American Attitudes toward Substance Use in the United States


© 2015 AP Photo/John Minchillo

More Americans now die every year from drug overdoses than they do in motor vehicle accidents, according to the Centers for Disease Control and Prevention (CDC).[1] The rise of heroin-related deaths has been particularly sharp.

In a recent poll conducted by The Associated Press-NORC Center for Public Affairs Research, few Americans say their communities are doing enough to deal with substance abuse, a problem that many see as particularly serious. 

In February, the Obama administration said it would ask Congress to spend an additional $1.1 billion next year to combat the growing epidemic of prescription painkiller and heroin abuse by expanding treatment facilities, developing programs intended to prevent prescription drug overdoses, and cracking down on illegal sales. The poll suggests there is public support for these policy approaches to the problem.


The nationwide poll of 1,042 adults used AmeriSpeak, the probability-based panel of NORC at the University of Chicago. Interviews were conducted between February 11 and 14, 2016, online and using landlines and cell phones.

Some of the poll’s key findings are: 

  • Most Americans (62 percent) say at least one type of substance use is a serious problem in their community. Forty-three percent have a relative or close friend with substance abuse issues. 
  • The public says more should be done to address the problem of substance use in their area. Seven in 10 Americans say their community is not doing enough to find improved methods of treating addiction (68 percent) or to make accessible treatment programs more available (69 percent). Nearly as many, 61 percent, want to see more effort made to crack down on drug dealers. There is a feeling that there is not enough education, either for the public (55 percent) or health professionals (49 percent). Just over half, 53 percent say their community should do more to go after the users themselves. 
  • A majority of Americans, 61 percent, support the legalization of marijuana, but only a third of them endorse legalization with no restrictions. Forty-three percent say there should be restrictions on the purchase amounts. And a quarter of those who support legalization only approve of its use when prescribed by a doctor.
  • The public perceives racial, socioeconomic, and geographic imbalances in conviction rates for drug possession. More than half of the public reports that black, Hispanic, poor, and urban substance users are at least very likely to be convicted of drug possession. Significantly fewer, about 3 in 10, say white, middle class, suburban, and rural substance users are likely to be convicted, and only a quarter think rich drugs users are likely to be convicted. 
  • Only 21 percent say all or most doctors and dentists regularly prescribe painkillers more than is necessary. But of those who think even a few doctors and dentists overprescribe, the vast majority (89 percent) believe this practice contributes to drug dependence and overdoses.


Americans Say Heroin And Prescription Pain Reliever Use Are Problems In Their Communities On Par With The Use Of Alcohol And Other Drugs Like Cocaine And Methamphetamines.

According to the CDC, opioids, a class of drugs that includes prescription painkillers and heroin, were involved in 28,647 deaths in the United States between 2000 and 2014.[2] That figure has been on the rise in recent years, and today many Americans see drug use as a problem in their communities.

While economic problems, terrorism, and health care top the list of priorities [3] for the country, only 3 percent named drug use as a top-of-mind priority for the nation. However, when asked specifically about drug use, most Americans (62 percent) say at least one type of substance use is a serious problem in their community.

About a third consider the use of heroin and prescription painkillers a very or extremely serious problem in their communities, similar to the number who say the same about the use of alcohol and other drugs such as cocaine or methamphetamines. Fewer say marijuana use is a serious problem, however.


For much of the public, the problem of drug use hits close to home. About 4 in 10 Americans surveyed say they have a relative or close friend who has a problem with some type of substance use. These Americans are more likely to view substance use of all kinds to be a problem in their communities.

While few say that overprescribing painkillers is widespread, many say the prescribing practices of doctors and dentists contribute to problems with drug abuse. Just 21 percent say most or all doctors regularly overprescribe pain relievers more than is medically necessary. But, 89 percent of those who say there is any overprescribing think this practice contributes to dependence on prescription pain relievers and drug overdoses.

A majority of Americans see prescription pain relievers and heroin as about equally risky to use (52 percent). Few say prescription pain relievers are more dangerous than heroin (4 percent), especially compared to the reverse (44 percent say heroin is more risky).

Americans Emphasize Drug Treatment Programs And Crackdowns On Drug Dealers As Means To Address The Problem Of Substance Abuse In Their Communities.

Americans favor a wide range of approaches to addressing issues of substance abuse in their communities. Many Americans think their communities are not devoting enough effort to several approaches of targeting this problem. Nearly 7 in 10 say their community is not doing enough to find ways to improve substance use treatment or to make it more affordable and accessible. Six in 10 say their community is not doing enough to crack down on drug dealers. Fewer, but still a majority, say their community is not doing enough to crack down on drug users or educate the public and students in school to prevent substance use. Slightly less than half say they are not doing enough to educate doctors and dentists about the risks of prescribing pain relievers, but a nearly equal amount say their communities are devoting the right amount of effort to this approach.


In line with the public’s preference for more affordable substance use treatment programs, under the Affordable Care Act, [4] the substance use treatment services are considered essential health benefits that are required to be covered by health plans in the health insurance marketplace at a level comparable to medical and surgical benefits. Drug treatment should have the same insurance coverage as other ailments according to 47 percent, and 38 percent say addiction therapies should get even more coverage than other medical problems. Only 14 percent say drug treatment should get less insurance coverage. Those with a relative or close friend who has a problem with substance use are more likely than those without one to say insurance should cover addiction services at a higher level than other medical problems (45 percent vs. 33 percent).

As far as improvements to substance use treatment that much of the public would like to see, one possibility is a drug called Naloxone, which recently became easier to administer outside of a health care setting.[5] Also known by its commercial name, Narcan, the drug can prevent people from dying if they are experiencing an overdose of a prescription painkiller or heroin by blocking the effects of opioids, effectively reversing an overdose. 

Some states have made this drug available to adults without a prescription, while other states restrict the sale of the drug because they think it might encourage the use of illegal drugs. Most Americans (57 percent) agree that this drug should only be available with a prescription to avoid encouraging drug abuse. However, a significant minority, 42 percent, agree with the 14 states that have made the medication available over the counter.[6] Those with a relative or close friend who has a problem with substance use are more likely to say it should be available without a prescription (48 percent) than those without such a relative or friend (38 percent). Whites are more likely than blacks or Hispanics to say it should be available without a prescription, while those age 60 and older are more likely than younger Americans to say it should only be accessible with a prescription.

Most Americans Support The Legalization Of Marijuana But Most Want Some Restrictions.

Marijuana has been legalized in some form in 23 states and the District of Columbia. Many states have passed medical marijuana laws allowing for its limited use, while in Alaska, Colorado, Oregon, Washington, and the District of Columbia, the recreational use of marijuana is now legal.[7] Among the public, 6 in 10 say the use of marijuana should be legal, but two-thirds of them temper that endorsement by favoring at least some restrictions. Among those who support legalizing marijuana use, 43 percent favor restrictions on purchase amounts and 24 percent say it should only be legal with a medical prescription. Thirty-three percent prefer no restrictions.

Younger adults are much more likely to favor legalization than older adults. Eighty-two percent of those age 18-29 say it should be legal compared to 59 percent of those age 30-44, 65 percent of those age 45-59, and 44 percent of those age 60 and older. Seventy percent of Democrats and 65 percent of independents favor legalization, compared to just 47 percent of Republicans.

On the other hand, very few Americans say the use of other drugs, such as heroin or cocaine, should be made legal. Just 7 percent say so, compared to 93 percent who say use of these drugs should remain illegal.

Americans Perceive An Imbalance In Drug Possession Convictions.

According to the 2013 National Survey on Drug Use and Health,[8] the percentage of drug users within white, black and Hispanic communities is roughly equivalent. The survey found that, overall, about 9.4 percent of Americans age 12 and over were illicit drug users. The rate was 8.8 percent for Hispanics, 9.5 percent for whites, and 10.5 percent for blacks. However, there is some evidence suggesting that black defendants tend to be more severely punished for drug-related crimes than white defendants.[9][10] 

Americans’ perceptions regarding the likelihood of convictions for drug use reflect this imbalance in the justice system. Sixty-six percent of Americans say it is extremely or very likely that a black substance user would be convicted of drug possession, and 55 percent say it is likely a Hispanic substance user would be convicted of possession. But, a much smaller share of Americans (30 percent) say a white user would likely be convicted of drug possession.

More Americans say substance users in cities (53 percent) are likely to be convicted of drug possession compared to those living in suburban or rural areas (29 percent each). More also say that poor people are likely to be convicted of drug possession (63 percent) than middle-class people (29 percent) or rich people (23 percent).

Differences emerge along racial lines in evaluations of the likelihood of criminal outcomes. Blacks are more likely than whites to say black substance users will likely be punished (78 percent vs. 64 percent) and that white substance users are not likely to be punished (42 percent vs. 17 percent).

About the Study

Survey Methodology

This survey was conducted by The Associated Press-NORC Center for Public Affairs Research and with funding from NORC at the University of Chicago. Data were collected using AmeriSpeak®, which is a probability-based panel designed to be representative of the U.S. household population. The survey was part of a larger study that included questions about other topics not included in this report. During the initial recruitment phase of the panel, randomly selected U.S. households were sampled with a known, non-zero probability of selection from the NORC National Sample Frame and then contacted by U.S. mail, email, telephone, and field interviewers (face-to-face).

Interviews for this survey were conducted between February 11 and 14, 2016, with adults age 18 and over from the 50 states and the District of Columbia. Panel members were randomly drawn from AmeriSpeak®, and 1,042 completed the survey—814 via the web and 228 via telephone. The final stage completion rate is 30.3 percent, the weighted household panel response rate is 36.9 percent, and the weighted household panel retention rate is 93.7 percent, for a cumulative response rate of 10.5 percent. The overall margin of sampling error is +/- 3.9 percentage points at the 95 percent confidence level, including the design effect. The margin of sampling error may be higher for subgroups.

Once the sample has been selected and fielded, and all the study data have been collected and made final, a poststratification process is used to adjust for any survey nonresponse as well as any non-coverage or under- and oversampling resulting from the study-specific sample design. Poststratification variables included age, gender, census division, race/ethnicity, and household phone status. The weighted data, which reflect the U.S. population of adults age 18 and over, were used for all analyses.

All differences reported between subgroups of the U.S. population are at the 95 percent level of statistical significance, meaning that there is only a 5 percent (or lower) probability that the observed differences could be attributed to chance variation in sampling.

A comprehensive listing of the questions, complete with tabulations of top-level results for each question, is available on The AP-NORC Center website:

Contributing Researchers
From NORC at the University of Chicago
Marjorie Connelly
Dan Malato
Jennifer Benz
Trevor Tompson
Nada Ganesh
Eric Goplerud
Emily Alvarez

From the Associated Press
Emily Swanson

About the Associated Press-NORC Center for Public Affairs Research

The AP-NORC Center for Public Affairs Research taps into the power of social science research and the highest-quality journalism to bring key information to people across the nation and throughout the world.

The Associated Press (AP) is the world’s essential news organization, bringing fast, unbiased news to all media platforms and formats.

NORC at the University of Chicago is one of the oldest and most respected, independent research institutions in the world.

The two organizations have established The AP-NORC Center for Public Affairs Research to conduct, analyze, and distribute social science research in the public interest on newsworthy topics, and to use the power of journalism to tell the stories that research reveals.

1. Centers for Disease Control and Prevention. (2016). Prescription Drug Overdose Data.
2. Centers for Disease Control and Prevention. (2016). Increases in Drug and Opioid Overdose Deaths – United States, 2000-2014.
3. AP-NORC Center for Public Affairs Research. (2016). Americans’ Priorities for 2016.
4. The Affordable Care Act is President Obama’s health care reform law enacted in 2010.
5. U.S. Food and Drug Administration. (2014). FDA approves new hand-held auto injector to reverse opioid overdose. FDA News Release.
6. Nealeigh, S. (Feb. 20, 2016). Narcan availability expanding. Chillicothe Gazette.
7. Governing Institute. (2016). Governing Data: State Marijuana Laws Map.
8. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings.
9. Kautt, P. and Spohn, C. (2002). Cracking down on black drug offenders? Testing for interactions among offenders’ race, drug type, and sentencing strategy in federal drug sentences. Justice Quaterly, 19:1, 1-35.
10. Stefensmeier, D., Ulmer, J., and Kramer, J. (1998). The interaction of race, gender, and age in criminal sentencing: The punishment cost of being young, black, and male. Criminology, 36:4, 763-798.