Substance Use Disorders and Unhealthy Alcohol Use Patterns Among American Indian/Alaska Native Veterans Receiving Care at the Veterans Health Administration

AI Summary

AIAN VA outpatients had higher prevalence of any substance use disorder than non-AIAN patients (10.8% vs 8.2%; aOR 1.18, 95% CI 1.09, 1.29).
AIAN patients had higher prevalence of high-risk unhealthy alcohol use (AUDIT-C ≥8): 4.8% versus 3.2%; aOR 1.31, 95% CI 1.18, 1.45.
Findings suggest roles for military trauma and structural inequities; targeted assessment of protective factors and evidence-based, tailored care is needed.

TL;DR (AI Generated)

Given known disproportionate historical and ongoing trauma for American Indian Alaska Natives (AIAN) and Veterans, we assessed the prevalence of SUD and unhealthy alcohol use (UAU) among AIAN patients at the Veterans Health Administration (VA).

We fit logistic regression models to compare AIAN patients to all others in prevalence and relative odds of: (1) any SUD (alcohol, stimulant, opioid, cannabis, tobacco, sedative, and/or hallucinogen use disorder) diagnostic codes documented in the year before AUDIT-C, (2) UAU (AUDIT-C ≥3 for women and ≥4 for men), and high-risk UAU (AUDIT-C ≥8).

Compared with non-AIAN, AIAN patients had higher prevalence and likelihood of any SUD [10.8% vs 8.2%; adjusted odds ratio (aOR): 1.18; 95% CI: 1.09-1.29; P < 0.001] and high-risk UAU (4.8% vs 3.2%; aOR: 1.31, 95% CI: 1.18-1.45; P < 0.001).

Basic summary

J Addict Med. 2026 Nov-Dec 01;20(6):701-704. doi: 10.1097/ADM.0000000000001617. Epub 2025 Dec 2.

ABSTRACT

OBJECTIVES: Trauma increases risk for substance use disorders (SUD). Given known disproportionate historical and ongoing trauma for American Indian Alaska Natives (AIAN) and Veterans, we assessed the prevalence of SUD and unhealthy alcohol use (UAU) among AIAN patients at the Veterans Health Administration (VA).

METHODS: We extracted national VA electronic health record (EHR) data for outpatients 18 years or older with ≥1 visit (October 1, 2009-July 31, 2017) who completed the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire in the year before a visit. We fit logistic regression models to compare AIAN patients to all others in prevalence and relative odds of: (1) any SUD (alcohol, stimulant, opioid, cannabis, tobacco, sedative, and/or hallucinogen use disorder) diagnostic codes documented in the year before AUDIT-C, (2) UAU (AUDIT-C ≥3 for women and ≥4 for men), and high-risk UAU (AUDIT-C ≥8). Models were adjusted for age, sex, and marital status.

RESULTS: Among 8,872,393 patients, 95,393 (1.1%) were AIAN, and 8,777,400 (98.9%) were non-AIAN. Compared with non-AIAN, AIAN patients had higher prevalence and likelihood of any SUD [10.8% vs 8.2%; adjusted odds ratio (aOR): 1.18; 95% CI: 1.09-1.29; P < 0.001] and high-risk UAU (4.8% vs 3.2%; aOR: 1.31, 95% CI: 1.18-1.45; P < 0.001).

CONCLUSIONS: AIAN VA outpatients are at higher risk for SUD and high-risk UAU relative to non-AIAN patients. Trauma risks due to both military service and structural inequities, as well as protective factors underlying differences, should be explored; evidence-based care may need to be targeted.

PMID:42976309 | DOI:10.1097/ADM.0000000000001617

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