Healing the Unseen Wounds
Let’s get real for a sec. We talk a lot about mental health now—and thank goodness for that. We’ve got celebs opening up, viral TikToks explaining ADHD, and a general vibe that it’s okay to not be okay. But what happens when your “not okay” is tangled up in centuries of history, a crisis of identity, and trauma so deep it’s literally been passed down through your DNA? That’s the heavy reality for many Native Americans battling substance use disorders (SUDs), and it’s a conversation we’re not having nearly enough.
Healing isn’t a one-size-fits-all journey, especially when the wounds aren’t just your own. For Indigenous peoples in the U.S., the path to recovery is paved with unique and profound challenges that most standard treatment models just weren’t built to handle. It’s time we unpack this baggage—the history, the science, and the radical power of healing in a space that finally, truly understands.
The Historical Hangover: Why This Isn’t Just ‘Bad Choices’
To understand the high rates of substance abuse in Native communities, you have to rewind way past last weekend. We’re talking centuries. History isn’t just in textbooks; for Native Americans, it’s a living, breathing presence that has shaped the landscape of health and wellness.
The story is brutal, and we can’t sugarcoat it: colonization, forced removal from ancestral lands, the outlawing of spiritual practices, and the infamous boarding school era where children were systematically stripped of their language, culture, and identity. These weren’t just “unfortunate events”; they were deliberate acts of cultural destruction. Alcohol was often introduced and used as a tool for trade and subjugation, creating a devastating dependency from the outset. As writer and scholar Sherman Alexie, a member of the Spokane-Coeur d’Alene Tribes, has powerfully documented in his work, this legacy created a cycle of pain and disenfranchisement.
The stats paint a stark picture of this inheritance:
- According to the National Institute on Drug Abuse (NIDA), American Indians and Alaska Natives (AI/AN) have the highest rates of substance use disorders in the United States.
- A 2019 report from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that AI/AN adults had the highest rate of past-year SUD compared to any other ethnic group.
- Alcohol-related deaths are 520% higher for Native Americans than for the general U.S. population. (Source: Indian Health Service – IHS)
This isn’t a moral failing. It’s the predictable outcome of profound, prolonged, and targeted trauma. As Dr. Gabor Maté, an expert on addiction, often says, the first question shouldn’t be “Why the addiction?” but “Why the pain?” For Native communities, the pain is historic.
Trauma happens in our history and we carry it inside of our bodies and our minds. This is a story of native American healing.
It’s in the Genes: The Real Science of Generational Trauma
Okay, let’s geek out on some science, because “generational trauma” isn’t just a buzzword your woke cousin uses. It’s a real, biological phenomenon studied in the field of epigenetics.
Think of your DNA as your body’s hardware—the fundamental code. Epigenetics is the software. It doesn’t change the code itself, but it can turn certain genes on or off based on your experiences and environment. When a population endures intense, chronic stress—like, say, genocide and forced assimilation—it can cause epigenetic changes that are passed down to future generations.
So, how does this work?
Stressful events trigger a flood of cortisol, the “stress hormone.” Chronic trauma can lead to dysregulation of the HPA axis (the body’s stress response system). Research, like a landmark study on Holocaust survivors and their children published in Biological Psychiatry, found that trauma can alter the genes responsible for regulating cortisol. This means the children and grandchildren of survivors can be born with a heightened stress response, making them more vulnerable to anxiety, depression, PTSD, and—you guessed it—substance use disorders as a way to self-medicate and numb that constant feeling of being on edge.
For Native Americans, this “software update” is written in the ink of historical trauma. Dr. Maria Yellow Horse Brave Heart, a Hunkpapa/Oglala Lakota social worker and the pioneer of the Historical Trauma concept, defines it as the “cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences.” It manifests as substance abuse, suicidal ideation, and domestic violence—not as individual pathologies, but as symptoms of a collective wound.
Walking in Two Worlds: The Weight of Identity and Perception
Now, add the social layer. Imagine trying to heal while constantly battling stereotypes and navigating a world that either misunderstands or erases you. Many Native Americans describe the feeling of “walking in two worlds”—one rooted in their ancestral traditions and the other in mainstream American society.
This duality is exhausting. It’s compounded by the pervasive, harmful stereotype of the “drunken Indian,” a caricature that inflicts immense shame and discourages individuals from seeking help for fear of confirming the bias. This isn’t just about hurt feelings; it’s a major barrier to care. When the world already has a preconceived notion of your struggle, vulnerability feels dangerous. Healing requires safety, and for many, that safety is nowhere to be found in conventional settings that lack cultural understanding.
Finding Your People: The Game-Changer of Culturally Competent Care
So, what’s the solution? This is where the magic happens. Imagine walking into a therapist’s office and not having to spend the first hour explaining your entire cultural history. Imagine not having your spirituality dismissed as “folk belief.” Imagine talking to someone who just… gets it.
This is the power of culturally competent care, especially when provided by a Native American therapist.
A therapist who shares your cultural background or is deeply educated in it can create a space of profound understanding and compassion. They recognize that healing isn’t just about cognitive behavioral therapy (CBT) or 12-step programs. It’s about integrating modern psychological practices with traditional healing methods. This can look like:
- Talking Circles: A traditional practice that fosters community, active listening, and shared healing without the direct confrontation of Western group therapy.
- Ceremonial Practices: Incorporating smudging, sweat lodges, or other spiritual traditions that connect the individual back to their cultural identity—a powerful anchor in recovery.
- Storytelling: Using narrative to reframe trauma and reclaim one’s personal and collective history from a place of strength, not victimhood.
Research confirms this approach works. A study published in the Drug and alcohol dependence found that culturally adapted substance abuse treatments for Native Americans resulted in significantly better outcomes, including higher rates of abstinence and a stronger sense of cultural identity. When treatment affirms who you are instead of asking you to assimilate, healing becomes possible.
It’s a Marathon, Not a Sprint: What to Actually Expect from Healing
Okay, let’s manage expectations. Healing from SUDs, especially when tangled with generational trauma, isn’t a 30-day fix. It’s a lifelong commitment. There’s no “after,” only “during.” But the changes are transformative.
In the first few months of culturally-attuned treatment, you might expect:
- A profound sense of relief: The feeling of being truly seen and understood for the first time is life-altering.
- Reduced shame: Contextualizing your struggle within history and biology lifts the burden of personal blame.
- A reconnection to self: Engaging with cultural practices can restore a sense of purpose and identity that addiction tried to steal.
Long-term, the changes ripple outward:
- Developing healthy coping mechanisms: Learning to manage triggers and stress without substances.
- Rebuilding relationships: Mending trust with family and community on a foundation of honesty and cultural strength.
- Breaking the cycle: Perhaps the most powerful outcome of all. By healing yourself, you are stopping the flow of trauma to the next generation. You are changing the software.
The Path Forward: Reclaiming a Future
Let’s bring it all home. The challenge of healing from substance abuse in Native American communities is incredibly complex. It’s not about a lack of willpower; it’s about the crushing weight of history, the biological inheritance of generational trauma, and a society that has too often failed to provide a safe space for healing.
But the story doesn’t end there. The path forward is through a decolonized approach to mental health—one that honors history, respects tradition, and is led by those with lived experience. For Gen Z and Millennials, who are already breaking down stigmas and demanding more from our systems of care, supporting and amplifying this approach is critical.
Healing is possible. It’s happening in community centers, in talking circles, and in therapy sessions where culture is not just an afterthought, but the very heart of the treatment. It’s about reclaiming not just sobriety, but identity, history, and the future. And that’s a cause worth fighting for.
If you or someone you know is struggling, help is available. The SAMHSA Tribal Training and Technical Assistance Center offers resources and support specifically for Native American communities.
By Jace A.
