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Mental Health and Substance Use Challenges (Volume 103)
Quarterly Article
Brendan Saloner
Jul 30, 2026
May 6, 2026
June 2026
Back to The Milbank Quarterly
Policy Points:
See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do?
This Perspective examines the role of Medicaid in the innovation of substance use disorder (SUD) treatment. In 2023, an estimated 49 million Americans met criteria for an SUD and more than 100,000 people died of a drug overdose.1, 2 Compared with the general population, people with SUD experience worse self-rated health, a higher burden of other chronic diseases, and more hospital care.3, 4 The social and economic consequences of SUD are also pervasive.5, 6 People with SUD are much more likely to be involved with the criminal legal system, unhoused, and unemployed than the general population.7 With treatment, SUD symptoms are just as manageable as other chronic diseases like diabetes, asthma, and hypertension.8 In spite of these benefits, only one-quarter of people with SUD receive treatment in any year.1 Furthermore, treatment is often too limited in its scope and duration to be effective. Many people discontinue care before achieving meaningful benefits.7