Substance Use and Self-Injury in American Indian Youth

A study conducted on the relationship between self-injurious behavior and substance abuse among young people of the White Mountain Apache Tribe found that suicidal behavior peaks among younger members of that tribe. This is similar to the pattern found in other American Indian communities, but unlike that of the general population of the United States, in which the rate of suicide is higher among middle-aged and older adults than it is among adolescents and young adults. The authors also identified an association between substance abuse and self-injurious behavior among young people on the Fort Apache Reservation which may help inform the creation of culturally specific interventions for the tribe in the future.

Although those between the ages of 15-24 compose 20 percent of the White Mountain Apache Tribe, they accounted for 65 percent of all suicides, 53 percent of all attempts, 44 percent of all ideation, and 43 percent of all non-suicidal self-injury (NSSI) during the study years (2007-2010).  Sixty-four percent of young people who died by suicide were “drunk or high” at the time of their death. Almost 76 percent were drunk or high when attempting suicide. Nearly half were drunk or high during suicidal ideation. Over one-third were drunk or high during NSSI.  The co-occurrence of substance use was markedly higher for more lethal behavior and among males, although the association between substance abuse and self-injurious behavior among females increased through the study years.

Alcohol was the substance most often associated with self-injury. Alcohol was associated with 97 percent of attempts, 92 percent of ideation, and 48 percent of NSSI. Marijuana was the drug with the next highest levels of association with self-injurious behavior. Marijuana was associated with 18 percent of attempts, 11 percent of ideation, and 5 percent of NSSI.

Although this study indicates that there is a relationship between substance abuse and suicidal behavior among younger members of the White Mountain Apache Tribe, it could not show “the extent to which substance use preceded or prompted suicide or other self-harm behaviors.” The authors suggest that more detailed research into the relationship between substance abuse and self-injury among American Indian youth could inform the creation of effective interventions.

The data on suicide, attempts, ideation, and self-harm analyzed for this study were taken from the tribally mandated self-injury surveillance registry created and implemented by the White Mountain Apache Tribe in conjunction with researchers from Johns Hopkins University, on the Fort Apache Reservation in Arizona.

Barlow, A., Tingey, L., Cwik, M., Goklish, N., Larzelere-Hinton, F., Lee, A., …Walkup, J. T. (2012). Understanding the relationship between substance use and self-injury in American Indian youth.American Journal of Drug and Alcohol Abuse, 38(5):403-408.