Native Americans: A Guide to Addiction and Recovery

American Indians and Alaska Natives (AI/AN) comprise only 1.7% of the population, but they are at increased risk of drug and alcohol abuse compared with other races.¹ Although alcohol is the most frequently abused substance in this community, illicit drug use is also on the rise, especially among Native American youth.² Substance abuse contributes to health, economic, and social disparities in this group.

This population may have difficulty accessing addiction treatment, particularly if they live on reservations. But rehab options exist, and recovery programs are increasingly incorporating elements of Native American culture.

Which Drugs Are Most Often Abused by This Group?

Statistically, alcohol appears to be the most widely abused substance among Native Americans. However, illicit drug use is also common within these communities. According to the 2015 National Survey on Drug Use and Health, the lifetime use of illicit substances among American Indians and Alaska Natives aged 12 and older was 54%; nearly 23% of AI/AN aged 12 and older used illegal drugs in the past year.³

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), Native American adolescents have the highest rates of marijuana use, painkiller abuse, and abuse of psychotherapeutic drugs compared to the national average.⁴

Some of the most common types of drugs abused by Native Americans include:

• Alcohol. The rate of lifetime alcohol use is 72% for Native Americans aged 12 and older. Heavy alcohol and binge alcohol use is also quite high in this population. In 2015, 24.1% of AI/AN aged 12 and older reported binge alcohol use in the past month, and 4.7% reported using alcohol heavily in the past month.³

• Tobacco. The rate of current (past month) tobacco product use among American Indians and Alaskan Natives aged 12 and older is 37%, which is the highest of any demographic group.³
• Marijuana. American Indians and Alaska Natives have the highest rates of lifetime, past year, and past month marijuana use of any single ethnic group. As of 2015, 54% of AI/AN had used marijuana at least once in their lives and 11.7% had used marijuana within the last month.³ According to the National Institute on Drug Abuse (NIDA), 15.3% of American Indian high school seniors smoke marijuana almost daily²
• Crystal meth. In the Native American community, methamphetamines seem to be the drug of choice for people whose jobs require long shifts and for people unable to afford more expensive drugs.⁵ According to the most recent statistics, American Indian and Alaska Natives had the highest rates of lifetime, past year, and past month use of methamphetamines compared to other ethnic groups.³
• Prescription medications. American Indian prescription opioid abusers are more likely to have a chronic medical condition, polysubstance abuse issues, and other psychiatric problems.⁶ Data from 2015 show that 5.6% of American Indians and Alaskan Natives had misused prescription drugs in the past year. Almost 3% had misused them in the past month, which is the highest rate of any single ethnic group.³

What Are the Effects of Drug Abuse on Native Americans?

• Health problems: The premature death rate for AI/ANs is 90% higher than the general (all races) population.¹ Researchers believe that alcoholism is the largest contributing factor to this life-expectancy disparity. AI/AN are 4.2 times more likely to die from cirrhosis and liver disease than the general population.¹
• Overdose: American Indians are three times as likely as the general population to die of an overdose. In the state of Washington, the rate for overdose deaths is more than twice that of whites, according to the Pew Research Center.⁷
• Violence: Drug and alcohol addiction in Native American communities can lead to violence and trauma within the home. Child abuse and neglect are other sources of trauma caused in part by addiction. Data from many studies suggest that Native American women are more likely than women from other ethnic groups to report domestic abuse.⁸
• Fetal alcohol syndrome: Another consequence of alcohol abuse in this population is fetal alcohol syndrome, which can be caused by drinking during pregnancy. Native Americans have among the highest rates of fetal alcohol syndrome in the United States. The rates are as much as 2.5 per 1,000 live births in some tribes.⁹
• Death: In 2010, Native Americans had the highest rate of drug-induced death at 17%.¹⁰ American Indians who live on reservations or in rural areas are at risk of fatal alcohol-related car accidents. Research suggests that AI/ANs are 3 times as likely to die from liver disease, diabetes, or accidents as the general population.⁸

What Are the Causes of Addiction in Native Americans?

Risk factors for addiction among Native Americans include the following:

• Mental health problems: One national study found that more than 20% of AI/AN women had post-traumatic stress disorder (PTSD) at some point in their lives.⁸ Major depressive disorder is another mental health condition that often co-occurs with substance abuse. The significantly higher risk of suicide among the AI/AN population suggests a high rate of untreated depression. Data suggest that the rate of death due to suicide is 72% higher in the Native American population than in the general population.⁸
• Unemployment or underemployment: Unemployment was found to be a risk factor for heavy drinking, alcohol abuse, and illegal drug dependence in Alaska Native and American Native populations.¹¹
• Lack of education: American Indians and Alaska Natives that have less than a high school or just a high school education are more likely to be heavy drinkers (5 or more drinks for men or 4 or more drinks for women in a 24-hour period at least once a week or on 4 or more days in the past month).¹¹
• Trauma: Of all races, Native Americans have the highest chance of being the victim of violence. Given the strong association between trauma and substance abuse, this is one significant risk factor for substance abuse in this population.¹² This includes the victimization of children, who then become more likely to develop substance abuse problems in the future.⁸
• History of substance abuse in the family: Similar to other populations, a family history of substance abuse is a risk factor for American Indians and Alaska Natives. Children of substance-abusing parents are more at risk for substance abuse themselves.¹²
• Limited health services: The federal government provides healthcare to American Indians. The problem is that the Indian Health Service, which was set up to provide this health care, is seriously underfunded. This limited availability of health services for substance abuse issues is probably one of the factors that leads to higher rates of substance abuse in this population.¹²
• Poverty: American Indian youths are more likely to abuse alcohol if their family has a low socioeconomic status.¹³

How Can You Tell if Someone Has a Problem?

Many Native Americans—and Americans in general—may be unaware of the signs and symptoms of drug or alcohol abuse, which may prevent them from recognizing the problem and getting help. The general signs of addiction include the following:¹⁴

• Using the drug frequently, daily, or several times per day
• Having intense cravings for the drug
• Needing larger doses to achieve the same effect (tolerance)
• Thinking a lot about obtaining the drug and not running out
• Spending all your money on drugs
• Continuing to use despite negative consequences at home, work, or school
• Engaging in risky or illegal behavior
• Spending lots of time obtaining and using drugs
• Unsuccessfully trying to quit or cut down
• Experiencing withdrawal symptoms when you miss a dose or reduce use

What Are the Barriers to Treatment for Native Americans and Alaska Natives?

Barriers to alcoholism and drug abuse treatment for Native Americans include the following:¹⁵

• Lack of cultural sensitivity in programs
• Rural or reservation living far from treatment centers
• Lack of transportation
• Shortage of quality providers
• Lack of health insurance
• Lack of awareness about addiction

Previous attempts to bring substance abuse treatment into these communities have not succeeded in addressing their specific cultural needs. Clinicians, clinical programs, tribes, and the Indian Health Service (IHS) have all worked to develop new treatment approaches, but these services are severely underfunded. Many communities remain without necessary substance abuse treatment programs.¹⁶

Additionally, due to their history of oppression and mistreatment, many AI/AN communities are reluctant to seek care from westernized medical institutions. Many question medical treatment and prefer to rely on traditional indigenous medical practices.¹⁵

What Kinds of Rehab Programs Are Available?

Native American rehab and recovery options vary widely depending on where the person lives and what type of medical coverage they have. Many reservations do not have adequate treatment programs for either mental illness or substance abuse disorders. However, a few of the wealthier tribes have excellent substance abuse treatment centers. Treatment options could include the following:

• Indian Health Service (IHS) Programs: The IHS is the federal health program for American Indians and Alaskan Natives. The IHS Health Care System offers behavioral health care for substance abuse issues.¹⁸
• State-funded addiction treatment programs: These addiction programs are funded by the government. They may provide a variety of mental health services to people that meet certain income and other restrictions.
• Programs operated by nonprofit organizations: These include substance abuse programs operated by the Salvation Army and Catholic Charities that typically offer a range of services and are often based on income.
• Private inpatient detox and addiction treatment centers: Many people that have addiction issues initially receive inpatient detoxification and medical management. They may receive inpatient substance abuse treatment until they are medically stable.
• Outpatient treatment: It may involve drug or alcohol counseling. Other services may be part of outpatient treatment, including job rehabilitation, case management, and medication management.
• Residential programs: These programs provide 24-hour care in a non-hospital setting. The care may involve a variety of treatments and therapies aimed at helping the individual conquer addiction, such as behavioral therapy, support services, holistic therapies, and medication management.

How to Find Programs Familiar with Native American Culture

Finding an addiction treatment program with culturally competent providers is ideal. Culturally competent health care providers have a basic understanding of and respect for culturally different patient groups. They can tailor addiction treatment in a way that accommodates and honors cultural values and beliefs.

Health care providers in major city hospitals usually undergo training in cultural competency because they interact with such a diverse group of patients. This is not necessarily the case in certain parts of the country, particularly rural areas unaccustomed to Native peoples. Tips for finding a respectful treatment program include the following:

• Ask questions before making an appointment or checking in.
• Read online reviews.
• Talk to your friends and family for recommendations.
• Talk to your community leaders.

No single addiction treatment approach works best for everyone. Some people benefit from seeking treatment along with their peer groups. Native American teenagers might, for example, prefer to seek treatment with other teenagers rather than older indigenous people. Women may benefit from single-gender facilities that allow them to open up and share their cross-cultural experiences.

How Are Traditional Healing Practices Being Incorporated into Treatment?

In some cases, evidence-based treatments, such as cognitive-behavioral therapy (CBT) and motivational interviewing, have been combined with traditional healing practices in drug rehab programs for Native Americans.^16,17

Participating in traditional healing practices can be a powerful source of strength for some American Indians. It can help strengthen cultural identity, political empowerment, and community ties. However, the majority of American Indians do not live in traditional reservation settings. An estimated 60%-70% of American Indians live in urban or suburban areas.¹⁷ They often live in mixed-race communities and multi-ethnic families, with few ties to their cultural roots.

The problem for clinicians is how to engage these city dwellers in traditional healing practices. Some traditional practices that clinicians have tried combining with evidence-based treatments in urban settings include sweat lodges, powwows, and consultations with tribal leaders.¹⁷ In reservation settings, other cultural traditions are being used, such as hunting, berry picking, steam baths, wood gathering, fishing, tundra walks, and craft activities.¹⁷

What Are Some Ways to Pay for Treatment?

If you have insurance through your job, your provider might cover some or all your substance abuse treatment. Check to make sure the provider you want to see accepts your insurance. Many programs offer flexible payment plans or sliding scale fees, and scholarships might be available to some people.

If you don’t have insurance or can’t afford to pay out of pocket, then you may need to seek other free and low-cost treatment options. You may consider seeking alternative funding sources, such as raising money from your community or starting an online crowdfunding campaign. Turn to your community leaders for advice on how to proceed. They may have valuable suggestions of where to find the best treatment.

You can also check below to see if your health insurance provider may be able to cover all or part of the cost of rehab and associated therapies at an American Addictions Centers (AAC) location.

Resources

The resources listed below can connect you with treatment providers and help you find out if you are eligible for public health insurance.

• The Substance Abuse and Mental Health Services Administration (SAMHSA) This is a national organization that maintains a database of free and low-cost treatment providers. You can search online to find a treatment provider near you, or call their hotline at 1-800-663-HELP (4357).
• Indian Health Services The IHS provides a variety of resources to help prevent and treat substance abuse issues. They also offer a comprehensive behavioral health program that includes a variety of alcohol and substance abuse treatment programs.
• Public Health Insurance. American Indians and Alaskan Natives are eligible for many public health services offered through the Affordable Care Act.
• We R Native. This comprehensive program, operated by the Northwest Area Indian Health Board, is aimed at American Indian youth. It promotes positive growth and holistic health through a variety of programs. They also provide a variety of resources to help youth get help for substance abuse issues.
• A.A. for the Native North American. This pamphlet from Alcoholics Anonymous introduces the program to Native Americans and tells the stories of many Natives who have used AA for their recovery.