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American Indian and Alaska Native (AI/AN) communities experience a disproportionate burden of substance use disorders (SUDs) alongside persistent barriers to culturally responsive care and research participation. Despite this need, AI/AN populations remain underrepresented in substance use research, in part due to historical and ongoing systemic inequities, including research practices that have not adequately respected Tribal sovereignty or incorporated Indigenous knowledge systems. This commentary synthesizes research conducted within the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) focused on AI/AN communities, identifies key lessons learned from this body of work, and offers recommendations for future research.

First, we provide an overview of CTN-supported studies involving AI/AN populations, highlighting both the diversity of substance use patterns across communities and the feasibility of conducting rigorous, culturally responsive research. Second, we synthesize lessons learned from these studies and related literature, including the importance of long-term relationship building, the need for culturally responsive research frameworks, structural barriers to implementation, and workforce and infrastructure challenges. Third, we present recommendations for the field, emphasizing the central role of community-based participatory research (CBPR) and Tribal participatory research (TPR), the integration of Indigenous knowledge systems, and the importance of Tribal data sovereignty and community-led dissemination.

Collectively, this commentary argues that sustainable progress in addressing SUDs among AI/AN populations requires a fundamental shift toward community-engaged, culturally responsive, and equity-focused research partnerships. The experiences of the CTN AI/AN Special Interest Group demonstrate that such approaches are not only feasible but essential for advancing both scientific knowledge and community health.

Related protocols: CTN-0020-A-1, CTN-0033-Ot-1, CTN-0033-Ot-2, CTN-0033-Ot-3, CTN-0033-Ot-4, CTN-0033-Ot-5, CTN-0044-A2, CTN-0078-Ot, CTN-0096, CTN-0096-A-1, CTN-0118, CTN-0123, CTN-0129

This is the Results Article for CTN-0033-Ot-2. Collaborations with Southwestern tribal entities and treatment programs in and around New Mexico were developed to investigate the extent of methamphetamine and other drug use among American Indians (AIs) in the Four Corners region. Nine focus groups were held, mostly with Southwestern AI participants (N=81) from three diverse New Mexico communities to understand community members’, treatment providers’, and clients/relatives’ views on methamphetamine. A telephone survey of staff was conducted (N=100) from agencies across New Mexico to assess perceptions of methamphetamine users among people working with AI populations. Self-reported drug use data from 300 AI clients/relatives who completed the Addiction Severity Index (AI) in the context of treatment at three diverse addiction treatment programs were collected and analyzed. Each focus group offered a unique perspective about the effect of drugs and alcohol on each respective community. Though data from the phone surveys and ASIs suggested concerning rates of methamphetamine use, with women more adversely affected by substance use in general, alcohol was identified as the biggest substance use problem for AI populations in the Southwest. There appears to be agreement that methamphetamine use is a significant problem in these communities, but that alcohol is much more prevalent and problematic. There was less agreement about what should be done to prevent and treatment methamphetamine use. Future research should attend to regional and tribal differences due to variability in drug use patterns, and should focus on identifying and improving dissemination of effective substance use interventions.

Related protocols: CTN-0033-Ot-2

In 2003, the Indian Health Service reported that methamphetamine use among Native Americans was three times higher than that of the general population. However, little is known about the use and prevalence of methamphetamine and other drug use in Native American populations within New Mexico. Telephone surveys were conducted with providers, counselors, and law enforcement personnel to assess their perceptions of drug use throughout New Mexico and the Four-Corners area. This poster reports on the preliminary findings of this ongoing study. Most respondents (67.5%) identified alcohol as the number one problem substance in their communities, followed by marijuana (17.5%), heroin (5%), and methamphetamine (5%). Most participants (86.8%) reported that methamphetamine was a mild or moderate problem; 13.2% said it was a severe problem. The degree to which participants saw methamphetamine as a problem, and the number of methamphetamine users they saw per month, were not significantly correlated with the rank assigned to methamphetamine as a problem substance. In conclusion, methamphetamine was perceived as less of a problem than other substances by most survey respondents. The findings of this survey shed light on the geographic distribution of methamphetamine problems in Indian Country and will help to focus future efforts in prevention and treatment research.

Related protocols: CTN-0033-Ot-2

Methamphetamine use has been endemic in the Western United States for over two decades, and higher rates of meth use have been reported in the Western U.S. New Mexico represents a severe case, ranking in the top 10 states for meth use in recent years. While the actual scope of meth use remains unknown for most tribal communities, surveys suggest elevated rates of substance use among American Indians and Alaska Natives (AIAN) compared with other racial/ethnic groups. The present study was designed to examine the treatment needs and impacts of meth and other drugs on AIAN individuals, families, and communities, using a community-based participatory research approach. Data were collected from three AIAN sites in New Mexico. All Addiction Severity Index (ASI) data were collected by chart review (n=212). Amphetamine use as reported in the ASI was used as a proxy for meth use. Descriptive statistics revealed that 24.9% of participants reported some lifetime amphetamine use, with 3.8% reporting amphetamine use in the previous 30 days. One participant reported amphetamine as their primary problem substance, while alcohol was reported as the major problem substance by 95% of respondents. Analyses also revealed different effects of gender across sites, highlighting the challenges at AIAN sites within the same region. Participants at all sites reported significant employment problems. In general, the results suggest that meth treatment at AIAN sites must be customized to meet the unique needs of these communities.

Related protocols: CTN-0033-Ot-2

New Mexico ranked as one of the top U.S. states for methamphetamine use, yet there are no limited data available on methamphetamine use in American Indian communities. This study, part of CTN-0033-Ot-s (“Methamphetamine Use and Treatment in Native American Communities in the Southwest”) involved a collaboration with an American Indian community to determine perceptions of methamphetamine and other drug use problems, effective prevention and treatment efforts, as well as protective factors in their community.

Findings suggested that there were many misconceptions about methamphetamine in this population, particularly with regard to how methamphetamine is made. Across the questions, community members seemed to be influenced substantially by the media, and the patients seemed to be the most informed (compared to treatment providers) about methamphetamine in general, as well as where it was coming from and signs that someone was using it. American Indian communities would benefit from resources to elucidate current community protective factors for methamphetamine and other drug problems, correcting misinformation, and testing intervention efforts to quell other drug problems.

Related protocols: CTN-0033-Ot-2

The Methamphetamine and Other Drugs (MOD) in American Indian and Alaska Native communities (AIAN) project grew from NIDA?s commitment to reducing health disparities with a specific emphasis on a better understanding of the epidemiology and treatment of drug abuse, and its health consequences in minority populations in general, and AIAN communities in particular. Because few data exist on methamphetamine and other drug use in AIAN communities, NIDA’s National Drug Abuse Treatment Clinical Trials Network (CTN) funded several exploratory and developmental projects in order to develop collaborative research partnerships with AIAN communities. Each participating Node has specific processes in place for reporting and disseminating research findings that require Tribal approval from its respective research partners and findings from these projects will be presented in future publications and at professional meetings — in full partnership with our community research partners.

The purpose of this brief report is to describe the process followed by each of the Nodes as they have developed their research partnerships with AIAN communities; lessons learned and recommendations for others interested in ethical research with AIAN communities are also presented.

Related protocols: CTN-0033-Ot, CTN-0033-OT-1, CTN-0033-Ot-2, CTN-0033-Ot-3, CTN-0033-Ot-4, CTN-0033-Ot-5