Montana Drug and Alcohol Statistics - Methadone dot org (NAMA Recovery)

Statistical Data on Drugs in Montana

Montana faces significant challenges with substance abuse and drug overdose deaths. The state consistently ranks above national averages for illicit drug use across multiple age groups, with particularly concerning rates among youth and young adults. While Montana’s overdose death rate remains below the national average, the state has experienced substantial increases in deaths involving fentanyl and methamphetamine. American Indian populations are disproportionately affected, and the opioid epidemic continues to impact communities statewide. This comprehensive statistical overview draws from state health department data, treatment facility records, and epidemiological surveillance to provide a detailed picture of Montana’s substance use landscape.

Drug Overdose Deaths

Overall Mortality Statistics

208 drug overdose deaths per year (current reporting period)
1.86% of all deaths are from drug overdose
Overdose deaths increased by 37.59% over the last 3 years
19.4 deaths per 100,000 residents (46.79% less than national rate)
0.19% of nationwide overdose deaths occur in Montana
Drug overdoses are the 4th leading cause of injury death in Montana

Montana Overall Mortality Statistics

While Montana’s overdose death rate remains below the national average, the 37.59% increase over three years indicates a worsening crisis. The state’s position as the fourth leading cause of injury death underscores the public health significance of this issue.

Historical Trends (2014-2023)

1,501 total drug overdose deaths between 2014-2023
Average of 150 drug overdose deaths per year
Death rate increased 37% from 12.2 per 100k (2014) to 16.7 per 100k (2023)
Most increases occurred 2018-2021
Rates stabilized 2021-2023

The decade-long trend shows a clear escalation in overdose mortality, with the most dramatic increases coinciding with the COVID-19 pandemic period. Recent stabilization suggests interventions may be having an effect, though rates remain elevated.

Comparison to Other Causes of Death

Year	Drug Overdose Deaths	Motor Vehicle Deaths	Firearm Deaths
2007	132	268	139
2009	147	227	166
2014-2023	1,501 total	1,930 total	2,244 total

Additional Context

Drug overdoses (1,501) vs. Unintentional falls (1,912) between 2014-2023

Drug overdose deaths have become comparable to traditional injury categories like motor vehicle crashes, reflecting the severity of the substance abuse crisis.

Drug Types Involved in Overdose Deaths

10-Year Totals by Drug Type (2014-2023)

Drug Type	Total Deaths	Rate per 100k
All opioids	728	7.2
All stimulants	511	5.2
Heroin	123	1.3
Fentanyl	323	3.3
Methamphetamine	487	4.9
Codeine/morphine/other opioids	241	2.2
Benzodiazepines	115	1.1
Other/unspecified antidepressants	132	1.2
Methadone	76	0.8
Cocaine	37	0.4

Opioids and stimulants (primarily methamphetamine) dominate Montana’s overdose deaths, with synthetic opioids (fentanyl) showing the most dramatic recent increases.

Polydrug Deaths

55.2% of deaths involved at least two drugs (2019-2023)
Multiple drug deaths became more common than single drug deaths after 2018

Number of Drugs Involved (2019-2023)

1 drug: 44.8% (387 deaths)
2 drugs: 25.7% (222 deaths)
3 drugs: 15.4% (133 deaths)
4 drugs: 7.4% (64 deaths)
5+ drugs: 6.6% (57 deaths)

The majority of recent overdose deaths involve multiple substances, complicating both prevention and treatment efforts. This trend reflects increasingly adulterated drug supplies.

Opioid Epidemic

Opioid Overdose Deaths

129 opioid overdose deaths in 2023
Opioids are a factor in 68.6% of all overdose deaths
12.0 deaths per 100,000 residents (50.0% less than national rate)
Opioid deaths increased 117% from 5.2 per 100k (2014) to 11.3 per 100k (2023)

Despite having half the national opioid overdose death rate, Montana has experienced more than a doubling of opioid-related mortality over the past decade, indicating growing availability and use of opioids.

Fentanyl Crisis

Synthetic opioids (fentanyl) involved in 76.7% of opioid overdose deaths
62 fentanyl overdose deaths in 2021
30% of fatal overdoses involved fentanyl in 2021 (14% increase from 2020)
Fentanyl death rate tripled from 2.7 per 100k (2020) to 8.9 per 100k (2023)
12,079 fentanyl pills seized between January 1-March 15, 2022 (more than 3x all of 2021)

The explosive growth in fentanyl-related deaths and seizures represents the most alarming trend in Montana’s overdose epidemic. The tripling of the death rate in just three years demonstrates fentanyl’s rapid infiltration into the drug Supply.

Prescription Opioids

19.4% of opioid overdose deaths involve prescription opioids
181 deaths linked to prescription opioids from 2012-2015
359 prescription drug overdose deaths from 2011-2013
Doctors write enough prescriptions for 40.4% of residents
21.5 per 1,000 births diagnosed with neonatal Opioid Withdrawal syndrome (2020)

While prescription opioid deaths represent a smaller proportion of total opioid deaths compared to fentanyl, the high prescribing rate and neonatal withdrawal cases indicate ongoing issues with prescription opioid exposure.

Age Distribution of Opioid Deaths

2021 Data

Adults aged 25-44: 58% of deaths
Adults aged 45-64: 38% of deaths
Males: 66% of deaths

Fentanyl-Specific (2021)

Adults aged 25-44: 73% of deaths
Adults aged 45-64: 21% of deaths
Males: 71% of deaths

Young and middle-aged adults bear the brunt of both opioid and fentanyl mortality, with males disproportionately affected. Fentanyl deaths skew even younger than overall opioid deaths.

Health Consequences

16.1 new hepatitis C cases per 100k linked to IV drug use (2022)
1.9 new HIV/AIDS diagnoses per 100k connected to IV drug use (2023)
Nearly $5 million charged by Montana hospitals for opioid-related hospitalizations and ED visits (2021)

Beyond mortality, opioid use drives infectious disease transmission and significant healthcare costs, creating broader public health and economic impacts.

Methamphetamine and Stimulants

Methamphetamine Deaths and Trends

Stimulant deaths increased from 3.1 per 100k (2014) to 8.2 per 100k (2023)
Methamphetamine deaths: 3.1 per 100k (2014) to 8.2 per 100k (2023)
53% of DCI drug investigations in 2016 were meth-related
427% increase in methamphetamine violations between 2010-2015
475% increase in heroin use since 2013

Montana Methamphetamine Deaths and Trends

Methamphetamine represents Montana’s other major drug crisis, with death rates nearly matching opioids. The dramatic increase in violations suggests widespread availability and use.

Methamphetamine Characteristics

Seizures and purity levels continue to increase
Firearms commonly found on offenders
Transported via Interstates 15, 25, and 90
Most commonly concealed in private or rental vehicles

The association with firearms and interstate trafficking routes indicates organized distribution networks and potential for violence.

Demographics of Overdose Deaths

Race and Ethnicity

American Indian/Alaska Native death rate: 52.5 per 100k (2019-2023)
Over 3x the state rate of 16.9 per 100k
White death rate: 13.0 per 100k (2014-2023)
234 American Indian deaths total (2014-2023)
1,231 White deaths total (2014-2023)

American Indian populations experience vastly disproportionate overdose mortality, representing one of the most severe health disparities in the state. This requires culturally-specific interventions and enhanced resources.

Age Groups (2019-2023)

Age Group	Death Rate per 100k	Total Deaths (2014-2023)
≤24 years	3.3	108
25-44 years	30.1	675
45-64 years	24.4	594
65+ years	6.2	124

Working-age adults (25-64) account for the vast majority of overdose deaths, representing lost productivity and family disruption. The relatively low rate among youth suggests prevention efforts may be effective for this group.

Gender

Male death rate: 21.2 per 100k (2019-2023)
Female death rate: 11.9 per 100k (2014-2023)
Males: 878 deaths (2014-2023)
Females: 623 deaths (2014-2023)
Males account for 66% of opioid deaths (2021)

Montana Opioid Overdose Deaths

Males die from overdoses at nearly twice the rate of females, consistent with national patterns and reflecting gender differences in substance use behaviors and risk-taking.

Intent of Overdose

Intent	Percentage	Rate per 100k (2014-2023)
Unintentional	78.8%	11.6
Suicide	14.4%	1.9
Undetermined	6.8%	1.0

Unintentional deaths increased from 7.4 per 100k (2014) to 15.0 per 100k (2023)
Suicide deaths declined from 2.9 per 100k (2014) to 2.2 per 100k (2020)

The overwhelming majority of overdose deaths are unintentional, suggesting victims underestimated drug potency or were unaware of adulteration. The increase in unintentional deaths contrasts with declining suicide deaths.

County-Level Data

Highest Overdose Death Rates by County (2019-2023)

County	Death Rate per 100k	Deaths
Silver Bow	38.7	66
Lake	33.6	45
Yellowstone	23.5	187
Park	21.2	20
Cascade	16.7	62
Missoula	16.0	95
Flathead	14.7	79
Lewis & Clark	14.0	47
Ravalli	9.9	23
Gallatin	8.5	54

Silver Bow County’s rate more than doubles the state average, indicating severe localized crisis. Urban counties (Yellowstone, Missoula) have high total deaths but moderate rates, while some rural counties face disproportionate impacts.

Nonresident Deaths

50 nonresident overdose deaths (2014-2023)
Most common state of residence: Wyoming (18%)

The small number of nonresident deaths suggests Montana’s overdose problem primarily affects residents rather than visitors or transients.

Historical Context and Long-Term Trends

Rate of Change Analysis (2000-2018)

Overdose death rate: 171% increase (4 to 12 per 100k)
First low in 15 years occurred in 2015
Drug-induced death rate (15.1 per 100k in 2009) exceeded national rate (12.8 per 100k)

Montana Rate of Change Analysis

Drug Use Rankings (2009-2010)

Montana ranked in top 10 states for:

Past-month illicit drug use (ages 12-17)
Past-month marijuana use (ages 12+)
Past-month marijuana use (ages 12-17)
Past-month illicit drug dependence/abuse (ages 12-17)

Montana’s long-standing position among highest-use states indicates persistent structural and cultural factors driving substance use, not just recent trends.

Emergency Department and Hospital Data

26,829 ER visits and hospitalizations from drug use (2010-2014)
7,200+ hospital inpatient admissions and ED encounters from prescription drugs alone (2011-2013)

For every overdose death, many more people require emergency medical care, creating substantial healthcare system burden beyond mortality.

Substance Use Prevalence

Youth (Ages 12-17)

Drug Use

8.53% or 7,000 teens used drugs in last month (17.49% more likely than average American teen)
71.43% of teen drug users reported marijuana use
12.39% used marijuana in last year
0.20% used cocaine in last year
0.18% used methamphetamine in last year
2.24% misused prescription pain relievers in last year

Substance Use Disorders

7.18% met criteria for Drug Use Disorder
3.49% met criteria for Alcohol Use Disorder
9.35% had any Substance Use Disorder

Historical Data (2017-2019)

13.3% past-month illicit drug use (higher than regional 8.3% and national 8.2%)
11.3% past-month marijuana use (higher than regional 6.8% and national 6.8%)

Montana youth show elevated rates of substance use compared to national peers, with marijuana being the dominant drug. The high rates of use disorders indicate many teens progress beyond experimentation to problematic use.

Young Adults (Ages 18-25)

Drug Use

41,000 used drugs in last month
33.46% more likely to use drugs than average American in age group
35.64% past-month illicit drug use
48.58% past-year marijuana use
35.80% past-month marijuana use
4.84% past-year cocaine use
10.61% past-year hallucinogen use

Substance Use Disorders

30.53% had Substance Use Disorder
23.85% had Drug Use Disorder
1.22% had Opioid Use Disorder
30.59% classified as needing treatment

Historical Data (2017-2019)

42.6% past-year marijuana use (increased from 2002-2004, higher than national 35.0%)
17.0% had Substance Use Disorder
8.2% had Illicit Drug Use Disorder

Young adults in Montana show alarming rates of substance use and disorder, with nearly one-third meeting criteria for substance use disorder. This age group faces the highest risk and represents a critical intervention target.

Adults (All Ages 12+)

Drug Use (2022-2023)

23.39% (225,000) past-month illicit drug use
28.68% (276,000) past-year marijuana use
21.97% (211,000) past-month marijuana use
1.92% (18,000) past-year cocaine use
1.37% (13,000) past-year methamphetamine use
3.02% (29,000) past-year prescription pain reliever misuse
2.96% (28,000) past-year opioid misuse

Substance Use Disorders

20.23% (195,000) had Substance Use Disorder
11.50% (110,000) had Drug Use Disorder
1.73% (17,000) had Opioid Use Disorder

Historical Data

10.77% past-month illicit drug use (2009-2010, vs. national 8.82%)
10% used illicit drugs within past month (2005-2006)
20.1% past-year marijuana use (2017-2019, higher than national 16.2%)
11.3% non-medical drug use in past year (ranked 5th nationally)

Montana consistently ranks among states with highest substance use rates. Nearly one in four residents used illicit drugs recently, and one in five has a substance use disorder, indicating widespread substance abuse issues across the adult population.

Prescription Drug Abuse Trends (2007-2013)

Age Distribution – Primary Drug

Age Group	2007	2013
Adolescent (0-17)	0%	1%
Young Adult (18-20)	5%	4%
Adult (21-64)	95%	93%
Senior (65+)	0%	1%

Prescription drug abuse as primary drug remains concentrated among working-age adults, with minimal change over time.

Gender Distribution – Primary Drug

Gender	2007	2013
Female	63%	44%
Male	37%	56%

Significant shift toward male predominance in prescription drug abuse from 2007-2013, reversing earlier patterns where females were majority of users.

Race/Ethnicity – Primary Drug (2013)

Race/Ethnicity	Percentage
White	78%
American Indian	17%
Multi-Racial	4%
Other	1%

While White residents represent the majority of prescription drug abuse cases, American Indians are overrepresented relative to their population proportion.

Public Health Risk Perceptions

Marijuana Risk Perception (Ages 12+, 2022-2023)

14.57% perceive great risk from monthly marijuana use
Youth (12-17): 17.47% perceive great risk
Young adults (18-25): 7.88% perceive great risk

Low risk perception, especially among young adults, may contribute to high use rates. Youth show slightly more caution than young adults.

Cocaine Risk Perception

60.82% perceive great risk from monthly cocaine use
Youth (12-17): 46.05% perceive great risk
Young adults (18-25): 49.99% perceive great risk

Higher risk perception for cocaine than marijuana aligns with public health messaging, though nearly half of youth and young adults don’t perceive monthly cocaine use as highly risky.

Heroin Risk Perception

80.40% perceive great risk from trying heroin once or twice
Youth (12-17): 53.59% perceive great risk
Young adults (18-25): 74.74% perceive great risk

High overall risk perception for heroin hasn’t prevented the 475% increase in heroin use since 2013, suggesting risk perception alone is insufficient to deter use.

Treatment Statistics

Treatment Capacity and Utilization

93 active treatment facilities
4,537 clients serviced annually for drug rehab
4,260 clients in outpatient services annually
249 clients in residential (non-hospital) services
28 clients in hospital-based drug rehab
1 facility offers free drug rehab treatment

Historical Data

7,744 people enrolled in treatment (2010): 68.5% male, 31.5% female
5,064 people enrolled (single-day count, 2015)
4,537 people enrolled (single-day count, March 2019)

Treatment capacity has decreased over time despite growing need. The small number of residential and hospital-based treatment slots relative to need suggests significant access gaps.

Treatment by Problem Type (2019)

38.7% received treatment for drug problem only
22.4% received treatment for alcohol problem only
38.8% received treatment for both drug and alcohol problems

The high proportion receiving treatment for multiple substance problems reflects polysubstance use patterns seen in overdose data.

Treatment Costs

Service Type	Average Cost per Person	Public Spending	Number Served
Outpatient	$1,627	$6.93 million (0.3% of U.S. total)	4,260
Residential	$62,530	$15.57 million (0.3% of U.S. total)	249
Average Total	$62,530	N/A	N/A

Montana tied for 44th state (cheapest to most expensive) for residential treatment
Approximately 10,067 adults seek substance abuse treatment annually

While Montana’s residential treatment costs are relatively low, the dramatic cost difference between outpatient ($1,627) and residential ($62,530) care creates financial barriers. With only 10,067 seeking treatment against 195,000 with disorders, most people needing help don’t receive it.

Medication-Assisted Treatment (MAT)

Methadone

727 people receiving methadone (March 2019)
Increased from 489 people (2015)

Buprenorphine

625 people receiving buprenorphine (March 2019)
Increased from 284 people (2015)

MAT utilization has grown substantially, with methadone up 49% and buprenorphine up 120%. However, with 17,000 people having opioid use disorder, only about 8% are receiving evidence-based medication treatment.

Treatment Gaps

5.78% received substance use treatment in past year
22.46% (216,000) classified as needing treatment
73.70% of those needing treatment did not receive it

Age-Specific Treatment Gaps

Ages 12-17: 56.19% needing treatment didn’t receive it
Ages 18-25: 84.21% needing treatment didn’t receive it
Ages 26+: 72.53% needing treatment didn’t receive it

Historical Data

Only 8% of alcohol-dependent people entered treatment
Over 7% (65,000) had alcohol use disorder

The treatment gap is severe across all age groups, with young adults facing the largest gap. For every person receiving treatment, three others who need it go without. This represents a massive unmet need and missed opportunity for intervention.

Primary Drugs of Abuse in Treatment

Marijuana

Most commonly cited drug among primary rehab admissions
29.5% of 12-17 year olds dependent on marijuana (2010)
Highest rates of dependence among adolescents

Marijuana’s position as the most common treatment admission reason, especially among youth, contrasts with its absence from overdose deaths, suggesting different intervention needs for different substances.

Amphetamines/Methamphetamine

498 people entered treatment for amphetamine use (2010)
Largest age group: 26-30 year olds at 23.7%

The age distribution for methamphetamine treatment admissions aligns with overdose death patterns, indicating consistent impact across the adult lifespan.

Prescription Opioids

841 people admitted for opiates other than heroin (2010)
54.1% female, 45.9% male

Unlike other substances, prescription opioid treatment admissions show near gender parity, possibly reflecting prescribing patterns or pain management practices.

Criminal Justice Impact

Drug Arrests and Violations

Drug-related arrests increased 62% between 2009-2015
Drug charges now account for 18% of all arrests
Drug charges are leading categories for both misdemeanor and felony arrests
57% of drug violations involved marijuana (2015)
31% of drug violations involved methamphetamines (2015)

Montana Drug Arrests and Violations

The dramatic increase in drug arrests reflects both increased use and law enforcement focus. The predominance of marijuana arrests contrasts with the greater harm from opioids and methamphetamine.

Incarceration

Jail population rate changed from 261 per 100k (2000) to 349 per 100k (2015)
34% increase in jail population
Overdose death rate increased 171% over same period (4 to 12 per 100k, 2000-2018)

Despite substantial increases in incarceration, overdose deaths increased at five times the rate, suggesting enforcement alone is insufficient to address the crisis.

Montana faces a persistent and evolving substance abuse crisis characterized by rates of illicit drug use consistently above national averages and dramatic increases in overdose deaths driven primarily by fentanyl and methamphetamine. The most urgent concerns include the disproportionate impact on American Indian communities, who experience overdose death rates over three times the state average, and the severe treatment gap where three-quarters of individuals needing substance use services do not receive them. While enforcement efforts have intensified with drug arrests increasing 62%, the corresponding 171% rise in overdose deaths demonstrates that incarceration alone cannot solve this public health emergency. Comprehensive solutions must prioritize expanding access to evidence-based treatment, culturally-appropriate interventions for vulnerable populations, and harm reduction strategies to address Montana’s growing polysubstance use patterns.

Statistical Data on Alcohol in Montana

Montana faces significant challenges with alcohol-related issues, ranking among the states with the highest rates of excessive drinking and alcohol-related fatalities in the United States. The state’s alcohol consumption patterns are notably above national averages across multiple demographics, from youth to adults. This comprehensive report presents data on alcohol use patterns, mortality rates, substance use disorders, treatment needs, and economic impacts in Montana, drawing from multiple years of surveillance data (2002-2024).

Alcohol-Related Deaths

Overall Mortality Statistics

Total Annual Deaths and Demographics

605 annual deaths in Montana are attributable to excessive alcohol use
2.81% of deaths from excessive alcohol use are individuals under age 21
Montana averages 1 death for every 1,792 people aged 18 and older
7.10 deaths per 10,000 adults

Montana’s alcohol-related death rate is exceptionally high, with the state experiencing one death from excessive alcohol use for every 1,792 adults. The relatively low percentage of underage deaths (2.81%) indicates that the primary burden falls on adult populations.

Death Demographics by Gender and Age

68.1% of excessive alcohol use deaths are male
84.0% of deaths are adults aged 35 years and older
62.1% of deaths are from chronic causes (such as Alcohol Use Disorder)

The gender disparity is pronounced, with men accounting for more than two-thirds of alcohol-related deaths. The concentration of deaths in older adults (35+) and the high proportion from chronic causes suggests long-term patterns of excessive drinking rather than acute incidents.

Mortality Trends Over Time

Decade-Long Comparison

2009-2013: 1,563 alcohol-related deaths (5-year total)
2019-2023: 2,941 alcohol-related deaths (5-year total)
This represents nearly double the number of deaths

Rate Increases

The 5-year average annual rate of excessive alcohol deaths per capita increased by as much as 42.0% from 2015 to 2019
15,254 years of potential life are lost to excessive alcohol use each year (CDC estimate)

The dramatic increase in alcohol-related deaths over the past decade—nearly doubling from 1,563 to 2,941—signals a worsening crisis. The 42% increase in per capita death rates from 2015 to 2019 alone demonstrates accelerating mortality trends that demand urgent public health intervention.

Comparative Death Rates

Per Capita Mortality (per 100,000 people)

Category	United States	Montana
Alcohol-induced death rate (adults 25+)	17.3 (2019)	30.9 (2019)
Death rate from alcohol-involved car crashes	2.3 (2018)	6.8 (2018)

Historical Context

From 2006-2010: 390 Montana residents died from alcohol consumption
Rate: 37.7 deaths per 100,000—the highest rate in the country

Montana’s alcohol-induced death rate of 30.9 per 100,000 is nearly double the national average of 17.3. The state’s alcohol-related traffic fatality rate of 6.8 per 100,000 is triple the national rate, highlighting both the prevalence of drinking and the dangerous combination with driving.

Alcohol Use Patterns

Adult Alcohol Consumption (2022-2023)

Past Month Alcohol Use

Age Group	Number (thousands)	Percentage
12+	498	51.75%
12-17	7	7.86%
18-25	64	55.96%
26+	427	55.93%
18+	491	55.94%

More than half of Montana adults (55.94%) reported alcohol use in the past month, with particularly high rates among young adults aged 18-25 (55.96%). The relatively low rate among 12-17 year-olds (7.86%) suggests prevention efforts may be having some impact on the youngest demographic.

Underage Drinking (Ages 12-20)

21,000 individuals aged 12-20 used alcohol in the past month
17.40% prevalence rate
13,000 individuals engaged in binge drinking
10.52% binge drinking prevalence

Montana Underage Drinking Statistics

Nearly one in five Montana minors (17.40%) reported recent alcohol use, with more than half of those (10.52% overall) engaging in binge drinking. This indicates that underage drinkers are more likely to consume alcohol in dangerous patterns.

Comparison to National Data

Indicator	United States	Montana
Adults 18+ drinking in past month	52.8%	59.1%
Adults 18+ binge drinking in past month	15.2%	19.5%

Montana adults drink at notably higher rates than the national average, with a 6.3 percentage point difference in overall consumption and a 4.3 percentage point difference in binge drinking.

Youth Alcohol Use

High School Students

Indicator	United States	Montana
Alcohol use in past 30 days	22.1%	26.2%
Binge drinking in past 30 days	8.8%	13.4%
Binge drinking (2019)	14%	18%

Montana high school students drink at rates 4.1 percentage points higher than the national average, with binge drinking rates 4.6-4.9 percentage points higher. The 18% binge drinking rate (2019 data) means nearly one in five Montana high schoolers engage in this high-risk behavior.

Additional Youth Statistics

One in three high school students reported alcohol use in the last month
Over 50% of students who reported alcohol use also engaged in binge drinking
61% of high school teenagers report having engaged in binge drinking (lifetime)

Montana Youth Alcohol Statistics

The statistic that 61% of Montana high school teenagers have ever engaged in binge drinking is particularly concerning, indicating widespread exposure to dangerous drinking patterns during adolescent development. The fact that over half of student drinkers binge drink suggests normalization of excessive consumption.

Ages 12-17 (2022-2023)

7,000 youth used alcohol in the past month
7.86% prevalence rate

Past Month Alcohol Use Changes (Ages 12-17)

2002-2004: Higher rates
2017-2019: 13.5% or 10,000 youth
Montana rate higher than regional average (8.5%) and national average (9.4%)

While youth drinking has decreased from 2002-2004 to 2017-2019, Montana youth still drink at significantly higher rates than their regional and national peers. The 13.5% rate is 5 percentage points above the regional average and 4.1 points above the national average.

Youth Rank

Montana Value: 9.4% (children ages 12-17 drinking in past month)
Montana Rank: 48th

Montana’s 48th ranking indicates the state has the 3rd highest rate of youth drinking in the nation, representing a critical public health concern for underage populations.

Young Adult Patterns (Ages 18-25)

Binge Drinking Trends (2017-2019)

Montana: 45.7% or 50,000 young adults
Regional average: 36.3%
National average: 35.4%
No significant change between 2015-2017 and 2017-2019

Nearly half of Montana young adults (45.7%) engage in binge drinking—10.3 percentage points above the national average. The lack of improvement between 2015-2017 and 2017-2019 suggests stagnation in addressing this age group’s drinking patterns.

Binge Drinking Patterns

Past Month Binge Alcohol Use (2022-2023)

Age Group	Number (thousands)	Percentage
12+	221	22.94%
12-17	3	3.96%
18-25	40	34.67%
26+	177	23.24%
18+	217	24.75%

Nearly one-quarter of Montana adults (24.75%) engage in binge drinking monthly. Young adults aged 18-25 show alarming rates at 34.67%—more than one in three. This age group’s elevated binge drinking correlates with their higher rates of alcohol use disorder.

Specific Adult Binge Drinking Statistics

19.7% of Montana adults over 18 binge drink at least once per month
Median number of drinks per binge: 5.4 drinks
Top 25% most active drinkers consume: 7.3 drinks per binge
Median binge frequency: 1.6 times monthly
Top 25% most active drinkers binge: 4.0 times per month

Montana Adult Binge Drinking Statistics

The distinction between typical and heavy binge drinkers is significant—the most active quarter of binge drinkers consume 34% more per session (7.3 vs 5.4 drinks) and binge 2.5 times more frequently (4.0 vs 1.6 times monthly), representing a high-risk subpopulation.

Excessive Drinking Rate

Montana: 21.0% (2019 data)
Montana Rank: 45th (indicating high rates relative to other states)
Alternative measurement: 24.3% excessive drinking rate

Montana’s ranking of 45th indicates the state is among the worst five states for excessive drinking. The excessive drinking definition includes both binge drinking and heavy drinking patterns, affecting approximately one in four Montana adults.

Risk Perception

Perceptions of Great Risk from Having 5+ Drinks Once or Twice Weekly (2022-2023):

Age Group	Number (thousands)	Percentage
12+	371	38.59%
12-17	30	36.27%
18-25	39	33.76%
26+	302	39.58%
18+	341	38.81%
Ages 12-20	43	34.84%

Only about one-third of young adults (33.76%) and underage drinkers (34.84%) perceive great risk from regular heavy drinking, compared to nearly 40% of older adults. This lower risk perception among the groups with highest binge drinking rates may contribute to their problematic consumption patterns.

Alcohol Use Disorder

Prevalence (Past Year Alcohol Use Disorder 2022-2023)

Age Group	Number (thousands)	Percentage
12+	105	10.97%
12-17	3	3.49%
18-25	22	18.75%
26+	81	10.61%
18+	103	11.68%
Ages 12-20	9	7.22%

More than one in ten Montana residents aged 12+ (10.97%) meet criteria for alcohol use disorder. The rate nearly doubles for young adults aged 18-25 (18.75%), affecting nearly one in five individuals in this age group. This concentration in young adulthood represents a critical intervention opportunity.

Historical Trends

Young Adults (Ages 18-25)

2002-2004: Higher rates (specific percentage not provided)
2017-2019: 12.5% or 14,000 individuals
Decreased between the two periods
Montana rate similar to regional average (11.7%) and national average (9.8%)

While young adult alcohol use disorder has decreased since 2002-2004, the 2017-2019 rate of 12.5% remained above the national average. The more recent 2022-2023 data showing 18.75% suggests a concerning reversal of this positive trend.

Overall Population (Ages 12+)

2002-2004: Higher rates (specific percentage not provided)
2017-2019: 7.9% or 70,000 individuals
Decreased between the two periods
Montana rate similar to regional average (6.9%) but higher than national average (5.3%)

Montana Alcohol Overall Population Statistics

Despite decreases from 2002-2004 to 2017-2019, Montana’s alcohol use disorder rate remained 2.6 percentage points above the national average. The more recent data (10.97% in 2022-2023) indicates a substantial increase, suggesting worsening conditions.

Treatment and Service Needs

Treatment Receipt (Past Year Substance Use Treatment 2022-2023)

Age Group	Number (thousands)	Percentage
12+	56	5.78%
12-17	5	5.80%
18-25	5	4.74%
26+	45	5.94%
18+	51	5.78%

Treatment receipt rates are remarkably consistent across age groups (4.74%-5.94%), suggesting similar barriers to care regardless of age. However, these rates appear insufficient given the prevalence of disorder and need for treatment.

Treatment Need

Classified as Needing Substance Use Treatment

Age Group	Number (thousands)	Percentage
12+	216	22.46%
12-17	11	12.79%
18-25	35	30.59%
26+	170	22.28%
18+	205	23.38%

Nearly one-quarter of Montana residents (22.46%) are classified as needing substance use treatment, with young adults aged 18-25 having the highest need at 30.59%—nearly one in three. This represents a massive treatment gap.

Not Receiving Treatment Among Those Needing It

Age Group	Number (thousands)	Percentage Not Receiving Treatment
12+	156	73.70%
12-17	6	56.19%
18-25	31	84.21%
26+	119	72.53%
18+	150	74.66%

The treatment gap is alarming—nearly three-quarters (73.70%) of those needing treatment do not receive it. Young adults aged 18-25 face the worst treatment gap at 84.21%, meaning more than four out of five who need treatment go without it. Youth aged 12-17 have the best (though still poor) treatment access at 56.19% not receiving needed care.

Treatment Entry Statistics (2010)

Alcohol-Specific Treatment

2,003 people entered rehab for alcohol only
2,699 people entered treatment for alcohol combined with a secondary drug
Total: 4,702 individuals receiving treatment for alcohol abuse

Treatment Facilities (2024)

Among Montanans receiving treatment for substance use disorders: 66.7% reported alcohol as primary substance
Additional 8.4% reported alcohol as secondary substance
Combined: 75.1% of treatment recipients report alcohol misuse

Alcohol remains the dominant substance of concern in Montana’s treatment system, with three-quarters of treatment recipients reporting alcohol issues. The 2010 data of 4,702 treatment entries represents a significant population requiring intensive services.

Healthcare Utilization and Costs

Hospital and Emergency Services

2023 Statistics

16,914 alcohol-related hospitalizations and emergency department visits
$222 million charged by Montana hospitals
Average cost per incident: $13,125

The $222 million in annual hospital charges represents a substantial healthcare burden, averaging over $13,000 per alcohol-related visit. The 16,914 visits translate to more than 46 alcohol-related hospital or ED visits every day in Montana.

2019 Statistics

18,157 alcohol-related hospitalizations and emergency department visits
$189 million charged by Montana hospitals

Comparing 2019 to 2023, there was a 6.8% decrease in visit volume (18,157 to 16,914) but a 17.5% increase in costs ($189M to $222M), suggesting either increased severity of cases or healthcare cost inflation.

Historical Context (2010-2014)

41,595 emergency room visits and hospitalizations for alcohol use over 5 years
Average: 8,319 per year

The doubling from an average of 8,319 annual visits (2010-2014) to 16,914 visits (2023) demonstrates a dramatic escalation in acute alcohol-related healthcare needs over the past decade.

Emergency Medical Services (2019)

79% of all substance use-related EMS activations involved alcohol

The dominance of alcohol in emergency medical responses underscores its role as the primary substance crisis in Montana, far exceeding all other substances combined.

Economic Impact

Taxpayer Costs (2010, inflation-adjusted)

Original cost: $870.8 million
2022 equivalent: $1.176 billion
Cost per drink: $2.34 (2022 dollars)

Montana Alcohol Economic Impact Statistics

Montana taxpayers bear more than $1 billion annually in costs from excessive alcohol use, equivalent to $2.34 for every alcoholic drink consumed in the state. This includes healthcare, law enforcement, lost productivity, and other societal costs.

Traffic Safety and Impaired Driving

DUI Arrests and Fatalities

DUI Arrests (2023)

3,997 DUI arrests in Montana
13.6% of all arrests made by law enforcement were alcohol-related DUIs

More than one in eight arrests in Montana are for DUI, indicating the substantial law enforcement resources devoted to addressing impaired driving and the prevalence of this dangerous behavior.

Fatal Crashes Involving Alcohol

Indicator	United States	Montana
Fatal crashes involving impaired driver (BAC 0.08+)	31.8%	33.3%
Alcohol-related traffic fatalities (2018)	—	37%
Driving fatalities involving alcohol	—	46%

Montana consistently exceeds national averages for alcohol involvement in fatal crashes. The statistic that 46% of driving fatalities involve alcohol—nearly half of all traffic deaths—represents a severe public safety crisis. Montana has the highest percentage of alcohol-involved driving fatalities in the nation.

Self-Reported Impaired Driving

Adults

2017-2018: 14% of Montana adults reported driving under the influence in the past year
National average (same period): 9%

Montana adults drive under the influence at rates 55% higher than the national average, indicating both high rates of impairment and concerning attitudes toward impaired driving.

Students

Group	Behavior	Percentage
College students	Drove under influence in past 3 months	>20%
High school students	Drove under influence in past 30 days	~6%
High school students	Rode with impaired driver in past 30 days	16.8%

More than one-fifth of college students reported recent impaired driving, representing a particularly dangerous behavior among young adults. The 16.8% of high school students who rode with impaired drivers indicates widespread exposure to risk, even among those not driving themselves.

Alcohol Sales Data

Spirits Sales (2024)

Volume Sales by Category (9-liter cases in thousands)

Category	Volume Sales
Vodka	312
Straight Whiskey	138
Cordials/Liqueurs	139
Canadian Whisky	171
Rum	79
Tequila	78
Cocktails	76
Gin	39
Irish Whiskey	25
Scotch Whisky	13

Total Spirits: 1,070 thousand 9-liter cases

Vodka dominates Montana’s spirits market with 312,000 cases (29.2% of total spirits sales), followed by whiskey categories. The combined whiskey sales (straight, Canadian, Irish, and Scotch) total 347,000 cases, representing 32.4% of the spirits market.

Beer Sales (2023)

Volume Sales by Category (9-liter cases in millions)

Category	Volume Sales
Light	4.4
Craft	2.7
Super & Super Premium	1.6
FMBs & Hard Seltzer	1.4
Imported	1.3
Popular	0.8

Total Beer: 12.2 million 9-liter cases

Light beer dominates Montana’s beer market at 4.4 million cases (36.1% of beer sales). Craft beer holds strong second place at 2.7 million cases (22.1%). The 1.4 million cases of flavored malt beverages and hard seltzers represent growing alternative alcoholic beverage preferences.

Wine Sales (2023)

Volume Sales by Category (9-liter cases in thousands)

Category	Volume Sales
Table Wine	887
Champagne & Sparkling	55
Dessert & Fortified	8
Wine Based RTD	3
Vermouth & Aperitif	3

Total Wine: 956 thousand 9-liter cases

Table wine comprises the vast majority of wine sales at 887,000 cases (92.8% of wine sales). Champagne and sparkling wines are distant second at 55,000 cases. The wine market is substantially smaller than beer (956,000 vs 12.2 million cases).

Overall Alcohol Sales Summary

Beer: 12,200,000 cases (85.6%)
Spirits: 1,070,000 cases (7.5%)
Wine: 956,000 cases (6.7%)

Total: 14,226,000 9-liter cases

Beer dominates Montana’s alcohol market, accounting for more than 85% of total volume sales. The high volume of alcohol sales corresponds with Montana’s elevated consumption and problem drinking rates documented throughout this report.

Montana faces a severe and worsening alcohol crisis characterized by exceptionally high rates of consumption, binge drinking, disorder, mortality, and impaired driving compared to national averages. The data reveals persistent patterns across age groups, with particularly concerning rates among young adults and high school students, substantial treatment gaps, and mounting economic and healthcare costs. Addressing Montana’s alcohol crisis requires comprehensive interventions spanning prevention, treatment access, enforcement, and policy measures.

Conclusion

In general, Montana confronts a critical dual substance crisis characterized by escalating drug overdose deaths—increasing 37.59% over three years, driven primarily by fentanyl and methamphetamine—and alcohol-related mortality that has nearly doubled in the past decade, with 605 annual deaths from excessive drinking. The state consistently ranks among the nation’s highest for substance use prevalence across all age groups, yet faces severe treatment gaps where three-quarters of individuals needing care do not receive it. American Indian populations experience particularly devastating disparities, with overdose death rates more than triple the state average, while young adults aged 18-25 show alarming rates of both substance use disorders (30.53%) and binge drinking (45.7%). Despite increased law enforcement efforts, the crisis continues to worsen, demanding comprehensive public health interventions that prioritize expanded treatment access, culturally-appropriate services for vulnerable populations, and evidence-based harm reduction strategies.