Chief Joseph of the Nez Perce Nation once said, “I am tired of fighting….from where the sun now stands, I will fight no more.” This quote effectively demonstrates the sense of desperation and shame that can be seen throughout many Native American Nations today. Many within the psychological community believe that these feelings have attributed to the epidemic of alcoholism and substance abuse that run rampant in many Native Nations. But what can be done to help combat this growing disease? Is there a one-size fits all treatment approach, or do Native American clients need a more tailored treatment program that address their cultural history and value system?
According to Tim Noe, Deputy Director of The Healthy Nations Initiative (T. Noe, personal communication, September 1, 2006), “Native Americans have disproportionate rates of substance abuse than other groups within the United States.” There are many theories as to the underlying reasons for this epidemic that runs through several of the Native American nations. It was once believed that Native Americans were biologically predisposed to alcoholism but that theory has not been proven. (Straussner, 2001, p. 83) The problem is more likely attributed to a combination of cultural, psychological and social issues.
Due to significant differences in the prevalence of alcohol use between Native nations it is essential that mental health professionals
take into account the social and cultural diversity of each nation (P. Spicer, personal communication, September 15, 2006). By classifying all
Native Nations into one vast group, the stereotype of the drunken Indian will continue to prevail.
When the newly formed United States government decided that it wanted to expand, military force was utilized to forcibly remove the Natives from their lands. While military strength was a large aspect of the colonization of the States other means of genocide were also incorporated into government policy towards Indians. The most heinous of these tactics included non-consensual sterilization, forcing Native children from their homes and into white schools and making cultural traditions illegal.
None of our esteemed founding fathers were innocent of the assault on the Native American population. Thomas Jefferson once wrote to Indian fighter George Rogers Clark, “The same world would scarcely do for them and us.” (Jones, 2004, p. 150) His words furthered the popular belief that Native Americans were savages and therefore easing any feelings of guilt for committing horrendous acts against another human.
In their book Alcohol Problem in Native America (2006), authors Don Coyhis and William White conclude that “suppression, oppression and colonization of Native people by a radically different cultural group, and that group’s deliberate use of alcohol as a weapon is an underlying
cause of indigenous alcohol problems in North America.” In fact prior to contact with Europeans, Native Americans had no contact with alcohol at all.
One Native person, when asked about alcoholism in his community was quoted as saying, “They first tried to get rid of us through disease like smallpox, diphtheria and all that and they couldn’t’ so they introduced us to alcohol.” (Straussner, 2001, p. 79) Many Native people feel that alcoholism is a white man’s disease that was forced onto the Native populace. (R. Currier, personal communication, 10/2/06)
Alcohol proved to be an effective tool in controlling the Native American population and procuring both land and trade deals that were highly beneficial to the white man. As the Native Americans lost their land, their culture and their identities, alcohol became a way to assuage their heartache and shame. Psychologists attribute this abuse of alcohol as form of self-medication to what is known as of post-colonial stress disorder (PCSD). PCSD is defined as the long-term trauma stemming from the repression of the Native American culture. (Rabasca, 2000) A fact that was further driven home by Vine Deloria in his book God is Red (1994) when he said, “Tribes can no longer form and reform on sociological, religious or cultural bases. People are not allowed to be Indians and cannot become whites. Alcoholism and suicide mark this tragic fact.” (p. 220-221)
Although the days of Indian hunting have long past and the boundaries of the United States are firmly marked, the injustices to the Native American people are still being committed. The public’s perception of the “drunken Indian” has been sustained for hundreds of years. Beginning as early as Ben Franklins’ time when he made the quote, “Rum plus Savage = 0” (Brodie, 2002, p. 109) and continue on still as shown by with Hornell Brewing Company’s naming their product Crazy Horse Malt Liquor.
That stereotype is especially hard on Native American youth. There are no stories in the media about the non-drinking Indians. There are no highly visible Native American role models for the Native youth of today. (R. Currier, personal communication, October 2, 2006)
As a clinician it is irresponsible to presume that there is widespread drinking amongst all the Native nations. Studies show that throughout the U.S., 52% of Native Americans abstain from alcohol completely and 23% only drink in moderation. (Straussner, 2001, p. 81) Dr. Robert Currier, a therapist that has been working with the Zuni Nation in New Mexico for twenty-three years, says that in his estimation, “Of those within the tribe that drink only about ¼ abuse and of those ¼ are addicted.”
But regardless of the facts, self-hatred runs deep within many of Native American decent, a result of generations of being stereotyped as
dirty, drunken savages. Native poet, Nia Francisco demonstrated this shame poignantly in her poem Ode to a Drunk Woman in which she writes, “We are sober but drunk with pain caused by the same damn shame you learned as children.”
The psychological theory behind the elevated cases of alcoholism within many of the Native communities’ supports the theory that this shame can trigger depression and that can be a high risk factor in alcohol abuse, (Straussner, 2001, p. 85) but socioeconomic factors also play a large part in the problems of alcohol abuse. According to a study done by Indian Health Services poverty is a considerable factor in alcohol abuse. The poverty rate for Native Americans is 24.5% compared to 7.8% for non-Hispanic whites. Additionally the median household income for Native Americans is $32,116 per year as opposed to $46,305 for non-Hispanic whites. (using APA, 2006)
Regardless of the underlying factors it is obvious that there is a serious problem within the Native American community as a whole. A study by The Robert Wood Johnson Foundation conducted in 1988 showed that in the 33 reservation states alcoholism was 438% higher than the rates for the total U.S. population. (RWJF.org, 2006)
Studies have also shown that Native Americans die of alcoholism related conditions at rates six times higher than other Americans.
Furthermore, drug and alcohol use among Native teens is 10-15% higher than among their European-American counterparts. (Rabasca, 2006)
Finally, lifetime rates of DSM-III-R alcohol dependence for Native American men sampled were fifty percent higher than those sampled nationally. (Spicer et al., 2003, p. 1785)
But despite all these statistics we are still severely limited in our facts of alcohol abuse amongst the Native American populace. Clinicians who are treating a patient within a Native American community must keep in mind the confines of available knowledge when reviewing any information about Native alcohol abuse.
While treatments like AA have been proven to work well within the general American communities, many Native Americans have been resistant to this program due to its Christian overtones. (P. Spicer, personal communication, September 15, 2006) However over the last decade great strides have been made in treatment programs for Native American communities. Organizations like One Sky Center and The Healthy Nations Initiative have stepped up to work towards creating treatment programs that combine both Traditional Native treatments with Western mental health practices.
When asked about the substance abuse program implemented within the Zuni Nation, Dr. Currier noted that integration of both Traditional values and Western mental health practices have been highly
beneficial. He noted that the most important facets of the treatment program are diversity and trust. His staff includes Zuni and white counselors, male and female, along Zuni elders and mentors. He stated, “The more you have to offer the better the program.” Dr. Currier and the elders of the nation also work with the youth of the area, teaching traditional Zuni values, visiting sacred Zuni sites, and help to develop a sense of community and identity. By doing this, it has helped in the prevention of youths’ who begin to abuse alcohol or drugs.
Dr. Michael Garrett and Dr. Jane Carroll offered the following recommendations to help in the treatment of Native clients in an article written for the Journal of Counseling and Development. (Atkinson, 2004) These suggestions utilize support systems that are already in place within Native American communities:
• Sociodemographics- Native clients participate in community-wide volunteer programs. Helping those in need within their communities has proven to be a successful part of healing.
• Physiology- Clients are encouraged to maintain a healthy life style and take care of any health issues that arise.
• Historical Context- This approach helps clients explore their cultural identity and development.
• Acculturation/identity- Clients are assisted with exploration of personal cultural identity and career issues through a focus on cultural themes. Some questions that can be asked are (a) Where do you belong? (b) What are you good at, what do you enjoy doing? (c) What are your strengths? Weaknesses? (d) What do you have to offer?
• Isolation/social connections- Participation in social events such as powwows allow clients to experience social cohesion and social interaction within their community.
• Generational splits- Learning from elders as role models
• Coping mechanisms- Clients learn other methods of dealing with stress, powerlessness, shame and identity confusion. Consultation with a Medicine person is recommended.
• Noninterference- The avoidance behavior that community members engage in as to maintain the cultural value of not imposing their will on another may be destructive to an individual client and must be addressed with the client as well as with community members. (p. 161-162)
Take for example the case of Sue, a 23 year-old Cree woman. She was raised in a home filled with violence and alcohol abuse and she was often placed in foster care. Sue was sexually abused and once expelled
from school when she demonstrated what was deemed uncontrollable behavior. Her father died from exposure when he became so intoxicated he was unable to come in from the cold. She also lost her grandfather, sister, two uncles and three cousins to alcohol related deaths. Sue began using inhalants at age nine and by age eleven she was abusing alcohol. She has three children now, one of which was born with Fetal Alcohol Syndrome. She has been in five treatment programs over eight years and has yet to be able to stay sober for more than six weeks. Most of the programs she participated in were court ordered and 12-step based. (Straussner, 2001, p.86)
Sue’s case shows common patterns and issues that face the Native community. Generally, substance abuse amongst Native adults began while they were children. (R. Currer, personal communication, October 3, 2006) In addition some of the underlying factors for Sue’s substance abuse could stem from physical and sexual abuse endured as a child, the isolation from family and community while in foster care, and the trauma associated with being placed in foster care.
Sue’s therapist would need to ensure that a comprehensive family history be taken in order to understand her. Her family and personal history are both vital pieces to her treatment. In addition, trying to understand the reasons why past treatment experiences failed and what if any successes she had need to be explored. By understanding both
Sue’s strengths and weakness, her therapist will have a better idea on how to best treat her.
While the assumption by some therapists may be that because Sue is of Native American decent that the logical treatment to follow would be one that is grounded in Traditional healing, but a clinician has to keep in mind that there is no one treatment that works for all people. It is important in this case to look at how connected Sue is in her culture. If she is very connected then reconnecting her with her culture and using a form of treatment that utilizes Traditional healing as well as Western theories may prove beneficial, however if she is not involved with the Cree culture use of the program could prove ineffective. By following some of the recommendations noted previously a therapist may be able to work a balanced and beneficial treatment program.
In the past few years there has been much written on the epidemic of alcohol and substance abuse within the Native American communities, yet there is still much we don’t know. For years there was no input from Native Indians as to the problem of substance abuse and what to do about it, instead Western interventions were forced upon them. (Rabasca, 2000) This lack of communication has led to a lack to trust. Many Native people are reluctant to discuss personal and community matters to outsiders, causing a deficiency of accurate information and
understanding of the problem. (R. Currier, personal communication, October 3, 2006)
But now the psychological community has acknowledged that it is essential for the Native community to have a say if there are to be successful programs for the treatment of substance abuse and also for the prevention of it. By working together with tribal leaders and understanding the Native community’s belief system in which a therapist is working, a Native client will be more comfortable and trusting in seeking help for their needs.
But there is still much to be done. More trained mental health professionals are needed as well as more money allocated from the federal government to go towards mental health and substance abuse programs. Underlying factors that can lead to alcohol abuse also need to addressed on a political level; issues like poverty, unemployment, and adequate housing in order to fully get a handle on the problem.
A therapist that plans to work within a Native American community must first take the time to establish a relationship within the Nation, learn their value and belief systems. This will help to build trust between yourself and your clients. Once that trust has been established and client feels safe with you, the most important thing to keep in mind is that no one treatment program works for every one person.
It is essential that you “start where the client is” (Straussner, 2001, p 89) and move forward from there. Work hard to understand your client, their history, the driving forces in their lives; once you understand how they came to the point they have reached, it will be easier for you to guide them to the place they would like to go.
REFERENCES
Atkinson, Donald, R. (2004). Counseling American Minorities Sixth Edition. Santa
Barbara. McGraw Hill.
Briefing Sheet on Indian Health Services Mental Health/Alcohol and Substance
Programs. Retrieved September 6, 2006 from http://www.apa.org/ppo/funding/ihsbriefingsheet.html.
Brodie, Janet, Farrell and Redfield, Marc. (2002). High Anxieties Cultural Studies in
Addition. Los Angeles. University of California Press.
Coyhis, Don, L. and White, William, L., (2006), Alcohol Problems in Native America,
The Untold Story of Resistance and Recovery. Colorado Springs. White Bison Inc.
Deloria, Vine. (1994). God Is Red, A Native View of Religion. Golden. North
American Press.
Francisco, Nia. (1988). Ode to a Drunk Woman. Blue Horses for Navajo Women. New
York. Greenfield Review Press
Healthy Nations: Reducing Substance Abuse Among Native Americans. Retrieved August
30, 2006 from http://www.rwif.org/reports/npreports/HealthyNations.htm
Jones, Landon, Y. (2004) William Clark and the Shaping of the West, New York. Hill &
Wang.
Rabasca, Lisa. (2000). Listening Instead of Preaching. Monitor on Psychology. 31.3.
Retrieved September 9, 2006, from http://www.apa.org/monitor/mar00/listening. html.
Spicer, Paul, Beals, Jennifer, Croy, Calvin D., Mitchell, Christina M., Novins, Douglas
K., Moore, Laurie, et al. (2003). The Prevalence of DSM-III-R Alcohol Dependence in Two American Indian Populations. Alcohol Clinical and Experimental Research. Vol 27, No 11. 1785-1797
Straussner, Shulamith Lala Ashenberg. (2001). Ethnocultural Factors in Substance
Abuse Treatment. New York. The Guilford Press.
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