Alcohol and Native Americans

Traditional drinks made from fermented corn or corn flour include tejuino, pozol, chicha or chicha de jora, and pox.^[28][30]

Evidence from

For at least 1,800 years the indigenous peoples of the

Libation was done in this manner: when octli was drunk, when they tasted the new octli, when someone had just made octli ... he summoned people. He set it out in a vessel before the hearth, along with small cups for drinking. Before having anyone drink, he took up octli with a cup and then poured it before the hearth; he poured the octli in the four directions. And when he had poured the octli then everyone drank it.^[42][41]

Pulque was drunk by Aztec priests and their sacrificial victims, to increase the priests' enthusiasm and to ease the suffering of the victim.^[43][44][39] Among commoners, it was permitted only to the elderly and pregnant or lactating women^[45] due to the association between pulque and fertility, purification and renewal.^[46] Production of pulque was ritualized and the brewers would abstain from sex during the fermentation period.^[47] During most festivals, participants were not permitted to drink more than four cups of pulque,^[48] and Aztec folklore describes the likely fate of people who drank too much, including death by disease or accident.^[49] Exaggerated tales of the Huastec people characterized them as habitual drunkards and detailed their shameful behavior under the influence of alcohol, in an effort to discourage drunkenness among the Aztecs.^[50] Elderly Aztecs who had reached the age of 70 and had raised families could drink as much as they wanted, as long as their children carried them home safely, keeping them covered up and "restraining and guiding" them so they would avoid "committing excesses and transgressions," and not fall "into a river or a hole."^[48] Drunkenness was also viewed as a means of establishing communication between humans and the gods, and was therefore not considered appropriate for commoners. Alcoholic intoxication was seen as an act of transcending the boundaries of human, divine and natural forces, one that should only be done by accomplished, brave and important members of society so as to avoid offending the supernatural world.^[46] Among the Maya, pulque was referred to as chih and was flavored with honey and spices.^[51]

Prior to contact with colonists, alcohol use and production were mainly concentrated in the southwestern United States. In 2007, archaeologist Glenna Dean conducted studies to show that, between AD 828 and 1126,

A number of early accounts report that many Native Americans had no tradition of making alcoholic beverages, and did not know the effects of alcohol.^[58] Rather than approval, most Native peoples initially responded to alcohol with distaste and suspicion. They considered drunkenness "degrading to free men" and questioned the motives of those who would offer a substance that was so offensive to the senses and that made men foolish. Most Native people who did drink alcohol were reported to show "remarkable restraint while in their cups."^[59] Most drank alcohol only during social or trading contact with whites.^[60]

When Europeans began making a large quantity of distilled spirits and wine available to Native Americans, the tribes had very little time to adapt and develop social, legal, or moral guidelines to regulate alcohol use.^[60] Early traders offered alcohol in trade, exchanging it for highly sought-after animal skins and other materials and resources.^[61] Traders also discovered that giving free alcohol to Native Americans during trading sessions gave them a distinct advantage during negotiations.^[62] Extreme intoxication was common among the colonists, contrary to the inexperienced native populations.^[60]

By the early 1700s the effects of

Great quantities of rum [are] continually brought to their town, insomuch as they [are] ruined by it, having nothing left but have laid out all, even their clothes, for rum, and may now, when threatened with war, be surprised by their enemies when beside themselves with drink, and so be utterly destroyed.^[64]

John Lawson described the effects of alcohol on the tribes of North Carolina, which he observed during his travels there in 1700-1708:

Most of the Savages are much addicted to Drunkenness, a Vice they never were acquainted with, till the Christians came amongst them. Some of them refrain drinking strong Liquors, but very few of that sort are found amongst them. Their chief Liquor is Rum, without any Mixture. This the English bring amongst them, and buy Skins, Furs, Slaves and other of their Commodities therewith. They never are contented with a little, but when once begun, they must make themselves quite drunk; otherwise they will never rest, but sell all they have in the World, rather than not have their full Dose. In these drunken Frolicks, (which are always carried on in the Night) they sometimes murder one another, fall into the Fire, fall down Precipices, and break their Necks, with several other Misfortunes which this drinking of Rum brings upon them; and tho' they are sensible of it, yet they have no Power to refrain this Enemy. About five years ago, when Landgrave Daniel was Governor, he summon'd in all the Indian Kings and Rulers to meet, and in a full Meeting of the Government and Council, with those Indians, they agreed upon a firm Peace, and the Indian Rulers desired no Rum might be sold to them, which was granted, and a Law made, that inflicted a Penalty on those that sold Rum to the Heathens; but it was never strictly observ'd, and besides, the young Indians were so disgusted at that Article, that they threatened to kill the Indians that made it, unless it was laid aside, and they might have Rum sold them, when they went to the Englishmen's Houses to buy it.^[65]

European-American settlers often viewed immoderate drinking as a sign that Native American culture was decaying and was unable to cope with the modern world. The obliteration of indigenous cultures was often regarded as an inevitable consequence of "progress." In 1753, Benjamin Franklin witnessed a drunken brawl in Carlisle, Pennsylvania, after providing rum to a party of Iroquois in exchange for their cooperation during treaty^[66] discussions, and wrote in his autobiography:

[They] are extremely apt to get drunk, and when so are very quarrelsome & disorderly ... indeed if it be the Design of Providence to extirpate these Savages in order to make room for Cultivators of the Earth, it seems not improbable that Rum may be the appointed Means. It has already annihilated all the Tribes who formerly inhabited the Sea-coast.^[67]

At the same treaty conference, the Oneida leader Scarouady complained:

Your Traders now bring scarce any Thing but Rum and Flour. ... The Rum ruins us. We beg you would prevent its coming in such Quantities, by regulating the Traders ... We desire it may be forbidden, and none sold in the Indian Country. ... When these Whiskey Traders come, they bring thirty or forty Cags, and put them down before us, and make us drink; and get all the Skins that should go to pay the Debts we have contracted for Goods bought of the Fair Traders; and by this Means, we not only ruin ourselves, but them too. These wicked Whiskey Sellers, when they have once got the Indians in Liquor, make them sell their very Clothes from their Backs. In short, if this Practice be continued, we must be inevitably ruined: We most earnestly therefore beseech you to remedy it.^[66]

In 1773 the missionary David Zeisberger was preaching in Shawnee communities in Ohio when he encountered Chief Gischenatsi, who told the missionary that the sale of alcohol was a deliberate attempt to undermine indigenous culture:

As the white people understand the weakness and incapacity of the Indians, they have a certain power over us, while pretending that, with all their deception, they mean well by the Indians. They come and bring rum into our towns, offer it to the Indians and say, drink; this they will do until they become quite beside themselves and act as though they were out of their heads. [Then] the white people stand, and point at them with their fingers, laugh at them and say, see what great fools the Shawanose are. But who makes them so foolish, who is at fault?^[21][68]

In his research for the Genocide Convention, Raphael Lemkin proposed that distribution of alcohol was one of several tools (such as forced relocations, destruction of cultural symbols, and "re-education" of children) by which European-American colonists committed cultural genocide in North America.^[69][70] Lemkin theorized that the availability of alcohol undermined social integrity, promoted violence, impeded organized resistance, and contributed to the belief that Native Americans were culturally inferior.^[71] Lemkin argued that once a people becomes dependent on alcohol "the desire for cheap individual pleasure [would] be substituted for the desire for collective feelings and ideals based on a higher morality."^[72]

Following the passage of the

During subsequent years alcohol further destabilized Native American communities. The Sauk warrior Black Hawk, (1767-1838), writes in his autobiography of the mistreatment of his people due to alcohol:

"The white people brought whisky to our village, made our people drink, and cheated them out of their homes, guns and traps. This fraudulent system was carried to such an extent that I apprehended serious difficulties might occur, unless a stop was put to it. Consequently, I visited all the whites and begged them not to sell my people whisky."^[76]: 101

Indian Agent Richard Cummins at

By the early eighteenth century it had become clear that alcohol was harming Native American society and health. A series of local regulations were passed beginning as early as October 1701, when the

Recognizing that penalties and exceptions needed to be written into law, Congress passed 25 U.S.C. § 177, "Act to regulate trade and intercourse with the Indian tribes, and to preserve peace on the frontiers" on 30 June 1834, superseding the old Nonintercourse Act of 1802 and imposing a fine of $500 for anyone who "shall sell, exchange, or give, barter, or dispose of, any spirituous liquor or wine to an Indian, (in Indian country)." The law provided exceptions for alcohol intended for US government troops, and stipulated that any supplies of illegal alcohol could be confiscated and destroyed. An additional provision in the law mandated a "$1,000 fine for setting up and operating a distillery in Indian Country for manufacturing ardent spirits," to prevent entrepreneurs from making alcohol rather than importing it.[75] Immediate results were encouraging: by 1835 the first Commissioner of Indian Affairs, Elbert Herring, declared, "The exclusion of ardent spirits, where it could be effected, has done much good." This act was amended multiple times but remained in force until 1953.^[22]

If liquor is injurious to them inside of a reservation, it is equally so outside of it; and why cannot Congress forbid its introduction into a place near by, which they would be likely to frequent? It is easy to see that the love of liquor would tempt them to stray beyond their borders to obtain it; and that bad white men, knowing this, would carry on the traffic in adjoining localities.[92]

Such action has been taken locally in several states, including in 2017 when the Nebraska Liquor Control Commission voted to deny license renewals to the four liquor stores in Whiteclay, Nebraska, on the edge of the Pine Ridge Indian Reservation.^[93][94][95]

In 1892 the

During the next seven years Congress engaged in a heated debate over the dangers and benefits of repealing the "Indian liquor laws." An attempt to repeal laws in Wisconsin and Minnesota was defeated, but in 1953 a law to repeal the laws in Arizona was amended to include all Indian country within the US. The record noted:

The Indians for many years have complained that the liquor laws are most discriminatory in nature. ... Inasmuch as Indians are expected to assume the responsibilities of citizenship and serve in the Armed Forces on an equal basis with other Americans, the committee sees no reason for continuing legislation that is applicable only to Indians.[104]

Within a few years, most tribes passed their own prohibition laws, but they were adopted by Indians for Indians, not imposed on them by the federal government.^[22] Discriminatory liquor legislation was never passed in Hawaii, where alcohol laws applied both to Native islanders and whites.^[105] In Alaska, liquor sales have been regulated by individual communities since 1986 as long as they conform to state laws.^[106][10]

It is now largely recognized that prohibition has been unsuccessful. As of 2007, 63 percent of the

A number of prominent Native Americans protested against the social and cultural damage inflicted by alcohol on indigenous communities, and encouraged others to avoid drinking. Initially, activists such as

A 2002 study looked at alcohol dependence and treatment in 172 Native American and Alaskan Native women who were in treatment at nine substance use disorder treatment centers in the west, southwest, northern plains, the midwestern US and Alaska.[114] As part of the study, participants' records were examined to confirm self-reported information. Fifty-two staff members employed at the treatment centers were also interviewed. Among the participants, 81% had been emotionally, physically and/or sexually abused as children and 78% had been abused as adults. Over half had been abandoned by one or both parents, raised by relatives, sent to a boarding school, or had run away from home as a child. Seventy-two percent had been arrested at least once for an alcohol-related reason. The mean age of first alcohol use was 14, with some participants reporting first use as young as age 6. Many of the participants had been introduced to alcohol by a parent or an older sibling. Close to 100% of the study participants described using alcohol to suppress grief, self-pity and loneliness. Most of the women said that the death of a close family member, a divorce, or the end of an important relationship motivated them to drink regularly and heavily. Seventy-three percent reported drinking during pregnancy.^[114]

The leading obstacles preventing women from starting treatment were lack of child care and lack of affordable transportation. This was especially true for women living in isolated rural areas, but also pertained to women in cities with inadequate

There is considerable variation in the level of alcohol use and patterns of intake between tribes.[1]^[115][116] This may be related to differing social tolerance of aberrant behavior when intoxicated, and certainly the socioeconomic conditions of different Native American communities play a role in alcohol misuse.^[117] Although drinking behavior has increased exponentially since colonization, since 1975 alcohol use patterns among Native Americans have remained constant.^[60] A 2003 study found that lifetime rates of alcohol dependence varied from 21 to 56 percent for men and 17 to 30 percent for women across seven geographically diverse American Indian tribes.^[118]

Beals et al. compared 1446 Native Americans living on a Southwest reservation with 1638 residents of a Northern Plains reservation, and examined their characteristics in relation to the US National Comorbidity Survey (NCS) conducted in 1990–1992. They found that alcohol dependence was more common in the Northern Plains sample (13.0%) than in the Southwest sample (12.2%), and both were higher than in the US sample (10.7%). Northern Plains women had a rate of alcohol dependence more than twice that of either US or Southwest women. The authors speculate that "Southwest women, as the carriers of tradition in this matrilineal culture, may have greater ties to their Native ways and thus be at less risk for the development of alcohol use disorders." Of those individuals in the Native American samples who sought professional help for a substance use disorder, 26.3% of the Southwest Indians went to a traditional or spiritual healer as compared to only 17.4% of those in Northern Plains sample.^[7][8][9]

Phillip A. May's in-depth examination of the epidemiology of alcohol use disorder and alcohol dependence among Native Americans (1994) found that tribes with a higher level of traditional social integration and less pressure to modernize had fewer alcohol-related problems. Tribes in which social interactions and family structure were disrupted by modernization and acculturative stress (i.e., young people leaving the community to find work) had higher rates of alcohol use and misuse. Native Americans living in urban areas have higher rates of alcohol use than those living in rural areas or on reservations, and more Native Americans living on reservations (where cultural cohesion tends to be stronger) abstain altogether from alcohol. May draws parallels to other societies affected by cultural change.^[119] Alaska Natives who follow a more traditional lifestyle have reported greater happiness and less frequent alcohol use for coping with stress.^[120]

Studies on drinking behavior among the

Surveys have shown that Native American youth are more likely to start drinking at a younger age, more likely to drink heavily, and more likely to suffer negative consequences of drinking than their non-Native counterparts.[15] Among Native American adolescents, alcohol and drug use are statistically associated with living on a reservation, dropping out of school, legal problems, antisocial behavior, and socializing with alcohol-using peers.^{[124][125][126]} A 2012 study by researchers at Colorado State University surveyed 1399 students in 33 schools in 11 US states and found that 52.8% of all Native American 8th-graders and 67.5% of all Native American 12th-graders had experimented with alcohol, compared with 13.8% and 41.1% of non-Native students in the same schools.^[127][128] Researchers have seen higher rates of academic failure, delinquency, violent criminal behavior, suicidality, and alcohol-related mortality among Native American youth than in the rest of the United States population.^[127]

Psychosocial stressors play a significant role in alcohol use among Native adolescents. Of 89 Native American adolescents admitted to a residential substance use treatment facility, only 25.3% came from a family with both biological parents present; 73% had been victims of physical or sexual abuse, 22.9% were not in school prior to their admission to this program, and 32.3% were referred by a judge or a court.^[126]

Native American youth become socialized into the culture of alcohol at an early age, and this pattern of testing alcohol limits persists until early adulthood.^[60] Approximately 20 percent of Native American youth between 7th and 12th grade belong in this category. Other youth exhibit an experimental pattern of drinking through adolescence and this is noted as one of the biggest identifiers of binge drinking later in life.^[60]

The National Institute on Alcohol Abuse and Alcoholism, or NIAAA, defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men, in about 2 hours.^[129] However, as Silk-Walker et al. point out, Native American drinking often does not conform to standard measurements as, for example, when a group shares one or more bottles. Binge drinking has less impact on health if enough time elapses between binges, however binge drinkers have a higher risk of death by accident, violence or alcohol poisoning as they are less accustomed to intoxication.^[117]

Anastasia M. Shkilnyk conducted an observational study of the Asubpeeschoseewagong First Nation of Northwestern Ontario in the late 1970s, when they were demoralized by Ontario Minamata disease, and observed that heavy Native American drinkers may not be physiologically dependent on alcohol, but they misuse it by engaging in binge drinking, a practice associated with child neglect, violence, and impoverishment.^[130]

Philip May (1996) found that the recreational drinking pattern of sporadic bingeing persists among many Native American drinkers throughout the early years that they drink, but that males often reach a turning point in their 30s and 40s when they quit drinking completely, for health reasons (42%), because they had joined the Native American Church (20%), because their responsibilities forced them to quit (18%), because they found drinking unrewarding (9%), or because they had joined an established Protestant church (4%).^[119]

A 2006 study found that 29.6% of Native Americans reported regular binge drinking as compared to 25.9% of whites, 25.6% of Hispanics and 21.4% of African-Americans.^[131] The 2015 National Survey on Drug Use and Health and National Survey of Substance Abuse Treatment Services, which surveyed adolescents and adults receiving treatment, found that 3.0% of Native Americans aged 12 to 17 reported binge drinking during the previous twelve months (compared to 6.6% of whites).^[111] Nonetheless, the overall rates of binge drinking appear to fluctuate: A National Center for Health Statistics survey showed 32.8% of Native Americans over age 12 reporting binge drinking in 2005,^[132] which fell to 18.2% in 2011^[133] and rose to 22.7% in 2016.^[134]

At least one recent study refutes the belief that Native Americans binge drink more than white Americans. Data from the National Survey on Drug Use and Health (NSDUH) from 2009 to 2013 showed that Native Americans compared to whites had lower or comparable rates of binge drinking. The survey included responses from 171,858 whites compared to 4,201 Native Americans. Native American and white binge drinking (defined as 5+ drinks on an occasion 1–4 days during the past month) estimates were similar: 17.3% and 16.7%, respectively.^[135]

The incidence of alcohol use disorder varies with gender, age, and tribal culture and history.^[136] While little detailed genetic research has been done, it has been shown that alcoholism tends to run in families with possible involvement of differences in alcohol metabolism and the genotype of the alcohol-metabolizing enzymes alcohol dehydrogenase and aldehyde dehydrogenase.^{[136][137][138]} Evidence that these genetic factors are more prevalent in Native Americans than other ethnic groups has been a subject of debate.^{[139][140][131]} According to one 2013 review of academic literature on the issue, there is a "substantial genetic component in Native Americans" and "most Native Americans lack protective variants seen in other populations."^[139] Another review of genetic studies from 2017 noted that few genetic studies of alcoholism in Native Americans had been done due to many Native American tribes' mistrust of scientists but stated that, in what few studies had been done, "the results are largely similar to findings in European-ancestry individuals indicating that [American Indians and Alaska Natives] do not have increased genetic risk for" alcoholism.^[141] Many scientists have provided evidence of the genetic component of alcoholism by the biopsychosocial model of alcoholism, but the molecular genetics research currently has not found one specific gene that is responsible for the rates of alcoholism among Native Americans, implying the phenomenon may be due to an interplay of multiple genes and environmental factors.^[142][143] Research on alcoholism in family systems suggests that learned behavior augments genetic factors in increasing the probability that children of alcoholics will themselves have problems with alcohol.^[144]

After European contact, white drunkenness was often interpreted by other whites as the misbehavior of an individual. Native drunkenness was interpreted in terms of the inferiority of a race. What emerged was a set of beliefs known as firewater myths that misrepresented the history, nature, sources and potential solutions to Native alcohol problems.^[59] These myths claim that:

• American Indians have an inborn, insatiable appetite for alcohol.^[5]
• American Indians are hypersensitive to alcohol (cannot "hold their liquor").
• American Indians are inordinately vulnerable to addiction to alcohol.
• American Indians are inordinately prone to violence when intoxicated.
• These very traits produced immediate, devastating effects when alcohol was introduced to Native tribes via European contact.
• The solutions to alcohol problems in Native communities lie in resources outside these communities.

Don Coyhis and William L. White argue that these "firewater myths" portrayed Native Americans as genetically inferior (inherently vulnerable to alcoholism) thus providing ideological support for the decimation and colonization of Native tribes, and that they continue to serve that function today.^[23][109] The scientific literature has refuted the claims to many of these myths by documenting the wide variability of alcohol problems across and within Native tribes and the very different response that certain individuals have to alcohol as opposed to others. Research has not conclusively identified any genetic or biological anomalies that render Native peoples particularly vulnerable to alcoholism.^[59][145]

Belief in the firewater myths is prevalent among Native American youth and many adults, and often leads to greater frequency and intensity of alcohol use.^[146] Such beliefs can also prevent young people from seeking treatment for alcoholism due to a lack of confidence in their own ability to recover.^[147]

Several studies indicate that Native Americans are at greater risk for alcohol-related domestic violence, rape, and assault compared with other U.S. ethnic groups.^[161][162] Alcohol and drug use is associated with higher rates of domestic violence among Native Americans compared to many other demographics. Over two-thirds (68%) of Native American and Native Alaskan sexual assault victims attribute their attacker's actions to drinking and/or taking drugs before the offense.^[163]

Certain risk factors have a high correlation with levels of domestic violence,

Compared with the United States population in general, the Native American population is much more susceptible to alcoholism and related diseases and deaths.[119] From 2006 to 2010, alcohol-attributed deaths accounted for 11.7 percent of all Native American deaths, more than twice the rates of the general U.S. population. The median alcohol-attributed death rate for Native Americans (60.6 per 100,000) was twice as high as the rate for any other racial or ethnic group.^[6] Males are affected disproportionately more by alcohol-related conditions than females.^[82] The highest risk of alcohol-related deaths is between 45 and 64 years of age. Chronic liver disease and cirrhosis are 3.9 times as prevalent in the Native American population than the general US population. Of all alcohol-attributable deaths, motor vehicle accidents account for 27.5% and alcoholic liver disease accounts for 25.2%. Alcohol-related fatal car accidents are three times more prevalent among Native Americans than in other ethnicities.

Alcohol was shown to be a factor in 69% of all suicides of Native Americans between 1980 and 1998.^[167] From 2003 to 2014, Native American suicide rates in the 18 states participating in the National Violent Death Reporting System were 21.5 per 100,000, more than 3.5 times higher than among other ethnicities in the US. Compared with whites, successful Native American suicides had 2.1 times the odds of a positive alcohol toxicology result and 1.8 times the odds of having had a reported alcohol abuse problem prior to suicide.^[168]

Native Americans have one of the highest rates of

• the medical model, based on the disease theory of alcoholism, which holds that it can be treated with coerced abstinence and medications in a clinical setting, the general approach of most US treatment facilities.
• the psychosocial model, which assumes that drinking is a maladaptive response to psychological trauma, social pressures and family dynamics, and that it can be managed 1) by educating the drinker to use other behavior patterns to cope with stress, and 2) by developing strong peer support and social support networks. This is the approach favored by Alcoholics Anonymous.
• the assimilative model, in which standard treatments are employed in a Native American setting operated by Native American practitioners.^[176]
• the
  group therapy
  sessions with emphasis on Native American cultural and historical themes.
• the
  syncretic model, which has primarily a Native American orientation, including the use of traditional modalities such as the medicine wheel, talking circles, the sweat lodge, and traditional healers. The Red Road is one example of a specifically Native American treatment approach.^{[177][178][179]}

Treatment for alcohol dependence usually relies on a combination of:^[180]

• Alcohol detoxification and medically managed withdrawal from the physical dependence induced by chronic alcohol misuse, usually implemented during a brief hospital stay.
• Partial hospitalization where the patient continues to reside at home, but commutes to a treatment center up to seven days a week.
• Residential treatment, either long-term (6–12 months) or short-term (3–6 weeks), commonly referred to as rehabilitation.
• Intensive outpatient programs
  (IOPs).
• Individualized counseling
• Group counseling^[181]

The Office of Tribal Affairs and Policy (OTAP) serves as primary point of contact between the Substance Abuse and Mental Health Services Administration (SAMHSA) and tribal governments, tribal organizations, and federal agencies on behavioral health issues that impact tribal communities.^[182] OTAP supports SAMHSA's efforts to implement the Tribal Law and Order Act (TLOA) of 2010 and the National Tribal Behavioral Health Agenda.^[183] The Office of Indian Alcohol and Substance Abuse (OIASA),^[184] an organizational component of OTAP, coordinates federal partners and provides tribes with technical assistance and resources to develop and enhance prevention and treatment programs for substance use disorders, including alcohol.

The Alcohol and Substance Abuse Program (ASAP) is a program for American Indian and Alaska Native individuals to reduce the incidence and prevalence of alcohol and substance use disorders. These programs are administered in tribal communities, including emergency, inpatient and outpatient treatment and rehabilitation services for individuals covered under

The Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986[186] was updated in 2010 to make requirements that the Office of Indian Alcohol and Substance Abuse (OIASA), a subdivision of SAMHSA, is to work with federal agencies to assist Native American communities in developing a Tribal Action Plan (TAP).^[187] The TAP coordinates resources and funding required to help mitigate levels of alcohol and substance use disorders among the Native American population, as specified in the Indian Alcohol and Substance Abuse Memorandum of Agreement of August 2011, and executed by OIASA.

• National Indian Health Board: Tribal Behavioral Health Agenda
• Youth Regional Treatment Centers (YRTC) funded by the Indian Health Service, provide clinical evaluation, substance use disorder education, psychotherapy, art therapy, adventure-based counseling, life skills, medication management, evidence-based treatment, aftercare relapse prevention, and post-treatment follow-up services.
• Native American Connections: Behavioral Health Services
• White Bison Recovery Resources Archived 2021-04-13 at the Wayback Machine
• Native American Indian General Service Office of Alcoholics Anonymous
• American Indian Committee on Alcohol and Substance Abuse, as of 2017, was over 4 decades old^[188] and was included in the 2-volume Encyclopedia of American Indian Issues Today, published 2013.^[189]
• SAMHSA's Tribal Training and Technical Assistance Center provides Native American communities with tools for preventing mental illness, substance use disorders and suicide.
• Native American Health Center's focus is the San Francisco Bay Area.
• Native American Indian Alcoholics Anonymous
• The Wellbriety Movement is an interconnected web carrying the message of cultural knowledge about recovery for individuals, families, and communities.
• One Sky Center, a National Resource Center for American Indian and Alaska Native Health, Education and Research dedicated to quality health care across Indian Country.
• Indian Country Child Trauma Center (ICCTC) Archived 2022-02-10 at the Wayback Machine develops trauma-related treatment protocols, outreach materials, and service delivery guidelines specifically designed for American Indian and Alaska Native (AI/AN) children and their families.
• First Nations Behavioral Health Association
• Society of TRUTH (Tribal Families, Rural and Urban, Together Healing), a coalition of American Indian/Alaskan Native organizations providing information and resources to support indigenous ways of life, healing and wellness.
• The National Council of Urban Indian Health (NCUIH), a national organization devoted to the support and development of quality, accessible, and culturally-competent health services for American Indians and Alaska Natives (AI/ANs) living in urban settings.

Although

Alcohol treatment facilities that cater specifically to Native Americans can be difficult to find outside of rural areas or reservations because Native Americans account for less than 1.7% of the United States population.[194]^[195] Coyhis and White make five recommendations in regard to the treatment of Native Americans for alcohol problems:^[23]

• In order to create a firm and effective relationship between the treatment agency and the tribal community, counselors and clinicians should understand the cultural and historical context that has provoked alcohol misuse, and be familiar with the organization, histories, values, ceremonies and cultures of Native Americans with whom they work. Counselors should be aware of the enormous diversity in personal experiences, personalities, spiritual beliefs, and acculturation, as well as the differing patterns of alcohol misuse and the multiple treatment modalities available.^[196]
• Counselors should take the time to master the
  personal space). Such etiquette varies between and within tribes.^[23]
• Family and community play an essential role in any individual's motivation to stay in recovery. Family members, tribal elders, and traditional healers should be encouraged to participate in designing and delivering treatment.^[197] Transgenerational trauma can be a significant factor in young people's substance use disorder patterns.^[23]
• Treatment can be made more effective by combining Native and Western healing practices.
  Traditional Native legends can be used as a framework for therapeutic storytelling.^[201]
• Alcohol treatment and recovery services should focus on broader goals related to Native communities rather than limiting themselves to individual therapy. Throughout history, religious and cultural revitalization movements have played a crucial role in mitigating the impact of alcohol on Native communities. Addiction treatment agencies and counselors can become actively involved in communities by emphasizing the connection between personal health and community health, so as to build a culture of abstinence, healthy substitution, or conscientious moderation.^[202]

A variety of

From January 1994 until May 31, 2002, the Robert Wood Johnson Foundation funded the Healthy Nations Initiative to help Native Americans reduce the demand for and use of alcohol and illegal drugs. Healthy Nations provided funds for public education, substance misuse treatment, post-treatment follow-up, and supporting services for 14 Native American tribes, incorporating traditional Native American cultural values to encourage youth to avoid drinking, drug use and smoking.^[206][207]

Prevention programs have used innovative strategies to promote healthy substitution and alternatives to drinking in Native American communities. With the help of

• Alcohol in New France
• Contemporary Native American issues in the United States
• Indian rolling
• Methamphetamine and Native Americans
• Missing and Murdered Indigenous Women in Utah
• Modern social statistics of Native Americans
• Native American health
• Navajo reservations and domestic abuse
• New World syndrome
• Peter Chartier
• Reservation poverty
• Whiteclay, Nebraska