Deaths from alcohol, drug overdoses, and suicide declined significantly across the United States for the first time since 1999, but Native Americans continue to have the highest rate of death in all three categories. That’s according to a new report by the Trust for America’s Health, a Washington, D.C.-based public health nonprofit.
The report analyzed data from the Centers for Disease Control and Prevention and other federal sources from 2018 to 2024. Combined age-adjusted deaths from alcohol, drugs and suicide declined by 16% in the overall population. Native people die by drug overdoses at rates 123% higher than the national average, with suicide rates 64% higher and alcohol deaths nearly five times the national average.
The drivers behind these disparities are well known. Centuries of genocide, disenfranchisement and broken treaty promises have cast long shadows of generational trauma, limited access to health care and dire economic conditions in Native communities.
The report highlights variations in Native suicide rates, finding that Apache and Alaska Native youth have significantly higher suicide rates than the overall American Indian and Alaska Native population.
On a scale that measures the health and behavioral effects of adverse childhood experiences, known as ACEs, Native people consistently score higher than any other demographic group. High ACE scores are associated with substance use disorders and poor mental health outcomes that can be passed from generation to generation.
Protective factors can reduce the risks presented by ACEs. Connection to culture and community has been shown to be a strong protective factor for Native youth against suicide.
The report points to social media use as a risk factor for depression, anxiety and suicide among all age groups, but especially among youth. Tribes across Indian Country have sued social media giants, alleging they exploit the unique vulnerabilities of young Native people.
Despite the high numbers, suicide rates in Indian Country dropped to pre-pandemic levels in 2024. The report examines several possible contributing factors, including the 2023 launch of a suicide hotline specifically for Native Americans. In 2024, the Indian Health Service also implemented a policy requiring all patients at IHS facilities to be screened for suicidal ideation.
Drugs, Alcohol, and Dollars
Deaths from drug overdoses among Native people increased by 92% from 2018 to 2024, the largest increase among any demographic group. The alarming figures reflect Native communities’ position on the front lines of the nation’s ongoing overdose crisis.
Alcohol-induced deaths were 21% higher in 2024 than in 2018. Native people experienced a 6% increase in alcohol-related deaths during that period.
During a Tuesday press briefing on the report, Allison Arwady, former director of the CDC Injury Center, cautioned against excessive optimism about the overall reduction in deaths, pointing to major cuts in federal spending on substance use and mental health programs.
“These workforce and funding disruptions threaten to reverse our progress,” Arwady said.
The Substance Abuse and Mental Health Services Administration, or SAMHSA, lost 40% of its workforce amid sweeping federal cuts made between 2025 and 2026. The administration has proposed combining the CDC and SAMHSA into a single agency, a move that could eliminate existing offices during the integration process.
Arwady emphasized that major shifts in federal budgets have increased pressure on states to make up for funding shortfalls.
“It’s really important to continue to prioritize public health, even in these strained budgetary environments, and for state legislators to recognize that public health is a critical issue that affects everyone in their state,” Arwady said. “By investing in public health and prevention, you are helping reduce health care costs, while also strengthening the safety and security of your residents and communities.”
