Epidemiology and Etiology of Substance Use among American Indians and Alaska Natives: Risk, Protection, and Implications for Prevention
Open accessAbstract
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.
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Among AIANs, forced relocation, poverty-related stress, exposure to violence, and substance use are closely associated with each other and with substance use.
“Among AIANs, forced relocation, poverty-related stress, exposure to violence, and substance use are closely associated with each other and with substance use [30,33,35].”
From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [33]
The Individual Risk and Protective Factors section (page not supplied) reports a strong association between trauma exposure or PTSD and substance use among AI/ANs. Contemporary AI/AN Populations mentions federal relocation policies and poverty, but does not link either to substance use; the copy also does not establish the claimed associations among all these factors or specifically identify violence exposure in that association. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPositive substance-related expectancies pose a risk for SUD.
“Cognitive-behavioral processes—specifically, positive substance-related expectancies pose a risk for SUD [33].”
From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [33]
The “Cognitive Behavioral Processes” subsection links alcohol-use expectancies with the quantity and frequency of drinking among American Indian and Alaska Native adolescents. It does not specify positive expectancies or establish a risk for substance use disorder, so the claim extends beyond the finding reported here (page unavailable). (LLM, conf=0.85)
Experimental — accuracy not yet measuredAccessibility to preventive healthcare and SUD treatment services is often limited.
“Accessibility to preventive healthcare and SUD treatment services is often limited [33,62]”
From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [33]
The Service Systems section says health services for substance use problems have limited availability in American Indian and Alaska Native communities, and that urban and suburban residents have little access to Indian Health Service facilities. It does not specifically establish limited access to preventive healthcare; the Implications for Prevention section discusses how to develop interventions, not access to preventive services. No page numbers are available in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPoverty, acculturation, and personality disorders appear to be risk factors for addiction in AIAN individuals as well.
“Consistent with prior research in non-AIAN samples, poverty, acculturation, and personality disorders [95,96,97,98] appear to be risk factors for addiction in AIAN individuals as well [33,43,50].”
From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [33]
The Psychiatric Risk section (page unavailable) associates personality characteristics and psychiatric comorbidities with substance use and disorder among AI/ANs, but does not specifically identify personality disorders. The Demographic Factors section says poverty is prevalent but cautions that attributing risk to it is difficult. The Cultural Identity section reports mixed findings about culture-related risk; it does not establish acculturation as a risk factor. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe repercussions of historical trauma continue to be evidenced in current structural racism and social determinants of health that adversely impact AIANs' overall health and outweigh their coping resources.
“The repercussions of historical trauma continue to be evidenced in current structural racism and social determinants of health that adversely impact AIANs’ overall health and outweigh their coping resources [27,33,43].”
From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [33]
The Historical Trauma section says the legacy of colonization and federal assimilation policies continues to affect AI/AN lives. The Contextual Risk and Protective Factors section links social settings and underfunded health services to substance-use disparities. The paper does not specifically say that present-day structural racism and social determinants outweigh AI/ANs’ coping resources or establish that claim for overall health. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Only one in four urban Indigenous people live within an Indian Health Services service area.
“Statistics show that only one in four urban Indigenous people live within an Indian Health Services service area (Roubideaux, 2008; Whitesell et al., 2012)”
From Culturally tailored substance use interventions for Indigenous people of North America: a systematic review (2023) · cites this paper as Whitesell et al., 2012
The Service Systems section says most Indian Health Service facilities are on tribal lands, leaving urban and suburban American Indians and Alaska Natives with little access. It does not give the claimed one-in-four figure or state what proportion live within an IHS service area; searches for that figure and service-area residence found no such passage in our copy. Page numbers were not available. (LLM, conf=0.83)
Experimental — accuracy not yet measuredLimited education about substance use and its adverse health effects in AIAN communities is a sociocultural factor in the onset and development of SUD.
“Another sociocultural factor that plays a role in the onset and development of SUD is limited education about substance use and its adverse health effects in AIAN communities [33].”
From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [33]
The Etiology section discusses community attitudes, substance-related expectancies, and limited treatment services, but does not identify limited education about substance use or its health effects as a risk factor. A search for education, awareness, and knowledge of harmful effects found no passage making that connection. Page numbers are not available in our copy. (LLM, conf=0.72)
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“Among AIANs, forced relocation, poverty-related stress, exposure to violence, and substance use are closely associated with each other and with substance use [30,33,35].”
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- Authors
- Whitesell, N. R., Beals, J., Crow, C. B., Mitchell, C. M., & Novins, D. K.
- Affiliations
- Colorado School of Public Health (US)
- Department of Community and Behavioral Health, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
- Corresponding author
- Whitesell, Nancy Rumbaugh
- Venue
- The American Journal of Drug and Alcohol Abuse
- Publisher
- Informa UK Limited
- Published
- 2012-08-29
- Volume
- 38
- Issue
- 5
- Pages
- 376-382
- ISSN
- 0095-2990 (ISSN-L)
- 1097-9891
- PMC
- PMC4436971
- OpenAlex
- W2162353791
- Cited by
- 196
- References
- 74
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 10 · 2023: 24 · 2022: 29 · 2021: 24 · 2020: 15 · 2019: 14 · 2018: 7 · 2017: 8 · 2016: 15 · 2015: 8 · 2014: 12 · 2013: 1 · 2012: 1
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Drug and Alcohol Abuse (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01da022239-04)
- National Institute on Drug Abuse (R01-DA022239, RC4DA029974)
- Topics
- Social Sciences › Health › Indigenous Health, Education, and Rights
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › General Health Professions › Indigenous Health and Education
- Keywords
- American Indians and Alaska Natives, substance use, alcohol consumption, alcohol abuse, tobacco use, drug use, substance use disorders, etiology, risk factors, protective factors, historical trauma, trauma exposure, family breakdown, cultural factors, prevention, indigenous peoples
- MeSH terms
- Smoking Prevention, Alaska, Alcohol Drinking, Cooperative Behavior, Humans, Indians, North American, Risk, Smoking, United States, Substance-Related Disorders
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