The Final Report of the American Indian Policy Review Commission reported that alcohol abuse among American Indians is the most severe and widespread health problem among the group. (Dores 86). The abuse of alcohol among the American Indian population is an endemic problem which is multidimensional, multicausal and multifunctional in its etiology. The relationship between Native Americans and alcohol resides in their biology, their history, and social dynamics of the culture, lack of education, socioeconomic struggles and the psychological disposition of the people.
The depth of the problem is as lengthy as the history of the people themselves. Alcohol or the Lakota tribe term, “magic water” was introduced to the tribes between 1790 and 1830 by European and American trappers. When trading ensued between the two groups, traders gave the Natives alcohol and even though the beverage was distasteful to the group, traders insisted that they accept it. A popular theory is that Europeans were eager to introduce alcohol to the Native Americans so that they would have an advantage during the trade process. A common physiological response to alcohol in many American Indian and East Asian populations is an unpleasant skin reaction called flushing which is a reddening of the face and neck and a loss of self-control. Biologically the body is sending out a warning sign to stop drinking and yet the person continues despite the physical indications and reactions. To press the biological components of the problem further, take for example if a man and a woman both drink and engage in unprotected sex, which can be frequent when alcohol is consumed, they then create a child who is genetically predisposed to alcohol. Alcoholic procreation is essentially equivalent to the biological engineering of future alcoholics.
Native Americans learned how to drink and how to act while inebriated from the Europeans, consequently this learned behavior corresponded with the sentiment of Native Americans as uncivilized and savage. When the Indian Trade and Intercourse Act of 1834 became enacted and alcohol distribution to Native Americans became illegal, it appeared that alcohol consumption would cease, though the opposite occurred. Entrepreneurs became rich by selling the Native Americans black market alcohol, although the Native Americans refused to conform to the laws imposed upon them by the white man, they reclaimed their traditions and cultural constructs that were being threatened. The struggle between the Native Americans and the colonizers was so deeply imbedded with hostility and discrimination that it seems as if the only tangible weapon the Native Americans had left to utilize was alcohol. It is unclear whether it was a symbol of independence or a coping mechanism to numb feelings of loss and isolation, though many American Indian tribes turned to alcohol.
The social constructs of Native American life are grounded within the tribe, the family, the land and the history. The long and painful history of these people is orally chronicled by the elders who are known as “the tellers” to “the listeners” who are the young (Morales 135). An atmosphere that joins groups together to listen to stories and tales of their tribes creates a perfect environment to drink alcohol. Furthermore, when the painful and sad oral history is being recounted the addition of alcohol numbs the pain of those who are listening and those who are speaking. There is a shared camaraderie in sadness that is heightened by inebriation. At these gatherings of young and old, are also the very young and the very impressionable children who are learning their tribal history and the social model of drinking. The history predominantly consists of the destruction of their people. To combat feelings of annihilation and helplessness, people often unite by engaging in common behaviors and group practices, like drinking to ultimately solidify ethnic identification.
Native American reservations are not only commiserating on a painful past, they are living in a depressed present and looking toward a bleak future. The prominence of alcohol as a coping mechanism illustrates their heightened awareness of their substandard way of life and unhealthy community. The alcohol induced oblivion allows the problems to continue and the drunken disregard creates more troubles for a population unable to discern the cause and effects of their circumstances.
The social environment contributes to the incidence of drinking in equal proportions as the isolated environment.
A reservation is considered to be a domestic dependent nation with self-governing laws, therefore the environment allows for a virtual private party that is of outside legal jurisdiction or normative ideas of public drunkenness. The reservation is also an environment that practices equal rights for women therefore, if the men are getting inebriated then the women have the same right to drink as the men do. If men and women are drinking together, are they drinking the same amount? Does a woman who is pregnant drink more or less than a woman who isn’t? When there are no parameters in place to indicate how much alcohol is acceptable to drink, what causes someone to stop? The external force of the community tolerates excessive drinking and does not make someone feel guilty even if a crime has been committed while intoxicated, since the pressure to drink is strongly instilled. Ironically, a person’s freedom is impervious to external forces and predetermined boundaries for conduct, except if the external source is offering an alcoholic beverage. Native American lack internal controls to urge themselves to stop drinking emotionally and often times physically.
Lack of education leads to numerous problems, the most detrimental for the purposes of this discussion is the relationship between ignorance and alcohol consumption. There is a profound impairment in their ability to differentiate between safe and unsafe behavior which can largely be attributed to a defunct educational regimen on the reservations. Native American parents allow their children to make their own mistakes and learn important life lessons on their own. While this is an admirable parenting tool in some respects it can also be negligible when alcohol is involved. In the occurrence of families who drink with their daughters, often the daughter will become the alcohol provider for the family by befriending someone who has access to alcohol.
The cognitive disconnect that allows these pregnant women to believe that they can consume alcohol without the fetus also consuming alcohol is very alarming. If pregnant women have a larger appetite because they are eating for two, then how is it conceivable to believe that they are not consuming alcohol for two? An absence of prenatal care leads to unhealthy mothers and babies with preventable birth defects. While consuming any amount of alcohol while pregnant is dangerous, my biggest concern is the women who are giving birth while totally intoxicated and the fetus emerges in a pool of alcohol. A salient feature in FAS children is their inability to learn from a mistake, coincidentally many of their mothers lack this ability as well, even when they are informed that the child has suffered from alcohol consumption in utero and yet continue to drink during future pregnancies.
If the history, biology, environment and the unfortunate lack of education was not alluring enough to cause a Native American to drink, the social practices will demand it. The Lakota tribe values: generosity, bravery, fortitude and moral integrity. (Dorris 89). With these values are widely omnipresent in their culture, it is considered as most disrespectful to refuse a drink that is being offered. The indignation of someone choosing not to drink is reminiscent of the instance of the Europeans having the Native Americans drink. If you refuse a drink, you risk being ostracized by the tribe, the only action tantamount to refusing a drink is the fear of being excluded from the tribe. The only way to ensure your presence in the tribe is to engage in the activities of the group, anything that irritates that anxiety will collapse under the pressure.
Any problem enormous in impact and deeply imbedded within a culture will necessitate a multi-dimensional intervention to stop the further proliferation of the problem and repair the gap that is left within the community. Michael Dorris explains some of the interventions that were attempted and inevitably failed within the book, The Broken Cord. When the United States government restricted alcohol to the Native Americans they had to lift the ban in 1953 because they were buying it illegaly or binge drinking as to not be caught with the evidence. Alcoholics Anonymous and the Antibuse, a drug that reduces the urge for alcohol is effective for many populations, but not for Native Americans. Many Native Americans cut down or stop drinking as they mature into midlife, but this does not ameliorate the problem of babies born with Fetal Alcohol Syndrome and it relies too much on time when the life span of the population is decreasing.
To address the problem on a micro-level would be ineffective. Not only is the problem to large to address on a micro level, it would not be appropriate for the individuals or condoned within the culture. “As a result of a strong sense of tribalism, everything is shared among Native Americans, including the solutions to problems, material goods, and time”(Morales 136). With this important sense of the collective community in mind it would be incumbent of the intervention to attend to the sentiment that makes the goal of the process clear to everyone.
To approach this epidemic we must employ cultural competence that will respect the people, the culture and the history. The accomplishment of any intervention depends on a few factors. They are: the inclusion and prominence of the elder members, the ethnicity of the outsiders and the respect demonstrated towards the cultural composition. The elder members of the tribe are the most respected and influential among the population, so for any intervention to be successful the support and respect of the elders is essential. It is detrimental to proceed too aggressively with any unknown population, but specifically with this group due to their painful history of oppression. Additionally the language and tone that the helping professionals will utilize with the group are an important dynamic of the process.
Whatever interventions are eventually deemed worthy, they should be free of harsh judgments and the tendency to place blame or rigidly define good and bad behavior. For these broad models to become more livable to the people who are following them, they must place their own cultural stamps of what defines good and bad to them. The lifespan of the intervention is limited if it is not indoctrinated into the culture in a manageable and positive way. If it feels punitive, it will impede the process and be ineffective and moreover in this case it could create a tremendous backlash similar to the one seen in 1953 towards the U.S. government attempt at controlling alcohol consumption. Given the lengthy stamina of this epidemic, fortunately there are opportunities to analyze what has not worked and why it has not, so that current interventions do not repeat the mistakes of unsuccessful initiatives.
The survival of the tribes is the biggest concern of the elders. The long struggle of the people, the oral history, and the culture will eventually be decimated if the cycle of alcohol abuse continues. The socio-cultural level approach emphasizes the existence of the culture in direct opposition to the abuse of alcohol. Utilization of the socio-cultural approach would enable the tribe council to enact policies for the reservations that change the culture of alcohol, the availability and a general level of community tolerance. Enacting a social policy of a dry reservation is a start to the problem, but it could just push the people to travel farther for alcohol, another problem which would have to be addressed.
The general systems theory used synergistically with the socio-cultural model would be a dual approach to change family rules and the environment that fosters alcoholic behavior. The emphasis remains on the culture and the family so that it embodies a macro level intervention within special attention to the families that comprise the community. Since families have more autonomy than an individual, a family therapy setting would protect an individual from being ostracized and strengthen the commitment of each member by having the support of one another. Native Americans rely a lot on body language are often reluctant to share emotional feelings a family therapy environment would start the practice of sharing feelings and strengthen the bond. Complete abstinence might be the only solution for some families who are not able to engage in moderate drinking, whether it is the extreme of total abstinence by all the members or the freedom to drink moderately for all the members the decision and solution is made by the family for the family. If a family is depending on a daughter to procure the alcohol for the rest of her family, this would have to stop. Additionally, the ramifications of a family forcing a relationship that enables abuse puts an emotional strain on the family that is counterproductive to the functioning the family. There has to be complete support of the family for any plausible intervention.
The second and essential intervention is the implementation of an educational model that teaches everyone in the community about the risks of alcohol consumption, alcohol during pregnancy, drinking and driving and the long lasting economic and social implications of alcohol abuse. It will be much harder to give in to the temptation of drinking if the reality of birth defects is concretely linked to alcohol. As educators, if we are to educated instead of reiterating the same warnings that has been ineffective for decades, it time to ask the people who are not comprehending the threat of alcohol, what exactly within the learning process is unclear and how do we make it more clear. When there is a foundation of the biological and emotional risks associated with excessive drinking, the impact of the knowledge will trigger an internal control to moderate or stop the consumption. Conversely, as the population becomes aware and familiar with the hazards associated with the behavior it will be impossible for an external force to remain uninvolved and impartial. For the alcohol education, it would be beneficial to start with the elders, to gain their respect but also to adhere to the tradition of the oral culture. The elders will pass down the information they have acquired so that it will feel similar to the other learned aspects of the culture. Eventually there would be direct educational intervention with the younger population so there is a reinforcement of the message.
By implementing an educational model, we are essentially promoting the biological model and supporting the public health model. The biology of susceptibility, genetic predisposition, genetic risk factors and the impact that alcohol has on the body will all be highlighted in the education. By creating negative connotation around alcohol we are trying to alienate it out of the culture and make it an outside harm to the environment. If we demonize alcohol just to the point of an environmental hazard then the efforts to restrict alcohol will be viewed as a cultural preservation instead of an individual limitation. The alcohol hurts the cultural environment in which they live, an unhealthy environment hurts the family and the individuals. The biology of alcohol abuse is visible in the health of the people and the development of the children, the abuse has to stop before the biological effects become a permanent characteristic of the culture. An inundation of pictures of Fetal Alcohol Syndrome children illustrates the physical and genetic ramifications of the disease state. It is imperative that the biology component be understood for the social ramifications to be fully comprehended.
The three part component of the public health model creates a triangular tension that is visibly apparent and creates resentment toward the agent for being destructive. The public health model is broad enough to identify various behaviors and reasons for alcohol abuse, but focused enough so that the three components involved are always clear. The awareness of alcohol as a problem will help to reinforce the implementation of social policy to restrict it. Furthermore, the public health approach designates blame onto the alcohol away from the individual and victimizes the abusers so that they feel hostility toward alcohol and empowers them to fight against the interloper. Native Americans have had to struggle against outside agents for most of their existence, General George Custer’s massacre of Native Americans should be analogized to the effects of alcohol. The devastation caused by smallpox and hepatitis is no different that then the dangers of alcohol to the group. If alcohol becomes marginalized instead of the people who choose not to consume it, then it creates a unity of the people against alcohol. Native Americans have been successful at eliminating external detriments to their health and their livelihood, why should their fight against alcohol abuse be any less stringent than their previous efforts.
In every intervention and consideration of helping the Native Americans rid their lives of alcohol and the hazards associated with excessive consumption the goal is for the tribes to remain intact and the sense of unity is preserved. The efforts are an attempt to preserve the people and their culture, not to alienate and divide them. I would hope that these interventions would be met with little resistance and an appreciation of the seriousness of the problem. As long as the Native Americans abuse alcohol in the ways that they have, the problems of poverty, incarceration, birth defects, infant mortality and violence will not abate. Hopefully there will be a strong resolve to eliminate the problems produced by alcohol, that the alcohol itself would not be needed.
Dorris, Michael. (1989). The Broken Cord. New York: Harper & Row.
Lisansky-Gomberg, E. (2000). Substance abuse disorders. In S. Whitborne (Ed) Psychopathology in later adulthood. (p.277-298). New York: Wiley & Sons.
Morales, P. (1999). The Impact of Cultural Differences in Psychotherapy with Older Clients: Sensitive Issues and Strategies. In M. Duffy (Ed.), Handbook of counseling and psychotherapy with older adults (pp. 132-153). New York: Wiley & Sons.
Miller, W., & Hester, R. (1995). Treatment for alcohol problems: Toward an informed eclecticism.