January 19, 2007

Substance Use and Substance Use Disorders among American Indians and Alaska Natives

In Brief
  • In 2002-2005, American Indians and Alaska Natives were more likely than members of other racial groups to have a past year alcohol use disorder (10.7 vs. 7.6 percent)

  • In 2002-2005, American Indians and Alaska Natives were more likely than members of other racial groups to have a past year illicit drug use disorder (5.0 vs. 2.9 percent)

  • Rates of past year marijuana, cocaine, and hallucinogen use disorders were higher among American Indians and Alaska Natives than among members of other racial groups

American Indians and Alaska Natives suffer disproportionately from substance use disorders compared with other racial groups in the United States.1 The National Survey on Drug Use and Health (NSDUH) is one of the few surveys that collect data on this relatively small, but important population.

NSDUH asks persons aged 12 or older to report on their use of alcohol and illicit drugs, as well as symptoms of substance dependence or abuse during the past year. Illicit drugs refer to marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically.2 NSDUH defines illicit drug or alcohol dependence or abuse using criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).3 Substance dependence or abuse includes such symptoms as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year.

NSDUH also asks a series of questions about race/ethnicity. First, respondents are asked about their Hispanic origin; then they are asked to identify which racial group best describes them: white, black or African American, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, Asian, or other. Respondents may select more than one race. For this report, American Indians and Alaska Natives include all respondents who reported this race, including those who reported it in addition to another race or ethnicity.4 All individuals who did not indicate being American Indian or Alaska Native are included in a separate racial group.

This report examines the rates of substance use and substance use disorders among American Indians and Alaska Natives aged 12 or older. For the purposes of this report, individuals with alcohol dependence or abuse are said to have an alcohol use disorder, and individuals with illicit drug dependence or abuse are said to have an illicit drug use disorder. Comparisons are made between American Indians and Alaska Natives and the overall group of persons having other racial backgrounds. All findings are annual averages based on combined 2002, 2003, 2004, and 2005 NSDUH data.

Alcohol Use and Alcohol Use Disorders

In 2002-2005, American Indians and Alaska Natives aged 12 or older were less likely to have used alcohol at least once in the past year than were members of other racial groups (60.8 vs. 65.8 percent), but they were more likely than members of other racial groups to have a past year alcohol use disorder (10.7 vs. 7.6 percent). Additionally, generally consistent patterns were found within gender and age groups (Table 1). For example, American Indian and Alaska Native males aged 12 or older were less likely to have used alcohol in the past year than males in other racial groups (65.5 vs. 70.2 percent), but they more likely to have a past year alcohol use disorder (13.6 vs. 10.5 percent). One exception was that American Indians and Alaska Natives aged 12 to 17 were equally likely as same-aged youths in other racial groups to report past year alcohol use, but they nevertheless were more likely than youths in other racial groups to have a past year alcohol use disorder (8.5 vs. 5.8 percent).

Table 1. Percentages of Persons Aged 12 or Older Reporting Past Year Alcohol Use and Alcohol Use Disorder, by Racial Group and Demographic Characteristics: 2002-2005
Demographic Characteristic Past Year
Alcohol Use		 Past Year Alcohol
Use Disorder
American Indians and
Alaska Natives		 Members of Other
Racial Groups*		 American Indians and
Alaska Natives		 Members of Other
Racial Groups*
Gender        
Male 65.5 70.2 13.6 10.5
Female 56.4 61.6   7.9   4.9
Age Group        
12 to 17 35.2 34.0   8.5   5.8
18 to 25 72.9 78.1 20.8 17.4
26 or Older 62.8 68.0   9.1   6.1
Total 60.8 65.8 10.7   7.6
Source: SAMHSA, 2002-2005 NSDUHs.
Illicit Drug Use and Illicit Drug Use Disorders

In 2002-2005, American Indians and Alaska Natives aged 12 or older were more likely than members of other racial groups to have used an illicit drug at least once in the past year (18.4 vs. 14.6 percent) and to have a past year illicit drug use disorder (5.0 vs. 2.9 percent). Again, generally consistent patterns were found within gender and age groups (Table 2). For example, American Indian and Alaska Native females aged 12 or older were more likely to have used an illicit drug in the past year than females in other racial groups (16.0 vs. 12.2 percent). One exception was that even though American Indians and Alaska Natives aged 18 to 25 were more likely than same-aged adults in other racial groups to have used an illicit drug in the past year (37.3 vs. 34.5 percent), they were equally likely as same-aged adults in other racial groups to report a past year illicit drug use disorder.

Table 2. Percentages of Persons Aged 12 or Older Reporting Past Year Illicit Drug Use and Illicit Drug Use Disorder, by Racial Group and Demographic Characteristics: 2002-2005
Demographic Characteristic Past Year
Illicit Drug Use		 Past Year Illicit
Drug Use Disorder
American Indians and
Alaska Natives		 Members of Other
Racial Groups*		 American Indians and
Alaska Natives		 Members of Other
Racial Groups*
Gender        
Male 21.0 17.1   5.0   3.8
Female 16.0 12.2   4.9   2.1
Age Group        
12 to 17 27.2 21.1   8.2   5.1
18 to 25 37.3 34.5   8.9   8.2
26 or Older 13.4 10.2   3.7   1.7
Total 18.4 14.6   5.0   2.9
Source: SAMHSA, 2002-2005 NSDUHs.
Specific Illicit Drug Use and Specific Illicit Drug Use Disorders

Rates of past year heroin use and past year nonmedical use of pain relievers, tranquilizers, and sedatives were similar between American Indians and Alaska Natives aged 12 or older and members of other racial groups (Figure 1). However, American Indians and Alaska Natives were more likely to have used all other drugs shown in Figure 1 than were members of other racial groups. For example, 13.5 percent of American Indians and Alaska Natives aged 12 or older used marijuana in the past year compared with 10.6 percent of members of other racial groups.

Figure 1. Percentages of Persons Aged 12 or Older Reporting Past Year Use of Specific Illicit Drugs, by Racial Group: 2002-2005
This figure is a bar chart showing percentages of persons aged 12 or older reporting past year use of specific illicit drugs, by racial group: 2002-2005. Accessible table located below this figure.

Figure 1 Table. Percentages of Persons Aged 12 or Older Reporting Past Year Use of Specific Illicit Drugs, by Racial Group: 2002-2005
Drugs American Indians and Alaska Natives Members of Other Racial Groups*
Marijuana 13.5+ 10.6
Cocaine   3.5+   2.4
Heroin   0.1     0.2
Hallucinogens   2.7+   1.7
Inhalants   1.3+   0.9
Pain Relievers**   5.4     4.8
Tranquilizers**   2.6     2.1
Stimulants**   2.0+   1.2
Sedatives**   0.5     0.3
Source: SAMHSA, 2002-2005 NSDUHs.

Rates of past year inhalant, pain reliever, tranquilizer, stimulant, and sedative use disorders were similar between American Indians and Alaska Natives and members of other racial groups, but rates were higher among American Indians and Alaska Natives for marijuana, cocaine, and hallucinogen use disorders (Figure 2). Past year heroin use disorders were more common among members of other racial groups than among American Indians and Alaska Natives.

Figure 2. Percentages of Persons Aged 12 or Older Reporting Specific Illicit Drug Use Disorders, by Racial Group: 2002-2005
This figure is a bar chart showing percentages of persons aged 12 or older reporting specific illicit drug use disorders, by racial group: 2002-2005. Accessible table located below this figure.

Figure 2 Table. Percentages of Persons Aged 12 or Older Reporting Specific Illicit Drug Use Disorders, by Racial Group: 2002-2005
Drugs American Indians and Alaska Natives Members of Other Racial Groups*
Marijuana 2.7+ 1.8  
Cocaine 1.2+ 0.6  
Heroin*** 0.0   0.1+
Hallucinogens 0.4+ 0.2  
Inhalants 0.3   0.1  
Pain Relievers** 1.0   0.6  
Tranquilizers** 0.4   0.2  
Stimulants** 0.3   0.2  
Sedatives** 0.1   0.1  
Source: SAMHSA, 2002-2005 NSDUHs.

End Notes
1 Office of Applied Studies. (2006). Results from the 2005 National Survey on Drug Use and Health: National findings (DHHS Publication No. 06-4194, NSDUH Series H-30). Rockville, MD: Substance Abuse and Mental Health Services Administration.
2 NSDUH measures the nonmedical use of prescription-type pain relievers, sedatives, stimulants, or tranquilizers. Nonmedical use is defined as the use of prescription-type drugs not prescribed for the respondent by a physician or used only for the experience or feeling they caused. Nonmedical use of any prescription-type pain reliever, sedative, stimulant, or tranquilizer does not include over-the-counter drugs.
3 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: Author.
4 It should be noted that this categorization varies from other NSDUH reports in which (1) persons who identify themselves as Hispanic AND American Indian or Alaska Native are categorized as Hispanic, and (2) persons who identify themselves as American Indian or Alaska Native AND another race (i.e., white, black or African American, Asian, Native Hawaiian or Other Pacific Islander, or other) are categorized as "two or more races."

Table and Figure Notes
* Includes white, black or African American, Hispanic, Asian, Native Hawaiian and Other Pacific Islander, or other.
** NSDUH measures the nonmedical use of prescription-type pain relievers, sedatives, stimulants, or tranquilizers. Nonmedical use is defined as the use of prescription-type drugs not prescribed for the respondent by a physician or used only for the experience or feeling they caused. Nonmedical use of any prescription-type pain reliever, sedative, stimulant, or tranquilizer does not include over-the-counter drugs.
*** Estimate for American Indians and Alaska Natives rounds to 0.
+ Difference between estimate for American Indians and Alaska Natives and estimate for members of other racial groups is significant at p < .05.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).   Prior to 2002, this survey was called the National Household Survey on Drug Abuse (NHSDA). The combined 2002, 2003, 2004, and 2005 data are based on information obtained from 271,978 persons aged 12 or older, 14,518 of whom were Native American or Alaska Native. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on NSDUH used in compiling data for this report is available in the following publications:

Office of Applied Studies. (2006). Results from the 2005 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 06-4194, NSDUH Series H-30). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Office of Applied Studies. (2005). Results from the 2004 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 05-4062, NSDUH Series H-28). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Office of Applied Studies. (2004). Results from the 2003 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 04-3964, NSDUH Series H-25). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Office of Applied Studies. (2003). Results from the 2002 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 03-3836, NSDUH Series H-22). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: http://www.oas.samhsa.gov.

Because of improvements and modifications to the 2002 NSDUH, estimates from the 2002 to 2005 surveys should not be compared with estimates from the 2001 or earlier versions of the survey to examine changes over time.

The NSDUH Report (formerly The NHSDA Report) is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://www.oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.

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SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.

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