Substance Abuse Among Native Americans (AI/AN) American Indians/Alaska Natives

Research on the American Indian and Alaska Native (AI/ANs) issues with regards to alcohol and substance abuse is essential in addressing the impacts of substance abuse among the community members. Research has shown that Substance abuse among the AI/ANs excessively affects the community. AI/ANs is rated to have one of the highest abusers of opioids with related deaths of about 15.7 deaths/100000 population as per 2017 (Odani et al., 2017). Cultural practices and beliefs are among the factors that enhance alcohol and substance abuse. To some extent, poor living standards among some community members are also contributing factors to the issues. Therefore, this research paper discusses the cultural awareness of the AI/AN community, cultural practices that propagates alcohol and substance abuse, various counseling techniques to the affected individuals while adhering to the cultural believes of the AI/AN community, religious and spiritual application that would enhance the effective elimination of the substance abuse among the community.

Cultural Awareness

The research about the AI/AN cultural awareness is important in addressing issues related to drug and substance abuse. Besides, research also helps in addressing physical and mental health as a result of drug abuse among the community.  Studies have shown that the American Indians and Alaska Natives (AI/AN) records the greatest incidence of alcohol, tobacco, and other substance abuse disorders (Odani et al., 2017). Over the years, a section of American Indian tribes has embraced the use of traditional tobacco for ceremonial purposes and medicinal significance. Cultural awareness research is also imperative in understanding intervention measures that can best work in the AI/AN community. Research shows that commercial tobacco products, including the packaged loose tobacco and cigarettes among the Indian tribes are commonly used for ceremonial purposes among the American Indian community (Odani et al., 2017). The research indicated that between 2010-215, tobacco use was higher in AI/ANs than any other tribe in the US. Apart from cultural practices, other reasons why the prevalence of drug abuse was significant among the community was due to low standards of educational achievements. The pervasiveness of tobacco consumption was 2.37 greater in individuals with lower education attainments, not higher than high school qualification accomplishment. Socioeconomic factors are also considered to be among the factors that contribute to the abuse of tobacco among the AI/ANs.  Besides, the American Indians and the Alaska Natives have also been impacted by the opioid tragedy. The community recorded the second-largest opioid-related overdose casualty rates compared to other American tribes.  Moreover, the opioid overdose death rates among the Indian tribe have risen rapidly over the past two decades. For this reason, cultural awareness is necessary to address all these problems the AI/AN is facing.

Political and Economic Concerns of the AI/ANs

The AI/AN community is very diverse. Some AI/AN communities live in tribal lands and have a solid connection to the inherited geographies. However, the tribal space can be small and overpopulated and is usually located in rural regions with large distances among the community members. The majority of the AI/AN community live in semi-urban areas, semirural areas and others live in urban areas.  As of 2017, the estimated AI/ANs in the United States was 5.2 million, which is 1.7 of the US total population (Xiong, 2020). Besides, the research shows that 22 percent of the AI/ANs live on non-ancestral or other trust plots. The statistics further reveal that 60 percent of the AI/ANs reside in urban areas, which is the lowest urban number compared to the other ethnic groups. Besides, the study reveals that 1.6 AI/ANs were under 18 years of age as of 2017. The under 18 of age represents 28.7 percent of the community. Additionally, as of 2017, the statistics show that the following states have the largest population of the AI/ANs community; “California, Oklahoma, Arizona, Texas, New Medico, Washington, New York, North Carolina, Florida, and Alaska,” (Xiong, 2020).  As of 2017, 26.9 percent of the AI/ANs spoke other languages other than the use of English while at home. Concerning educational accomplishment, 83.8 percent of the AI/ANs attained not less than a high school qualification.  In comparison, 92,9 percent of the non-Hispanic whites whose academic achievements that were higher than a high school qualification. Besides, only 19.6 percent of the AI/ANs of ages 25 and over had achieved an advanced degree as compared to 35.8 percent of the Whites. Furthermore, 6.8 percent of the AI/ANs accomplished an advanced academic qualification as compared to the non-Hispanic white population.

Furthermore, as of 2017, the average household income for the AI/ANs was $45,448, in comparison, the non-Hispanic whites’ average is $65845. The statistics further revealed that 30.5 percent of the AI/ANs of ages 16 and above work in professional accusations and management as compared to the 42.9 percent of the non-Hispanic whites. Additionally, 21.9 percent of the AI/ANs living at poverty levels in comparison with 9.6 percent of the whites (Xiong, 2020).

AI/AN Family Dynamics

            AI/AN customs and norms are also dynamic diverse, yet there are ethnic traditions rooted for many communities, high respect for the elders, customary spiritual views, extended kinship system. The structural setting of the family among the AI/AN is enormous in history and traditional cultural standards. For instance, AI/AN women are often viewed in the setting of an inspiring role such as childrearing, domestic roles, and general family concerns. The AI/AN men are always given the roles of leadership and lead the community in tribal matters. The centrality of the culture is maintained by the AI/AN women.  The women are also in charge of others’ development. Additionally, tribal councils such as The National Congress of American Indians (NCAI) are tasked with the protection of AI/AN rights. The council’s main role in the community is to advocate for the protection of the treaty rights protections, inherent rights, and other rights owed to the AI/AN community under the US federal laws. The council’s other role in the community is to promote the welfare of the AI/AN and enhance a better understanding of the community. On the other hand, the AI/AN elders are valued as mentors, teachers, wisdom keepers and transmit cultural knowledge from one generation to another. The elders play a key role in decision-making in the community.

AI/AN Communication.

            Apart from their native language, the AI/AN can as well speak fluent English. Recently, the primary language for most AI/AN children and the youth is English (Xion, 2020). Besides, the AI/AN community also communicates through non-verbal gestures, for instance using downcast eye gestures or ignoring people when feeling unhappy with them.  Additionally, the AI/AN also uses humor when expressing the truth or challenging information. In the AI/AN communities, music is valued as a source of information that is transmitted from one generation to the next. Music in the AI/AN community is a form of communicating with the supernatural powers They also used pictographs to communicate cultural practices from one generation to another. Therefore, for the discussed AI/AN substance abuse problem and the community’s cultural awareness, effective interventions should be put in place the eliminate the issue.

Counseling Approach

People of all ethnicities or any other social background can receive therapy. Counseling therapy is an individualized experience, therefore, the psychotherapists should consider the patient’s cultural practices and how the unique practices may affect the counseling process. The AI/AN community is culturally diverse hence multicultural counseling would be regarded as a perfect strategy. Regarding the below counseling approaches for the alcohol and other drug addiction issues in the AI/AN community, the therapist would consider the application of a multicultural approach. This would benefit the therapist in better understanding the client’s needs, without infringing on the patient’s personal space and violating cultural norms and beliefs.   Understanding the AI/AN can help build trust hence the probability of accomplishing the therapy aims. Additionally, the therapists should be able to use the preferable AI/AN community language for those who would be uncomfortable with English or any other language. Besides, the therapist should familiarize with the AI/AN community to be able to successfully apply the therapy approaches. It is also advisable for the therapists to conduct research about the AI/AN community and learn so much about the culture to enhance further knowledge about the community before carrying out the therapy sessions. The therapist should also embrace engaging the community and becoming familiar with their culture before the therapy program commence (Dickerson et al., 2020). 

Existential Therapy

            There are essential practical issues that need to be considered effective for the required interventions to be effective. The above cultural awareness would be essential in understanding the patterns of the community, hence valid and reliable data may be applied to draw appropriate counseling therapies. The AI/AN community as seen in the cultural awareness has embraced Western culture, and the youths, mostly affected by drug abuse, use English as their first language. Therefore, Western psychological counseling would be effective among the most affected, the youths. As the statics discussed above show, the AI/AN are perceived to be of lower class compared to the non-Hispanic whites. Research has shown that individuals with a perceived lower level of life may be prone to substance abuse. Therefore, existential therapy seeks to address rooted in the people’s survival. The therapy emphasizes the anxiety that occurs when a patient is faced with a conflict that life brings about. In this case, the role of the therapist would be to help the patient focus on personal responsibility for decision making and the therapist may apply some humanistic approaches and strategies. When treating the substance abuse disorder as witnessed in the AI/AN community, the therapist would be tasked with assisting the client to tackle the anxiety that provokes the urge to substance abuse. The patient would then be urged to focus on their responsibilities and make their own choices to abstain from substance abuse. The therapist would assist the client make meaningful decisions, how to live a life free of drugs. The therapist would advise the patient to avoid outside events that would trigger the behavior and participate in creative activities while focusing on love.  

Behavioral Therapy Approach

            The data above shows that cases of drug abuse are highest among the AI/AN community. Many factors contribute to the high levels of drug abuse including cultural beliefs, unequal treatment, and low status in life. cognitive behavior theory would be essential in addressing the substance abuse problem among the AI/AN. The behavioral approaches would assist engage the affected individuals by providing incentives to abstain from substance abuse. For instance, studies have shown that contingency management is important in controlling substance abuse. The therapy involves giving a patient reward such as money to encourage positive behaviors. On the other hand, voucher-based reinforcement would also be appropriate in reinforcing positive behaviors while avoiding opioids such as heroin or stimulants such as cocaine. The patient would receive a voucher for the drug-free urine samples provided. The voucher values would increase as the client provides more drug-free urine. The VBR has been effective in enhancing abstinence among cocaine and opioids abusers (Lincoln & Hoffman, 2019). 

Cognitive Behavior Therapy.

            The application of cognitive behavior therapy to address depression and other harmful effects resulting from drug abuse is effective since it allows modification of schemes that would be respectful to the AI/AN cultural practice. Cultural variables that may be accommodated by the Indian culture are adhered to.  Cognitive behavior therapy would be essential in solving issues such as anxiety, drug addiction, depression, and other emotional issues among the AI/AN community. The therapy would enable the affected individuals unhealthy and unhelpful cultural beliefs, thoughts, behaviors, and emotional control. Besides, cognitive behavior therapy would be essential in addressing symptoms of mental illness caused by the drug and alcohol abuse that is rampant among the AI/AN community. It would also be essential in preventing relapse mental disorder. The patient would be able to learn new techniques of coping with stress, loss, or grief, overcoming emotional issues associated with violence neglect, or even abuse. 

            In cognitive behavior therapy, the therapist would first identify the unwanted thoughts leading to the problem at hand. It is imperative to learn how feelings, thoughts, and situations might lead to unwanted behaviors such as drug addiction. The process will lead to self-discovery and understandings that would be necessary for the therapy process. The therapist ensures that the affected individual would practice new skills that can be practically applicable. In this case, the AI/AN drug addict youth would start practicing new coping skills to avoid situations that could lead to the relapse of the problem.  The therapist would also ensure that the affected individual sets goals that would be important in the recovery from drug addiction and make changes to improve their health and condition. The goals must be specific, relevant, time-based, and attainable. The therapist ensures that the patient learns effective problem-solving skills that would help in the identification of the issue and applying the possible solution to eliminate negative impact on the psychological and mental disorder. The therapist would guide the patient through these problem identification steps; identification of the problem, listing possible solutions, choosing the most appropriate solution for the problem identified, and implementing the solution. The therapist would then monitor the progress of the client and assist where necessary. Self-monitoring is also encouraged to enable the therapist to get the necessary information and provide the best treatment. The therapist would then assist the person gradually to progress. Gradual progress would be necessary for the change adjustment.  

Rational Emotive Behavior-therapy.

            Rational behavior therapy (REBT) is essential in identifying irrational beliefs and negative thoughts that would lead to emotional and behavioral issues. The patient would identify these patterns and the therapist would assist in developing strategies that would replace the negative thoughts with more rational thought patterns. REBT is essential in addressing issues such as depression, drug addictions, phobias, a feeling of anger, rage or guilt, procrastination, aggression, or sleep problem. During the REBT therapy, the therapist would identify irrational thoughts patterns beliefs and feelings that would lead to emotional suffering. The unreasonable views are imitated as solutions and they might include; feeling extremely saddened over others’ faults or wrongdoing, trusting that you are 100% successful and capable. Besides, one would also feel that they have no control over their happiness. Once the therapist has identified the feelings, they should assist the client dispute these beliefs using confrontational methods. REBT aims to assist the affected individuals to respond to irrational thoughts. The therapist would inspire the patient to change the unwanted conduct by applying techniques such as directed imagery, contemplation, and journaling (Ellis & Joffe Ellis, 2019). 

Reality Therapy  

            Reality therapy is counseling where individual behaviors are viewed as choices. The therapy asserts that psychological symptoms happen not due to mental illness but as a result of irresponsible choices of behaviors that fulfill one’s needs. A reality therapist aims to assist people to acknowledge responsibility for these behaviors and prefer more desirable actions. The theory asserts that humans have five basics genetically driven wants such as; achievement, survival, love and belonging, independence, ad enjoyment. Reality therapy focuses on the present events. The aim is to alter the present conduct to manage the mental disorder.

Family System Theory.

            A family system theory focuses on individual conduct that describes the family system as a multifaceted social structure whereby members cooperate to impact the other’s conduct. Family associates connect and make an appropriate view of the system as a whole rather than an individual element. The therapy is effective in addressing mental and behavioral issues. This therapy may also be effectively applied to address concerns that manifest within the family and is effective in addressing family, couple, or individual issues. The approach may help address issues related to alcohol and substance abuse, bipolar, anxiety, depression among others. In the AI/AN community where alcohol and substance abuse is imminent, the family system theory would a preferable choice due to the close ties the family members embrace.

Solution-Focused Therapy.

            A solution-focused therapy places an individual’s present and future issues and aims rather than focusing on the past. This system does not consider the issues that bring the affected person to a therapist, instead, a therapist would encourage those on the solution focus therapy to develop future visions and offers support to achieve the identified goals. In other words, the therapy would help provide the tools necessary to manage the symptoms and manage the challenges. The therapy assumes that people already know the problems in their lives and the change that is needed. The therapist would apply specific questions to guide the program and identify the specific issues. When applied to address the specific issues of drug addictions, this therapy would be fundamental in aiding the affected AI/AN youths gain life accomplishments hence avoiding triggers that would lead to a relapse of the drug addiction.

Religious and Spiritual Application

An effective substance addiction should be made up of three aspects creating an addiction treatment triangle such as soul body and mind. Individuals recovering from substance abuse would probably link the progress to spiritual assistance. Alcohol and substance abuse especially among the AI/AN community has been researched for centuries. Many of these researches have been significant in treating the addiction, however, few have the same impact as the Bible. For instance, many verses in the Bible warn about the dangers of alcohol and drug abuse, “…wine is a mocker, and beer a brawler; whoever is led astray by them is not wise,” (Proverbs 20:1). Other verses reveal that there are still hopes for the addicts and God can lead them out of the addiction, “But when you are tempted, He (God) will also provide a way out so that you can endure it,” (1 Corinthians 10:13).

 Spiritual access for addiction problems should be a significant consideration to manage the issue. Faith-based programs that seek to enable patients to establish their faith and relationship with God while managing their addiction would be necessary for the AI/AN individuals affected by alcohol and drug addiction. Such programs would incorporate the recommended clinical therapies and faith-based strategies into individualized Christian programs (Butts, & Gutierrez, 2018). Concerning spiritual intervention, the role of the Church in the AI/AN community is to be involved in every life aspect of the believers. The Christians, through the guidance of the Bible, should look at the needs of the believers and help in various issues such as the discussed alcohol and substance abuse. Many people would see life after death as a very dynamic occasion. Most communities believe that a person’s deeds while still alive would determine the consequences after death. Therefore, based on many religious perceptions, substance, and drug addiction misconducts would be impactful in life after death.    


Therefore, findings from the research paper reveal the widespread use of the substance and drug abuse among the AI/AN community. The high cultural practices majorly contribute to substance abuse among the community. Therefore, various intervention approaches that could be applied to the diverse culture of the society are discussed. Family dynamics, political, economic concerns, and the communication of the AI/AN are major concerns considered in addressing alcohol and substance abuse among the community. Various counseling approaches that could be successfully used to address the issue while considering the community’s cultural practices have also been discussed. The religious and the spiritual application that would also be integrated with the clinical counseling therapy have also been discussed. Therefore, future studies should emphasize the protective and risk factors caused by the addiction to enhance appropriate treatment strategies and outcomes among the AI/AN community. Initiatives that would see the elimination of alcohol and substance abuse such as the creation of awareness and campaign programs among the community would also help limit the problem.


Odani, S., Armour, B. S., Graffunder, C. M., Garrett, B. E., & Agaku, I. T. (2017). Prevalence and disparities in tobacco product use among American Indians/Alaska Natives—the United States, 2010–2015. MMWR. Morbidity and mortality weekly report66(50), 1374.

Xiong, W. (2020). American Indians and Alaska Natives and Chinese Ethnic Minorities: Demographics and Higher Education. In Ethnic Minority-Serving Institutions (pp. 5-29). Palgrave Macmillan, Cham.

Dickerson, D., Baldwin, J. A., Belcourt, A., Belone, L., Gittelsohn, J., Kaholokula, J. K. A., … & Wallerstein, N. (2020). Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions. Prevention Science21(1), 33-42.

Striemer, G. (2020). The Bible and Alcohol Use. TEACH Services, Inc.

Habsy, B. A., & Wahyuni, F. (2019). Scientific Foundation of Nusantara Culture-Based Counseling Model: Kipas (Konseling Intensif Progressif Adaptive Struktur). European Journal of Education Studies.

Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J. S., & Carroll, K. (2019). A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. Journal of consulting and clinical psychology87(12), 1093.

Dickerson, D., Baldwin, J. A., Belcourt, A., Belone, L., Gittelsohn, J., Kaholokula, J. K. A., … & Wallerstein, N. (2020). Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions. Prevention Science21(1), 33-42.

Lincoln, J., & Hoffman, L. (2019). Toward an integration of constructivism and existential psychotherapy. Journal of Constructivist Psychology32(2), 108-125.

Ellis, A., & Joffe Ellis, D. (2019). Rational emotive behavior therapy. American Psychological Association.

Butts, C. M., & Gutierrez, D. (2018). Expanding intake assessment to incorporate spirituality using five functional tasks. Counseling and Values63(2), 147-163.

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