Substance Abuse among American Indians
Sarah Whitaker
Background / Definition
One of the biggest health issues currently facing American Indians and Alaska Natives (AIANs) is alcoholism and substance abuse. For decades now, researchers have collected data which show that AIANs suffer disproportionately from substance dependencies, especially among youth populations. In fact, one study of youth alcohol and drug usage showed that Native American youth not only consumed alcohol more frequently than white youth, but also that Native American youth started their consumption far earlier than any other ethnicity studied. The same pattern was found for most drugs, as well, including cigarettes, smokeless tobacco, marijuana, and cocaine (Schinke et al. 2000. In addition, in a study conducted over ten years (from 1999-2000), Native Americans showed an alcohol-related mortality rate 3.3x higher than white populations (Landen et al. 2014 346).
Context
Although alcoholism is an inheritable disease, studies specifically on AIAN genetics have shown that these populations do not have any greater genetic predisposition to alcoholism than other populations (Ehlers et al. 2013 155). Rather, researchers have offered several environmental factors which could explain why native populations are so much more dependent on alcohol and other drugs than white populations, most concerning native traditions and values and the historical trauma which frames the American Indian narrative.
In their article, “Early-Onset Alcohol Use among Native American Youth: Examining Female Caretaker Influence” (Walls et al. 2007), Melissa L. Walls, Les B. Whitbeck, Dan R. Hoyt, and Kurt D. Johnson discuss one such environmental factor. Many child development studies have shown that parental drinking has a large effect on their children, especially on their relationship to alcohol. Children often grow up to be adults who display drinking patterns quite similar to that of their parents, so the child of a parent who consumes large amounts of alcohol is more likely to both start drinking at an earlier age and develop a stronger dependence on alcohol later in life (Walls et al. 2007). According to Walls et al., this effect is even more pronounced in American Indian families due to the heavy emphasis placed on the importance of family and parental authority in native culture. Since one’s family is the center of one’s life in AIAN culture, if a child grows up in a household with parents or caretakers who are dependent on alcohol, this behavior will imprint on them (Walls et al. 2007 453).
Many anthropologists also argue that the substance abuse issues observed in many AIAN communities is due to the historical trauma they have suffered from since colonization. Maria Yellow Horse Brave Heart discusses this concept specifically among the Lakota tribe. According to Brave Heart, before colonization, American Indian tribes did not use alcohol or other drugs, but since the arrival of Europeans, these communities have developed substance abuse issues, which have led to higher suicide rates, higher premature death rates, and higher alcohol-related mortality rates than the national averages (Brave Heart 2003 8). The forced assimilation and genocide of American Indian populations led to a loss of spiritual and cultural values and the breakdown of traditional family and social structures, an occurrence which perpetuates the trauma which began during colonization and has led to higher rates of substance abuse (Brave Heart 2003). For example, the Lakota tribe has very specific mourning rituals for the loss of a loved one. In 1881, however, the US government outlawed the practice of native ceremonies. As a result, many tribes displayed a surplus of unresolved grief, and turned to alcohol (Brave Heart 2003 9). According to Brave Heart, these observances occur in a vicious cycle, with each generation growing to be dependent on alcohol, and breeding children who, growing up in a household with substance dependent parents whose caretaking skills are compromised, also grow up to overuse alcohol and other drugs (Brave Heart 2003). In short, AIAN’s historical trauma not only led to the emergence of substance abuse issues, but these issues perpetuate the trauma as well.
Joseph P. Gone, in his article “‘We Never was Happy Living Like a Whiteman’: Mental Health Disparities and the Postcolonial Predicament in American Indian Communities” (Gone 2007), presents Traveling Thunder, a tribal member who shares sentiments similar to Brave Heart’s. According to Traveling Thunder, mental health issues which plague many AIAN communities are due to the trauma which they have long suffered due to colonization and continued discrimination (Gone 2007).
Controversies / Perspectives
One of the biggest controversies surrounding AIAN populations’ substance abuse is how to treat it. Although by 1988 the Indian Health Service (IHS) had over 300 treatment programs available for American Indians suffering from alcoholism or other drug dependencies, and likely have even more today, these services are insufficient (Rhoades et al. 1988 621). Due to language and cultural barriers, poverty, lack of available transportation, long waiting times, and disrespectful handling of American Indian patients (especially by white doctors), IHS services largely go unused (Neff et al. 2007).
Many American Indian populations and scholars argue that this is not due to any fault of tribal communities, but rather of the American health system and its inflexibility regarding different cultures. In Gone’s aforementioned article, Traveling Thunder states that the reason many American Indians do not seek mental health treatment, especially from IHS is that the services provided do not accord with cultural and traditional beliefs and values. The disrespect and indelicacy which Traveling Thunder says typify the average individual’s experience with IHS is the primary reason which these services are insufficient (Gone 2007).
The Robert Wood Johnson Foundation, for example, noted the inability of IHS services to properly treat substance abuse among American Indian organizations and tribes, so, in 1993, the RWJF enacted a two-phase initiative, called “Healthy Nations,” to provide tribal organizations with the resources to treat substance abuse among their members themselves (Noe et al. 2003). In phase one, the RWJF donated $150,000 each to fifteen tribes and AIAN organizations to fund a development stage, wherein these communities spent two years developing models and strategies to combat substance abuse. After two years, those communities who successfully completed the developmental stage were each awarded $1,000,000 to actually implement their models (Noe et al. 2003 16). Of the thirteen tribes who completed phase one, each had a different creative approach. Some tribes focused on mentor relationships with youth members, some partnered with local schools to add a healthy lifestyle curriculum, some emphasized traditional healing practices such as sweat lodges, etc. (Noe et al. 2003 17). This initiative had a profound impact on many communities, but the most noteworthy was that it cemented the fact that AIAN communities do, in fact, have the ability to care for their own members and to prevent substance abuse if given the proper resources (Noe et al. 2003).
Many IHS officials and supporters, however, believe that their provided care is entirely adequate to treat substance abuse among AIAN populations. In fact, many IHS officials believe that the biggest barrier to health care for American Indians is not the fault of the health care system, but rather due to apathy among these populations. Many IHS supporters say that these communities, until the late twentieth century, simply accepted the alcoholism epidemic among its members, and now that they have finally realized it to be a troubling issue, it is too deep-seeded an issue for them to successfully overcome it on their own (Rhoades et al. 1988).
Politics of Health
This topic relates to politics of health in a multitude of ways. First, given the Healthy Nations initiative by the RWJF, it is clear that, given the proper resources, AIAN communities are fully capable of treating substance abuse among its members. If the United States government allocated more money specifically for this cause, it would ensure that each community would be making an active effort to reduce its frequency of substance dependency and its alcohol-related mortality rate. In addition, the health care barriers that prevent American Indians from accessing IHS services make it an almost unusable service, especially in the context of substance abuse. Since IHS is a government-funded program, policymakers certainly have an impact on how IHS operates and serves AIAN communities. Changing how individuals can access the provided services and creating a more in-depth training program for IHS physicians could increase its accessibility, and in turn offer more useful services for American Indians suffering from substance dependency.
References
Ehlers, C. L., & Gizer, I. R. (2013). Evidence for a Genetic Component for Substance Dependence in Native Americans. The American Journal of Psychiatry. Retrieved from http://ajp.psychiatryonline.org
Gone, J. P. (2007). ‘‘We Never was Happy Living Like a Whiteman’’ : Mental Health Disparities and the Postcolonial Predicament in American Indian Communities. American Journal of Community Psychology, 290-300.
Landen, M., Roeber, J., Naimi, T., Nielsen, L., & Sewell, M. (2014). Alcohol-Attributable Mortality Among American Indians and Alaska Natives in the United States, 1999-2009. American Journal of Public Health. Retrieved from http://ajph.aphapublications.org
Neff, D. F., Kinion, E. S., & Cardina, C. (2007). Nurse Managed Center: Access to Primary Health Care for Urban Native Americans. Journal of Community Health Nursing. Retrieved from JSTOR database.
Noe, T., Fleming, C., & Manson, S. (2003). Healthy Nations: Reducing Substance Abuse in American Indian and Alaska Native Communities. Journal of Psychoactive Drugs. Retrieved from http://www.tandfonline.com/
Rhoades, E. R., Mason, R. D., Eddy, P., Smith, E. M., & Burns, T. R. (1988). The Indian Health Service approach to alcoholism among American Indians and Alaska Natives. Public Health Reports. Retrieved from NCBI database.
Schinke, S. P., Tepavac, L., & Cole, K. C. (2000). Preventing substance use among native american youth: Three-year results. Addictive Behaviors. Retrieved from ScienceDirect database.
Walls, M. L., Whitbeck, L. B., Hoyt, D. R., & Johnson, K. D. (2007). Early-Onset Alcohol Use among Native American Youth: Examining Female Caretaker Influence. Journal of Marriage and Family. Retrieved from JSTOR database.
Brave Heart, M. Y. H. (2003). The Historical Trauma Response Among Natives and Its Relationship with Substance Abuse: A Lakota Illustration. Journal of Psychoactive Drugs. Retrieved from http://www.tandfonline.com/
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