Native American Drug and Alcohol Rehab Centers

Many cultural populations in the United States have unique medical and mental health care needs. Factors like genetics, traditions and historical trauma can play a role in addiction risk, for example. According to the Federal Health Program for American Indians and Alaska Natives, individuals in these communities are more likely to have alcohol use disorder or certain drug use disorders than the general population in the United States.

Native American and Alaska Native people with drug or alcohol use disorders can choose from a variety of pathways when seeking treatment. This guide discusses treatment options, what culturally responsive treatment is and how to choose a quality program.

The definition of Native American rehab depends on the person looking for this type of treatment. Native American drug and alcohol rehab centers may refer to:

• Treatment programs operated by tribal organizations
• Inpatient or outpatient programs supported by or affiliated with the Indian Health Service (IHS)
• Community programs that provide culturally responsive rehab and other care
• Modern programs that integrate traditional healing with rehab, pairing the spiritual and medicinal practices of a culture with evidence-based treatment and therapy

The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that differences between the cultural and health needs of American Indian and Alaska Native populations, as well as other populations in the country, have historically led to poorer outcomes for healthcare treatment. Culturally responsive care can increase trust, safety and treatment engagement, helping to support better outcomes.

According to SAMHSA, the benefits of culturally responsive addiction treatment include:

• Increased trust and respect between providers and persons with substance abuse disorders
• Better inclusion for all members of Native American communities
• Greater ability to support individuals and families on the recovery journey

When researching treatment options, you may come across terms used to describe Native peoples in the United States. These terms aren’t always interchangeable, and individuals and communities may have preferences about which terms apply to them.

• Native American and American Indian are often used interchangeably in general use, but some individuals and tribes prefer one term over the other.
• Alaska Native refers specifically to the Indigenous peoples of Alaska, including the Iñupiat, Yup’ik and Tlingit.
• Indigenous is a broader term that can refer to Native peoples across North America and globally.
• Tribal sovereignty means that federally recognized tribes function as self-governing nations. Available treatment programs, eligibility requirements and services can vary significantly depending on a person’s tribal affiliation and where they live.
• Traditional healing refers to cultural and spiritual practices used by Native communities to support health and wellness. In a treatment context, participation in traditional healing should always be voluntary and driven by a person’s preferences.

Across pathways, rehab can include various levels of care. Treatment centers may offer inpatient or outpatient services, and the right option depends on your substance use disorder (SUD) and your goals for recovery.

Inpatient treatment requires admittance into a program where you live on-site for several weeks or months. If you have an alcohol use disorder, opioid use disorder or certain other drug use disorders, you may start with medical detox. During detoxification, clinical staff help support stabilization, comfort and well-being when withdrawal risks are high.

During inpatient or residential rehab, you typically participate in behavioral therapy, including individual and group sessions. A culturally responsive program may pair evidence-based approaches like cognitive behavioral therapy (CBT) with participation in optional traditional healing practices like sweat lodges, medicine wheel use and talking circles.

Outpatient levels of care include:

• Partial hospitalization programs (PHP) and intensive outpatient programs (IOP). Structured programs are often the next step after inpatient care. PHP and IOP options usually involve several hours of treatment daily or multiple days per week.
• Standard outpatient counseling. Regular individual or group therapy sessions help support ongoing recovery as you step down from higher levels of care.
• Recovery housing or sober living. Substance-free living environments can help with post-rehab stability and incorporate peer support. These living options can be especially helpful to those with unstable home environments that don’t support ongoing recovery efforts.

SAMHSA notes that culturally responsible treatment providers:

• Are involved with local or tribal communities and willing to learn about tribal history and traditions
• Collaborate with tribal leaders to serve communities and show respect for native knowledge
• Respect the cultural differences of various peoples and demonstrate willingness to support them with treatment

Culturally competent addiction treatment providers tend to have:

• Staff trained specifically to provide respectful care without making assumptions
• Options that include family members, elders or community support when someone wants them
• Trauma-informed approaches that prioritize overall wellness, consent and safety
• Space for optional spiritual practices or traditional healing in rehab
• Policies that support coordination of care with community resources, particularly near discharge, when aftercare plans are made

Traditional healing practices vary widely across tribes and communities, and not every person seeking treatment wants to incorporate them. In a quality program, participation in any cultural or spiritual practice is usually voluntary.

When traditional practices are available, and a person chooses to engage with them, they should complement evidence-based treatment, not replace it. Talking circles, for example, may be offered alongside standard group therapy. Where group therapy focuses on clinical skills and processing, a talking circle creates space for communal sharing in a format that some might find more familiar.

A study published in the American Journal of Drug and Alcohol Abuse looked at dual diagnosis treatment needs among Native American populations in rehab. Notable statistics included:

• 47% of individuals in treatment were using more than one type of substance per day before entering rehab
• More than 45% had a chronic medical condition
• More than 73% had a history of depression or anxiety
• Close to 20% reported auditory or visual hallucinations
• Almost 40% had suicidal thoughts, and around 19% had a previous suicide attempt
• Close to 44% were on psychiatric medication

Literature published by StatPearls also indicates that American Indian and Alaska Native populations are more prone to post-traumatic stress disorder (PTSD) than the general population nationwide. The rate of PTSD among Americans is 4.8% to 6.4%. Among Native populations, it’s 16% to 24%.

Ensuring a rehab is equipped to support co-occurring disorders can help support better overall outcomes. Providers that offer integrated care can better address addiction and mental health cycles and help you create better after-care plans that include ongoing coordinated treatment.

Medical detox and medication-assisted treatment (MAT) involve using medications as an evidence-based part of SUD treatment. MAT support is common with alcohol and/or opioid addiction, but MAT may also be used with other substance addictions.

If you’re considering MAT, look for programs that offer support for medication management rather than shaming medicine use. Ask about how a recovery center oversees medication use, who monitors meds and whether you’ll need to keep taking medications after discharge.

For many living in a Native American culture, privacy concerns can be a barrier to seeking care for addiction. In a small community, privacy may feel non-existent, and you have a connection to the people working at treatment facilities that are options for you.

Discreet treatment options do still exist. Confidentiality in rehab is generally required, and healthcare workers typically have binding agreements that forbid them from discussing patients and case details with others. While it may be difficult to hide the fact that you’re gone from home or involved in some kind of care, depending on how involved you are with a community, some level of privacy is possible.

When you talk to a rehab provider before admission, ask about:

• Communication and confidentiality policies. What laws do staff have to follow, and how does the organization ensure it’s only sharing information with authorized parties?
• Records access and protection. How does the treatment center protect physical or electronic records? Who can access your medical records?
• Discreet billing. What are the billing processes? What will mail from the center look like if it arrives at your home later?

Choosing a level of care for SUD treatment is an important step when seeking help with addiction. The best way to answer questions like whether you need detox or if outpatient treatment is a good place to start is to talk to an addiction treatment provider.

Some basic guidelines:

• Detox typically comes first when withdrawal symptoms are very uncomfortable or pose health risks, such as with opioid use disorder.
• Inpatient or residential care is often the right place to start when you need highly structured support away from your current life and triggers to break free of addiction. It’s also usually the right care level when addiction occurs alongside mental health disorders like anxiety or PTSD.
• Outpatient care may be a good place to start when your substance use disorder is milder, or you need to balance your home or work obligations with treatment. It also provides options for step-down care as you exit inpatient or intensive outpatient programs.

When looking for an addiction treatment program, consider whether rehab options meet the criteria below:

• National accreditation. National or third-party accreditation from the Joint Commission or other organizations can demonstrate that a provider meets minimum standards of care.
• State licenses, if applicable. Where providers might hold state licenses, consider asking about their credentials or checking with state boards.
• Evidence-based therapies. Look for rehab centers that employ credentialed doctors, therapists and nurses to provide quality clinical care and evidence-based therapy.
• Treatment plans that support mental health conditions. Even if you don’t think you have a co-occurring mental health diagnosis, this ability often indicates a quality rehab facility. You may also learn during treatment that depression or another factor is involved in your SUD.
• Clear policies. Look for rehab centers that make patient privacy, referral and billing policies easy to understand.
• Discharge planning. Ensure providers discuss aftercare and support you with plans and referrals for the next levels.
• Integration of culturally responsive treatment. Find out if providers support optional healing practices that align with your culture and beliefs.

Choosing a safe rehab also means being aware of rehab warning signs, such as:

• Lack of clear accreditation or licensing information or not being able to answer questions about credentials
• Unclear answers or lack of knowledge around topics like staffing coverage and emergency procedures
• Programs that claim to be “Native-focused” but don’t explain how treatment processes include culturally responsive foundations
• Programs that only include traditional healing practices and don’t incorporate evidence-based therapy and life skills building
• Spiritual or cultural practices are positioned as not optional, or there’s pressure to participate to “get the best outcome”
• Lack of discharge planning or dual diagnosis support
• No written policies about costs, insurance verification or patients’ rights or staff seem uncomfortable or unwilling to explain those policies

Before you sign up with a rehab provider, ask questions like:

• What licenses or accreditation does your center hold, and what are the backgrounds of your staff?
• What level of care do you recommend for me and why?
• Do you provide detox? If not, will you help me coordinate it?
• What type of referrals do you do for discharge planning and aftercare?
• What does culturally responsive care look like at your center?
• What’s included in the cost, what might be billed separately and can you estimate what I might owe?

The cost for treatment services is driven by:

• Level of care needed
• Length of treatment
• Whether you need medical services
• The location and optional services

If you have health insurance, whether a rehab is in-network with your plan can impact how much you end up paying. Some rehabs may offer sliding scale fees and other assistance programs, and tribal and community treatment may operate differently from traditional healthcare with regard to billing and payment.

Always ask about costs and billing up front so you can create a plan. Your rehab provider can verify your insurance to help you understand costs.

Lasting recovery means working on overall well-being, building on skills throughout rehab and taking the time to go through appropriate step-down care. Even after you finish formal treatment, peer support and ongoing check-ins can help with the recovery process and relapse prevention.

Help.org can help you find an alcohol or drug detox center that fits your recovery and cultural needs, located near you.