A blunt answer exists, but it needs context. In the broad federal category of past-year substance use disorder, the highest rate in the most recent national survey belongs to American Indian and Alaska Native people.
In 2023, SAMHSA reported a past-year substance use disorder rate of 25.3% for American Indian or Alaska Native people age 12 and older, higher than multiracial people at 18.9%, White people at 12.4%, Black people at 11.2%, Hispanic people at 10.8%, and Asian people at 5.0%.
Still, any article that stops there risks giving readers the wrong idea. “Addiction rates” can mean several things: alcohol use disorder, opioid use disorder, overdose deaths, treatment need, or treatment access.
Racial and ethnic categories also reflect social history, public policy, poverty, trauma, and health care access, not biology.
Why a Simple Ranking Can Mislead
When readers ask which ethnic group has the highest addiction rates, they usually want one clean answer. Federal data can provide that answer for overall substance use disorder, but the picture gets more layered once you break it down.
- One group can have the highest overall SUD rate
- Another can face especially severe overdose mortality
- Some groups have lower measured prevalence but worse barriers to treatment
- Broad labels can hide major differences inside a category, especially among Asian, Hispanic, Native, and multiracial populations
So the most accurate answer is not “one community has an addiction problem, and others do not.”
The accurate answer is that American Indian and Alaska Native communities are carrying the heaviest burden in several national measures, while other groups also face serious and sometimes rising harm in specific areas.
What the Latest Federal Data Shows
SAMHSA’s 2023 National Survey on Drug Use and Health offers the clearest national snapshot for substance use disorder by race and ethnicity.
Among people age 12 and older, American Indian or Alaska Native people had the highest past-year SUD rate at 25.3%. Multiracial people followed at 18.9%. Asian people had the lowest reported rate at 5.0%.
Past-Year Substance Use Disorder by Race and Ethnicity, 2023
| Group | Past-year SUD rate |
| American Indian or Alaska Native | 25.3% |
| Multiracial | 18.9% |
| White | 12.4% |
| Black | 11.2% |
| Hispanic | 10.8% |
| Asian | 5.0% |
Even older multi-year federal analyses point in the same direction. An HHS issue brief based on 2015 to 2019 NSDUH data found the highest adult SUD rate among American Indian or Alaska Native adults at 12.2%, followed by multiracial adults at 10.8%, with White adults at 8.2%, Black adults at 7.6%, Hispanic adults at 7.5%, and Asian adults at 4.3%.
That consistency matters. One-year estimates can move around. A pattern that appears in both a recent annual survey and a multi-year federal brief is harder to dismiss as noise.
Overdose Deaths Tell a Similar Story
If someone means “which group is suffering the worst drug harm right now,” overdose deaths are another crucial measure.
CDC data released in January 2026 showed that in both 2023 and 2024, the highest age-adjusted drug overdose death rate was again among non-Hispanic American Indian and Alaska Native people.
Rates were 65.0 per 100,000 in 2023 and 51.6 per 100,000 in 2024. Black non-Hispanic people were next at 48.9 in 2023 and 33.8 in 2024.
CDC also warns that overdose rates for American Indian and Alaska Native people are likely underestimated because race can be misclassified on death certificates.
In the same data brief, CDC notes an underestimation of about 34% for non-Hispanic American Indian and Alaska Native people. That means the burden may be even heavier than the official count suggests.
For readers trying to separate prevalence from severity, that distinction matters. A community can have high rates of substance use disorder, and at the same time face a sharply elevated risk of death once drugs like fentanyl enter the supply. American Indian and Alaska Native communities are dealing with both pressures.
Why Rates Are So High in American Indian and Alaska Native Communities
Any serious article has to be careful here. High addiction rates among Native communities are not the result of some built-in trait. Researchers and federal public health agencies point instead to a long chain of structural harms.
- historical trauma and forced displacement
- chronic underfunding of health systems
- poverty and housing instability
- rural isolation and limited treatment access
- exposure to violence and adverse childhood experiences
- weaker access to culturally grounded care and recovery support
Federal and academic sources repeatedly frame race and ethnicity in addiction research as markers of lived conditions, policy history, and unequal access to care.
A recent commentary on racial inequities in addiction research points directly to racism and historical trauma as contributors to drug-related disparities.
HHS’s minority health office also highlights the need for prevention and treatment approaches tailored to American Indian and Alaska Native communities.
That context changes the meaning of the headline. High rates are a public health and policy outcome, not a character judgment.
Category by Category, the Story Gets More Complicated
Overall SUD rates point clearly to American Indian and Alaska Native populations at the top. Yet specific substances can shift the comparison.
SAMHSA’s companion material for 2021 to 2023 reports that more than 1 in 3 American Indian or Alaska Native people and multiracial people used illicit drugs in the past year, higher than most other groups. Another SAMHSA release on 2023 data says past-year illicit drug use was higher among American Indian or Alaska Native people than in other major groups.
For opioid misuse, the pattern is less clean. SAMHSA’s 2023 race and ethnicity highlights say past-year opioid misuse did not differ significantly among racial or ethnic groups, with estimates ranging roughly from 1.7% to 4.0%.
Alcohol can also look different depending on which metric you use. Older federal and peer-reviewed sources have often found high alcohol use disorder rates among American Indian and Alaska Native populations, while White adults have sometimes ranked high on heavy alcohol use in broad adult surveys.
In other words, one group may drink more heavily in one measure, while another may face more severe alcohol-related harm or disorder.
So if the question is:
Which group has the highest overall substance use disorder rate?
American Indian and Alaska Native people.
Which group has the highest overdose death rate?
Again, American Indian and Alaska Native people, according to the latest CDC data.
Does every addiction-related measure rank groups in exactly the same order?
No. Substance type, age group, survey design, and outcome being measured all affect the result.
Treatment Access Is Part of the Problem
High need is only part of the story. Access to effective treatment remains uneven across the country, and racial disparities still shape who gets care, when they get it, and what kind of care they receive.
A 2024 Health Affairs review on opioid use disorder medications found that people of color are less likely than White patients to receive medication treatment such as buprenorphine. The article points to provider shortages in communities of color, Medicaid access issues, and interpersonal discrimination as key reasons.
SAMHSA’s race and ethnicity companion report also notes that treatment gaps remain huge across all groups. Pew reported that in 2022, 28% of American Indians and Alaska Natives needed substance use disorder treatment in the past year, the highest share among racial and ethnic groups.
So a fair reading of the data is not only that Native communities show the highest burden, but also that long-running gaps in access, funding, and culturally responsive care have made recovery harder to reach.
Why Broad Racial Labels Still Have Limits
One more caution belongs here. “Asian,” “Hispanic,” “American Indian or Alaska Native,” and “multiracial” are large umbrella categories. They can hide major differences between tribes, regions, immigration histories, urban and rural communities, and age groups.
Recent research on Asian American, Native Hawaiian, and Pacific Islander populations, for example, argues strongly for more detailed subgroup data because broad averages can mask very different substance use patterns.
That matters for Native data too. A national average can point to a real crisis while still hiding large variation across tribal nations and local conditions.
The Bottom Line
For the broad question in the headline, the best evidence points in one direction: American Indian and Alaska Native people face the highest overall substance use disorder rates in the United States, and they also have the highest recent drug overdose death rates.
A careful answer, though, has to add one more sentence. Addiction patterns in the United States are shaped by policy, trauma, poverty, geography, and treatment access. Any ranking without that context turns a public health crisis into a stereotype, and that gets the story wrong.
