Researchers at the University of Arizona have found that Native Americans abstain from alcohol far more often than do whites, that fewer Native Americans than whites are light or moderate drinkers and that the two groups engage in binge and heavy drinking at pretty much the same rates.
This is the first study to look at drinking in the American Indian population as a whole. Other studies have focused only on specific tribes or places, such as a particular urban area, says lead author James K. Cunningham, a social epidemiologist with UA’s Department of Family and Community Medicine, Native American Research and Training Center.
Looking at responses from more than 4,000 Native Americans and 170,000 white Americans who took part in a federal government survey between 2009 and 2013 pertaining to their alcohol use in the past month, the study found that almost 60 percent of Native Americans abstained from alcohol, compared with 43 percent of whites; 14.5 percent of Native Americans were light or moderate drinkers, compared with 32.7 percent of whites; 17.3 percent of Native Americans were binge drinkers, compared with 16.7 percent of whites; and 8.3 percent of Native Americans were heavy drinkers, compared with 7.5 percent of whites.
Courtesy Paul Van Helden
James Cunningham is a social epidemiologist with the University of Arizona’s Department of Family and Community Medicine, Native American Research and Training Center.
Erroneous beliefs about excessive drinking among American Indians go back at least as far as the late 1700s, when the Catholic priest Abbé Belmont described the Ottawa as “passionately attached” to brandy, according to the study.
And the bias continues to this day in movies, television and newspaper articles, extending even into the Indian Health Service, says Cunningham. The study quotes a 2015 IHS Behavioral Health Fact Sheet: “The high rates of alcohol and substance abuse… in American Indian and Alaska Native (AI/AN) communities are well documented.”
This study, in conjunction with a dearth of positive evidence for a genetic vulnerability to alcoholism among American Indians, could revolutionize both popular and medical thinking about drinking in Native American communities.
The health care implications cannot be overstated. “There are reports, for example, of higher liver disease mortality among Native Americans. We wanted to see if higher drinking rates could explain that disparity. Our study doesn’t indicate that,” says Cunningham.
“It does underscore the importance of realizing that when you’re looking at health disparities oftentimes the explanation is complex. The study should provide an impetus for taking a more complex and realistic view of what the causes of health disparities really are,” he continues.
Teshia A. Solomon, Choctaw Nation of Oklahoma, is director of the UA Native American Research and Training Center and a co-author of the study. She points out similar rates of alcohol use do not necessarily result in the same rates of alcohol-related health problems. “Native Americans as a group have less access to medical care, safe housing and quality food, which can amplify health problems connected to alcohol,” she says.
UA Family and Community Medicine Department Head Myra Muramoto, the third study author, says, “Negative stereotyping of groups of people who have less access to health care creates even more health disparities. Based on a false negative stereotype, some health care providers may inaccurately attribute a presenting health problem to alcohol use and fail to appropriately diagnose and treat the problem.”
“The problem with stereotypes,” says Solomon, “is that they can get in the way of finding the real causes of problems.”
Teshia A. Solomon, Choctaw Nation of Oklahoma, is director of the Native American Research and Training Center at the University of Arizona.
The social implications of these findings are equally profound. For instance, a person may hesitate to seek alcohol treatment because she thinks she will be stereotyped. Or, “If you’re applying for a job and the employer thinks that you’re from a group that has extraordinary alcohol use, you may be less likely to get the job,” notes Cunningham.
The idea that Native Americans have a particular vulnerability to alcoholism, says Cunningham, is long-standing, but probably inaccurate. “There was one study some years ago which seemed to find some evidence that American Indians and Alaska Natives [might have a genetic predisposition to alcoholism]. But the bulk of the research since then has not been able to demonstrate that. And in the field itself it is fairly accepted that there is no real data to back that notion up at this point in time. For some reason this information has not gotten out to the public; I don’t know why.”
But, says Solomon, “alcoholism does exist in communities regardless of race or ethnicity. Getting rid of the stereotypes will help ensure people get the kinds of care they need to overcome that serious issue. There’s a real need for culturally-competent care for alcoholism in Native American communities.”
The study, “Alcohol use among Native Americans compared to whites: Examining the veracity of the ‘Native American elevated alcohol consumption’ belief,” is published in the in the journal Drug and Alcohol Dependence.