The Hidden Toll of Substance Use Disorder: Annual Cost of Lost Productivity to US Economy Nearly $93 Billion

A new study shows that in 2023, substance use disorders led to nearly $93 billion in lost productivity in the United States from missed work, reduced job performance, inability to work, and lost household productivity. The novel analysis appearing in the American Journal of Preventive Medicine, published by Elsevier, highlights the need for prevention and treatment strategies to reduce harm and costs.

“Substance use disorders can impair cognitive and behavioral functioning, resulting in productivity losses,” said the team of investigators from the Centers for Disease Control and Prevention. “While medical costs and premature deaths associated with substance use disorders have been well documented, the impact of productivity losses on workers, families, and employers due to illness remains less visible and are often underestimated.”

The researchers used recent national survey data—primarily from the National Survey on Drug Use and Health (NSDUH)—on adults 18 years of age or older with substance use disorders to estimate costs related to absenteeism and inability to work as well as two often-overlooked factors: presenteeism (being present but not productive at work), and household production (e.g., cooking, cleaning), thereby offering a more complete picture of the societal burden.

The analyses show estimated productivity losses of $92.65 billion in total, or $3,703 per adult with a substance use disorder, in 2023 (analyzed in 2025). The breakdown of these costs is as follows:

• Inability to work: $45.25 billion

• Absenteeism: $25.65 billion

• Presenteeism: $12:06 billion

• Household productivity loss: $9.68 billion

Of this total cost, males accounted for $61.19 billion and females for $31.45 billion.

The study’s authors note, “These costs are comparable to direct healthcare spending on substance use disorders, showing the wide economic impact of these disorders. The largest shares came from the inability to work, followed by absenteeism, highlighting that economic harms extend well beyond medical bills.”

The investigators also point out the striking magnitude of the shares of costs associated with presenteeism (13%) and household productivity losses (10%), which indicate that interventions aimed at improving workers’ functioning, not just their attendance, could yield substantial economic benefits.

The researchers conclude, “Effective prevention and treatment of substance use disorders require integrated, ethically grounded approaches that address both individual risk factors and broader social determinants through coordinated efforts across health, social, and justice systems. At a time when employers and policymakers are weighing investments in treatment access, workplace supports, and prevention, our results highlight the potential returns on such investments beyond healthcare savings.”

Notes for editors

The article is “Productivity Losses From Substance Use Disorder in the U.S. in 2023,” by Ramesh Ghimire, PhD, Curtis Florence, PhD, and Gery Guy, PhD, MPH (https://doi.org/10.1016/j.amepre.2025.108102). It appears online in the American Journal of Preventive Medicine, published by Elsevier.

The article is openly available for 30 days at https://www.ajpmonline.org/article/S0749-3797(25)00570-7/fulltext.

Full text of this article is also available to credentialed journalists upon request; contact Astrid Engelen at +31 6 14395474 or [email protected]. Journalists wishing to interview the authors should contact CDC’s Division of Media Relations at +1 404 639 3286. Please submit additional questions/inquiries via the “Request for Comment Form”.

The findings and conclusions are those of the authors and do not necessarily represent the official position of the CDC.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

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