Asana Recovery

Understanding Native Americans and Substance Abuse Treatment

Although alcoholism and substance abuse are prevalent in every geographic area and among every people group, Native Americans have disproportionately high addiction rates compared to the population at large. Currently, over six million Native Americans live in the United States, making up just over 2% of the population. Although not often thought of as a drug, alcohol is the most highly abused substance among Native Americans.

According to a National Survey on Drug Use and Health from 2018, over 20% of Native Americans reported recent binge drinking, including three out of 10 young adults. Furthermore, one out of every six Native American adolescents reported engaging in underage drinking.

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The rate of Native Americans struggling with an alcohol use disorder hovers around 7%, almost 2% higher than that of the total population.

The rates of other substance abuse disorders are also disproportionately high among Native American people. They make up the largest portion of people with one or more addictions to:

Research shows that about one out of every 10 Native Americans has some type of substance use disorder, with 4% of the total being illicit drug addictions. These numbers become even more striking when talking about young Native Americans—one in five young adults (between 18 and 25 years old) has some type of substance abuse disorder and 40% of children between the ages of 12 and 17 show indicating signs of a lifetime of drug use.

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What Alcohol and Substance Abuse Means for Native American Communities

Although alcohol use disorders harm any person, family, or people group, there are even more severe impacts on Native American communities. These include:

Why Are Native Americans at Such High Risk for Substance Abuse?

All of this begs the question, “Why are Native Americans at such a high risk for alcohol use disorders and substance abuse?” Several factors are at play here, including economic disadvantages, generational and cultural loss and trauma, various health issues, and the availability of treatment options.

Economic Disadvantages

The unemployment rate in Native American communities is higher than the population at large; whereas the Caucasian population has about 10% of people living in poverty, over 20% of Native peoples live at or below the poverty line. Native Americans have lower rates of school completion for both high school and college; less than 20% of Native Americans go on to earn a bachelor’s degree.

Living below the poverty line means less access to high-quality medical care, as well. Many Native Americans don’t have health insurance and have a difficult time making it to appointments because of transportation issues. Lack of education, money, and resources all make substance abuse much more likely.

Generational and Cultural Loss and Trauma

Historically, Native Americans have been the victims of oppression, brutality, and loss because of European colonization. Losing countless people on top of their land and culture caused intense generational grief, passed down among family members. This is the foundation for psychological distress, overall poor health, and unmet needs (both physical, emotional, and psychological). All of these are factors that contribute to negative coping mechanisms such as substance abuse.

Studies also show that when a child grows up in a home where substance use or abuse are prevalent, they are much more likely to use and abuse substances themselves. So, since trauma, economic disadvantage, violence, chronic stress, and substance abuse have been present in Native American cultures for generations, children born into these communities are already at a disadvantage. This makes it even more important to provide treatment for those currently struggling with addiction and to create and offer resources that prevent children from falling into the same coping mechanisms.

Discrimination and Racism

Adding salt to the wound, the generational trauma experienced by Native American peoples creates further struggle because of the discrimination and systemic racism that is still highly prevalent in the United States. In their hometowns and beyond, Native Americans are often the victims of hate crimes, racial slurs, and lack of opportunity because of their ethnicity.

Generalized Health Issues

Native Americans don’t only suffer from health problems related to substance abuse and alcohol use. They have high rates of several types of diseases, including:

Of course, some of these issues can be attributed to alcohol use, but chronic stress and illness are closely linked. Economic disadvantages and unresolved trauma are a cause of chronic stress, which often leads to trauma. Chronic stress then leads to alcohol and substance use and abuse.

High Levels of Community Violence

Studies show that in communities where poverty, low education levels, unemployment, and substance abuse are high, violence rates are higher, as well. Of course, all of these things are closely related, often on both sides of the cause-and-effect cycle.

Treatment Options

Possibly because of the compounding issues that all of the other disadvantages cause when grouped, Native Americans are more likely to need intensive treatment for substance use disorders than people of other ethnic groups. The Substance Abuse and Mental Health Services Administration reports that a tenth of Native Americans needs treatment for substance use disorders. This treatment is necessary and helpful; however, culturally sensitive programs are few and far between. This leads us to the next topic—creating programs that speak to and specifically help Native peoples.

Culturally Sensitive Substance Abuse Treatment for Native Americans

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Substance abuse treatments are not one-size-fits-all. Specifically, when treating a population that has survived hundreds of years of generational trauma and cultural loss, the program must treat the whole person instead of simply the addiction. Studies show that traditional health practices are often the most successful for Native American patients.

There is great irony in the fact that much of the reason Native Americans struggle with drug and alcohol abuse is because of the long-range effects of European colonization and the fact that Western and Native healthcare values are largely incongruent, making Western treatments highly ineffective. 

It’s no wonder that many Native Americans, in addition to not having easy access to medical care, probably don’t tend to seek it out as readily because they know that they will not truly be listened to or cared for in a way that fits their ideals. Western medicine tends to focus on the individual. Native American healing, on the other hand, emphasizes interconnectedness and the importance of community on the health of the person. Western medicine tends to isolate the patient during treatment and then “reintroduce” them to their regular environment after they have presumably achieved healing. Native American practices, though, understand that the emotional, physical, mental, and spiritual aspects of a person are all deeply intertwined, in addition to those roles as they relate to the environment and the spiritual world. Thus, if a person is to truly heal, all of those aspects must come together.

So far, most programs that have attempted to integrate Native American perspectives into their care plans have opted for adaptations instead of fully organic exchanges. In a sense, they’ve tried to take the easy way out instead of fully overhauling what they were offering.

Furthermore, including family members, tribe elders, and spiritual leaders in a person’s recovery program is another way to make recovery more likely.

Interestingly, some research shows that adding traditional Native American elements to an addiction treatment program encourages a “cultural reawakening”; many patients feel that it brings about a path to reintroduction into their Native society, traditions, and culture. Elements such as talking circles help patients work through and process their struggles in a way that allows them to be honest and understanding of both themselves and others. Research also shows that spiritual elements teach patients healthy coping mechanisms in a culturally relevant and appropriate way, which helps continue recovery long after patients have finished a treatment program.

Of course, access to care is limited because of poverty levels, lack of transportation, and a shortage of treatment availability in Native American communities. Therefore, it’s even more important to bring culturally sensitive care into the areas where Native American populations are prevalent. Doctors and physicians would benefit from receiving cultural sensitivity training as well as education on the elements that would specifically help Native Americans heal from their addiction. Understanding the foundations of their culture, customs, and language is a start.

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Oklahoma Tribes and Communities that Would Benefit from Culturally Sensitive Care

Currently, there are 574 American Indian and Alaska Native tribes and communities recognized by the federal government. The majority of the Native American population in Oklahoma is made up of people from the Arapaho, Cheyenne, Chickasaw, and Osage tribes.

Every Native American tribe and community has specific, individual customs, traditions, and languages. Understanding that, Oklahoma treatment centers need to provide programs that are not only inclusive of Native American particulars in a general sense but in the individual needs of each Oklahoma-based tribe

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Many Oklahoma communities—specifically reservations—and treatment centers serving large populations of Native American patients have created treatment programs tailored to this particular group. These are often combined with Western practices such as group therapy and Alcoholics Anonymous.

Of course, Native American people of many generations each have their own level of acculturation to consider. Acculturation is the level to which a person has adjusted and conformed to mainstream society. Interestingly, studies show that people who have a low orientation to their traditional culture are at higher risk of alcohol and substance abuse.

Native American tribes have a long history of exposure to and influence from Western religions, beginning with European colonization, the addition of missions on reservations, and the prevalence of mainstream religion in boarding schools which many Natives were forced to attend. Therefore, some aspects of organized religion are still widely accepted and closely held in Native communities, so a combined approach is often effective. However, the staff and physicians who lead the treatment program need to be highly aware of both the overarching needs of the particular tribes in their community as well as those directly affecting the individuals in their care.

Final Thoughts

Native Americans have much higher rates of substance use and abuse than any other ethnic population. The reasons for this are wide and deep-seated, many of which root back to the generational loss and trauma caused by European colonization. This drives home the responsibility that health practitioners have to create and make accessible culturally sensitive treatment programs for Native American people struggling with addiction. Western treatment isn’t without benefits, but combining Native American traditions and healing practices with tolerant and sensitive Western practices offers the best potential for successful programs that treat alcohol and substance use and abuse.

Asana Recovery offers detoxresidential, and outpatient addiction treatment services. Please contact us today to speak with one of our experienced addiction treatment team if you have any questions about our programs.