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Alcohol and Drug Abuse Among Native Americans

Michael Kaliszewski, PhD – 2020

It is estimated that there are 5.6 million Native Americans (classified as American Indian and Alaska Native alone or in combination with one or more other races) living in the United States, comprising 1.7% of the total population.1 While Native Americans account for only a small part of the U.S. population, these people experience much higher rates of substance abuse compared to other racial and ethnic groups. Some of the factors that contribute to the increased risk of addiction among Native Americans include:1-2
• Historical trauma.
• Violence (including high levels of gang violence, domestic violence, and sexual assault).
• Poverty.
• High levels of unemployment.
• Discrimination.
• Racism.
• Lack of health insurance.
• Low levels of attained education.
Native Americans are also at an increased risk for several health issues such as:1
• Mental illness and suicide.
• Unintentional injuries.
• Obesity.
• Sudden infant death syndrome (SIDS).
• Teenage pregnancy.
• Diabetes.
• Heart disease.
• Cancer.
• Stroke.
• Liver disease.
• Hepatitis.
• Tuberculosis.

Substance Abuse Among Native Americans
The rates of substance abuse among Native Americans are generally much higher than those of the general U.S. population. Data indicate that Native Americans have the highest rates of alcohol, marijuana, cocaine, inhalant, and hallucinogen use disorders compared to other ethnic groups.3 Recent findings from the 2018 National Survey on Drug Use and Health (NSDUH) include:4
• 10% of Native Americans have a substance use disorder.
• 4% of Native Americans have an illicit drug use disorder.
• 7.1% of Native Americans have an alcohol use disorder.
• Nearly 25% of Native Americans report binge drinking in the past month.
• Native Americans are more likely to report drug abuse in the past month (17.4%) or year (28.5%) than any other ethnic group
Additionally, the rate of substance dependence or abuse is higher among Native Americans than any other population group in the country. Native Americans have the highest methamphetamine abuse rates, including past month use at more than 3 times the rate of than any other group. They are also more likely to report drug abuse in the past month (17.4%) or year (28.5%) than any other ethnic group. Substance abuse and addiction are major concerns among young Native Americans. Results from the 2018 NSDUH show that nearly 1 in 5 Native American young adults (aged 18-25 years) has a substance use disorder, including 11% with illicit drugs and 10% with alcohol.4 The survey also indicates that approximately 4 in 10 Native American adolescents (aged 12-17 years) have a lifetime prevalence of illicit drug use. According to another study, Native American adolescents have the highest rates of lifetime tobacco product use, marijuana use, nonmedical use of pain relievers, and nonmedical use of prescription-type psychotherapeutics.5
Treatment Considerations
Native Americans are more likely to need alcohol or illicit drug use treatment than persons of any other ethnic group. The Substance Abuse and Mental Health Services Administration reports that 13% of Native Americans need substance use treatment, but only 3.5% actually receive any treatment.6 Unfortunately, many Native Americans have limited access to substance abuse services due to transportation issues, lack of health insurance, poverty, and a shortage of appropriate treatment options in their communities.7 Some of the disparities in treatment that occur within the Native American population can be resolved through increased availability of culturally sensitive treatment programs. Local adaptations of treatment protocols are needed to address the significant diversity among Native Americans, as there are important differences in the language, culture, and customs of the 573 federally recognized American Indian and Alaska Native tribes and communities.8 Studies have shown that cultural identity and spirituality are important issues for Native Americans seeking help for substance abuse, and these individuals may experience better outcomes when traditional healing approaches (such as powwows, drum circles, and sweat lodges) are incorporated into treatment programs.9