North Dakota Drug and Alcohol Statistics

North Dakota faces a growing substance use crisis that touches every corner of the state — from urban centers to rural counties, from teenagers to older adults. While the state’s drug and alcohol use rates have historically fallen below national averages in many categories, recent years have brought sharp increases in overdose deaths, rising fentanyl involvement, and persistently high rates of binge drinking that rank among the worst in the nation.

This report compiles statistical data from multiple public health, law enforcement, and survey sources into a single comprehensive overview, covering drug overdose trends, opioid and fentanyl data, illicit drug use by age group, substance use disorder prevalence, youth substance use, treatment access, and alcohol consumption and its human and economic costs.

The data is organized into two sections — drugs followed by alcohol — to give policymakers, practitioners, educators, and community members a clear, evidence-based picture of where North Dakota stands and where the greatest needs remain.

Statistical Data on Drugs in North Dakota

Drug Overdose Deaths

North Dakota’s drug overdose death rate, while rising significantly in recent years, remains well below the national average. The following statistics capture the scale, trajectory, and demographics of overdose fatalities across the state.

State-Level Overview

• 148 drug overdose deaths per year (recent data).
• OD deaths account for 2.17% of all deaths in North Dakota.
• The OD death rate is 19.8 deaths per 100,000 residents — 37.97% less than the national OD death rate.
• North Dakota accounts for 0.14% of nationwide OD deaths.
• OD deaths increased by 73.68% over the last three years.

Overdose Deaths by Year (2014–2024)

Overdose deaths rose sharply from 2014 to 2022 before declining. The table tracks known annual and period data.

Year / Period	OD Deaths	Rate per 10,000	Key Change
2014	43	—	Baseline reference
2016	77	—	+79% from 2014
2018	70	—	Slight decrease
2019 (est.)	~85	0.98	Pre-pandemic baseline
2022 (peak)	135	1.44	+48% from 2019; highest on record
2023 (provisional)	113	~1.44 (5-yr avg.)	−16% from 2022
Jan–Jul 2024 (partial)	54	—	Pace consistent with 2023

• Between 2019 and 2023, overdose deaths rose roughly 48%, peaking at 135 in 2022 then falling to 113 in 2023.
• The overdose death rate increased from 0.98 per 10,000 in 2019 to 1.44 per 10,000 in 2022 — a 48% increase.
• On average, 2 North Dakotans die each week from an unintentional drug overdose.

Demographics of Overdose Deaths (2019–2023 Combined)

Overdose deaths in North Dakota show consistent demographic patterns. The five-year dataset of 625 total unintentional drug overdose deaths reveals the following:

Gender

• Two-thirds (approximately 67%) of all overdose deaths were male.
• Male overdose death rate: 1.95 per 10,000 (2019–2023).
• Female overdose death rate: 0.99 per 10,000 (2019–2023).

Age

• Most overdose deaths were under age 39.
• Average age at time of death: 37.2 years.

Location of Death

• Over 74% of overdose deaths occurred at a home or apartment.
• 30% of deaths had alcohol present in toxicology results.

Racial Disparities

• The overdose death rate for American Indian / Native American residents was 8.48 per 10,000 (2019–2023).
• The overdose death rate for white residents was 1.14 per 10,000 — approximately 7.4 times lower.
• Native American overdose deaths exceeded those of all other racial demographics.

Geographic Distribution

• 33 of North Dakota’s counties have recorded at least one overdose death since 2019.
• Mountrail, Sioux, and Benson Counties have the highest overdose death rates in the state — more than twice the statewide average.

The combination of young victims dying at home with multiple substances present, and the extreme racial disparity affecting Native American communities, points to deeply structural drivers that require targeted, community-specific responses.

The Opioid Epidemic

Opioids — particularly synthetic opioids such as fentanyl — are the primary driver of overdose deaths in North Dakota. The opioid crisis has intensified significantly since 2019.

Opioid Overdose Deaths

• 87 people died from opioid overdose in 2023.
• Opioids are a factor in 71.3% of all overdose deaths.
• The opioid OD death rate is 11.7 per 100,000 residents — 51.3% less than the national rate.
• Synthetic opioids such as fentanyl are involved in 87.4% of all opioid overdose deaths.
• Intravenous drug use was connected to approximately 1.3 new HIV/AIDS diagnoses in 2023.
• In 2020, 21.4 of every 1,000 births were diagnosed with neonatal opioid withdrawal syndrome.
• Doctors write enough opioid prescriptions for 32.4% of North Dakota residents to have one.

Fentanyl Trends

• In 2019, 42% of overdose deaths tested positive for fentanyl.
• By 2023, that figure had risen to 77% of all overdose deaths.
• Across the full 2019–2024 period, 64% of all 625 overdose deaths had fentanyl present in toxicology results.
• Fentanyl-involved overdose deaths reached as high as 1.26 per 10,000 in 2022.
• A new emerging threat: xylazine — a non-opioid tranquilizer increasingly combined with fentanyl. North Dakota has recorded 13 xylazine-positive overdose deaths since 2019.

Substances Identified in All Overdose Deaths (2019–2024, N=625)

The majority of deaths involved more than one substance (polysubstance use). The table shows how frequently each substance appeared across the 625 total unintentional overdose deaths.

Substance	Deaths Involved	% of 625 Deaths
Opioids (any)	490	78.4%
Fentanyl	403	64.5%
Amphetamines	347	55.5%
Alcohol	190	30.4%
Marijuana	186	29.8%
Benzodiazepines	103	16.5%

The most common two-substance combination was opioids and amphetamines, found in 37% of polysubstance deaths.

Prescription Opioids and Gateway Risk

• People addicted to prescription pain killers are 40 times more likely to become addicted to heroin.
• 51.3% of people aged 12+ who misuse pain relievers obtain them from a friend or relative.
• The number of controlled substance prescriptions increased from 935,201 in 2008 to a peak of 1,498,714 in 2015, then decreased to 1,195,475 by 2019 — still 28% above the 2008 level.
• Nationally, more than three out of five drug overdose deaths involve an opioid, with nearly half from prescription opioids.
• Among individuals receiving SUD treatment at regional human service centers, nearly 10% report heroin or prescription opioid use.

Despite a decline in prescription volume since 2015, the volume remains far above 2008 levels, sustaining a pipeline of divertible opioids into communities.

Marijuana — Detailed Data

Marijuana is the most commonly used illicit substance in North Dakota and the most cited drug in treatment admissions. Community perception of its risk is low, particularly among youth and young adults.

Marijuana Use Prevalence

• 11.8% past-year use among people aged 12+ during 2017–2019 (~73,000 people) — lower than regional (19.9%) and national (16.2%) averages.
• Past-year use among people 12+ increased between 2002–2004 and 2017–2019.
• 13.0% of ND young adults (ages 18–29) report marijuana use in the past 30 days.
• 12.3% of ND college students used marijuana within the past 30 days.
• 6.0% of ND adults (age 26 and older) report using marijuana in the past month (vs. 8.3% nationally).
• Past-month marijuana use decreased among youth aged 12–17 between 2002–2004 and 2017–2019.

Marijuana — Community Perceptions

• 85.3% of ND adults believe youth marijuana use is a problem in their community.
• 76.2% believe adult marijuana use is a problem.
• 73.7% of ND youth (ages 12–17) do NOT perceive great risk in smoking marijuana once a month.
• 76.7% of ND adults (18+) do NOT perceive great risk in smoking marijuana once a month.
• 77% of young adults thought smoking marijuana once or twice a week had no risk or only slight risk.
• 53% of young adults supported legalizing possession of small amounts for personal use.
• 38.7% of ND adults believe it is not at all difficult for adults or youth to access marijuana.

Marijuana in Law Enforcement and Treatment

• Nearly 49% of all drugs seized in drug/narcotic violations in 2019 were marijuana-related (3,651 cases).
• Marijuana is the most commonly cited primary drug among treatment admissions.
• In 2010, 696 people entered treatment for marijuana addiction (65.9% male, 33.6% female); the largest age group was 12–17 year olds.
• In 2011, two-thirds of North Dakota drug treatment admissions cited marijuana as the primary substance.
• Among adolescents in SUD treatment at regional human service centers, 91% report marijuana use.

Low risk perception and high accessibility make marijuana a persistent public health challenge, despite use rates that remain below national averages overall.

Illicit Drug Use Rates

North Dakota’s drug use rates are generally below national averages. The following tables present use prevalence by age group based on 2021–2022 annual average data from the National Survey on Drug Use and Health (NSDUH).

Illicit Drug Use — Percentages by Age Group (Annual Averages, 2021–2022)

Measure	12+	12–17	18–25	26+	18+
Illicit drug use, past month	12.07%	6.73%	20.87%	11.08%	12.63%
Illicit drug use other than marijuana, past month	3.30%	1.75%	4.03%	3.36%	3.46%
Marijuana use, past year	17.70%	9.58%	35.97%	15.23%	18.55%
Marijuana use, past month	11.30%	4.93%	20.28%	10.40%	11.97%
Cocaine use, past year	1.45%	0.12%	3.15%	1.30%	1.59%
Hallucinogen use, past year	2.82%	1.62%	6.67%	2.24%	2.94%
Methamphetamine use, past year	1.18%	0.10%	1.09%	1.34%	1.30%
Prescription pain reliever misuse, past year	2.94%	1.61%	2.56%	3.18%	3.08%
Opioid misuse, past year	3.14%	1.63%	2.75%	3.41%	3.30%
Heroin use, past year	—	—	0.21%	0.46%	0.42%

Illicit Drug Use — Estimated Numbers (Thousands, Annual Averages, 2021–2022)

Measure	12+	12–17	18–25	26+	18+
Illicit drug use, past month	77k	4k	19k	54k	73k
Marijuana use, past year	113k	6k	34k	74k	107k
Marijuana use, past month	72k	3k	19k	50k	69k
Cocaine use, past year	9k	<1k	3k	6k	9k
Hallucinogen use, past year	18k	1k	6k	11k	17k
Methamphetamine use, past year	8k	<1k	1k	6k	7k
Opioid misuse, past year	20k	1k	3k	16k	19k
Heroin use, past year	~2k	—	<1k	2k	2k
Illicit drug use other than marijuana, past month	21k	1k	4k	16k	20k

Perceptions of Risk

Perception of risk is a key predictor of use. North Dakotans generally underestimate risks from marijuana and cocaine.

Substance / Behavior	12+	12–17	18–25	26+	18+
Perceive great risk: smoke marijuana once a month (%)	17.80%	20.64%	8.73%	19.18%	17.51%
Perceive great risk: use cocaine once a month (%)	65.00%	46.46%	53.78%	69.44%	66.93%
Perceive great risk: try heroin once or twice (%)	81.01%	52.74%	75.56%	85.54%	83.93%

• 73.7% of ND youth (ages 12–17) do NOT perceive great risk in smoking marijuana once a month.
• 76.7% of ND adults (18+) do NOT perceive great risk in smoking marijuana once a month.
• Only 17.8% of all North Dakotans aged 12+ perceive great risk from monthly marijuana use.

An estimated 5.3–6% of North Dakota residents are past-month users of illicit drugs, compared to a national average of approximately 8–8.82%. Young adults aged 18–25 show the highest rates across nearly every category.

Substance Use Disorder (SUD)

Substance use disorder affects a significant and growing portion of North Dakota’s population. Nearly 20% of residents aged 12+ meet SUD diagnostic criteria annually.

SUD Prevalence — Percentages (Annual Averages, 2021–2022)

Disorder	12+	12–17	18–25	26+	18+
Any Substance Use Disorder	19.68%	8.97%	31.02%	18.86%	20.80%
Drug Use Disorder	8.51%	5.07%	15.75%	7.56%	8.87%
Pain Reliever Use Disorder	1.70%	0.86%	0.83%	1.97%	1.79%
Opioid Use Disorder	1.90%	0.86%	0.84%	2.24%	2.01%
Alcohol Use Disorder	13.50%	3.71%	20.46%	13.39%	14.53%
AUD (ages 12–20 only)	7.21%	—	—	—	—

SUD Estimated Numbers (Thousands, Annual Averages, 2021–2022)

Disorder	12+	12–17	18–25	26+	18+
Any Substance Use Disorder	125k	5k	29k	91k	120k
Drug Use Disorder	54k	3k	15k	37k	51k
Pain Reliever Use Disorder	11k	1k	1k	10k	10k
Opioid Use Disorder	12k	1k	1k	11k	12k
Alcohol Use Disorder	86k	2k	19k	65k	84k
AUD (ages 12–20 only)	7k	—	—	—	—

Broader SUD Estimates and Trend Data

• 4.4% of youth (ages 12–17) had a substance use disorder in the past year (general survey data).
• 8.8% of adults (18+) had a substance use disorder in the past year.
• 6.20% of teenagers aged 12–17 met the criteria for Drug Use Disorder in the past year.
• 2.54% of teenagers aged 12–17 met the criteria for Alcohol Use Disorder in the past year.
• During 2017–2019, past-year SUD prevalence in ND was 8.4% (approximately 52,000 people) — similar to the regional average (9.4%) and national average (7.4%).
• Among young adults (18–25), 2017–2019 past-year SUD prevalence was 17.8% (approximately 17,000) — similar to regional (17.7%) and national (14.7%) averages.
• Past-year opioid use disorder among people 12+ was 0.8% (approximately 5,000) during 2017–2019 — similar to regional (0.7%) and national (0.7%) averages.
• Past-year marijuana use disorder among people 12+ was 1.2% (approximately 7,000) during 2017–2019 — lower than regional (2.3%) but similar to national (1.6%).
• Past-year illicit drug use disorder among people 12+ was 2.5% (approximately 15,000) during 2017–2019 — lower than regional (4.0%) but similar to national (2.9%).

Young adults aged 18–25 bear the highest SUD burden — nearly 1 in 3 meets diagnostic criteria. Opioid use disorder rates have remained stable, while illicit drug use disorder among young adults increased between 2015–2017 and 2017–2019.

Youth Drug Use

Drug use among North Dakota youth is lower than the national average in most categories. However, marijuana use among high school students notably exceeds the national rate, and alcohol use among teens is above average.

High School Student Drug Use

• 27.2% of ND high school students reported using synthetic marijuana one or more times in their lifetime.
• 3.4% reported using cocaine at least once in their lifetime.
• 1.6% reported using methamphetamine at least once (vs. 2.5% nationally).
• 1.3% reported using heroin at least once (vs. 1.7% nationally).
• 6.8% of middle school students and 14.3% of high school students report using prescription pain medication without a prescription at least once in their lifetime.
• 12.1% of high school students were offered, sold, or given an illegal drug on school property in the past year.
• 5.0% of high school students first tried marijuana before age 13.5 — equivalent to approximately 1,989 students, roughly the total enrollment of the Jamestown School District.

Youth Substance Initiation (Annual Averages, 2017–2019)

• 7.3% (approximately 4,000) of youth aged 12–17 used alcohol for the first time — similar to the regional average (8.2%) and national average (9.3%).
• 3.8% (approximately 2,000) used marijuana for the first time — similar to regional (4.8%) and national (5.2%) averages.
• 4.6% (approximately 2,000) used cigarettes for the first time — similar to regional (3.2%) but higher than the national average (2.3%).
• First use of marijuana in the past year among those at risk: 2.53% of all aged 12+; 3.52% of those aged 12–17; 10.25% of those aged 18–25.

Youth (Ages 12–17) — Illicit Drug Use

• 6.18% of 12- to 17-year-olds report using drugs in the last month (approximately 4,000 youth).
• North Dakota teenagers are 14.81% less likely to have used drugs in the last month than the average American teen.
• Among 12- to 17-year-olds who used illicit drugs in the past month, 75.00% reported marijuana use.
• 7.78% of 12- to 17-year-olds reported using marijuana in the past year.
• 0.16% of 12- to 17-year-olds reported using cocaine in the past year.
• 0.08% of 12- to 17-year-olds reported using methamphetamine in the past year.
• 1.91% of 12- to 17-year-olds reported using pain relievers non-medically in the past year.
• During 2017–2019, past-month illicit drug use among youth aged 12–17 was 5.4% — lower than both the regional average (8.3%) and national average (8.2%).
• During 2017–2019, past-month marijuana use among youth aged 12–17 was 5.0% — similar to the regional average (6.8%) but lower than the national average (6.8%).

Youth — Substance Use Disorder

• 6.20% of teenagers aged 12–17 met the criteria for Drug Use Disorder (DUD) in the past year.
• 2.54% of teenagers aged 12–17 met the criteria for Alcohol Use Disorder (AUD) in the past year.
• Among adolescents receiving SUD treatment at regional human service centers, 91% report marijuana use.

Young Adults (Ages 18–25)

• Approximately 20,000 adults aged 18–25 used drugs in the past month.
• 18- to 25-year-olds in ND are 21.52% less likely to use drugs than the average American in the same age group.
• 1.0% of ND young adults (ages 18–29) report use of prescription medication in the last 30 days to get high.
• 5.3% of ND college students report use of other illegal drugs in the past year (heroin, inhalants, synthetic drugs, etc.).
• During 2017–2019, past-year marijuana use among young adults was 26.7% (~25,000) — lower than regional (38.8%) and national (35.0%) averages.
• Past-year marijuana use disorder among young adults was 3.9% (~4,000) during 2017–2019 — lower than regional (6.9%) and national (5.6%) averages.
• Past-year opioid use disorder among young adults was 1.5% (~1,000) — similar to regional (1.3%) and national (1.0%) averages.
• Past-year illicit drug use disorder increased between 2015–2017 and 2017–2019 to 6.5% (~6,000) — lower than regional (9.7%) but similar to national (7.5%).

While North Dakota’s youth drug use is broadly below national averages, marijuana use among high school students exceeds the national rate (27.2% vs. 19.8%), and the high concentration of marijuana among youth in SUD treatment suggests targeted prevention is needed.

Substance Use Treatment Services

North Dakota offers a range of substance use treatment options and is notably cost-effective for outpatient treatment, ranking first nationally for lowest outpatient rehab costs. Despite this, the vast majority of those who need treatment are not receiving it.

Treatment Capacity and Cost

• 90 active substance abuse clinics in North Dakota.
• 3,754 clients are serviced annually for drug rehab (single-day count, March 2019).
• 3 facilities in North Dakota offer completely free drug rehab treatment for all patients.
• North Dakota ranks #1 in the nation for lowest-cost outpatient drug rehabilitation treatment.
• North Dakota ranks 45th out of 50 states for cheapest residential drug abuse treatment.

Outpatient Services

• 3,358 clients enroll in ND’s outpatient drug rehab services annually.
• Average individual outpatient cost: $1,376.
• 0.2% ($4.62 million) of the U.S. public’s total outpatient spending is in North Dakota.

Residential (Non-Hospital) Services

• 321 clients enroll in ND’s residential (non-hospital) drug rehab services annually.
• Average individual residential cost: $64,673.
• 0.4% ($20.76 million) of the U.S. public’s total residential spending is in North Dakota.

Hospital-Based Services

• 75 clients are in North Dakota’s hospitals for drug rehab.

Treatment Access and the Treatment Gap (2022)

Despite available services, far more people need treatment than receive it. The table below shows the gap between need and access by age group.

Measure	12+	12–17	18–25	26+	18+
Received SU treatment, past year (%)	4.78%	4.40%	4.57%	4.87%	4.82%
Received SU treatment (thousands)	31k	3k	4k	24k	28k
Classified as needing treatment (%)	20.03%	11.27%	30.17%	19.11%	20.94%
Classified as needing treatment (thousands)	128k	7k	29k	92k	121k
Needed but NOT receiving treatment (%)	76.74%	—	86.28%	74.53%	77.62%
Needed but NOT receiving treatment (thousands)	98k	—	27k	67k	94k

More than 76% of all North Dakotans who need substance use treatment are not receiving it. The gap is widest among young adults (18–25), where 86% of those who need treatment go without it.

Treatment Focus and Profile

• 39.3% of treatment enrollees received treatment for a drug problem only.
• 15.9% received treatment for an alcohol problem only.
• 44.7% received treatment for both drug and alcohol problems — more than half of admissions involve co-occurring issues.
• More than half of substance abuse admissions in North Dakota are for clients with both drug and alcohol problems.
• In 2010, 2,478 people entered treatment for both alcohol and drug addiction (61.5% male, 38.5% female).
• 145 people entered substance abuse treatment for amphetamines in 2010 (44.1% male, 55.9% female; largest group aged 21–25).

Medication-Assisted Treatment (MAT) for Opioids

• In March 2019, 535 people were receiving methadone through opioid treatment programs — up from 0 in 2015.
• In March 2019, 710 people were receiving buprenorphine as part of substance use treatment — up from 84 in 2015.
• Overall treatment enrollment grew from 2,404 in 2015 to 3,754 in March 2019.

Syringe Service Programs

• 667 individuals received services at one of the three authorized Syringe Service Programs between January 1 and June 30, 2020.
• This represented a 60% increase in participants compared to the same period in 2019.
• 192 referrals to substance use treatment centers were made through Syringe Service Programs in that same six-month period.

The rapid scale-up of MAT between 2015 and 2019 reflects a significant public health investment, and syringe programs are successfully bridging people into formal treatment.

Law Enforcement and Drug Seizures

Drug violations represent a major component of law enforcement activity in North Dakota. Marijuana and methamphetamine dominate both seizures and treatment admissions.

Drug Types Seized (2019 Data)

Drug Type	Cases Seized	Share of Total Seizures
Marijuana	3,651	~49% of all drug seizures
Amphetamines / Methamphetamines	2,498	Second largest category
Heroin	325	Third largest category
Other narcotics	290	Fourth largest category

Arrests and Criminal Justice

• Nearly 15% of all arrests in 2019 were for drug/narcotic violations.
• Approximately 1 in 7 (15%) adult arrests in ND in 2022 were for Driving Under the Influence (DUI).
• 17% of adult arrests in ND historically are for driving under the influence.
• 94.6% of women and 84.7% of men entering North Dakota correctional facilities have an active substance use disorder diagnosis.
• 68.9% of community members believe methamphetamine is difficult to access — up from 62% in 2015.

The criminal justice system bears a substantial burden from substance use disorders, with nearly all incarcerated individuals carrying an active SUD diagnosis. This underscores the need for diversion to treatment as an alternative to incarceration.

Mental Health and Co-Occurring Conditions

Substance use and mental health disorders frequently co-occur. The following data reflects mental health treatment receipt among North Dakotans in 2022.

Mental Health Treatment Receipt (2022)

Age Group	Received MH Treatment in Past Year (thousands)	Percentage
12–17	18k	30.86%
18–25	30k	31.33%
26+	117k	24.13%
18+ (total)	147k	25.32%

Co-Occurring Mental Health Data

• 1 in 10 (11%) of young adults seriously considered suicide in the past year (WYSAC survey).
• 94.6% of women and 84.7% of men entering ND correctional facilities have an active substance use disorder diagnosis — reflecting a high co-occurrence with criminal justice involvement.

Mental health treatment receipt is highest among youth and young adults (approximately 31%), yet a substantial portion of those with mental health needs remain untreated, particularly among adults 26 and older.

Statistical Data on Alcohol in North Dakota

Alcohol-Related Deaths and Mortality

Excessive alcohol use is a leading cause of preventable death in North Dakota. The state has seen a significant rise in alcohol-related mortality, with death rates increasing sharply between 2015 and 2019.

Annual Alcohol-Attributable Mortality

• Average annual alcohol-attributable deaths: 347.
• 2.59% of those deaths involve persons under age 21.
• 70.3% of people who die from excessive alcohol use in North Dakota are male.
• 82.1% of excessive alcohol deaths are adults aged 35 years and older.
• 62.2% of excessive alcohol use deaths are from chronic causes, such as Alcohol Use Disorder.
• North Dakota averages 1 death from excessive alcohol use for every 2,245 people aged 18 and older.
• The death rate is 5.85 per 10,000 adults.
• The 5-year average annual rate of excessive alcohol deaths per capita increased by as much as 58.2% between 2015 and 2019.
• The CDC estimates 8,898 years of potential life are lost to excessive alcohol use each year in North Dakota.

Alcohol-Related Traffic Fatalities

• 38% of all fatal crashes in 2022 were alcohol-related, resulting in 43 fatalities.
• 35% of fatal crashes in North Dakota are alcohol-related (general statistic).
• Every 13 hours, one alcohol-related crash occurred.
• Every 10 days, one alcohol-related vehicle fatality occurred.

Alcohol and Fetal/Neonatal Health

• In North Dakota in 2023, 24.3% of women of childbearing age (18–44) reported binge drinking in the past month — compared to 17.6% nationally.
• In 2021, 7.2 newborns per 1,000 hospitalized were diagnosed with neonatal abstinence syndrome (NAS).

The 58.2% increase in excessive alcohol death rates between 2015 and 2019, combined with the highest rate of binge drinking among women of childbearing age in the country, signals an urgent and growing public health challenge.

Alcohol Consumption Rates

North Dakota consistently ranks among the highest states for alcohol consumption. Per capita use has grown substantially since 2000.

Adult Alcohol Use — Percentages by Age Group (Annual Averages, 2021–2022)

Measure	12+	12–17	18–25	26+	18+
Alcohol use, past month (%)	55.56%	8.49%	64.02%	59.87%	60.52%
Binge alcohol use, past month (%)	26.72%	5.01%	40.43%	26.81%	29.00%
Perceive great risk from 5+ drinks 1–2x/week (%)	38.14%	40.39%	31.08%	39.22%	37.90%
Alcohol use (ages 12–20 only) (%)	20.65%	—	—	—	—
Binge alcohol use (ages 12–20 only) (%)	14.02%	—	—	—	—

Adult Alcohol Use — Estimated Numbers (Thousands, Annual Averages, 2021–2022)

Measure	12+	12–17	18–25	26+	18+
Alcohol use, past month (thousands)	354k	5k	60k	289k	349k
Binge alcohol use, past month (thousands)	170k	3k	38k	130k	167k
Perceive great risk from 5+ drinks 1–2x/week (thousands)	243k	24k	29k	190k	219k
Alcohol use (ages 12–20) (thousands)	19k	—	—	—	—
Binge alcohol use (ages 12–20) (thousands)	13k	—	—	—	—

Per Capita Consumption Trend

• Per capita alcohol consumption was 2.4 gallons in 2000.
• By 2022, per capita consumption had risen to 3.3 gallons — an increase of 38%.
• This is the second-largest increase of any state since 2000, and 2.7 times the national average rate of increase.

Adult Binge Drinking Patterns

• 22.7% of North Dakota adults over 18 binge drink at least once per month.
• North Dakota ranks 2nd in the nation for binge alcohol use (past month) among adults age 26 and older (31.2%).
• North Dakota ranks 48th (2nd highest) nationally for excessive drinking overall — 22.3% of adults report binge or heavy drinking.
• Median number of drinks per binge episode: 5.9.
• The most active 25% of binge drinkers consume a median of 9.4 drinks per binge.
• Binge drinking adults binge a median of 1.8 times monthly; the most active 25% binge 4.2 times per month.
• 60.1% of adults age 26 and older used alcohol in the past month.

Bar and License Density

• North Dakota ranks highest in the nation for bars per capita: 1 bar for every 1,809 people.
• Compare: Virginia has 1 bar for every 64,773 people.
• There is 1 alcohol beverage license (bar, restaurant serving alcohol, or liquor store) for every 492 people.

Alcohol Use Disorder (AUD)

Alcohol Use Disorder (AUD) affects a disproportionately large share of North Dakota’s population relative to national norms, particularly among young adults.

AUD Prevalence — Percentages (Annual Averages, 2021–2022)

Measure	12+	12–17	18–25	26+	18+
Alcohol Use Disorder, past year (%)	13.50%	3.71%	20.46%	13.39%	14.53%
AUD (ages 12–20 only) (%)	7.21%	—	—	—	—

AUD — Estimated Numbers (Thousands)

Measure	12+	12–17	18–25	26+	18+
Alcohol Use Disorder, past year (thousands)	86k	2k	19k	65k	84k
AUD (ages 12–20 only) (thousands)	7k	—	—	—	—

AUD Trend and Comparison Data

• During 2017–2019, past-year AUD among people 12+ was 6.5% (~40,000) — similar to the regional average (6.9%) but higher than the national average (5.3%).
• AUD rates among people 12+ decreased between 2002–2004 and 2017–2019.
• Among young adults (18–25), 2017–2019 AUD prevalence was 13.8% (~13,000) — higher than the national average of 9.8%.
• Approximately 5.7% of ND adults age 26 or older met the criteria for AUD in the past year.
• Approximately 4.4% of ND youth (ages 12–17) met the criteria for AUD in the past year.
• In 2010, 871 people entered treatment for alcohol-only treatment, with an additional 562 people who suffered from alcohol abuse combined with a secondary drug.

While long-term AUD rates have declined, they remain above national averages — especially among young adults — and the state’s extremely high binge drinking rates suggest AUD diagnoses may undercount the true burden.

Underage and Youth Alcohol Use

Underage drinking has declined significantly over the past two decades, yet North Dakota youth remain more likely than average American teens to use alcohol, and access remains a persistent concern.

Youth Alcohol Use Rates

• 8.19% of all 12- to 17-year-olds used alcohol in the past month (~4,000–5,000 youth).
• 12- to 17-year-olds in ND are 19.01% MORE likely to use alcohol than the average American in their age group.
• During 2017–2019, past-month alcohol use among youth aged 12–17 was 8.8% (~5,000) — similar to regional (8.5%) and national (9.4%) averages.
• 22.5% of middle school students report alcohol use in their lifetime — down from 24.8% in 2003.
• 27.6% of high school students report current alcohol use (past 30 days) — down from 35.3% in 2013 (some data sources report 15.6% for recent years).
• 15.6% of high school students report current binge drinking (past 30 days) — down from 21.9% in 2013.
• 12.9% of high school students report their first use of alcohol before age 13 — down from 25.4% in 2003.

Young Adult and College Student Alcohol Use

• 60% of ND young adults (ages 18–29) report using alcohol.
• 61.8% of ND college students report using alcohol.
• 63.3% of ND young adults (ages 18–29) report binge alcohol use.
• 22.7% of ND young adults (ages 18–29) report driving within two hours of drinking in the past 30 days.
• During 2017–2019, past-month binge alcohol use among young adults aged 18–25 was 48.3% (~45,000) — higher than both the regional average (36.3%) and the national average (35.4%).
• Prevalence rates for self-reported alcohol use among young adults have remained stable since 2016.
• Men and women had similar alcohol use except for binge drinking.

North Dakota young adults binge drink at dramatically higher rates than national peers. Nearly half engage in past-month binge drinking — 37% above the national young adult average.

Youth Drinking and Risk Behaviors

• 5.5% of ND high school students report driving after drinking alcohol within the past 30 days — down from 10.7% in 2013.
• 14.2% (1 in 6) of ND high school students report riding with a driver who had been drinking in the past 30 days — down from 21.9% in 2013.
• 11.6% of juvenile arrests are alcohol-related (DUI and liquor law violations).

Youth Access to Alcohol

• 11.3% of ND adults believe it is not at all difficult for youth to buy alcohol at a store themselves.
• 41.2% of ND adults believe it is not at all difficult for youth to get an older person to buy alcohol for them.
• 55.9% of ND adults believe it is not at all difficult for youth to sneak alcohol from home or a friend’s home.
• As many as 50% of servers in alcohol establishments have served alcohol to underage youth in compliance checks by local law enforcement.

Early Onset Risk

• Research shows that individuals who start drinking before age 15 are four times more likely to develop alcohol use disorder at some point in their lives than those who begin at age 21.
• 70.8% of ND high school students believe binge drinking one or two times a week does NOT pose a great risk.
• 70.8% of ND young adults aged 18–29 share the same low-risk perception of binge drinking.
• 92.9% of ND adults agree that underage drinking is a problem in their community.

Positive trends — fewer teens drinking, driving after drinking, or starting at a very young age — show prevention efforts working. However, the persistence of high youth access and low risk perception limits further progress.

Economic and Social Costs of Alcohol

Excessive alcohol use imposes major financial and social costs on North Dakota. These extend far beyond healthcare into traffic safety, criminal justice, domestic violence, and child welfare.

Economic Costs

• Total economic costs of excessive alcohol use in ND: $487 million (2010 estimate).
• Per-person cost: $725; per-drink cost: $1.40 (2010 estimates).
• Adjusted for inflation to 2022 US dollars: $658.3 million total, or $1.89 per drink.
• North Dakota taxpayers spent this amount as a direct result of excessive alcohol consumption.
• Nationally, excessive alcohol use led to approximately 95,158 deaths and 2.76 million years of potential lives lost per year (2011–2015), shortening the lives of those who died by an average of 40 years.

Social Harms

• 30% of new domestic violence cases in North Dakota involve alcohol.
• Approximately 1 in 7 (15%) adult arrests in ND in 2022 were for Driving Under the Influence (DUI).
• 4.7% of adults report drinking to excess and then driving in the past 30 days.
• 73% of North Dakotans perceive alcohol as a moderate or serious problem in their community.
• 94.6% of women and 84.7% of men entering ND correctional facilities have an active substance use disorder diagnosis.

With nearly one-third of domestic violence cases and a significant share of all traffic fatalities linked to alcohol, the social toll of excessive drinking extends deeply into North Dakota family and community life.

Community Attitudes, Prevention, and Protective Factors

North Dakota adults broadly support alcohol prevention policies, and many youth report strong parental oversight. However, gaps between stated support and actual outcomes — particularly around youth access — remain significant.

Community Support for Prevention Measures

• 86.7% of ND adults support compliance checks for alcohol retailers.
• 81.1% support maintaining the legal drinking age of 21.
• 81.0% support penalties for adults who provide alcohol to minors.
• 67.7% support DUI checkpoints.
• 66.2% believe alcohol servers and bartenders should be specially trained.
• 72.7% believe it is possible to reduce alcohol and other drug problems through prevention.
• 73.6% believe that prevention programs are a good investment.

Youth Protective Factors

• 78.4% of ND high school students report their parents most of the time or always ask where they are going and with whom.
• 78% report their parents have clear rules and consequences for their behavior.

Community Awareness

• 90.8% of ND adults believe adult alcohol use is a problem in their community.
• 92.9% of ND adults agree that underage drinking is a problem.
• 73% of North Dakotans perceive alcohol as a moderate or serious problem.

Strong community awareness and high support for prevention measures provide a solid foundation for policy action. The presence of clear parental rules and oversight is a key protective factor for youth, and continued investment in evidence-based prevention is broadly supported by the public.

Conclusion

The data presented in this report tells a complex but consistent story. North Dakota’s overall drug use rates remain below the national average, yet overdose deaths have risen nearly 50% since 2019, fentanyl is now present in nearly two-thirds of all overdose deaths, and Native American residents die from overdoses at more than seven times the rate of white residents.

On the alcohol side, the state ranks second in the nation for binge drinking and has seen per capita alcohol consumption grow at nearly three times the national rate since 2000. Across both substances, the treatment gap is severe — more than three-quarters of those who need help are not receiving it. At the same time, the data offers reasons for cautious optimism: youth substance use rates have declined across most categories over the past two decades, community support for prevention is strong and broad, and investment in medication-assisted treatment has grown significantly.

Translating that public support into sustained, adequately funded, and equitably distributed prevention and treatment services remains the central challenge facing North Dakota in the years ahead.

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, Perceptions of Great Risk, Substance Use Disorder, and Mental Health Measures
6. Behavioral Health Barometer: North Dakota, Volume 6
7. North Dakota Drug Control Update
8. Explore Non-Medical Drug Use – Past Year in North Dakota | AHR
9. Behavioral Health in North Dakota – Data Book 2021
10. North Dakota Drug Overdose Deaths Down in 2023, but Fentanyl Deaths Are Up
11. Unintentional Drug Overdose Deaths
12. WYSAC Surveyed the Young Adults in North Dakota about Alcohol, Marijuana, and Prescription Drug Abuse
13. North Dakota Drug Use Statistics | Recovery Connection
14. Alcohol Abuse Statistics [2026]: National + State Data – NCDAS
15. Explore Excessive Drinking in North Dakota | AHR
16. North Dakota Sees 2nd Biggest Increase in Alcohol Consumption
17. RBS Facts – ND Safety Council
18. Alcohol Use Before Pregnancy: North Dakota, 2018-2022