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Prevalence of Substance Abuse in Native American Communities

Substance abuse is a significant public health concern in the United States.  Although it can affect anyone, regardless of race, gender, sexuality, religion, or socioeconomic status, it has unfortunately affected Native American communities in disproportionate amounts.  Native Americans are more likely than any other ethnic group to suffer from substance abuse problems.

Substance abuse can have substantial consequences on the health and overall well-being of individuals, families, and communities.  Substance abuse can lead to mental health disorders, chronic diseases, social problems, and economic strife. Understanding the incidence of substance abuse in Native American communities is central to addressing the issue and developing effective prevention programs and accessible treatment options.

Rates of Substance Use/Abuse

A 2019 report from the National Survey on Drug Use and Health (NSDUH) cites Native Americans as having the highest rates of substance abuse among any other ethnic group in the US.  The study found that 12.5% of Native Americans (aged 12 and older) struggle with a substance use disorder.  When compared to the 6.5% of the general population, this number is quite staggering.  The report went on to show the percentage of Native Americans with alcohol use disorder (10.5%) as being much higher than the general population (5.7%) as well.

Additionally, and in part due to the high rate of substance use/abuse, Native Americans have a lower life expectancy of 5.5 years (when compared to other ethnic populations).  And in recent years, it seems the problem may be worsening.  From 2016 to 2020, Native Americans experienced significantly higher alcohol-related deaths (at 52 out of 100,000) when compared to the rest of the population (at 12 out of 100,000).

Commonly Used Substances

The types of substances commonly used by Native Americans can vary based on the community and/or geographic region. Yet looking at the overall numbers, the most frequently abused substances among Native Americans include alcohol, tobacco, and prescription opioids.

According to a report from the Substance Abuse and Mental Health Services Administration (SAMHSA), Native Americans have the highest rates of alcohol use and binge drinking among all ethnic groups in the United States. Tobacco use is also high among Native Americans, with rates of cigarette smoking and use of other tobacco products soaring far above other ethnic groups.

Additionally, opioid addiction has become a substantial issue in many Native American communities, with prescription opioids being a major source of addiction. Other commonly used substances include cocaine, marijuana, and methamphetamine.

Contributing Factors to Substance Use/Abuse

There are many potential factors (both individual and environmental) that influence the high rates of substance abuse in Native American communities.

  • Lack of awareness/education: Many Native Americans lack access to comprehensive information and education about the potential risks and consequences of substance abuse. This limited awareness hinders their ability to recognize problematic substance use and seek appropriate help. Improved education initiatives can empower individuals with knowledge and promote informed decision-making regarding substance use.
  • Lack of access to healthcare: Geographical remoteness, limited financial resources, and systemic barriers contribute to reduced access to healthcare services, including mental health and substance abuse treatment, in many Native American communities. The scarcity of healthcare facilities and professionals makes it challenging for individuals to receive timely and appropriate treatment for substance use issues.
  • Peer pressure: Native American youth often face significant peer pressure related to substance and alcohol use. Social norms within their communities may normalize or encourage substance use behaviors, making it difficult for individuals to resist peer pressure and make healthy choices. Addressing peer influence through community-wide prevention efforts and promoting positive social connections can help mitigate this risk factor.
  • Trauma: Native American communities have a history of experiencing trauma, including forced assimilation, displacement, and ongoing marginalization. These experiences can lead to post-traumatic stress disorder (PTSD) and other forms of trauma, which significantly increase the likelihood of engaging in substance abuse as a coping mechanism. Trauma-informed care and culturally sensitive interventions that address underlying trauma are crucial in supporting recovery.
  • Genetics: There is evidence to suggest that Native Americans may have a genetic predisposition to alcoholism and other substance use disorders. Genetic factors can influence the way the body metabolizes alcohol and drugs, increasing susceptibility to addiction. Recognizing these genetic vulnerabilities can inform targeted prevention and treatment approaches.

By understanding these contributing factors, we can develop tailored prevention and intervention strategies that address the specific needs of Native American communities. Culturally sensitive programs, increased access to healthcare services, community engagement, and trauma-informed care can help mitigate these factors and promote healthier outcomes for Native Americans affected by substance abuse. Empowering individuals with knowledge, support, and resources are essential to reducing substance abuse rates and fostering overall well-being within Native American communities.


In conclusion, addressing the prevalence of substance abuse in Native American communities requires a comprehensive and culturally sensitive approach. To effectively combat substance abuse, efforts must focus on increasing awareness, improving access to healthcare services, promoting positive social connections, providing trauma-informed care, and recognizing the genetic vulnerabilities of Native Americans. Culturally tailored prevention programs and treatment approaches that incorporate traditional healing practices and involve families and communities are vital to supporting recovery and promoting overall well-being. By addressing these contributing factors and implementing targeted interventions, we can work towards reducing substance abuse rates and improving the health outcomes of Native American communities. It is through collaboration, understanding, and empowerment that we can break the cycle of substance abuse and foster healthier futures for Native Americans.

Sources Cited

  • U.S. Department of Health and Human Services, Office of Minority Health. (2018). Profile: American Indian/Alaska Native.
  • Futures Without Violence. (2017). The Facts on Violence Against American Indian/Alaskan Native Women.
  • Young, R.S., & Joe, J.R. (2009). Some thoughts about the epidemiology of alcohol and drug use among American Indian/Alaska Native populations. Journal of Ethnicity in Substance Abuse, 8(3), 223-41.
  • Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health Detailed Tables.
  • Substance Abuse and Mental Health Services Administration. (2014). SAMHSA American Indian/Alaska Native Data.
  • Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health Detailed Tables, Figure 5.38B.
  • Dickerson, D.L., Spear, S., Marinelli-Casey, P., Rawson, R., Li, L., & Hser, YI. (2011). American Indians/Alaska Natives and Substance Abuse Treatment Outcomes: Positive Signs and Continuing Challenges. Journal of Addictive Diseases, 30(1), 63–74.
  • U.S. Department of the Interior, Bureau of Indian Affairs. (2019). Indian Entities Recognized by and Eligible To Receive Services From the United States Bureau of Indian Affairs.
  • 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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