Native American Rehab Centers for Substance Abuse Treatment

Substance Abuse in Native Americans: Statistics

According to Census estimates released in 2018, 6.8 million people (or 2.1% of the population) in the United States identified as Native American.² Of those, 4.1 million people identified as only Native American; the remaining 2.7 million identified as mixed-race Native American.² However, Native American communities are highly diverse culturally and even in the languages they speak. There are 574 federally recognized tribes and an additional 100 recognized by various states.^3,4 Yet, nearly all tribes face similar problems:

• Young American Indians have significantly higher rates of substance use when they live on or near reservations than other adolescents. For instance, one study found that 39.7% of reservation-based American Indian 8^th graders (during the 2016-2017 school year) had used alcohol, 4.3% used cocaine, and 2.8% had used heroin (compared to 22.8%, 1.1%, and 0.5%, respectively for a national sample of 8^th-grade students).⁵
• Mortality rates for American Indians and Alaska Natives are higher compared with “all races” in the United States for alcohol, chronic liver disease and cirrhosis, drugs, and lung cancer. In fact, American Indians and Alaska Natives die from alcohol-related causes six times more often than the national average.^4,6
• Native Americans who use substances tend to start using earlier and more heavily than other ethnicities. Early use of substances has been linked with greater risk for developing substance use disorders (SUDs).² A study of indigenous adolescents found that the prevalence of SUDs increased by more than eight times from early to mid-adolescence.^7,8
• Statistics show that Native Americans are less likely to drink than their white counterparts. However, they do have a higher rate of past-year alcohol use disorder than other racial and ethnic groups.²
• Marijuana is the second most common substance of abuse for Native Americans. American Indians and Alaska Natives are more likely to develop cannabis use disorder than are members of many other racial groups. Methamphetamine and prescription opioid misuse are growing problems for American Indians and Alaska Natives and are of major concern in several native communities.²
• There’s a greater likelihood that Native American women who abuse alcohol abuse other substances as well.⁷
• American Indians and Alaska Natives are diagnosed with alcohol, marijuana, cocaine, and hallucinogen disorders more than any other ethnic or racial group in the country.⁹

Risk Factors for Substance Abuse

There are several factors that affect Native American communities, which can increase the risk for developing SUDs. Some of the major risk factors that Native American communities commonly face include:

• Historical trauma. Centuries of exposure to intergenerational trauma plague the American Indian and Alaska Native populations.² Native Americans continue to be affected by trauma resulting from centuries of genocide, forced relocation, broken government treaties, discriminatory government policies, and placement into residential boarding schools. These schools mandated assimilation while forcibly separating children from their families and banning them from speaking their native language, wearing traditional clothing, and participating in traditional cultural practices or family life.^4,6
• Lack of easy access to health care. While the federal government established the Indian Health Service (IHS) to provide health care to Native American people, the service is severely underfunded, making it difficult to provide adequate care to the people in need.¹⁰
• Lower educational attainment. Native Americans often have poor access to education because of systemic inequities.^11,12
• Poverty. The Native American population has the highest poverty rate among all minority groups, and is more than twice as likely to live below the poverty line than the average population in the United States.¹³
• Housing problems. Poverty and overcrowding make it difficult to maintain stable housing.^12,14 Native Americans are significantly more likely to live in overcrowded conditions and struggle with access to reliable transportation, electricity, telephone, and internet.¹⁴ Homelessness provides another risk factor for substance use.¹⁴
• Unemployment. According to the Current Population Survey (from 2016-2018), 6.6% of American Indians and Alaska Natives were unemployed, considerably higher than the 3.9% rate for the country. The unemployment rate is even higher for those living on reservations or other tribal lands.^2,15
• Violence. Native Americans face an increased risk of exposure to violence—domestic abuse, physical abuse, and sexual assault.² Native American women have nearly double the risk for sexual assault than African American or white women.² And studies indicate strong associations between substance abuse and sexual, physical, and emotional abuse.⁷
• Mental health issues. Research suggests that American Indians and Alaska Natives are more likely than the general population to have psychological distress that interferes with daily functioning and to have higher suicidality.² Among American Indians and Alaska Natives, the most significant mental health concerns include anxiety disorders, post-traumatic stress disorder (PTSD), depression, bipolar disorder, and suicide.^2,4 As with other populations, mental health disorders in American Indians and Alaska Natives frequently co-occur with substance use disorders.⁷
• Loss of connection to culture. After generations of violent colonization, assimilation policies, and general loss, many Native American people, cultures, and traditions suffered. As a result, traditional ways of child rearing, family structure, and relationships changed. This led to a loss of Native role models, languages, pride, safety, and a sense of belonging, which has filtered down through generations, and continues to affect American Indians and Alaska Natives.^14,16

Native American Substance Abuse: Barriers to Treatment

In 2019, 350,000 American Indians and Alaska Natives had a mental illness and/or SUD. Less than half of them received treatment.¹⁸ There are several factors that contribute to this.

For one, Native American people often have limited access to substance abuse services. Most of the IHS facilities are located on tribal lands. However, less than 30% of Native Americans live there, making it difficult for the urban and suburban American Indians and Alaska Natives to access these services.^4,6 On the other hand, mental health services in rural, isolated areas are severely limited.⁴ Additionally, in 2019, nearly 15% of American Indians and Alaska Natives lacked health insurance coverage of any kind.¹⁰ Because more than 20% of this racial group lives at the poverty level, treatment costs and lack of transportation make it difficult for many of them to access care.^10,19

Also, IHS receives less funding than other government health care programs like Veterans Affairs (VA), Medicaid, and Medicare. Advocates for American Indians and Alaska Natives have long voiced concerns about whether the funds are sufficient to provide eligible individuals with the care they need. In 2017, for instance, IHS’s total spending of $6.68 billion was less than 10% of what the VA spent and about 1% of what Medicaid and Medicare spent.¹⁷ In addition, IHS treatment programs struggle to meet demands, often caused by staff shortages and turnover.²

And for some, the burden of historical trauma makes trusting other people, institutions, and organizations outside their community difficult.¹⁶ Treatment approaches may conflict with their values, beliefs, and cultural expressions, especially as they pertain to health and illness, emotional well-being, and resilience.¹⁶

For others, the stigma surrounding addiction creates a barrier to treatment.

Yet, even with these barriers, American Indians and Alaska Natives appear to be more likely than all other major racial and ethnic groups to seek substance abuse treatment services.²

• All Treatment Centers

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  Native American Rehab Programs

  The type of treatment provided depends on the type of drug and individual needs. Effective treatment programs incorporate various components that address the many needs of the individual—not just the substance abuse but any co-occurring conditions as well. Treatment may include detox, behavioral therapies, counseling, medications, or a combination.

  American Indians and Alaska Natives, however, have other considerations when choosing a drug or alcohol rehab. Maintaining ties to one’s culture can help treat both substance use and mental health disorders.² Facilities with specialty programming for Native Americans often focus on balance, harmony, and interconnectedness that contributes to Native American spirituality and makes up part of the spiritual needs of this community.² Thus, treatments that incorporate practices that support this have been found to be especially effective.

  Traditional methods of healing include but are not limited to:^6,9,20,21

  • 12 Wisdom Steps Program.
  • Powwows.
  • Ceremonial teepee construction.
  • Drum circles.
  • Meditations with Native American elders.
  • Smudging
  • Sweat ceremonies.
  • Talking circles.
  • Art circles.
  • Sun dances.
  • Vision quests.
  • Medicine wheel.
  • Sacred pipe.

  Researchers note that the most successful treatment programs combine one or more traditional healing practices with other modified forms of therapy. For instance, motivational interviewing (MI), a counseling method used to increase motivation towards making positive changes and building self-confidence, has been effective in the treatment of some American Indians and Alaska Natives when cultural adaptations are made. These include social interactions that involve a spiritual aspect and a reliance on spirituality, extended family, and clan relations as motivational factors.²²

  Take Our Substance Abuse Self-Assessment

  Take our free, 5-minute substance abuse self-assessment below if you think you or someone you love might be struggling with substance abuse. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result.

  How to Find the Best Native American Rehab Near Me

  If you’re ready to seek treatment for a substance use disorder, consider your options carefully. The best and most effective treatment is that which is tailored to your individual needs—whether that’s short- or long-term inpatient rehab treatment, outpatient care, or a dual-diagnosis program.

  Depending on your location, you may find an IHS facility. If there’s not an IHS program nearby, weigh the pros and cons of traveling for treatment. American Addiction Centers, for instance, have treatment facilities in California, Nevada, Texas, Mississippi, Florida, Rhode Island, Massachusetts, and New Jersey.

  When you identify potential programs, you should contact them and ask about whether they have experience treating Native American people and how their treatment methods accommodate your cultural and spiritual needs. Many programs also provide dual-diagnosis treatment, which treats both substance use and mental health issues at the same time.

  Affordable Rehab Treatment

  The Affordable Care Act (ACA) increased access to insurance coverage and also authorized additional programs and services within IHS.^23,24 This allows Native Americans to receive care through IHS, tribal, or urban Indian programs; get coverage through the insurance Marketplace; or obtain Medicaid or Medicare if they qualify.^23,24 Indian Health Services can be utilized even if the individual has another form of health insurance, and treatment is available through IHS or a tribal or urban Indian facility at no cost.²⁴

  Treatment Outlook

  Treatment of Native Americans with substance use disorders can be effective, especially when forms of traditional healing and cultural beliefs are incorporated into the treatment program.^9,21 That’s why it’s important to find a facility that will integrate your unique needs into its treatment plan.

Sources

1. American Psychiatric Association. (2017). Mental Health Disparities: American Indians and Alaska Natives.
2. Substance Abuse and Mental Health Services Administration. Behavioral Health Services for American Indians and Alaska Natives. Treatment Improvement Protocol (TIP) Series 61. HHS Publication No. (SMA) 18- 5070EXSUMM. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.
3. National Conference of State Legislatures. (2021). Federal and state recognized tribes.
4. American Psychiatric Association. (2010). Mental health disparities: American Indians and Alaska Natives.
5. Swain, Randall C., Ph.D., Stanley, Linda R., Ph.D. (2019). Substance Use Among American Indian Youths on Reservations Compared with a National Sample of US Adolescents. JAMA Network Open, 1(1).
6. Whitesell, N.R., Beals, J., Big Crow, C., Mitchell, C.M., & Novins, D.K. (2012). Epidemiology and etiology of substance use among American Indians and Alaska Natives: Risk, protection, and implications for prevention. American journal of drug and alcohol abuse, 38(5), 376-382.
7. Gray, N., & Nye, P. (2001). American Indian and Alaska Native substance abuse: Co-morbidity and cultural issues. American Indian and Alaska Native mental health research, 10(2), 67-84.
8. Whitbeck, Les B., Ph.D., Yu, ManSoo, Ph.D., Johnson, Kurt D., Ph.D., Hoyt, Dan R., Ph.D., Walls, Melissa L., Ph.D. (2008). Diagnostic Prevalence Rates from Early to Mid-Adolescence among Indigenous Adolescents: First Results from Longitudinal Study. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 890-900.
9. Dickerson, D.L., Spear, S., Marinelli-Casey, P., Rawson, R., Li, L., & Hser, Y=I. (2011). American Indian/Alaska Natives and substance abuse treatment outcomes: Positive signs and continuing challenges. Journal of addictive diseases, 30(1), 63-74.
10. S. Department of Health and Human Services Office of Minority Health. (2019). Profile American Indian/Alaska Native.
11. Urban Indian Health Institute. (2021). Urban Indian health.
12. Substance Abuse and Mental Health Services Administration. (2021, October 5). Tribal affairs.
13. United States Census Bureau. (2019). Selected Characteristics of People at Specified Levels of Poverty in the Past 12 Months.
14. Satter, D.E., Mercer Kollar, L.M., O’Gara ‘Djik Sook’ D. (2021). American Indian and Alaska Native knowledge and public health for the primary prevention of missing or murdered Indigenous Persons. Journal of federal law and practice, 69(2), 149-188.
15. S. Bureau of Labor Statistics. (2019). American Indians and Alaska Natives in the U.S. labor force.
16. Substance Abuse and Mental Health Services Administration. (2014). Tips for disaster responders: Understanding historical trauma when responding to an event in Indian Country.
17. S. Government Accountability Office. (2018). Indian Health Service: Spending Levels and Characteristics of HIS and Three Other Federal Health Care Programs.
18. Substance Abuse and Mental Health Services Administration. (2019). National Survey on Drug Use and Health: American Indians and Alaska Natives (AI/ANs).
19. Legha, R., Raleigh-Cohn, A., Fickenscher, A., & Novins, D. (2014). Challenges to providing quality substance abuse treatment services for American Indian and Alaska native communities: Perspectives of staff from 18 treatment centers. BMC psychiatry, 14(181).
20. Indian Health Service. (n.d.) Culturally relevant best practices.
21. Moghaddam, J.F., & Momper, S.L. (2011). Integrating spiritual and Western treatment modalities in a Native American substance use center: Provider perspectives. Substance use and misuse, 46(11), 1431-1437.
22. Venner, K.L., Greenfield, B.L., Hagler, K.J., Simmons, J., Lupee, D., Homer, E., … Smith, J.E. (2016). Pilot outcome results of culturally adapted evidence-based substance use disorder treatment with a Southwest Tribe. Addictive behaviors reports, 3, 21-27.
23. Indian Health Service. (n.d.) Affordable Care Act.
24. Indian Health Service. (n.d.) ACA and you.