• Allison Barlow, Lauren Tingey, Mary Cwik, Novalene Goklish, Francene Larzelere-Hinton, Angelita Lee, Rosemarie Suttle, Britta Mullany, and John T Walkup.
• Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA.
• Am J Drug Alcohol Abuse. 2012 Sep 1;38(5):403-8.

BackgroundAmerican Indian communities compared to other US populations are challenged by the largest health disparities in substance abuse and suicidal behavior among youth ages 15-24.ObjectivesThis article examines the co-occurrence of substance use and self-injury among reservation-based youth in the US.MethodsWhite Mountain Apache tribal leaders and Johns Hopkins University formed a partnership to address self-injury and substance abuse among Apache youth. Data on suicide (deaths, attempts, ideation), non-suicidal self-injury, and substance use were analyzed from the White Mountain Apache tribally mandated self-injury surveillance registry from 2007 to 2010, including 567 validated incidents from 352 individuals aged 15-24 years. Findings regarding characteristics of co-occurrence - including differences in the type of self-harm behavior, gender, and reported reasons for the act - were interpreted through a community-based participatory research process.ResultsFrom 2007 to 2010, 64% (n = 7/11) of Apache youth ages 15-24 were "drunk or high" at the time of suicide death with data missing for 2/11 deaths; 75.7% (n = 118/156) were "drunk or high" during suicide attempt; 49.4% (n = 83/168) during suicidal ideation; and 49.4% (81/166) during non-suicidal self-injury. Co-occurrence of substance use was higher for more lethal acts and among males.ConclusionHigh rates of co-occurring self-injury and substance use within this population highlight the importance of research to understand relationships between these behaviors to design preemptive and integrated interventions.Scientific SignificanceTribal-specific and culturally informed data on the co-occurrence of self-injury and substance use hold promise for reducing the combined toll of years of productive life lost among American Indian youth.

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