Which ethnicity has the highest rate of substance use disorder? A look at national trends

September 22, 2025 •

3 min read

According to the 2021 National Survey on Drug Use and Health, American Indian or Alaska Native people had the highest rate of past-year substance use disorder (SUD) among all racial and ethnic groups. This critical finding highlights significant health disparities and underscores the need for culturally-informed care.

Quick Summary

Based on national health surveys, American Indian and Alaska Native populations have the highest rates of substance use disorder, followed closely by multiracial individuals. These disparities are linked to complex socioeconomic factors, systemic inequities, and historical trauma, rather than any inherent traits.

Key Points

Prevalence Disparity: National surveys consistently show that American Indian or Alaska Native and Multiracial individuals experience the highest rates of substance use disorder (SUD) compared to other ethnic groups.
Systemic Factors: High SUD rates are linked to systemic issues like historical trauma, socioeconomic inequality, and ongoing discrimination, not to inherent ethnic traits.
Barriers to Treatment: People from marginalized ethnic groups often face significant obstacles to accessing substance use treatment, including lack of insurance, geographic limitations, and culturally insensitive care.
Underdiagnosis: Some research suggests that mental health and substance use disorders may be underdiagnosed in people of color, which can influence reported statistics.
Equity-Based Solutions: Addressing these disparities requires culturally responsive treatment models, expanded access to care, and tackling the underlying socioeconomic and systemic inequities.

Understanding the Complex Data on Substance Use Disorder

Examining statistics on substance use disorder (SUD) by ethnicity requires a careful, nuanced approach that considers both the data and the factors influencing it. National surveys reveal significant disparities in SUD prevalence, with some groups facing a disproportionate burden. Rather than indicating inherent vulnerability, these figures often reflect historical injustices, systemic barriers, and social determinants of health.

Key Findings from National Surveys

The Substance Abuse and Mental Health Services Administration (SAMHSA) conducts the annual National Survey on Drug Use and Health (NSDUH), a primary source for national statistics on substance use. According to the 2021 report, American Indian or Alaska Native (AI/AN) people had the highest percentage with a past-year SUD at 27.6% among people aged 12 or older, followed by multiracial individuals at 25.9%. Rates for other groups were lower: Black or African American (17.2%), White (17.0%), Hispanic or Latino (15.7%), and Asian (8.0%). These patterns are consistent across different types of substance use, with AI/AN and multiracial people more likely to have used illicit drugs in the past year, and White people having the highest rate of past-month alcohol use. Illicit drug use rates, including marijuana and methamphetamine, tend to be higher in AI/AN populations.

Comparison of Past-Year SUD Prevalence (2021)


Ethnic/Racial Group	Past-Year SUD Prevalence (Ages 12+)
American Indian or Alaska Native	27.6%
Multiracial	25.9%
Black or African American	17.2%
White	17.0%
Hispanic or Latino	15.7%
Asian	8.0%

Factors Contributing to Ethnic Disparities in SUD

The reasons behind these statistical disparities are multifaceted and complex, extending beyond individual choices. Systemic issues rooted in historical, social, and economic factors play a powerful role in shaping health outcomes.

Historical Trauma

Generations of systemic oppression have significantly impacted Indigenous communities. Historical trauma is a key factor contributing to higher substance use rates in AI/AN populations.

Socioeconomic Inequities

Disparities in income, education, and employment are prevalent among marginalized communities and are well-documented risk factors for substance use. Higher income inequality is linked to higher overdose death rates, disproportionately affecting Black and AI/AN people.

Barriers to Treatment Access

People of color are less likely to receive the substance use treatment they need compared to White individuals. Barriers include lack of insurance, limited access to facilities in certain areas, and insufficient culturally competent care.

Systemic Racism and Discrimination

Ongoing discrimination in healthcare, housing, and the criminal justice system impacts substance use patterns and outcomes. Experiencing discrimination is also associated with greater substance use risk.

Contextualizing the Statistics: The Impact of Measurement

It's important to consider how these statistics are collected and interpreted. Some researchers suggest underdiagnosis among certain people of color. The high rates among AI/AN and multiracial individuals highlight the need for focused, culturally appropriate interventions.

Addressing Disparities and Promoting Health Equity

Addressing these disparities requires a shift to an approach that incorporates cultural awareness and addresses systemic inequities. Strategies include expanding culturally responsive care, addressing socioeconomic determinants, increasing access to treatment, promoting harm reduction, and focusing on prevention. Efforts by organizations like the CDC to address widening overdose death disparities underscore the urgency of this work. Focusing on equity in public health is critical for reducing the disproportionate impact of SUD on marginalized communities.

Frequently Asked Questions

No, ethnicity itself does not cause a higher risk. Statistical disparities in substance use disorder rates are tied to complex factors such as socioeconomic conditions, historical trauma, systemic racism, and unequal access to healthcare, not biological or inherent ethnic traits.

The high rates of SUD in the AI/AN population are strongly linked to historical trauma, cultural disruption, and generations of systemic oppression. These factors contribute to increased rates of poverty, mental health issues, and limited access to culturally appropriate healthcare, all of which are risk factors for substance use.

Not necessarily. While some national surveys show that White individuals have higher rates of overall substance use compared to some people of color, the rates of substance use disorders vary. For instance, multiracial individuals also show very high SUD prevalence. It is crucial to look at specific data rather than generalizing.

Historical trauma refers to the collective and cumulative emotional and psychological wounds experienced by a group of people over generations. For Indigenous peoples, this is rooted in colonization and dispossession. The unresolved grief and stress from these experiences can contribute to higher rates of substance use as a coping mechanism.

Yes, studies have shown disparities in treatment outcomes. Some research indicates that Black Americans are less likely to complete treatment compared to White Americans. This can be due to a variety of factors, including negative experiences during treatment, a lack of culturally competent care, and underlying socioeconomic challenges.

Reducing disparities requires a multifaceted approach. This includes increasing access to health insurance and treatment facilities, integrating culturally responsive and trauma-informed care into all programs, and addressing the systemic inequities that fuel health disparities in the first place.

Yes. Research from the Centers for Disease Control and Prevention (CDC) indicates that counties with greater income inequality have higher rates of overdose deaths, and these disproportionately affect Black and American Indian/Alaska Native people.