Alcohol Abuse in American Indian Populations

Introduction

Alcohol abuse is a serious social issue, not only because it affects our physical health but also because it affects our mental health, and, in turn, our actions, our circumstances, our relationships, and so on. A group often associated with this issue are American Indians as an entity, even though there are over 500 federally recognized American Indian tribes throughout the United States, each with its own unique culture (Szlemko, Wood, & Thurman, 2006). Though it is true that American Indians “tend to use alcohol earlier, use it more often and in higher quantities, and experience more negative consequences from it” (Walters, Simoni, & Evans-Campbell, 2002), it is also true that this only represents certain American Indian tribes and, even more specifically, individuals within those tribes.

Therefore, this should not be used to make assumptions regarding American Indians as a whole. Rather, it is important to recognize the variance between American Indian tribes as we examine the history of alcohol abuse in American Indian populations, identify the problem, apply it to social work values as outlined by the National Association for Social Workers (NASW), and discuss steps for advocacy on the micro, mezzo, and macro levels. Historical Analysis In order to discuss the issue of alcohol abuse in American Indian populations, we must first discuss the history of American Indians in general, especially as it relates to Westerners and, eventually, the U.S Government. It is well known that Westerners brought much death and destruction to American Indians in the “New World”, reducing their numbers from 4.5 to 12.5 million to only 250,000 by 1900 (Szlemko, Wood, & Thurman, 2006).

According to Szlemko, Wood, & Thurman (2006), Westerners not only killed American Indians, both directly and indirectly, but also “destroyed elements of Native American culture, wrenched people from their…homelands, and forced the…values of the majority culture upon Native people.” Though the number of American Indians increased after 1900, the U.S. Government continued this trend, subjugating American Indians in order to access their land and resources. The result of this can be referred to as historical trauma, or the “cumulative… wounding, over the lifespan and across generations, emanating from massive group trauma experiences. The historical trauma response is the constellation of features in reaction to this trauma” (Brave Heart, 2003). Responses vary but, in many cases, include mental health issues, such as anxiety, depression, and alcohol/ substance abuse. It has also been hypothesized that this population’s experiences with alcohol as it relates to the first Westerners might play a role in their current usage of it. Beauvais (1998) says that American Indians, who had limited experience with alcohol before the arrival of Westerners, “had little time to develop social, legal, or moral guidelines to regulate alcohol use” before it was popularized. This means that it was used before many American Indians knew about the risks, and it was not until after it was already popular that they considered if or how to incorporate it into their lifestyles. Beauvais (1998) continues, saying that this, combined with the extreme intoxication demonstrated by Westerners “provided a powerful model for… use of alcohol among the inexperienced American Indian populations.” This may have contributed to an pattern of use that was passed down and, inevitably, led to the abuse that we see in some of today’s American Indian populations, though there is no way to know for sure.

Problem Identification

The central issue here is alcohol abuse in American Indian populations. As stated above, American Indians, particularly American Indian youth, are at risk more than other, non American Indians. The statistics are shocking. According to Walters, Simoni, & Evans-Campbell (2002), “American Indians are 5 times more likely to die of alcohol-related causes than non American Indians” and “4 of the 10 causes of death among American Indians are alcohol-related.” That said, it is important to bear in mind that data on American Indian adults, in particular, is difficult to come by. According to Szlemko, Wood, & Thurman (2006), difficulties in assembling such data could include “diversity, geographical considerations, and mistrust of researchers.” Data on American Indian youth, on the other hand, is much more common because of yearly school-based surveys, which can — perhaps — aid in making certain deductions about American Indians adults. In general, research on American Indian youth indicates a high level of alcohol use. (Remember that alcohol use does not equate alcohol abuse. Alcohol use can, however, lead to alcohol abuse given certain conditions, many of which many American Indians have experienced.)

According to Hawkins, Cummins, & Marlatt (2004), “American Indian teens…tend to drink more frequently and to consume more alcohol in larger quantities when they do drink.” This is also called binge drinking, or the consumption of an excessive amount of alcohol — 4 to 5 drinks or more — in a short period of time. Hawkins, Cummins, & Marlatt (2004) continue, stating the following: These trends are likely to…impact the development of American Indian adolescents by interfering with the learning of age-appropriate behaviors and skills. In addition, these trends place them at increased risk for participating in potentially dangerous behaviors and for experiencing acute negative consequences of use. It is possible, then, that some of the habits developed in adolescence are carried into adulthood. In this case, the use of alcohol by American Indian youths, who eventually grow into American Indian adults, may help explain the alcohol abuse in that population.

Fundamentally, though, the root causes of this issue are much more systematic in nature and include “traumatic stress, particularly stress associated with an oppressed group status” (Walters, Simoni, & Evans-Campbell, 2002). This includes stress from historical trauma (discussed above) as well as stress from everyday oppression that American Indians continue to face despite the common misconception that the circumstances of American Indians have improved. This can cause a variety of mental health challenges, which may lead to alcohol or substance abuse issues in order “to relieve certain symptoms…” (Beauvais, 1998). Other causes could include a variety of other influences, including current socioeconomic status, boarding school experiences, and loss of culture. According to Beauvais (1998), “the socioeconomic picture for many tribes is bleak. Unemployment rates are high, school completion rates are low, and basic support systems are underdeveloped. These conditions place a great deal of stress on…Indian communities.” Given this, it is understandable that an individual might seek a way to block or repress the reality of their circumstances. Beauvais (1998) continues, speaking of the boarding schools attended by many American Indian youth, who were removed from their homes in order to “eliminate American Indian culture and replace it with White culture.” Over time, this caused many American Indians to lose touch with their Native identities, and many American Indians believe that this “is the primary cause of many of their existing social problems, especially those associated with alcohol” (Beauvais, 1998). (This is discussed in more detail above.)

Application to Social Work Values

The issue of alcohol abuse in American Indian populations is important and should garner much more support than it does. The ideal outcome would be to increase overall assistance to American Indians through increased education and culturally appropriate intervention techniques that would be community based and community led. To be effective, these would also need to incorporate American Indian practices throughout. On a larger scale, this would involve laws to protect the rights that American Indians have and increase their access to certain systems that may aid in recovery, such as access to better education, healthcare, and/ or job opportunities. Though the gap between the current and ideal state of affairs is wide, it is not impossible to address. We can advocate for the rights of others, not only those that we identify with but also those that we recognize as human, and therefore deserving of the same rights, despite any differences.

Social workers, in particular, are called to address this issue because it speaks to their unique Code of Ethics, which includes a brief list of values that those in the profession should follow. Though all of these values are important in keeping within ethical guidelines, the values that are particularly noteworthy in this case are service, social justice, and dignity and worth of the individual (National Association workers, 2008). Firstly, this issue should be addressed by social workers because social work practice is, first and foremost, based in service. According to National Association workers (2008), “Social workers elevate service to others above self-interest. Social workers draw on their knowledge, values, and skills to help people in need and to address social problems.” The issue of alcohol abuse in American Indian populations falls under this category because the abuse of any substance by any individual or group has the power to affect the whole. Secondly, this is also a social justice issue because bias from those not in this group results in unjust discrimination and prejudice toward this group.

According to National Association workers (2008), social workers are called to “pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people.” It is well-known that American Indians have suffered at the hands others since some of their first interactions with Westerners. As a result, they have been forced into a mold of what is allowed by Westerners and subjugated. (This is discussed in more detail above.) The National Association workers (2008) continues, saying that the work of social workers should “seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity. Social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people.” This refers to both American Indians and to those that do not identify as American Indian. The final value that speaks to this particular population is dignity and worth of the individual.

According to National Association workers (2008), social workers are called to “treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity.” They also, “seek to enhance clients’ capacity and opportunity to change and to address their own needs.” As discussed above, American Indian history is ripe with examples of abuse at the hands of others, which has carried on over time, and defines how they are treated today. Because of this — and because they are human and, therefore, like us — it is important that we show them the respect that they rightly deserve. Advocacy Steps at the Micro, Mezzo, and Macro Levels Research by Hawkins, E., Cummins, L., & Marlatt, G.A. (2004) states that the theme of advocacy as it relates to alcohol abuse in American Indian populations, “is one stressing health promotion and disease prevention with an emphasis on developing skills for lifestyle balance.” This is a great starting point but much too general in scope to incite action that results in tangible change.

Rather, we must seek specific approaches in order to solve these complex challenges. As we explore the micro, mezzo, and macro level solutions to this issue, it is important to keep in mind that the format must be appropriate to the population (Szlemko, W., Wood, J. & Thurman, P. J., 2006). This means that for many American Indian tribes, certain techniques or tools must be adapted to fit their unique attitudes and lifestyles. Here again, we remember that American Indians are very diverse. Their individual identities, as well as their group identities, should be accounted for when creating and implementing change within their communities. Similarly, all techniques should include Native practices, such as sacred dances, sweat lodges, and talking circles, whenever possible. According to Brave Heart (2003), use of these practices can help “enhance harmony between the individual and nature, the animals and spirits” and revitalize the traditional culture of many American Indians. This is not to say that Western techniques should not be used but, rather, that Native practices should work in conjunction with Western practices.

These Western practices do have their place in the process, but Brave Heart (2003) says that they should “only be utilized to the extent that they are not disrespectful or inconsistent with traditional methods.” This not only places American Indians at the center of their own recovery but also gives them ability to engage with these practices in a personal way and recreate them with others later. According to Hawkins, Cummins, & Marlatt (2004), skills training can be effective on the micro level. They continue, saying that “the goal of socialization is the development of the abilities and competencies needed to function successfully within a culture.” While this seems basic, it is something that many American Indians have not had the opportunity to learn. In this case, examples of relevant skills could include avoiding high-risk situations, communicating with others, establishing healthy relationships, managing stress, and practicing self-care, among many others. Of the three levels, the mezzo level seems to have the most potential within American Indian populations. According to Brave Heart (2003), this is because many tribes place a “great emphasis on family, especially extended family. This emphasis contributes to a worldview that promotes intra-group cooperation and respectful…interactions. Additionally…views universally emphasize respect and connection with all of nature.” It is fair to say then that some, though not all American Indians, deeply value their community. Because of this, group-based techniques might be more valuable than other techniques. Brave Heart (2003) continues, saying that “…group processing provides occasions for increasing capacity to tolerate and regulate emotion, trauma mastery, and at least short-term amelioration of historical trauma response.” Part of this is make American Indian communities more self-sustaining by increasing community involvement.

According to Hawkins, Cummins, & Marlatt (2004), the first step “is the development of a core group composed of community members who serve as leaders, role models, and decision makers regarding the implementation of…strategies.” These individuals guide the communities in which they are involved and might, with the help of allies, take certain steps to “organize community-wide alcohol and drug-free events; enhance health, welfare, and youth services; and advocate for new tribal policies restricting the use and abuse of drugs and alcohol” (Hawkins, Cummins, & Marlatt, 2004). The hope is that this will eventually allow tribes to be completely autonomous and independent, capable of addressing and solving these issues from within. The macro level is also highly involved. Previous attempts by the U.S. Government have failed to address these issues on a grand scale. According to Beauvais (1998), “prohibition has been the most prevalent policy in attempting to reduce alcohol consumption among Indian tribes, although it has been inconsistently applied.” In fact, there has been some concern that prohibition has actually exacerbated, instead of alleviated, the issue. According to Beauvais (1998), other macro level options “are divided into the categories of controlling supply, shaping drinking practices, and reducing social and physical harm.” He continues, saying that though these options are not feasible everywhere, “a core set could be implemented in most communities. All researchers here stress the need for additional research in order to see what does or does not work within American Indian populations, as the data is lacking. Summary Alcohol abuse is a serious social issue with any individual and within any population.

However, a specific group that faces this issue is American Indians. Here, we have examined the history of American Indians and this issue specifically, identified the problem, applied it to social work values as outlined by the National Association for Social Workers (NASW), and discussed steps for advocacy on the micro, mezzo, and macro levels. Though this paper presents a accessible starting point for those who may not be as familiar with the issues at hand, it is also that much more research and work with American Indian populations in general is necessary in order to gain a better understanding of the issues, as well as how to address and solve them.