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.
The Social and Physical Effects of Substance Abuse
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:
- A higher rate of liver disease (up to four times higher than the general population)
- A higher rate of drinking and driving
- Increased rates of heart and lung disease
- Increased rates of suicide
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):
- Heart disease
- Unintentional injuries
- Liver disease
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.
Mental Health Concerns of Native Americans
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.
Meeting the Treatment Needs of Native Americans
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:
- By acknowledging the importance of Native American cultural and spiritual traditions in healing and recovery
- By engaging family and tribal community members in the process of addiction treatment
- By providing support for social services that facilitate access to treatment, such as transportation and child care
- By increasing access to care for medical and psychiatric conditions that affect overall wellbeing, such as diabetes, depression, heart disease, and respiratory illness
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.
- Centers for Disease Control and Prevention (CDC): American Indian & Alaska Native Populations: This is an important collection of statistics and information on the major health concerns and social challenges facing Native Americans, including chronic disease, substance abuse, and mental illness.
- 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. 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 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 Indian law 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.