Vivian Marlowe
Alcohol abuse and alcoholism have long been a problem for Native Americans, with historical and current factors contributing to high rates of substance use disorders in this community. Native Americans have the highest rates of alcohol use disorders compared to other ethnic groups, with 7.1% suffering from alcohol use disorder and nearly 25% reporting binge drinking in the past month. This issue is further compounded by the negative stereotype that Native Americans are afflicted with alcohol problems, which has burdened Native communities.
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What You'll Learn
Native Americans have the highest rates of alcohol use disorder
Alcohol abuse and alcoholism have had devastating effects on Native American communities. Native Americans have the highest rates of alcohol use disorder compared to other ethnic groups in the US. The National Survey on Drug Use and Health (NSDUH) in 2018 found that 7.1% of Native Americans have an alcohol use disorder.
There are several factors that have contributed to the high rates of alcohol use disorder among Native Americans. One of the major factors is the historical trauma inflicted by European colonists, who introduced large amounts of distilled spirits and wine to Native Americans without allowing them time to develop social, legal, or moral guidelines to regulate alcohol use. This sudden availability of alcohol was further exacerbated by its use as a medium of trade, with early traders often providing free alcohol during trading sessions to gain a negotiating advantage.
In addition to historical factors, the current social and cultural conditions of Native American communities also play a significant role in alcohol misuse. These include lower educational attainment, poverty, housing problems, unemployment, violence, loss of connection to culture, and mental health issues. Mental health illnesses, particularly anxiety disorders and post-traumatic stress disorder (PTSD), are more prevalent among Native Americans than other Americans. The influence of these factors is evident in a 2002 study, which found that among 172 Native American and Alaskan Native women in treatment for substance use disorder, 81% had experienced emotional, physical, and/or sexual abuse as children, and 78% as adults.
The pattern of alcohol use among Native Americans also contributes to the high rates of alcohol use disorder. Native American youth are socialized into the culture of alcohol at an early age, with approximately 20% of Native American youth between 7th and 12th grade belonging to this category. This early exposure to alcohol and the normalization of testing alcohol limits can increase the risk of developing alcohol addiction and contribute to the high rates of alcohol use disorder in adulthood.
Despite the high rates of alcohol use disorder, the stigma associated with alcohol addiction and the lack of accessible treatment options present significant barriers to Native Americans seeking help. The Indian Health Service (IHS), a federal health program, provides resources and support to tribal and urban Indian communities, including inpatient and outpatient rehab services. However, the Substance Abuse and Mental Health Services Administration reports that while 13% of Native Americans need substance use treatment, only 3.5% receive it. Addressing the stigma and increasing access to culturally-appropriate treatment services are crucial steps in combating the high rates of alcohol use disorder among Native Americans.
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Risk factors for alcohol addiction
Alcoholism, or alcohol addiction, is a severe public health problem in the United States, particularly among Native Americans. Native Americans have the highest rates of alcohol use disorder compared to other ethnic groups in the country. While the prevalence of alcohol use among Native Americans in the past year is lower than that of the general US population, heavy alcohol use in the past month is higher for Native Americans.
There are various risk factors that contribute to alcohol addiction. Firstly, genetics and inherited traits play a significant role. Between 50% and 60% of the vulnerability to alcohol use disorder (AUD) is inherited. Certain genetic variations influence the form of liver enzymes responsible for ethanol metabolism. For example, individuals who have a naturally low response to alcohol or can "hold their liquor" are at increased risk for heavy drinking and AUD. Additionally, people who experience stimulating effects from alcohol, such as a euphoric or energizing feeling, are more likely to drink heavily and develop AUD.
Mental health and psychiatric disorders are also significant risk factors for alcohol addiction. Psychiatric conditions such as attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety can increase the risk for developing AUD and complicate treatment. Individuals with these disorders may be more susceptible to the negative emotionality and executive function deficits associated with AUD.
Trauma and adverse life events are other critical factors influencing alcohol addiction. Native Americans have reported using alcohol to cope with grief, self-pity, and loneliness. In a study of Native American and Alaskan Native women, 81% had experienced childhood trauma through emotional, physical, or sexual abuse, and 78% had been abused as adults. Additionally, over half had experienced parental abandonment or unstable home environments during childhood. These traumatic experiences likely contribute to the high rates of alcohol use disorder in this population.
Socioeconomic conditions and cultural factors also play a role in alcohol misuse among Native Americans. Drinking behaviour has increased exponentially since colonisation, and while it has stabilised since 1975, it continues to persist. Native American youth are socialised into the culture of alcohol at an early age, and this pattern of testing alcohol limits can continue into early adulthood. The social tolerance of intoxicated behaviour and the socioeconomic conditions of different Native American communities influence alcohol misuse.
Finally, age, gender, and sexual minority status are demographic factors that can impact the risk for alcohol-related harm. Native Americans aged 18-25 have a high prevalence of substance use disorders, with 10% having alcohol use disorders. Additionally, Native American women face unique challenges, such as drinking during pregnancy and confidentiality concerns, that can delay treatment.
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Genetics and heritability
While the exact percentage of Native Americans afflicted with alcoholism is unclear, the condition is a significant problem in this community. Statistics show that 79.6% of American Indians and Alaska Natives aged 12 or older have consumed alcohol at some point in their lifetime, with 56.5% reporting alcohol consumption in the past year. Binge drinking is also prevalent among this demographic, with 21.2% reporting binge drinking in the past month, and 7.2% engaging in heavy alcohol use. Alcohol-related deaths among Native Americans are about four times higher than in the general US population, with men and Northern Plains Indians experiencing the highest rates.
Now, let's delve into the genetics and heritability aspects of this issue.
The role of genetics in the development of alcoholism, or alcohol use disorder (AUD), is well-established. According to the National Institute on Drug Abuse, up to 50% of the predisposition to addiction can be attributed to genetics. This means that if your family has a history of alcohol misuse, you have a 50% chance of inheriting a predisposition to AUD. However, it's important to note that having this predisposition does not guarantee that an individual will definitely develop AUD.
Research has identified several genes that are candidates for being inheritable addiction genes, including ADH1B, CHNR5, GCKR, and DRD2. These genes play a role in how the central nervous system responds to alcohol and how the body metabolizes it. It is estimated that 40% to 60% of individuals with AUD have genes that increase their risk of developing an addiction.
While genetics play a significant role, it's not the sole factor. Epigenetics, the combination of genes and environment, is also crucial. Environmental factors, such as living with parents who drink or encourage drinking, can increase the chances of developing alcohol-related issues. Additionally, certain risk factors, such as low self-esteem and transgenerational trauma, have been associated with substance use disorders among Native American teens.
It's important to note that there is no specific genetic test for alcoholism. Diagnosis of AUD is made through standard diagnostic tests that assess alcohol intake, potential for dependence, and harm related to alcohol consumption.
In summary, while genetics can increase the likelihood of developing AUD, it is not the sole determinant. Environmental and social factors also play a significant role in the development of alcohol use disorders.
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History of alcohol use
Alcohol use among Native Americans has been a significant public health concern, with higher rates of alcohol use disorders compared to other ethnic groups in the United States. The history of alcohol use among Native Americans is complex and deeply rooted in historical and cultural factors.
Historical Context
Historically, Native American tribes manufactured alcoholic drinks, which were used in ritual settings rather than for personal enjoyment. With the introduction of liquor by Europeans, alcohol dependence became an issue within Native American communities. The interpretation of Native drunkenness as a sign of racial inferiority led to the emergence of "firewater myths," which misrepresented the nature and causes of alcohol problems among Natives.
Alcohol as a Trade Item
Alcohol became a trade item, and the practice of intoxication for pleasure or stress relief began to erode traditional Native American culture. By the late 18th century, alcoholism was recognized as a serious problem. The situation was exacerbated by the 1872 amendment to the Nonintercourse Act, which allowed Native Americans to sell and trade alcohol among themselves.
Relocation and Urbanization
The Indian Relocation Act of 1956 led to the relocation of thousands of Native Americans from reservations to cities. This upheaval resulted in cultural disconnection, poverty, unemployment, and homelessness for many. The resulting acculturative stress contributed to higher rates of alcohol use among urban Native Americans.
Socioeconomic Factors
Socioeconomic conditions play a significant role in alcohol misuse among Native Americans. Historical trauma, including experiences of loss, abuse, neglect, and disenfranchisement, has led to pathological coping strategies such as substance misuse. Additionally, low self-esteem and transgenerational trauma have been associated with substance use disorders among Native American youth.
Genetic Factors
While there is evidence of a genetic component to substance dependence in Native Americans, the specific genes involved are still under investigation. Studies suggest that the interplay of multiple genes and environmental factors contributes to the high rates of alcoholism in this population.
Tribal Variations
It is important to note that alcohol use patterns vary among different tribes. Some tribes have passed their own prohibition laws, and as of 2007, 63% of federally recognized tribes in the lower 48 states had legalized alcohol sales on their reservations.
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Initiatives to address alcohol abuse
Native Americans have the highest rates of alcohol abuse compared to other ethnic groups in the US. A 2018 survey revealed that 10% of Native Americans have a substance use disorder, with 7.1% having an alcohol use disorder. Another survey found that 19.2% of Native Americans had an alcohol use disorder during the previous twelve months, and 43.4% had experienced it at some point in their lives.
To address this issue, various initiatives have been implemented to provide support and resources to Native American communities:
- The Indian Health Service (IHS) observes Alcohol Awareness Month in April to increase awareness, understanding, and education about alcoholism, reduce stigma, and address the causes and treatment of this issue. The IHS also provides resources such as grants, technical assistance, education, and webinars to tribal and urban Indian communities through its Division of Behavioral Health.
- The Alcohol and Substance Abuse Program (ASAP) offers emergency, inpatient, and outpatient treatment and rehabilitation services for American Indian and Alaska Native individuals. It addresses alcoholism from a disease model perspective.
- The Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 was updated in 2010 to require the Office of Indian Alcohol and Substance Abuse (OIASA) to work with federal agencies in developing a Tribal Action Plan (TAP). The TAP aims to coordinate resources and funding to mitigate alcohol and substance use disorders among Native Americans.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) has devoted a portion of its discretionary grant program to addiction prevention and treatment programs for American Indians and Alaska Natives.
- The Healthy Nations Initiative, funded by the Robert Wood Johnson Foundation, aimed to help Native Americans reduce the demand for and use of alcohol and illegal drugs from January 1994 until May 2002.
- The Seattle Indian Health Board developed technology-focused youth mentoring projects in partnership with the American Indian Science and Engineering Society.
- The Cherokee Nation of Oklahoma engaged its members in initiatives to increase physical activity, promote healthy lifestyles, and implement cultural heritage projects and school-based health promotion, including alcohol education.
- The Norton Sound Health Corporation in Alaska instituted a Village-Based Counselor program to provide behavioral health services to remote villages.
- Lechner et al. developed a series of interventions, including life skills development, suicide prevention training, talking circle paradigms, and the "Healing the Canoe" program, which focuses on promoting a sense of belonging and cultural identity to prevent substance abuse.
- Focus groups and motivational interviewing have been used to help Native American adolescents and their parents explore and address ambivalent attitudes toward drug and alcohol use.
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Frequently asked questions
It is difficult to give a precise figure as alcohol use varies between tribes and communities. However, a 2003 study found that lifetime rates of alcohol dependence varied from 21 to 56 percent for men and 17 to 30 percent for women across seven geographically diverse American Indian tribes. A 2018 survey reported that 7.1% of Native Americans have an alcohol use disorder.
There are several factors that have contributed to the high prevalence of alcohol use among Native Americans. One of the main reasons is the historical influence of European colonists, who introduced large amounts of distilled spirits and wine to Native Americans. This was often used as a medium of trade for highly sought-after resources such as animal skins. Native Americans also have a higher prevalence of mental health illnesses, such as anxiety disorders and PTSD, which can contribute to alcohol misuse. Other factors include lower educational attainment, poverty, housing problems, unemployment, violence, and loss of connection to culture.
There is evidence to suggest that substance dependence has a substantial genetic component in Native Americans, similar to that of other populations. Studies have found that Native Americans lack some of the protective genetic variants against alcohol dependence found in other populations.
The Indian Health Service (IHS) is a federal health program that provides support and resources to tribal and urban Indian communities to address substance abuse and mental health issues. The IHS Alcohol and Substance Abuse Branch (ASAB) implements alcohol programs within tribal communities, including inpatient and outpatient rehab in rural and urban settings.
