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Compared to other racial groups, Native Americans experience some of the highest rates of substance abuse, mental health disorders, violence, and suicide.1 The cultural and spiritual beliefs of American Indians and Alaska Natives, as well as the historical trauma suffered by people who identify with these ethnic groups, require special considerations to be taken in the treatment of addiction and other mental health conditions. Understanding the needs of this demographic is critical to finding effective rehab services and achieving lasting recovery.
Although American Indians and Alaska Natives make up a relatively small percentage of the total U.S. population, they are disproportionally affected by social issues that are widely recognized as contributing factors to substance abuse, addiction, and overdose.
According to the 2015 census, there are 6.6 million people who identify as American Indian or Alaska Native, representing roughly 2% of the total population.2 Native Americans are more than twice as likely to live in poverty compared to the general population (26% vs. 12%).3 More than 1 in 3 Native Americans lack health insurance coverage, and the average life expectancy for this population is 6 years lower than the national average.3
American Indians are more likely to experience interracial violence than any other ethnic group. According to the U.S. Department of Justice, at least 70% of violent crimes experienced by Native Americans are committed by someone who does not identify as American Indian or Alaska Native. This is a significantly higher rate of interracial violence than experienced by Caucasians or African Americans.4
Currently, there are 566 federally-recognized tribes in the United States, with a tremendous amount of diversity between each tribe, including unique and distinct governments, cultural traditions, customs, and languages.5
Over the past 3 decades, Native American populations have increasingly relocated from reservations and rural areas to cities.6 Roughly 67% of all American Indians live in urban areas, and this percentage continues to grow.6 Urban natives may not feel a strong connection to their tribal communities, cultural history, or even their immediate family—a factor that may impact their mental health and contribute to issues such as depression and substance abuse.
American Indians and Alaska Natives face an increased risk of substance abuse and addiction given their history in the United States. Forced relocations, broken treaties, and other political injustices have disproportionately affected this ethnic minority. High rates of historical trauma, violence, racism, loss, legalized segregation, isolation, and discrimination in native communities place these people at an increased risk for alcohol and drug abuse.7
Historical trauma (HT) refers to the emotional and psychological harm that cumulates across one’s lifespan and across multiple generations.8 HT can include individual and collective trauma; group trauma and can result in depression, anxiety, low self-esteem, suicidal thoughts, unresolved grief, and substance abuse. People who experience HT may attempt to cope with painful feelings by self-medicating with alcohol or other substances.8
Compared with other ethnicities, Native Americans are more likely to report:7,9
It’s interesting to note that among Native Americans, the rate of alcohol use is actually lower than among Caucasians, Hispanics, and African Americans.10 However, the rate of binge drinking in the native community is higher than in other ethnicities, as is the number of people with alcohol use disorders.10
People who identify as American Indian or Alaska Native are more likely to report a past-year substance use or alcohol use disorder than any other race.1 This is especially true for young adults—more than 1/5 of young adults in this ethnic group report having an alcohol use disorder.10
According to the Native American Center for Excellence:10
Across all age groups, illicit drug use by American Indians and Alaska Natives is higher than any other single ethnic group.11 Among Native Americans over the age of 12:11
Illicit drug use by American Indians and Alaska Natives is higher than any other single ethnic group.
People of Native American descent have the highest rate of methamphetamine use of any demographic, including people of 2 or more races.11 In 2015, 11.5% of native people over the age of 12 reported having used meth in their lifetime, and 2.7% reported using it in the past year.11
The negative consequences of meth use are felt across the entire tribe. In 2006, the White Mountain Apache Tribe in Arizona testified in front of the Senate Indian Affairs Committee that 30% of employees had recently tested positive for meth.12 Nearly 90% of child welfare cases in Yavapai-Apache Nation are related to methamphetamine. And, according to California Indian Legal Services (CILS), nearly every case in which an American Indian child must be taken from their home involves meth use by one or both parents.12
Suicide is a major public health problem among American Indians. Studies show that American Indians and Alaska Natives have the highest rate of suicide among all ethnic groups in the United States.13 Suicide is complex, and no single reason leads a person to commit suicide. Instead, a variety of individual and societal circumstances, barriers to mental health services, and comorbid conditions such as substance abuse all play a role in the occurrence of suicide.
For Native Americans, many of the risk factors that contribute to high rates of drug and alcohol abuse also contribute to a high risk of suicide. These include historical trauma, cultural distress, poverty and unemployment, family history of mental illness and/or substance abuse, and feelings of hopelessness, isolation, or stigmatization.14
A 2014 evaluation of mental health among American Indians and Native Alaskans found that:15
Suicide is the second leading cause of death among American Indian youths ages 15 to 24.16
For Native Americans, many of the risk factors that contribute to high rates of drug and alcohol abuse also contribute to a high risk of suicide.
According to the U.S. Centers for Disease Control and Prevention (CDC), the number of suicides among American Indian or Alaska Native youth have the highest rate of suicide—1.5 times higher than the national average.17
According to the U.S. Centers for Disease Control and Prevention (CDC), the number of suicides among American Indian or Alaska Native men has increased significantly over recent decades. In 1999, the age-adjusted number of deaths from suicide in this group was 19.8 per 100,000. By 2014, that number increased to 27.4 per 100,000.18
Many crimes go unreported or underreported in Native American communities, making reliable crime data scarce.19 In addition, the justice systems on tribal lands are typically underfunded and may not prioritize specialized training for law enforcement or robust intervention services.16
Available data indicates that a high level of violence occurs in Indian country, negatively affecting native communities, particularly American Indian women. Violence among Native Americans often overlaps with alcohol and/or drug abuse, as well as mental health disorders such as anxiety and PTSD.20 Most violent crimes involve alcohol or drugs.20
Many Native American communities have limited access to substance abuse services. Nearly 20% of native adults need treatment for drug or alcohol use disorders, but only 12% actually receive treatment.1 These low rates of treatment engagement may be in part due to significant barriers to treatment that native communities face, including transportation issues, lack of health insurance or poor insurance coverage, poverty, cultural stigma associated with substance abuse, and a shortage of appropriate treatment options in regions where native populations are concentrated.22
Researchers have developed strategies that blend traditional native teachings with evidence-based practices.
Every tribe is unique, with varying locations, populations, histories, substance abuse patterns, and degrees of trust placed in westernized medicine. In order to be effective, treatment approaches need to be tailored to address the barriers and needs of each individual tribe and patient.
To help eliminate these barriers to care, communities and researchers have developed strategies that blend traditional native teachings with evidence-based practices and cognitive behavioral therapies.23
Traditional approaches include but are not limited to:22,24
Researchers have noted that the most successful treatment programs are based on traditional healing approaches, Alcoholics Anonymous, or a combination of both. Using traditional healing to addresses substance abuse and mental health problems alone or in combination with westernized approaches may provide a more holistic approach to treatment.25
Some researchers advocate that more native communities turn toward traditional healing methods when addressing substance abuse and mental health issues within the tribe.26 Indian Health Service (IHS), the federal health program for American Indians and Alaska Natives, recommends an approach that blends the traditional medicine wheel with the 12 steps of Alcoholics Anonymous or Narcotics Anonymous. The IHS also funds the Methamphetamine and Suicide Prevention Initiative (MSPI), which aims to develop prevention programming and culturally relevant best practices to address high rates of methamphetamine use and suicide among American Indians and Alaska Natives.
Substance abuse prevention and treatment programs should always be respectful of a person’s culture, beliefs, practices, and language needs. It’s important that intervention and prevention efforts tailor information to address the community it is serving—whether Native American or any other ethnic or religious group.
Certain factors place native youth at increased risk for substance abuse. Within tribal communities, young people are more likely to live in extreme emotional and social circumstances, with high rates of poverty and domestic abuse.1
American Indian youth aged 12 to 17 have the highest rate of alcohol use of all racial/ethnic groups, and 1 in every 5 native youth engage in underage drinking.14 Significant risk factors such as discrimination, racism, and related stress affect this group and contribute to high rates of substance abuse.
Native Americans report the lowest level of education of any racial or ethnic group in the United States, another factor that may contribute to their disenfranchisement and susceptibility to addiction. Graduation rates for native high school students are roughly 50% nationwide, compared to over 75% for white students.16 Nearly 25% of the general population now holds an undergraduate degree; however, only 13% of Native Americans have achieved this level of education.16
Due to high rates of substance abuse, suicide, and violence among Native American youth, there are a wide number of programs aimed at providing positive outlets and safe alternatives to drug use and gang activity in tribal communities. Youth initiatives and efforts across the country aim to build on the assets of native culture. A few examples of successful programs include:16
Because the prevalence of substance abuse among Native Americans is disproportionately high, there are a number of community programs and tribal resources available to connect American Indians and Alaska Natives with treatment that integrates native rituals and considers their unique needs.
If you’re a person of Native American descent struggling with drug or alcohol addiction, don’t hesitate to seek out the help you need. There are programs and resources available to help you find a treatment program that honors your culture and beliefs. Don’t let addiction keep you from living a fulfilling, meaningful life.
What would you do with that money if treatment was affordable? Find out if your insurance covers treatment now!