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Bentson H. McFarland, MD, PhD, Roy M. Gabriel, PhD, Douglas A. Bigelow, PhD and R. Dale Walker, MD

All authors are with the One Sky Center (the American Indian/Alaska Native National Resource Center for Substance Abuse), Center for American Indian Health Education and Research, Oregon Health and Science University, Portland. Bentson McFarland, Douglas Bigelow, and Dale Walker are also with the Department of Psychiatry, Oregon Health and Science University, and Roy Gabriel is also with RMC Research, Portland, Oregon.

Correspondence: Requests for reprints should be sent to Bentson H. McFarland, MD, PhD, One Sky Center, Oregon Health and Science University, CR-139, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (e-mail: mcfarlab{at}ohsu.edu).

Objectives. Although American Indians and Alaska Natives have high rates of substance abuse, few data about treatment services for this population are available. We used national data from 1997–2002 to describe recent trends in organizational and financial arrangements.

Methods. Using data from the Indian Health Service (IHS), the Substance Abuse and Mental Health Services Administration, the National Institute on Alcohol Abuse and Alcoholism, the Henry J. Kaiser Family Foundation, and the Census Bureau, we estimated the number of American Indians served by substance abuse treatment programs that apparently are unaffiliated with either the IHS or tribal governments. We compared expected and observed IHS expenditures.

Results. Half of the American Indians and Alaska Natives treated for substance abuse were served by programs (chiefly in urban areas) apparently unaffiliated with the IHS or tribal governments. IHS substance abuse expenditures were roughly what we expected. Medicaid participation by tribal programs was not universal.

Conclusions. Many Native people with substance abuse problems are served by programs unaffiliated with the IHS. Medicaid may be key to expanding needed resources.