Risks of Alcoholism Among Native Americans

3 min read · 4 sections

There are 5.6 million American Indians and Alaska Natives, collectively known as Native Americans, currently living in the United States.1 Although they only make up 1.7% of the U.S. population, Native Americans experience substance abuse and addiction at much higher rates than other ethnic groups.

Alcohol Abuse Among Native Americans

Alcohol is the most commonly used drug among Native Americans, although the rate of alcohol use among Native Americans is lower than among Caucasians, Hispanics, and African Americans. The major concerns of alcohol use stem from the high rates of problem drinking and alcoholism among Native Americans. Findings from the 2018 National Survey on Drug Use and Health include:2

  • The rate of past month (35.9%) and past year (54.3%) alcohol use among Native Americans is significantly higher than other ethnic groups.
  • Nearly a quarter of Native Americans report binge drinking in the past month (22.4%).
  • The rate of Native Americans with an alcohol use disorder (7.1%) is higher than that of the total population (5.4%).
  • 3 in 10 Native American young adults (age 18-25) report binge drinking (consuming 5 or more drinks in 2 hours), 1 in 11 report heavy alcohol use (binge drinking on 5 or more days in the past month), and 1 in 10 have an alcohol use disorder.
  • 1 in 6 Native American adolescents (age 12-17) engage in underage drinking, the highest rate of alcohol use of all racial/ethnic groups.

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Consequences of Alcohol Abuse in Native American Communities

Alcohol can have a severe impact on the health of Native American individuals, families, and communities. The consequences of alcohol abuse for Native Americans include increased risks for heart disease, cancer, gastrointestinal problems, pneumonia, tuberculosis, dental problems, hearing and vision problems, depression, and other mental health disorders.3

A recent analysis found that alcoholic liver disease is a major leading cause of death for Native Americans.4 Alcohol use is also a major cause of preventable birth defects and developmental disabilities in Native Americans, with the Centers for Disease Control and Prevention reporting that the rate of fetal alcohol syndrome among some tribes is more than eight times the national average.5

Alcohol use leads to increased risk for unintentional injuries, including those resulting from poor decision making and risky behaviors. Studies show that Native American men have the second-highest self-reported rates of driving under the influence, as well as the second highest arrest rates for drunk driving, compared to men from other racial and ethnic groups.6

Alcohol also contributes to the harm that many Native Americans suffer as a result of violence. Studies show that alcohol is involved in more than 6 in 10 violent crimes committed by Native Americans, and nearly half of the violent crimes experienced by Native Americans involve alcohol.7

Factors Contributing to Risk of Alcoholism Among Native Americans

The high prevalence of alcohol abuse among Native Americans can be attributed to a number of factors. Some of the key issues that contribute to the development of alcoholism among Native Americans are described below.

Economic Disadvantage

Native American communities suffer from high rates of unemployment and over 20% of Native Americans live at or below the poverty level, a rate more than double that of Caucasians.1 Native Americans have below average rates of high school and college completion, with less than 1 in 5 earning a bachelor’s degree.

The Native American population is also less likely to have health insurance and access to adequate medical care. The overall economic disadvantage of Native Americans, characterized by poor education, poverty, and limited resources, likely contributes to the prevalent abuse of alcohol among this ethnic group.8

Cultural Loss and Historical Trauma

Compared with all other racial groups, Native Americans are at greater risk of suffering from psychological distress, poorer overall health, and unmet medical and psychological needs.9

Many experts propose that the brutality and loss experienced by Native Americans after Europeans colonized the United States led to this historical trauma. The loss of population, land, and culture caused unresolved grief to be transmitted across generations of Native Americans, likely leading to the development of negative coping mechanisms such as drinking.10

Health Issues

Native Americans have high rates of several diseases including diabetes, heart disease, cancer, obesity, liver disease, and hepatitis.1 Research shows that illness leads to chronic stress, which subsequently increases the risk of alcohol abuse and addiction.11

Treatment Options

Native Americans are more likely to need alcohol use treatment than persons of any other ethnic group, with the Substance Abuse and Mental Health Services Administration reporting 1 in 10 Native Americans are in need of such treatment.12 Treatment can be extremely helpful for Native Americans struggling with alcohol problems, although there is unfortunately a lack of availability of culturally sensitive treatment programs.

Treatment plans should account for the influence of Native American culture on recovery, and programs should incorporate traditional healing approaches (such as powwows, drum circles, and sweat lodges), music, foods, and crafts such as beadwork.13 The participation of elders, spiritual leaders, and family members should also be included whenever possible.14


  1. United States Department of Health and Human Services, Office of Minority Health. (2018). Profile: American Indian/Alaska Native.
  2. Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health Detailed Tables.
  3. American Association for the Advancement of Science. (2006). American Indians with alcohol problems have more medical conditions.
  4. SAMHSA. Tip 61: Behavioral Health Services for American Indians and Alaska Natives.
  5. Miller, L., Tolliver, R., Druschel, C., Fox, D., Schoellhorn, J., …& Baio, J. (2003). Fetal alcohol syndrome–Alaska, Arizona, Colorado, and New York, 1995-1997. Morbidity and Mortality Weekly Report, 51(20), 433–435.
  6. Caetano, R., & McGrath, C. (2004). Driving under the influence (DUI) among U.S. ethnic groups. Accident Analysis and Prevention, 37(2), 217-224.
  7. Perry, S. (2004). A BJS Statistical Profile, 1992-2002: American Indians and Crime. Bureau of Justice Statistics, Washington, D.C.
  8. Beauvais, F. (1998). American Indians and alcohol. Alcohol Research and Health, 22(4), 253-259.
  9. Barnes, P. M., Adams, P. F., & Powell-Griner, E. (2010). Health characteristics of the American Indian or Alaska Native adult population: United States, 2004–2008. National Health Statistics Reports, No. 20. Hyattsville, MD: National Center for Health Statistics.
  10. Brown-Rice, K. (2013). Examining the theory of historical trauma among Native Americans. The Professional Counselor, 3(3), 117-130.
  11. Sinha, R. (2009). Chronic Stress, Drug Use, and Vulnerability to Addiction. Annals of the New York Academy of Sciences, 1141(1), 105-130.
  12. Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health Detailed Tables, Figure 5.38B.
  13. Garrett, M. T., & Carroll, J. J. (2000). Mending the broken circle: Treatment of substance dependence among Native Americans. Journal of Counseling and Development, 78(4), 379-388.
  14. Beals, J., Novins, D.K., Spicer, P., Whitesell, N.R., Mitchell, C.M., Manson, S.M., & American Indian Service Utilization, Psychiatric Epidemiology, Risk, and Protective Factors Project Team. (2006). Help seeking for substance use problems in two American Indian reservation populations. Psychiatric Services, 57(4), 512–520.


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