American Indian And Alaska Native (AI/AN) Substance Abuse Trends

American Indian and Alaska Native communities are very diverse but overall experience higher rates of alcohol and drug abuse than the general population. Treatment that focuses on AI/AN culture and includes clinicians who are members of these communities gets the best results.

Representing 1.7% of the U.S. population, American Indian and Alaska Native (AI/AN) populations are very diverse, with over 280 cultural groups and over 500 tribes.

Among such great diversity also exists a wide range of substance use patterns. However, AI/AN people tend to experience higher rates of alcohol and drug addiction than the general population.

Historical trauma and discrimination experienced by AI/AN communities have been linked with the higher rates of substance abuse, with use generally starting at a young age.

Addiction treatment options that involve indigenous healthcare workers and a community-focus offer the best results.

They also help AI/AN people overcome historical barriers to care, such as those created through discrimination and a lack of resources.

Disclaimer: It’s important to note that Native Americans and Alaska Natives may use some substances in certain cultural contexts, which is not the same as abuse. However, Bedrock Recovery Center does not advocate any use of substances. All substance use, even for cultural or spiritual purposes, comes with the risk of addiction and other mental health issues.

Rates Of Substance Misuse For American Indians And Alaska Natives

Although the prevalence of alcohol use among AI/AN tribes is well documented, these groups also have a higher rate of illicit drug use than the general population.

AI/ANs are more likely than any other ethnic group in America to die from alcohol-related causes, making alcohol addiction treatment a primary concern.

Studies also show that American Indians and Alaska Natives have been hit the hardest of any ethnic group by the opioid epidemic.

Among illicit drugs, marijuana was the most abused substance by AI/AN people in 2020, with 7% of respondents aged 26-plus using it daily or almost daily, according to government data.

Other drugs with the highest rates of use among AI/ANs in 2020 include the following:

  • psychotherapeutic drugs (5.4%)
  • hallucinogens (5%)
  • cocaine (3%)
  • inhalants (1.7%)

Treatment for substance abuse was sought by approximately 193,000 AI/AN people in 2020 at rehab centers, mental health centers, and hospitals.

With about 2.6 million AI/AN people living in the U.S. today, that’s about 7.7% of the population. This doesn’t reflect those living with an SUD who don’t seek treatment.

Risk Factors For Substance Misuse Among AI/AN Communities

People in AI/AN communities have culturally specific risk factors for substance use, making it more likely that they might develop a substance use disorder.

Intergenerational Trauma

Trauma that crosses generations has been well documented, including in families of Holocaust survivors as well as those of many indigenous groups.

Examples of trauma among AI/AN groups include being forced to leave their homelands and give up their languages, spiritual practices, and culture. Epidemics are another example.

Historical trauma in the form of these huge losses and often violent struggles has affected the emotional and psychological health of generations of indigenous people.

This puts them at greater risk of substance use and abuse, as trauma and chronic stress have been tied to mental health disorders and addiction.

Cultural Isolation

In 1830, the Indian Removal Act by Congress began the forcible relocation of thousands of Indigenous people to what was called “Indian Territory.”

Being culturally isolated continues to have a negative effect on AI/AN people. During the COVID-19 pandemic, for example, more indigenous people got COVID and died.

AI/AN people have less representation in government, higher rates of poverty, a lower life expectancy, and less access to education and healthcare than others in the U.S.

Many do not even have access to running water. For example, 40% of the Navajo Nation do not, according to the COVID report.

All of this can contribute to substance use as a way to deal with stressors. It can also make it difficult for young people to leave their reservations and attend college to help improve their circumstances.


In a recent Harvard University poll, more than one-third of Native Americans reported workplace experiences involving offensive comments, violence, threats, or harassment.

Many reported additional discrimination because of their native status during situations such as going to the doctor, interacting with police, or applying for jobs or loans.

Being discriminated against leads to fewer opportunities, which contributes to stress and raises the risk of substance use and other mental health disorders.

Discrimination also contributes to barriers to receiving high-quality medical and behavioral health care.

Most Commonly Abused Drugs Among American Indian And Alaska Native People

Alcohol is widely used among American Indian and Alaska Native people, but illicit drugs such as marijuana, psychotherapeutic drugs, and others are also prevalent.

Among adolescents, past 30-day use of alcohol and tobacco is higher for AI/ANs than it is for white people, as is lifetime use of cocaine, marijuana, inhalants, heroin, meth, ecstasy, steroids, and injected drugs.

Alcohol Dependence

Alcohol abuse kills more AI/AN people than any other ethnic group in America. One study shows that three-quarters of all AI/AN deaths are alcohol-related.

Those numbers are higher for suicide deaths and for homicides, with 80% and 90%, respectively, involving alcohol.

Alcohol abuse has even been found in young children in AI/AN communities, with addiction counselors reporting that most of their clients began drinking at age 10 or 11.

Studies also show that there are more people who either drink heavily or abstain, with fewer people who drink in moderation. However, as many as half of all abstainers report previous heavy alcohol use.

Among adolescents, both AI/AN people and white people tend to use alcohol, marijuana, and tobacco together.

Marijuana Use

Marijuana use is considerably higher in AI/AN populations, with 26.3% reporting use in the past year compared to 17.9% of the general U.S. population.

It’s important to note that cultural norms often contribute to the use of marijuana in these communities.

Many Native Americans do not consider marijuana a drug of abuse. Some use it socially for its healing or relaxing properties. So the above numbers may not necessarily take into account cultural context.

One study showed that AI/AN adolescents’ marijuana use was related to anticipated socializing and parental approval, although frequent drug use wasn’t attributed to this.

Psychotherapeutic Drugs

Psychotherapeutic drugs are prescription drugs used to treat conditions that involve thought problems, such as depression, bipolar disorder, and schizophrenia.

Behind marijuana, psychotherapeutic drugs are the second most abused illicit substance by people in AI/AN communities.

In 2020, 5.4% of AI/AN people over the age of 12 reported using a psychotherapeutic drug in the past year, while 5.8% of the general U.S. counterpart reported the same.

Prescription Pain Relievers

From 1999 to 2010, U.S. retail pharmacy sales of opioid prescription pain medications quadrupled. There is a lack of data on the impact on AI/AN people.

However, a few studies do provide insights. One showed that 9% of AI/ANs over the age of 50 misused prescription pain pills, compared to 1.3% of white people and 1.9% of Hispanic people.

A review of deaths in the U.S. from 1999 to 2009 also showed that the highest rate of opioid pharmaceutical-related deaths was among AI/AN people.

From 2013 to 2015, AI/ANs were 2.7 times more likely to die from drug overdoses than white people and 4.1 times more likely to die of heroin- or opioid-related overdoses.

Heroin Abuse

Reports indicate that heroin use is on the rise in American Indian and Alaska Native communities.

In 2018, the U.S. Bureau of Indian Affairs (BIA) drug agents’ seizures of heroin increased by 190% from the previous year in tribal communities.

The BIA and Drug Enforcement Administration (DEA) are particularly concerned about the increasing trend of heroin cut with fentanyl, a powerful synthetic opioid involved in many overdoses.

Heroin is among the drugs that are used more by young AI/AN people (22 lifetime uses, on average) than their white counterparts (1.5 lifetime uses, on average).

Steroid Use

AI/AN adolescents are more likely to use steroids than their white counterparts, with more frequent use as well; i.e., 29.5 average uses versus six uses.

Steroid use often goes together with injected drug use among young AI/AN people, a recent study shows.

Knowing more about polysubstance use, or the use of more than one drug at a time, can help health care providers screen for and treat substance use disorders.

Cocaine Abuse

Cocaine use is also higher among AI/ANs (3%) compared to the general U.S. population (1.9%), according to 2020 data.

The use of cocaine by young AI/ANs is also considerably higher than among white adolescents, with the former group reporting an average of 14.5 uses versus six for the latter.

Inhalant Use

Inhalant abuse refers to using glue, paints, aerosol spray cans, or sprays for the purpose of getting high.

Slightly more AI/AN people used inhalants (1.7%) versus the general U.S. population (0.9%) in 2020.

Regarding polysubstance use, inhalants and heroin tend to be used together by both white and AI/AN young people.

Addiction affects everyone differently. However, there are some trends among different demographics, including those of AI/AN communities.

Substance Abuse Among Women In AI/AN Populations

American Indian and Alaska Native women face alarmingly high rates of sexual assault and intimate partner violence, with 39% reporting such incidents.

This adds to the trauma that AI/AN women already experience through forced cultural assimilation and other cross-generational causes.

Illicit drug use among young AI/AN women and men is comparable in some tribal communities, which generally see more drug abuse than their white counterparts.

For AI/AN women, drinking alcohol is sometimes associated with deviance, abnormality, and promiscuity. These beliefs could impede good alcohol treatment options for women.

It could also contribute to the fact that young AI/AN women who abuse alcohol are more likely than their male counterparts to also use other substances, such as cocaine and amphetamines.

Addiction Trends In Men In AI/AN Populations

More AI/AN men than women die from alcohol-related causes. One study showed that 80% of AI/AN men in their 20s reported alcohol use.

Men in American Indian and Alaska Native communities are also more likely than women to use illicit drugs.

An increase in violence in AI/AN communities reported by the BIA has been linked with increases in meth, heroin, and prescription drug use.

Substance Misuse By Age

It isn’t surprising that young AI/ANs are more likely than older members of their communities to use alcohol and illicit drugs.

However, the age at which they start using these substances is much younger than in other ethnic groups in the U.S.

One study showed that it isn’t uncommon for AI/AN people with an SUD to have begun using drugs or alcohol at 10 or 11 years old or younger.

The report also showed cases of chronic alcohol use in children as young as 2 to 16 in one northwestern tribe.

Co-Occurrence Of Substance Abuse And Mental Illness In AI/AN Populations

Substance use and other mental health disorders commonly occur together. This is called co-occurring disorders, or dual diagnosis.

When regularly experiencing fear, anxiety, depression, or other distressing emotions, people might turn to drugs or alcohol. However, this only exacerbates the problem.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing traumatic events.

AI/ANs are estimated to be two to three times more likely than the general population to develop PTSD. They also have higher rates of experiencing trauma in general.

For example, Indian Health Service (IHS) data shows that 15.1% of deaths in AI/AN communities were the result of “accidents and adverse effects.”

Comparable U.S. data shows that “accidents and adverse effects” led to 4.1% of deaths, the fifth cause of death in the U.S. but the second in AI/AN communities.

In one AI/AN community randomly selected for a recent study, 21.9% of the population was shown to have PTSD.

This is comparable to the percentage of survivors who would be expected to develop PTSD after extreme events such as mass shootings and combat.

Mood Disorders

The link between mood disorders, such as depression, and addiction in AI/AN populations requires more study, but a link does seem to exist.

Part of the difficulty in establishing the link stems from cultural differences in what depression is or how it’s defined, possibly leading to its underdiagnosis in AI/AN people.

However, of those who seek IHS mental health treatment for psychiatric symptoms in general, 70% report drug or alcohol problems, a recent study showed.

Other studies have shown that depressive symptoms are very common in AI/AN groups such as working women who feel they have to fit into cultural gender roles (48%) and college students (45%).

Depression and other mood disorders and substance abuse tend to feed into each other, meaning that when symptoms of one disorder worsen, so do those of the other.


Suicide is a major concern for American Indian and Alaska Native communities, with a suicide rate that is 1.7 times higher than the general U.S. population, or 70% higher.

Some in the community believe that a weakening of tribal unity is at least partially to blame, but drug and alcohol abuse has also been tied to the high suicide rate.

As many as 80% of suicide deaths among AI/ANs are reported to involve alcohol.

Studies show that heavy drinking can impair decision-making and make self-regulation more difficult, increasing the risk of suicide in some people.

Treatment for substance abuse and other mental health disorders in AI/AN populations is being focused more on community-based care.

Indigenous health care workers can help remove barriers to care, such as discrimination, that perpetuate substance abuse in AI/AN communities.

They can also provide treatment that emphasizes the role of the community in a person’s health, versus Western treatment, which focuses on the role of the individual.

Behavioral Health Treatment Disparities

American Indian and Alaska Native populations face more barriers to mental and other health care than the general U.S. population does.

These barriers include:

  • historical trauma
  • ongoing discrimination
  • higher poverty rates
  • a lack of Indigenous care providers and other resources

Best Treatment Approaches For AI/AN People With Addictions

Research shows that addiction treatment options that incorporate and honor AI/AN people’s cultural heritage and self-determination deliver the best results.

This includes health services provided through native psychologists and other medical professionals along with Indigenous community mental health workers.

AI/AN people have reported an increased likelihood of seeking health care if the provider is someone from within their community.

Importance Of Culturally Responsive Care

Culturally responsive care has been shown to help prevent substance abuse in young AI/AN people and restore balance in tribal communities.

One 2022 study involving 13 focus groups of urban AI/AN young people found that cultural values provide binding pathways for positive behaviors.

These values, such as mindfulness and respect for nature, help fight against the increased risk of substance use in AI/AN young people caused by cultural isolation and discrimination.

Celebrating emerging adulthood as a sacred experience was also identified as a way for young people to build cultural identity and make healthier decisions.

Young AI/ANs are also more likely to seek mental health care treatment if the provider is an Indigenous person.

In a 2016 study, AI/AN people who had attempted suicide reported reduced depressive symptoms and a more positive attitude about seeking care after meeting with native community mental health workers.

Medical Detox

Medical detox offers 24/7 medical care while those with an SUD go through the detoxification process, which can have severe side effects.

Many people in AI/AN communities struggle with the stigma associated with seeking substance abuse and other mental health treatment. This stigma that characterizes mental health help as weak or shameful has become a consistent barrier to treatment.

Education about the process could help AI/AN people see their addiction not as a weakness, but as the body’s physical dependence on a substance.

Motivational Enhancement Therapy

Motivational enhancement therapy (MET) and interviewing help people discover their own reasons for wanting to stop abusing alcohol or drugs.

In one recent study, AI/ANs with alcohol use disorders received better outcomes from MET than from cognitive behavioral therapy (CBT) or 12-step groups.

Helping people with SUDs take back their power is one of the hallmarks of MET and could be a solution to historical trauma experienced by AI/AN populations.

Group And Family Counseling

The Indian Health Service’s Alcohol and Substance Abuse Program (ASAP) recommends that people don’t “go it alone” when it comes to SUD treatment.

Group therapy offers AI/AN people the opportunity to share experiences with other people in their community going through addiction treatment in a safe environment.

Family therapy involves family members, not to blame them for contributing to their loved one’s addiction but rather to improve family communication and understanding.

This can be critical in communities where substance use is considered a normal part of life, such as during family get-togethers and other social events.

Group therapy can also provide the sense of community that many AI/AN people, and all people, require for relapse prevention.

Drum-Assisted Recovery Therapy For Native Americans

Drum-Assisted Recovery Therapy For Native Americans (DARTNA) was developed in response to the need for culturally responsive treatment options.

Drumming is culturally popular across many AI/AN tribes and serves as a way for people to come together while staying sober.

Following one study involving a DARTNA treatment plan, participants reported fewer physical ailments, less anxiety, and fewer drinks per day.

More studies are needed to prove the efficacy of this treatment.

Addiction Resources For American Indian And Alaska Native People

A variety of resources exist for AI/AN people looking for help with substance use disorders and treatment options.

Here are a few good starting places for your research:

  1. Adversity and Resilience Science – Cultural Dynamics, Substance Use, and Resilience Among American Indian/Alaska Native Emerging Adults in Urban Areas
  2. American Indian and Alaska Native Mental Health Research – American Indian and Alaska Native Substance Abuse: Co-Morbidity and Cultural Issues
  3. Centers for Disease Control and Prevention (CDC) – Patterns of Polysubstance Use Among Non-Hispanic White and American Indian/Alaska Native Adolescents: An Exploratory Analysis
  4. The Journal of Rural Health – Practices Surrounding Pain Management among American Indians and Alaska Natives in Rural Southern California: An Exploratory Study
  5. Morbidity and Mortality Weekly Report – Drug, Opioid-Involved, and Heroin-Involved Overdose Deaths Among American Indians and Alaska Natives — Washington, 1999–2015
  6. National Library of Medicine – Response of Native American clients to three treatment methods for alcohol dependence
  7. Substance Abuse and Mental Health Services Administration (SAMHSA) – Results from the 2020 National Survey on Drug Use and Health: Detailed Tables
  8. Substance Abuse and Mental Health Services Administration (SAMHSA) – 2020 National Survey on Drug Use and Health: American Indians and Alaska Natives (AI/ANs)
  9. U.S. Department of the Interior – Drugs In Indian Country

Written by Bedrock Recovery Center Editorial Team

Published on: October 7, 2022

© 2024 Bedrock Recovery Center | All Rights Reserved

* This page does not provide medical advice.

Prefer Texting?
We've got you covered.

Receive 24/7 text support right away.
There is no obligation and you can opt out at any time.

Sign up for text support

Receive 24/7 text support right away.
There is no obligation and you can opt out at any time.
Ready to make a change? Talk to a specialist now.
(617) 657-2877
icon-angle icon-bars icon-times