Amid an overall decline in the number of young adults in Massachusetts seeking addiction treatment, alcohol has displaced heroin as a leading reason for entering rehab.
An analysis of federal treatment data by Woodlands Grove Recovery Campus, a northwest Ohio based addiction treatment center, found that alcohol accounted for 32.6% of substance-use treatment admissions among Massachusetts residents ages 18 to 24 in 2023, the largest share, and up from 10.1% in 2013. Eight of the 10 states with the largest increases in alcohol’s share of admissions were in the Northeast, including five of the six New England states. Vermont was the lone New England exception, with cocaine and crack seeing the largest increase.
But additional figures provided by Woodlands Grove reveal that Massachusetts recorded just 735 alcohol-related admissions among young adults in 2023, down from 1,519 in 2013, a 51.6% decline. Heroin admissions fell even more dramatically, from 10,628 to 359, a 96.6% decrease.
“I think the key here is that we’re looking at a changing treatment landscape, not necessarily a surge in drinking,” said Rebecca Boone, clinical lead at Woodlands Grove Recovery Campus. “In Massachusetts, alcohol became a much larger share of admissions while heroin declined dramatically, so the mix of substances bringing young adults into treatment looks very different than it did a decade ago.”
The findings are consistent with broader evidence that young people are drinking less. Cambridge Public Health Department data show that binge drinking among the city’s high school students has declined over the longer term. Statewide estimates from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) show that past-month drinking among Massachusetts residents ages 18 to 25 fell from 62.3% in 2022–2023 to 55.6% in 2023–2024. Nationally, SAMHSA data show that past-month drinking among young adults declined from 49.9% in 2022–2023 to 48.5% in 2023–2024.
The decline in treatment admissions extends beyond Massachusetts. According to the Woodlands Grove Recovery Campus study, recorded substance-use treatment admissions among young adults nationwide fell 60.4% between 2013 and 2023. Alcohol-related admissions also declined, from 70,365 to 27,343, even as alcohol’s share increased from 22.4% to 26
Boone said the precipitous decline in heroin admissions has reshaped the treatment landscape nationwide, though the substances accounting for a larger share of admissions differ dramatically by region. “Heroin declined dramatically across the treatment landscape, but what became more prominent afterward varies depending on where you look, alcohol in several New England states, methamphetamine in others, and non-heroin opioids and synthetics elsewhere.”
Alcohol effects increase with age
Dr. Andrew Hyatt, a psychiatrist at Cambridge Health Alliance and a researcher at its Health Evaluation Research Laboratory, cautioned that focusing exclusively on young adults may overlook some of the most serious consequences of prolonged alcohol abuse. State data show that alcohol-related emergency room visits among Cambridge residents involve substantially more adults over 30 than younger residents. While younger patients may occasionally require emergency care for acute intoxication, complications such as liver disease often emerge later in life. “It just takes some time for alcohol-related health problems to develop,” Hyatt said.
Hyatt suggested that the evolving landscape of opioid addiction treatment may help explain why opioid-related treatment admissions experienced the steepest decline. As Massachusetts mobilized to address the crisis, opioid treatment expanded beyond specialized facilities into primary care, where physicians increasingly prescribed medications such as buprenorphine, which reduces opioid cravings and withdrawal symptoms. Severe alcohol withdrawal, meanwhile, can be fatal and require round-the-clock medical supervision. “I think the reason alcohol may be making up a bigger portion of [specialized treatment admissions] is that alcohol withdrawal is life-threatening,” Hyatt said. “You’re still going to see a lot of admissions to things like detox.”
Marijuana’s growing popularity may also help explain why young adults are drinking less. “There’s been a very, very, very large increase in cannabis use, and there’s been almost this seesaw effect, where [alcohol use is] going down, but cannabis use is really skyrocketing,” Hyatt said.
Hyatt suggested that changing generational attitudes toward drinking and declining in-person socialization since the pandemic may also be contributing to the trend. “People used to go to the bar and drink,” he said. “But now people just don’t have as many friends, so they’re not getting together.”
Ultimately, Hyatt said the most significant finding wasn’t alcohol’s growing share of treatment admissions, but the dramatic decline in admissions overall. “I think that by far the biggest story is the gigantic drop in treatment [admissions] just across the board for every substance.”
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