Nicotine dependence and psychiatric and substance use disorder comorbidities among American Indians/Alaska Natives: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Drug Alcohol Depend. 2014 Nov 1:144:127-33. doi: 10.1016/j.drugalcdep.2014.08.017. Epub 2014 Sep 3.


Background: American Indians and Alaska Natives (AI/ANs) have high rates of tobacco use compared to the general population. AI/ANs also have elevated rates of psychiatric and substance use disorders associated with nicotine dependence. However, very few studies have examined the comorbidity between nicotine dependence and psychiatric and substance use disorders within this population.

Methods: This study analyzes the comorbidity of lifetime nicotine dependence with both current and lifetime psychiatric disorders and substance use disorders in a nationally representative sample of 701 AI/AN women and men.

Results: Using 95% confidence interval testing, lifetime nicotine dependence (29.5%) was associated with all main diagnostic categories (any mood disorder, any anxiety disorder, any personality disorder, any alcohol use disorder, and any drug use disorder) both at the lifetime level and current (12-month) level. Of the lifetime disorders, the strongest associations were with psychosis and drug dependence. For (current) 12-month disorders, the strongest associations were with alcohol dependence and drug dependence. Differences were noted between genders regarding personality disorders.

Conclusions: Culturally appropriate tobacco screening, prevention, and treatment curricula for adult AI/ANs with dual diagnoses are recommended. Understanding historically based factors that may contribute to psychiatric illness and substance use disorders may assist in more effective nicotine treatments for AI/ANs.

Keywords: Alaska Native; American Indian; Comorbidity; Nicotine dependence; Smoking; Substance abuse.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Alaska / ethnology
  • Alcohol-Related Disorders / diagnosis
  • Alcohol-Related Disorders / ethnology
  • Alcohol-Related Disorders / psychology
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / ethnology
  • Anxiety Disorders / psychology
  • Comorbidity
  • Diagnosis, Dual (Psychiatry)
  • Drug Users* / psychology
  • Female
  • Health Surveys* / methods
  • Humans
  • Indians, North American / ethnology*
  • Indians, North American / psychology*
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / ethnology*
  • Mental Disorders / psychology
  • Middle Aged
  • Mood Disorders / diagnosis
  • Mood Disorders / ethnology
  • Mood Disorders / psychology
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / ethnology
  • Substance-Related Disorders / psychology
  • Tobacco Use Disorder / diagnosis
  • Tobacco Use Disorder / ethnology*
  • Tobacco Use Disorder / psychology*