According to the documents, drug and alcohol abuse is a major problem in America. In 2009, 23.9 million people aged 12 and older needed treatment for substance abuse issues, but only 2.6 million received treatment. Between 2000 and 2014, fatal overdoses from opioids and heroin more than tripled. Additionally, 90% of Americans with substance abuse problems began using drugs, alcohol, or smoking before age 18.