Did you know that nearly 1 in 5 Native American young adults, aged between 18 and 25 years of age, has a substance use disorder (SUD)? Nearly 20%? That’s an absurdly high ratio, even for a minority group in the U.S.
There are an estimated 5.6 million Native Americans currently living in the U.S., classified as American Indian and Alaska Native alone or in combination with one or more other races, and they comprise 1.7% of the total U.S. population. However, the Native American community experiences significantly greater rates of substance abuse compared to any other U.S. minority group.
Historically, the Native American community has been the one demographic that has endured the very worst rates of mental health disorder, too, such as major depressive disorder, emotional disturbance as school children, and suicidal ideation, and suicide itself as teenagers and adults, as well as life-long drug addiction and alcoholism.
So why does this one particular U.S. minority suffer so greatly and endure so much during their lives? The reasons for this, unfortunately, are many – they’re diverse, and, in some cases, they’re utterly unique to the Native American community:
- Historical / Transgenerational Trauma
- Violence (gang, domestic, and sexual)
- High Unemployment
- Lack of Health Insurance
- Other Forms of Discrimination
- Low Levels of Attained Education
This article will look at the alarming rates of severe behavioral health issues among Native Americans, and explore in more detail the many reasons for this crisis, as well as how effective addiction treatment for widespread substance abuse could very well lie in the cultural backgrounds and centuries-old traditions of these historic people.
Substance Abuse as “Self-Medication”
Decades of medical research and analysis have found a strong link between exposure to traumatic events and SUD. In addition, individuals with SUDs are also more likely to experience traumatic events, leaving those affected in a perpetual cycle of traumatic experiences and substance abuse.
According to a research study entitled “Risk Pathways among Traumatic Stress, Posttraumatic Stress Disorder Symptoms, and Alcohol and Drug Problems,” severe trauma, and its resulting mental health symptoms, is the primary hypothesis behind high levels of later substance use and abuse, as individuals seek to “self-medicate” the symptoms of their untreated mental health issues.
U.S. Native American Mental Health & Substance Use: Facts & Statistics
That’s the hypothesis. Here’s the reality. According to the 2018 National Survey on Drug Use and Health (NSDUH), Native Americans have the highest rates of alcohol, marijuana, cocaine, inhalant, and hallucinogen use disorders compared to all other ethnic groups in the U.S. Furthermore:
- 10% of Native Americans have a SUD
- 4% of Native Americans have an illicit drug use disorder
- 7.1% of Native Americans have an alcohol use disorder (AUD)
- Nearly 25% of Native Americans reported binge drinking in the past month
- Native Americans are more likely to report drug abuse in the past month (17.4%) or year (28.5%) than any other ethnic group
- Among U.S. adolescents ages 12 to 17, Native American youth have the highest lifetime prevalence of major depressive episodes
- Native children are 70% more likely to be identified in school as students with an emotional disturbance.
- Suicide is the second leading cause of death – 2.5 times the national rate – for Native American male youth (aged 15 to 24)
- Native American youth experience Post-Traumatic Stress Disorder (PTSD) rates at 3 times the national rate, and at the same rate as Iraqi war veterans
For example, when it comes to one of the most addictive and most damaging of illicit substances – methamphetamine – Native Americans have the highest meth abuse rates at more than 3 times the rate of any other group in the U.S. Additionally, Native Americans were 12 times more likely to die from a drug overdose involving meth than any other group in the U.S. during the COVID-19 pandemic.
Other Health Concerns for the Native American Community
It’s not just the clinical issues of substance abuse and untreated mental health disorders that affect the Native American community much more than most. It’s also a range of other chronic medical diseases and conditions, too. These include:
- Heart disease
- Unintentional injuries (accidents)
- Sudden infant death syndrome (SIDS)
- Liver disease
Specific issues, such as cultural barriers, geographic isolation, inadequate sewage disposal, and low income, often prevent Native Americans from receiving quality medical care. This can be clearly seen in the rates of tuberculosis (TB) rate for 2019. For Native Americans, the rate of TB was 7 times higher than the white population.
Transgenerational Trauma: The Lost Indigenous Children
If ever indisputable medical proof was needed for the direct link between historical trauma and subsequent substance abuse and poor mental health, then, unfortunately, this is it:
Fortunately, a statement like “kill the Indian, and save the man” would not even be tolerated in today’s society – one would hope, anyway. Yet a century and a half ago, it was an active policy pursued by the U.S. federal government, enabled by the powerful structure of the Roman Catholic Church, and it has left generation upon generation of Native American communities struggling every day with their resulting trauma, and the high rates of mental health disorders and substance addiction it has undoubtedly caused.
To summarize, for centuries the children of Native American families were forcibly removed from their loved ones and homelands, and placed into harsh “indigenous assimilation” boarding schools. Funded by the federal government and run by religious groups. On arrival, the children were shorn of their hair, their name, and their heritage – any trace of their real identity, either individually or as a proud, historic people was eradicated.
Tragically, thousands died – thousands never went back home.
“My boy, I want to tell you a story. There was things that happened to me, personally, as a child, I wish never happens to any other kid. The drinking began when I was 12 years old. Drinking was something that made me forget about things that happened to me.” – William Greenland, Native North American, in a letter to his son, highlighting the continuing transgenerational trauma, such as that caused by the indigenous assimilation schools system, that many members of the Indigenous community experienced as young children themselves.
Only now, decades and decades later, are the nations of the U.S. and Canada dealing with this shameful period in their respective histories. Only this week it was announced by Deb Haaland, the U.S. Interior Secretary (and the first Native American to serve as a Cabinet Secretary) that the U.S. government will investigate the legacy of Native American boarding schools, and to finally “uncover the truth about the loss of human life and the lasting consequences” of the institutions, which over the decades forced hundreds of thousands of children from their families and communities.”
Carlisle Indian Industrial School, Pennsylvania: Class photo, 1884
Source: National Native American Boarding School Healing Coalition (NABS)
The trauma of the lost indigenous children, and the suffering of the “boarding-school survivors” (a Native American description), have been passed down from generation to generation. Unsurprising then that 90% of respondents to a National Native American Boarding School Healing Coalition (NABS) survey blamed high rates of substance abuse and mental health problems on the emotional scars of this deeply cruel system.
“Horrific and Shocking”
Also this week, it was reported that a huge site of around 750 unmarked graves has been uncovered in Canada on the land of a former residential school known as Marieval Indian Residential School in Saskatchewan. The Cowessess First Nation, who discovered the site using ground-penetrating radar, stated the discovery was “the most significantly substantial to date in Canada – horrific and shocking.”
Sadly, it is not the first, and it won’t be the last. In Canada or here in the U.S., for that matter. In fact, a few short weeks ago, the Tk’emlups te Secwepemc First Nation announced it had found the remains of 215 children at a similar residential school site in British Columbia.
Back in 2017, here in the U.S., the U.S. Army uncovered the remains of 4 young boys at the site of the U.S.’s first “indigenous assimilation” school – the Carlisle Indian Industrial School in central Pennsylvania.
Believed to be the graves of just 3 boys, aged 14,11 and 9, and forcibly taken from their Northern Arapaho families in Wyoming in 1881, on analysis, one grave held the remains of 2 boys, and neither was the boy identified on the simple headstone – Little Plume, the youngest.
Black Feet Indians at the Carlisle Indian Industrial School, PA: c. 1980
Source: National Native American Boarding School Healing Coalition (NABS)
As criminal and tragic as this centuries-long episode of what basically amounts to genocide actually is, it is yet another clear example of the persecution of the Native American peoples that has darkened North American history ever since the first European settlers arrived here.
As Deb Haaland, U.S. Interior Secretary also stated in her announcement: “Many Americans may be alarmed to learn that the United States has a history of taking Native children from their families in an effort to eradicate our culture and erase us as a people. It is a history that we must learn from if our country is to heal from this tragic era.”
“I am a product of these horrific assimilation policies. My maternal grandparents were stolen from their families when they were only 8 years old, and were forced to live away from their parents, culture, and communities until they were 13. Many children like them never made it back home.”
Indian Country: Deliberately Targeted by Drug Traffickers
All of this begs the following question: Exactly how are huge quantities of these illicit substances, like heroin, meth, cocaine, and counterfeit pills, regularly being trafficked into the reservations of Native American communities?
The answer lies in the daily challenges and struggles faced by every Native American living in the U.S. – high levels of unemployment, chronic trauma, and a distinct lack of resources, to name but a few. Such poor socio-economic conditions make these communities highly susceptible to drug and alcohol abuse, and therefore, exceptionally easy targets to be exploited by ruthless drug traffickers, either in-state, from neighboring states, or from across the Mexican border.
The Drug Enforcement Agency’s 2020 National Drug Threat Assessment (NDTA), published in December of last year, highlights how these illicit drugs arrive on the reservations and where they arrive from. Unsurprisingly, Mexican traffickers are the principal wholesale suppliers and producers of most of the illicit drugs available on reservations throughout Indian Country.
In Native American communities, although marijuana and methamphetamine are the most widely used illicit substances, the use of prescription drugs and heroin has increased significantly in recent years.
Additionally, other easily available substances include powder and crack cocaine, fentanyl, fentanyl-laced counterfeit pills (as either prescription opioids or benzodiazepines, like Xanax), and MDMA tablets (ecstasy). Significant numbers of 2020 fatal drug overdoses in the Native American community were caused by fentanyl-laced meth.
Here in Arizona, transnational criminal organizations (TCOs), as the DEA refers to them, continue to smuggle huge quantities of marijuana through the Tohono O’odham Nation, whose land consists of 4 separate areas covering 2.8 million acres in total (the 2nd largest American Indian landholding in the U.S.). Their land is located within the Sonoran Desert of south-central Arizona and borders the Mexican border for 74 miles (119 km) – making it a prime access route for the drug cartels.
Cultural Healing: A Pathway to Successful Addiction Treatment?
Many Native American communities have limited access to the substance abuse services they need. It is believed that nearly 20% of adults require addiction treatment for either drug or alcohol use disorders; however, only around half of these actually receive treatment, and much of that is later shown to be unsuccessful.
Low rates of engagement with treatment may well be caused by cultural stigma and the obvious socio-economic factors, such as transportation issues, lack of health insurance or poor insurance coverage, and poverty. However, the primary reason for the poor success rate can be found in the treatment itself, which is considered too “western,” and rarely adapted to incorporate the powerful traditional healing practices that Native Americans have historically relied upon.
In a report prepared by the Centers for American Indian and Alaska Native Health’s Substance Abuse Treatment Advisory Board, entitled “Use of the Evidence Base in Substance Abuse Treatment Programs for American Indians and Alaska Natives” (June, 2011), it was stated that “there have been some highly successful efforts to meld the traditions of American Indian and Alaska Native tribes with that of 12-step approaches.”
However, it continues, “Some American Indian and Alaska Natives remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse treatment in their communities.”
Fortunately, however, this is changing. To address the issue of using these current therapies, medical researchers have developed strategies that do actively integrate “western” treatment with traditional native teachings.
Traditional approaches often include:
- Ceremonial tepee construction
- Sweat lodges
- Talking / Art / Drum circles
- Purification sweats
- Meditations with elders / Sacred pipe
- Sun dances
- Smudging ceremonies
- Vision quests
- Medicine wheel
Traditional Healing Case Study: Sweat Lodges at Coconino Jail, Arizona
In Coconino County Jail, located near Flagstaff in central Arizona and where at least half the inmate population at any given time are Native Americans, prisoners have been given the opportunity to participate in sweat lodge ceremonies since 2001.
In a Native American sweat lodge ceremony, rocks are heated in a fire pit outside the structure being used, and then brought inside, where they are placed into a small hole in the ground. Conducted in 4 parts – mental, emotional, physical and spiritual – the ceremony can last as long as 3 hours. The Navajo people use these sweat lodge ceremonies before major events or after a mental battle.
Adapting CBT to Connect Spirituality with Mental Health Treatment
Researchers have now accepted that the most successful treatment programs are based on traditional healing approaches, 12-Step programs, or a combination of both, and are definitely holistic in their approach. However, the use of an adapted version of Cognitive Behavioral Therapy (CBT) has also been linked with recent successful outcomes in mental health issues – often the precursor to severe substance abuse and addiction, as we have seen.
White Mountain Apache, Arizona
Arizona’s White Mountain Apache Tribe, located in the mid-east of Arizona at their ancestral homeland on the Fort Apache Indian Reservation, experienced an extremely high suicide rate for 15 to 24-year-olds from 2001-2006: 128 youths out of every 100,000, which was 13 times the U.S. general population rate and 7 times the American Indian and Alaska Native rate.
Desperate to resolve the issue, the tribe sought help from Johns Hopkins University in 2006. University psychologist Mary Cwik, Ph.D., collaborated with the tribe to incorporate their traditional beliefs and practices into a suicide prevention program. As Cwik recalled: “When we were discussing the cognitive-behavioral therapy model, the tribal representatives felt like something was missing. They felt that spirituality should be a part of treatment.”
Instead of using the triangular CBT model of “thinking – feeling – doing,” she and the tribal representatives devised a model with 4 quadrants in the shape of a circle: thoughts, feelings, behaviors, and spirituality. Additionally, data showed that the vast majority of those who committed suicide were either drunk or high at the time.
The adapted CBT, as part of a holistic program, is proving to be successful. A 2016 study reports that the incidence of suicide deaths within the White Mountain Apache Tribe dropped 38% from 2006-2012, compared with the previous 6-year period.
Importantly, the rate among those aged 15 to 24 dropped 23% during the same comparison period.
Please Note: All images (unless otherwise stated) are open source.
- Substance Abuse & Mental Health Services Administration (SAMHSA): 2018 National Survey on Drug Use & Health (NSDUH) Tables. August 2019. Available at SAMHSA.gov.
- U.S. Department of Health & Human Services: Office of Minority Health: Profile: American Indian/Alaska Native. May 2021. Available at MinorityHealth.HHS.gov.
- American Psychological Association (APA): “Risk Pathways among Traumatic Stress, Posttraumatic Stress Disorder Symptoms, and Alcohol and Drug Problems.” 2014. Available at PsycNet.APA.org.
- Executive Office of President Obama: 2014 Native Youth Report (U.S. Department of the Interior). December 2014. Available at ObamaWhiteHouse.Archives.gov.
- HMP Global Learning Network: NIH’s HEAL Initiatives Keep Progressing Thanks to Scientists’ Ingenuity. June 2021. Available at HMPGlobalLearningNetwork.com.
- National Native American Boarding School Healing Coalition (NABS): Homepage. 2021. Available at BoardingSchoolHealing.org.
- National Native American Boarding School Healing Coalition (NABS): Carlisle Repatriation. 2021. Available at BoardingSchoolHealing.org.
- U.S. Drug Enforcement Agency (DEA): 2020 National Drug Threat Assessment (NDTA). March 2021. Available at DEA.gov.
- U.S. National Library of Medicine: Use of the Evidence Base in Substance Abuse Treatment Programs for American Indians and Alaska Natives. June 2011. Available at NLM.NIH.gov.
- Arizona’s White Mountain Apache Tribe: Homepage. 2021. Available at WhiteMountainApache.org.
- American Public Health Association (APHA): Toward Understanding Suicide Among Youths: Results From the White Mountain Apache Tribally Mandated Suicide Surveillance System, 2001–2006. October 2009. Available at APHAPublications.org.
American Public Health Association (APHA): Decreases in Suicide Deaths and Attempts Linked to the White Mountain Apache Suicide Surveillance and Prevention System, 2001–2012. December 2016. Available at APHAPublications.org.