By Edmund Murphy

Last updated: 14 January 2024 & medically reviewed by Dr. Samantha Miller

Over 165 million Americans abuse illicit and illegal substances. Here are the top 10 most abused substances in the USA currently.

What are the top 10 most common addictions?

Nicotine (tobacco)

Nicotine is the most common substance to become addicted to in the United States, with approximately 50 million Americans addicted to some form of tobacco product. Nicotine is a stimulant and an addictive substance in tobacco and is found in cigarettes, cigars, and chewing tobacco. Tobacco is legal and is one of the most readily available and socially acceptable addictive substances. Nicotine has a stimulant effect, increasing blood pressure and heart rate, but not to the same euphoric levels as, for example, cocaine. It takes a long time to develop harmful and life-threatening symptoms from tobacco use, including respiratory illness, cardiovascular disease, and cancer.


Alcohol is also readily available, legal, and socially acceptable, making it the second most common addiction in the United States. The social acceptance of drinking can make alcohol addiction hard to spot. Alcohol’s potential for abuse opens users up to many health risks and possible addiction despite its legal status. Many people can enjoy alcohol in recommended quantities, and it’s often difficult to predict who may succumb to an addiction.


The legalization of marijuana in some states has made the drug’s use more socially acceptable and can often create a false assumption that marijuana is harmless. Marijuana is often also associated with socializing, and large quantities can be consumed without the user realizing an addiction has taken hold.


Painkillers such as Vicodin and Oxycontin are derived from opium and have a similar effect on the brain to heroin. They are often prescribed legally for chronic pain; however, even a relatively low dosage can lead to addiction if unchecked. In addition, opiate painkillers can rapidly cause tolerance, with a user requiring a greater quantity to achieve the same effect, meaning costs can rapidly escalate.


Rates of addiction to powdered cocaine are less than they were a decade ago, though are still comparatively high. Crack cocaine, which is cheaper and more intense, can lead to more crippling addiction than powdered cocaine.


Heroin is highly addictive, with a large proportion of first-time users rapidly becoming addicted. Heroin use also harbors additional dangers when used as an injectable, such as blood-borne viruses. Withdrawal from heroin is often extremely uncomfortable and one of the main reasons for relapse if attempted alone. Medical detox and ongoing therapy are proven to have the highest success rates for beating heroin addiction.


Valium, Xanax, and Klonopin are all common forms of “benzos,” typically used to treat anxiety disorder. Benzodiazepines can be obtained on prescription and can easily lead to addiction. In addition, withdrawal from benzodiazepines can be life-threatening and detox should only be attempted under medical supervision.


Stimulants cover a wide range of substances, from prescription drugs like Adderall to illicit substances like meth and ecstasy. These drugs cause euphoria by flooding the brain with chemical neurotransmitters such as dopamine and are highly addictive once a tolerance develops.


Inhalant addiction is prevalent in teens, as substances inhaled to produce a high are legal and readily available. Anything from gasoline to whippet canisters cans can be used as inhalants and their effects, though short-lived, can have a severe impact on health.

Sedatives (barbiturates)

Sedatives include drugs such as sleeping pills (e.g., Lunesta and Ambien). These produce a depressant and relaxant effect and can also have mind-altering effects that can lead to abuse.