In 2018, 6.9 million Americans identified themselves as American Indians or Alaska Natives (AI/AN), according to the U.S. Census.1 These individuals have faced numerous struggles, and when compared to other races in the U.S., they have a lower life expectancy by 5.5 years due to issues that include substance abuse, chronic illness, and suicide.2,3
Substance abuse has been a longtime concern for American Indians and Alaska Natives (AI/AN). During the height of the opioid crisis, the AI/AN population was disproportionately impacted, suffering overdose deaths at a rate 2.7 times higher than white Americans between 2013 and 2015.4 Unfortunately, many substance use problems for Native Americans may begin early, especially among those on reservations.5 According to one survey of young people in the U.S., AI/AN youth living on or near a reservation reported significantly higher rates of drinking, cigarette smoking, as well as marijuana and other illicit drug use, when compared to a sample of youths in America.6
Risk Factors for Substance Abuse in American Indians and Alaska Natives
Risk factors refer to those factors that can make a person more vulnerable to substance use, while protective factors are those that do the opposite.
While many of the risk and protective factors are the same for youth of all races and ethnicities, AI/NA youth tend to have more risk factors and fewer protective factors than other youths.7
Risk factors include:5,7
- Family history of drug or alcohol use.
- Trauma, including historical trauma.
- High levels of stress.
- Poor coping skills.
- Comorbid mental disorders.
- Minimal parental involvement.
- Not living with both parents.
- Poor academic performance.
- Experiencing violence.
- Feeling alienation from the larger culture.
- Normalization of substance use in the community.
- Inadequate healthcare.
- Living in poverty.
Protective factors include:7
- Healthy and secure relationship between parent and child.
- Perceived parental disapproval of substance use.
- Parental monitoring and encouragement.
- Living in a two-parent home.
- Religious belief.
- Higher levels of engagement in school.
- Access to good healthcare.
- Bicultural competence.
- Participation in hobbies/activities.
- Ability to handle oneself effectively in social situations.
With a tendency toward having a greater number of risk factors and fewer protective factors, Native Americans may be left particularly vulnerable to substance abuse and substance use disorders. The effects of substance abuse and addiction range from physical ailments to mental health problems.
Disparities in Health & Treatment
AI/AN individuals experience higher rates than other Americans of many health issues, including:8
- Chronic liver disease.
- Cirrhosis of the liver.
- Unintentional injuries.
- Lower respiratory diseases.
- Self-harm/suicidal behaviors.
Several of these health issues are themselves sometimes associated with or potentially worsened by substance use. High rates of serious health issues such as the above contribute to poorer health and lower life expectancy overall in the AI/AN population as compared with other Americans.8
According to the Indian Health Service, the following factors play into the health disparity between Native Americans and the general American population:8
- Inadequate education.
- Discrimination in healthcare service delivery.
- Cultural differences.
Risk factors for substance abuse include both poor education and poverty,5,7 and discrimination in healthcare services may leave those who are struggling with drug or alcohol use without the resources to get better. Living in poverty may make even attempting to access treatment extremely difficult.
Cultural competence is necessary to lessening the disparities that exist in behavioral health.
A lack of understanding on the part of healthcare providers of an AI/AN patient’s culture and background may also lead to less-than-effective treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) places an emphasis on culturally competent treatment, stating that programs that are attempting to be “culturally competent” must “respect and respond to the cultural, linguistic, and other social and environmental needs of the individual.”9 SAMHSA also states that cultural competence is necessary to lessening the disparities that exist in behavioral health.10
Meeting the Treatment Needs of American Indians & Alaska Natives
According to SAMHSA, inadequate knowledge of the needs and culture of Native Americans in treatment programs may be among the main reasons for underutilization of treatment by AI/AN individuals, as well as low rates of retention in these programs.10
Culturally competent substance abuse treatment can promote recovery and abstinence. Loss of cultural identity has the potential to both worsen substance abuse and lead to poor treatment outcomes.10 Culturally competent treatment can work toward optimal recovery for Native Americans by:10
- Integrating tribal cultural and traditional spiritual activities in the treatment process.
- Helping patients work through conflicting cultural expectations.
- Recognizing the impact of historical trauma on patient’s substance use and mental health and making trauma treatment a standard part of treatment services for AI/AN patients.
- Understanding cultural differences in how patient’s view illness and healthcare.
- By engaging family and tribal community members in the process of addiction treatment.
- Stressing confidentiality, as mistrust is often an issue among those who neglect to seek treatment.
- By providing support for social services that facilitate access to treatment, such as transportation and child care.
The many resources available for tribal communities include the following:
- Centers for Disease Control and Prevention Tribal Health Website: A collection of information and resources relating to AI/AN health.
- Indian Health Service—The Affordable Care Act: Lack of access to health insurance is one of the most serious challenges faced by Native Americans seeking psychiatric care or substance abuse treatment. According to the CDC, nearly one-third of American Indians and Alaska Natives were uninsured in 2018.11 This website presents information on the health insurance options available under the Affordable Care Act (ACA), including Indian health or tribal programs, Marketplace health plans, and Medicare/Medicaid.
- Native American Aid (NAA): The mission of this organization is to improve quality of life and increase self-sufficiency among Native Americans through a variety of social services programs aimed at strengthening American Indian communities.
- Native American Rights Fund (NARF): This organization has been providing affordable legal assistance to Native American tribes and individuals since 1971. Its website includes an extensive collection of resources on tribal law and legal resources.
- Substance Abuse and Mental Health Services Administration (SAMHSA)—American Indian and Alaska Native: Tribal Affairs: This federal agency provides a collection of resources on mental health, substance abuse, and national survey results pertaining to American Indians and Alaska Natives.
- Suicide Awareness Voices of Education (SAVE)—Help for Native Americans: The SAVE site includes suicide prevention information and support services for Native Americans, with an emphasis on suicide prevention among Native American youth.
- White Bison: This grassroots nonprofit organization, based in Colorado, offers resources on addiction prevention, sobriety, recovery, and wellness to American Indians and other interested individuals. Its website includes information about the program, listings of meetings, and daily meditations based on a Native American approach to spirituality.
- United States Census Bureau. (2019). American Indian and Alaska Native Heritage Month: November 2019.
- National Congress of American Indians. (2020). Demographics.
- U.S. Department of Health and Human Services, Office of Minority Health. (2018). Profile: American Indian/Alaska Native.
- Centers for Disease Control and Prevention. (2018). Drug, Opioid-Involved, and Heroin-Involved Overdose Deaths Among American Indians and Alaska Natives — Washington, 1999–2015.
- Whitesell, N. R., Beals, J., Crow, C. B., Mitchell, C. M., & Novins, D. K. (2012). Epidemiology and etiology of substance use among American Indians and Alaska Natives: risk, protection, and implications for prevention. The American journal of drug and alcohol abuse, 38(5), 376–382.
- National Institute on Drug Abuse. (2018). Higher rate of substance use among Native American youth on reservations.
- Native American Center for Excellence. (2008). Environmental Scan Summary Report.
- Indian Health Service. (2019). Disparities.
- Substance Abuse and Mental Health Services Administration. (2020). CCBHCs and Cultural Competence.
- Substance Abuse and Mental Health Services Administration. Improving Cultural Competence. Treatment Improvement Protocol (TIP) Series No. 59. HHS Publication No. (SMA) 14-4849. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
- Centers for Disease Control and Prevention. (2017). Health of American Indian or Alaska Native Population.