The 2025 NSDUH Treatment Gap Is 39.6 Million People. That Is Not the Same as 39.6 Million Patients.

What the Survey Found

SAMHSA released the 2025 National Survey on Drug Use and Health on July 27, 2026. It was the earliest release in the survey’s history. The survey draws on self-reported responses from more than 60,000 people, and for the first time it presents five years of comparable data covering 2021 through 2025.

The headline figure for operators is the treatment gap. Of the estimated 47.2 million people aged 12 or older who needed substance use treatment in the past year, 16.0% (roughly 7.6 million people) received it. The remaining 84.0%, about 39.6 million people, did not.

A second finding runs in a different direction. Adolescents aged 12 to 17 and young adults aged 18 to 25 continued to show downward or stable trends across most behavioral health indicators. Among 12 to 17 year-olds specifically, prevalence declined for past-month tobacco, alcohol, binge drinking, and marijuana use. It also declined for past-year major depressive episode, co-occurring major depressive episode and substance use disorder, serious thoughts of suicide, and making a suicide plan.

The Honest Read on the Treatment Gap

It is tempting to read 39.6 million untreated people as 39.6 million prospective patients. That reading is wrong, and operators who build capacity on it get hurt.

The NSDUH treatment gap measures the difference between people who met criteria for needing treatment and people who received it. It does not measure people actively seeking care and unable to find a bed. Much of the gap comes from factors that adding capacity does not solve: people who do not perceive a need for treatment, who are not ready to engage, who face cost or coverage barriers, who lack transportation or childcare, or who are deterred by stigma.

That distinction matters commercially. A market can show a large statistical treatment gap and still fail to fill beds if referral infrastructure is weak, commercial payer presence is thin, or treatment-seeking behavior is low. Census comes from referral relationships, payer contracts, and program reputation, not from population-level need on its own.

What the gap does establish is that demand is structural rather than cyclical. Nearly 40 million people with unmet need is not a figure that resolves in a business cycle. For operators, and for investors underwriting long-term leases on treatment real estate, that durability is the meaningful signal. It supports the case for long-duration assets. It says nothing about any particular facility in any particular market.

The Youth Trend Nobody Wants To Talk About

The declining adolescent indicators are good news for public health. They are also a real consideration for operators running adolescent and young-adult programs, or planning them.

Five consecutive years of declining or stable prevalence among 12 to 25 year-olds, across tobacco, alcohol, binge drinking, marijuana, depression, and suicidality, is a durable trend rather than a single-year fluctuation. Operators building adolescent capacity should underwrite census assumptions against that trend, not against the aggregate national gap. The adult and adolescent populations are moving differently, and a business plan that treats behavioral health demand as one undifferentiated growth story will misprice adolescent capacity.

This is the kind of finding an advisor with commercial interest in expansion is tempted to leave out. We think operators are better served by seeing it.

What This Means for Real Estate Decisions

For operators evaluating expansion. Use the NSDUH data as context, not as a market study. Durable national need supports a long-term view of the sector. It does not tell you whether a specific market has the referral density, payer mix, and competitive position to fill a new facility. Market-level analysis of competitor density, payer landscape, referral sources, and treatment-seeking behavior remains the basis for any site decision.

For operators considering a sale-leaseback. Durable long-term demand is exactly what net-lease investors underwrite. A structural rather than cyclical demand picture strengthens the case for behavioral health as a long-duration net-lease asset class, which works in favor of operators bringing real estate to market. Pricing on an individual sale-leaseback transaction still turns on census history, payer mix, licensing position, and lease terms.

For investors and private equity sponsors. The five-year trend data is the most useful part of this release for underwriting. It allows demand to be assessed as a trend rather than a snapshot, and it separates the picture by age cohort. An investment thesis built on adolescent behavioral health should account for the declining youth indicators. A thesis built on adult SUD and mental health services faces a different and more stable picture.

Where This Leaves Operators

The 2025 NSDUH confirms what operators already experience. Need substantially exceeds delivered care, and it has for years. That durability is real and it matters for anyone making a long-term real estate or capital decision. But a treatment gap measures unmet need, not demand waiting at your door. The operators who grow well are the ones who keep the two separate.

Source: Substance Abuse and Mental Health Services Administration, 2025 National Survey on Drug Use and Health, released July 27, 2026. samhsa.gov

Behavioral Health Properties advises operators, investors, and private equity sponsors on behavioral health real estate, including sale-leasebacks, acquisitions, de novo site selection, and sell-side M&A. To discuss how sector conditions affect a specific facility or market, contact the BHP team.