South Carolina Drug and Alcohol Statistics - World Forum for Mental Health

Statistical Data on Drugs in South Carolina

South Carolina faces significant challenges with substance abuse and drug overdoses. The state has experienced a dramatic increase in overdose deaths over the past decade, though 2023 marked a historic turning point with the first decrease in over 10 years. Synthetic opioids, particularly fentanyl, have become the primary driver of fatal overdoses, while the state continues to grapple with prescription drug misuse, methamphetamine use, and other substance abuse issues across all age groups.

Overall Drug Overdose Deaths

1,127 overdose deaths per year (earlier dataset)
2.23% of all deaths in the state are from drug overdose
OD death rate: 22.7 deaths per 100,000 residents (9.66% higher than national average)
1.60% of nationwide OD deaths occur in South Carolina
Annual increase rate: 7.98% over 3-year period

South Carolina Drug Overdose Deaths Statistics

The data reflects the dramatic acceleration of the overdose crisis in South Carolina over recent years.

Overdose Deaths By Intent (2012-2021)

Year	Total	Unintentional	Suicide	Homicide	Undetermined
2012	573	478	80	1	14
2013	613	528	74	0	11
2014	718	629	74	3	12
2015	789	713	66	0	10
2016	876	785	76	3	12
2017	1,001	924	65	1	11
2018	1,103	1,030	64	3	6
2019	1,131	1,051	67	0	13
2020	1,734	1,652	70	1	11
2021	2,168	2,077	71	9	11

Unintentional overdoses account for the vast majority of deaths, with suicide-related overdoses remaining relatively stable while total deaths have quadrupled.

Deaths By Drug Category (2017-2021)

Year	Total Drug OD	Prescription Drugs	Opioids	Psychostimulants	Fentanyl	Heroin	Methadone	Cocaine
2017	1,001	782	748	194	362	144	45	235
2018	1,103	863	816	242	460	168	57	254
2019	1,131	923	876	338	537	196	28	230
2020	1,734	1,463	1,400	551	1,100	244	46	352
2021	2,168	1,853	1,733	778	1,494	136	69	446

Fentanyl deaths increased 313% from 2017 to 2021, becoming the dominant driver of overdoses. Meanwhile, heroin deaths declined 5.6% from 2017 to 2021, likely due to fentanyl displacement.

Top 10 Counties by Death Rate (2022)

Rank	County	Deaths per 100,000
1	Barnwell County	98.0
2	Dillon County	90.1
3	Jasper County	62.4
4	Georgetown County	61.8
5	Aiken County	56.8
6	Horry County	54.0
7	Florence County	52.7
8	Lancaster County	52.6
9	Greenville County	51.8
10	Spartanburg County	51.2

Death rates vary dramatically by geography, with Barnwell County’s rate more than 4 times higher than Beaufort County’s. Rural counties appear disproportionately affected.

Opioid-Specific Deaths

Opioid Death Rates

2011: 5.3 per 100,000
2021: 35.0 per 100,000
U.S. rate (2011): 7.3 per 100,000
U.S. rate (2021): 24.7 per 100,000
Current rate: 17.1 per 100,000 (17.1% above national death rate)

South Carolina’s opioid overdose death rate increased 560% from 2011 to 2021.

Breakdown by Opioid Type

835 people die from opioid overdose annually
Prescription opioids factor in 44.9% of opioid overdose deaths
Heroin factors in 21.9% of deaths
Synthetic opioids factor in 61.1% of deaths
Opioids are a factor in 74.2% of all overdose deaths

The percentages exceed 100% because many overdose deaths involve multiple opioid types simultaneously, with synthetic opioids (primarily fentanyl) being the most common factor.

County Opioid Deaths (2021)

County	Total OD Deaths	Opioid Deaths	Opioid Rate per 100,000
Horry	272	212	68.9
Greenville	270	213	41.6
Charleston	201	156	36.1
Spartanburg	153	129	39.4
Richland	137	98	24.6
York	115	97	34.3
Lexington	106	85	29.4

Large population centers account for the highest absolute numbers of opioid deaths, though rural counties often have higher per-capita rates.

Fentanyl-Specific Statistics

2022: Fentanyl was involved in 72% of total overdose deaths
2023: Fentanyl was involved in 1,550 of 2,157 overdose deaths (approximately 72%)
Fentanyl death rates increased 66.4 times between 2002 and 2022
From 2020 to 2021: Over 35% increase in fentanyl-involved deaths (1,100 to 1,494)
2022: Fentanyl-attributed deaths rose 9% from 2021

South Carolina Fentanyl Specific Statistics

Fentanyl has become the single most deadly substance in South Carolina, often mixed unknowingly with other drugs like cocaine and methamphetamine, dramatically increasing overdose risk.

Substance Use Patterns (2021)

All Ages (12+) – Estimated Numbers (in Thousands)

Illicit drug use in past month: 546
Marijuana use in past year: 687
Marijuana use in past month: 456
Illicit drug use other than marijuana in past month: 145
Cocaine use in past year: 85
Heroin use in past year: 23
Methamphetamine use in past year: 58
Prescription pain reliever misuse in past year: 127
Opioid misuse in past year: 135

Marijuana is one of the most commonly used substances, but prescription pain reliever misuse affects over 127,000 residents annually.

Substance Use by Youth (Ages 12-17)

Measure	Numbers in Thousands	Percentage
Illicit drug use (past month)	27	6.67%
Marijuana use (past year)	38	9.39%
Marijuana use (past month)	19	4.83%
Illicit drug use other than marijuana (past month)	9	2.27%
Cocaine use (past year)	1	0.17%
Methamphetamine use (past year)	0	0.11%
Prescription pain reliever misuse (past year)	10	2.46%
Opioid misuse (past year)	10	2.46%

Youth (12-17) First-Time Use (2013-2017 Annual Averages)

Substance	Number	Percentage	Regional Avg	National Avg
Alcohol	26,000	7.0%	8.5%	9.4%
Marijuana	15,000	4.0%	4.2%	4.8%
Cigarettes	12,000	3.3%	3.4%	3.1%

South Carolina youth initiate substance use at rates similar to or below regional and national averages for all substances measured.

Additional Youth Statistics

31,000 (8.11%) of 12-17 year-olds report using drugs in the last month
Among drug users: 80.65% report using marijuana in the last month
11.24% of all 12-17 year-olds report using marijuana in the last year
0.26% report using cocaine in the last year
0.26% report using methamphetamines
Up to 0.13% used heroin
Pain reliever misuse: 3.40%
8.89% used alcohol in the last month
Teenagers are 2.69% less likely to have used drugs than average American teens
Teenagers are 2.84% less likely to use alcohol than average American teens
2.88% met criteria for Illicit Drug Use Disorder (IDUD)
1.31% met criteria for Alcohol Use Disorder (AUD)

South Carolina Additional Youth Statistics

South Carolina youth use substances at slightly lower rates than the national average, though prescription pain reliever misuse remains concerning.

Substance Use by Young Adults (Ages 18-25)

Measure	Numbers in Thousands	Percentage
Illicit drug use (past month)	123	24.45%
Marijuana use (past year)	164	32.54%
Marijuana use (past month)	106	21.07%
Illicit drug use other than marijuana (past month)	22	4.39%
Cocaine use (past year)	16	3.25%
Heroin use (past year)	1	0.21%
Methamphetamine use (past year)	2	0.44%
Prescription pain reliever misuse (past year)	16	3.17%
Opioid misuse (past year)	15	2.97%

Additional Statistics

139,000 adults aged 18-25 used drugs in the last month
18-25 year-olds are 26.12% less likely to use drugs than average Americans in same age group

Young adults have the highest substance use rates of any age group, with nearly one-quarter using illicit drugs in the past month.

Substance Use by Adults (Ages 26+)

Measure	Numbers in Thousands	Percentage
Illicit drug use (past month)	396	11.36%
Marijuana use (past year)	486	13.92%
Marijuana use (past month)	331	9.49%
Illicit drug use other than marijuana (past month)	114	3.26%
Cocaine use (past year)	68	1.96%
Heroin use (past year)	22	0.62%
Methamphetamine use (past year)	55	1.59%
Prescription pain reliever misuse (past year)	102	2.91%
Opioid misuse (past year)	111	3.17%

While percentages are lower than young adults, the larger population means absolute numbers of adult users are substantial.

Marijuana Initiation

44,000 people (1.70% of those at risk) used marijuana for first time in past year
Among 12-17 year-olds: 14,000 (3.91%) first-time users
Among 18-25 year-olds: 24,000 (7.80%) first-time users
Among 26+: 6,000 (0.30%) first-time users

Young adults have the highest initiation rate, suggesting this is a critical intervention period.

Historical Marijuana Trends (2014-2017 Annual Averages)

Youth (12-17)

Past-month marijuana use: 5.4% (20,000)
Similar to regional average (6.1%)
Lower than national average (6.8%)

Young Adults (18-25)

Past-year marijuana use: 29.5% (152,000)
Similar to regional average (30.5%)
Similar to national average (33.0%)
Past-year marijuana use disorder: 5.4% (28,000)
Similar to regional (4.9%) and national (5.1%) averages

All Ages (12+)

Past-year marijuana use: 11.6% (475,000)
Similar to regional average (12.1%)
Lower than national average (13.9%)
Past-year marijuana use disorder: 1.4% (59,000)
Similar to regional (1.3%) and national (1.5%) averages

South Carolina’s marijuana use rates have remained stable and slightly below national averages across all age groups.

Historical Opioid Trends (2015-2017 Annual Averages)

Young Adults (18-25)

Opioid use disorder: 1.9% (10,000)
Similar to regional (1.4%) and national (1.3%) averages

All Ages (12+)

Opioid use disorder: 1.1% (46,000)
Similar to regional (0.9%) and national (0.8%) averages
Prescription pain reliever misuse: 4.3% (177,000)
Similar to regional and national averages (both 4.3%)

While opioid use disorder rates were comparable to national averages in the mid-2010s, death rates suggest the problem has intensified significantly since then.

Historical Heroin Trends (2014-2017 Annual Averages)

Past-year heroin use: 0.17% (7,000)
Similar to regional average (0.26%)
Lower than national average (0.33%)

Heroin use rates remained low and stable during this period, before fentanyl largely displaced heroin in subsequent years.

Substance Use Disorder Prevalence (2021)

All Ages (12+)

Disorder Type	Number (Thousands)	Percentage
Drug Use Disorder	362	8.24%
Pain Reliever Use Disorder	87	1.97%
Opioid Use Disorder	95	2.15%
Substance Use Disorder	647	14.73%

By Age Group – Numbers (Thousands)

Disorder	12-17	18-25	26+
Drug Use Disorder	25	74	262
Pain Reliever Use Disorder	4	6	77
Opioid Use Disorder	4	6	84
Substance Use Disorder	26	122	499

By Age Group – Percentages

Disorder	12-17	18-25	26+
Drug Use Disorder	6.27%	14.81%	7.52%
Pain Reliever Use Disorder	1.04%	1.15%	2.20%
Opioid Use Disorder	1.04%	1.20%	2.42%
Substance Use Disorder	6.56%	24.22%	14.29%

Nearly one in four young adults (24.22%) has a substance use disorder, the highest rate of any age group.

Risk Perceptions (2021)

Perceptions of Great Risk from Smoking Marijuana Once a Month

Ages 12-17: 111,000 (27.81%)
Ages 18-25: 51,000 (10.22%)
Ages 26+: 736,000 (21.09%)

Perceptions of Great Risk from Using Cocaine Once a Month

Ages 12-17: 211,000 (52.76%)
Ages 18-25: 317,000 (62.99%)
Ages 26+: 2,463,000 (70.60%)

Perceptions of Great Risk from Trying Heroin Once or Twice

Ages 12-17: 245,000 (61.25%)
Ages 18-25: 399,000 (79.39%)
Ages 26+: 2,989,000 (85.67%)

Risk perception is lowest among young adults, particularly for marijuana, which correlates with higher use rates in this age group.

Treatment Gaps (2021)

Unmet Treatment Need – Numbers (Thousands)

Age Group	Needing But Not Receiving Drug Treatment	Needing But Not Receiving Substance Treatment
12-17	21	26
18-25	67	108
26+	188	419
Total (12+)	277	553

Unmet Treatment Need – Percentages

Age Group	Drug Treatment Gap	Substance Treatment Gap
12-17	5.33%	6.55%
18-25	13.38%	21.47%
26+	5.40%	12.01%
Total (12+)	6.31%	12.60%

Over half a million residents need but do not receive substance use treatment, with young adults facing the largest treatment gap.

Treatment Infrastructure and Utilization

Treatment Facilities and Capacity

2006: 104 drug and alcohol facilities
Current: 126 active substance abuse clinics
8 facilities offer free drug rehab treatment for all clients
20,539 patients serviced annually for drug rehab

South Carolina Treatment Facilities and Capacity Statistics

Treatment Enrollment (2010)

27,802 people entered drug and alcohol rehab
68.3% were male
31.7% were female

Treatment Enrollment (2017)

March 31, 2017: 16,844 people enrolled (single-day count)
2013: 15,824 people enrolled (single-day count)

Treatment Focus (2017):

52.3% received treatment for drug problem only
15.3% received treatment for alcohol problem only
32.4% received treatment for both drug and alcohol problems

Treatment capacity has grown but remains insufficient to meet demand, with thousands unable to access needed services.

Outpatient and Residential Treatment

Outpatient Treatment

19,754 patients enroll in outpatient services annually
1.46% of U.S. public total ($33.73 million) spent on outpatient services
Average individual cost: $1,707
South Carolina ranks 35th in cheapest to most expensive state for residential rehab
South Carolina and Delaware share same average cost for outpatient service

South Carolina Outpatient Treatment Statistics

Outpatient treatment is significantly more affordable than residential treatment, but capacity remains limited relative to need.

Residential Treatment

Non-Hospital

539 patients enroll in residential services annually
0.6% of U.S. public total ($31.14 million) spent on residential treatment
Average individual cost: $57,774

Hospital-Based Treatment

246 patients in hospitals for drug rehab annually

Residential treatment is extremely expensive, limiting accessibility for many who need intensive intervention.

Medication-Assisted Treatment (MAT)

Methadone Treatment

March 31, 2017: 5,360 people receiving methadone in opioid treatment programs
2013: 4,323 people receiving methadone

Buprenorphine Treatment

March 31, 2017: 946 people receiving buprenorphine
2013: 671 people receiving buprenorphine

Medication-assisted treatment utilization has grown significantly, though it still reaches only a fraction of those with opioid use disorder.

Healthcare-Related Consequences

Neonatal and Hospital Impacts

0.5% of hospital births are cases of neonatal opioid withdrawal syndrome
Alcohol is involved in 18.5% of opioid-related hospital visits

Prescription Patterns

Doctors write enough prescriptions for 69.2% of residents to have one
2016: Nearly 5 million opioid prescriptions filled
South Carolina has the 9th highest opioid prescription rate in the U.S.
793 prescriptions per 1,000 residents (CDC estimate)
863 prescriptions per 1,000 residents (SC SCRIPTS estimate)

Overprescribing remains a significant contributor to the opioid crisis, with prescription rates far exceeding what would be medically necessary for the population.

Disease Transmission

35,600 cases of hepatitis C attributed to intravenous drug use
16,858 cases of HIV/AIDS attributed to intravenous drug use

Injection drug use creates secondary public health crises through infectious disease transmission.

Final Words

South Carolina’s drug crisis has intensified dramatically over the past decade, with overdose deaths increasing nearly 300% from 2012 to 2022, though 2023 showed the first decline in over 10 years. Fentanyl has emerged as the dominant killer, involved in 72% of all overdose deaths, while treatment capacity remains critically insufficient with over 550,000 residents needing but not receiving substance use services. Young adults face the highest rates of substance use disorders at 24.22%, and geographic disparities reveal rural counties are disproportionately affected, with death rates varying from 23 to 98 per 100,000 residents across counties.

Statistical Data on Alcohol in South Carolina

South Carolina faces significant challenges with alcohol abuse, particularly binge drinking, which affects the state at rates higher than the national average. The state has experienced a substantial increase in alcohol-related deaths over recent years, with excessive alcohol use contributing to thousands of deaths annually. Binge drinking is especially prevalent among young adults, and the economic and health costs to the state are considerable. Youth alcohol use, while showing some decline, remains a concern, particularly among older teenagers.

Overall Alcohol-Related Deaths

Annual Death Statistics

2,586 total deaths attributable to excessive alcohol use annually
3.2% of alcohol-related deaths involve people under age 21
South Carolina has more alcohol-related deaths per capita than the average state
Deaths are 18.1% more likely to involve underage drinkers compared to national average

South Carolina Alcohol Annual Death Statistics

South Carolina’s alcohol-related mortality burden exceeds national norms, with a disproportionate impact on underage populations.

Death Rate Trends

2020 death rate: 13.9 per 100,000 residents
National average (2020): 13.1 per 100,000 residents
South Carolina averages 1 death from excessive alcohol use for every 1,979 people aged 18 and older
Equivalent to 6.44 deaths for every 10,000 adults
The 5-year average annual rate of excessive alcohol deaths per capita increased by 53.4% from 2015 to 2019

The dramatic 53.4% increase in alcohol-related death rates over just five years indicates a rapidly worsening crisis that significantly outpaces drug overdose trends during the same period.

Demographics of Alcohol-Related Deaths

By Gender

70.8% of people who die from excessive alcohol use are male
29.2% are female

By Age

82.7% of deaths from excessive alcohol use are adults aged 35 years and older
3.21% of deaths are people under age 21
17.3% are adults under age 35

By Cause Type

54.5% of excessive alcohol use deaths are from chronic causes (such as Alcohol Use Disorder)
45.5% are from acute causes

The majority of alcohol deaths affect older adults and males, with chronic conditions like Alcohol Use Disorder accounting for more than half of fatalities.

Deaths by Specific Causes (5-Year Average, 2015-2019)

All Causes Attributable to Alcohol

Total deaths per year: 1,177

875 were males over 21
302 were females over 21
61 were males under 21
20 were females under 21

Specific Causes

Suicides due to alcohol: 192
Homicides due to alcohol: 208
Alcohol Dependence Syndrome: 62
Coronary Heart Disease due to alcohol: 121

Beyond direct alcohol poisoning, excessive drinking contributes substantially to violent deaths (homicides and suicides) and cardiovascular disease.

Potential Life Lost

The CDC estimates 66,458 years of potential life is lost to excessive alcohol use each year in South Carolina

Underage Population

Years of potential life lost (under 21): 4,716

The substantial loss of potential life years, particularly among youth, represents an enormous human and economic cost to the state.

Underage Drinking (Ages 12-20)

Overall Statistics (2021)

76,000 people aged 12-20 reported alcohol use in the past month (13.28%)
40,000 people aged 12-20 reported binge drinking in the past month (6.88%)

Detailed Breakdown by Age

Total population ages 12-20: 591,000
Past-month alcohol use (ages 12-20): 95,000 (16.1%)
Past-month binge alcohol use (ages 12-20): 64,000 (10.8%)

Ages 12-14

Past-month alcohol use: 9,000 (4.7%)
Past-month binge alcohol use: 5,000 (2.4%)

Ages 15-17

Past-month alcohol use: 24,000 (12.9%)
Past-month binge alcohol use: 11,000 (6.2%)

Ages 18-20

Past-month alcohol use: 62,000 (29.3%)
Past-month binge alcohol use: 48,000 (22.4%)

Alcohol use increases dramatically with age among minors, with 18-20 year-olds showing use rates comparable to legal-age adults.

Youth and Adult Alcohol Use Trends

Historical Comparison (Ages 12-17)

2014-2017 average: 8.1% (30,000) past-month use – decreased from 2002-2005
Regional average (2014-2017): 8.7%
National average (2014-2017): 10.1%

Current Statistics

6.4% of children ages 12-17 reported drinking alcohol in the past month
South Carolina ranks 10th among states for youth alcohol use

While youth drinking has declined over time and remains below the national average, South Carolina still ranks in the top 10 states for underage alcohol consumption.

Adults Aged 21+

Past-month alcohol use: 1,811,000 (48.9%)
Past-month binge alcohol use: 961,000 (26%)

Nearly half of legal-age adults drink monthly, with more than one in four engaging in binge drinking behavior.

Binge Drinking Patterns

Adult Population (18+)

16.3% of South Carolina adults binge drink at least once per month
16.2% of residents are classified as binge drinkers (national average: 15.3%)
24.67% of people over 18 reported binge alcohol use in the last 30 days
16.1% of adults reported binge or heavy drinking (state ranking: 19th)
Survey revealed 18.1% of South Carolina residents admit to binge drinking

South Carolina consistently ranks above the national average for binge drinking, placing near the top of worst states in the Southeast region.

Young Adult Binge Drinking (Ages 18-25)

Historical Trends (2015-2017 Average)

Past-month binge alcohol use: 38.6% (198,000)
Regional average: 33.4%
National average: 38.1%

Young adults in South Carolina binge drink at rates significantly above the regional Southeast average, matching the concerning national trend.

Binge Drinking Intensity

Median drinks per binge: 5.7
Top 25% most active drinkers: Median 8.4 drinks per binge
Median binge frequency: 1.9 times monthly
Top 25% most active drinkers: 4.6 times per month
Average binge drinker exceeds the binge drinking threshold, consuming 7-8 drinks per session

South Carolina Binge Drinking Intensity Statistics

Not only do more South Carolinians binge drink, but they consume alcohol at dangerous levels far exceeding the clinical threshold for binge drinking.

Special Populations

Women of Childbearing Age

2022: 20.4% of women aged 18-44 reported binge drinking in the past month
National average: 19.7%

Neonatal Impact

2020: 5.5 newborns per 1,000 hospitalized were diagnosed with neonatal abstinence syndrome (NAS)

Binge drinking among women of childbearing age exceeds the national average, contributing to neonatal health complications.

Alcohol Use Disorder Prevalence (2021)

By Age Group – Numbers in Thousands

Age Group	Number with AUD	Percentage
12-17	11	2.83%
18-25	64	12.78%
26+	337	9.67%
18+ (total)	402	10.06%

Nearly one in eight young adults (12.78%) has Alcohol Use Disorder, the highest rate of any age group and exceeding drug use disorder rates.

Risk Perceptions (2021)

Perceptions of Great Risk from Having 5+ Drinks Once or Twice a Week

Ages 12+: 1,932,000 (43.99%)
Ages 12-17: 177,000 (44.19%)
Ages 18-25: 195,000 (38.86%)
Ages 26+: 1,560,000 (44.71%)
Ages 18+ (total): 1,755,000 (43.97%)

Less than half of South Carolinians perceive regular heavy drinking as a great risk, with young adults showing the lowest risk perception at only 38.86%.

Treatment Gaps (2021)

Unmet Treatment Need – Numbers in Thousands

Age Group	Number Needing Treatment	Percentage
12-17	10	2.40%
18-25	62	12.37%
26+	325	9.30%
18+ (total)	387	9.69%
Total (12+)	396	9.03%

Nearly 400,000 South Carolina residents need but do not receive treatment for alcohol use, with young adults facing the largest treatment gap at over 12%.

Treatment Admissions (2010)

11,571 people admitted to treatment for alcohol as the primary substance
5,034 people admitted for alcohol combined with a secondary drug
Total alcohol-related admissions: 16,605

Alcohol remains a leading reason for substance abuse treatment admission, often co-occurring with other drug use.

Alcohol and Driving

DUI-Related Crashes

29,300 people were involved in DUI-related car crashes from 2011 to 2015

Fatal Crashes (Ages 15-20, BAC > 0.01%)

Number of fatalities: 28
Percentage of all fatal crashes: 20%

Binge drinking directly contributes to thousands of traffic crashes, with alcohol involved in one-fifth of fatal crashes among teenage and young adult drivers.

Economic Burden

South Carolina taxpayers spent $3.983 billion as a result of excessive alcohol use in 2010
Adjusted for inflation, this equals $5.377 billion in 2022 US dollars
Equivalent to $2.88 per drink in 2022 dollars

South Carolina Alcohol Economic Burden Statistics

The economic burden of excessive alcohol use significantly exceeds direct healthcare costs, including lost productivity, criminal justice expenses, and social services.

Final Words

South Carolina’s alcohol crisis rivals its drug overdose epidemic in scope and severity, with binge drinking rates, alcohol-related deaths, and economic costs all exceeding national averages. The 53.4% increase in alcohol death rates from 2015-2019 demonstrates a rapidly escalating public health emergency, particularly among young adults where nearly 40% engage in binge drinking and one in eight has Alcohol Use Disorder. With nearly 400,000 residents needing but not receiving treatment and over 66,000 years of potential life lost annually, South Carolina faces urgent challenges in prevention, intervention, and expanding access to evidence-based alcohol treatment services.

Conclusion

In general, South Carolina faces twin substance abuse crises that together claim over 4,700 lives annually, with drug overdose deaths quadrupling since 2012 and alcohol-related deaths increasing 53% from 2015-2019. Fentanyl-driven overdoses and binge drinking disproportionately devastate young adults, who face the highest rates of both substance use disorders (24%) and treatment gaps, while nearly 950,000 residents need but cannot access treatment services. The combined economic toll exceeds $5.4 billion annually, with dramatic geographic disparities leaving rural counties particularly vulnerable to both epidemics.