South Dakota presents a complex and often contradictory picture when it comes to substance use. On one hand, the state’s drug overdose death rate sits well below the national average, and youth illicit drug use is lower than in most comparable states. On the other hand, alcohol-related mortality ranks among the worst in the nation, binge drinking is pervasive across nearly all counties, and American Indian communities bear a disproportionate and severe burden from both alcohol and drug-related harms.
This report draws on data from multiple federal and state surveillance systems to present a comprehensive statistical portrait of substance use in South Dakota. The findings span drug overdose deaths, opioid trends, youth and young adult use patterns, substance use disorders, treatment infrastructure, alcohol consumption, and alcohol-related mortality, covering both the current situation and changes over time.
Statistical Data on Drugs in South Dakota
Drug Overdose Deaths
South Dakota’s drug overdose death rate is substantially below the national average. The following key indicators provide a baseline for understanding the scope of the overdose crisis in the state.
State Overview
- Annual drug overdose deaths (average): 95
- OD deaths as % of all deaths: 1.11%
- OD death rate per 100,000 residents: 11.3
- Change in OD deaths over last 3 years: +7.62%
- % of nationwide OD deaths occurring in SD: 0.09%
- Comparison to national OD death rate: 68.18% lower
Despite being significantly below the national average, the 7.62% increase in overdose deaths over the past three years signals a concerning upward trend that warrants continued public health attention.
Unintentional and Undetermined Overdose Deaths (SUDORS, 2020–2023)
Annual Totals
- Total unintentional/undetermined overdose deaths (2020–2023): 284
- Deaths in 2022: 74
- Deaths in 2023: 65 (12% decrease from 2022)
- Unintentional (accidental) overdoses: 98% of total
- Undetermined intent: 2% of total
- Most common overdose category: Substance use/misuse (74%)
Substances Involved
Stimulants and opioids dominate fatal overdoses; multiple substances may contribute to a single death.
- Stimulants involved (2020–2023): 51% of deaths — most common category
- Opioids involved (2020–2023): 47% of deaths
- Opioids only (no stimulants) in 2023: 43% — largest single category in 2023
- Stimulants only (no opioids) in 2023: 38%
- Most common stimulant (all years): Methamphetamine
- Most common opioid (all years): Fentanyl
In 2021 and 2022, stimulants without opioids made up the largest proportion of deaths. In 2023, the pattern shifted to opioids without stimulants being most prevalent.
Overdose Death Demographics
Sex
- Male share of overdose deaths: 60% — rate of 9.2 per 100,000
- Female share of overdose deaths: 40% — rate of 6.5 per 100,000
Age
- Highest-risk age group: 35–44 years for unintentional/undetermined overdose deaths
- All age groups: Represented in overdose death data
Race
American Indian residents face a dramatically elevated overdose death rate compared to White residents.
- White share of overdose deaths: 62% — rate of 5.8 per 100,000
- American Indian share of overdose deaths: 30% — rate of 26.6 per 100,000
- Other (Black, Asian, unknown) share: 8%
- American Indian vs. White death rate: 4.6 times higher
Circumstances and Intervention Opportunities
Coroner reports provide context on circumstances surrounding fatal overdoses and missed opportunities for intervention.
- Deaths with known substance use history: 54%
- Of those: history of unspecified substance use: 41%
- Of those: history of methamphetamine use: 36%
- Of those: history of opioid use: 24%
- Cases with any evidence of drug use at scene: 50%
- Of those: evidence of illicit drug use: 45%
- Of those: evidence of prescription drug use: 41%
- Deaths with at least one opportunity for intervention: 62%
- Deaths with a potential bystander present: 44%
- Deaths with a known bystander present: 37%
- Bystander type — partner or ex-partner: 32% of known bystander cases
- Bystander type — friend/roommate: 30%
- Bystander type — family: 26%
Location of Overdose Injuries and Deaths
The vast majority of fatal overdoses occur in private residences; fewer than a quarter reach a hospital before death.
| Location | % of Injuries | % of Deaths |
|---|---|---|
| House / apartment | 78% | 57% |
| Emergency department / hospital | — | 24% |
| Hotel / motel | 5% | — |
| Street / highway / sidewalk | 4% | — |
| Facilities (hospital, jail, shelters) | 4% | — |
| Natural areas (field, river, woods) | 2% | — |
| Other / unknown | 7% | 18% |
The gap between injury and death location indicates that only a minority of overdose victims receive medical care before dying, underscoring the importance of community-level emergency response.
The Opioid Epidemic
South Dakota’s opioid overdose death rate is significantly below the national average, but synthetic opioids such as fentanyl are increasingly driving opioid-related deaths.
- Opioid overdose deaths in 2023: 48
- Opioid deaths per 100,000 residents: 5.7
- Comparison to national opioid death rate: 76.3% lower
- Opioids as % of all overdose deaths: 50.5%
- Synthetic opioids (e.g., fentanyl) as % of opioid OD deaths: 87.5%
- Opioid prescriptions — % of SD residents with one: 35.8%
- Neonatal opioid withdrawal syndrome per 1,000 births (2020): 6.7
- New hepatitis C cases linked to IV drug use (2022): 8.3 per 100,000
- New HIV/AIDS diagnoses linked to IV drug use (2023): ~3.3
While South Dakota’s opioid death rate is 76.3% below the national rate, fentanyl’s role in 87.5% of all opioid overdose deaths reflects national trends and poses a growing challenge for harm reduction.
Drug Use Prevalence
Overall Use Rates — Ages 12+ (NSDUH 2022–2023 Annual Averages)
The following data shows the prevalence of various substance use behaviors among South Dakota residents aged 12 and older.
| Substance / Behavior | Number (thousands) | % of Ages 12+ |
|---|---|---|
| Illicit drug use in past month | 100 | 13.30% |
| Marijuana use in past year | 139 | 18.55% |
| Marijuana use in past month | 89 | 11.85% |
| Illicit drug use (excl. marijuana) in past month | 21 | 2.84% |
| Cocaine use in past year | 11 | 1.50% |
| Heroin use in past year | <2 | ~0.33% |
| Hallucinogen use in past year | 14 | 1.94% |
| Methamphetamine use in past year | 9 | 1.18% |
| Prescription pain reliever misuse in past year | 24 | 3.15% |
| Opioid misuse in past year | 22 | 2.95% |
| Non-medical drug use in past year (excl. cannabis) | — | 10.8% — ranked 4th nationally |
In 2017–2019, South Dakota’s past-year marijuana use (11.5%) was below both the regional (19.9%) and national (16.2%) averages, suggesting that overall rates were historically lower than comparable states.
Drug Use by Age Group (2022–2023 Averages)
Drug use patterns vary substantially by age group, with young adults (18–25) showing the highest rates across most substances.
| Substance | Ages 12–17 | Ages 18–25 | Ages 26+ | Ages 12+ |
|---|---|---|---|---|
| Illicit drug use — past month | 5.49% | 19.98% | 13.21% | 13.30% |
| Marijuana — past year | 8.37% | 34.46% | 17.24% | 18.55% |
| Marijuana — past month | 4.82% | 19.79% | 11.45% | 11.85% |
| Cocaine — past year | 0.21% | 3.39% | 1.36% | 1.50% |
| Heroin — past year | N/A | 0.35% | 0.32% | ~0.33% |
| Methamphetamine — past year | 0.15% | 1.34% | 1.29% | 1.18% |
| Prescription pain reliever misuse | 1.91% | 2.25% | 3.46% | 3.15% |
| Opioid misuse — past year | 1.89% | 2.93% | 3.10% | 2.95% |
Young adults aged 18–25 exhibit the highest rates of illicit drug use and marijuana use, while prescription pain reliever misuse is notably higher among adults 26 and older.
Youth Drug Abuse (Ages 12–17)
South Dakota teenagers use illicit drugs at a lower rate than the national average. Marijuana accounts for nearly all illicit drug use in this age group.
Current Prevalence
- Illicit drug use in past month: 5.49% — 24.31% less likely than average American teen
- Alcohol use in past month: 6.25% — 9.15% less likely than national average
- Marijuana use in past year: 8.37%
- Marijuana users who also reported marijuana use — of all illicit drug users: ~100%
- Cocaine use in past year: 0.21%
- Methamphetamine use in past year: 0.15%
- Pain reliever misuse in past year: 1.91%
- Drug use disorder (DUD) in past year: 5.84%
- Alcohol use disorder (AUD) in past year: 2.99%
Approximately 4,000 (5.49%) of 12–17 year-olds report using drugs in the last month. South Dakota teens are 24.31% less likely to use drugs than the average American teenager.
Historical Trends (2017–2019 vs. 2002–2004)
| Indicator | SD Rate 2017–2019 | Trend | Regional Avg. | National Avg. |
|---|---|---|---|---|
| Past-month marijuana use | 6.5% (4,000) | No significant change vs. 2002–2004 | 6.8% | 6.8% |
| Past-month illicit drug use | 8.3% (6,000) | No significant change vs. 2015–2017 | 8.3% | 8.2% |
| First-time alcohol use in past year | 9.6% (7,000) | Similar to national | 8.2% | 9.3% |
| First-time marijuana use in past year | 3.6% (2,000) | Lower than national | 4.8% | 5.2% |
| First-time cigarette use in past year | 1.8% (1,000) | Similar to national | 3.2% | 2.3% |
Youth drug use rates in South Dakota were broadly stable between 2002–2019 and aligned with or below regional and national averages. Initiation rates for alcohol were comparable to the national level.
Young Adult Drug Use and Use Disorders (Ages 18–25)
Young adults aged 18–25 show the highest rates of substance use across nearly all categories. Historical trend data provides additional context.
Historical Trends (2017–2019)
| Indicator | SD Rate | Regional Avg. | National Avg. | Trend |
|---|---|---|---|---|
| Past-year marijuana use | 29.5% (27,000) | 38.8% | 35.0% | No sig. change vs. 2002–2004 |
| Marijuana use disorder | 5.4% (5,000) | 6.9% | 5.6% | No sig. change |
| Opioid use disorder | 0.9% (1,000) | 1.3% | 1.0% | No sig. change |
| Illicit drug use disorder | 8.0% (7,000) | 9.7% | 7.5% | No sig. change |
| Substance use disorder | 18.8% (17,000) | 17.7% | 14.7% | No sig. change; above national |
Although young adult marijuana and opioid use rates were below regional and national comparisons in 2017–2019, the substance use disorder rate (18.8%) was notably higher than the national average (14.7%), indicating that a significant portion of users develop dependency.
Current Data (2022–2023 Averages)
| Measure | Ages 18–25 | Ages 26+ | Ages 18+ |
|---|---|---|---|
| Substance use disorder | 30.87% | 16.58% | 18.61% |
| Drug use disorder | 15.79% | 7.56% | 8.72% |
| Pain reliever use disorder | 1.11% | 2.04% | 1.91% |
| Opioid use disorder | 1.17% | 2.22% | 2.07% |
Nearly 31% of 18–25 year-olds met criteria for substance use disorder in 2022–2023, the highest rate of any age group, underscoring the vulnerability of young adults to developing problematic use patterns.
Substance Use Disorders and Treatment Need
Disorder Prevalence — Ages 12+ (2022–2023)
A substantial portion of the South Dakota population meets clinical criteria for substance use disorder.
| Measure | Ages 12+ | Ages 12–17 | Ages 18–25 | Ages 26+ |
|---|---|---|---|---|
| Substance use disorder — number (thousands) | 131 | 6 | 29 | 96 |
| Drug use disorder — number (thousands) | 63 | 4 | 15 | 44 |
| Pain reliever use disorder — number (thousands) | 14 | 1 | 1 | 12 |
| Opioid use disorder — number (thousands) | 15 | 1 | 1 | 13 |
| Substance use disorder — % | 17.51% | 7.70% | 30.87% | 16.58% |
| Drug use disorder — % | 8.44% | 5.84% | 15.79% | 7.56% |
Treatment Need vs. Treatment Receipt
A major gap exists between the number of residents classified as needing substance use treatment and those who actually receive it.
| Measure | Ages 12+ | Ages 12–17 | Ages 18–25 | Ages 26+ |
|---|---|---|---|---|
| Received substance use treatment | 35,000 (4.64%) | 3,000 (4.44%) | 4,000 (4.53%) | 27,000 (4.68%) |
| Classified as needing treatment | 146,000 (19.40%) | 9,000 (11.59%) | 31,000 (32.36%) | 106,000 (18.27%) |
| Needed treatment, not receiving it | 109,000 (75.81%) | 5,000 (58.41%) | 26,000 (85.62%) | 78,000 (74.21%) |
More than three-quarters (75.81%) of those classified as needing substance use treatment are not receiving it. The treatment gap is most severe among 18–25 year-olds, where 85.62% in need go untreated.
Drug Rehabilitation and Treatment System
Treatment Infrastructure
South Dakota maintains a network of substance abuse treatment facilities, with outpatient services dominating the treatment landscape.
- Active substance abuse clinics: 64
- Patients serviced annually (total): 2,864
- Patients in outpatient services annually: 2,346
- Patients in residential (non-hospital) services annually: 370
- Patients in hospital-based rehab annually: 148
- Facilities offering free treatment for all clients: 3
- Single-day treatment count (March 2020, N-SSATS): 2,371 clients across 58 facilities
- Survey response rate (N-SSATS 2020): 89.2%
Outpatient services dominate South Dakota’s treatment system, serving the large majority of patients. Nearly 60% of admissions involve clients with both drug and alcohol problems.
Cost of Drug Rehabilitation
- Outpatient rehab — average individual total: $1,969 (2nd most expensive state)
- Residential (non-hospital) rehab — average individual total: $56,108 (ties 10th cheapest state)
- Public spending on outpatient services (SD): $4.62 million (0.2% of U.S. total)
- Public spending on residential treatment (SD): $20.76 million (0.4% of U.S. total)
Type of Care and Facility Operation (2020 N-SSATS)
The majority of treatment facilities and clients are in the outpatient setting. Private non-profits operate the largest share of facilities and serve the most clients.
Type of Care
| Type of Care | Facilities | % of Facilities | All Clients | % of Clients |
|---|---|---|---|---|
| Outpatient (total) | 50 | 86.2% | 2,192 | 92.5% |
| — Regular outpatient | 49 | 84.5% | 1,349 | 56.9% |
| — Intensive outpatient | 35 | 60.3% | 778 | 32.8% |
| — MAT (methadone/buprenorphine/naltrexone) | 9 | 15.5% | 55 | 2.3% |
| — Detoxification (outpatient) | 3 | 5.2% | 10 | 0.4% |
| Residential (non-hospital) | 16 | 27.6% | 133 | 5.6% |
| Hospital inpatient | 5 | 8.6% | 46 | 1.9% |
Facility Operator Type
| Operator Type | Facilities | % of Facilities | Clients | % of Clients |
|---|---|---|---|---|
| Private non-profit | 34 | 58.6% | 1,801 | 76.0% |
| Private for-profit | 9 | 15.5% | 141 | 5.9% |
| Federal government | 6 | 10.3% | 98 | 4.1% |
| Tribal government | 6 | 10.3% | 315 | 13.3% |
| State government | 2 | 3.4% | 16 | 0.7% |
| Local / county / community government | 1 | 1.7% | — | — |
Tribal government facilities serve 13.3% of all clients and 41% of clients under age 18, reflecting the particular treatment needs of American Indian communities in South Dakota.
Payment Options and Funding
- Cash or self-payment: 51 facilities (87.9%)
- Private health insurance: 43 facilities (74.1%)
- Medicaid: 42 facilities (72.4%)
- Treatment at no charge or minimal payment for clients who cannot pay: 38 facilities (65.5%)
- Sliding fee scale: 34 facilities (58.6%)
- State-financed health insurance (other than Medicaid): 29 facilities (50.0%)
- Federal military insurance: 28 facilities (48.3%)
- IHS / Tribal / Urban (ITU) funds: 23 facilities (39.7%)
- Medicare: 17 facilities (29.3%)
- Receive federal, state, county, or local government funds: 47 facilities (81.0%)
- Free treatment for all clients: 1 facility (1.7%)
Clinical Approaches
Virtually all facilities employ evidence-based clinical approaches. Telehealth is available at more than half.
- Substance abuse counseling: 98.3% of facilities
- Relapse prevention: 98.3%
- Brief intervention: 93.1%
- Cognitive behavioral therapy (CBT): 93.1%
- Motivational interviewing: 91.4%
- 12-step facilitation: 81.0%
- Trauma-related counseling: 75.9%
- Anger management: 72.4%
- Dialectical behavior therapy (DBT): 65.5%
- Contingency management / motivational incentives: 63.8%
- Telemedicine / telehealth: 53.4%
Medication-Assisted Treatment (MAT)
Access to MAT, particularly methadone, grew significantly between 2015 and 2019, though overall numbers remain small.
| MAT Indicator | 2015 | 2019 / 2020 |
|---|---|---|
| Patients receiving methadone | 5 | 130 (2019) |
| Patients receiving buprenorphine | 5 | 12 (2019) |
| Clients on any MAT in non-OTP facilities (2020) | — | 110 |
| — Buprenorphine | — | 58 |
| — Naltrexone | — | 52 |
The increase in methadone patients (from 5 to 130) between 2015 and 2019 reflects expanded access to opioid treatment programs, though coverage remains limited relative to overall population need.
Treatment Episode Data (TEDS-D 2023)
In 2023, 17,872 treatment discharge episodes were recorded in South Dakota. Alcohol and amphetamines are the two dominant primary substances.
Primary Substance at Discharge
| Primary Substance | Number | % of Total |
|---|---|---|
| Alcohol only | 9,103 | 50.9% |
| Alcohol with secondary drug | 2,717 | 15.2% |
| Amphetamines | 4,069 | 22.8% |
| Marijuana | 1,044 | 5.8% |
| Other opiates | 276 | 1.5% |
| Heroin | 86 | 0.5% |
| Cocaine (other route) | 67 | 0.4% |
| Cocaine (smoked) | 13 | 0.1% |
| Other / Unknown | 395 | 2.2% |
Alcohol (alone or with a secondary drug) accounts for 66.1% of all treatment episodes. Amphetamines represent the largest non-alcohol category at 22.8%, highlighting methamphetamine’s continued impact.
Demographics of Treatment Episodes
Sex
- Male share of all admissions: 66.9%
- Female share of all admissions: 33.1%
- Female share of amphetamine admissions: 46.1% — more balanced sex distribution
Age at Admission
| Age Group | % of All Admissions | % of Amphetamine Admissions |
|---|---|---|
| 12–17 years | 3.1% | 1.6% |
| 18–20 years | 2.8% | 2.2% |
| 21–25 years | 10.0% | 10.8% |
| 26–30 years | 13.6% | 19.3% |
| 31–35 years | 16.8% | 21.7% |
| 36–40 years | 15.5% | 18.1% |
| 41–45 years | 11.8% | 12.3% |
| 46–50 years | 9.2% | 6.2% |
| 51–55 years | 6.4% | 3.4% |
| 56–60 years | 6.2% | 2.5% |
| 61–65 years | 3.5% | 1.4% |
| 66+ years | 1.1% | 0.3% |
The 26–40 age range accounts for the largest share of treatment admissions across most substances. For heroin specifically, 37.2% of admissions were aged 26–30.
Race at Admission
American Indian residents are significantly overrepresented in treatment admissions relative to their share of the general population.
| Race | % of All Admissions | % of Alcohol-Only Admissions |
|---|---|---|
| White | 52.2% | 33.7% |
| American Indian or Alaska Native | 45.3% | 63.7% |
| Black or African-American | 1.4% | 1.4% |
| Other | 0.8% | 0.7% |
American Indian residents make up 45.3% of all treatment admissions and 63.7% of alcohol-only admissions, reflecting the disproportionate burden of alcohol and substance use disorders in these communities.
Historically Abused Substances in South Dakota
Over the past two decades, methamphetamine and marijuana have dominated treatment admissions.
- Marijuana admissions (2007): Over 60% of drug treatment admissions — most commonly cited drug of abuse; 1,959 individuals (73% male)
- Largest age group for marijuana treatment (2007): 12–17 year-olds
- Drug treatment admissions for marijuana (2011): 59%
- Drug treatment admissions for stimulants including meth (2011): 21%
- Amphetamine treatment entries (2010): 649 people
- Opiate prescription drug admissions: 357 people — 52% female; largest group aged 21–25
- People who entered drug and alcohol rehab (2010): 14,615 — 72.1% male, 27.9% female
- Meth lab seizures (2005): 16 — down ~50% from 2002–2003
- Drug arrests (2005): 85
- Drug-induced deaths (2007): 34
- Drug-induced deaths (2009): 51 — 6.3 per 100,000 (national rate: 12.8)
- Illicit drug use in past month, circa 2009–2010: 6.07% of SD residents (national average: 8.82%)
- Illicit drug use other than marijuana, circa 2009–2010: 2.39% (national average: 3.6%)
South Dakota historically ranked below the national average for drug-induced deaths and illicit drug use overall. Methamphetamine and amphetamine use remain persistent challenges, consistently representing a major share of treatment admissions.
Statistical Data on Alcohol in South Dakota
Alcohol-Related Deaths
Mortality Overview
Alcohol-related deaths have been increasing in South Dakota, with the state holding one of the highest age-adjusted death rates in the nation.
- Average annual deaths from excessive alcohol use: 463
- Alcohol-related deaths in 2023: 306
- Alcohol-related deaths in 2024: 365 (+19% from 2023)
- Age-adjusted death rate — South Dakota (2024): 31.4 per 100,000
- Age-adjusted death rate — United States (2019–2023): 12.7 per 100,000
- South Dakota national ranking for alcohol-related death rate: 3rd highest (2024)
- 5-year increase in per-capita excessive alcohol deaths: Up to 64.7% (2015–2019)
- Deaths among males: 65–66% — rate of 39.8 per 100,000
- Deaths among females: 34–35% — rate of 21.6 per 100,000
- Deaths among adults aged 35 and older: 82.5%
- Age group with largest proportion of deaths: 50–59 years
South Dakota’s alcohol-related death rate is nearly 2.5 times the national average. The 19% increase from 2023 to 2024 continues a troubling upward trend that accelerated significantly between 2015 and 2019.
Causes of Alcohol-Related Deaths
- Chronic causes (e.g., AUD, liver disease): 65.9% of all excessive alcohol deaths
- Alcohol-associated liver disease: 64% of all alcohol-related deaths — most common cause
- Alcohol poisoning / acute intoxication — unintentional deaths: 24% of unintentional deaths
- Transportation / machinery accidents — unintentional deaths: 19%
- Falls — unintentional deaths: 16%
Manner of Death for Alcohol Poisoning / Acute Intoxication Cases
- Unintentional / accidental: 78%
- Suicide: 14%
- Natural causes: 3%
- Homicide: 3%
- Undetermined: 2%
Road crashes involving alcohol claimed 46 South Dakotans in 2022, with alcohol involved in 36% of all driving deaths — the 6th highest rate nationally.
Alcohol-Related Deaths by County
County-level data reveals stark geographic disparities, with predominantly American Indian counties having dramatically higher rates.
| County | Alcohol-Related Death Rate (per 100,000) | Notes |
|---|---|---|
| Buffalo | 214.5 | Highest death rate |
| Mellette | 185.8 | |
| Corson | 164.8 | |
| Oglala Lakota | 164.8 | |
| Dewey | 161.4 | |
| Marshall County | — | Highest excessive drinking rate: 25% |
| Todd County | — | Lowest excessive drinking rate: 17% |
| Oglala Lakota County | — | Tied lowest excessive drinking rate: 17% |
The five counties with the highest alcohol-related death rates are predominantly American Indian counties, with rates 4–8 times higher than the statewide average. At least 20% of adults in 57 of South Dakota’s 67 counties (85%) report excessive drinking.
Racial Disparities in Alcohol-Related Deaths
American Indian residents face dramatically elevated mortality from alcohol compared to White residents.
| Race | % of Deaths (2015–2024) | Death Rate (per 100,000) | Relative Risk |
|---|---|---|---|
| White | 54% | 19.6 | Baseline |
| American Indian | 43% | 150.0 | 7.6x higher than White |
| Other (Black, Asian, multiracial, unknown) | 3% | — | — |
American Indian residents die from alcohol-related causes at a rate 7.6 times higher than White residents. American Indian female death rates showed a decrease from 2023 to 2024, whereas rates increased for American Indian males, White females, and White males.
Overview of Alcohol Use
South Dakota consistently ranks among the highest states for alcohol use, binge drinking, and alcohol-related mortality. The following indicators reflect the scope of the problem.
- Adults who binge drink at least once monthly: 22.3%
- Adults reporting drinking in past 30 days (2021): 57% — above national median of 53%
- Adults engaging in binge drinking (2021): 20% — above national median of 15%
- Adults engaging in heavy drinking (2021): 7% — above national median of 6%
- Adults meeting criteria for heavy or binge drinking (2023): 27% — one of highest rates nationally
- Average annual deaths attributable to excessive alcohol use: 463
- Excessive alcohol death rate per 10,000 adults: 6.92
- State ranking for excessive drinking rate (2022): 46th (21.3%) — 6th highest nationally
- State ranking for alcohol-related death rate (2024): 3rd highest — 31.4 per 100,000 vs. 12.7 nationally
- Annual years of potential life lost to excessive alcohol: 12,203
- SD taxpayer cost of excessive alcohol use (2022 inflation-adjusted USD): $807.6 million ($2.15 per drink)
South Dakota’s alcohol-related death rate of 31.4 per 100,000 is more than double the national rate (12.7) and ranks 3rd highest in the nation as of 2024, making excessive alcohol use a critical public health priority.
Alcohol Use Prevalence
Overall Prevalence — Ages 12+ (2022–2023 Annual Averages)
| Measure | Ages 12+ | Ages 12–17 | Ages 18–25 | Ages 26+ |
|---|---|---|---|---|
| Alcohol use in past month — number (thousands) | 374 | 5 | 52 | 318 |
| Binge alcohol use in past month — number (thousands) | 175 | 3 | 33 | 139 |
| Alcohol use in past month — % | 49.84% | 6.25% | 54.73% | 54.70% |
| Binge alcohol use in past month — % | 23.30% | 3.51% | 35.10% | 23.92% |
More than half of all South Dakotans aged 18 and older report drinking in the past month, and nearly a quarter engage in binge drinking. The 18–25 age group has the highest binge drinking rate at 35.1%.
Alcohol Use Disorder (AUD)
| AUD Measure | Ages 12+ | Ages 12–17 | Ages 18–25 | Ages 26+ |
|---|---|---|---|---|
| AUD — number (thousands) | 85 | 2 | 19 | 64 |
| AUD — percentage | 11.33% | 2.99% | 19.65% | 11.04% |
Nearly 1 in 5 South Dakotans aged 18–25 (19.65%) meets the criteria for alcohol use disorder. In 2017–2019, the rate for ages 12+ was 6.7% (vs. 5.3% nationally), indicating South Dakota has consistently exceeded the national average.
Alcohol Use by Demographic Subgroups (2017–2021)
Alcohol use varies significantly by gender, age, race/ethnicity, income, and education.
| Subgroup | % Who Drank — Past 30 Days | % Who Binge Drank | % Heavy Drinkers |
|---|---|---|---|
| Male | 64% | 25% | 8% |
| Female | 50% | 14% | 6% |
| Ages 18–29 | 59% | 31% | 9% |
| Ages 30–39 | 62% | 25% | 7% |
| Ages 40–49 | 64% | 25% | 9% |
| Ages 50–59 | 58% | 19% | 7% |
| Ages 60–69 | 57% | 11% | 6% |
| Ages 70–79 | 47% | 4% | 3% |
| Ages 80+ | 33% | 2% | 2% |
| White, Non-Hispanic | 59% | 20% | 7% |
| American Indian, Non-Hispanic | 35% | 18% | 6% |
| Hispanic | 54% | 21% | 6% |
| Household income <$35,000 | 45% | 18% | 7% |
| Household income $75,000+ | 72% | 24% | 8% |
| College graduate | 67% | 19% | 5% |
| Less than high school / GED | 40% | 18% | 9% |
Higher income and education levels are associated with higher rates of past-month drinking. Young adults (18–29) have the highest binge drinking rates. Despite lower overall drinking rates, American Indian residents face disproportionately severe health consequences from alcohol use.
Youth and Underage Alcohol Use
Prevalence Among Ages 12–20
Underage drinking remains a concern in South Dakota, with rates broadly similar to national averages.
- Population ages 12–20: 108,000
- Alcohol use in past month (ages 12–20): 16,000 (14.4%)
- Binge alcohol use in past month (ages 12–20): 10,000 (9.3%)
- Average age of first alcohol use: 15.1 years
- Alcohol-attributable deaths under age 21 (annual): 16
- Years of potential life lost — under age 21: 928
- Fatal crashes — 15–20 yr old drivers with BAC >0.01%: 4 fatalities (18% of all fatal crashes in that age group)
- High school students who reported binge drinking (2021): 11%
In 2017–2019, past-month alcohol use among 12–17 year-olds was 9.3% (6,000 youth), similar to both regional (8.5%) and national (9.4%) averages, and had decreased from the 2002–2004 period.
Young Adults (Ages 18–25) — Historical Trend
Young adults in South Dakota have consistently shown higher-than-average binge drinking rates, exceeding both regional and national comparisons.
| Indicator (Ages 18–25) | SD Rate (2017–2019) | Regional Avg. | National Avg. | Trend |
|---|---|---|---|---|
| Binge alcohol use in past month | 44.6% (41,000) | 36.3% | 35.4% | Decreased vs. 2015–2017 |
| Alcohol use disorder in past year | 14.3% (13,000) | 11.7% | 9.8% | Decreased vs. 2002–2004 |
South Dakota’s 18–25 year-olds binge drink at a rate nearly 10 percentage points above the national average, and have an alcohol use disorder rate nearly 50% higher than the U.S. average.
Nonfatal Alcohol-Related Hospitalizations and Emergency Department Visits
Beyond mortality, alcohol places a substantial burden on South Dakota’s hospital and emergency department system.
- Total alcohol-related hospitalizations and ED visits (2020–2024): 36,089
- Alcohol-related ED visits in 2024: 5,267 — highest count in the last 5 years
- Most common cause of visits: Alcohol Use Disorder / use / misuse
- Second most common cause: Non-alcohol diagnosis with blood alcohol level present (≥80 mg/100 ml)
- Males as % of all nonfatal visits: 67% — rate of 1,045.8 per 100,000
- Females as % of all nonfatal visits: 33% — rate of 535.4 per 100,000
- Highest-risk age group for nonfatal visits: 30–59 years
- White share of visits (2020–2024): 46% — rate of 430.1 per 100,000
- American Indian share of visits (2020–2024): 47% — rate of 4,249.7 per 100,000
- American Indian vs. White visit rate: 9.9 times higher
Alcohol-related ED visits reached their highest level in 5 years in 2024. American Indian residents account for nearly half of all alcohol-related visits despite being a smaller portion of the total population, with a visit rate 9.9 times higher than White residents.
Binge and Heavy Drinking Patterns
Binge Drinking
South Dakota has one of the highest binge drinking rates in the nation, with patterns of frequent and heavy consumption.
- Adults who binge drink at least once monthly: 22.3%
- State excessive drinking rate (adults): 21.3% — 6th highest nationally (tied with Pennsylvania)
- Median drinks per binge episode: 5.7
- Median drinks per binge — top 25% of drinkers: 7.9
- Median binge frequency per month — all bingers: 1.7 times
- Binge frequency per month — top 25% of drinkers: 4.0 times
- Adults who consume 9+ drinks per binge (of those who binge): 25%
- Adults who binge 4+ times per month (of those who binge): 25%
- High school students who reported binge drinking (2021): 11%
- Adults aged 18–25 who engaged in binge alcohol use in past month: 33%
- Women of childbearing age (18–44) who binge drink (2023): 25.4% — national average: 17.6%
South Dakota’s binge drinking rate consistently exceeds the national median (15%). Women of childbearing age binge drink at a rate 44% higher than the national average, raising important concerns for maternal and fetal health.
Excessive Drinking by County
Excessive drinking is widespread across nearly all South Dakota counties.
- Marshall County: 25% — highest excessive drinking rate
- Brookings County: 24%
- Minnehaha County: 20%
- Brown County: 19%
- Lincoln County: 19%
- Codington County: 21%
- Pennington County: 16%
- Meade County: 16%
- Todd County: 17% — tied lowest
- Oglala Lakota County: 17% — tied lowest
- Counties where at least 20% of adults report excessive drinking: 57 of 67 (85%)
Excessive drinking is a near-universal challenge across South Dakota, with 85% of all counties exceeding the 20% threshold. South Dakota tied with Pennsylvania for the 6th-highest excessive drinking rate nationally.
Alcohol-Impaired Driving
While South Dakota has fewer total alcohol-impaired driving deaths than many states, alcohol’s role in fatal crashes is among the highest nationally.
- Alcohol-impaired driving deaths (2016–2020 total): 223 — 10th lowest nationally
- Alcohol’s share of all driving deaths: 36% — 6th highest nationally
- Alcohol-related crash deaths in 2022: 46
- Counties where 100% of driving deaths involved alcohol (2016–2020): 3 — Spink, Perkins, and Mellette (combined 6 total deaths)
Although South Dakota’s total count of alcohol-impaired driving deaths is low (10th lowest nationally), the proportion of driving deaths involving alcohol (36%) ranks 6th highest in the nation, reflecting a disproportionate role of alcohol in fatal crashes.
Maternal Alcohol Use and Neonatal Impact
Alcohol use during and around pregnancy poses significant risks in South Dakota, where rates are notably elevated compared to national benchmarks.
- Women aged 18–44 who binge drink (2023): 25.4% — national average: 17.6%
- Pregnant women who drank alcohol in past 30 days (2017–2021 survey data): 10%
- Mothers who smoked during last 3 months of pregnancy (2022): 7.7%
- Newborns with Neonatal Abstinence Syndrome per 1,000 hospitalized (2021): 2.1
South Dakota women of childbearing age binge drink at a rate 44% above the national average. Monitoring prenatal alcohol and drug exposure remains a priority given the state’s elevated use rates.
Economic Cost of Excessive Alcohol Use
Excessive alcohol use imposes enormous financial and social costs on South Dakota taxpayers, families, and communities.
- State taxpayer cost of excessive alcohol use (2010): $598.2 million
- Same cost in inflation-adjusted 2022 USD: $807.6 million ($2.15 per drink)
- Annual deaths per 1,915 adults aged 18+: 1 death
- Annual deaths per 10,000 adults: 6.92
- Annual years of potential life lost (YPLL): 12,203
- Alcohol-attributable deaths under age 21 (annual): 16
- Years of potential life lost — under age 21: 928
The economic burden of excessive alcohol use in South Dakota exceeds $800 million annually in inflation-adjusted terms. The loss of 12,203 years of potential life each year underscores the profound human cost of the state’s high alcohol consumption rates.
Alcohol Treatment and Substance Use Services
Alcohol is the dominant driver of treatment demand in South Dakota. Most facilities accept multiple payment types and offer a broad range of services.
Treatment Demand
- People who entered drug and alcohol rehab in 2010: 14,615
- Admitted for alcohol as primary substance (2010): 7,013
- Admitted for alcohol with a secondary drug (2010): 4,306
- Admissions — male (2010): 72.1%
- Admissions — female (2010): 27.9%
| 2020 N-SSATS Single-Day Count | Clients | % of Clients |
|---|---|---|
| Clients with both alcohol and drug problems | 1,230 | 62.2% |
| Clients with alcohol only | 482 | 24.4% |
| Clients with drug only | 267 | 13.5% |
2023 TEDS-D: Alcohol Treatment Episodes
| 2023 TEDS-D: Alcohol Treatment Episodes | Number | % of All Admissions |
|---|---|---|
| Alcohol only | 9,103 | 50.9% |
| Alcohol with secondary drug | 2,717 | 15.2% |
| Total alcohol-related episodes | 11,820 | 66.1% |
Alcohol accounts for two-thirds of all treatment episodes in South Dakota. The majority of patients (62.2%) present with both alcohol and drug problems, highlighting the need for integrated treatment approaches.
Alcohol Use Disorder — Population Treatment Gap
As with drug treatment, most South Dakotans classified as needing alcohol-related treatment are not receiving it.
| AUD Treatment Measure | Ages 12+ | Ages 12–17 | Ages 18–25 | Ages 26+ |
|---|---|---|---|---|
| Alcohol use disorder (thousands) | 85 | 2 | 19 | 64 |
| AUD — % | 11.33% | 2.99% | 19.65% | 11.04% |
In 2017–2019, South Dakota’s alcohol use disorder rate (6.7% for ages 12+) was higher than the national average (5.3%), and the rate for young adults aged 18–25 (14.3%) substantially exceeded both the regional average (11.7%) and the national average (9.8%).
Conclusion
The data presented in this report point to two distinct but interconnected public health challenges facing South Dakota. The drug overdose picture, while below national averages in absolute death rates, is worsening — overdose deaths have risen 7.62% over three years, fentanyl now drives nearly 90% of opioid fatalities, and more than three-quarters of residents classified as needing substance use treatment are not receiving it.
The alcohol picture is more acute: with the 3rd-highest alcohol-related death rate in the nation, binge drinking rates that exceed national medians across nearly every demographic group, and county-level mortality figures that rank among the most severe anywhere in the country, excessive alcohol use represents the state’s most pressing substance-related crisis.
Running through both challenges is a stark racial disparity — American Indian residents die from drug overdoses at 4.6 times the rate of White residents, and from alcohol-related causes at 7.6 times the rate — a gap that reflects deep structural inequities requiring targeted and culturally grounded responses. Expanded access to treatment, stronger harm reduction infrastructure, and community-specific interventions will be essential to reversing these trends.
Sources:
- Drug Overdose Death Statistics [2025]: Opioids, Fentanyl & More
- Average Cost of Drug Rehab [2026]: by Type, State & More
- Opioid Crisis Statistics [2025]: Prescription Opiod Abuse
- Teenage Drug Use Statistics [2025]: Data & Trends on Abuse
- Substance Use and Perceptions of Great Risk
- Behavioral Health Barometer: South Dakota, Volume 6
- 2023 TEDS-D South Dakota | CBHSQ Data
- Explore Non-Medical Drug Use – Past Year in South Dakota | AHR
- South Dakota Drug Control Update
- South Dakota Data Report
- Explore Illicit Drug Use – Youth in South Dakota | AHR
- South Dakota One of Two States Where Drug Overdoses Decreased in 2020
- South Dakota Statistics on Substance Abuse | Recovery Connection
- Smoking/Alcohol/Drugs
- 2020 State Profile — South Dakota National Survey of Substance Abuse Treatment Services (N-SSATS) | SAMHSA
- Alcohol Abuse Statistics [2026]: National + State Data – NCDAS
- Alcohol-Related Deaths and Nonfatal Visits | South Dakota Department of Health
- Alcohol-Related Deaths & Hospitalizations | South Dakota Department of Health
- Alcohol Use
- Alcohol Use | South Dakota Behavioral Health
- Excessive Drinking in South Dakota
- Map: These South Dakota Counties Are Home To The Most Excessive Drinkers
- 2024 State Reports – Underage Drinking Prevention and Enforcement South Dakota
- Explore Excessive Drinking in South Dakota | AHR