American Spirit is a campaign on the issues faced by the Native American Community in America. Over the next week, this column will feature stories of determination, triumph, legacy and redemption

While Native Americans represent a small percentage of the population of the United States, the community accounts for higher rates of alcohol abuse than other ethnic groups. For instance, the 2018 National Survey on Drug Use and Health found that 54.3 percent of Native Americans reported alcohol use a significantly higher rate than other ethnic groups. Nearly a quarter of Native Americans reported binge drinking the past month (to the survey) and the rate of Native Americans with an alcohol use disorder (7.1%) is higher than that of the total population (5.4%). Additionally, it was reported that one in six Native American adolescents (between 12 and 17 years old) engaged in underage drinking the highest rate for that age group among all ethnic groups.

Alcoholism has had a negative effect on Native American communities, however, causing emotional turmoil, physical health problems and economic burdens and has contributed to the false stereotype that a majority or all Native Americans have unhealthy relationships with alcohol. The consequences of alcohol abuse for Native Americans include increased risks for heart disease, cancer, gastrointestinal problems, pneumonia, tuberculosis, dental problems, hearing and vision problems, depression and other mental health disorders. Alcohol use is also a major cause of preventable birth defects and developmental disabilities in Native Americans with the Center for Disease Control and Prevention (CDC) reporting that the rate of fetal alcohol syndrome among some tribes is more than eight times the national average. Studies show that Native American men have the second-highest self-reported rates of driving under the influence, as well as the second-highest arrest rates for drunk driving, compared to men from other racial and ethnic groups.

Before the age of European colonization, while Native Americans did produce fermented beverages to be used for ceremonial purposes, the alcohol content in these drinks was reportedly much weaker and underdeveloped than that brought over by the colonists. When Europeans came to America and suddenly made large amounts of distilled spirits and wine available to Native Americans, the tribes had little time to develop social, legal or moral guidelines to regulate alcohol use. Moreover, among the European colonists, alcohol was consumed on a regular basis and often in high amounts. Numerous historical accounts describe extremely violent bouts of drinking among Indian tribes during trading sessions and on other occasions but at least as many accounts exist of similar behavior among the colonists. This rapid introduction to alcohol consumption may have contributed to the community's drinking problems. History may have sown the seeds as alcohol began to play a pivotal role as means of trade and money between the Native Americans and the colonists, thus helping shape the political and economic basis of early America.

Studies have attributed the high prevalence of alcohol abuse among Native Americans to a number of factors, including economic disadvantage, cultural loss and historical trauma, as well as other health issues. Native Americans suffer from high rates of unemployment. Over 20% of Native Americans live at or below the poverty level a rate more than double that for White people. Moreover, fewer Native Americans tend to complete high school or college, with less than one in five earning an undergraduate degree. The Native American community is also less likely to have access to insurance and adequate medical care. Additionally, Native Americans are at a greater risk of psychological distress and unmet medical and physiological needs. Many experts suggest that the brutality and loss experienced by Native Americans in the aftermath of the European colonization of the United States led to historical trauma. Native Americans also have higher rates of several diseases, including, diabetes, heart disease, cancer, obesity, liver disease and hepatitis. Research shows that illness leads to chronic stress which subsequently increases the risk of alcohol abuse and addiction.

The Firewater myth is the notion that Native Americans are more susceptible to the effects of alcohol and vulnerable to alcohol problems due to biological or genetic differences. However, there is no truth to this theory that has been linked to those wanting to attribute addiction to "weaker genes." Further, the presence of the myth exacerbates vulnerabilities to problems with alcohol. Studies show that the mythmay be harmful and have negative effects on attempts to moderate drinking.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), inadequate knowledge of the needs and culture of Native Americans in treatment programs may be among the main reasons for the underutilization of treatment by Native Americans, as well as low rates of retention in these programs. Community-based alcohol treatment programs targeted toward Native Americans often have a cultural or spiritual element to treatment. Experts agree that incorporating cultural traditions, spirituality and practices can help to provide a holistic, well-rounded care approach.

An example is the Tribal Healing to Wellness Courts, also known as drug courts, which have proliferated within Native American country during the last two decades. The drug court model, beginning within state courts, was later adapted for tribes to better allow for the diversity of cultures, languages, needs, governance structures and laws. Essentially, a Tribal Healing to Wellness Court, like a state drug court, integrates substance abuse treatment with the criminal justice system to provide substance-abusing offenders judicially supervised treatment and transitional services through the use of intense supervision, sanctions and incentives and drug testing in a non-punitive setting.

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American Spirit: Alcohol abuse in US highest among Native Americans but there is hope with spiritual treatment - MEAWW