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.