Stress is a major concern among American Indian/Alaska Native (AI/AN) populations because of the toll it takes on mental and physical health, as well as the strong relationship between stress and relapse into addictive behaviors. Indeed, chronic stress places AI/AN populations at higher risk for chronic disease, mental health disorders, and substance abuse than the general population. Further, susceptibility to chronic stress is exacerbated by issues such as adverse childhood experiences as well as those specific to tribal populations, such as historical trauma, political turmoil, and systemic injustice.

For Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) grantees—and anyone else— working to address substance abuse in tribal areas, this article offers support to identify stress and anxiety and how they affect behavioral health outcomes in Native American populations while also offering ways to mitigate, handle, and even embrace stress.