Gender Differences among American Indian Treatment Admissions Aged 18 to 25

In Brief
Among American Indian substance abuse treatment admissions aged 18 to 25 in 2007, males were more likely than females to report alcohol (61.1 vs. 44.7 percent) or marijuana (22.4 vs. 16.0 percent) as the primary substance of abuse; however, young adult female American Indian admissions were almost three times more likely than their male counterparts to report primary methamphetamine abuse (17.5 vs. 5.9 percent) Over half of young adult American Indian male and female admissions (54.7 percent each) had been in treatment at least once before Among young adult American Indian admissions, only about one third (34.1 percent) of males and less than one fifth (19.3 percent) of females were employed

Substance abuse disorders disproportionately affect minority populations, making it important to understand the specific characteristics and substance use behaviors of these groups. Among American Indian communities, substance abuse is a serious health and social problem, especially among youth and young adults. Of the approximately 1.8 million substance abuse treatment admissions in 2007, 2.2 percent or about 40,000 were American Indian. Of these, 21.5 percent were young adults between the ages of 18 and 25.¹ Because young adult American Indians are transitioning from adolescence to adulthood and establishing important social, economic, and community relationships, understanding the characteristics and substance use behaviors of those in substance abuse treatment may assist in the development of more effective treatment and prevention options.

Data from the Treatment Episode Data Set (TEDS) for 2007 can be used to examine American Indian substance abuse treatment admissions aged 18 to 25 (hereafter referred to as "young adult American Indian admissions"). This report focuses on gender differences among this population. Of the approximately 8,600 young adult American Indian admissions in 2007, about 59.1 percent or 5,100 were male, and 40.9 percent or 3,500 were female.

Alcohol was the most common primary substance of abuse reported among young adult American Indian admissions for both genders, with males more likely than females to have reported it as a primary substance of abuse (61.1 vs. 44.7 percent) (Figure 1). Male admissions were also more likely than female admissions to report primary marijuana abuse (22.4 vs. 16.0 percent). Female admissions, however, were almost three times more likely than their male counterparts to report methamphetamine as the primary substance of abuse (17.5 vs. 5.9 percent). In addition, primary methamphetamine abuse was more common among young adult American Indian female admissions than among non-Hispanic White (13.2 percent) or non-Hispanic Black (2.8 percent) female admissions of the same age. Young adult American Indian female admissions were also more than twice as likely as their male counterparts to report primary abuse of opiates other than heroin (7.3 vs. 3.2 percent) or cocaine (5.9 vs. 2.4 percent).

Figure 1. Primary Substance of Abuse among American Indian Admissions Aged 18 to 25, by Gender: 2007

Note: Percentages may not sum to 100 percent due to rounding. Source: SAMHSA Treatment Episode Data Set (TEDS), 2007.

Figure 1 Table. Primary Substance of Abuse among American Indian Admissions Aged 18 to 25, by Gender: 2007
Primary Substance of Abuse	Total	Male	Female
Alcohol	54.4%	61.1%	44.7%
Marijuana	19.8%	22.4%	16.0%
Methamphetamines	10.7%	5.9%	17.5%
Opiates Other than Heroin	4.9%	3.2%	7.3%
Cocaine	3.8%	2.4%	5.9%
Heroin	2.1%	1.6%	2.7%
Other	4.4%	3.4%	5.8%
Note: Percentages may not sum to 100 percent due to rounding. Source: SAMHSA Treatment Episode Data Set (TEDS), 2007.

Among young adult American Indian admissions, the most common source of referral for both genders was the criminal justice system, with males more likely than females to be referred from that source (64.3 vs. 42.5 percent) (Figure 2). Female admissions were more likely than male admissions to be referred by other community organizations (23.4 vs. 10.6 percent) or to be self- or individually referred (20.0 vs. 14.0 percent).

Figure 2. Principal Source of Referral among American Indian Substance Abuse Treatment Admissions Aged 18 to 25, by Gender: 2007

Note: Percentages may not sum to 100 percent due to rounding. Source: SAMHSA Treatment Episode Data Set (TEDS), 2007.

Figure 2 Table. Principal Source of Referral among American Indian Substance Abuse Treatment Admissions Aged 18 to 25, by Gender: 2007
Principal Source of Referral	Total	Male	Female
Criminal Justice System	55.5%	64.3%	42.5%
Individual/Self	16.4%	14.0%	20.0%
Other Community	15.8%	10.6%	23.4%
Alcohol/Drug Abuse Care Provider	6.4%	5.5%	7.8%
Other Health Care Provider	4.7%	4.3%	5.2%
Other	1.2%	1.3%	1.1%
Note: Percentages may not sum to 100 percent due to rounding. Source: SAMHSA Treatment Episode Data Set (TEDS), 2007.

There were few gender differences in the types of treatment received by young adult American Indian admissions. Similar proportions of both male and female admissions received ambulatory, nonintensive outpatient treatment (48.0 vs. 45.7 percent), ambulatory, intensive outpatient treatment (17.2 vs. 15.9 percent), short-term rehabilitation/residential treatment (11.7 vs. 13.4 percent), and detoxification (13.3 vs. 10.5 percent). There was more of a gender difference in the receipt of long-term rehabilitation/residential treatment. A higher proportion of young adult American Indian female admissions than male admissions received long-term rehabilitation/residential treatment (13.6 vs. 9.1 percent).

When examined by gender, the number of prior treatment episodes also did not differ among young adult American Indian admissions. Over half of both male and female admissions (54.7 percent each) had been in treatment at least once before.

A relatively small proportion of young adult American Indian admissions had some college education (males—10.1 percent vs. females—12.0 percent) (Figure 3). Half (50.8 percent) of female admissions and about two fifths (45.0 percent) of male admissions had less than a high school education.

Figure 3. Education and Employment Status among American Indian Substance Abuse Treatment Admissions Aged 18 to 25, by Gender: 2007

Note: Percentages may not sum to 100 percent due to rounding. Source: SAMHSA Treatment Episode Data Set (TEDS), 2007.

Figure 3 Table. Education and Employment Status among American Indian Substance Abuse Treatment Admissions Aged 18 to 25, by Gender: 2007
Education and Employment Status	Total	Male	Female
Less than High School	47.4%	45.0%	50.8%
High School/GED	41.8%	44.9%	37.3%
Some College	10.9%	10.1%	12.0%
Unemployed	47.0%	43.8%	51.5%
Employed	28.1%	34.1%	19.3%
Not in Labor Force	24.9%	22.0%	29.1%
Note: Percentages may not sum to 100 percent due to rounding. Source: SAMHSA Treatment Episode Data Set (TEDS), 2007.

Most young adult American Indian admissions were either unemployed or not in the labor force regardless of gender. Only about one third (34.1 percent) of male admissions and less than one fifth (19.3 percent) of female admissions were employed.

Similarly, among American Indian admissions, most young adults were never married, although the proportion was higher among males than females (86.2 vs. 81.1 percent).² About 1 in 10 young adult American Indian admissions were married (males—10.8 percent vs. females—12.4 percent). Although the proportions were small, female admissions were twice as likely as male admissions to be separated, divorced, or widowed at the time of admission (6.5 vs. 3.1 percent).

Among young adult American Indian admissions, nearly three quarters (72.6 percent) of males and over half (54.9 percent) of females had no health insurance (Figure 4).³ Female admissions were nearly three times more likely than male admissions to have Medicaid coverage (26.4 vs. 8.9 percent). Similar proportions of male and female admissions had some type of private health insurance (5.4 vs. 4.2 percent).

Figure 4. Health Insurance among American Indian Substance Abuse Treatment Admissions Aged 18 to 25, by Gender: 2007

* "Private" includes Blue Cross/Blue Shield, health maintenance organizations (HMOs), and other private health insurance. ** "Other" includes Medicare and other health insurance sources such as TRICARE and CHAMPUS. Note: Percentages may not sum to 100 percent due to rounding. Source: SAMHSA Treatment Episode Data Set (TEDS), 2007.

Figure 4 Table. Health Insurance among American Indian Substance Abuse Treatment Admissions Aged 18 to 25, by Gender: 2007
Health Insurance	Total	Male	Female
None	65.8%	72.6%	54.9%
Medicaid	15.6%	8.9%	26.4%
Private*	5.0%	5.4%	4.2%
Other**	13.6%	13.1%	14.4%
* "Private" includes Blue Cross/Blue Shield, health maintenance organizations (HMOs), and other private health insurance. ** "Other" includes Medicare and other health insurance sources such as TRICARE and CHAMPUS. Note: Percentages may not sum to 100 percent due to rounding. Source: SAMHSA Treatment Episode Data Set (TEDS), 2007.

Gender differences also were found in the prevalence of co-occurring mental health and substance use disorders. Among young adult American Indian admissions, females were more likely than males to report a co-occurring psychiatric disorder (25.3 vs. 16.3 percent).⁴

Substance abuse has long been recognized as a serious health and social problem facing American Indian communities.⁵ In order to provide the most effective interventions, prevention experts and treatment providers should understand the specific characteristics associated with American Indians between the ages of 18 and 25 and be prepared to meet those needs in culturally appropriate and gender-specific ways. For example, treatment providers need to be aware that while alcohol was the most common primary substance of abuse among both genders, almost one fifth of young adult American Indian female admissions reported primary methamphetamine abuse. Because methamphetamine abuse can have devastating individual and societal consequences, service providers need to be prepared to meet the mental and physical health and other ancillary needs of these young women. In addition, about half of young adult American Indian admissions had less than a high school education and most were either unemployed or not in the labor force, and over half had been in treatment at least once before. These findings suggest that young adult American Indians in treatment are in need of employment support services and job training, as well as on-going and culturally appropriate follow-up services to promote long-term recovery.

¹ Treatment Episode Data Set (TEDS) [Data file]. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Data for 2007 based on data received through October 6, 2008.
² Marital status is a Supplemental Data Set item. The 39 States and jurisdictions in which it was reported for at least 75 percent of all admissions in 2007—AR, CO, DC, DE, FL, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, WA, WY—accounted for 63 percent of all substance abuse treatment admissions in 2007.
³ Health insurance is a Supplemental Data Set item. The 30 States and jurisdictions in which it was reported for at least 75 percent of all admissions in 2007—AR, AZ, CO, DE, HI, ID, IL, IN, KS, KY, LA, MA, MD, ME, MT, ND, NE, NH, NJ, NM, NV, OK, OR, PA, PR, SC, SD, TX, UT, WY—accounted for 45 percent of all substance abuse treatment admissions in 2007.
⁴ Psychiatric problem in addition to alcohol or drug problem is a Supplemental Data Set item. The 29 States and jurisdictions in which it was reported for at least 75 percent of all admissions in 2007—AR, CA, CO, DE, FL, IA, ID, IL, KS, KY, LA, MA, MD, ME, MI, MO, NC, ND, NE, NM, OH, OK, PR, RI, SC, SD, TN, UT, WY—accounted for 54 percent of all substance abuse treatment admissions in 2007.
⁵ National Congress of American Indians. (2000). Resolution #STP-00-027. To Support and Recognize National Indian Advisory Board on Alcohol Substance Abuse. Retrieved March 11, 2010, from http://www.ncai.org/ncai/advocacy/hr/docs/027.htm

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (June 24, 2010). The TEDS Report: Gender Differences among American Indian Treatment Admissions Aged 18 to 25. Rockville, MD.