The COVID-19 emergency may be behind us, but its effects are still being felt across Tribal communities. The pandemic brought isolation, disrupted treatment, stretched behavioral health programs and added new layers of grief to communities already facing significant barriers to substance use disorder care.
During the first year of the pandemic, drug overdose death rates rose 39% among American Indian and Alaska Native people, according to the Centers for Disease Control and Prevention. The crisis continued after communities reopened. In 2023 and 2024, American Indian and Alaska Native people had the highest age-adjusted overdose death rate of any racial or ethnic population tracked by the CDC. Although that rate declined from 65 deaths per 100,000 people in 2023 to 51.6 in 2024, it remained far above the national rate, according to the CDC’s most recent overdose data.
Those numbers represent parents, children, grandparents, friends and Tribal leaders. They also reveal a basic problem that too many communities still face–help is often too far from home.
For someone living in a rural Tribal community, entering treatment may mean traveling several hours, finding reliable transportation, arranging childcare and leaving work. Residential treatment can require an even greater sacrifice. Patients may have to leave their families, community, cultural traditions and support systems for weeks or months at a time.
Recovery is difficult under any circumstances. It becomes even harder when receiving care requires leaving behind the very people and connections that can help sustain it.
The Pandemic Widened Existing Gaps
COVID-19 did not create the shortage of behavioral health services across Indian Country. It made a long-standing problem harder to ignore.
Research involving providers who serve American Indian and Alaska Native communities found that the pandemic disrupted opioid use disorder treatment while worsening many of the conditions that contribute to substance use. Programs struggled with staff shortages, service reductions and limited technology. Patients faced greater isolation, housing instability, financial hardship and grief. The findings, published by the National Institutes of Health, show how quickly an already-fragile care system can become overwhelmed.
The challenges are especially serious in rural areas. A 2024 report from the U.S. Department of Health and Human Services found that distance, limited infrastructure and workforce shortages continue to restrict access to care in rural communities.
Telehealth helped many providers stay connected with patients during the pandemic, and it remains an important tool. But it cannot replace every form of treatment. Withdrawal management, residential care, medication services and crisis stabilization require trained professionals, physical facilities and dependable local systems. Virtual care can also be difficult in areas where broadband access is limited, or patients do not have a private place to speak with a provider.
When someone decides they are ready for treatment, the window to act may be brief. A long drive, a waiting list or a confusing referral process can be enough to lose that opportunity.
Culture Is Not an Add-On to Treatment
Locating treatment on Tribal lands does more than reduce travel. It allows care to be developed around the history, values and needs of the community it serves.
The Indian Health Service calls for opioid treatment that addresses physical, emotional and spiritual health while respecting American Indian and Alaska Native cultures and traditions. That approach recognizes something Tribal communities have long understood, recovery involves more than treating symptoms.
Family, ceremony, language, spiritual traditions and connection to the land can all contribute to healing. A program designed in partnership with Tribal leaders can include those strengths while also providing evidence-based clinical services, medication for opioid use disorder, counseling, peer support and treatment for co-occurring mental health conditions.
Culturally grounded care should not be treated as an alternative to clinical excellence. The strongest programs bring both together.
The Substance Abuse and Mental Health Services Administration has highlighted numerous programs that combine Indigenous knowledge with established prevention and behavioral health practices. These models demonstrate that treatment is more likely to earn trust when patients recognize their community, values and experiences in the care they receive.
Treatment at Home Supports Long-Term Recovery
A treatment facility alone will not solve the substance use crisis. Communities need a connected system of care that supports people before, during and after treatment.
That system may include prevention, early intervention, withdrawal management, residential treatment, medications for opioid and alcohol use disorders, mental health services, outpatient care, peer support, recovery housing and help returning to work and family life.
When those services are located within or near the community, patients are less likely to become lost during transitions. Someone leaving residential treatment can move into outpatient care with providers who know their history. Families can participate more consistently. Tribal health programs, courts, schools, public safety agencies and social services can work together instead of relying on a disconnected group of distant providers.
Local programs can also create jobs and build behavioral health expertise within the Tribe. Community members can be trained as counselors, peer recovery specialists, healthcare workers and program leaders. That knowledge stays in the community and strengthens its ability to respond to future needs.
Just as important, on-reservation care supports Tribal sovereignty. Each Tribe has its own history, government, culture and priorities. There is no standard treatment model that should simply be placed into every community.
The Tribe must have a meaningful role in deciding what is built, how it operates and how culture is reflected in care.
Building Something That Lasts
Federal programs, including Tribal Opioid Response grants, have helped Tribes fund prevention, treatment, harm reduction and recovery support. A review by the U.S. Government Accountability Office found that these grants have supported a broad range of services across Tribal communities.
Grant funding matters, but communities also need infrastructure that will remain in place after a grant period ends. Sustainable treatment requires reliable reimbursement, trained staff, strong clinical leadership, sound operations and long-term planning.
Developing a program on Tribal lands can involve licensing, facility development, payer contracting, workforce recruitment and coordination with Tribal health and government leaders. Outside partners can bring valuable experience to that process, but they must begin by listening.
At Ascension Recovery Services, we believe the goal is not simply to open a treatment center on Tribal land. It is to help a Tribe build a program that reflects its priorities, serves its people and becomes part of the community for years to come.
The overdose crisis following COVID-19 has made the cost of inadequate access painfully clear. A person’s chance at recovery should not depend on whether they have a car, can leave their children or are willing to travel hundreds of miles away from home.
Bringing treatment onto Tribal lands removes some of those barriers. More importantly, it allows recovery to take place closer to family, culture, community and the sources of strength that have sustained Tribal nations for generations.