Alcohol and Native Americans
Native Americans in the United States have historically had extreme difficulty with the use of alcohol. Problems continue among contemporary Native Americans; 11.7% of the deaths among Native Americans and Alaska Natives are alcohol-related. Use of alcohol varies by age, gender and tribe with women, and older women in particular, being least likely to be regular drinkers. Native Americans, particularly women, are more likely to abstain entirely from alcohol than the general US population. Frequency of use among Native Americans is generally less than the general population, but the quantity consumed when it is consumed is generally greater.
A survey of death certificates over a four-year period showed that deaths among Native Americans due to alcohol are about four times as common as in the general US population and are often due to traffic collisions and liver disease with homicide, suicide, and falls also contributing. Deaths due to alcohol among Native Americans are more common in men and among Northern Plains Indians. Alaska Natives showed the least incidence of death. Alcohol abuse by Native Americans has been shown to be associated with development of disease, including sprains and muscle strains, hearing and vision problems, kidney and bladder problems, head injuries, pneumonia, tuberculosis, dental problems, liver problems, and pancreatitis. In some tribes, the rate of fetal alcohol spectrum disorder is as high as 1.5 to 2.5 per 1000 live births, more than seven times the national average, while among Alaska Natives, the rate of fetal alcohol spectrum disorder is 5.6 per 1000 live births.
Native American youth are far more likely to experiment with alcohol than other youth with 80% alcohol use reported. Low self-esteem is thought to be one cause. Active efforts are underway to build self-esteem among youth and to combat alcoholism among Native Americans.
Prior to contact with colonists, alcohol use and production was mainly concentrated in the southwestern United States. Some tribes produced weak beers, wine and other fermented beverages, but they had low alcohol concentrations (8–14% ABV) and were to be used only for ceremonial purposes. The distillation technique required to make stronger, potent forms of alcohol were unknown. It was well documented that Mexican Native Americans prepared over forty different alcoholic beverages from a variety of plant substances, such as honey, palm sap, wild plum, and pineapple. In the Southwestern US, the Papago, Piman, Apache and Maricopa all used the saguaro cactus to produce a wine, sometimes called haren a pitahaya. The Coahuiltecan in Texas combined mountain laurel with the Agave plant to create an alcoholic drink, and the Pueblos and Zunis were believed to have made fermented beverages from aloe, maguey, corn, prickly pear, pitahaya and even grapes. To the east, the Creek of Georgia and Cherokee of the Carolinas used berries and other fruits to make alcoholic beverages, and in the Northeast, there is some evidence that the Huron made a mild beer made from corn. In addition, despite the fact that they had little to no agriculture, both the Aleuts and Yuit of Alaska were believed to have made alcoholic drinks from fermented berries.
When Europeans began making a large quantity of distilled spirits and wine available to Native Americans, the tribes had very little time to adapt and develop social, legal, or moral guidelines to regulate alcohol use. Early traders built a large demand for alcohol by using it as a means to trade, using it in exchange for highly sought after animal skins and other materials and resources. Traders also discovered that giving free alcohol to the Native Americans during trading sessions made the likelihood of trading much higher. Extreme intoxication was common among the colonists, contrary to the inexperienced native populations. Numerous historical accounts describe extremely violent bouts of drinking among native tribes during trading sessions and on other occasions, but at least as many accounts exist of similar behavior among the colonizing traders, military personnel, and civilians. Such modeling was not limited to the early colonial era but continued as the land was colonized from east to west; trappers, miners, soldiers, and lumbermen were notorious for their heavy drinking sessions. History may have therefore sown the seeds for the prevalence of alcohol abuse in North American indigenous populations. Early demand, with no regulation and strong encouragement, may have contributed to a heavy alcohol use. It was then passed down from generation to generation, which has led to the current high level of alcohol-related problems.
Influence of MesoamericaEdit
The use of alcohol originated in Middle America but rapidly diffused to Northern Mexico and from there to the Southwestern United States. The majority of aboriginal production and use of alcoholic beverages was in this region. However, there was a surprising number of scattered accounts of intoxicating beverage use throughout the United States prior to White contact. For the most part, the use of alcoholic drinks required an agricultural base but not in all instances. The reason for this is primarily that alcoholic beverages were made from domesticated plants, but there are examples of liquor being derived from wild plants. Aboriginal use generally did not involve excessive drunkenness but controlled and supervised use often in highly ritualized occasions. Further, accounts of Native Americans' initial encounters with alcoholic beverages did not describe reckless or disinhibited behavior.
Rather than infatuation, most Native peoples initially responded to alcohol with distaste and suspicion. They considered drunkenness "degrading to free men" and questioned the motives of those who would offer a substance that was so offensive to the senses and that made men foolish. Most Native people who did drink alcohol were reported to show "remarkable restraint while in their cups". Most drank alcohol only during social or trading contact with whites. Although drinking patterns since colonization grew almost exponentially, since 1975, drinking patterns among Native Americans have remained constant. Around the world, since 1975, Native Americans can be found more commonly than other US citizens in places that serve alcohol.
After colonial contact, white drunkenness was interpreted by whites as the misbehavior of an individual. Native drunkenness was interpreted in terms of the inferiority of a race. What emerged was a set of beliefs known as firewater myths that misrepresented the history, nature, sources and potential solutions to Native alcohol problems. These myths proclaimed that Indian people:
- had a natural craving for alcohol, were sensitive to alcohol, became belligerent when they were intoxicated, were susceptible to alcohol addiction, and could not resolve such problems on their own.
The scientific literature has refuted the claims to many of these myths by documenting the wide variability of alcohol problems across and within Native tribes and the very different response that certain individuals have to alcohol opposed to others. Another important way that scientific literature has refuted these myths is by identifying that there are no current discovered genetic or other biological anomalies that render Native peoples particularly vulnerable to alcoholism.
There are longstanding beliefs that date back to colonial times when it was thought native people all over the world were particularly vulnerable to addiction, but there is no evidence of this. It has been found that the incidence of alcohol abuse varies with gender, age, and tribal culture and history. While little detailed genetic research has been done, it has been shown that alcoholism tends to run in families with possible involvement of differences in alcohol metabolism and the genotype of alcohol-metabolizing enzymes. There is no evidence, however, that these genetic factors are more prevalent in Native Americans than other ethnic groups. According to one 2013 review of academic literature on the issue, there is a "substantial genetic component in Native Americans" and that "most Native Americans lack protective variants seen in other populations."  Many scientists have provided evidence of the genetic component of alcoholism by the biopsychosocial model of alcoholism, but the molecular genetics research currently has not found one specific gene that is responsible for the rates of alcoholism among Native Americans, implying the phenomenon may be due to an interplay of multiple genes and environmental factors.
High concentrations of thiamin found in beans may buffer symptoms of alcoholism while the preparation of maize using “lime water” in the traditional preparation of tortillas may free folate for human biological use. The agricultural food practices in Mesoamerica differed from the dietary food preparation of North American indigenous people. Because of the differences in diet, the effects of tequila on Mesoamerican Native Americans with regards to macrocytic anemia and alcohol-induced Beri-Beri disease and may be less pronounced than the effects of whisky or other ethanol beverages in North American tribes that do not pre-treat maize with alkaline solutions prior to eating.
The National Institute on Alcohol Abuse and Alcoholism, or NIAAA, defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men, in about 2 hours.
Anastasia M. Shkilnyk, who conducted an observational study of the Asubpeeschoseewagong First Nation of Northwestern Ontario in the late 1970s, when they were demoralized by Ontario Minamata disease, has observed that heavy Native American drinkers may not be physiologically dependent on alcohol, but they abuse it by engaging in binge drinking, a practice associated with child neglect, violence, and impoverishment.
- Craving: a strong need to drink
- Loss of control: cannot stop drinking once drinking has started
- Physical dependence: having withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after a time of heavy drinking
- Tolerance: need to drink greater amounts of alcohol in order to become inebriated
Native American youth become socialized into the culture of alcohol at an early age, and this pattern of testing alcohol limits persists until early adulthood. Approximately 20 percent of Native American youth between 7th and 12th grade belong in this category. Other youth exhibit an experimental pattern of drinking through adolescence and this is noted as one of the biggest identifiers of binge drinking later in life. Given the high rates of alcohol and substance abuse on reservations, researchers have seen higher rates of academic failure, delinquency, violent criminal behavior, suicidality, and alcohol-related mortality among Native American youth, which is far greater than the rest of the United States population.
Disease and deathEdit
Compared with the United States population in general, the Native American population is much more susceptible to alcoholism and related diseases and deaths. According to IHS records on alcohol-related illness, the mortality due to alcohol was as much as 5.6 times higher among the Native American population than the general US population. The rate was 7.1 times higher in 1980. Males are affected disproportionately more by alcohol-related conditions than females. The highest risk of alcohol-related deaths is between 45 and 64. Chronic liver disease and cirrhosis are 3.9 times as prevalent in the Native American population than the general US population. Alcohol-related fatal car accidents are three times as prevalent. Alcohol was shown to be a factor in 69% of all suicides of Native Americans. This number has grown larger since 1975.
During the past twenty years, there has been growing recognition among health care professionals that domestic violence is a highly prevalent public health problem with devastating effects on individuals, families, and communities. A risk factor is a characteristic that has a high correlation with levels of domestic violence. They include the offender and victim both being under the age of 40, substance abuse, receiving public assistance, and the offender and/or the victim witnessing domestic violence between their parents as a child. For abuse victims, the health care setting offers a critical opportunity for early identification and even primary prevention of abuse. Alcohol and drugs use is attributed higher rates of domestic violence among Native Americans compared to many other demographics. Over two-thirds (68%) of American Indian and Alaska Native sexual assault victims attribute their attacker's actions to drinking and/or taking drugs before the offense
Fetal alcohol syndrome (FAS)Edit
Native Americans have one of the highest rates of fetal alcohol syndrome recorded. According to the Centers for Disease Control and Prevention, from 1981 to 1991, the prevalence of FAS in the overall U.S. population per 10,000 births was 2.1. Among Native Americans, that number was 31.0. The significant difference between the FAS rates of the U.S. population and Native Americans has been attributed to a lack of healthcare, high poverty levels, and a young average population. Healthcare spending for an average American on Medicare is about $11,762 whereas average spending on healthcare for a Native American is $2,782. In a 2007 document, "Fetal Alcohol Spectrum Disorders among Native Americans," the U.S. Department of Health and Human Services reported that the prevalence of fetal alcohol syndrome in Alaska was 1.5 per 1,000 live births but, among American Indians and Alaska Natives, the rate was 5.6.
Alcohol and substance abuse ProgramsEdit
Indian Health ServicesEdit
The Alcohol and Substance Abuse Program (ASAP) is a program for American Indian and Alaska Native individuals to reduce the incidence and prevalence of alcohol and substance abuse. These programs are administered in tribal communities, including emergency, inpatient and outpatient treatment and rehabilitation services for individuals covered under Indian Health Services. It addresses and treats alcoholism from a disease model perspective.
Tribal Action PlanEdit
The Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 was updated to make requirements that the Office of Indian Alcohol and Substance Abuse (OIASA) is to work with federal agencies to assist Native American communities in developing a Tribal Action Plan (TAP). The TAP coordinates resources and funding required to help mitigates levels of alcohol and substance abuse among the Native American population.
- American Indian Committee on Alcohol and Substance Abuse, as of 2017, was over 4 decades old and was included in the 2-volume Encyclopedia of American Indian Issues Today, published 2013.
- Native American Health Center's focus is the San Francisco Bay Area.
Issues in the Treatment of Native AmericansEdit
It can be difficult to treat alcoholism in Native Americans for a number of reasons. Studies show that there are varying levels of difficulties with treating Native Americans. Some prefer having tribal aspects to their treatment, and successes have been shown with combining tribal practices with traditional AA therapy. It can be difficult because many Native Americans might prefer to have a tribal specific practices, rather than a Pan-Native approach. Treatment facilities that cater specifically to Native Americans can be difficult to find because Native Americans account for less than 1% of the United States population, and many Native Americans live in areas like reservations and close knit communities. This can finding make culturally inclusive treatment for Native Americans living outside of these areas difficult.
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