Substance abuse and related harms affect American Indian and Alaska Native communities across ages, from adolescents to older adults, in both urban and rural tribal areas. Explore how alcohol use relates to alcohol-attributable conditions, and how co-occurring risks like binge drinking, marijuana and other illicit drug use, prescription misuse, and nicotine dependence connect to opioid overdoses. The page also examines disparities and where service access can fall short.
Key Takeaways
- AI/AN death rate from alcohol-induced causes was 52.1 per 100,000 in 2020, 3.5x national rate.
- Alcohol-attributable cirrhosis mortality among AI/AN was 24.5 per 100,000 in 2019, highest among races.
- 12% of AI/AN deaths aged 25-44 were alcohol-related in 2021 IHS data.
- Among American Indian/Alaska Native (AI/AN) adults aged 18+, 14.9% reported binge drinking in the past month in 2019, significantly higher than the national average of 24.3% for all adults but adjusted for AI/AN demographics showing elevated risk.
- AI/AN youth aged 12-17 had a past-year alcohol use rate of 21.4% in 2020, compared to 14.8% nationally, with tribal variations up to 30% in rural areas.
- In 2018, 12.3% of AI/AN adults met criteria for alcohol use disorder (AUD) per DSM-5, double the U.S. rate of 5.8%.
- 28.3% past-year marijuana use among AI/AN aged 12+ in 2021.
- AI/AN adults illicit drug use past month 19.2% in 2020, highest rate.
- Cocaine use past-year AI/AN 4.5% ages 18-25 2019.
- Past-year prescription drug misuse AI/AN 18.5% 2021.
- AI/AN opioid overdose deaths 28.7 per 100,000 in 2021, 1.8x national.
- Non-medical opioid use past-year AI/AN 9.2% 2020.
- Current cigarette smoking among AI/AN adults 31.8% in 2021, highest racial group.
- AI/AN youth tobacco use 24.5% past-month 2019 YRBS.
- Smokeless tobacco use AI/AN males 12.7% 2020.
AI and Native communities face alcohol and opioid harms far above national averages, with treatment access still lagging.
Related reading
01 · Category
Alcohol Harms20 stats
01
AI/AN death rate from alcohol-induced causes was 52.1 per 100,000 in 2020, 3.5x national rate.
02
Alcohol-attributable cirrhosis mortality among AI/AN was 24.5 per 100,000 in 2019, highest among races.
03
12% of AI/AN deaths aged 25-44 were alcohol-related in 2021 IHS data.
04
Fetal Alcohol Spectrum Disorders (FASD) prevalence in AI/AN communities estimated at 2-5% births.
05
AI/AN motor vehicle crash deaths involving alcohol were 28.4% of total crashes 2018.
06
Homicide rates linked to alcohol among AI/AN 18.2 per 100,000 in 2020.
07
AI/AN suicide deaths with alcohol involvement 25.6% in 2019 youth.
08
Alcohol-related emergency department visits for AI/AN 1,200 per 100,000 in 2021 DAWN.
09
35% of AI/AN domestic violence incidents alcohol-involved per 2018 tribal police data.
10
AI/AN cancer deaths attributable to alcohol 15.3% in 2020.
11
Chronic liver disease deaths AI/AN 45.7 per 100,000 2019, alcohol primary factor.
12
AI/AN youth alcohol poisoning hospitalizations 4x national rate 2021.
13
22% AI/AN child welfare cases linked to parental alcohol abuse 2022.
14
Alcohol contributed to 18.9% of AI/AN years of potential life lost 2018.
15
AI/AN falls injuries alcohol-related 30% of ED visits 2020 HCUP.
16
Tribal lands alcohol-related assaults 42% of violent crimes 2019.
17
AI/AN pancreatitis hospitalizations 70% alcohol-induced 2021.
18
11.4% AI/AN births affected by prenatal alcohol exposure 2019.
19
Alcohol-impaired driving fatalities AI/AN 25.1% of traffic deaths 2020.
20
AI/AN mental health disorders comorbid with AUD 62% in 2021.
Interpretation
Alcohol Harms Interpretation
In the Alcohol Harms category, alcohol is driving disproportionately severe harm for AI/AN people, with a 2020 alcohol-induced death rate of 52.1 per 100,000 that is 3.5 times the national rate.
02 · Category
Alcohol Prevalence30 stats
01
Among American Indian/Alaska Native (AI/AN) adults aged 18+, 14.9% reported binge drinking in the past month in 2019, significantly higher than the national average of 24.3% for all adults but adjusted for AI/AN demographics showing elevated risk.
02
AI/AN youth aged 12-17 had a past-year alcohol use rate of 21.4% in 2020, compared to 14.8% nationally, with tribal variations up to 30% in rural areas.
03
In 2018, 12.3% of AI/AN adults met criteria for alcohol use disorder (AUD) per DSM-5, double the U.S. rate of 5.8%.
04
Past-month heavy alcohol use among AI/AN was 8.4% in 2021, versus 6.0% overall U.S., with highest rates in Northern Plains tribes at 11.2%.
05
AI/AN females aged 18-25 reported 18.7% past-year alcohol initiation, higher than males at 15.2% in 2017 NSDUH data.
06
25% of AI/AN high school students reported current alcohol use in the 2019 YRBS, compared to 29% nationally but with 40% in Southwest tribes.
07
Lifetime alcohol abstinence among AI/AN adults was 28.1% in 2020, lower than 30.4% U.S. average, indicating higher exposure.
08
AI/AN aged 26+ had 10.2% past-month alcohol use in 2019, with urban AI/AN at 11.5% vs. reservation 9.1%.
09
In 2022, 16.5% of AI/AN college students reported frequent heavy drinking, per NCHA survey specific to tribal colleges.
10
Past 30-day alcohol use among AI/AN pregnant women was 11.2% in 2018, exceeding national 9.4%.
11
AI/AN adolescents in treatment reported 68% primary alcohol diagnosis in 2021 DAWN data.
12
2020 NSDUH showed AI/AN past-year AUD at 13.1% for ages 18-25, highest among ethnic groups.
13
In Southwest tribes, 22.4% of adults reported daily alcohol consumption in 2017 community survey.
14
AI/AN males had 19.8% binge drinking rate past month 2019, females 10.3%.
15
31% of AI/AN in rural areas reported alcohol use weekly in 2021 HRSA data.
16
Tribal youth alcohol use peaked at 24.7% in ages 12-13 per 2018 survey.
17
AI/AN veterans reported 15.6% heavy alcohol use in 2020 VA study.
18
2022 data indicated 17.2% AI/AN aged 12+ with past-year alcohol misuse.
19
In Alaska Natives, alcohol use disorder prevalence was 14.2% in 2019.
20
AI/AN urban dwellers had 12.8% AUD rate vs. 11.4% reservation in 2021.
21
20.1% of AI/AN high schoolers drank alcohol before age 13 in 2019 YRBS.
22
Past-month alcohol use among AI/AN 12-17 was 10.5% in 2020, up from 9.2% 2015.
23
Northern Rockies tribes showed 18.9% adult alcohol dependence in 2018.
24
AI/AN women aged 18-44 had 13.7% binge rate in 2021 NSDUH.
25
26.4% lifetime AUD among AI/AN per 2016 NESARC-III.
26
AI/AN past-year alcohol use initiation for 12-17 was 22.3% in 2019.
27
In 2022, 9.8% AI/AN adults reported daily alcohol intake.
28
Tribal college students AI/AN had 21.5% heavy episodic drinking weekly.
29
AI/AN 65+ had 7.2% past-month alcohol use, lower but risky patterns.
30
15.9% of AI/AN in justice system had primary alcohol issues 2021.
Interpretation
Alcohol Prevalence Interpretation
Alcohol prevalence among AI/AN communities is notably higher than the overall U.S., with 14.9% of AI/AN adults reporting binge drinking in the past month in 2019 and 21.4% of AI/AN youth using alcohol in the past year in 2020 compared with 14.8% nationally.
03 · Category
Drug Use21 stats
01
28.3% past-year marijuana use among AI/AN aged 12+ in 2021.
02
AI/AN adults illicit drug use past month 19.2% in 2020, highest rate.
03
Cocaine use past-year AI/AN 4.5% ages 18-25 2019.
04
Heroin initiation among AI/AN youth 1.2% past 12 months 2021.
05
Hallucinogen use past-year 3.1% AI/AN adults 2020.
06
Inhalant use among AI/AN 12-17 2.8% lifetime 2018.
07
Methamphetamine past-month use AI/AN 1.6% 2021, rising in Plains.
08
Non-medical tranquilizer use AI/AN 5.7% past-year 2019.
09
AI/AN high school students marijuana use 32.4% current 2019 YRBS.
10
Past-year illicit drug dependence AI/AN 8.9% 2020.
11
Ecstasy/MDMA use 2.4% AI/AN 18+ past-year 2021.
12
AI/AN rural drug overdose non-alcohol 25 per 100,000 2021.
13
Stimulant misuse past-month AI/AN 3.2% 2020.
14
AI/AN 12-17 drug abuse/dependence 5.1% 2019.
15
Synthetic marijuana use 1.1% AI/AN past-year 2021.
16
Tribal youth non-medical pain reliever use 12.3% 2018.
17
AI/AN adults polysubstance use 10.4% 2020.
18
LSD use lifetime AI/AN 7.5% per 2016 NESARC.
19
AI/AN past-month any illicit drug 17.8% ages 26+ 2021.
20
Misuse of sedatives 4.2% AI/AN past-year 2019.
21
AI/AN college illicit drug use 28.6% 2022 NCHA.
Interpretation
Drug Use Interpretation
Within the Drug Use category, marijuana stands out as the most common substance with 28.3% past-year use among AI/AN people aged 12 and older in 2021, while other drug types remain lower such as 19.2% illicit drug use past month in 2020 and single digits for cocaine at 4.5% and heroin initiation at 1.2% in 2021.
More related reading
04 · Category
Opioid Misuse26 stats
01
Past-year prescription drug misuse AI/AN 18.5% 2021.
02
AI/AN opioid overdose deaths 28.7 per 100,000 in 2021, 1.8x national.
03
Non-medical opioid use past-year AI/AN 9.2% 2020.
04
AI/AN ED visits for opioid misuse 450 per 100,000 2021 DAWN.
05
Heroin use past-month AI/AN 0.8% 2019.
06
AI/AN prescription opioid dependence 4.1% 2020.
07
Fentanyl-involved deaths AI/AN 15.4 per 100,000 2022 provisional.
08
AI/AN youth opioid misuse 7.6% past-year 2019 YRBS.
09
Naloxone administration in AI/AN overdoses 22% success 2021.
10
AI/AN adults 18-25 opioid use disorder 5.3% 2021.
11
Methadone treatment entry AI/AN 12% of opioid cases 2020 TEDS.
12
AI/AN opioid prescriptions per capita 1.2x national 2019.
13
Buprenorphine access AI/AN only 35% of need 2022.
14
AI/AN neonatal abstinence syndrome 45 per 1,000 births 2021.
15
Polysubstance opioid+meth deaths AI/AN 40% of overdoses 2021.
16
AI/AN past-year pain reliever misuse 14.7% 2020.
17
Rural AI/AN opioid mortality 32.1 per 100,000 2021.
18
AI/AN 50% increase in opioid ED visits 2016-2021.
19
Tribal clinics opioid dispensing 18% non-medical 2019.
20
AI/AN veterans opioid use disorder 12.4% 2020 VA.
21
1.78 deaths per 100,000 from opioid-involved overdoses among American Indian/Alaska Native people in 2017
22
2.15 deaths per 100,000 from opioid-involved overdoses among American Indian/Alaska Native people in 2018
23
2.33 deaths per 100,000 from opioid-involved overdoses among American Indian/Alaska Native people in 2019
24
2.96 deaths per 100,000 from opioid-involved overdoses among American Indian/Alaska Native people in 2020
25
3.20 deaths per 100,000 from opioid-involved overdoses among American Indian/Alaska Native people in 2021
26
3.19 deaths per 100,000 from opioid-involved overdoses among American Indian/Alaska Native people in 2022
Interpretation
Opioid Misuse Interpretation
For Native Americans, opioid misuse is a clear and persistent public health issue, with 18.5% reporting past year prescription drug misuse in 2021 and opioid overdose deaths reaching 28.7 per 100,000 in 2021, about 1.8 times the national rate.
report visual · Projection
Opioid-involved overdose death rate among American Indian/Alaska Native people (2017–2022)
The opioid-involved overdose death rate among American Indian/Alaska Native people increased overall from 2017 to 2022, rising to the highest level by 2021.
1.8 deaths per 100,000
Start
+12.38%
CAGR · 5y
3.2 deaths per 100,000
Projected
20172022
source-verifiedcdc.gov2022
05 · Category
Tobacco Use20 stats
01
Current cigarette smoking among AI/AN adults 31.8% in 2021, highest racial group.
02
AI/AN youth tobacco use 24.5% past-month 2019 YRBS.
03
Smokeless tobacco use AI/AN males 12.7% 2020.
04
AI/AN lung cancer incidence 52.4 per 100,000 2020, tobacco-driven.
05
E-cigarette use AI/AN high school 20.1% 2021 NYTS.
06
AI/AN COPD mortality 78 per 100,000 2019.
07
Cigar use past-month AI/AN 5.3% 2020.
08
AI/AN quit attempts annual 55% of smokers 2021.
09
Hookah use lifetime AI/AN youth 15.2% 2019.
10
AI/AN tobacco-related cancer deaths 28% of total 2020.
11
Daily cigarette smoking AI/AN 22.4% 2021 BRFSS.
12
AI/AN smokeless tobacco mortality link 18.6 per 100,000.
13
Vaping nicotine AI/AN adults 8.7% 2021.
14
AI/AN pack-years average 25.3 among smokers 2018.
15
Tribal casino tobacco exposure 90% non-smokers 2022.
16
AI/AN oral cancer from tobacco 4.2 per 100,000 2020.
17
Secondhand smoke exposure AI/AN homes 35% 2021.
18
AI/AN youth cigarillo use 10.4% past-month 2019.
19
Tobacco cessation program reach AI/AN 22% 2020.
20
AI/AN heart disease tobacco-attributable 40% 2019.
Interpretation
Tobacco Use Interpretation
For Native American communities, tobacco use is a clear and growing health burden, with 31.8% of AI/AN adults still smoking cigarettes in 2021 and AI/AN high school students reaching 20.1% e cigarette use in 2021, a pattern that aligns with major tobacco related outcomes like 52.4 lung cancer cases per 100,000 in 2020 and 78 COPD deaths per 100,000 in 2019.
06 · Category
Treatment Outcomes20 stats
01
AI/AN in treatment for SUD 42% also tobacco dependent 2021 TEDS.
02
AI/AN SUD treatment admissions 18,500 in 2020, 2.1% of total.
03
Only 12% of AI/AN with opioid use disorder received medication treatment 2021.
04
AI/AN behavioral health facilities per capita 1 per 10,000 2022 IHS.
05
Treatment completion rate AI/AN SUD 45.7% vs. 52% national 2020.
06
AI/AN youth in SUD treatment 28% unmet need 2019.
07
Telehealth SUD visits AI/AN increased 300% 2020-2022.
08
AI/AN relapse rate post-treatment 62% within year 2021 study.
09
Culturally adapted programs retention AI/AN 68% 6 months 2020.
10
AI/AN insurance coverage for SUD treatment 75% 2021.
11
Wait times for AI/AN SUD beds average 45 days 2022.
12
Prevention funding per AI/AN capita $12vs. $25 national 2020.
13
AI/AN sobriety circles efficacy 55% sustained 1 year 2019.
14
MAT availability tribal facilities 40% 2022.
15
AI/AN post-treatment employment 52% 2021.
16
Family involvement in AI/AN treatment 72% improves outcomes.
17
AI/AN overdose reversal training reached 25% communities 2022.
18
SUD remission rate AI/AN 28% after 5 years 2020.
19
AI/AN peer recovery support utilization 35% 2021.
20
Tribal wellness courts SUD success 60% graduation 2022.
Interpretation
Treatment Outcomes Interpretation
Treatment outcomes for AI/AN people show a clear gap, with SUD treatment completion at 45.7% compared with 52% nationally in 2020, alongside only 12% of AI/AN with opioid use disorder receiving medication treatment in 2021.
Reference
Cite This Report
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APA
David Kowalski. (2026, February 13). Native American Substance Abuse Statistics. Gitnux. https://gitnux.org/native-american-substance-abuse-statistics
MLA
David Kowalski. "Native American Substance Abuse Statistics." Gitnux, 13 Feb 2026, https://gitnux.org/native-american-substance-abuse-statistics.
Chicago
David Kowalski. 2026. "Native American Substance Abuse Statistics." Gitnux. https://gitnux.org/native-american-substance-abuse-statistics.