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

Statistical Data on Drugs in South Dakota

South Dakota maintains an overdose death rate lower than the national average and ranks second-lowest nationally for youth drug use, demonstrating significant prevention success. However, the state faces a dual epidemic of methamphetamine and fentanyl driving nearly equal shares of overdose deaths. Despite these challenges, a critical treatment gap persists: 76% of the 146,000 residents needing substance use treatment cannot access it, and fewer than 1% of those with opioid use disorder receive medication-assisted treatment. This comprehensive statistical overview presents South Dakota’s complete substance use landscape, revealing both notable achievements in prevention and urgent infrastructure gaps requiring immediate policy attention.

Drug Overdose Statistics

Overall Overdose Data

Annual overdose deaths: 95
Percentage of all deaths from overdose: 1.11%
Overdose death rate: 11.3 deaths per 100,000 residents
National comparison: 68.18% lower than the national rate
State’s share of nationwide OD deaths: 0.09%
3-year trend: 7.62% increase in OD deaths

South Dakota Overall Overdose Data

South Dakota maintains significantly lower overdose death rates than national averages, though deaths have increased modestly over three years.

Recent Trends (2020-2023)

Total unintentional and undetermined overdose deaths (2020-2023): 284
2023 deaths: 65
2022 deaths: 74
Year-over-year change (2022-2023): 12% decrease
Overdose type breakdown: unintentional (accidental): 98%; undetermined intent: 2%
Most common overdose category: Substance use/misuse (74%)

The 12% decrease from 2022 to 2023 continues South Dakota’s lower-than-average overdose rates. The overwhelming majority being unintentional suggests prevention should focus on education and harm reduction.

Drug-Induced Deaths (2009)

Total drug-induced deaths: 51
Death rate: 6.3 per 100,000
National death rate: 12.8 per 100,000
Comparison deaths in South Dakota (2009): motor vehicle accidents: 134; firearms: 75

The increase from 51 deaths (2009) to 95 (current) represents an 86% increase over approximately 14 years.

Overdose Death Demographics and Circumstances (2020-2023)

Sex Distribution

Males: 60% of overdose deaths (rate: 9.2 per 100,000)
Females: 40% of overdose deaths (rate: 6.5 per 100,000)

South Dakota Overdose Sex Distribution Statistics

Males face 42% higher overdose death rates, requiring targeted prevention strategies.

Age and Race Distribution

Highest risk group: Adults aged 35-44 years
White: 62% of deaths (rate: 5.8 per 100,000)
American Indian: 30% of deaths (rate: 26.6 per 100,000)
Other: 8% of deaths

American Indians die at 4.6 times the rate of Whites—a public health crisis requiring culturally specific interventions and expanded tribal services.

Substances Involved in Overdose Deaths

Primary Substances (2020-2023)

Stimulants: 51% of deaths
Opioids: 47% of deaths

2023 Patterns

Opioids without stimulants: 43%
Stimulants without opioids: 38%

The nearly equal distribution between opioid and stimulant deaths indicates a dual epidemic requiring different prevention approaches for each drug class.

Opioid Overdose Data

Opioid overdose deaths (2023): 48
Opioid death rate: 5.7 per 100,000 residents
National comparison: 76.3% lower than national death rate
Opioids as factor in all overdoses: 50.5%
Synthetic opioids in opioid deaths: 87.5%
Prescription rate: Enough for 35.8% of residents

South Dakota Opioid Overdose Data

Despite below-average rates, fentanyl dominance mirrors national trends. High prescription rates suggest need for continued prescribing oversight.

Opioid-Related Health Impacts

Neonatal Opioid Withdrawal syndrome (2020): 6.7 per 1,000 births
Neonatal abstinence syndrome (2021): 2.1 per 1,000 hospitalized newborns
Hepatitis C cases linked to IV drug use (2022): 8.3 new cases (estimated)
HIV/AIDS diagnoses linked to IV drug use (2023): 3.3 new cases (estimated)

Health consequences extend beyond overdoses to newborns and infectious diseases, though rates remain relatively low.

Overdose Circumstances and Risk Factors

Substance Use History and Evidence

Known substance use history: 54% (Methamphetamine 36%, Opioids 24%)
Evidence of drug use at scene: 50% (Illicit 45%, Prescription 41%)

Over half had documented substance use history, indicating missed intervention opportunities.

Location of Overdose and Death

Overdose location: House/apartment 78%, Hotel/motel 5%, Street 4%
Death location: House/apartment 57%, Hospital 24%, Other 18%

Most overdoses occur in private residences where intervention depends on bystander action. Only 24% reach hospitals before death.

Youth Drug Use (Ages 12-17)

Current Use Statistics (2022-2023 Average)

Illicit drug use in past month: 5.49% (4,000 youth)
Alcohol use in past month: 6.25%
Marijuana use in past month: 4.82%
Marijuana use in past year: 8.37% (6,000 youth)
Cocaine use in past year: 0.21%
Methamphetamine use in past year: 0.15%
Pain reliever misuse in past year: 1.91%

National Comparisons

Drug use comparison: 24.31% less likely than average American teen
Alcohol use comparison: 9.15% less likely than average American teen
Marijuana prevalence among drug users: Nearly 100%

South Dakota youth demonstrate significantly lower substance use rates than national averages, suggesting successful prevention efforts.

Youth Substance Use Disorders

Drug Use Disorder (DUD) prevalence: 5.84%
Alcohol Use Disorder (AUD) prevalence: 2.99%

While overall use rates are low, nearly 6% meeting DUD criteria indicates those who use face significant risk.

Historical Youth Trends (2017-2019 Averages)

Past-month marijuana use: 6.5% (4,000 youth)
Past-month illicit drug use: 8.3% (6,000 youth)
First-time alcohol use: 9.6% (7,000 youth)
First-time marijuana use: 3.6% (2,000 youth)
First-time cigarette use: 1.8% (1,000 youth)

Comparing 2017-2019 to 2022-2023 data shows slight decreases in marijuana and overall illicit drug use among youth, continuing positive trends.

Young Adult Substance Use (Ages 18-25)

Current Use Statistics (2022-2023 Average)

Illicit drug use in past month: 19.98% (19,000 young adults)
Marijuana use in past year: 34.46% (33,000 young adults)
Marijuana use in past month: 19.79% (19,000 young adults)
Cocaine use in past year: 3.39%
Heroin use in past year: 0.35%
Hallucinogen use in past year: 5.80%
Methamphetamine use in past year: 1.34%
Prescription pain reliever misuse: 2.25%
Opioid misuse in past year: 2.93%

Substance Use Disorders

Substance Use Disorder: 30.87%
Drug Use Disorder: 15.79%
Opioid Use Disorder: 1.17%
National comparison: 25.18% less likely to use drugs than average American

Nearly one-third meet SUD criteria—the highest risk population. This age group requires targeted interventions.

Historical Young Adult Trends (2017-2019 Averages)

Past-year marijuana use: 29.5% (27,000)
Marijuana use disorder: 5.4% (5,000)
Opioid use disorder: 0.9% (1,000)
Illicit drug use disorder: 8.0% (7,000)
Substance use disorder: 18.8% (17,000)

Comparing periods shows increases in both marijuana use and overall substance use disorder rates among young adults, indicating this population requires targeted interventions.

Adult Population Statistics (Ages 12+)

Overall Substance Use (2022-2023 Average)

Illicit drug use in past month: 13.30% (100,000 people)
Marijuana use in past year: 18.55% (139,000 people)
Marijuana use in past month: 11.85% (89,000 people)
Illicit drugs other than marijuana (past month): 2.84% (21,000 people)
Cocaine use in past year: 1.50% (11,000 people)
Hallucinogen use in past year: 1.94% (14,000 people)
Methamphetamine use in past year: 1.18% (9,000 people)
Prescription pain reliever misuse: 3.15% (24,000 people)
Opioid misuse in past year: 2.95% (22,000 people)

Substance Use Disorders

Overall SUD: 17.51% (131,000 people)
Drug Use Disorder: 8.44% (63,000)
Opioid Use Disorder: 1.99% (15,000)

Nearly one in five residents meet SUD criteria, representing a substantial public health challenge.

Historical Adult Trends (2017-2019 Averages)

Past-year marijuana use: 11.5% (82,000)
Marijuana use disorder: 1.4% (10,000)
Heroin use in past year: 0.02% (less than 500)
Prescription pain reliever misuse: 3.2% (23,000)
Opioid use disorder: 0.7% (5,000)
Illicit drug use disorder: 2.5% (18,000)
Substance use disorder: 8.0% (57,000)

The doubling of SUD prevalence from 8.0% to 17.51% is particularly concerning and requires comprehensive response.

Risk Perceptions

Great risk from marijuana monthly: 18.87%
Great risk from cocaine monthly: 64.45%
Great risk from heroin once/twice: 79.01%

Lower marijuana risk perception potentially contributes to higher use rates.

Non-Medical Drug Use Ranking

National Ranking

South Dakota value: 10.8%
National rank: 4th
Definition: Non-medical prescription drugs or illicit drugs (excluding cannabis) past year

Despite lower overdose rates, 4th-place ranking indicates substantial misuse with potential for worsening outcomes.

Youth Illicit Drug Use Ranking

South Dakota value: 5.5%
National rank: 2nd lowest
Definition: Ages 12-17 illicit drug use (including marijuana) past month

Exceptional youth performance represents significant prevention success.

Drug Treatment and Rehabilitation

Treatment Facilities and Capacity

Active substance abuse clinics: 64
Total patients served annually: 2,864
Outpatient services enrollment: 2,346 patients annually
Residential (non-hospital) services enrollment: 370 patients
Hospital-based drug rehab patients: 148
Free treatment facilities: 3

South Dakota Treatment Facilities and Capacity Statistics

Treatment capacity appears adequate for current demand, with a strong emphasis on outpatient services (82% of patients).

Treatment Costs

Residential average: $56,108 (10th cheapest nationally)
Outpatient average: $1,969 (2nd most expensive nationally)
Dual diagnosis: 60% involve both drug and alcohol

High outpatient costs create potential barriers despite low residential costs.

Spending on Treatment Services

Outpatient services: $4.62 million (0.2% of U.S. public total)
Residential treatment: $20.76 million (0.4% of U.S. public total)

The higher spending on residential versus outpatient care reflects the intensity and duration of residential treatment, though fewer patients access this level of care.

Substance Use Treatment Needs and Access

Treatment Statistics (2022-2023 Average)

Received substance use treatment: 4.64% (35,000 people)
Classified as needing treatment: 19.40% (146,000 people)
Not receiving treatment among those needing it: 75.81% (109,000 people)

By Age Group

Age Group	Need Treatment	Received Treatment	Treatment Gap
12-17 years	11.59%	4.44%	58.41% not receiving
18-25 years	32.36%	4.53%	85.62% not receiving
26+ years	18.27%	4.68%	74.21% not receiving

Massive treatment gap with three-quarters untreated. Young adults face largest gap (85.62%) despite highest need.

Funding Sources

Facilities receiving federal, state, county, or local government funds for substance use treatment: 81.0% (47 facilities)

Heavy public funding reliance underscores need for sustained government investment.

Treatment Episode Data (2023 TEDS-D)

Total Discharges and Primary Substances

Total treatment discharges: 17,872

Primary Substance	Number	Percentage
Alcohol Only	9,103	50.9%
Amphetamines	4,069	22.8%
Alcohol with secondary drug	2,717	15.2%
Marijuana	1,044	5.8%
Other opiates	276	1.5%
Other/Unknown	395	2.2%
Cocaine (other route)	67	0.4%
Heroin	86	0.5%
Other stimulants	54	0.3%
Cocaine (smoked)	13	0.1%
Sedatives	24	0.1%
Tranquilizers	8	0%
Hallucinogens	6	0%
Inhalants	10	0.1%
PCP	0	0%

Alcohol (66.1% combined) and methamphetamine (22.8%) are primary treatment challenges.

Demographics of Treatment Population

Gender Distribution

Male: 66.9%
Female: 33.1%

Males are twice as likely as females to be in treatment, though this varies by substance.

Age Distribution (All Substances)

Age Group	Percentage
12-17 years	3.1%
18-20 years	2.8%
21-25 years	10.0%
26-30 years	13.6%
31-35 years	16.8%
36-40 years	15.5%
41-45 years	11.8%
46-50 years	9.2%
51-55 years	6.4%
56-60 years	6.2%
61-65 years	3.5%
66+ years	1.1%

Peak treatment admissions occur in the 31-35 age range (16.8%), with adults aged 26-40 representing 45.9% of all admissions.

Race Distribution

White: 52.2%
American Indian or Alaska Native: 45.3%
Black or African-American: 1.4%
Asian/Pacific Islander: 0.1%
Other: 0.8%
Unknown: 0.2%

American Indians are significantly overrepresented in treatment admissions relative to their population share, particularly for alcohol-only treatment (63.7%).

Facility Operations and Services (2020 N-SSATS)

Facility Overview

Total facilities surveyed: 58
Survey response rate: 89.2%
Total clients on March 31, 2020: 2,371
Clients under 18: 195 (8.2%)

South Dakota Facility Overview Statistics

Facility Operation Type

Operation Type	Facilities	% of Facilities	Clients	% of Clients
Private non-profit	34	58.6%	1,801	76.0%
Private for-profit	9	15.5%	141	5.9%
Tribal government	6	10.3%	315	13.3%
Federal government	6	10.3%	98	4.1%
State government	2	3.4%	16	0.7%
Local/county/community government	1	1.7%	—	—

Private non-profits dominate, while tribal facilities serve significant minority.

Substance Abuse Problem Treated

Problem Type	Facilities	% of Facilities	Clients	% of Clients	Rate per 100,000 adults
Both alcohol and drug	31	53.4%	1,230	62.2%	182
Alcohol only	27	46.6%	482	24.4%	71
Drug only	24	41.4%	267	13.5%	40

Most clients have complex dual problems requiring comprehensive approaches.

Facility Capacity and Utilization

Residential: 91.6% utilization (107 beds)
Hospital inpatient: 76.7% utilization (60 beds)

High utilization indicates strong demand and potential access challenges.

Medication-Assisted Opioid Therapy (MAOT)

Current Capacity

OTP facilities: 1
Total receiving MAT: 110 clients (Buprenorphine 58, Naltrexone 52)

South Dakota Medication Assisted Opioid Therapy Statistics

Historical Trends

2015: 5 methadone, 5 buprenorphine
2019: 130 methadone, 12 buprenorphine

Despite increases, only 110 of 15,000 with OUD receive MAT—less than 1% coverage. Critical treatment gap with only 1 OTP facility statewide.

Historical Treatment Trends

Treatment Admissions by Substance (2011)

Marijuana: 59%
Stimulants (including methamphetamine): 21%

Treatment Admissions (2010)

Total individuals entering treatment: 14,615
Males: 72.1%
Females: 27.9%

South Dakota Treatment Admissions Statistics

Historical data shows marijuana dominated treatment admissions in 2011, but current data shows alcohol as the primary substance, suggesting shifting patterns toward alcohol or changes in treatment-seeking behavior.

Facility and Program Trends (2006-2010)

Alcohol and drug rehabs (2006): 59 facilities
Residential treatment facilities (year unspecified): 24
Certified opiate addiction treatment facilities: 1

Patient admissions for illicit drugs combined with alcohol:

1998: 28%
2005: 41%

Steady growth in polysubstance (alcohol plus drugs) admissions demonstrates increasing complexity of substance use disorders.

Historical Substance-Specific Treatment Admissions

Marijuana (2007)

Treatment admissions: 1,959 individuals (60% of total)
Gender: 73% male
Largest age group: 12-17 years

South Dakota Marijuana Treatment Admissions Statistics

Marijuana’s dominance in 2007 treatment admissions, particularly among youth, contrasts with current patterns where alcohol and methamphetamine lead.

Stimulants/Amphetamines (2010)

Treatment admissions for amphetamine dependence: 649 people

Methamphetamine has remained a persistent challenge.

Other Opiates (Prescription Opioids)

Treatment admissions: 357 people
Gender: 52% female
Largest age group: 21-25 years

Prescription opioid treatment admissions showed female predominance, contrasting with male majority for most other substances.

Drug-Related Arrests and Enforcement (2005)

DEA meth lab seizures (2005): 16
Comparison to 2002-2003: Nearly 50% reduction
Drug arrests (2005): 85

Significant reduction in meth lab seizures from 2002-2003 to 2005 suggests successful law enforcement efforts, though current methamphetamine problems indicate Supply shifted from local production to trafficking networks.

South Dakota maintains overdose death rates 68% below the national average and ranks second-lowest for youth drug use, yet faces critical challenges including a dual methamphetamine-fentanyl epidemic and American Indian overdose rates 4.6 times higher than White residents. The most urgent crisis is treatment access: 76% of those needing care cannot receive it, and fewer than 1% of people with opioid use disorder access medication-assisted treatment. Expanding MAT capacity, closing treatment gaps—especially for young adults facing an 86% unmet need—and implementing culturally appropriate interventions for American Indian communities are essential priorities for building on the state’s prevention successes.

Statistical Data on Alcohol in South Dakota

South Dakota faces significant challenges with alcohol consumption and its consequences, ranking among the states with the highest rates of excessive drinking and alcohol-related deaths in the nation. The state’s statistics reveal concerning patterns across all age groups, with particular impact on American Indian communities and young adults. This comprehensive report examines the prevalence of alcohol use, its health consequences, and demographic patterns based on available data.

Alcohol-Related Deaths

Average annual deaths: 463
State death rate: 31.4 per 100,000 (2019-2023)
U.S. death rate: 12.7 per 100,000
National ranking: 3rd highest
Death ratio: 1 death per 1,915 people aged 18+
Rate per adults: 6.92 deaths per 10,000 adults

South Dakota Alcohol Related Deaths Statistics

South Dakota’s alcohol-related death rate is more than double the national average.

Death Trends

2023 deaths: 306
2024 deaths: 365 (19% increase)
5-year rate increase (2015-2019): 64.7%

Despite a brief decline in 2023, alcohol-related deaths surged dramatically in 2024, continuing a long-term upward trend.

Demographics of Deaths

Gender

Males: 66.1% of deaths (rate: 39.8 per 100,000)
Females: 33.9% of deaths (rate: 21.6 per 100,000)

Age

82.5% occur in adults aged 35 and older
Ages 50-59 have the highest rate
Under age 21: 3.89% (16 deaths)

Alcohol-Related Death Rates by Race (2015-2024)

Race	Percentage of Deaths	Rate per 100,000	Rate Comparison
White	54%	19.6	Baseline
American Indian	43%	150.0	7.6x higher than White
Other	3%	–	–

American Indian alcohol-related death rates are 7.6 times higher than White rates, with both males and females experiencing elevated rates.

Causes of Death

Alcohol-associated liver disease: 64% of deaths
Chronic causes (including Alcohol Use Disorder): 65.9%
Acute causes: 34.1%

Manner of Death for Alcohol Poisoning/Acute Intoxication

Manner of Death	Percentage
Unintentional/Accidental	78%
Suicide	14%
Homicide	3%
Natural Causes	3%
Undetermined	2%
Legal Intervention	<1%

Among 362 unintentional deaths, the leading causes were alcohol poisoning/toxic effects (24%), transportation/machinery accidents (19%), and falls (16%).

High-Risk Counties

Counties with Highest Age-Adjusted Alcohol-Related Death Rates (per 100,000)

County	Rate per 100,000
Buffalo	214.5
Mellette	185.8
Corson	164.8
Oglala Lakota	164.8
Dewey	161.4

Alcohol Consumption Patterns

General Population Use

Past-Month Alcohol Consumption by Age Group (2022-2023)

Age Group	Number of People	Percentage
12+	374,000	49.84%
12-17	5,000	6.25%
18-25	52,000	54.73%
26+	318,000	54.70%
12-20	14,000	13.16%

South Dakota’s overall drinking rate of 57% (2017-2021 data) exceeds the nationwide median of 53%.

Binge Drinking Prevalence

Past-Month Binge Drinking by Age Group (2022-2023)

Age Group	Number of People	Percentage
12+	175,000	23.30%
12-17	3,000	3.51%
18-25	33,000	35.10%
26+	139,000	25.51%
12-20	8,000	8.15%

South Dakota’s binge drinking rate of 20-21% significantly exceeds the nationwide median of 15%.

Heavy Drinking

South Dakota: 7%
Nationwide median: 6%
Combined excessive drinking (heavy + binge): 27%
National ranking: 4 (one of the highest rates)

While South Dakota’s heavy drinking rate is only slightly above the national median, the combined impact is severe—over one in five adults engage in excessive drinking.

Alcohol Use Disorder (2022-2023)

Total population 12+: 85,000 people (11.33%)
Ages 12-17: 2,000 people (2.99%)
Ages 18-25: 19,000 people (19.65%)
Ages 26+: 64,000 people (11.04%)
Ages 12-20: 6,000 people (5.80%)

The 18-25 age group shows particularly high rates of alcohol use disorder at 19.65%, nearly double the rate for adults 26 and older.

Demographic Patterns in Alcohol Use

Gender Differences

Past-Month Alcohol Use (2017-2021)

Males: 64%
Females: 50%

Binge Drinking

Males: 25%
Females: 14%

Heavy Drinking

Males: 8%
Females: 6%

Males consistently show higher rates across all drinking categories.

Age Group Analysis

Binge Drinking Rates by Age Group (2017-2021)

Age Group	Percentage	95% CI Low	95% CI High
18-29	31%	28.1%	33.7%
30-39	25%	22.4%	27.9%
40-49	25%	22.3%	28.0%
50-59	19%	16.8%	20.9%
60-69	11%	9.5%	12.6%
70-79	4%	3.2%	5.5%
80+	2%	1.3%	3.6%

Young adults (18-25) show the highest rates, with 44.6% reporting past-month binge drinking during 2017-2019, exceeding both the regional average (36.3%) and national average (35.4%).

Race and Ethnicity

Past-Month Alcohol Use (2017-2021)

White, Non-Hispanic: 59%
Hispanic: 54%
American Indian/White, Non-Hispanic: 49%
American Indian, Non-Hispanic: 35%

American Indian populations show significantly lower rates of past-month alcohol use compared to other groups.

Socioeconomic Factors

By Household Income

Less than $35,000: 45% (binge: 18%)
$35,000-$74,999: 60% (binge: 20%)
$75,000+: 72% (binge: 24%)

By Education

Less than High School: 40% (binge: 18%)
High School/GED: 50% (binge: 19%)
Some Post-High School: 61% (binge: 21%)
College Graduate: 67% (binge: 19%)

Higher income and education strongly correlate with increased alcohol consumption, though binge drinking rates remain relatively stable across all socioeconomic levels.

County-Level Excessive Drinking

Counties with ≥20% excessive drinking: 57 of 67 counties
Highest rate: Marshall County (25%)
Lowest rate: Todd and Oglala Lakota Counties (17%)

South Dakota Alcohol County Level Excessive Drinking Statistics

Excessive drinking is widespread across South Dakota, affecting the vast majority of counties at concerning levels.

Nonfatal Alcohol-Related Visits

From 2020-2024, South Dakota recorded 36,089 alcohol-related hospitalizations and emergency department visits. In 2024, there were 5,267 ED visits, the highest count in five years.

Causes of Visits

Alcohol Use Disorder/use/misuse: most common
Non-alcohol-related diagnoses with elevated blood alcohol levels (≥80mg/100ml): second most common

Demographics of Visits

Nonfatal Alcohol-Related Visit Rates by Demographics (2020-2024)

Demographic	Percentage	Rate per 100,000	Rate Comparison
Gender
Males	67%	1,045.8	2x higher than females
Females	33%	535.4	Baseline
Race
White	46%	430.1	Baseline
American Indian	47%	4,249.7	9.9x higher than White
Other	8%	–	–

Age: Individuals aged 30-59 are at highest risk

American Indian visit rates are 9.9 times higher than White rates, representing one of the most significant health disparities in the state

Traffic Safety

Alcohol-impaired driving deaths (2016-2020): 223 (10th-lowest nationally)
Percentage of all driving deaths involving alcohol: 36% (6th-highest nationally)
Alcohol-related crash deaths (2022): 46
Fatal crashes involving drivers ages 15-20 with BAC > 0.01%: 18%
Counties with 100% alcohol-involved driving deaths (2016-2020): Spink, Perkins, Mellette

While South Dakota has relatively few total alcohol-impaired driving deaths, alcohol is disproportionately involved in a high percentage of all traffic fatalities.

Economic Impact

2010 taxpayer spending on excessive alcohol use: $598.2 million
2022 inflation-adjusted equivalent: $807.6 million
Cost per alcoholic drink: $2.15
Years of potential life lost annually: 12,203

South Dakota Alcohol Economic Impact Statistics

The economic burden of excessive alcohol use represents over $800 million in taxpayer costs, with each drink carrying a hidden societal price tag of $2.15 beyond its purchase cost.

South Dakota faces a critical public health crisis with alcohol consumption, ranking third nationally in alcohol-related deaths and 46th in excessive drinking rates. The most alarming disparities exist within American Indian communities, where death rates are 7.6 times higher and hospitalization rates are 9.9 times higher than White populations. Despite recent declines, the 64.7% increase in alcohol-related deaths from 2015 to 2019 and the 19% surge in 2024 demonstrate an escalating problem that demands immediate, comprehensive intervention across all demographic groups.

Conclusion

In general, South Dakota presents a paradox in substance use: exceptional prevention success with overdose death rates and the second-lowest youth drug use, yet a severe alcohol crisis with the third-highest alcohol-related death rate nationally. The state’s most critical challenge is the profound treatment gap—76% of those needing substance use treatment cannot access it, and fewer than 1% with opioid use disorder receive medication-assisted treatment. American Indian communities bear a disproportionate burden, with alcohol-related death rates 7.6 times higher and overdose rates 4.6 times higher than White populations, demanding immediate culturally-specific interventions. Addressing these infrastructure gaps while maintaining prevention successes requires urgent expansion of treatment capacity, particularly MAT services, and comprehensive strategies targeting the 85% treatment gap among young adults.