Global, Regional, and National Burden of Substance Use Disorders, 2013–2023: Insights from the Global Burden of Disease Study 2023 with Projections to 2050

Author(s): Anandalakshmi Ponnaluri, Emon Javadi, Anisha Sharma, Patrick Mingledorff, Emily Ng, Mitali Wadekar, Anil Sharma, Ahmad Khedraki.

Background: Substance use disorders (SUDs) remain an escalating growing global public health challenge. This study analyses the global, regional, and U.S. state-level SUD burden from 2013–2023 using Global Burden of Disease (GBD) 2023 estimates and projects trends through 2050. Methods: We analyzed data from the GBD 2023 database. SUDs were defined using ICD-10 codes F10–F19, including alcohol (AUD), opioid (OUD), cannabis (CUD), cocaine, amphetamine, and other drug use disorders. Age-standardized incidence rate (ASIR), prevalence (ASPR), disability-adjusted life years (ASDR), and mortality (ASMR) per 100,000 population were analyzed by sex, age, region, and income group, with emphasis on High-Income North America (HINA). Temporal trends (2013–2023) and DALY projections to 2050 were assessed. Results: In 2023, high-income (HI) regions recorded the highest ASPR, ASDR, and ASMR, while ASIR peaked in Central and Eastern Europe and Central Asia (CEECA), followed by HI regions. Within HI regions, HINA showed the greatest overall burden. In HINA, AUD had the highest ASIR and ASPR, while OUD accounted for the highest ASDR and ASMR. Between 2013 and 2023, all SUD metrics increased significantly in HINA. Males and individuals aged 25–44 years showed peak prevalence. Across the U.S., rates were highest in West Virginia (9,163.16 per 100,000). Projections indicate continued increases in global DALYs, particularly in the U.S. Conclusions: HI regions particularly HINA experienced the largest and fastest-growing SUD burden, predominantly driven by AUD and OUD. Rising impacts among younger adult males emphasize the urgent need for targeted, integrated, and state-specific evidence-based interventions.