Epidemiology and Etiology of Substance Use among American Indians and Alaska Natives: Risk, Protection, and Implications for Prevention

Abstract

Background The epidemiology and etiology of substance use and disorder in American Indian and Alaska Native (AI/AN) communities have received increasing attention over the past 25 years and accumulating evidence provides important insights into substance use patterns in these populations. Objectives and methods We provide a descriptive sketch of the AI/AN population in the United States today, present a brief review of the literature on the epidemiology and etiology of substance use within these populations, and discuss key implications of this literature for prevention efforts. Conclusions and Scientific Significance Patterns of alcohol use and abuse in AI/AN populations are complex and vary across cultural groups, but alcohol clearly impacts both physical health and mental health within these communities. Tobacco use – and associated health consequences – is typically higher in these populations than among other US groups, although significant variation across Native communities is apparent here as with alcohol. Evidence regarding drug use and disorder is less extensive and thus less conclusive, but evidence demonstrates higher rates of use as well. Etiological explanations for substance use and disorder cut across individual characteristics (e.g., genetics) or experiences (e.g., exposure to trauma), to social contexts (e.g., family disruption), and to cultural factors (e.g., historical trauma). Protective factors likely cut across these multiple levels as well and deserve more focused attention for informing prevention efforts. The development of effective prevention strategies, built through collaboration between researchers and Native communities, drawing from the wisdom of both, is a high priority.

Nicotine dependence and psychiatric and substance use disorder comorbidities among American Indians/Alaska Natives: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

“…To date, research has been relatively limited regarding smoking characteristics among the 562 federally recognized tribes in the U.S. However, studies conducted thus far have revealed higher smoking rates among Northern Plains tribes in history (i.e., forced removal from Native lands, coerced placement into boarding schools, and laws prohibiting Indigenous spiritual practices; Walters et al, 2002;Duran and Duran, 1995;Whitesell et al, 2012). According to this theory, the effects of historically based traumas have been inter-generational, meaning these influences have had ongoing deleterious effects on the health and well-being of this population, including significant substance use and smoking, high suicide rates, and lower levels of family cohesion (Wiechelt et al, 2012;Brave Heart et al, 2011;Walters et al, 2002).…”

Similarities in the Etiology of Alcohol Use Among Native American and Non-Native Young Women

“…NA girls are at increased risk for trauma exposure during childhood (Ehlers & Gizer, 2013;Yuan et al, 2006), which increases later risk for substance use (Whitesell et al, 2012). Discrimination and historical loss are two important risk factors for alcohol abuse among NA women (Whitbeck et al, 2004).…”

“…Correlations among each construct at each time point were expected. Given the reports of NA girls' greater exposure to social risks (Ehlers & Gizer, 2013;Friese et al, 2015;Whitesell et al, 2012;Yuan et al, 2006), we hypothesized that NA young women would have exposure to higher levels of social risks that would result in higher individual-level risks. However, we hypothesized similar effects of the risk and protective factors on alcohol use among NA and non-Native young women.…”

“…There are more than 500 diverse NA tribes within the United States, with significant variability in alcohol-specific death rates across the tribes and regions (Whitesell et al, 2012). The Cherokee Nation is one of the two largest federally recognized tribes in the United States, with more than 300,000 members.…”

Impact of a methadone maintenance program on an Aboriginal community: a qualitative study: Table 1:

“…11 These programs have proven benefits at both the individual and societal levels, including reductions in use of injection drugs, acquisition and transmission of viral hepatitis and HIV, death, crime rates, and improvements in participants' overall quality of life. 11,12 In Canada, 13 the United States 14 and Australia, 15 rates of opioid dependence tend to be higher in Aboriginal than in non-Aboriginal communities, as are the rates of associated harms and death. 16 However, the beneficial effects of methadone programs are similar among both Aboriginal and non-Aboriginal participants.…”