Native American communities face some of the highest rates of addiction and overdose in the country. This guide explains why, what challenges are driving the crisis, and what solutions are helping people heal.
Substance use in native communities: key statistics
Substance use continues to affect native communities at significantly higher rates than the general population. These stats help paint a clearer picture of just how deep the crisis runs:
- Commercial tobacco use is also more common among (American Indians and Alaska Natives) AIANs than among other U.S. racial and ethnic groups.
- Native Americans have the highest prevalence, mortality, and morbidity rates tied to substance use in the U.S. (SAMHSA, 2018).
- Drug poisoning death rates for American Indian and Alaska Native (AIAN) individuals were 36.9 per 100,000 between 2013–2017—higher than the 32.6 per 100,000 rate for white individuals.
- In 2018, 7.4% of AIAN adults ages 18–25 used opioids, compared to 5.5% in the general population.
- Among those 26 and older, opioid misuse rose from 4.7% in 2015 to 6.2% in 2018—compared to 3.4% in the general population.
- Methamphetamine is widely reported as a drug of choice in AIAN communities. About 15% of AIANs reported lifetime use of stimulants like meth and cocaine.
- A social media study found that 9.5% of tweets mentioning overdose were geocoded to U.S. Tribal lands—71% of which were first-person overdose accounts.
Why Native American communities are more vulnerable
Several overlapping factors contribute to the high rates of addiction in Native communities. These are not isolated causes—they build on each other, creating a lasting impact across generations.
Historical and generational trauma
Centuries of colonization and cultural suppression have created deep wounds across Native communities.
This long history of forced displacement and loss continues to affect mental and emotional health today. This trauma is still felt because of:
- Forced assimilation: Children were taken from their homes and placed in boarding schools where their language and identity were stripped away.
- Family disruption: Many children never returned, leaving families grieving and disconnected.
- Cultural loss: Generations grew up without access to their traditions, stories, or native languages.
Recent efforts, including the U.S. Interior Department’s investigation into Native boarding schools, are uncovering the long-term damage of these policies. A 2021 report revealed the location of hundreds of unmarked graves at former residential schools, reinforcing the generational trauma that still impacts Native families today.
Poverty and limited access to care
Many native communities are located in remote areas with few job opportunities or healthcare resources. These conditions make it difficult to stay healthy or recover from addiction. This leads to:
- Delays in accessing addiction treatment
- Missed early warning signs
- Fewer options for recovery close to home
Discrimination and social exclusion
Systemic racism creates additional barriers for Native Americans. They often face unequal treatment in schools, hospitals, and the justice system. Discrimination can:
- Increase stress, anxiety, and depression
- Discourage people from seeking care
- Make recovery programs feel unwelcoming or unsafe
Together, these overlapping factors create a cycle of trauma and limited support—one that puts Native American communities at greater risk for substance use and makes recovery more difficult to achieve.
Trauma and self-medication
Many Native Americans use alcohol or drugs to cope with emotional pain. This is known as self-medication. The trauma may come from abuse, violence, or cultural loss. Self-medication leads to a cycle:
- Short-term relief from drugs or alcohol
- Long-term harm, like health issues or legal trouble
- More trauma and more substance use.
Drug exposure and exploitation
Drug traffickers often target native communities. Some reservations lie near borders or rural areas with limited law enforcement.
These vulnerabilities make it easier for traffickers to push drugs into these areas. This puts communities at risk for:
- Exposure to meth, fentanyl, and counterfeit pills
- Higher rates of overdose and addiction
- Greater difficulty keeping communities safe
Health effects of substance use addiction
Addiction harms more than mental health. It also worsens physical health. Native Americans may face high rates of:
- Heart disease
- Liver disease
- Stroke
- Cancer
- Diabetes
- Tuberculosis
Limited access to nutritious food, clean water, and regular healthcare makes managing these conditions even harder. Alcohol use and illicit drug exposure can make chronic conditions worse, especially among elders.
Barriers to treatment among Native Americans
Despite high rates of addiction, fewer than half of Native Americans who need treatment receive it. Several barriers get in the way. These obstacles include:
- Long distances to treatment centers
- Lack of insurance or underinsurance
- The cultural stigma around addiction
- Programs that ignore Native beliefs and traditions
These barriers make it difficult to:
- Start treatment early
- Stay engaged in recovery
- Build trust with care providers
The Indian Health Service and the Substance Abuse and Mental Health Services Administration both acknowledge that improving treatment access among American Indians in Native areas is critical.
Better health services are needed for treatment programs to succeed among Native Americans.
Cultural healing and recovery
Many Native communities combine traditional healing with modern treatment. These blended programs honor Native identity and values. They often include:
- Sweat lodges
- Talking or drum circles
- Smudging ceremonies
- Vision quests
- Medicine wheel teachings
- Time with elders and spiritual leaders
These practices support healing by:
- Restoring balance between mind, body, and spirit
- Reconnecting people with their culture
- Rebuilding community support
Some jails in Arizona, like Coconino County Jail, even offer sweat lodge ceremonies for Native inmates as part of recovery—a step toward more inclusive care.
These approaches have inspired other tribal leaders to integrate tradition into substance abuse treatment.
Success example: White Mountain Apache Tribe
In the early 2000s, this tribe faced high youth suicide rates. They partnered with Johns Hopkins University to create a therapy model with tribal spirituality.
Key changes included:
- Replacing the standard CBT triangle with a circle that includes spirituality
- Using culturally relevant language and traditions
This approach led to a 38% drop in suicide deaths—showing that culturally adapted care can save lives. It also lowered rates of substance use disorders among American Indian youth on the reservation.
Meeting the treatment needs of American Indians & Alaska Natives
The most successful programs are:
- Native-led and community-based
- Built on a mix of modern care and traditional practices
- Designed to be flexible and trauma-informed
To keep improving outcomes, Native communities need:
- More local treatment options
- Long-term funding and support
- Culturally sensitive training for healthcare providers
- Greater use of telehealth in rural areas
- More investment in programs that blend Western and traditional approaches
Health insurance expansion and improved collaboration between Indian Health and external providers can also remove access barriers.
How telehealth treatment can support native communities
Access to care remains one of the biggest barriers for Native communities seeking addiction treatment. This is where Modern Recovery’s telehealth program can help. By offering online substance abuse treatment that’s accessible from anywhere, it removes key obstacles like travel distance, lack of local providers, or schedule conflicts.
Telehealth treatment is especially helpful in tribal and rural areas, where traditional treatment centers may be out of reach. It supports recovery by:
- Providing therapy and recovery coaching from home.
- Connecting patients to support groups without needing to travel.
- Including family in the recovery process through virtual sessions.
- Offering privacy and flexibility to reduce stigma and improve comfort.
We’re in-network and accept insurance
Online therapy covered by insurance does exist. Modern Recovery works with leading insurance providers across the United States to bring you quality mental health treatment that’s both accessible and affordable.
Sources
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2. Calac AJ, McMann T, Cai M, Li J, Cuomo R, Mackey TK. Exploring substance use disorder discussions in Native American communities: a retrospective Twitter infodemiology study. Harm Reduct J [Internet]. 2022 Dec 14 [cited 2024 May 16];19:141. Available from: https://pubmed.ncbi.nlm.nih.gov/36510388/
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4. United States Department of the Interior. bsi_investigative_report_may_2022_508.pdf [Internet]. Washington, DC; 2022 Apr 1 [cited 2024 May 16]. Available from: https://www.bia.gov/sites/default/files/assets/bia/ois/pdf/BIA_Federal_Indian_Boarding_School_Initiative_Investigative_Report_May_2022.pdf
5. AI/AN 2020_01_14.pdf [Internet]. [cited 2024 May 16].