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Considerations for American Indian/Alaska Native and Tribal Populations

American Indian/Alaska Native (AI/AN) populations and tribal communities are more likely to report certain types of substance use disorders (SUDs) when compared to other racial and ethnic groups. Data from the National Survey on Drug Use and Health shows that AI/ANs aged 18 and older were more likely to receive SUD treatment in the past year (4.8%) than any other racial and ethnic population.

There are still a number of barriers to treatment in tribal communities, including limited resources, stigma, and fear of arrest. Tribal communities may not have naloxone available or people who are trained to administer naloxone. Additionally, there is a lack of education about how to help someone who is overdosing. Documentation of substance misuse, including opioid use disorder and overdose, may also be underestimated if neighboring communities provide emergency medical services and do not identify tribal status in records. This lack of data impacts the ability of tribes to apply for funds to support SUD treatment programs and track their success in implementing these programs.

Programs addressing SUD in AI/AN populations should take into consideration the effects of historical trauma on SUD behaviors. Populations experience historical trauma across generations due to an event of oppression. AI/AN populations have experienced historical trauma due to European colonization of the United States beginning in the 1400s that resulted in loss of land, population, and culture. The trauma from these events has persisted through generations and contributes to mental and behavioral health conditions, including SUD. Rural SUD treatment programs should provide AI/AN populations with historical trauma-informed care. The Indian Health Services offers a series of presentations on historical trauma, including the intersection of trauma and SUD.

Rural communities may consider strategies to engage AI/AN individuals and families in need of SUD prevention or treatment services. One rural SUD treatment program serving tribal populations contracted with a Native project coordinator who had existing relationships with contacts at partner tribes. Programs have also invested in social marketing campaigns to ensure that the messages of the program are tailored to the culture of the community. Programs that address tobacco use should understand that tobacco has traditional, medicinal, or sacred connotations in some tribal communities.

The University of Washington also conducted an environmental scan of tribal opioid overdose prevention responses that provides an overview of community-based strategies. Other resources to address SUDs include the Northwest Tribal Substance Abuse Action Plan.

Resources to Learn More

2018 National Survey on Drug Use and Health: American Indians and Alaska Native (AI/ANs)
Document
An overview of the data collected from the 2018 National Survey on Drug Use and Health for American Indian and Alaska Native populations.
Author(s): McCance-Katz, E.
Organization(s): Substance Abuse and Mental Health Services Administration

Alcohol and Substance Abuse Program (ASAP)
Website
A collection of information and resources addressing substance abuse in American Indian and Alaskan Native populations. Provides screening tools, trainings, treatment options, and technical assistance.
Organization: Indian Health Services

Systematic Review of Interventions Focusing on Indigenous Adolescent Mental Health and Substance Use
Document
Analyzes mental health and substance use interventions for American Indian and Alaska Native adolescent populations to identify key factors in reducing mental health disparities.
Authors: Antonio, M., & Chung-Do, J.
Date: 2015

Wellbriety Movement
Website
Offers culturally based information and teachings for Indigenous populations pursuing recovery from alcohol and substance abuse, and intergenerational trauma.
Organization: Wellbriety