Re-examining alcohol problems among American Indian communities

November 13, 2003

Numerous stereotypes exist about American Indians' use of alcohol. However, a new study of alcohol dependence among two culturally distinct tribes in the United States - called Northern Plains (NP) and Southwest (SW) tribes in the report - has found that alcohol problems are not nearly as serious as some stereotypes may suggest. Results are published in the November issue of Alcoholism: Clinical & Experimental Research.

"Previous research has tended to report on only one tribe or to aggregate American Indian samples in ways that do not permit explicit examination of cultural issues," said Paul Spicer, associate professor of psychiatry in American Indian and Alaska Native Programs at the University of Colorado Health Sciences, and first author of the study. "While no one study could do justice to the tremendous cultural diversity among contemporary American Indian tribes, we wanted to include two distinct tribal populations representing important variations in aboriginal subsistence adaptation, social organization, and religious/spiritual traditions in order to document possible cultural differences in alcohol dependence."

"A lot of what was 'known' in the past about alcohol use among American Indians was anecdotal, stereotypical and fueled by bias," added Fred Beauvais, senior research scientist at the Tri-Ethnic Center for Prevention Research at Colorado State University. "This manuscript helps to clarify that there is more abstinence from alcohol among American Indians than there is among non-Indians. I think the average person would be taken aback when hearing this since it contradicts the conventional wisdom."

Spicer and his colleagues analyzed data collected by the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) since 1997 from 3,084 NP and SW individuals living on or within 20 miles of their reservations. "Our goal was to describe reservation and near-reservation American Indian populations as opposed to urban Indian populations," said Spicer, "as the former have not been included in sufficient numbers in national studies to permit inferences about their health status."

Rates of Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) alcohol dependence among the NP and SW tribes were then compared with U.S. averages collected by the National Comorbidity Survey (NCS).

"There are two major sets of findings in this paper," said Spicer. "The first concerns prevalence rates, which indicate that alcohol dependence is a serious concern in these American Indian communities, but not nearly as dramatic as has been reported in previous research using non-random samples that may have provided biased estimates. The second concerns the importance of cultural differences, both in terms of alcohol dependence and related to other factors such as gender, age, and marital status."

Although the study found higher rates of alcohol dependence among men in both tribes than in the NCS sample, NP women had lifetime rates of DSM-III-R alcohol dependence twice that of NCS women; whereas SW women had rates very similar to those of NCS women. Both Spicer and Beauvais said these findings warrant further investigation.

"Indian men are clearly accounting for the greatest proportion of the difference between Indian and non-Indian rates of alcohol use," said Beauvais. "There is some speculation that disruption of traditional culture is a heavier burden for Indian men, thus they endure more stress and are likely to use more alcohol. The much lower rates of alcohol abuse among the SW women than the NP women is very intriguing, but there is no readily obvious explanation for this. It could be that there are cultural/historical reasons why the NP women are more at risk. Women have often been characterized as 'bearers of the culture' and thus eschew alcohol since it interferes with their cultural responsibilities. It could be that in the NP, there has been such cultural disruption that culture no longer provides this deterrent. This explanation is, of course, speculative and must await further research. This is another example of why research among American Indians is important. If the exact nature of the protective factors existent among the SW women could be determined, it would provide information for designing more effective prevention interventions."

In summary, said both Spicer and Beauvais, although rates of DSM-III-R alcohol dependence found in the AI-SUPERPFP were generally higher than U.S. averages, they are not nearly as high as other studies using less-stringent sampling methods have found.

"Most important is the finding that only a minority of American Indian people in these samples met the criteria for alcohol dependence," said Spicer. "There are significantly higher levels of alcohol dependence in the Northern Plains for both men and women and in the Southwest for men, and these are worth continued serious attention, but the level of such problems is not nearly as high as stereotypes of the 'drunken Indian' might lead people to believe."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper included: Janette Beals, Calvin D. Croy, Christina M. Mitchell, Douglas K. Novins, Laurie Moore, and Spero M. Manson, of the American Indian and Alaska Native Programs at the University of Colorado Health Sciences Center; and the AI-SUPERPFP Team. The study was funded by the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, and the National Center for Minority Health and Health Disparities.

Alcoholism: Clinical & Experimental Research

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