Addiction Data Bulletin 8

This bulletin presents information on transition age (TA) adults, individuals aged 18 to 25 years old, in New York State (NYS) with substance use disorder (SUD) and their engagement in SUD treatment. It is important for the Office of Addiction Services and Supports (OASAS) to monitor this population’s substance use behaviors and interaction with the SUD treatment system to better guide outreach efforts, understand distinct treatment needs, and support engagement and retention in SUD care.

Key Findings

In NYS:

• Low levels of perceived risk paired with high levels of substance use may contribute to the high prevalence of SUD among TA adults.
• Compared to other adults, TA adults have a higher need for SUD treatment, but they are less likely to be engaged in SUD treatment, suggesting age-related engagement barriers.

In the OASAS SUD treatment system:

• TA adult engagement for primary opioid use and primary cannabis use has declined over time. This decline may be related to state-wide prevention efforts and policy changes.
• Compared to other adults, TA adults were over four times as likely to be engaged in SUD treatment for primary cannabis use.
• TA adults in SUD treatment have both sources of support and sources of challenge. Compared to other adults, they were significantly:
  • More likely to identify as lesbian, gay, bisexual, and/or transgender (LGBT).
  • Less likely to be unstably housed.
  • More likely to report criminal legal system involvement.
  • More likely to report polysubstance use for all primary substances except cannabis.

Young adulthood is a period of life characterized by changing social roles, increased independence, new vocational and educational opportunities, and continuing brain development.² Young people aged 18 to 25 years old, transition age (TA) adults, face a range of behavioral health challenges, including increased risk for the development of SUD.^2,3

Acknowledging this risk, we used national survey data⁵ to compare substance use risk perceptions and behaviors, SUD prevalence, and SUD treatment need and engagement between TA adults and other adults (26 years old and older) in NYS.

Then, using OASAS SUD treatment system data, we measured annual trends in TA adult engagement by primary substance group. We also compared sociodemographic characteristics and substance use patterns between TA adults and other adults engaged in SUD treatment in 2023, overall and stratified by primary substance groups (alcohol, cannabis, opioids, stimulants, sedatives, and all others).

Substance Use Risk Perceptions

Compared to other adults in NYS, fewer TA adults associated great risk with various substance use behaviors, like having five or more alcoholic drinks once or twice a week (47.9% vs 40.4%, -7.6% difference), smoking cannabis once a month (23.7% vs 12.0%, -11.7% difference), using cocaine once a month (66.7% vs 58.6%, -8.1% difference), and trying heroin once or twice (84.0% vs 76.0%, -8.0% difference) (Figure 1).

Substance Use Behaviors

In 2023, compared to other adults in NYS, more TA adults reported binge alcohol use (23.2% vs 31.0%), cannabis use (15.6% vs 27.1%), and illicit substance use (3.7% vs 4.9%) in the past month (Figure 2).

Substance Use Disorder Prevalence and Treatment Need

Compared to other adults in NYS, TA adults had a higher prevalence of SUD (16.6% vs 26.3%) and a higher need for SUD treatment (19.2% vs 28.1%) in 2023 (Figure 3). However, among those classified as needing SUD treatment, compared to other adults, fewer TA adults were engaged in SUD treatment (27.0% vs 16.5%).

OASAS offers several programs and services across the SUD care continuum geared towards youth and TA adults. These programs address the unique developmental and clinical needs of this age group.

Substance Use Disorder Treatment Engagement Among TA Adults

The number of TA adults engaged in SUD treatment decreased from 28,822 in 2017 to 12,103 in 2023 (Table 1) (Figure 4). In 2017, cannabis and opioids (39.0% and 29.4%) were the two most reported primary substances among TA adults engaged in SUD treatment. In 2023, alcohol and cannabis (33.4% and 32.8%) were the two most reported substances. This shift was due primarily to a steep decline in the annual number of TA adults engaged for opioid and cannabis (Figure 4).

Characteristics of TA Adults Engaged in Substance Use Disorder Treatment

TA adults accounted for 8.1% (N=12,103) of all unique adults engaged in SUD treatment in 2023 (N=148,611).
Several sociodemographic characteristics varied significantly between TA adults and other adults engaged in SUD treatment (Figure 5). Compared to other adults, TA adults were significantly more likely to identify as lesbian, gay, bisexual, pansexual, and/or transgender (LGBT) (5.6% vs 11.7%) and significantly more likely to report criminal legal system (CLS) involvement (33.3% vs 46.2%). Compared to other adults, they were significantly less likely to be unstably housed (24.3% vs 15.6%). Lastly, compared to other adults, TA adults were significantly more likely to report primary cannabis use (7.4% vs 32.8%) but were significantly less likely to report primary opioid use (37.5% vs 20.0%).

The difference in primary alcohol use between other adults and TA adults was significant (38.8% vs 33.4%), but the effect size was not meaningful. Other adults and TA adults did not differ significantly in terms of race/ethnicity, sex at birth, co-occurring mental health disorders, or whether they lived in rural versus urban counties (Table 2). These findings point to the unique needs of TA adults that should be addressed in SUD treatment.

Figure 5. Individuals Engaged in Substance Use Disorder Treatment N=148,611

* Significant difference in proportions comparing TA adults vs other adults and meaningful effect size.

Polysubstance Use by Primary Substance Group

* Significant difference in proportions comparing TA adults vs other adults and meaningful effect size.

Age group differences in polysubstance use emerged when comparing adults by primary substance group (Table 3) (Figure 6). Compared to other adults with the same primary substance, TA adults with primary alcohol (45.2% vs 60.2%, +15.0% difference), opioid (63.1% vs 74.2%, +11.2% difference), or sedative use (58.9% vs 88.6%, +29.7% difference) were significantly more likely to report polysubstance use. However, compared to other adults with primary cannabis use, TA adults with primary cannabis use were less likely to report polysubstance use (48.4% vs 42.0%, -6.4% difference).

Criminal Legal System Involvement by Primary Substance Group

Criminal legal system (CLS) involvement was significantly greater among TA adults compared to other adults (Table 3) (Figure 5). This was true across all primary substance groups to varying degrees (+16.8% to +4.7% difference), except for adults with primary cannabis use (Figure 7). Compared to other adults with primary cannabis use, CLS involvement was significantly lower for TA adults with primary cannabis use (58.4% vs 45.6%, -12.7% difference).

* Significant difference in proportions comparing TA adults vs other adults and meaningful effect size.

This data bulletin explores substance use, SUD, and SUD treatment engagement among TA adults. Fundamentally, TA adults have different risk perceptions and behaviors surrounding substance use which may contribute to the high prevalence of SUD in this age group. This high prevalence and coupled with a gap in SUD treatment need versus engagement among TA adults emphasizes the importance of age-tailored outreach and treatment approaches.

From 2017 to 2023, TA adult engagement in treatment for primary opioid use and primary cannabis use declined. This trend may be related to the legalization of adult-use cannabis⁶ and efforts to address the opioid epidemic in NYS^7,8, shifting the needs of the SUD treatment population.

We also found that TA adults who are engaged in SUD treatment have identities and patterns of substance use that differ from other adults. While certain findings suggest potential sources of support for TA adults (stably housed possibly with family⁹ or friends and LGBT identification and community inclusion10) that can be leveraged for improved treatment outcomes, others (greater CLS involvement¹¹ and different patterns of polysubstance use¹²) may place TA adults at risk for adverse outcomes. SUD treatment providers should account for how these characteristics impact TA adults’ SUD treatment needs.

Throughout this analysis, it is also clear that cannabis use among TA adults differs from use of other substances. TA adults with primary cannabis use were less likely to have polysubstance use and CLS involvement than other adults with primary cannabis use, a reversal of the pattern between TA and other adults in treatment for all other primary substance groups. Again, these findings may be related to recent cannabis policy changes, which have affected the population in SUD treatment for cannabis use¹³.

By understanding the unique characteristics of TA adults with SUD and the strengths and challenges of the TA adult treatment population, OASAS can develop strategies to improve SUD outcomes for this age group in NYS.

Authors

Vanessa Drury, Sam Kawola, Jamie del Rosario, Maria Morris, Pat Lincourt, Chinazo O Cunningham, Ashly E Jordan

Suggested Citation

Drury V, Kawola S, del Rosario J, Morris M, Lincourt P, Cunningham CO, Jordan AE. Transition Age Adults Engaged in Substance Use Disorder Treatment: A Unique Population with Distinct Needs. Addiction Data Bulletin (No. 2026-8). April 2026.

See also

Drury V, Aleksanyan J, Narayanan N, Echenique J, Melkonian, M, Renteria D, Fawole A, Choi S, Kawola S, del Rosario J, Lincourt P, Morris M, Neighbors C, Cunningham CO, Jordan AE (in press). Beyond age: transition age adults have distinct identities, substance use patterns compared to other adults in substance use disorder treatment. Journal of Addiction Medicine.

Data Sources, Definitions, Methods

Data sources: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUH), 2022-2023; OASAS Client Data System (CDS), 2025.

Abbreviations: SUD, substance use disorder; NYS, New York State; TA, transition age (18-25 years old); LGBT, lesbian, gay, bisexual, (pansexual) and/or transgender; CLS, criminal legal system; NH, non-Hispanic.

Past-month binge drinking (NSDUH): Average annual percentage of respondents drinking 5 or more (for males) or 4 or more (for females) alcoholic drinks on one occasion on at least one day in the past month. Estimates based on survey-weighted hierarchical Bayes small area estimation approach.¹

Past-month cannabis use (NSDUH): Average annual percentage of respondents using cannabis in the past month, including cannabis vaping. Estimates based on survey-weighted hierarchical Bayes small area estimation approach.1

Past-month illicit substance use (NSDUH): Average annual percentage of respondents using cocaine, heroin, hallucinogens, inhalants, or methamphetamine and/or misuse of prescription psychotherapeutics, including pain relievers in the past month. Estimates based on survey-weighted hierarchical Bayes small area estimation approach.¹

Substance use disorder (NSDUH): Average annual percentage of respondents meeting criteria for past-year drug or alcohol use disorders per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) among those reporting any past-year substance use. Estimates based on survey-weighted hierarchical Bayes small area estimation approach.^1,4,5

SUD treatment (NSDUH): Average annual percentage of respondents receiving SUD treatment in the past year through inpatient treatment/counseling, outpatient treatment/counseling, medication-assisted treatment, telehealth treatment, or treatment in a prison, jail, or juvenile detention center. Estimates based on survey-weighted hierarchical Bayes small area estimation approach.¹

SUD treatment need (NSDUH): Average annual percentage of respondents either meeting SUD criteria or receiving SUD treatment. Estimates based on survey-weighted hierarchical Bayes small area estimation approach.1
Engaged in SUD treatment (NSDUH): Average annual number of respondents receiving SUD treatment divided by the average annual number of respondents classified as needing SUD treatment. Estimates based on survey-weighted hierarchical Bayes small area estimation approach.¹

Primary substance of use (CDS): Patients can report up to three substances of use at admission. The primary substance reported is typically the substance for which the patient is seeking treatment and often corresponds to a SUD diagnosis. Substances were grouped into six categories: alcohol, cannabis, opioids, stimulants, sedatives, and all others.

Individuals (CDS): A unique ID variable is created for all records from personal identifiers. This variable allows for deduplication of admissions to study individual-level data. Individual-level data provide a better representation of the sociodemographic characteristics of the SUD treatment population than admission counts.

Engaged in SUD treatment (CDS): Unique individuals receiving SUD treatment services in a calendar year, even if admitted in a prior year. For each individual engaged, the most recent episode was chosen. Individuals not residing in NYS, those under 18 years old, and those accessing only medically managed/supervised withdrawal services were excluded; for 2023, those admitted before 2015 were also excluded due to sociodemographic data missingness.

Polysubstance use (CDS): Reported use of two or more categories of substances at admission (alcohol, cannabis, opioids, stimulants, sedatives, all others).

LGBT (CDS): Individuals who reported a sexual orientation of lesbian, gay, bisexual, pansexual, and/or a gender identity of transgender at admission.

Criminal legal system (CLS) involvement (CDS): Any reported involvement with the CLS at admission, including probation, parole, incarceration, pending charges, or any CLS referral. CLS referrals to treatment may originate from the court system, police, impaired driving services, DOCS, county/city jails, parole/probation conditions, or as an alternative to incarceration.

Significance: Two-sample proportion tests were conducted to determine differences between TA adults and other adults. The significance threshold was set at alpha=0.01. Due to the large sample size, Cohen’s h was also calculated to determine relative effect size. Only findings that were significant via proportion test and of at least small effect size h≥0.2 are labeled with an asterisk (*).

Citations 

1. Center for Behavioral Health Statistics and Quality SAMHSA. National Survey on Drug Use and Health (NSDUH): Methodological summary and definitions. 2024.
2. Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol. May 2000;55(5):469-80.
3. Jordan CJ, Andersen SL. Sensitive periods of substance abuse: Early risk for the transition to dependence. Developmental Cognitive Neuroscience. 2017/06/01/ 2017;25:29-44. doi:https://doi.org/10.1016/j.dcn.2016.10.004
4. American Psychiatric Association. Diagnostic and Statistical manual of Mental Disorders: Fifth Edition (DSM-5). vol 21. 2013.
5. Center for Behavioral Health Statistics and Quality SAMHSA. National Surveys on Drug Use and Health, 2022 and 2023 (NSDUH). 2024.
6. Askari MS, Keyes KM, Mauro PM. Cannabis use disorder treatment use and perceived treatment need in the United States: Time trends and age differences between 2002 and 2019. Drug Alcohol Depend. Dec 1 2021;229(Pt A):109154. doi:10.1016/j.drugalcdep.2021.109154
7. Chhatwal J, Mueller PP, Chen Q, et al. Estimated Reductions in Opioid Overdose Deaths With Sustainment of Public Health Interventions in 4 US States. JAMA Netw Open. Jun 1 2023;6(6):e2314925. doi:10.1001/jamanetworkopen.2023.14925
8. New York State Department of Health Office of Drug User Health. Opioid Overdose Prevention. Updated June 2025.
9. Pew Research Center. Parents, young adult children and the transition to adulthood. 2024. Accessed August 27, 2025.
10. 10. Paschen-Wolff MM, DeSousa A, Paine EA, Hughes TL, Campbell ANC. Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs. Substance Abuse Treatment, Prevention, and Policy. 2024/01/03 2024;19(1):2. doi:10.1186/s13011-023-00581-8
11. Rafful C, Orozco R, Rangel G, et al. Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs. Addiction. Jun 2018;113(6):1056-1063. doi:10.1111/add.14159
12. Lim JK, Earlywine JJ, Bagley SM, Marshall BDL, Hadland SE. Polysubstance Involvement in Opioid Overdose Deaths in Adolescents and Young Adults, 1999-2018. JAMA Pediatr. Feb 1 2021;175(2):194-196. doi:10.1001/jamapediatrics.2020.5035
13. Mennis J, Stahler GJ, McKeon TP. Criminal Justice Referrals to Cannabis Use Disorder Treatment among Adolescents and Young Adults following Recreational Cannabis Legalization in the United States. Journal of Addiction Medicine. 2023;17(6):725-728. doi:10.1097/adm.0000000000001219

Table 1. SUD treatment engagement among transition age (TA) adults by primary substance of use, 2017-2023. 

Individuals not residing in NYS, those under 18 years old, those accessing only medically managed/supervised withdrawal services, were excluded; for 2023, those admitted before 2015 were also excluded.

Table 2. Characteristics of adults engaged in SUD treatment in NYS, 2023.

Individuals not residing in NYS, those under 18 years old, those accessing only medically managed/supervised withdrawal services, and those admitted before 2015 were excluded.
^a Individuals reporting sex at birth as X not shown due to small N but included in totals.
^b “All others” includes substances such as hallucinogens, ketamine, certain over-the-counter medications, and synthetic cannabinoids. 
^c Residence in an NYS county with ≥50% rural population, based on 2020 US Census Bureau designations.
* Significant difference in proportions (p<0.01) comparing TA adults vs other adults and at least small effect size (Cohen’s h≥0.2).

Table 3. Select characteristics of adults engaged in SUD treatment in NYS, stratified by primary substance of use, 2023.

Individuals not residing in NYS, those under 18 years old, those accessing only medically managed/supervised withdrawal services, and those admitted before 2015 were excluded.
* Significant difference in proportions (p<0.01) comparing TA adults vs other adults and at least small effect size (Cohen’s h≥0.2).