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2019 National Survey on Drug Use and Health: 

American Indians and Alaska Natives (AI/ANs)

Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services

September 2020
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National Survey on Drug Use and Health (NSDUH)

• NSDUH is a comprehensive household interview survey of substance use, 

substance use disorders, mental health, and the receipt of treatment services for 

these disorders in the United States.

• NSDUH is collected face-to-face by field interviewers who read less sensitive 

questions to respondents and transition respondents to audio computer assisted 

self-interviewing for sensitive items.

• NSDUH covers the civilian, noninstitutionalized population, aged 12 or older:

– Includes: Households, college dorms, homeless in shelters, civilians on 

military bases 

– Excludes: Active military, long-term hospital residents, prison populations, 

homeless not in shelters

• Sample includes all 50 states and DC

• Approximately 67,500 persons are interviewed annually

• Data collected from January to December 
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How Do We Use NSDUH?

• Provides a window into the state of substance use and mental

health issues in the United States

• Helps to guide policy directions in addressing:

– problem substances

– prevalence of mental illness

– intersection of substance use and mental health issues

– provides insights that can be studied in the context of data

from other agencies to help in decision-making about what

types of resources are needed and where resources should be

directed
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Mental Illness and Substance Use Disorders in America 

among AI/AN Adults (≥18 y.o.)
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Alcohol Use among AI/ANs
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Alcohol Use Disorder among AI/ANs
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Summary: Alcohol Use in 2019

• Past month alcohol use and alcohol use disorder among the AI/AN population is

increasing in ages 12-17.

• Alcohol Use Disorder in the AI/AN population slightly increased for ages 18-25.

• SAMHSA will continue its prevention programs:

– SAMHSA Prevention Technology Transfer Centers produce resources and materials

related to alcohol misuse prevention

– CSAP ‘Talk They Hear You’ focuses on underage drinking

– CSAP requires Partnerships for Success grantees to emphasize underage drinking prevention

– CSAT has promoted SBIRT for alcohol use in all programs including CJ, PPW,

adolescent treatment, HIV and homeless programs

– CSAT has funded SBIRT training in medical residencies and other healthcare

practitioner programs which screen for hazardous alcohol use and use disorders
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Illicit Drug Use among AI/ANs: Major Concerns: Opioids, 

Marijuana, Methamphetamines
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Progress on the Opioid Epidemic: Prescription Pain Reliever Misuse 

among AI/ANs 
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Opioid Misuse among AI/ANs
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Prescription Pain Reliever Misuse and Heroin Use among AI/ANs
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Prescription Pain Reliever Misuse among AI/ANs
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Misuse of Prescription Opioid Subtypes among AI/ANs
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Heroin Use among AI/ANs
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Heroin-Related Opioid Use Disorder among AI/ANs
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Opioid Use Disorder among AI/ANs
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Treatment Gains: Number of Individuals Receiving 

Pharmacotherapy for Opioid Use Disorder (MAT)
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Summary: Opioid Misuse in the United States in 2019 Compared to 2018 

• Among the AI/AN population aged 12-17, opioid misuse and prescription pain

reliever misuse has increased slightly from 2018 but is decreased in all other

ages.

• Heroin use and heroin-related opioid use disorder has remained stable across

all age groups in the AI/AN population, including ages 18-25 after a slight

increase in 2017.

• Opioid use disorder remains stable across all ages in the AI/AN population.

• Access to MAT continues to increase.
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Other Illicit Substances
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Past Month Marijuana Use for All Age Groups among AI/ANs
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Marijuana Use among AI/AN Young Adults (18-25 y.o.)
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Marijuana Use among AI/AN Adults 26+
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Marijuana Use Disorder among AI/ANs
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Marijuana Use among AI/AN Women by Pregnancy Status
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Daily or Almost Daily Marijuana Use among AI/AN Women by 

Pregnancy Status
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Marijuana Use: Health Concerns

• Past month marijuana use and past year daily or almost daily use among the AI/AN

populations has declined among ages 26 and older after a slight increase in 2018.

• Marijuana use disorder in the AI/AN population has increased in ages 12-17 after

remaining stable in 2017 and 2018.

• There was a decrease in marijuana use disorder for ages 18-25 in the AI/AN

population compared to 2018.
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Cocaine Use among AI/ANs
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Methamphetamine Use among AI/ANs
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Misuse of Prescription Stimulants among AI/ANs
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LSD Use among AI/ANs for All Age Groups
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Summary: Other Substance Use in the United States in 2019 Compared to 2018

• There was a significant decrease in cocaine use for ages 18-25 of the AI/AN

population as compared to 2017.

• Methamphetamine use for 18 and older for the AI/AN population continues to

decline.

• Prescription stimulant misuse has slightly increased for ages 12-17 and 18-25 of the

AI/AN population.
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Polysubstance Use and Mental Illness
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Alcohol Use Related to Other Substance Use, MDE and SMI among 

AI/ANs
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Marijuana Use Related to Other Substance Use, MDE and SMI 

among AI/ANs
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Comparison of Rates of Mental/Substance Use Disorders Associated with Marijuana Use among 

AI/ANs: National vs. Colorado Data from the National Survey on Drug Use and Health (2019)

Measure/Age Group

National (%) Colorado (%)

National vs. 

Colorado

P-value

Past Month Marijuana Use (18-25 y) 20.8 * *

Past Year Daily Marijuana Use (18-25y) 11.4 * *

Past Month Marijuana Use (≥ 26y) 10.5 * *

Substance Use Disorder (SUD) (18+) 10.2 * *

Co-occurring SUD and SMI (18+) 1.5 * *

* Estimate not shown due to low precision.

Estimates for Colorado are direct single-year estimates for 2019 and will differ

from model-based estimates using data from 2018 and 2019.
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Opioid Misuse Related to Other Substance Use, MDE and SMI 

among AI/ANs
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Methamphetamine Use Related to Other Substance Use, MDE and 

SMI among AI/ANs
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Summary

• Polysubstance use is common—if a person is having problems with one

substance, they are likely using and may be having problems with other

substances

• Treatment providers must screen for and treat all substance use disorders

and problem substance use

• Association of substance misuse and mental illness is clear—we must all do a

better job of helping Americans understand these relationships and risks
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Mental Health
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Serious Mental Illness (SMI) among AI/ANs
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Major Depressive Episodes among AI/ANs
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Major Depressive Episodes with Severe Impairment among AI/ANs
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Suicidal Thoughts, Plans, and Attempts among AI/AN Young Adults (18-25 

y.o.) and AI/AN Adults (26-49 y.o.)
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Co-Occurring 

Mental and Substance Use Disorders
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Substance Use among AI/AN Youths (12-17 y.o.) by Past Year Major 

Depressive Episode (MDE) status
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Co-Occurring Substance Use Disorder and Any Mental Illness in 

AI/AN Adults
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Co-Occurring Issues: Substance Use and Mental Illness among 

AI/AN Adults
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Substance Use Disorder (SUD) is Associated with Suicidal 

Thoughts, Plans, and Attempts among AI/AN Adults ≥18 y.o.
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Locations Where Substance Use Treatment was Received among 

AI/ANs
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Summary: Mental Health/Co-Occurring Issues in the United States in 2019

• Major Depressive Episodes among AI/AN ages 18-25 significantly increased compared

to 2016.

• Substance use disorder significantly increased suicidality among AI/AN adults ages 18

and older.

• Progress is being made, as co-occurring substance use disorder and any mental illness in AI/AN adults ages 18-25 and 26-49 is declining. There is a slight increase for ages 50 and older.

• Outpatient rehabilitation centers are the main location where substance use treatment

was received.
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What Can We Do Now?

• SAMHSA must use its resources to benefit as many as possible:

• Community based treatment and recovery services

• Build on the Certified Community Behavioral Health Clinic model

– Crisis intervention services/suicide prevention resources

– Integrated mental health, substance use, general medical services

– Children’s mental health services-linkages with schools

• Keep telemedicine/telehealth in place including use of telephone where 

audio/visual is not possible and pay for these services at same rate as faceto-face—no reduction in reimbursement because it is telemedicine

• Continue and expand as possible technical assistance and training to 

behavioral health providers—clinicians and peers
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It’s Up to Us Now

• Let’s work as hard as we can to make decision-makers understand mental health and

substance use needs in America—pre and post-COVID-19

• Let’s keep the virus in mind in planning and implementing our services so that we

can safely deliver care, but we cannot ignore the overall health needs of the

American people—that is not an option

• Let’s work to meet the mental health/substance use needs of our people:

– Restore our systems—mental health and substance use disorder services are

‘essential services’

– Expand our treatment and community recovery support systems permanently

– Every American life is precious and every American death—regardless of the

cause is a terrible loss