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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.
ACKNOWLEDGMENTS
The authors thank Dr. Kathy Etz (National Institute on Drug Abuse), who was instrumental in shaping the focus of this review article. This study was supported by the National Institute on Drug Abuse (RC4 DA029974, Whitesell & Beals, PIs; R01 DA022239, Novins, PI). This review was presented, in part, at the 2010 Building Bridges: Advancing American Indian/Alaska Native Substance Abuse Research (October 5–7th, Rockville, MD).
Declaration of Interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
Notes
1. The term “American Indian and Alaska Native” is used throughout. In 1977, the National Congress of American Indians issued a joint resolution that, in the absence of specific tribal names, American Indian is the preferred term of the indigenous populations of the contiguous United States.
2. The distinctions between ethnic, cultural, and racial identities are complex and beyond the scope of this review. In this discussion, we use cultural identity because we believe that it links most directly to cultural influences, but the issues remain much broader.