Montana Drug and Alcohol Statistics

Montana is sparsely populated but faces high rates of substance use and related harm. Drug overdose deaths have risen 37% over the past decade, driven by fentanyl and methamphetamine, while the state also ranks among the worst for alcohol-related issues.

This report compiles data from 2007 to 2023 on drug and alcohol use, including overdose deaths, affected populations, and treatment access. It highlights a major gap: about 216,000 Montanans need treatment each year, but nearly three-quarters do not receive it.

Statistical Data on Drugs in Montana

This section presents a comprehensive statistical overview of drug use, overdose deaths, treatment, and enforcement in Montana. Data spans multiple state and federal sources covering 2007 through 2023.

Overdose Deaths

Overall Scale and Trend

Drug overdose deaths have risen sharply over the past decade. The figures below establish the overall scale of the crisis and how it has evolved since 2014.

• Annual OD deaths (current): 208
• OD deaths as % of all Montana deaths: 1.86%
• OD death rate: 19.4 per 100,000 residents — 46.79% below the national average
• OD death rate increase over last 3 years: 37.59%
• Montana’s share of nationwide OD deaths: 0.19%
• 4th leading cause of injury death (2014–2023): 1,501 total deaths — behind firearms (2,244), motor vehicle crashes (1,930), and falls (1,912)
• Average annual OD deaths (2014–2023): 150
• Most deaths are unintentional: About 8 in 10 (78.8%); 14.4% were suicides; 6.8% undetermined

Montana’s overdose death rate is well below the national figure, but has increased 37% over the past decade — from 12.2 deaths per 100,000 in 2014 to 16.7 in 2023. Rates rose most steeply from 2018 to 2021, then began to stabilize.

Annual Overdose Deaths (2014–2023)

The table below shows annual deaths, rates, and the growing shift toward polydrug fatalities across the decade.

Year	Total Deaths	Rate per 100,000	Single-Drug Deaths	Multi-Drug Deaths
2014	123	12.2	82	36
2015	133	13.2	81	43
2016	117	11.4	89	20
2017	116	11.3	85	31
2018	123	11.9	59	60
2019	141	13.9	68	73
2020	161	15.4	75	86
2021	198	19.4	87	110
2022	204	18.9	78	106
2023	185	16.7	79	101
TOTAL	1,501	Avg: 14.5	783	666

A critical shift occurred after 2018: multi-drug deaths began to exceed single-drug deaths and have remained higher ever since. From 2019 to 2023, 55.2% of all OD deaths involved at least two substances.

Polydrug Deaths: Number of Substances Involved (2019–2023)

Of the 863 overdose deaths recorded from 2019 to 2023, the following shows how many substances were found in each case.

Number of Substances Involved	Deaths	% of Total
1 substance	387	44.8%
2 substances	222	25.7%
3 substances	133	15.4%
4 substances	64	7.4%
5 or more substances	57	6.6%
Total	863	100%

Over half of all fatal overdoses in 2019–2023 involved two or more substances, complicating both clinical treatment and public health prevention strategies.

Deaths by Substance (2014–2023)

The table below presents cumulative death counts by specific substance for the full decade, with key annual figures to illustrate trends over time.

Substance	2014	2018	2020	2021	2022	2023	10-Year Total
All Opioids	51	59	85	113	113	123	728
Fentanyl	6	8	26	62	95	93	323
Heroin	—	21	29	20	—	5	123
Codeine / Morphine / Other Opioids	22	21	35	27	31	26	241
Methadone	16	—	—	—	10	11	76
Other / Unspecified Narcotics	—	11	18	16	—	—	74
Methamphetamine	6	30	64	79	87	89	487
All Stimulants	7	31	69	94	84	90	511
Benzodiazepines	—	12	17	16	15	18	115
Cocaine	—	—	5	9	8	—	37
Other / Unspecified Antidepressants	12	11	19	21	19	14	132
Unspecified Drug	71	64	69	79	67	56	673
Cannabis	—	—	—	0	0	0	8
ALL DRUGS COMBINED	123	123	161	198	204	185	1,501

Fentanyl and methamphetamine are the two dominant drivers of Montana’s rising overdose toll. Fentanyl deaths tripled between 2020 and 2023. Methamphetamine deaths have grown nearly continuously since 2014, from 6 deaths to 89 in 2023.

Deaths by County (2014–2023)

County-level analysis focuses on the ten Montana counties with at least 20 overdose deaths in the 2019–2023 period. Rates are per 100,000 residents.

County	Deaths 2014–18	Deaths 2019–23	Rate 2014–18	Rate 2019–23
Silver Bow	35	66	19.3	38.7  ← highest
Lake	27	45	21.3	33.6
Yellowstone	114	187	14.6	23.5
Park	14	20	—	21.2
Cascade	38	62	11.0	16.7
Missoula	67	95	11.2	16.0
Lewis & Clark	42	47	12.5	14.0
Flathead	64	79	13.2	14.7
Ravalli	23	23	10.4	9.9
Gallatin	30	54	5.7	8.5   ← lowest

Silver Bow County’s death rate (38.7) is more than four times Gallatin County’s (8.5). Yellowstone County recorded the highest absolute number of deaths in both periods. An additional 50 nonresident deaths occurred in Montana from 2014–2023; Wyoming residents accounted for the largest share (18%).

The Opioid Epidemic

Opioid Overdose Deaths: Scale and Trend

Opioids are involved in more than two-thirds of all Montana overdose deaths. The following figures describe the overall opioid burden and how it has evolved.

• Opioid OD deaths in 2023: 129
• Opioid OD death rate (2023): 12.0 per 100,000 — 50% below the national rate
• Opioids as share of all OD deaths: 68.6%
• Total opioid OD deaths (2014–2023): 728
• Opioid OD death rate change (2014–2023): +117% — from 5.2 to 11.3 per 100,000

Fentanyl

Fentanyl — a synthetic opioid 50× stronger than heroin and 100× stronger than morphine — has become the single largest driver of opioid deaths.

• Fentanyl share of all opioid OD deaths: 76.7%
• Total fentanyl OD deaths (2014–2023): 323
• Fentanyl OD deaths in 2021: 62
• Fentanyl OD death rate in 2020: 2.7 per 100,000
• Fentanyl OD death rate in 2023: 8.9 per 100,000 — more than tripled in 3 years
• Fentanyl share of fatal drug ODs in 2021: 30% — a 14% increase from 2020
• Fentanyl pills seized Jan 1 – Mar 15, 2022: 12,079 — more than 3× the total for all of 2021

Prescription Opioids

• Prescription opioids’ share of opioid OD deaths: 19.4%
• Opioid prescriptions written annually per 100 Montanans: 40.4 (one source); 46.1 (another source)
• Prescription opioid OD deaths (2011–2013): 359 adults; 369 including all prescription-only ODs
• Hospital and ER encounters from prescription-only ODs (2011–2013): Over 7,200
• Hospital charges for opioid-related hospitalizations/ER (2021): Nearly $5 million
• High school students with non-prescribed Rx drugs (2019): 1 in 10
• High school students offered illegal drugs on school property (2021): 22.3%
• 70% of those who misuse prescription opioids: obtain them from family or friends

Heroin

• Heroin-related drug violation increase (2010–2015): +1,557%
• Heroin use rate increase since 2013: +475%

Montana’s opioid death rate has more than doubled since 2014, driven almost entirely by fentanyl. While still below the national average, the trajectory is steep: fentanyl deaths more than tripled between 2020 and 2023 alone. Early 2022 fentanyl seizures already exceeded the entire prior year’s total after just 11 weeks.

Secondary Health Harms from Opioid / IV Drug Use

• Neonatal opioid withdrawal syndrome per 1,000 births (2020): 21.5
• New hepatitis C cases linked to IV drug use (2022): 16.1 per 100,000
• New HIV/AIDS diagnoses linked to IV drug use (2023): 1.9

IV drug use continues to drive infectious disease transmission in Montana. Neonatal opioid withdrawal syndrome — affecting more than 2% of births — signals the epidemic’s reach into the next generation.

Opioid Overdose Death Demographics (2021)

In 2021, 113 people died from opioid overdose and 62 from fentanyl overdose in Montana.

Group	% of Opioid OD Deaths	% of Fentanyl OD Deaths
Adults aged 25–44	58%	73%
Adults aged 45–64	38%	21%
Other ages	4%	6%
Male	66%	71%
Female	34%	29%

Men aged 25–44 bear the heaviest opioid burden, accounting for the majority of both opioid and fentanyl fatalities. The fentanyl death profile skews even younger and more male than opioids overall.

Methamphetamine

Methamphetamine has emerged as the state’s most significant stimulant threat, driving the majority of DCI drug investigations and nearly equaling opioids in overdose mortality.

• Methamphetamine OD deaths (2014–2023): 487 — the highest total for any single substance in Montana
• Meth OD death rate (2014): 3.1 per 100,000
• Meth OD death rate (2023): 8.2 per 100,000 — nearly tripled
• DCI drug investigations related to meth (2016): 53% of all investigations
• Meth violations increase (2010–2015): +427%
• Drug violations involving meth (2015): 31% of all drug violations
• Primary transport routes into Montana: Interstates 15, 25, and 90 — usually concealed in private or rental vehicles
• Largest treatment age group for amphetamine (2010): Ages 26–30 (23.7% of 498 admissions)

Methamphetamine accounts for the largest cumulative overdose death toll of any single substance in Montana over the past decade, and its death rate nearly tripled from 2014 to 2023. Seizures and purity levels continue to increase statewide.

Who Is Most Affected: Demographics of Drug Use

Overdose Death Rates by Race, Age, and Sex (2014–2023)

The following tables break down overdose death rates across three demographic dimensions. All figures are deaths per 100,000 residents.

By Race / Ethnicity

Group	2014 Rate	2023 Rate	2019–2023 Rate
American Indian / Alaska Native (AI/AN)	—	57.8	52.5  (3× state avg)
White	11.6	14.1	~13.0
All other races	—	—	13.4
Montana overall	12.2	16.7	16.9

By Age Group

Age Group	2014 Rate	2023 Rate	2019–2023 Rate
25–44 years	19.5	29.4	30.1  (above state avg)
45–64 years	19.9	25.0	24.4  (above state avg)
Under 24 years	—	—	3.3
65+ years	—	—	6.2
Montana overall	12.2	16.7	16.9

By Sex

Sex	2014 Rate	2023 Rate	2019–2023 Rate
Male	11.2	21.0	21.2
Female	13.2	12.2	11.9

American Indian/Alaska Native residents face an overdose death rate more than three times the state average — the most severe disparity of any demographic group. Among age groups, working-age adults (25–64) consistently exceed the state average. Men’s death rates have nearly doubled since 2014, while women’s have remained relatively stable.

Drug Use Prevalence (Ages 12+, Annual Average 2022–2023)

Survey data estimates how many Montanans of each age group used various substances in the past month or year. Numbers are in thousands; percentages follow in a separate table.

Estimated Users (Thousands)

Substance / Measure	Age 12+	Age 12–17	Age 18–25	Age 26+
Illicit Drug Use – Past Month	225	7	41	177
Marijuana – Past Year	276	10	56	209
Marijuana – Past Month	211	5	41	164
Illicit Drug (excl. marijuana) – Past Month	32	1	6	25
Cocaine – Past Year	18	0	6	13
Heroin – Past Year	—	—	0	2
Hallucinogen – Past Year	40	1	12	27
Methamphetamine – Past Year	13	0	1	12
Rx Pain Reliever Misuse – Past Year	29	2	3	24
Opioid Misuse – Past Year	28	2	3	23

Prevalence Percentages

Substance / Measure	Age 12+	Age 12–17	Age 18–25	Age 26+
Illicit Drug Use – Past Month	23.39%	8.53%	35.64%	23.16%
Marijuana – Past Year	28.68%	12.39%	48.58%	27.45%
Marijuana – Past Month	21.97%	6.52%	35.80%	21.56%
Illicit Drug (excl. marijuana) – Past Month	3.36%	1.72%	5.31%	3.25%
Cocaine – Past Year	1.92%	0.20%	4.84%	1.67%
Heroin – Past Year	—	—	0.42%	0.26%
Hallucinogen – Past Year	4.18%	1.65%	10.61%	3.48%
Methamphetamine – Past Year	1.37%	0.18%	0.86%	1.58%
Rx Pain Reliever Misuse – Past Year	3.02%	2.24%	2.64%	3.17%
Opioid Misuse – Past Year	2.96%	2.17%	2.96%	3.04%

Montana consistently exceeds national drug use averages. Approximately 10.77% of Montana residents reported past-month illicit drug use vs. the national average of 8.82%. Young adults (18–25) show the highest rates across nearly all substances — 35.64% used illicit drugs in the past month. Non-medical prescription drug use among adults ranks Montana 5th nationally (11.3%). Young adults in Montana are 33.46% more likely to use drugs than the national average for their age group.

Youth Drug Use (Ages 12–17)

Montana teenagers use illicit substances at significantly elevated rates compared to national peers. The state has consistently ranked among the top ten worst for multiple youth drug-use categories.

Key Youth Drug Use Figures

Indicator	Montana	National Benchmark
Illicit drug use – past month (2022–23)	8.53%  (7,000 teens)	17.49% more likely than avg. American teen
Illicit drug use – past month (2017–19)	13.3%  (~10,000)	National avg: 8.2%
Marijuana – past month (2022–23)	6.52%	71.43% of illicit drug users cited marijuana
Marijuana – past year (2022–23)	12.39%	—
Marijuana – past month (2017–19)	11.3%  (~9,000)	National avg: 6.8%
Marijuana dependence (2010)	29.5%  of 12–17 age group	Highest by age group
First-time marijuana use – past year (2017–19)	6.3%  (~5,000)	National avg: 5.2%
Cocaine – past year	0.20%	—
Methamphetamine – past year	0.18%	—
Rx pain reliever misuse – past year	2.24%	—
Drug Use Disorder (DUD) – past year	7.18%	—
Offered illegal drugs on school property (2021)	22.3% of high schoolers	—
Non-prescribed Rx drug use (2019)	1 in 10 high school students	—

In 2009–2010, Montana was one of the top ten states in the nation for past-month illicit drug use, marijuana use, and illicit drug dependence among ages 12–17. Marijuana remains the dominant substance, but nearly one in four youth high school students has encountered illegal drugs on school property.

Substance Use Disorders (Ages 12+, 2022–2023)

The following table presents estimated numbers (thousands) and percentages of Montanans meeting diagnostic criteria for a substance use disorder in the past year.

Disorder	Ages 12+ (000s)	Ages 12–17 (000s)	Ages 18–25 (000s)	Ages 26+ (000s)	Ages 12+ %	Ages 18–25 %
Any Substance Use Disorder	195	8	35	152	20.23%	30.53%
Drug Use Disorder	110	6	27	77	11.50%	23.85%
Pain Reliever Use Disorder	15	1	1	13	1.56%	1.02%
Opioid Use Disorder	17	1	1	14	1.73%	1.22%

Over one-fifth of Montanans aged 12 and older met criteria for a substance use disorder in the past year. Young adults (18–25) had the highest rate at 30.53%. Opioid Use Disorder alone affected an estimated 17,000 Montanans.

Substances Most Commonly Seen in Treatment

Primary Substances at Admission

Treatment admissions data identifies which substances most commonly drive Montanans to seek help. The following reflects 2010 admissions data and statewide enforcement figures.

• Marijuana: Most commonly cited primary substance in treatment admissions
• Marijuana dependence — ages 12–17 (2010): 29.5% — highest rate of any age group
• Alcohol only (2010): 2,003 entered rehab for alcohol as the sole substance
• Alcohol + secondary drug (2010): 2,699 entered rehab for alcohol combined with another substance
• Opiates (non-heroin) (2010): 841 admissions — 45.9% male, 54.1% female
• Amphetamines / methamphetamine (2010): 498 admissions — largest group aged 26–30 (23.7%)
• Total enrolled in drug and alcohol rehab (2010): 7,744 — 68.5% male, 31.5% female
• Drug violations involving marijuana (2015): 57% of all drug violations
• Drug violations involving meth (2015): 31% of all drug violations

While marijuana dominates primary admissions, the treatment population for methamphetamine and opiates is substantial — and significantly male-skewed for meth, female-skewed for opiates.

Prescription Drugs in Treatment (2007–2013)

The following tables detail how prescription drug admissions broke down by age, gender, and race/ethnicity over the period 2007 to 2013, for clients where Rx drugs were the primary substance.

Primary Prescription Drug Admissions by Age Group (%)

Age Group	2007	2008	2009	2010	2011	2012	2013
Adolescent (0–17)	0%	1%	1%	3%	2%	1%	1%
Young Adult (18–20)	5%	6%	11%	6%	5%	7%	4%
Adult (21–64)	95%	91%	87%	90%	93%	91%	93%
Senior (65+)	0%	1%	1%	1%	1%	0%	1%

Primary Prescription Drug Admissions by Gender (%)

• 2007: 63%
• 2008: 55%
• 2009: 48%
• 2010: 56%
• 2011: 52%
• 2012: 47%
• 2013: 44%

• 2007: 37%
• 2008: 45%
• 2009: 52%
• 2010: 44%
• 2011: 48%
• 2012: 53%
• 2013: 56%

Primary Prescription Drug Admissions by Race / Ethnicity (%)

Race / Ethnicity	2007	2008	2009	2010	2011	2012	2013
White	79%	81%	80%	71%	70%	70%	78%
American Indian	16%	13%	14%	24%	24%	19%	17%
Multi-Racial	5%	4%	4%	4%	5%	9%	4%
Black	0%	0%	1%	0%	0%	1%	0%
Asian	0%	0%	0%	1%	0%	0%	0%
Native Hawaiian	0%	0%	0%	0%	0%	0%	0%
Other Single Race	0%	1%	1%	0%	1%	1%	1%

Secondary Prescription Drug Admissions by Gender (%)

Gender	2007	2008	2009	2010	2011	2012	2013
Female	55%	55%	47%	45%	33%	36%	39%
Male	45%	45%	53%	55%	67%	64%	61%

Adults aged 21–64 account for 87–95% of all prescription drug treatment admissions. Gender composition shifted over the period: women initially dominated but by 2012–2013 men had become the majority. American Indians make up a disproportionately large share of admissions — reaching 24% in 2010–2011 — far exceeding their share of the state population.

Treatment System: Access, Capacity, and Cost

Treatment Need vs. Availability

Despite the scale of Montana’s substance use crisis, the treatment gap is severe. The following figures describe how many people need care, how many receive it, and who falls through the cracks.

• Classified as needing treatment (ages 12+): 216,000 — 22.46% of Montanans
• Received treatment in past year: 56,000 — 5.78% of Montanans
• Needed treatment but did not receive it: 156,000 — 73.70% of those who need care
• Adults seeking substance abuse treatment annually: ~10,067

Treatment Capacity and Enrollment

• Active treatment facilities in Montana: 93
• Facilities offering free treatment to all clients: 1
• Clients in treatment (single-day count, 2019): 4,537
• Clients in treatment (single-day count, 2015): 5,064 — enrollment decreased from 2015 to 2019
• Enrolled in outpatient drug rehab annually: 4,260
• Enrolled in residential (non-hospital) drug rehab annually: 249
• Clients in hospital drug rehab: 28

Treatment Mix (2019 Single-Day Count)

• Drug problem only: 38.7% of enrolled clients
• Alcohol problem only: 22.4%
• Both drug and alcohol: 38.8%

Medication-Assisted Treatment (MAT) Growth (2015 vs. 2019)

MAT Medication	Clients (2015)	Clients (2019)	Change
Methadone	489	727	+49%
Buprenorphine	284	625	+120%

Montana’s treatment gap is acute: nearly three-quarters of those who need help do not receive it. While MAT has expanded significantly between 2015 and 2019, total treatment enrollment has actually declined over the same period. Only one facility in the state offers fully free treatment.

Drug Rehabilitation Costs

Treatment costs vary dramatically by setting, creating a significant financial barrier to care — particularly for the most intensive residential treatment.

Treatment Setting	Avg. Individual Cost	Annual Public Expenditure	Annual Clients	Notes
Outpatient	$1,627	$6.93M (0.3% of US total)	4,260	Tied 44th cheapest state; equal to Nevada
Residential (non-hospital)	$62,530	$15.57M (0.3% of US total)	249	—
Hospital-based	—	—	28	—

Residential treatment costs nearly 38× more per client than outpatient care. Despite treating far fewer patients, residential programs receive more than twice the public funding. The high cost of residential care is a key barrier to the most intensive level of treatment.

Criminal Justice and Public Safety Impact

Drug use has significantly burdened Montana’s criminal justice system, with arrests, incarceration rates, and healthcare costs all rising over the past two decades.

• Drug-related arrests increase (2009–2015): +62%
• Drug charges as share of all arrests (2015): 18% — leading category for both misdemeanor and felony arrests
• OD death rate increase (Montana, 2000–2018): +171% — from 4 to 12 per 100,000
• Jail population rate change (2000–2015): +34% — from 261 to 349 per 100,000 residents
• Drug-related ER visits and hospitalizations (2010–2014): 26,829 total encounters
• From 2012 to 2015: Montana reported 181 deaths linked to prescription opioids
• From 2011 to 2013: Prescription-drug-only ODs caused at least 369 deaths and over 7,200 hospital/ER encounters

Both the overdose death rate and the jail incarceration rate rose in parallel from 2000 to 2015, reflecting dual public health and public safety dimensions of Montana’s drug crisis. Drug charges now constitute the largest arrest category statewide.

Statistical Data on Alcohol in Montana

Montana consistently ranks among the highest states in the nation for alcohol-related mortality, impaired driving, and rates of youth and adult drinking. This section presents a comprehensive statistical overview.

Alcohol-Related Mortality

Scale and Overall Trend

Excessive alcohol use is a leading cause of preventable death in Montana. The state’s alcohol-induced death rate is nearly double the national average.

• Average annual deaths from excessive alcohol use: 605
• Deaths per 10,000 adults aged 18+: 7.10
• One excessive alcohol death for every: 1,792 adults aged 18+ in Montana
• 5-year increase in excessive alcohol deaths (2015–2019): +42.0%
• Alcohol-related deaths 2009–2013: 1,563
• Alcohol-related deaths 2019–2023: 2,941 — an 88% increase over 10 years
• Years of potential life lost to alcohol annually: 15,254

Alcohol-Induced Death Rate Comparison (2019)

	Rate per 100,000 adults aged 25+
Montana	30.9
United States	17.3
Difference	Montana nearly 2× the national rate

The number of Montanans dying from alcohol-related causes nearly doubled over the past decade. The state’s alcohol-induced death rate of 30.9 per 100,000 is nearly twice the national figure of 17.3.

Demographic Profile of Alcohol Deaths

• Male: 68.1% of all excessive alcohol deaths
• Adults aged 35 and older: 84.0% of all excessive alcohol deaths
• Deaths from chronic causes (e.g., AUD): 62.1%
• Deaths from acute/injury causes: 37.9%
• Under age 21: 2.81% of excessive alcohol deaths

Alcohol deaths in Montana are overwhelmingly male and concentrated among adults over 35. Most deaths result from chronic conditions such as Alcohol Use Disorder rather than acute events.

Economic Cost of Excessive Alcohol Use

• Total cost to Montana taxpayers (2010): $870.8 million
• Inflation-adjusted cost (2022 dollars): $1.176 billion
• Cost per drink consumed (2022 dollars): $2.34

The societal cost of excessive alcohol use in Montana amounts to over $1.17 billion annually in today’s dollars — a substantial burden on taxpayers, healthcare systems, and communities.

Alcohol Use Prevalence

Adult Alcohol Use: Montana vs. United States

Montana adults drink at rates substantially above the national average. The following compares key indicators between Montana and the United States.

Indicator	Montana	United States
Adults 18+ who drank in past month	59.1%	52.8%
Adults 18+ who binge drank in past month	19.5%	15.2%
Adults reporting binge or heavy drinking	21.0%–24.3%	—
Fatal crashes with alcohol-impaired driver (BAC 0.08+)	33.3%	31.8%
Alcohol-induced death rate (per 100,000, 2019)	30.9	17.3
Death rate from alcohol car crashes (per 100,000, 2018)	6.8	2.3

Additional Montana Binge Drinking Details

• Adults who binge drink at least once per month: 19.7%
• Median drinks per binge episode: 5.4
• Median drinks per binge — top 25% most active drinkers: 7.3
• Median binge episodes per month: 1.6
• Binge episodes per month — top 25% most active drinkers: 4.0

Montana adults are significantly more likely to drink and binge drink than the average American. The state’s death rate from alcohol-related car crashes is nearly three times the national rate. Montana is ranked 45th nationally for excessive drinking — meaning only four states drink more.

Alcohol Use by Age Group (Annual Average 2022–2023)

Survey data estimates how many Montanans of each age group used or misused alcohol. Numbers are in thousands; percentages follow.

Estimated Numbers of Alcohol Users (Thousands)

Measure	Age 12+	Age 12–17	Age 18–25	Age 26+
Alcohol Use – Past Month	498	7	64	427
Binge Alcohol Use – Past Month	221	3	40	177
Alcohol Use – Past Month (Ages 12–20)	21	—	—	—
Binge Alcohol Use (Ages 12–20)	13	—	—	—

Prevalence Percentages

Measure	Age 12+	Age 12–17	Age 18–25	Age 26+
Alcohol Use – Past Month	51.75%	7.86%	55.96%	55.93%
Binge Alcohol Use – Past Month	22.94%	3.96%	34.67%	23.24%
Alcohol Use (Ages 12–20)	17.40%	—	—	—
Binge Alcohol Use (Ages 12–20)	10.52%	—	—	—
Perceived great risk from heavy drinking	38.59%	36.27%	33.76%	39.58%

More than half of all Montanans aged 12 and older reported drinking in the past month, and nearly one in four binge drank. Adults aged 18–25 and 26+ show nearly identical past-month use rates (~56%), while the 18–25 group has a much higher binge rate (34.67% vs. 23.24%).

Youth Alcohol Use

Youth Alcohol Use: Prevalence and Trends (Ages 12–17)

Montana youth consistently report alcohol use above national averages. The state ranks 48th (2nd highest) nationally for youth alcohol use among ages 12–17.

Indicator	Montana	Benchmark
Past-month alcohol use (2022–23)	7.86%	14.25% more likely than avg. American teen
Past-month alcohol use (2017–19)	13.5%  (~10,000 teens)	National avg: 9.4%; Regional: 8.5%
First-time alcohol use (2017–19)	10.7%  (~8,000 teens)	National avg: 9.3%
Alcohol Use Disorder (ages 12–17)	3.49%	—
Alcohol Use Disorder (ages 12–20)	7.22%	—
State ranking for youth alcohol use (ages 12–17)	48th — 2nd highest in US	—

Montana teenagers are significantly more likely to drink than peers nationally. By 2017–2019, the state’s youth drinking rate was 43% above the national average.

High School Student Alcohol Behavior

High school survey data reveals the breadth of alcohol involvement among Montana teenagers, including drinking, binge drinking, and impaired driving.

Indicator	Montana	United States
Past-month alcohol use	26.2%	22.1%
Past-month binge drinking	13.4%	8.8%
Past-month binge drinking (2019)	18%	14%
Binge drinking (another source)	61%	—  (reported as ‘having binge drunk’)
1 in 3 high school students reported past-month alcohol use	~33%	Over 50% of those who drink also binge drank

Alcohol and Driving Among High School Students

• Drove under the influence of alcohol (past 30 days): ~6% of high school students
• Rode in a vehicle with an impaired driver (past 30 days): 16.8% of high school students

Montana’s high school binge drinking rate is more than 50% above the national average. Nearly one in six high school students has recently been in a vehicle with an alcohol-impaired driver.

Young Adults and College Students (Ages 18–25)

Young adults aged 18–25 exhibit the highest alcohol use and binge drinking rates of any age group in Montana.

Indicator	Montana	Benchmark
Past-month alcohol use	55.96%	—
Past-month binge drinking (2017–19)	45.7%  (~50,000)	National: 35.4%; Regional: 36.3%
Past-month binge drinking (2022–23)	34.67%	—
Alcohol Use Disorder (2017–19)	12.5%  (~14,000)	National: 9.8%
Alcohol Use Disorder (2022–23)	18.75%	—
College students: DUI in past 3 months	More than 20%	—
Adults: DUI in past year (2017–18)	14%	National: 9% — 56% above national

Montana’s young adults lead the state in alcohol consumption. Nearly half reported binge drinking in a single month in 2017–2019, and more than 1 in 5 college students reported driving under the influence within the past three months. Montana’s self-reported DUI rate is over 50% above the national average.

Alcohol Use Disorder (AUD)

AUD Prevalence (2022–2023)

Survey data estimates the number of Montanans meeting AUD criteria in the past year, across age groups.

Group	AUD (thousands)	AUD (%)
Ages 12+	105	10.97%
Ages 12–17	3	3.49%
Ages 18–25	22	18.75%  ← highest
Ages 26+	81	10.61%
Ages 12–20 (alt)	9	7.22%

Historical AUD Data

• Value: 7.9% (~70,000 people)
• Comparison: National average: 5.3%

• Value: 12.5% (~14,000 people)
• Comparison: National average: 9.8%

• Value: ~65,000 people
• Basis: Estimated from a rate above 7%

• Value: ~8%
• Note: Indicates very low treatment uptake

AUD is widespread across all age groups, with young adults (18–25) at 18.75% — nearly double the national average. Despite its prevalence, only about 8% of alcohol-dependent Montanans entered treatment — one of the most striking indicators of the treatment gap.

Alcohol-Impaired Driving

Impaired driving is among the most deadly consequences of Montana’s drinking culture. The state’s alcohol traffic fatality rate is nearly three times the national average.

Indicator	Montana	United States
Fatal crashes with alcohol-impaired driver (BAC 0.08+)	33.3%	31.8%
Alcohol share of all traffic fatalities (2018)	37%	—
Alcohol share of driving deaths (highest source)	46%	— (identified as highest in US)
Death rate from alcohol car crashes (per 100,000, 2018)	6.8	2.3
DUI arrests (2023)	3,997	—
DUI arrests as % of all arrests (2023)	13.6%	—
Adults who reported DUI in past year (2017–18)	14%	9%
EMS activations for substance use involving alcohol (2019)	79%	—
Montana hospital charges for alcohol-related care (2019)	$189M+	—
Montana hospital charges for alcohol-related care (2023)	$222M+	—

Montana’s alcohol traffic fatality rate (6.8 per 100,000) is nearly three times the national rate (2.3). One measure identifies Montana as the state with the highest percentage of driving fatalities involving alcohol in the country. In 2023, DUI arrests accounted for nearly 14% of all arrests.

Alcohol Treatment and Healthcare Burden

Healthcare Utilization

Alcohol misuse generates enormous and growing healthcare costs in Montana, with thousands of hospitalizations and emergency department visits recorded each year.

Period	Alcohol-Related Hospitalizations / ER Visits	Hospital Charges
2010–2014	41,595 total visits	—
2019	18,157 visits	$189 million+ charged
2023	16,914 visits	$222 million+ charged

Despite a slight reduction in the number of visits, charges for alcohol-related hospital care rose from $189M in 2019 to $222M in 2023 — a 17% cost increase. In 2019, alcohol was involved in 79% of all substance use-related emergency medical services activations.

Alcohol Treatment Utilization

Alcohol is the leading substance driving treatment demand in Montana, yet most people who need help do not receive it.

• Primary substance in treatment (2024): Alcohol — 66.7% of those in treatment
• Secondary substance in treatment (2024): Alcohol — 8.4% of those in treatment
• Adults who entered rehab for alcohol only (2010): 2,003
• Adults who entered rehab for alcohol + secondary drug (2010): 2,699
• Alcohol-dependent individuals who sought treatment: ~8% — the vast majority go untreated
• People classified as needing treatment (all substances, ages 12+): 216,000 — 22.46% of Montanans
• People who received treatment: 56,000 — 5.78%
• People who needed but did not receive treatment: 156,000 — 73.70% of those who need care

Alcohol accounts for approximately 75% of all treatment cases in Montana (primary + secondary). Despite this dominance, the treatment gap remains severe: roughly three-quarters of all Montanans who need substance use treatment — driven heavily by alcohol — do not receive it.

Alcohol Sales in Montana

Montana spirits, beer, and wine volume sales data provides context for consumption patterns. All figures are in 9-liter cases.

Spirit Sales by Category (2024)

Spirit Category	Volume (9-liter cases)
Vodka	312
Canadian Whisky	171
Cordials / Liqueurs	139
Straight Whiskey	138
Rum	79
Tequila	78
Cocktails (pre-made)	76
Gin	39
Irish Whiskey	25
Scotch Whisky	13

Beer Sales by Category (2023)

• Light Beer — 4.4 (9-liter cases)
• Craft Beer — 2.7
• Super & Super Premium Beer — 1.6
• FMBs & Hard Seltzer — 1.4
• Imported Beer — 1.3
• Popular Beer — 0.8

Wine Sales by Category (2023)

Wine Category	Volume (9-liter cases)
Table Wine	887
Champagne & Sparkling	55
Dessert & Fortified	8
Wine-Based RTD	3
Vermouth & Aperitif	3

Vodka dominates spirit sales by a wide margin, followed by Canadian whisky and cordials. Light beer leads in the beer category. Table wine accounts for the overwhelming majority of wine consumption. Sales patterns reflect a state with one of the highest per-capita alcohol consumption rates in the country.

Summary

Montana faces a serious and multifaceted substance use crisis on two parallel fronts. Drug overdose deaths increased 37% over 2014–2023, driven primarily by the rapid rise of fentanyl and methamphetamine; opioid deaths alone more than doubled. American Indian/Alaska Native residents face overdose death rates more than three times the statewide average. Meanwhile, alcohol abuse remains a deeply embedded public health challenge: Montana’s alcohol-induced death rate is nearly double the national average, its DUI fatality rate is among the highest in the country, and both youth and adult drinking rates consistently exceed national benchmarks.

Approximately 216,000 Montanans need substance use treatment each year, but roughly three-quarters of them — some 156,000 people — do not receive it. Expanding access to affordable, evidence-based treatment for both drug and alcohol disorders is among the most urgent public health priorities for the state.

Sources:

1. Drug Overdose Death Statistics [2025]: Opioids, Fentanyl & More
2. Average Cost of Drug Rehab [2026]: by Type, State & More
3. Teenage Drug Use Statistics [2025]: Data & Trends on Abuse
4. Opioid Crisis Statistics [2025]: Prescription Opiod Abuse
5. Substance Use and Perceptions of Great Risk: Among People Aged 12 or Older in Montana
6. Non-Medical Drug Use – Past Year in Montana
7. Overdose Deaths and Jail Incarceration – Montana
8. Montana Substance Abuse Treatment Statistics
9. Drug and Alcohol Statistics in Montana | Health Care Montana Addiction Treatment
10. Opioid Use/Misuse in Older Adults – Extension Family & Human Development | Montana State University
11. Drug Overdose Deaths in Montana 2014-2023
12. The Drug Impact on Montana
13. Montana Drug Control Update 
14. Montana Drug Statistics | Recovery Connection
15. Behavioral Health Barometer: Montana, Volume 6
16. Montana Drug and Alcohol Addiction Information
17. Alcohol Abuse Statistics [2026]: National + State Data – NCDAS
18. Alcohol Use in Montana
19. Explore Excessive Drinking in Montana | AHR
20. Explore Alcohol Use – Youth in Montana | AHR
21. Top 10 States For Excessive Drinking
22. Montana Alcohol Laws and Sales (Buying & Selling in 2026)