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Key Results: American Indian and Alaska Native Alcohol Policies
Citations Listed in Key Results
- Epidemiological research consistently indicates that many American Indian and Alaska Native communities suffer disproportionately from the consequences of alcohol use (USCDC, 2008; Spicer et al., 2003).
Recent analyses by the U.S. Centers for Disease Control, for example, found that 11.7% of all deaths in American Indian and Alaska Native communities can be attributed to alcohol, with an age-adjusted rate of alcohol-attributable deaths that is twice that of the United States. Analyses of these patterns of mortality by region underscore important variation, with death rates the highest in the plains, southwest, and Alaska (USCDC, 2008). Research using diagnostic criteria in random community samples has also documented significantly higher levels of alcohol dependence for both men and women in some American Indian communities (Spicer et al., 2003).
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- Effective control of the supply of alcohol in American Indian and Alaska Native communities can have a dramatic and immediate impact on alcohol-related consequences (Chiu et al., 1997).
The most compelling research here arises from a natural experiment that directly observed changes in alcohol-related consequences that coincided with changes in policies affecting the availability of alcohol. As Chiu and colleagues report, over a 33-month period Barrow, Alaska banned the possession and transportation of alcohol twice, with substantial decreases in alcohol-related outpatient visits at the time of both bans, and a significant increase in these visits during the interim period when the community returned to legalized possession and transportation (Chiu et al., 1997).
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- Where restrictions on alcohol supply are less enforceable, however, such policies may not reduce alcohol-related harm at all. They may actually increase certain consequences as individuals put themselves at risk to procure alcohol in non-tribal jurisdictions (Gallaher et al., 1992; Landen, 1997; May, 1976).
Comparisons between tribes that prohibit alcohol and those that do not have suggested that alcohol-related consequences may actually be more prevalent in communities that prohibit alcohol (May, 1976), although this research does not support a causal interpretation because tribes that have retained prohibition may have done so as part of their response to higher levels of alcohol-related harm in their communities. Absent the kind of isolation that may permit local jurisdictions to effectively limit supply, prohibition may sometimes put individuals at risk as they try to procure alcohol at off-reservation sites (Landen, 1997; Gallagher et al., 1992). However, research in Alaska, where isolation may make local prohibition more effective, suggests that alcohol-related consequences are consistently lower in communities that prohibit alcohol (Berman, Hull, and May, 2000; Landen et al., 1997), and are further reduced in dry communities that also have a local police force (Wood and Gruenewald, 2006).
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- Examining different alcohol control policies in diverse American Indian and Alaska Native communities should support further refinements in policy recommendations if the impacts of the policies are carefully measured (May, 1977; Kovas et al., 2008).
All American Indian tribes had formal prohibition of alcohol sales until 1953. In a survey of alcohol policies in 1975, May found that only 92 out of 293 reservations had changed their laws to permit alcohol sales between 1953 and 1974 (May, 1977). In a more recent survey, Kovas et al. (2008) found that 212 out of 334 tribes in the lower 48 had legalized alcohol to at least some extent by 2006, although the complexity of these laws suggests that communities are using other policy options to control alcohol-related consequences. These include variations in point of sale, tribal licensing requirements, taxation, and provisions related to the sale of alcohol to underage drinkers and pregnant women (Kovas et al., 2008). This increasing variation in alcohol policy may permit investigators to document the impact of a broader set of policy changes on alcohol-related health consequences. At the same time, these more targeted policies are being implemented in the context of the liberalization of alcohol control in many tribal communities as a consequence of casino development. Careful attention to the impact of this loosening of alcohol control can and should guide future alcohol control policy in tribal communities.
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