor. The earlier that someone is exposed to drugs and alcohol (i.e., fetal, childhood, adolescence), the greater the likelihood that the individual will develop long-term SUD.9
  • Emotional Trauma: People who experience traumatic experiences before 18 are at increased risk of developing an SUD. Such emotional traumatic experiences include abuse and neglect.10
  • Mental Health Conditions: People with mental health conditions like anxiety, depression, and post-traumatic stress disorder (PTSD) are more likely to use alcohol or drugs to self-medicate; this can offer temporary relief but create long-term dependency.11 Among adults 18+ in 2023 with an SUD, 35% were also experiencing a mental health illness such as depression.12
  • Social and Relationship History: Peer or family history of excessive substance use, as well as anti-social behaviors such as verbal abuse and harassment by friends and family, can encourage dangerous behaviors, like substance use.9
  • Physical Environment: Local neighborhood attributes, such as poverty, easy access to addictive substances and violence, all increase the risk of SUD.13

Prevalence of SUD Across Demographics in the United States

In 2023, an estimated 17.1% of people had an SUD-related disorder in the U.S.12  The level of SUDs varies across demographics and regions in the U.S., highlighting significant disparities:

 

Race and Ethnicity

While drug overdose deaths decreased by 7% for White individuals from 2022 to 2023, it increased for Black and Native Hawaiian or Other Pacific Islander, with the latter experiencing a substantial 26.2% increase.14 This is in part due to Black Americans with SUD being more likely than others to use drugs that are laced with fentanyl, an extremely potent and lethal synthetic opioid formulation that is often added to other drugs without knowledge of the user.15


 

Income / Education Level:

In 2019, overdose rates were concentrated in zip codes characterized by higher rates of poverty and unemployment, as well as lower median incomes and education.


 

Sex and Gender:

Men are more likely to have SUD, but women are more likely to suffer side effects and overdose because of differences in biological and social makeup.16 


 

Age:

Young adults from 18-25 have the highest rates of SUD, but from 2022 to 2023 the rate of overdose deaths decreased among young and middle-aged adults.13 On the other hand, adults age 65 and older experienced an 11.4% increase.13 Notably, this age group is more isolated in retirement and are screened for SUD less often.


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