Differences in substance use treatment utilization among American Indian and Alaska native people compared to...

American Indian and Alaska Native (AIAN) populations experience disproportionately high rates of substance use disorders (SUD), yet limited research has examined their engagement with and outcomes from specialty SUD treatment.

This cross-sectional study used data from the 2021 Treatment Episode Dataset - Discharges (TEDS-D) to examine differences in clinical characteristics, treatment utilization, and outcomes between AIAN and non-Hispanic White adults (N = 423,990). Logistic and multinomial logistic regression models estimated unadjusted and adjusted odds ratios comparing American Indian and Alaska Native and non-Hispanic White individuals across multiple treatment domains. Covariates included age, gender, education, and housing status.

AIAN individuals were more likely to initiate substance use in early adolescence (adjusted OR = 1.69, 95% CI: 1.57-1.81), be referred to treatment through the criminal justice system (OR = 2.12, 95% CI: 2.04-2.21), and receive detoxification services (OR = 3.21, 95% CI: 3.08-3.35). They were significantly less likely to receive medications for opioid use disorder (OR = 0.76, 95% CI: 0.71-0.82) despite clinical need, and had higher odds of reporting substance use at discharge. Rates of treatment completion did not differ significantly by race. AIAN individuals were also less likely to receive diagnoses of co-occurring psychiatric disorders, highlighting potential gaps in screening and linkage to mental health services.

Disparities in referral source, service utilization, and clinical management suggest that AIAN individuals may not be receiving fully equitable or culturally responsive care. Efforts to improve treatment outcomes should prioritize early intervention, expanded access to pharmacotherapy, and the integration of trauma-informed, community-based models of care.