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In 2010, 5.2 million Americans identified themselves as American Indians or Alaska Natives, according to the U.S. Census. Out of this number, 22 percent were living on tribal lands, or reservations, while 78 percent lived outside of these areas. Native Americans have had a long and troubled history with alcohol and drug abuse, but individuals living on reservations have been more severely affected than the rest of this group. The social isolation, poverty, and lack of healthcare services that plague the country’s reservations have contributed to higher than average levels of alcoholism, drug abuse, and alcohol-related crime in these areas. At the same time, American Indians still struggle against the negative cultural stereotypes and racial discrimination that have affected the tribes for hundreds of years.
Native American reservations are located predominantly in the vast, sparsely populated lands of the American West and Southwest; however, there are tribal lands throughout the country, including the South, Midwest, Northwest, and Northeast. The living environment on these lands has been compared to conditions in the Third World, with inadequate housing, unreliable utilities, and poor nutrition. The geographic and social isolation of the reservations makes it difficult for residents to receive education, medical care, and social services comparable to the rest of the country. The combined effects of poverty, poor health care, and substance abuse have led to an increased risk of chronic disease and a lower life expectancy among Native Americans.
According to the Treatment Episode Data Set (TEDS) Report, around 2.5 percent of American adults admitted for substance abuse treatment are Native Americans, although this group makes up less than 1 percent of the US population. The majority of these individuals are referred to treatment through the criminal justice system, while a relatively low percentage refer themselves. This discrepancy reflects a need for more culturally sensitive programs for education, outreach, and treatment.
National survey results indicate that substance abuse rates are consistently higher among American Indian/Alaska Natives than other racial groups. The 2013 National Survey on Drug Use and Health(NSDUH) shows that 12.3 percent of American Indians were current users of illicit drugs, compared with 9.5 percent of whites, 8.8 percent of Hispanics, and 10.5 percent of African Americans. The rate of binge drinking among American Indians was 23.5 percent, and the rate of tobacco use was 40.1 percent.
Providing these services to Native Americans could help to reduce the devastating social, physical, and psychological effects of substance abuse on this population, as reported by the National Institute on Alcohol Abuse and Alcoholism:
These substance abuse patterns are contributing factors in the leading causes of death among Native Americans, as reported by the Centers for Disease Control and Prevention(CDC):
A troubling new study published in Public Health Reports suggests that rates of substance abuse may increase even more dramatically among the younger generations of American Indians. In this study, the substance use patterns of a large sample of students living on or near American Indian reservations were compared to those of teenagers in the general population. The prevalence of alcohol and marijuana use among American Indian youth was significantly higher than other racial groups, especially among 8th grade students. Another emerging problem among American Indian junior high and high school students is the abuse of prescription opiates like OxyContin (oxycodone). These substance abuse patterns in Native American students lead to higher dropout rates, poor academic performance, violent crime, and suicidal behavior.
The effects of alcohol and drug abuse among residents of tribal lands have undermined the strength and stability of the Native American community. Unless the living conditions and healthcare services on these lands can be improved, it is unlikely that there will be a corresponding improvement in the overall health of this population.
Suicide is the eighth leading cause of death among American Indians and Alaska Natives, according to the CDC, and the second leading cause of death among those between the ages of 10 and 34. One of the primary reasons for the high suicide rate in this population is the lack of mental health services on reservations. Although American Indians have disproportionately high rates of depression, anxiety, and other forms of mental illness, the reservations suffer from a severe lack of psychiatric support resources, notes Trauma, Violence and Abuse. Mental health clinics on tribal lands are limited, and there is a high turnover among therapists and counselors working on reservations. Addressing these problems requires a national focus on the health concerns of American Indians, along with a willingness to devote more resources to education, prevention, and rehab for the residents of tribal lands.
A disparity in mental health and recovery services, combined with high rates of substance abuse and chronic disease, have created a serious public health problem on Native American reservations. The acculturation of American Indian youth into mainstream American society, combined with a weakening of the influence of cultural traditions and family connections, have also contributed to rising rates of addiction and self-destructive behavior.
Culturally competent substance abuse treatment can promote recovery and abstinence in the following ways:
Supporting Native Americans in their search for affordable mental health care and addiction treatment can reduce the threat to this community’s wellbeing, while strengthening the nation’s public health as a whole.
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