Substance Abuse Among Indigenous Americans

While the vulnerability of the Native American population to substance abuse has been long recognized, the inability of national surveys to accurately collect data from or around reservations has prevented researchers from fully realizing the scope of the problem until recently.

The recent findings are alarming. A 2018 survey published in JAMA Network Open found that young American Indian students living on or near reservations are at a much higher risk for substance use than national U.S. students.¹ Also disturbing is the fact that Native American youth seem to start using drugs and alcohol earlier than other ethnic groups in the same age range.²

Data indicates that Native Americans have the highest rate of substance use and dependence when compared to all other ethnic groups—with an estimated 10.1% of American Indian/Alaska Native (AI/AN) people over 12 years old suffering from substance use disorder (SUD),³ though only a fraction of these individuals receive the treatment they require.⁴

There are many circumstances that contribute to the high rate of addiction within AI/AN peoples as well as significant barriers to receiving adequate treatment.

Conditions Contributing to SUD in Indigenous American Communities

Indigenous Americans contend with a variety of social inequalities, including low median household income, geographic isolation, high unemployment, limited access to quality medical care, and the highest poverty rate of any ethnic group in the United States.⁵

Lack of socioeconomic opportunity has been shown to correlate with addiction and other mental health problems. But in the case of AI/AN people and many other ethnic minorities, historical trauma is also increasingly recognized as a contributing factor.

The Administration for Children and Families defines historical trauma as “multigenerational trauma experienced by a specific cultural, racial or ethnic group.” The concept was first described by social workers working with descendants of the Holocaust and Japanese internment camps in World War II. Indigenous Americans undergo historical trauma as a response to violent colonization,⁶, genocide, forced relocation, and the breakdown of their traditional familial structure.⁷

Responses to historical trauma often include:⁸

• Low self-esteem.
• Depression.
• Anxiety.
• Suppressing emotions.
• Suicidal thoughts and actions.
• Substance abuse as a coping mechanism.

Treating substance use disorder and other mental disorders simultaneously is a recognized necessity for most individuals with dual diagnosis. However, limited access to adequate substance abuse services continues to be a problem for many AI/AN people, with only 3.5% of native adults actually receiving treatment for substance use disorder.³

Addiction Treatment Considerations for Indigenous Americans

There are many barriers to receiving adequate addiction treatment for AI/AN people. These may include:⁷

• Low percentage of native people with insurance.
• Low income.
• Stigma of addiction.
• Lack of transportation to facilities.
• Shortage of available programs.
• Distrust in “westernized” treatment.

Despite the dire need for more accessible and affordable treatment in Indigenous communities, some inspiring work is being done and progress is being made. To combat issues like the loss of cultural identity, many treatment facilities have begun combining native teachings with modern evidence-based practices and cognitive behavioral therapies.

The Indian Health Service (IHS) has outlined several culturally relevant programs for AI/AN people and communities dealing with substance use disorder and other mental health problems (various tribes or nations may practice differing methods). These programs include:⁹

• The Medicine Wheel: A 12-step program modified to be culturally appropriate for Native Americans.
• Drum circles.
• Ceremonial teepee construction.
• Annual powwows that provide opportunities to engage indigenous communities about various initiatives regarding mental health.
• The 4 Seasons (i.e. Késhjéé (Shoe Game): A ceremony and story that demonstrates how the natural order cannot be altered.
• Doorway to a Sacred Place (for Alaska Native peoples), which serves as a guide for incorporating 4 sacred healing techniques. These include:
  • Talking circles.
  • Teaching circles.
  • Body energy work.
  • Song, dance, drumming, and storytelling.
• Gathering of Native Americans (GONA): Substance abuse prevention event for youth based on 4 principles:

While there are cultural concerns inherent to injecting “Western” therapeutic practices into native communities, research on adjusted 12-step programs and Drum-Assisted Recovery Therapy for Native Americans (DARTNA) has yielded promising results.¹⁰ These findings highlight the need for recovery programs that address both addiction and restore cultural identity.

Sources

1. Stanley LR, Swaim RC., Substance Use Among American Indian Youths on Reservations Compared With a National Sample of US Adolescents. JAMA Netw Open. 2018;1(1):e180382
2. National Institute on Drug Abuse. (2014). Substance Use in American Indian Youth is Worse than We Thought.
3. Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health Detailed Tables.
4. United States Department of Health and Human Services. (2011). American Indian/Alaska Native Behavioral Health Briefing Book.
5. United States Census Bureau. (2017). American Indian and Alaska Native Heritage Month: November 2017.
6. Administration for Children and Families. What is Historical Trauma.
7. Dickerson, D. L., Hser, Y. I. Libo, L., Marinelli-Casey, P., Rawson, R. & Spear, S., (2011). American Indians/Alaska Natives and Substance Abuse Treatment Outcomes: Positive Signs and Continuing Challenges. Journal of addictive diseases, 30(1), 63–74.
8. Maria Yellow Horse Brave Heart. (2003). The Historical Trauma Response Among Natives and Its Relationship with Substance Abuse: A Lakota Illustration. Journal of Psychoactive Drugs. 35:1, 7-13.
9. Indian Health Service Culturally relevant best practices.
10. Dickerson, D., Hser, Y. I., Nagaran, K., Robichaud, F., Teruya, C., (2012). Utilizing drumming for American Indians/Alaska Natives with substance use disorders: a focus group study. The American journal of drug and alcohol abuse. 38(5), 505–510.