SUBSTANCE ABUSE IN

AMERICAN INDIANS
AND ALASKA NATIVES
ASHLEY CHACON, CLAIRE RODRIAN, PHOEBE
BECKMAN, SANDRA GUZMAN, YU CHU CHANG,
VALERIE VILLASENOR
Scope of the

Problem
10.2% of
6.2% of

AIs/ANs

general U.S.

comprise
AIs/ANs

population
1.3% of
have a

has a

U.S.
substance

substance

Population use disorder use disorder

(U.S. Census Bureau, 2021 & SAMHSA 2020)
Scope of the
Problem
AI/AN substance

Due to
abuse

misclassification
underestimated

of race by as much as

35%

(Joshi et al. 2018)

Scope of the

Problem Substance use disorders correlated with

increased risk of suicidal thoughts, plans, &

attempts

AIs/ANs have substance use disorders at

disproportionate rates

Even more frequent association between

alcohol use and suicide in AI/AN population

(SAMHSA, 2015 & 2020)

 Patterns of
Substance Abuse
Exposure to alcohol at young ages

Cycles of trauma and abuse

(Cheadle & Whitbeck, 2011)

 Mental and Physical Health

Signs &
Symptoms Family/Relational Issues

Suicidial Ideation and Death

(Soto, 2022)
Influential Factors

Individual-factors Microsystem-factors Macrosystem-factors

Individual Factors
Protective Factors Risk Factors
Gender
Females are 49% less likely to abuse illicit Family History
drugs compared to their male counterparts parental alcoholism predicts escalation of
Perceptions of substance use alcohol use, alcohol use disorder (AUD)
perceiving alcohol as harmful and having Age of first use
parents and peers who disapprove of youth who start alcohol/drug use at an
alcohol reduced the odds of alcohol use. earlier age are more susceptible to
Self-efficacy substance abuse
relying not only on self but also on family
and community enhances resilience against
substance initiation
Academic orientation
being academically inclined decreased the
odds of cigarette use

(Stanley et al., 2014; LeMaster et al., 2002;Galliher et al.; 2004)

Micro-System Factors
Protective Factors Risk Factors
Strong Pro-Social Bonds Anti-Social Peer Affiliation
having a prosocial adult who encourages negative peer influence
future aspirations and a positive AI/AN identity School Location
Sense of Belonging in School Reservation youths reported significantly more
lower lifetime use of alcohol, cigarette, and lifetime alcohol abuse/dependence
marijuana use and a later age of initiation into symptoms than urban youths
drug use Neighborhood Crime
Parental Monitoring Individuals who reported a low sense of safety
Parental knowledge of their child's friends, were more likely to report depressive
whereabouts & what they do with their free symptoms, alcohol or marijuana use in the
time reduced substance use. past month
Exposure to Intimate Partner Violence
increased risk for substance use, depression,
poly-drug use, and PTSD symptoms

(Napoli et al., 2003; Shillington et al., 2005; Stanley & Swaim, 2015; Nalls et al., 2009; Brockie et al., 2015)
Macro-System Factors
Risk Factors
Protective Factors
Connection to their culture
strong cultural ties & spirituality are
protective factors leading to fewer
or no alcohol abuse/dependence
symptoms
Low cultural orientation
American Indians with a low
orientation towards traditional
culture are 4.4 times as likely to be
heavy drinkers
Exposure to adverse experiences
stressful life events and death/Loss
increase the risk for cigarette use &
Smokeless Tabacco
Historical trauma
linked to increased substance use
in Al/AN individuals
(Boyd-Ball et al., 2011;Herman-Stahl et al., 2003; LeMaster et al., 2002)
Barriers
Personal Pragmatic
Barriers Barriers

Culturally- Social
Specific Network
Barriers Barriers
(Legha et al., 2014)
(Venner et al., 2012)
 Personal Barriers
Beliefs and attitudes
Enjoyment of substance use
Not wanting help
Afraid to seek treatment
Not feeling like they need
treatment
Lack of motivation
Pragmatic Barriers
Insufficient financial
resources / time
Long waiting lists
Lack of awareness of
treatment options
Lack of transportation
Unemployment /
Homelessness
Legal issues
(Legha et al., 2014)
(SAMHSA, 2019)
(Smith, 2021)
(Venner et al., 2012)
Culturally-Specific Social Network
Barriers Barriers

Traditional modalities not

incorporated in care
Social stigma
Ineffectiveness of available
Lack of support for seeking
help
treatment
Clinicians: pressure to use
evidence-based treatments

(Legha et al., 2014)

(Smith, 2020)
(Venner et al., 2014)
Treatments
The 12-Step Approach
The 12-step of Alcoholics Anonymous
(AA) were found effective in some
AI/AN tribes

The dominance of Euro-

American approaches
Not culturally appropriate Background
Funding sources require the Evidence-based Treatment (EBT)
use of EBT
Result in a growth of adapted EBT
programs
Dialectical Behavior Therapy (DBT)
Emphasizes learning mindfulness techniques and improving one’s daily coping
and interactions with others
Effective DBT incorporates specific cultural, traditional, and spiritual practices

The State-Wide Indian Drug Prevention Program (SIDPP)

Bicultural competence theory emphasizes the skills that help the AI/AN
population to adapt the roles in which they were raised with the culture in
which they were surrounded

The SFP 10-14 and the Bii-Zin-Da-De-Dah (BZDDD)

SFP 10-14 prevents early initiation of substance use through engaging young adolescents and their
parents, improving family communication and reducing family conflict
BZDDD (an adapted SFP 10-14) prompts community conversations about cultural strengths, family
resilience, community assets, and traditional values

Evidence-based Treatment Programs

Engagement
Strategies

Strategies should be multi-

level and inter-relational
that take into account
Native culture, traditions,
knowledge, and values

(Skewes et al., 2019)

Individual level
Family level
INCREASE SPIRITUAL AND CULTURAL
HEAL HISTORICAL AND INTERGENERATIONAL
CONNECTEDNESS
TRAUMA
Reservation
Reservation
take part in language classes,
Family counseling, family camps and other
traditional spiritual practices,
activities such as attending ceremonies
ceremonies, and peer mentors and
Urban
support groups
Family counseling, care managers or
Urban
connect coaches that provide support,
TACUNA workshops: participate in
and teaching families CRA
traditional practices, discuss effects of
historical trauma, and increase social
support through wellness circles Community level
INCREASE COMMUNITY SUPPORT AND AWARENESS
Both
Provide health and educational programs and
services founded in Native spirituality and culture
such as family action kits, increase community
organizing, increase engagement in traditional (Skewes et al., 2019;
ceremonies on the reservation and TACUNA Komro et al., 2022;
wellness circles for urban settings Campbell et al., 2015)


Thank you for listening!

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