Changing Numbers, Changing Needs American Indian Demography and Public Health (1996) / Chapter Skim
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11 Overview of Alcohol Abuse Epidemiology for American Indian Populations
11 Overview of Alcohol Abuse Epidemiology for American Indian Populations
Pages 235-261
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From page 235... ...
Also special thanks to Aaron Handler of the Office of Program Planning, Evaluation and Legislation of the Indian Health Service, Rockville, Maryland. 1''American Indian" is used in this paper as a general term for the approximately 2 million native peoples of North America in the United States and Canada, including Alaska Natives, Eskimo, and Indians.
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From page 236... ...
This is followed by a discussion of the epidemiology of substance abuse among Indian youth. We then turn to a review of findings on alcohol abuse among adult American Indians, examining first survey data and then the results of two longitudinal studies.
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From page 237... ...
Studies show that the style of drinking also varies among American Indians, spanning the four commonly mentioned styles of abstinence, moderated social drinking, heavy recreational drinking, and anxiety or chronic alcohol-dependent drinking (see Ferguson, 1968; Levy and Kunitz, 1974; May, 1992~. Many studies support the commonly held belief that alcoholism and alcohol abuse are epidemic among some tribal populations (see, for example, Brod, 1975; Lamarine, 1988; Littman, 1970; Swanson et al., 1971; Stratton, 1973; Stewart, 1964~.
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From page 238... ...
ADULT ALCOHOL ABUSE SURVEYS There have been eight major studies concerned with the prevalence and epidemiological features of drinking among adult Indian populations, as well as three survey samples of older adults recently completed as part of a cardiovascular disease study. Table 11-1 lists the prevalence rates for alcohol use among the populations sampled for these studies, along with the rate among the general U.S.
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57.0 68.0 47.0 NIAAA, 1993 Standing Rock Sioux 1960 (ages 15+) 69.0 82.0 55.0 Whittacker, 1962 1980 (ages 12+)
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· Urban Indian populations generally have a higher prevalence of drinking than do many reservation populations, whereas reservation populations generally have a higher prevalence of abstention. For example, the Lumbee adult study, a study among the Navajo, and Indian youth studies clearly illustrate this pattern (Beltrame and McQueen, 1979; Levy and Kunitz, 1974; Beauvais, 1992~.
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From page 241... ...
. · There are many American Indian males in virtually every tribal community who have been problem or heavy drinkers in the past, but have quit in early or later middle age (e.g., early 30s to middle 40s)
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From page 245... ...
The estimated alcohol involvement has been calculated for this table as well, and rates, numbers, and percentages of death are presented. The conclusion from this table with regard to all 12 Indian Health Service areas is that the age-adjusted alcohol-related death rate among American Indians is 2.4 times that of the general U.S.
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in all parts of the 35 reservation states served by the Indian Health Service (IHS) (total deaths in reservation states 1989-1991 = 19,084~.
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92 8.4 68.0 8.7 7.8 11.7 11.2 6.4 38.8 8.4 4.6 317 (100%) 317 Total deaths for above causes 1290 783 % of all Indian deaths 7.0% 4.3% % of all female Indian deaths 17.1% 10.4% (N=7,560)
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population in 1940. Includes deaths of Indians and Alaska Natives only in those counties within reservation states where IHS maintains services.
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. SOURCES: Computed from Indian Health Service (1994a and 1994b)
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, these causes were responsible for an estimated 2,239 of the 3,318 lives lost as a result of alcohol involvement in all 12 Indian Health Service areas. As noted earlier, alcohol-specific causes are those that typically result from chronic alcohol consumption, the pattern generally defined as alcoholic (alcohol dependence syndrome, cirrhosis of the liver from alcohol consumption, and others)
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From page 251... ...
It also refers to how the individual is attached symbolically and structurally to the larger social aggregates, such as the family and social, political, and religious groups (lessor et al., 1968~. Overall, American Indian tribes have levels of traditional social integration that have been classified by anthropologists as ranging from high to low (see Field, 1991, and Levy and Kunitz, 1974:Chapter 3, for specifics related to tribal alcohol patterns; see Davis, 1994, and Champagne, 1994, for general discussion)
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From page 252... ...
A consistent finding is that FAS and most alcohol-related birth defects occur to a small number of women, 6.1/1000 women of childbearing age among seven Southwestern Indian communities (May et al., 1983~. This finding reflects the drinking patterns in many tribes: a majority, or at least a very high percentage, of the women are abstainers, but among those who drink, there is generally a rather limited subset of women who are very heavy drinkers.
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From page 253... ...
In general, a comprehensive, community-wide program of alcohol-misuse prevention should embrace two general approaches: motivating populations to change and changing the environment to make it more protective (May et al., 1993~. The goal of these programs is to keep problematic and heavy alcohol use from causing premature morbidity and mortality so that individuals remain healthy and live long enough to mature out of youthful and young adult drinking patterns.
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From page 254... ...
In one "natural experiment," the fetal alcohol syndrome rate in a small Indian community dropped from 14/1000 to zero for a 5-year period as the latent consequence of a change in economic policy that suspended monthly payments of gas and oil royalties to individual families (May, 1991~. In other cases, alcohol-related arrests have been reduced by 30 to 60 percent because of policies related to alcohol availability (May, 1975, 1976~.
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From page 255... ...
Individuals in advanced states of alcohol misuse could be identified in detox centers and aggressively referred to alcohol treatment and other therapeutic health and behavioral interventions. SUMMARY OF FINDINGS AND AREAS FOR FUTURE RESEARCH There is a great deal of heavy and problematic drinking and therefore alcohol-involved mortality among American Indians, but there are a number of positive findings as well.
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From page 256... ...
The bulk of the alcohol-related problems surrounding heavy recreational and binge drinking occur from the late teens through the mid-30s, and alcohol dependency problems increase dramatically from ages 25 through the late years among a select minority of the Indian population. Confirmation of these life-cycle trends is needed.
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From page 257... ...
1992 Indian adolescent drug and alcohol use: Recent patterns and consequences. American Indian and Alaska Native Mental Health Research 5~1~:1-67.
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1971 The world's oldest ongoing protest demonstration: North American Indian drinking patterns. Pacific History Review 40~3~:311-322.
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1992 Alcohol policy considerations for Indian reservations and bordertown communities. American Indian and Alaska Native Mental Health Research 4~3~:5-59.
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American Indian and Alaska Native Mental Health Research 4~3~:120-125.
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From page 261... ...
Sellers 1989 Social learning theory, drug use, and American Indian youths: A cross-cultural test. Justice Quarterly6~3~:395417.
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